LOOK AWAY! Whistling Dixie, Gawandes team threw out the foreign experience: // link // print // previous // next //
TUESDAY, AUGUST 18, 2009
Ugh: Bob Herbert gets it right. Just click here.
We liberals get fed some thin gruel: We look forward to reading Matt Taibbis forthcoming report on the health care wars in Rolling Stone. That said, we were often massively underwhelmed by Taibbis discussion with Rachel Maddow last night. (If the transcript ever gets posted, it will get posted here. As of this morning, MSNBC still hadnt posted last Fridays programs!)
Maddow began with an overview about different types of health care systemsa discussion which was quite clear and concise. (The analysts cheered. To watch the full segment, click this.) We began to balk when she discussed Obamas apparent retreat from a public optionand the earlier retreat by Max Baucus, who seems to have supported a public option back in November. Maddow gave this explanation for why the pair have flipped:
We wouldnt say that explanation is wrongbut wed call it ginormously underwhelming. But then, this was Taibbis response when asked why the Dems have flipped:
Is this what Obama wanted all along? We have no idea. But it was sad to see this dual attempt to explain the Democrats flip.
It doesnt make any sense? Jeez, we get fed some thin gruel!
Its sad when liberals have to turn to Fox to get competent analysis. But on last nights Special Report, one commentator had little trouble explaining why Obama has flipped. Charles Krauthammers analysis differed vastly from Taibbis. Sadly, it made much more sense:
A quick note about Krauthammers statement that the public option...is the road to a government-run system. That remained an explicit Democratic appraisal at least through early 2008. (To see Krugman explaining this point in February 2008, see THE DAILY HOWLER, 6/23/09. Today, we liberals pretend this is tea-bagger lunacy.) Was this ever Obamas thinking? We dont know. But it was the explicit thinking behind John Edwards proposal of a public plan as part of a wider health package.
Was Krauthammer right about Obamas current motives? Is Obama walking away from the public option because of all the town-hall commotion? Because the commotion has scared away too many Democratic votes? We cant read Obamas mind. (On Sunday, Kent Conrad said there were never enough Dem votes for a public plan.) But Krauthammer was stating an obvious possibility. Its stunning to think that neither Maddow nor Taibbi could have imagined this explanation for Obamas apparent retreat.
Are liberals forbidden from hearing an obvious possibility: This is your keister getting kicked by a bunch of tea-baggers?
A great deal more was underwhelming in the Maddow-Taibbi discussion. But liberals were fed some very thin gruel about this basic point. This is a complete and total mystery to me? Our analysts mouthed one word: Why?
Also underwhelming: Liberals were fed some very thin gruel in other parts of the confab. At one point, Maddow puzzled about the fact that single-payer was never part of Senator Baucus deliberations this spring:
For the record, Maddow is talking about May 2009. Click here. (We luv Russell Mokhiber, who was once our biggest comedy fan.)
Why was single-payer off the table when these deliberations began? Sorry. Whatever your view of single-payer might be, that approach was hardly inexplicable. Presumably, single-payer was off the table for an obvious reason: Barack Obama got elected president while campaigning against single-payer! There were three major candidates in last years Democratic campaign: Obama, Hillary Clinton and Edwards. And none of the three proposed single-payer! We might want to ask why that was the case. But it was hardly inexplicable when single-payer was sidestepped by Baucus. In fact, it would have been fairly inexplicable if Baucus had pursued single-payer. His partys newly-elected, popular president had run on a different approach!
For ourselves, wed be inclined to support single-payer. Wed certainly like to see its merits widely discussed; our liberal leaders avoided that over the past fifteen years. (Most are Very Serious People. Mokhiber isnt, and thus gets ignored.) But Obama didnt run on single-payer! Despite that, Maddow found Baucus conduct inexplicableand Taibbi seemed bollixed too:
Duh. Could that be because Obama didnt run on single-payer?
Children of the poverty class sometimes get a bad deal at school. Sometimes, when we watch our shows, we libs get a weak deal too.
PART 1LOOK AWAY: Atul Gawande and three associates authored an informative column in last Wednesdays New York Times.
Then too, there was the striking throw-away line which came at the start of the column.
Gawande directs the Center for Surgery and Public Health at Brigham and Womens Hospital in Boston. His associates are health care policy experts. Their question: Can the U.S. figure out ways to deliver health care at lower cost?
Good news! In studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible, Gawande and his team wrote.
Gawandes team searched the countrys 306 Hospital Referral Regions, looking for regions which 1) had low or declining Medicare costs and 2) had above-average health care outcomes. They identified 74 such regions. Here is Gawandes nugget:
When it comes to Medicare, these regions spend 16 percent less per patient than the national average. Gawande goes on to offer ten lessons from these high-performing, lower-cost regions. Would our cost crisis really be over if the rest of America performed like these regions? That could be true, but we feel unsurein part because of that throw-away comment, right at the start of this column.
Do we want to learn how to curb health costs? If so, weve come to the right planet! All over the globe, other developed nations deliver health results comparable to ours at vastly lower cost. Below, we highlight the most striking line in yesterdays Krugman column:
Again, we meet that astounding statistic: The United Kingdom gets health outcomes much like ourswhile spending 40 percent as much per person! (Interpreted baldly, that suggests that 60 percent of our health care spending is wasted.) Truly, thats an astounding figure, but lets present it a different way. According to the OECD, this was the per-person spending in these countries in 2007:
Those are astonishing figures. Meanwhile, if you dont want to trust Krugmans claim about the British systems overall good care, go ahead and tackle this column from yesterdays Washington Post.
Back to Gawande: The U.S. is looking for ways to provide health care at lower cost. At the same time, were confronted by that astonishing figure from Britain. (More figures, from other countries, as the week proceeds.) That brings us back to the throw-away comment at the start of Gawandes report.
How might we produce less costly health care? We really do live in North Korea when frameworks like the one which follows are so standardwhen a framework like Gawandes can even seem to make sense:
With that throw-away line about not being Europe, Gawande sets his sites on health care regions in this countryregions which are saving 16 percent per patient. He stops considering a place like Great Britainwhere the overall saving per person is instead 60 percent!
Were not suggesting that Gawandes team is involved in some sort of plot. But truly, could it be more astounding? Great Britain is spending $2992 per personcompared to our own $7290! But again, were told by a team of experts: Look away! Look away, Dixie land!
We arent Europe, Gawande says. So true! With a long-term discussion built on such frameworks, were more like North Korea. But then, our health care discussion often seems like a tribute to mental illness. More tomorrow, as CNN throws away a stunning report.
TomorrowPart 2: CNN, in a throw-away comment: All of these combined areas could add up to $1.2 trillion in waste [per year]or, as the study notes, more than half of our health spending.