The GOP goal is to kill healthcare reform outright; their strategists are saying as much. Not to kill single payer or a public option, but to kill the whole notion of reform. The legislators tasked with coming up with alternative plans  declared, this last week, that none were needed; Senator Inhofe muses out loud about how much his party might be helped if they can manage to stop reform outright.

I suppose it is worth pondering the how and the why of such things.  Do they earnestly believe that there's absolutely nothing that needs to be done about health care in this country?  Are they so transparently in the pockets of the lobbyists that they are willing make a bold stand on "everything is fine", when a mere look out the window says it's not?

It's puzzling that such a stance could even be remotely effective. Everybody in America seems to hate their insurance provider, at least everyone who has ever had to use it because they actually got sick. Everybody knows how bad getting actual healthcare has become in this country; everybody has stories of being screwed roundly by their insurance, or not being able to get insurance in the first place, or knows someone else who has had worse experiences.

And yet even in something with such widespread support, all you have to do to foul up the works is (1) invoke partisan pride, so that all the other conservatives or Republicans will simply oppose whatever-it-is out of reflex, and (2) make up a bunch of scary-sounding bullcrap, much of it provided by the insurance companies themselves, and hork it up on television via friendly hosts and anchors. (And again -- transparently. The very same scary-sounding phrases or made-up statistics make it into twenty or fifty or a hundred different political and pundit mouths in a single day, with not even an attempt to disguise the obvious commonality of the source.)

Consider it: this is all it takes to possibly stop something that has, what, 80 or 85% of the public behind it. And it's yet another example of how a single industry, spending not all that much money in the grand scheme of things, can very, very easily counter the collective will of the entire population. And how entrenched the notion is, among the majority of politicians, and pundits, and anchors, and political hangers-on, that that's not only fine but the way things should work.

It seems increasingly easy to understand why there's an culture of mistress-banging and airport-bathroom-handjob-seeking and prostitute-visiting, among our leaders. They truly believe themselves above normal morality or normal law by virtue of their positions. The same mind that can demand moral perfection in others, when it comes to sex, has absolutely no problem preaching those things to others while doing the exact opposite themselves, because they are different from others. There's no contradiction in their minds: they're powerful, so they're a special case. Arrests can be made by the dozen, in New Jersey, and it seems hardly noteworthy. Rush Limbaugh can be caught with illegal prescriptions, after years of railing against drug users, and it does not so much as put a scratch in his Four Hundred Million Dollar career. Rules exist for others; laws exist for others; morality exists for others; personal power or personal advantage is the only goal worth seeking.

After twenty years of the same fight on the same healthcare issues, one thing is transparently obvious, from the pronouncements of the supposed leaders of the opposition: whether or not anyone in America is truly needing of healthcare, from a practical, economic, moral, ethical, or any other standard simply does not enter the debate. I personally do not expect many of these politicians even have an awareness that other people might have medical needs different from their own, or not have insurance like their own insurance, or not be as connected or as well-off; that requires a level of awareness that few of them can even bother to credibly pretend at. The question among our supposed leaders and brilliant minds is only how can this debate be used to extract personal or career advantage for them. If we kill healthcare reform, who will "win" the politics of killing it? Who will have an easier time being elected, or find themselves on television more often?

There's no moral calculus at all, for people like Kristol, or Inhofe, or Gingrich, or other supposed leaders. None is pretended at: none is cowed to. There's no good or bad, there's no long term vs short term -- nothing. And it's among both Republican and Democrat, and it has become increasingly easy to see which are which. Gingrich can have his affairs, and you can't. Our leaders can visit their whores, but you're a dirty rotten sinner if you do. They can have healthcare, because that's just how things work, pal. You can't -- at least, not if there is personal, political advantage to them in preventing it.

It's not even corruption, because "corruption" implies they know they're doing something wrong. It's a complete amorality. This same group of people, this same party of high-minded No, this same party of constant scandal, constant national security blunders, constant deficits, constant manipulations is going to kill healthcare reform because it helps them get cash or influence; they will happily attempt an impeachment of a president for denying an affair while having and denying affairs by the dozens themselves; they're going to ditch the wife and their duties and fly to Argentina to get laid because it makes them happy, and that's all that matters. If it causes problems later, shed some tears and make it go away. (If you're Sarah Palin, pride of Republicanism, hell -- you don't even have to do your actual job. You can pull a Carrie Prejean, bail on all your duties and just wander off to give speeches to promote yourself, and if anyone has a problem with it it's because they don't understand how great you are.)

Republicans are still citing, with pride, how they blocked healthcare reform attempts in the Clinton years, an action which directly led to the runaway healthcare costs between then and now. In the Clinton years, 95 cents of every dollar paid in premiums was paid out again for medical care: now it's plummeted to 80 cents, the rest going to administration and profits. But they're proud of this result, and not defensive at all, because whether it be twenty years ago of twenty minutes ago, the whole debate hinges, for them, on what political advantage can be squeezed out of it at any given moment of time, and not on what effects their actions might actually have.

If it means your mother can't get her medicines, or means you can't see a doctor, or your injured child gets wheeled out of the hospital just as soon as they are stabilized, with absolutely no long term care whatsoever, they don't just not care: it doesn't enter their heads.

That is what is so striking about our governance: it is increasingly devoid of even the pretenses of public good. The notion that we should reform healthcare in this nation because it needs reforming is nearly a comical argument; the only relevant or even commonly debated question is who will gain or lose from a strictly political fight to achieve or block the effort. Regardless of popular opinion it can be absolutely assured that whether or not you believe American citizens deserve a more rational healthcare system is entirely dependent on which party you belong to.

If I say, "Rowan's a school teacher - he makes $50,000 a year," you have a pretty good sense of what I mean. Every couple of weeks, Rowan gets a paycheck, less whatever taxes he owes. At the end of the year, he'll get a Form W-2 from the school district, and the "Gross Pay" line will read $50,000. Obviously, Rowan's total take-home pay will be some amount less than that, but he "made" $50 grand, and that's what he'll be taxed on.

But now if I tell you, "Lydia owns a laundromat - it made $250,000 last year," there's a good chance you'll interpret that differently. When we're talking about the amount of money a business "makes," we often mean how much revenue it brought in, not how much profit it cleared. The government doesn't tax raw revenues, it taxes profits. So our picture is incomplete. Lydia's company may have taken in $250K, but her payroll, rent, and expenses might have totaled $200K. If her net profit is $50,000, then that's the amount she'll get taxed on, much like Rowan's schoolteacher salary.

This is all very elementary, but when it comes to businesses, revenues regularly get confused with profits. Even Barack Obama did it, in his infamous conversation with Joe the Plumber. Samuel Wurzelbacher made the following claim:

I'm getting ready to buy a company that makes 250 to 280 thousand dollars a year. Your new tax plan's going to tax me more, isn't it?

For some reason, Obama got mixed up and described his own tax plan incorrectly:

If your revenue is above 250, then from 250 down, your taxes are going to stay the same. It is true that, say for 250 up — from 250 to 300 or so, so for that additional amount, you’d go from 36 to 39 percent, which is what it was under Bill Clinton.

Obama meant to say profit, not revenue. And Joe the Plumber was most undoubtedly nowhere near buying a company with $250,000 in profits. That would have meant $250K left over after paying for all salaries, expenses, equipment, insurance, and more. Based on standard valuations, such a company would have sold for a few million dollars, and that's because a $250,000 profit for a small, individually-owned company means you're doing damn well.

It's super-simple, really. Imagine if Rowan instead earned a $250,000-a-year salary from his employer (maybe he became an executive at Halliburton). Could anyone deny he was very well off? He'd be in the top 2% of earners in this nation. Of course, there are some people who are vastly richer, and make Rowan look like small potatoes in comparison. But regardless, Rowan would be very fortunate, and, in the end, winding up with a lot more money in his bank account than Lydia.

Remember this when dangerous underminers like Jared Polis try to demagogue the issue. Only four percent of all small businesses would have been subject to the new revenue-raising measures proposed by the House Ways & Means committee to help pay for healthcare reform. (And most "small businesses" don't even employ anyone - the definition takes it all manner of entities.) Nancy Pelosi is even saying now that she wants any new taxes to only affect individuals earning $500,000 or more, which of course would hit an even tinier number of small businesses.

So when we're talking about small businesses that might have to pay a little bit more in taxes so that we can make sure everyone in this country has health insurance, we aren't talking about Lydia's humble laundromat, hustling to scrape in a million quarters a year but netting just $50,000 before taxes. We're talking companies which make several times what Joe the Plumber's hypothetical but very profitable small enterprise would have made - companies which can, in other words, afford it.

Over the course of posting interview with various health figures, many commenters have asked about the

role of non-physician providers, both in terms of scope and cost. When writing up the nomination of Dr. Regina Benjamin for Surgeon General, I learned that she, like myself, works with a health team that includes physician assistants. And given that the PA that I work with was recently elected to the position of president-elect of the American Academy of Physician Assistants, this seemed like an opportune time to explore another dimension of health care.

Patrick E. Killeen MS, PA-C currently serves as the president elect of the American Academy of Physician Assistants (AAPA). He has held an active role within AAPA for more 22 years as a board member and participant of the House of Delegates, Medical Congress and strategic relations workgroup. He also has served as a peer reviewer and liaison coordinator for AAPA. Killeen earned a BS in human development and family studies with a concentration in early childhood education from Colorado State University. He is certified as a child life specialist from John Hopkins University and earned his MS as a child health associate and certified PA from the University of Colorado Health Science Center. I've known Patrick for a decade and a half, and am delighted to have him as an interviewee.

Daily Kos: Patrick, thanks for taking some time for this interview. One of the key components of health reform involves cost control, and one way to control costs is to more expansively use non-physician providers such as Physician Assistants and Advance Practice Nurses. Does the AAPA have a position about health reform, and in particular the role PAs can play?

Physician assistants (PAs) are an integral part of health care reform. PAs are primary care providers and work in all medical and surgical specialties and settings as part of physician-PA teams. PAs practice medicine in a team-based model of care with physician supervision.

PAs control health care cost by:

• Participating in the provision of preventive care, management of long term and chronic conditions and in patient education.  The most cost effective treatment of any disease is prevention.
• Helping to assure that patients are seen at the right time, in the right setting by the right provider.  Every time a patient who could be seen in a primary care setting is seen in an emergency department it is an unnecessary cost for the system, and unnecessary stress for the patient.  
• PAs can help decrease waiting time and efficiency in practices, making the physician’s time and talents used more cost effectively.  This also helps patients get appointments more readily – something that can help assure that conditions are treated in their early stages, before more traumatic and costly treatments are required.
• The profession’s affordable salaries (averaging about $89,000 per year across all specialties) make PAs an attractive choice for increasing the volume of providers within the medical system at a fraction of the cost. Because of their generalist medical training, PAs often deliver or supplement primary and preventative care even if they work in specialties. It is not uncommon for PAs in oncology to see survivors for years after their cancer has been treated and the routine, diligent monitoring of the patients’ health often uncovers other issues such as diabetes or heart disease.
• We’re continuing to learn more about how PAs deliver care and whether or not they skew toward quality of care or quantity of care. Recently, Perri Morgan, PhD, PA-C, director of Physician Assistant Research at the Duke University Medical Center, examined PA cost-efficiency by asking whether they increase the availability of the services offered by physicians or instead provide additional care that actually increases the number of visits that a patient uses. Morgan and her colleagues concluded that, on average, PAs are replacing care that would be provided by physicians rather than offering additional or redundant services to patients. The research showed that when PAs provided 30 percent or more of a patient's office visits in a year, there was no increase in the total number of office visits per year.

Daily Kos: Numbers! Let's have some numbers about the profession. is there growth ahead for PAs?

• The American Academy of Physician Assistants (AAPA) estimates there were 85,345 people eligible to practice as PAs and 73,893 people in clinical practice as PAs at the beginning of 2009
• Approximately 257 million patient visits were made to physician assistants in 2008.
• Approximately 332 million medications were prescribed or recommended by PAs in 2008.
• All 50 states, the District of Columbia, and Guam authorize PAs to prescribe.
• The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 27 percent between 2006 and 2016. The BLS predicts the total number of jobs in the country will grow by 10 percent over this 10-year period. The PA profession was ranked the fourth fastest growing profession in the country by CNN.com and Forbes.com in 2007.

Daily Kos: As it happens, you and I have worked as a team for many years, and I recently became aware that the new Surgeon General nominee, Dr. Regina Benjamin, works as a team with PAs in her clinic in Alabama. Can you tell me anything about that partnership from the PAs perspective?

Dr. Benjamin is an advocate for care to the underserved, primary care, elimination of health disparities and of using creative options to provide care to difficult to serve populations.  These values are shared by the PA profession.  Dr. Benjamin has seen the value of the physician-PA team personally in her clinic, the La Batre Rural Health Clinic. Currently, she employs and works closely with a PA who is an AAPA member.

Dr. Benjamin is also a friend to the PA profession and the AAPA. Most recently, Benjamin was featured as a keynote speaker at a February 2009 AAPA conference for constituent organization leaders during her tenure as Chair of the Federation of State Medical Boards in 2008-2009. She spoke about the physician-PA team, the important roles of professional organizations working together, the initiatives of the Federation that were important to PAs and PA practice, and the work to be done by all health professionals to assure access to care and the elimination of disparities of all kinds.

We think she will be a true leader as the nation’s surgeon general.

Daily Kos: Does the AAPA have a position on the public option currently being discussed in Congress as part of health reform?

AAPA policy does not speak specifically to the public plan option that is currently being considered by Congress. AAPA policy does, however, address the need to provide access to quality, affordable, cost-effective health care to all Americans. AAPA will certainly evaluate the various health care reform proposals by their ability to fulfill that policy.

Daily Kos: Did the AAPA taken a position on CHIP (children's health insurance program) or tobacco taxes and FDA regulation of tobacco?

AAPA strongly supported the reauthorization and expansion of the Children’s Health Insurance Program. Additionally, AAPA has strong policy encouraging PAs to strive to eliminate tobacco products from their personal lives and the lives of their patients and colleagues.

More specifically, on tobacco, the American Academy of Physician Assistants (AAPA) applauded the 111th Congress for enacting, and President Obama for signing into law, the "Family Smoking Prevention and Tobacco Control Act."
The Act protects public health by granting the Food and Drug Administration (FDA) certain authority to regulate tobacco products. The regulation of tobacco products by the FDA is essential to AAPA’s goal to educate consumers and eliminate the use of tobacco products. AAPA encourages all PAs to be actively involved in community outreach that educates people of all ages about the dangers of smoking with the goal of eliminating tobacco use.

On CHIP, AAPA applauded the Congressional approval of the expansion of the Children's Health Insurance Program (CHIP) on February 4. This move provides coverage for an additional four million children of working parents. Congressional action on the CHIP reauthorization is an important step forward, but more remains to be done. As evidenced in the recent Institute of Medicine (IOM) report, "America's Uninsured Crisis: Consequences for Health and Health Care," massive health care reform is imperative to improving the health care of those Americans who are uninsured and underinsured.

^{more below the fold}

Blah blah.

Sunday summer special punditation... now with exclamation marks!!

Frank Rich!:

Who exactly was the competition in the race to be the most trusted man in America? Lyndon Johnson? Richard Nixon?

Not to take anything away from Walter Cronkite, but he beat out Henry Kissinger by only four percentage points when a 1974 Roper poll asked Americans whom they most respected...

What really outraged him was more elementary than any prognostication. He saw that the American government was lying to its own people.

Tom Friedman!:

After spending a week traveling the frontline of the "war on terrorism" — from the aircraft carrier U.S.S. Ronald Reagan in the seas off Iran, to northern Iraq, to Afghanistan and into northwest Pakistan — I can comfortably report the following: The bad guys are losing.

Not that our allies are doing so great.

Maureen Dowd!:

Being obnoxious isn’t a crime.

As we reflect on the arc of civil rights dramas from Jim Crow to Jim Crowley, my friend John Timoney, the police chief of Miami, observes: "There’s a fine line between disorderly conduct and freedom of speech. It can get tough out there, but I tell my officers, ‘Don’t make matters worse by throwing handcuffs on someone. Bite your tongue and just leave.’ "

As the daughter of a police detective, I always prefer to side with the police. But this time, I’m struggling.

Glenn Loury!:

Though this nation has proudly thought of itself as an ethnic melting pot," Mr. Holder said, "in things racial we have always been and I believe continue to be, in too many ways, essentially a nation of cowards." The nation’s leading law enforcement officer — who happens also to be an African-American man — was widely criticized for making this provocative comment.

Stanley Fish!:

The message was unmistakable: What was a black man doing living in a place like this?

WaPo!:

Merritt Harrison, a 75-year-old white man who lives around the corner from Gates, said that he understands why the police feel defensive, but that he probably would have had the same reaction as Gates if a police officer had showed up at his home and suspected him of being a burglar.

"I'm white, so I probably wouldn't have been arrested," said the part-time Episcopalian pastor, real-estate agent and counselor who has called the community home for 25 years. "I don't know. Was it racial profiling? I don't think anyone will ever know. But plenty of people think it was. The thing to do is to use it as an occasion to look at the issue. People need to talk."

CNN!:

Days after the U.S. government announced upcoming trials for an H1N1 flu vaccine, Saint Louis University has been inundated with phone calls and e-mails from people volunteering for the study.

Want some opinions on polling? Join us at Netroots Nation!

How to Get The Most Out Of The Polling Data You Read About

This panel will share insights and observations from some veteran pollsters and analysts that might help you interpret the next set of poll data you see. Charlie Cook (The Cook Political Report, www.cookpolitical.com), Mark Blumenthal and Charles Franklin (www.pollster.com), and Nate Silver (www.fivethirtyeight.com) will join moderator Greg Dworkin (Daily Kos) on a discussion about how to get the most out of poll watching.

View the full Netroots Nation Agenda

When "lame duck" Sarah Palin leaves the Gov's mansion today, Vladimir Putin won't be the only one celebrating.

A new Washington Post-ABC News poll finds that a majority of Americans think she's a wicked witch.

And how do they know?

Hope floats.

This evening's Rescue Ranger krewe consists of that daring trolley conductor YatPundit, the travelin' from Oz to Nz jlms qkw, birthday dinner thrower noddem, grand herder of stray hep-cats grog, our newest newbie mtperson, and our ever joyful joyful, with watercarrier4diogenes at the wheel of the Editmobile, careening toward the IMAX version of Half-Blood Prince this coming Thursday afternoon

The rescued diaries are:

• fake consultant improves our vocabulary in On Respect, Or, How To Avoid Mispronounciation. (jlms qkw)
• Obama’s multi-pronged media strategy is analyzed by D Wreck in NY Times Conern Troll: Obama's Media Overexposure. (mtperson)
• Winter Rabbit shares the powerful story of her struggle to "belong" in Me as a Mixed Blood. (YatPundit)
• David Swanson describes some new lows in the military situation in US Troops Hiding in Iraqi Homes. (jlms qkw)
• Geenius at Wrok pens a beautifully introspective diary about looking within oneself, and why it will benefit us to Fight Money With Love: Kinder, Gentler Health Reform Talking Points. (noddem)
• In Being FAR to the left on health is all any DEM has for 2010/12, BlatantLiberal posits that Democrats should not be afraid to run to the left on implementing health care. (mtperson)
• plumbobb shares the lessons learned about marriage rights in LGBT marriage, Michael Jackson & my dead dad. (jlms qkw)
• danps disserts an unfortunate Supreme Court decision re Executive Power and its even more troubling consequences in From Discovery to Concealment. (noddem)
• Vikingkingq suggests an interesting model for a new US Labor Market Policy - Think Swedish. (joyful)
• Coming of age in Los Angeles is the edifying theme of leftyparent’sClinging so Tenuously to Durant Drive. (mtperson)
• Bcgntn tells us all about The Reporter who asked The Question in A Sweet Profile. (jlms qkw)
• jeanjaques notes that the cost savings of health care reform are a strong selling point in It Should Always Have Been About Cost. (mtperson)
• Username4242 brings ancient history to life in a beautifully illustrated diary on the Bonus Dinosaur of the Week--Feathered Dinsoaurs. (joyful)

Our ever meticulous jotter brings us High Impact Diaries: July 24, 2009

, while emeraldmaiden delights us with Top Comments 7-25-09.

Enjoy and please promote your own favorite diaries in this open thread (even if you're the author! Here's where that's actually appreciated). And, of course, since it's an open thread, PLAY NICE, OK? 8^)

David Shuster, guest hosting Countdown, delivers a highlight reel of the best of SNL 2008 to honor Tina Fey's Emmy nomination for her Sarah Palin impersonation:

Blah blah.

Anyone living in the northern hemisphere in the balmy days of late July doesn't have to be reminded that water evaporates and wet pool towels dry out faster in the scorching midday sun than on cooler, cloudy days or nights. Traditional wisdom would infer the same holds true for oceans. That's important, because it would mean that air above oceans on hot days would be more humid, causing more cloud formation, and the white puffy clouds would help keep the temperature from rising further just like the shiny sunscreen in your car's windshield. Unfortunately, one recent analysis suggests the earth's climate may not be that simple:

Dr Clement described the findings as "almost shocking". They noticed that, in the past 50 years, there had been a "positive feedback" cycle in the low-cloud cover, so when the surface of the ocean was warmer, there had been less cloud cover.

When the researchers looked for a climate model that might explain the unexpected result, the best fitting one they found happens to make some the most aggressive global warming predictions. This is just one study on a single region of the Pacific -- albeit a significant one for US northwest coast -- and the model that fits the data best is but one theoretical explanation. More work will be done. It is however an excellent illustration of a trend: again and again over the last two decades empirical observations of land-sea temperature changes and reduction in ice cover outrace consensus models, causing climate scientist to fall back on or develop even more agressive models to explain the streaming data.

That's an ominous trend and it's not your friend.

It's against that reality based backdrop that clowns like George Will or James Inhofe continue to shamelessly pump out debunked, discredited, and deformed misinformation for public consumption. And since they collect fat paychecks and fantastic benefits forever beyond the reach of most hard working Americans for doing so, it's hard to see why they would slaughter that golden goose as long as she's still dropping expensive eggs in their luxuriously feathered nests.

US favorability ratings around the world, per Pew's survey of 25 countries.

I chose 2007 as the reference year since it was the last year that the United States was unabashedly Bush's (2008 was a transitional election year). Pew has data for most years this decade, click on the link above to see that data.

The image of the United States has improved markedly in most parts of the world, reflecting global confidence in Barack Obama. In many countries opinions of the United States are now about as positive as they were at the beginning of the decade before George W. Bush took office. Improvements in the U.S. image have been most pronounced in Western Europe, where favorable ratings for both the nation and the American people have soared. But opinions of America have also become more positive in key countries in Latin America, Africa and Asia, as well.

Signs of improvement in views of America are seen even in some predominantly Muslim countries that held overwhelmingly negative views of the United States in the Bush years. The most notable increase occurred in Indonesia, where people are well aware of Obama's family ties to the country and where favorable ratings of the U.S. nearly doubled this year. However for the most part, opinions of the U.S. among Muslims in the Middle East remain largely unfavorable, despite some positive movement in the numbers in Jordan and Egypt. Animosity toward the U.S., however, continues to run deep and unabated in Turkey, the Palestinian territories and Pakistan.

Israel stands out in the poll as the only public among the 25 surveyed where the current U.S. rating is lower than in past surveys.

Pew's polling indicates that Obama's Cairo speech was ill-received in Israel, hence his flagging numbers in that country, but most everywhere else -- and in particular in Western Europe -- the world is giving us a big pat on the back for electing Obama. And this isn't just a feel-good stat. Our nation's increased standing in the world has repercussions on a whole host of American interests, from economic to military.

Only Republicans cherish pariah status.

Coming up on Sunday Kos ....

• The next event on the election calendar is a special election to replace Ellen Tauscher that promises to be very competitive. Steve Singiser will have an interview with one of the leading candidates in the race, Anthony Woods.
• Continuing his health care interview series, DemFromCT will interview the president-elect of the American Academy of Physician Assistants on the organization's role and views on health reform, and how members see themselves fitting into the health system.
• In "Driving while white," Jed Lewison will share a recent experience he had with law enforcement, and wonders if things would have turned out the same if he'd traded places with Prof. Gates.
• Plutonium Page will discuss how the proposed European missile defense shield has become an issue in the US and Russian negotiations for a new Strategic Arms Reduction Treaty.
• DavidNYC wants to make sure we're all on the same page when it comes to healthcare, taxes, and dollars-n-cents.

Dear Mr. President: I am writing you today because I am outraged at the notion of involving government in healthcare decisions like they do in other countries. I believe healthcare decisions should be between myself and my doctor.

Well, that is not strictly true. I believe healthcare decisions should be between myself, my doctor, and my insurance company, which provides me a list of which doctors I can see, which specialists I can see, and has a strict policy outlining when I can and can't see those specialists, for what symptoms, and what tests my doctors can or cannot perform for a given set of symptoms. That seems fair, because the insurance company needs to make a profit; they're not in the business of just keeping people alive for free.

Oh, and also my employer. My employer decides what health insurance company and plans will be available to me in the first place. If I quit that job and find another, my heath insurance will be different, and I may or may not be able to see the same doctor as I had been seeing before, or receive the same treatments, or obtain the same medicines. So I believe my healthcare decisions should be between myself, the company I work for, my insurance company, and my doctor. Assuming I'm employed, which is a tough go in the current economy.

Hmm, but that's still a little simplistic. I suppose we should clarify.

I also believe my healthcare should depend on the form I fill out when I apply for that health insurance, which stipulates that any medical problems I ever had previously in my life won't be covered by that insurance, and so I am not allowed to seek further care for them, at least not at my insurance company's expense. That seems fair; otherwise my insurance company might be cheated by me knowing I needed healthcare for something in advance.

And if I didn't know about an existing condition I had, but I could have known about it, had someone discovered it, I suppose it doesn't make much sense for my insurance to cover that either.

But let us assume that all hurdles have been cleared and I am allowed to see my doctor, chosen from a list of available doctors, about a health problem, except health problems I have previously been treated for. After that, I believe my healthcare decisions should be between myself, my insurance company, my insurance plan, my employer, and my doctor.

Oh -- and the doctors at the insurance company, of course.

They will never actually meet me, or even speak to me on the phone, and in fact I couldn't tell you the name of a single one of them, or what state they were in, or whether or not they've just all been outsourced to a computer program somewhere in Asia at this point -- but they're in charge of determining which treatments might be "effective" for me, and which will be a waste of money, er, time. They do this by looking not at my case, which is individualistic and piffling and minor, but at the statistical panoply of treatments on the insurance company spreadsheet and their statistical cost vs. effectiveness. My doctor may think one treatment or another might be effective for me in a particular instance -- but he may be a little too closely involved with my personal case, and unable to make these decisions nearly as well as my less involved, more dispassionate insurance company can.

And then there's the claims office. When my doctor sends a bill to my insurance company, it must travel through a phalanx of people and departments and procedures in order to determine whether or not it is, in fact, a valid medical complaint to be treated for, done the right way, at the right time, by a doctor on the right list. If the paperwork is not done on time, or not done completely, or not done to the satisfaction of the right people, or if I did not receive the proper prior approval for the medical treatment administered, or if that approval expired, or if the insurance company rescinded the approval months after the fact, my medical care will not be covered. While my doctor has had to sometimes forgo payments because the 30-day window for receiving "all requested documentation" somehow slipped by, I myself have received notes from the insurance company denying coverage for treatments from twelve full months beforehand. It can't be helped: sometimes it takes twelve months for their computers to process the paperwork and determine that I owe them more money. They like to be thorough.

So that's getting a bit more complete. I believe my healthcare decisions should be between me, my insurance company plan, my statement of preexisting conditions, the claims adjusters at my insurance company, my insurance company's doctors, my employer, and myself.

And the separate claims review team that will be looking over my treatment.

My health insurer might have flagged me as someone who needs a lot of healthcare, and who is therefore costing the company money. Needing to use the insurance you paid for is naturally a suspicious activity: that means that a special review team will look over my paperwork, seeing if there is any vaguely plausible reason for the company to be rid of me. They will look for loopholes in my application, irregularities in the paperwork my doctor filled out or any other situations which, like magic, mean that all the money I have paid for health insurance premiums was in fact irrelevant, null and void, and they don't have to pay a single cent of claims because I defrauded them by neglecting to remember that I had chicken pox in sixth grade, not fifth, or that what I presumed was a bad cold in 1997 was in fact maybe-possibly-bronchitis, and I can't possibly expect to be covered for any lung-related complaints since then. I suppose I cannot complain too much; after all, this is a crack squadron of employees whose pay is determined by how much they can reduce the healthcare costs incurred by the company. It would be irresponsible for them to not look for such loopholes.

And then there is the board of directors at the insurance company, of course. My personal healthcare is irrelevant, when considered in the abstract; a health insurance company exists to make a profit, and the pay of every executive in the company and every board member is dependent on squeezing out the maximal amount of profits from every dollar.

This is where "experimental" and/or "preventative" treatments come in. New-fangled treatments, things that have only been around for a decade or two, are usually the most expensive. For example, when I complained of chest pains I could have had an CT scan to determine the state of the arteries around my heart, and it would have shown exactly where the problems, if any, lie. This is what the specialist recommended -- but using a CT scan in this way is considered "preventative" treatment, not "diagnostic" treatment, so it is not covered, and I am not allowed to have one. Instead, less accurate tests were used to get a "feel" for what the arteries might look like; these tests are covered. Problem solved; as it turned out, my chest pains were probably a preexisting condition, most likely caused by me having bones. And if it's not, I suppose we'll find out in another ten years or so, when no doubt I am covered by another insurance company and not this one.

These may seem like arbitrary determinations, but they are not. They are based on a rigorous study of how well the treatment works, how much it costs, and how likely it is that the company will have its corporate ass sued off if they do not provide it. This is weighed against the desired profit announcements for the insurance company during that quarter in order to determine how much care must be denied to customers, in aggregate, in order to meet the appropriate financial goals.

Let us not forget the obligations to the stockholders, after all.  Of every dollar paid in premiums, currently eighty cents it paid back out for actual medical claims; the rest is administration and profit-taking. Fifteen years ago the number was 95 cents: in other words, the insurance companies themselves have gone from taking five cents of every healthcare dollar to taking twenty cents of every dollar, all since the Clinton presidency.

The stockholders require healthy profits. The executives require personal profits for providing those profits. And since people for some reason aren't getting any healthier, those profits can only come from one place -- reducing what the company pays out when people do become sick.

I recently heard a radio interview with a health insurance company whistleblower; he was describing his trips on the company jet. Gourmet meals were served on china, and the forks were gold plated.

I was pondering this, while looking over the letter from my insurance company informing me that they were switching the coverage of my most expensive monthly medication -- those expensive allergy/asthma shots now count as a "procedure", not as "medicine", and so therefore those vials are not covered by my pharmaceutical plan anymore. It must be very difficult to balance all the tasks of an insurance company CEO. If the corporate jet has inferior place settings, imagine the corporate shame. If a new medication or treatment is no longer considered "experimental", or a treatment classified as actually useful, as opposed to "preventative" nonsense, consider how many millions of dollars the company would have to pay out to give people that treatment. It seems reasonable indeed for the president of my insurance company to have personally pocketed a few hundreds of millions here or there -- I cannot imagine the stress of keeping up with proper utensil etiquette during a time when those you insure are doing you the constant insult of actually getting sick.

So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company's list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company's claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company's crack cost-review and retroactive cancellation and denial squads, my insurance company's executives and board of directors, my insurance company's profit requirements, the shareholders, my employer, and my doctor.

Anything else would be insulting.

President Obama's remarks yesterday in the White House briefing room about the arrest of Henry Louis Gates have received nearly universal applause, with one notable exception: Republicans, who are still up their same old tricks.

Let's take a look at where things now stand.

First, Professor Gates and Officer Crowley have accepted President Obama's invitation to meet together at the White House:

"My entire academic career had been based on improving race relations, not exacerbating them. I am hopeful that my experience will lead to greater sensitivity to issues of racial profiling in the criminal justice system. If so, then this will be a blessing for our society. It is time for all of us to move on, and to assess what we can learn from this experience," he [Gates] said.

A fellow officer said Crowley had told Obama he would attend the meeting. "Jimmy said, 'I'd be happy to come to the White House and sit down with you and Gates and have a beer,' " the veteran Cambridge officer said, who asked not to be identified because he is not authorized to speak publicly about the issue.

Second, Cambridge police have applauded President Obama's comments, saying Officer Crowley was "profoundly grateful" for them:

Hours after demanding an apology from President Obama, several unions representing Cambridge police officers responded to the president’s latest remarks regarding the arrest of Harvard professor Henry Louis Gates.

Cambridge and area police unions released a statement on his behalf saying that Crowley and the president had a "friendly and meaningful conversation" and that Crowley was "profoundly grateful that the President took time out of his busy schedule to attempt to resolve this situation."

And third, Congressman Thaddeus McCotter (R-MI) decided to make political hay out of the controversy and waste the time of Congress by appealing to racial disharmony:

Congress would demand that President Obama apologize to the officer the president said had "acted stupidly" in the arrest of a prominent Harvard professor under a resolution set to be introduced by one Michigan lawmaker.

Rep. Thaddeus McCotter (R-Mich.) will introduce a House resolution on Monday demanding Obama retract and apologize for remarks he has made about Cambridge Police Sergeant James Crowley this past week.

To recap:

1. In a show of reconciliation and unity, both Prof. Gates and Officer Crowley will meet with President Obama at the White House.

2. The Cambridge police union is happy.

3. A Republican representative wants Congress to debate a political resolution slamming President Obama and reigniting the controversy.

Obviously, the only reason McCotter is pushing this attack is to try to score political points, but it's such a transparent ploy, it's almost guaranteed to blow up in his face. Does he really think that nobody will notice that while everybody else is working to come together and reduce the heat, he is stepping forward to try to crank up the flame?

Talk about stupid...Thaddeus McCotter has got it.

• Cheney and Addington were urging Bush to use military troops on American soil, against a civilian population, the New York Times reports. Of course, the memo authorizing such lawbreaking behavior was written by the infamous John Yoo. Jay Elias expresses bafflement and Kossacks discuss the issue in more depth.
• Quote of the Stupid for the day, from Rep. Virginia Foxx:

  There are no Americans who don’t have healthcare. Everybody in this country has access to healthcare."

• Al Franken introduces his first piece of legislation: providing dogs for wounded vets.
• Business Week compiles the Best and Worst Performance Review Comments. Here's just a sample (the responses were Twittered):

  —"TX govt employee scolded for wearing white [panty]hose cuz ‘they make your legs look fat.’ Boss resigned during sexual harassment inv"

  —"boss once pointed out that I took out both days of Rosh Hashanah but he didn’t think I was that religious... in a review..."

• Wired has a terrific in-depth story on the struggle of Dilbert creator Scott Adams to recover his lost voice.
• Rumproast stumbles upon art more horrifying than dogs playing poker.
• Pew finds that African Americans are the fastest-growing segment of active users of the mobile web and its devices.
• Columbia Journalism Review notes how the press hyperventilates over every issue the Obama administration faces, resulting in an Everything's a Crisis brand of journalism.
• Erik Tarloff over at The Atlantic pens a throat-catching eulogy for UC Berkeley, his alma mater, as the institution suffers dismemberment via drastic budget cuts:

  ... the creation of the university in 1868 embodied a genuinely noble democratic idea, one simultaneously embracing egalitarianism and excellence. The state of California determined to establish an elite public university that could rival any private institution on the East Coast, and one that, in addition, would be effectively tuition-free to any qualified California resident. There's something admirably American, and perhaps admirably western, about the whole notion. This would be an institution free of class and familial and financial restrictions;  it would pursue excellence without regard to such feudal vestiges, and it would open up opportunity to those formerly excluded....

  No doubt Berkeley will remain an estimable institution, and a significant player in the intellectual and economic life of the state. But its days as one of the very greatest universities in the country are clearly numbered.

  It's a great loss. Not merely for the university itself, nor even solely for the state of California.  It's a loss for everyone who cherishes a certain notion of how higher education, and society itself, ought to function.

Roddy McCorley, in last week's roundup edition of this series, made the following observation in the comments about the hate mail:

The one thing that jumps out at me from all the hate mail is the amount of "arguments" constructed on things like "you probably...", "I bet you...", "I'm sure you...", and the like.  Assumption is piled on supposition, mixed with profanity, and sprinkled with invective, in an endless series of virtuoso displays of muddled thinking.

Hilarious observation.

But this week installment isn't really that much fun, to be honest. With race a sudden hot topic, and with Republicans like Rush Limbaugh and Pat Buchanan stoking racial tensions, you can imagine what's below the fold. The ugliest week yet.

It's a talking point you hear regularly from President Obama--in order to fix the larger economy, healthcare costs have to be brought under control. That's not just rhetoric, there's plenty of empirical evidence to back up the claim, including two brand new studies.

The first, conducted by the non-profit Rand Corp links the rapid growth in U.S. health care costs to job losses and lower output. Commenting on the study at BusinessWeek's Money & Politics blog, Cathy Arnst says

The Rand researchers examined the economic performance of 38 industries from 1987 through 2005, in an attempt to assess the economic impact of "excess" growth in health care costs on U.S. industries. Excess growth is defined as the increase in health care costs that exceeds the overall growth of the nation’s GDP—a yearly occurrence in the U.S. The team compared changes in employment, economic output and the value added to the GDP product for industries that provide health benefits to most workers to those where few workers have job-based health insurance.

After adjusting for other factors, industries that provide insurance had significantly less employment growth than industries where health benefits were not common. Industries with a larger percentage of workers receiving employer-sponsored health insurance also showed lower growth in their contribution to the GDP....

The rate of growth in U.S. health care costs has outpaced the growth rate in the gross domestic product (GDP) for many years. In 1940, the share of GDP accounted for by health care spending was just 4.5%. By 1990, it had reached 12.2%, and 16% in 2005, when health care spending totaled nearly $2 trillion, or $6,697 per person, far more than any other nation. This year health care spending is on track to equal 18% of GDP.

That's largely the reason why so many American businesses are supporting reform.

Wal-Mart, on the other hand, recently came out in support of a mandate on employers to provide health insurance, and the temp firm Kelly Services, which employs thousands, followed with a similar statement.

Less noted has been the diversity of opinion among small and medium-size businesses. Many agree with the Chamber that a public insurance option would undermine the private insurance market and that requiring companies to provide coverage would impair job growth. Others say the current system is so broken that they are assessing whether to support the reform plans.

The wait-and-see approach that many businesses are taking -- alternately skeptical and hopeful -- is a further sign that the alliances that previously scuttled health-care reform may be scrambled this time around, not just in the health-care industry but also in the business world at large. President Obama and congressional Democrats face formidable obstacles to their reform efforts, but one factor in their favor is businesspeople who may not be as inclined as they were in the past to bring grass-roots pressure against reform.

Another new study, conducted by the progressive Center for American Progress looks at the potential costs for American families if the system isn't reformed.

Health care costs are expected to grow 71 percent over the next decade, which will in turn drive premium increases for health insurance. Unless we take serious steps now to reform our health care system—in particular to reduce the rate of growth in health care costs—health insurance coverage will slip out of reach for even more individuals than the 52 million Americans who today are uninsured.

This analysis shows that without health reform, average family premiums will grow to more than $22,000 by 2019, up from $13,100 today. In some states with higher-than-average premiums, family premiums will exceed $25,000 in 10 years. Of course, a family’s total health care costs will be even higher once co-payments and other out-of-pocket expenses are calculated into the total.

The costs of not fixing this now are extreme, and have the potential to bankrupt not only individual Americans, but the country. It will continue to hamper job growth, which will in turn lead to more people unable to get insurance, which in turn will increase the premium costs for those "lucky" enough to have insurance. This is not an acceptable future.

But don't forget the short term costs of not getting this done, because this can't be repeated enough. Three weeks of delay means:

• 143,250 people will lose their health insurance coverage [pdf]
• 53,507 people will file for bankruptcy because they can't pay their medical bills
• 1,265 people will die [pdf] because they lack coverage

You wanna get paid for artwork, or to write science articles, poetry, or sci-fi short stories? I plan to have a comprehensive post on several orgs that do so in the near future. But in the meantime I came across just such a site and there's no subscription required:

Strange Horizons has an all-volunteer staff, which enables us to pay our fiction and poetry writers professional rates. We are committed to expanding the readership, professional status, and literary appreciation of speculative fiction in all media, for all people.

Translation: they're working for free and willing to pay prospective writers. So please, if you're interested, send only finished pieces, or queries on ones you have ready to go, for consideration here.

• Cassini finds signs of a subsurface ocean on Saturn's moon Enceladus. If confirmed, the tiny moon would become a junior member in the exclusive outer solar polar bear club with its larger Jovian siblings Europa and Ganymede. Speaking of which, Mighty Jupiter takes another hit for the solar team. Lots of great pics and links via RJ
• PZ Myers flips over some slimy rocks in Texas and finds this homegrown MN clown:

  For an idea of the quality of his mind, you should read his disproof of global warming. He builds on an old map, the Oronteus Finaeus map of 1532, which shows the outlines of a southern continent, Antarctica. From this, he draws the conclusion that ... it had been free of ice with flowing rivers, and therefore, the world had been much, much warmer than it is now 500 years ago ...

   

• Kossack ASiegal slapped down Inhofe's latest PR climate change. But author/artist Karen Wehrstein and I would rather light a candle than curse the Senator's darkness. So we're proud to announce Climate Change Denial 101:

  
  Week 1 Introduction -- An overview of the global warming conspiracy with vigorous classroom discussion of why facts and science have an unfair liberal bias, and a careful review of the NASA Global Temperature Record with correct interpretations written by our crack science faculty ...

• Because it works so good for healthcare: A 17 year-old Eagle Scout who was praised for using his wits and training to survive for three days after being injured in a rugged wilderness area has now been hit with a $25,000 bill for his search and rescue.