Wednesday, March 31, 2010

This Time We Really Mean It

Published: March 30, 2010

This newspaper (NYT)  carried a very troubling article on the front page on Monday. It detailed how President Hamid Karzai of Afghanistan had invited Iran’s president, Mahmoud Ahmadinejad, to Kabul — in order to stick a thumb in the eye of the Obama administration — after the White House had rescinded an invitation to Mr. Karzai to come to Washington because the Afghan president had gutted an independent panel that had discovered widespread fraud in his re-election last year.

The article, written by two of our best reporters, Dexter Filkins and Mark Landler, noted that “according to Afghan associates, Mr. Karzai recently told lunch guests at the presidential palace that he believes the Americans are in Afghanistan because they want to dominate his country and the region, and that they pose an obstacle to striking a peace deal with the Taliban.”
The article added about Karzai: “ ‘He has developed a complete theory of American power,’ said an Afghan who attended the lunch and who spoke on the condition of anonymity for fear of retribution. ‘He believes that America is trying to dominate the region, and that he is the only one who can stand up to them.’ ”

That is what we’re getting for risking thousands of U.S. soldiers and having spent $200 billion already. This news is a flashing red light, warning that the Obama team is violating at least three cardinal rules of Middle East diplomacy.
Rule No. 1: When you don’t call things by their real name, you always get in trouble. Karzai brazenly stole last year’s presidential election. But the Obama foreign policy team turned a blind eye, basically saying, he’s the best we could get, so just let it go. See dictionary for Vietnam: Air Marshal Nguyen Cao Ky.
When you can steal an election, you can steal anything. How will we get this guy to curb corruption when his whole election, and previous tour in office, were built on corruption? How can we be operating a clear, build-and-hold strategy that depends on us bringing good governance to Afghans when the head of the government is so duplicitous?
Our envoy in Kabul warned us of this before the election, but in his case, too, we were told to look the other way. On Nov. 6, the ambassador, Karl Eikenberry, wrote to Washington in a cable that was leaked: “President Karzai is not an adequate strategic partner,” he warned. “Karzai continues to shun responsibility for any sovereign burden, whether defense, governance or development. He and much of his circle do not want the U.S. to leave and are only too happy to see us invest further. They assume we covet their territory for a never-ending ‘war on terror’ and for military bases to use against surrounding powers.”
One reason you violate Rule No. 1 is because you’ve already violated Rule No. 2: “Never want it more than they do.”
If we want good governance in Afghanistan more than Karzai, he will sell us that carpet over and over. How many U.S. officials have flown to Kabul — the latest being President Obama himself — to lecture Karzai on the need to root out corruption in his administration? Do we think he has a hearing problem? Or do we think he believes he has us over a barrel and, in the end, he can and will do whatever serves his personal power needs because he believes that we believe that he is indispensable for confronting Al Qaeda?
This rule applies equally to the Israeli prime minister, Bibi Netanyahu, and the Palestinian president, Mahmoud Abbas. There is something wrong when we are chasing them — two men who live in biking distance from one another — begging, cajoling and pressuring them to come to a peace negotiation that should ostensibly serve their interests as much as our own.
Which leads to Rule No. 3: In the Middle East, what leaders tell you in private in English is irrelevant. All that matters is what they will defend in public in their own language.
When Karzai believes that the way to punish America for snubbing him is by inviting Iran’s president to Kabul — who delivered a virulently anti-U.S. speech from inside the presidential palace — you have to pay close attention to that. It means Karzai must think that anti-Americanism plays well on the streets of Afghanistan and that by dabbling in it himself — as he did during his presidential campaign — he will strengthen himself politically. That is not a good sign.
As Filkins and Landler noted, “During the recent American-dominated military offensive in the town of Marja — the largest of the war — Mr. Karzai stood mostly in the shadows.” And if Karzai behaves like this when he needs us, when we’re there fighting for him, how is he going to treat our interests when we’re gone?
We have thousands of U.S. troops on the ground in Afghanistan and more heading there. Love it or hate it, we’re now deep in it, so you have to want our engagement there to build something that is both decent and self-sustaining — so we can get out. But I still fear that Karzai is ready to fight to the last U.S. soldier. And once we clear, hold and build Afghanistan for him, he is going to break our hearts.

Saturday, March 27, 2010

Boycott Nordstrom's for Retailing AHAVA Beauty Products

Hey folks,
I just took action to tell Nordstrom to stop selling Ahava products. Ahava promises “Beauty Secrets from the Dead Sea” but the real secrets are an ugly truth—its products actually come from stolen Palestinian natural resources in the Occupied Territory of the Palestinian West Bank, and are produced in the illegal settlement of Mitzpe Shalem. There is a coalition effort to get stores across the country, including Nordstrom, to stop carrying the products. Costco has already dropped them! Ahava means "Love" in Hebrew, but there's nothing loving about occupation!
You can read more ( and send Nordstrom an email yourself (!

Whose Country Is It? Ringing the curtain down on the Tea Partiers!

Whose Country Is It?

Published: March 26, 2010

The far-right extremists have gone into conniptions.

The bullying, threats, and acts of violence following the passage of health care reform have been shocking, but they’re only the most recent manifestations of an increasing sense of desperation.
It’s an extension of a now-familiar theme: some version of “take our country back.” The problem is that the country romanticized by the far right hasn’t existed for some time, and its ability to deny that fact grows more dim every day. President Obama and what he represents has jolted extremists into the present and forced them to confront the future. And it scares them.

Even the optics must be irritating. A woman (Nancy Pelosi) pushed the health care bill through the House. The bill’s most visible and vocal proponents included a gay man (Barney Frank) and a Jew (Anthony Weiner). And the black man in the White House signed the bill into law. It’s enough to make a good old boy go crazy.

Hence their anger and frustration, which is playing out in ways large and small. There is the current spattering of threats and violence, but there also is the run on guns and the explosive growth of nefarious antigovernment and anti-immigrant groups. In fact, according to a report entitled “Rage on the Right: The Year in Hate and Extremism” recently released by the Southern Poverty Law Center, “nativist extremist” groups that confront and harass suspected immigrants have increased nearly 80 percent since President Obama took office, and antigovernment “patriot” groups more than tripled over that period.

Politically, this frustration is epitomized by the Tea Party movement. It may have some legitimate concerns (taxation, the role of government, etc.), but its message is lost in the madness. And now the anemic Republican establishment, covetous of the Tea Party’s passion, is moving to absorb it, not admonish it. Instead of jettisoning the radical language, rabid bigotry and rising violence, the Republicans justify it. (They don’t want to refute it as much as funnel it.)
There may be a short-term benefit in this strategy, but it’s a long-term loser.

A Quinnipiac University poll released on Wednesday took a look at the Tea Party members and found them to be just as anachronistic to the direction of the country’s demographics as the Republican Party. For instance, they were disproportionately white, evangelical Christian and “less educated ... than the average Joe and Jane Six-Pack.” This at a time when the country is becoming more diverse (some demographers believe that 2010 could be the first year that most children born in the country will be nonwhite), less doctrinally dogmatic, and college enrollment is through the roof. The Tea Party, my friends, is not the future.

You may want “your country back,” but you can’t have it. That sound you hear is the relentless, irrepressible march of change. Welcome to America: The Remix.

GOP + Truthfulness = Oxymoron. (Emphsis on Oxy - as in slow to get it)

Police Say Stray Bullet Hit Office of Lawmaker

On Thursday, Representative Eric Cantor of Virginia, the second-ranking Republican leader in the House, said that Democratic members of Congress were not the only ones who had been the targets of threats and vandalism in recent days. He said that he had been threatened, too, and that a bullet had been fired through the window of his campaign office in Richmond.
But a preliminary investigation indicated that the bullet was probably not aimed at his office, the Richmond police said Friday.
“We believe it was a stray bullet as a result of random gunfire,” said Gene Lepley, a spokesman for the Richmond Police Department.
Mr. Cantor drew attention to the incident at a news conference he held Thursday to criticize Democrats for publicizing the threats and vandalism several Democratic lawmakers have faced since they voted for the health care bill. Then he made a dramatic announcement.
“Just recently, I have been directly threatened,” he said. “A bullet was shot through the window of my campaign office in Richmond this week, and I have received threatening e-mails. But I will not release them because I believe such actions will only encourage more to be sent.”
A preliminary investigation indicated that the incident in question took place around 1 a.m. Tuesday, when a bullet was apparently fired into the air, striking the office window as it traveled back downward, the Richmond police said in a statement.
The bullet struck the window with enough force to break a pane, the police said, but did not penetrate the blinds inside the window. The bullet landed about one foot inside the office, which Mr. Cantor had occasionally used for meetings, the police said.

At his news conference, where he declined to take questions from reporters, Mr. Cantor had urged that threats be left to law enforcement officials, and not used for publicity purposes.
“Legitimate threats should be treated as security issues, and they should be dealt with by the appropriate law enforcement officials,” he said. “It is reckless to use these incidents as media vehicles for political gain.”
A spokesman for Mr. Cantor did not return two calls or respond to an e-mail message seeking comment on Friday.

Friday, March 19, 2010

Health Care Lesson

Labor War in the Mojave
By Mike Davis

The biggest hole in California, with the exception of the current state
budget, is Rio Tinto's huge open-pit mine at the town of Boron, near Edwards
Air Force Base, eighty miles northeast of Los Angeles.

The Boron pit, which replaced an underground mine, produces almost half the
world's supply of refined borates.

Once upon a time, there were several thousand mining communities in North
America; perhaps fewer than a hundred still exist. Boron (unincorporated,
population 2,000) is one of the survivors.

In last year's contract negotiations, Rio Tinto (the British-Australian
multinational acquired its Boron facility, U.S. Borax, in 1968 and renamed
it Rio Tinto Borax) stunned members of the International Longshore and
Warehouse Union, ILWU, Local 30 (Boron), by demanding abolition of the
contractually enshrined seniority system and the surrender of any worker
voice in the labor process.

The company wants a contract that would allow it to capriciously promote or
demote; to outsource union jobs; to convert full-time to part-time positions
with little or no benefits; to reorganize shift schedules without warning;
to eliminate existing work rules; to cut holidays, sick leave and pension
payments; to impose involuntary overtime; and to heavily penalize the union
if workers file grievances against the company with the National Labor
Relations Board.

"The company's proposal," union negotiators emphasize, "would destroy our
union, lower our living standards, and give Borax total control over our
jobs." On January 30, Local 30 members unanimously rejected the concessions
demanded by Rio Tinto.

The company deadline expired the next morning, when Terri Judd set off for
work as usual with her lunchbox and thermos. At the locked front gate she
and other day-shift workers encountered a phalanx of nervous Kern County
sheriff's deputies in full riot gear. Inside the plant, an elite "strike
security team" hired by Rio Tinto had taken control of operations.

"Being locked out," says Terri, "is different from going on strike.
Initially there's disbelief that the company is actually serious about
booting you out the door. Hey, my granddad worked in this mine. But then you
see that caravan of scabs coming to take your jobs, and the betrayal cuts
like a knife in your heart."

Comment:  Empathetic souls will find the full version of this article to be
very tough reading. When the 560 wage earners unanimously rejected the
demands of Rio Tinto to give up much of their job security, the company
terminated all of them in a job lockout. The impact on their small community
of Boron is devastating.

Even though this story is not about health care, there is a very important
health policy lesson here.

These people lost company support of their health benefits program at
termination. With loss of their paychecks, many of these individuals are
struggling to pay their rent and to buy food. Extension of health coverage
through COBRA, even with subsidies, is of no benefit if they don't have the
funds to pay for it.

And President Obama's promise of being able to keep the insurance you have
if you want to? He left off the part that says you can keep it until your
COBRA runs out, and at that only if you can pay your share (and all of the
other reasons why hardly anyone still has the insurance they had twenty
years ago, even if they wanted to keep it).

The policy lesson is that a health care financing system should be designed
to cover absolutely everyone automatically throughout life. Individuals
unfortunate enough to lose their jobs shouldn't be further penalized by
losing their health care as well.

Wednesday, March 17, 2010

The Green They Steal, the Greed They Wear ...a St. Patrick's Day Lamentation

It was amazing. Every story on the front page of Monday's New York Times told the story of the Age of Greed during which a system known as capitalism is slowly, but surely, killing us:
Insurance company greed: "Millions Spent to Sway Democrats on Health Care"
War profiteers: "Contractors Tied to Effort to Track and Kill Militants"
There's no profit in repairing our infrastructure: "Repair Costs Daunting as Water Lines Crumble"
China, the bank: "China Uses Rules on Global Trade to Its Advantage"
You mean NAFTA didn't improve life in Mexico: "Two Drug Slayings in Mexico Rock US Consulate"
What happens when Big Food profits from hurting kids: "Forget Goofing Around: Recess Has New Boss"
There's now a daily parade of news like this -- well, not really "news," more like the media division of large corporations shoving your face into the dirt that is your life. You already know the schools are a disaster and the war is a boon for the Halliburtons and a bust for you. You don't need a newspaper to tell you the roads and electrical lines and the local sewage plant is in miserable disrepair.
And by now you've figured out that you don't really have any say in this, that what we call the "democratic process" is mostly a sham, pretty words that get repeated in the hopes we will all still fall for it. But the fix is in and we don't fall for it anymore. Admit it: Wall Street owns "our" Congress lock, stock and big barrel o' campaign cash. You want a say in this? Well, I don't see you on the Forbes 400, so shut the f@*& up and go fetch me another bottle of bubbly.
Within days, the House of Representatives will vote to pass the Senate health care "reform" bill. This bill is a joke. It has NOTHING to do with "health care reform." It has EVERYTHING to do with lining the pockets of the health insurance industry. It forces, by law, every American who isn't old or destitute to buy health insurance if their boss doesn't provide it. What company wouldn't love the government forcing the public to buy that company's product?! Imagine a bill that ordered every citizen to buy the extended warranty on all their appliances? Imagine a law that made it illegal not to own an iPhone? Or how 'bout I get a law passed that makes it compulsory for every American to go see my next movie? Woo-hoo! Who wouldn't love a sweet set-up like this windfall?
Well, the insurance companies -- get this -- don't like the Democrats' bill! That alone should be reason enough to vote for it.
Now, you would think these thieves would love this bill -- but they are actually fighting it. Why? Because it doesn't give them ONE HUNDRED PERCENT of the what they want. It only gives them... 90%! YOU SEE, pure greed demands all or nothing.
The insurance industry hates this bill because it puts a few minor restrictions on them. Six months after its passage they won't be able to deny children coverage if they have a pre-existing condition. How awful! Government interference! SOCIALISM!
But, hey, they'll still be able to deny these children's parents coverage until 2014! So if a parent gets sick and dies in the next four years, I'm sure someone will step in and raise these already-insured orphans.
And how big will the fines be if the insurance companies do deny someone coverage for having a pre-existing condition? Are you sitting down? A hundred dollars a day! That's it! So if you're the insurance company, and Judy is a customer of yours, and Judy needs an operation that will cost $100,000, what do you do? You take the fine! Let's say Judy lives another year after you've sentenced her to death, your $100-a-day fine will only cost you $36,500! That's a savings of $63,500! And trust me, my friends, that's EXACTLY what's going to happen.
There are some good things in this bill. Parents will be able to keep their children on their policy until the kids turn 26. A few things like that. So, yes, pass that.
But don't insult me and 300 million Americans by calling this "health care reform." At least you've stopped calling it "universal health care." We will not have universal health care or anything close to it. I wish the president and the Democratic leadership would just stand up and say, "We're sorry, America. We didn't get the job done you sent us here to do. We're weak and scared and unable to communicate the simplest of messages to the American people. Therefore, our bill will guarantee that 12 million of you will still have NO health insurance. And that's because we have decided to leave the greedy, private insurance industry in charge of our system. Forgive us for this and for continuing to allow profit to be the determining factor as to whether a patient gets the help she or he needs."
Please, Democrats -- just say that -- then pass this poor excuse of a bill. Pass it because, if President Obama takes a fall on this one, I don't know if he'll be able to get back up. And then NOTHING will get done. We can't have that. (And thank you Dennis Kucinich for hanging in there right up to the end and being the only one out of the 435 members to speak the awful truth.)
On the front page of yesterday's New York Times, the dateline was, sadly, once again, "Flint, Michigan." The story was about how doctors are no longer accepting Medicaid patients. Which means tens of thousands of poor can no longer go to the doctor. Last year, the State of Michigan also prohibited doctors from accepting Medicaid patients who had anything wrong with their vision, their hearing, their feet or their teeth. In a 16-county area northwest of Flint, there will soon be not one single hospital that will allow you to give birth there if you're on Medicaid. The official unemployment rate in Flint is 27% (unofficially, closer to 40%).
This is an American tragedy. And, as I've warned you for years, this tsunami is heading your way -- if it's not there already.
I've just turned on my new iPhone and it informs me that it has "apps" it would like to suggest I buy. One is called "Scanner." It will allow me to listen in on police scanners anywhere across the country. I buy the app. I see that the Flint police scanner is part of this. I turn it on out of curiosity. And this is what I hear, at one in the morning: A woman is being beaten by her husband... A home invasion is taking place ("16-year-old black male, wearing a white skull cap")... A child has been missing since noon today... Another woman is being beaten by her boyfriend... A diabetic, obese man is having trouble breathing and needs to be rushed to the hospital (there will be three more of these obese diabetics in the hours to come; the entire town is ill)... One more woman calling, screaming for help, "officers urged to use caution..."
...And on and on and on. This is what I have listened to before going to bed. I am filled with despair and helplessness as I hear my former neighbors crying out for help. I hate it. I have to turn it off. I start to cry. Thank you, iPhone. Thank you, Democrats. I'll sleep better knowing that you're looking out for all of us.
P.S. I'll continue my jihad today on Dylan Ratigan (MSNBC, 4pm ET) and, for the first time together in the same studio since our, um, 2007 debate, I'll join Wolf Blitzer live in his CNN Studio (5-8pm, ET). I'll also be on live for the entire 11am hour this morning on the wonderful Diane Rehm Show on NPR. You can listen live online here.
The rest of the day I'll spend wandering the halls of Congress with my shillelagh and shamrocks, doing my best impersonation of St. Patrick as I try to drive the snakes out of Capitol Hill. Wish me luck..

Friday, March 12, 2010

"Ahava promises “Beauty Secrets from the Dead Sea.” - Not So! Sign the Petition

Sign the petitions at:
Ahava promises “Beauty Secrets from the Dead Sea.” And wait until you hear those secrets!
Because Ahava is hiding the ugly truth—its products actually come from stolen Palestinian natural resources in the Occupied Territory of the Palestinian West Bank, and are produced in the illegal settlement of Mitzpe Shalem. Don’t let the “Made in Israel” sticker fool you—when you buy Ahava products you help finance the destruction of hope for a peaceful and just future for both Israelis and Palestinians.
Ahava puts a pretty face on its crimes, even paying Oxfam Ambassador and “Sex in the City” star Kristen Davis to be its spokeswoman. But here’s what Oxfam itself has to say about Ahava’s deceptive packaging:
  • “The settlements on the West Bank are illegal under international humanitarian law and that creates a lot of problems for the Palestinians that live there.”
  • “Consumers that are buying produce that are grown in illegal settlements need to have that information so that they can make an informed choice.”
See for more.

This Report on the Uninsured Situation is Sobering!

Health Affairs
March 11, 2010
A Partisan Divide On The Uninsured
By Tara Sussman Oakman, Robert J. Blendon, Andrea L. Campbell, Alan M.
Zaslavsky and John M. Benson


The partisan split in Congress over health reform may reflect a broader
divide among the public in attitudes toward the uninsured. Despite expert
consensus over the harms suffered by the uninsured as a group, Americans
disagree over whether the uninsured get the care they need and whether
reform legislation providing universal coverage is necessary. We examined
public perceptions of health care access and quality for the uninsured over
time, and we found that Democrats are far more likely than Republicans to
believe that the uninsured have difficulty gaining access to care. Senior
citizens are less aware than others of the problems faced by the uninsured.
Even among those Americans who perceive that the uninsured have poor access
to care, Republicans are significantly less likely than Democrats to support
reform. Thus, our findings indicate that even if political obstacles are
overcome and health reform is enacted, future political support for ongoing
financing to cover the uninsured could be uncertain.

Attitudes Toward Universal Coverage

Creating a national health insurance system to pay for most forms of health
care was significantly more popular among people who perceived that the
uninsured are unable to get care (72 percent) or able to get care with great
difficulty (75 percent) than it was among those who perceived that it is not
too difficult (38 percent) or not at all difficult (31 percent) for the
uninsured to get care. Similarly, 63 percent of respondents who perceived
that the uninsured do not get the same quality of care as the average
insured person also favored national health insurance, as compared to a
minority (43 percent) of respondents who said that there is no difference in
the care obtained by uninsured and insured people.

These associations persisted even after political party and demographic
characteristics were controlled for in multivariate analysis. As expected
from prior literature, political party is still a significant predictor of
support for reform. The effect of partisanship does not appear to be
mediated by the perceptions of how difficult or not it is to obtain care.
Republicans are less favorable toward national health insurance than
Democrats, even after perceptions of care access or quality for the
uninsured are controlled for.

Comment:  Since the failure of the Clinton effort at reform there has been
an intense campaign by innumerable entities to educate the nation on the
problems with our health care system and the potential impact of the various
solutions. The results of the surveys reported in this Health Affairs
article are sobering, if not depressing.

A proliferation of studies has demonstrated beyond all doubt that uninsured
individuals have difficulty gaining access to health care, and the results
of those studies have been widely disseminated. Yet these surveys show that
far too many individuals do not believe this is true in spite of the
overwhelming evidence presented to them through the years.

This study demonstrated that those less likely to believe the facts about
impaired access for the uninsured included Republicans, males, seniors, and
the wealthy. What is perhaps most disconcerting of all is that even
Republicans who do understand that lack of insurance impairs access still
are opposed to creating a national health insurance system. They simply
don't care about the fate of those who must do without adequate health care.

Those supporting the current proposal before Congress should take note of
this quotation from the article:

"Even among those who perceive that the uninsured have poor access to care,
Republicans are significantly less likely than Democrats to support reform.
Further, the elderly, who are a politically influential group because of
their high political participation rates, are not cognizant of the problems
faced by the uninsured. Thus, our findings indicate that even if President
Barack Obama signs health reform into law, its future political support
could be uncertain. A shift from Democratic to Republican control of either
congressional body could mean the reduction or elimination of funding for
insurance subsidies. Subsidies are essential to a coverage expansion that
these critical constituencies ultimately deem unnecessary."

The proposed private insurance subsidies are already so modest that RAND
predicts that 25 million people will remain uninsured. When Republicans take
control, under the proposed model of reform they wouldn't even have to
repeal the program. All they would have to do is slash the premium subsidies
to wipe out the effectiveness of this legislation. Then the next step would
be to reduce the actuarial value of the plans supported, thereby requiring
sick and injured individuals to pay even more out of pocket than these plans
already require.

Try that with a single publicly-financed and publicly-administered program
that belongs to the people. The Republicans have already tried that with
Medicare, and though they caused some damage, the program barely budged.

We desperately need a single program built on a solid foundation, a program
that belongs to all of us - an improved Medicare for all.

Thursday, March 11, 2010

Medicine in the Dark

Los Angeles Times
March 10,2010
Medicine in the dark
By Michael Hochman and Danny McCormick

Some doctors treat patients with early-stage prostate cancer with radiation.
Others favor surgery, while some advocate only close monitoring. Which
approach is most successful? No one knows.

When it comes to diabetes management, doctors don't have answers to key
questions: At what point should insulin be started? Is it safe to lower the
blood sugar to normal levels? What is the best way to monitor blood sugar

Similarly, endocrinologists don't know what is the best way to treat
patients with hyperactive thyroids. Doctors in Europe typically use
medications, while those in the U.S. more frequently give radioactive
iodine. Only limited evidence is available to guide the decision.

It may seem perplexing that there is so much uncertainty about these
relatively simple questions. All of the above treatments have been around
for decades. Shouldn't we have definitive answers by now?

In this week's issue of the Journal of the American Medical Assn., we report
the results of a study that may help explain why we don't. In the study, we
analyzed 328 medication studies recently published in six top medical
journals and found that just 32% were aimed at determining which available
treatment is best. The rest were either aimed at bringing a new therapy to
market or simply compared a medication with a placebo. Whether the therapy
was better or worse than other treatments was simply not addressed.

Research involving new therapies is of course crucial for medical progress,
but there is also a need for research that compares the effectiveness of the
rapidly growing array of existing therapies and approaches.

So why, then, did only a third of medication studies focus on helping
doctors use existing therapies more effectively? The answer lies in the fact
that pharmaceutical companies fund nearly half of all medication research,
including the lion's share of large clinical trials. For obvious reasons,
commercially funded research is primarily geared toward the development of
new and marketable medications and technologies. Once these products have
won approval for clinical use, companies no longer have incentives to study
exactly how and when they should be used.

In support of this claim, we found that 87% of the comparative effectiveness
studies we analyzed were funded entirely or in part by non-commercial
sources, such as nonprofit foundations or government institutions. In
addition, 91% of studies comparing medications with non-pharmacologic
therapies (such as surgery or lifestyle changes) received non-commercial
funding, as did 94% of studies comparing different medication strategies
(such as different blood sugar targets in patients with diabetes) and 90% of
studies comparing the safety profiles of medications. Non-commercial sources
funded 100% of studies comparing the cost- effectiveness of different
treatments, though only 2% of the studies we reviewed included such

Congress recently appropriated more than $1 billion in the American Recovery
and Reinvestment Act to promote comparative effectiveness research. This is
a good first step, but the money will need to be spent carefully. We believe
studies that address fundamental clinical decisions -- such as when to use
medications versus surgery or how to use therapies more effectively --
should be favored over those that simply compare two alternative
medications. There is also clearly a need for more research on the
comparative safety and costs of different treatments. And although many
researchers are thankful for the new research funds, it may soon become
apparent that $1 billion is far from sufficient.

Reform is also necessary to ensure that commercially funded research is
designed in a way that is more helpful to doctors. Our study showed that
two-thirds of commercially funded randomized trials compared medications
with a placebo rather than with another active therapy. Though placebos are
appropriate when no alternative therapies are available, in many of the
trials we examined, we suspect alternative therapies could have been used
instead. For this reason, we believe that regulatory agencies such as the
Food and Drug Administration should only approve new therapies that have
been shown to be at least as good as existing therapies whenever such
alternatives exist. Alternatively, though more controversial, some experts
have proposed that pharmaceutical companies should be allowed to fund -- but
not design -- clinical studies.

As medical science advances, clinical decision-making will only become more
complex. Only by expanding public funding for comparative effectiveness
research can we hope to put existing medical treatments and healthcare
services to their best use. Doing so would ensure that national research
priorities are determined by patient needs rather than by corporate agendas.

Michael Hochman, MD, is an assistant professor of clinical medicine at USC's
Keck School of Medicine. Danny McCormick, MD, MPH, is an assistant professor
of medicine at Harvard Medical School.,0,3812725.story

JAMA - Characteristics of Published Comparative Effectiveness Studies of
Medications, by Michael Hochman, MD and Danny McCormick, MD, MPH:

JAMA editorial - Charting a Path From Comparative Effectiveness Funding to
Improved Patient-Centered Health Care, by Patrick H. Conway, MD, MSc and
Carolyn Clancy, MD:

Comment:  Rather than using excerpts from the JAMA article by Hochman and
McCormick as today's qotd, their op-ed in today's Los Angeles Times provides
an even better summary of their findings along with their astute comments.
 Their op-ed obviates the need for me to provide any additional commentary.
-------------- next part --------------

Tuesday, March 02, 2010

Consumer Protection Legislation = "...Doom Loop..."

Update: The Consumer Financial Protection Agency continues to be a moving target for opponents of financial reform. The latest cave in compromise proposal being floated by Senate Banking chairman Chris Dodd now has the agency being housed within the Federal Reserve. An earlier "compromise" would have placed it in the Treasury Department. The end result is the same: a toothless regulator lacking the authority to enforce the consumer protection rules it writes.
Original Post:
A "doom loop." That's what Andy Haldane, executive director of financial stability for the Bank of England, warned last fall would happen if serious financial reform wasn't enacted.
Well, we appear to be a step closer to that "doom loop" with the leak this weekend of Senate Banking Committee Chairman Chris Dodd's plan for a seriously watered-down consumer financial protection agency.
Back in June, President Obama released a proposal calling for the creation of a Consumer Financial Protection Agency that would be "independent," with "broad authority" and the power to "combat the worst abuses in mortgage markets." The agency, Treasury Secretary Tim Geithner said, would "have an independent seat at the table in our financial regulatory system."
Well, that was before the banking lobby went into action. A couple of hundred million dollars later, and we're left with this punch-to-the-gut of reform, from the top-line summary of Dodd's plan: "the independent agency proposal would be dropped." Seven words dirtier than George Carlin ever uttered.
Instead, according to the Dodd plan, the agency would be housed within the Treasury Department and called the Bureau of Financial Protection. And that's not the only compromise. Here's how the eviscerated entity would work, as laid out by HuffPost's Ryan Grim:
Each time the agency wanted to write a rule, it would have to consult with bank regulators. The agency would then have to respond to the objections of each and every bank regulator in the Federal Register. If the bank regulator was still unsatisfied, it could appeal to the 'systemic regulator,' whose mission is to protect the safety and soundness of the banking industry.

Anytime a new rule is proposed, bank lobbyists argue that it will be burdensome and make the system less safe and sound. If the systemic regulator agreed with the banks -- as they often do -- then the consumer protection rule would be voided.
Notably, the consumer protection agency has no veto power over any rules issued by bank regulators, which demonstrates which regulator will be superior. The first concern is the banks.
So much for "independence" and "broad authority."
The proposal will no doubt be very popular with the banks that, as Sen. Dick Durbin put it, "own the place." But it's already been met with criticism from consumer groups.
"Effective reform is once again being blocked by opposition from the big banks that caused the current financial crisis, " said Heather Booth, director of Americans for Financial Reform. "The revised proposal does not provide what is needed to protect American families or the financial system as a whole."
This view was seconded by Nancy Zirkin of the Leadership Conference on Civil and Human Rights: "Big banks and abusive lenders fought responsible regulation before the crisis, and we are all paying the price. It is unacceptable for Congress to allow them to succeed again," she said.
But, then, we seem to be living in a time when the unacceptable is routinely accepted -- and written off as unavoidable.
On Saturday, Dodd told Bloomberg Television's Al Hunt that he prefers an independent agency, but said it might not be possible to reach the 60 votes needed to break the inevitable Republican filibuster.
Maybe so. But how about at least trying before waving the white flag? Instead, Dodd, in the hope of attracting Republican votes, appears to have preemptively surrendered. But there's no evidence that Dodd's concession has achieved anything other than kneecapping the bill. Democrats have mastered the art of negotiating against themselves.
It's hard to believe that even the messaging-challenged Democrats could fail to frame to their advantage a bill that would prevent banks from abusing the public and engaging in the same practices that brought on the financial catastrophe taxpayers have paid so high a price for. Instead, the attitude seems to be, why even try?
That's assuming, of course, that a powerful consumer protection agency is something Democrats -- including those in the White House -- think is important enough to fight for.
"Here lies the crux of the problem," write Simon Johnson and Peter Boone. "The Obama administration lacks an inner core of smart, well-informed advisers who are deeply skeptical of big banks and eager to do whatever it takes to break a cycle that points to financial and fiscal doom."
So how likely is another ride on the doom loop of financial crises? Johnson and Boone lay out some sobering statistics: Fifteen years ago, the combined assets of our six biggest banks totaled 17 percent of our GDP. By 2006, that number was 55 percent. Right now, it stands at 63 percent.
In the Bloomberg interview, Dodd claimed to still support the so-called Volcker Rules banning proprietary trading and capping the size of banks, as does, we're told, Obama. But Johnson and Boone argue that even the Volcker Rules wouldn't make much of a difference -- and that something much bolder is needed.
"It is still possible that the White House could go all-in against the distorted incentives at large banks and the corrupted regulatory structures that have created our 'doom loop,' and make this the central campaign issue for November," they write. "Branding opponents as supporters of too big to fail could get traction, at least if led by an articulate and impassioned president."
Well, we know he'll be articulate, but his passion for reigning in the banks remains to be proven.
The Senate Banking Committee is expected to take up Dodd's proposal this week. Some strong leadership from an "impassioned" Obama could shoot down this deflated trial balloon and ensure that what the committee sends to the full Senate to vote on is actually closer to what Obama called for last year -- and, indeed, closer to the stronger package, including a stand-alone consumer financial protection agency, that passed the House in December.
During last week's health care summit, President Obama very cogently explained why piecemeal health reform won't work -- connecting the dots between the need to prevent insurers from denying coverage for those with pre-existing conditions and the need for universal coverage.
How about doing the same for an issue that is even more sellable to the public? Of course, reforming our broken health care system would have been sellable, too -- if the White House had not ceded the messaging playing field to the Republicans for most of the last year.
The good news is, there's still plenty of time to do for financial reform what Obama should have done for health care -- go out and sell a clear and specific package. And he needs to make the point that, much like health care, doing it incrementally won't work. Leaving too-big-to-fail banks to continue doing business as they have been is like operating on a cancer patient and taking out only half the tumor -- the disease is guaranteed to come back. And eventually prove fatal.
The president can take a page from the How to Win Bipartisan Support By Playing Hardball With Your Opponents playbook used so effectively by FDR, LBJ, and Ronald Reagan. Or he can go along with the preemptive surrender strategy favored by Senate Democrats: negotiate against yourself, water down what you know is right, earn your bipartisanship merit badge... and get absolutely nothing in return.

What do we need health insurers for anyway?

Los Angeles Times
February 28, 2010
What do we need health insurers for anyway?
By Michael Hiltzik

(Before a congressional subcommittee, WellPoint's chief executive Angela)
Braly was forced to make an implicit admission that her industry almost
never makes explicitly: The nation's health coverage system is so hopelessly
broken that even the health insurance industry can't handle it anymore.

Her testimony, and other statements she and other WellPoint executives have
made, suggests that insurers can't profitably manage through periods of high
unemployment. They can't price policies in a way that keeps healthy young
people in the same pool as older people, producing a mockery of the very
point of indemnity insurance. Despite a decade of unobstructed
consolidation, which was sold to regulators as a way to control healthcare
costs by creating mega-insurers like hers, her industry can't control
healthcare costs.

Braly's words are a reminder of the most important unasked question in the
entire healthcare debate: What do we need insurance companies for, anyway?

The only way insurers can remain profitable at all is by selling healthy
people on policies that don't offer much coverage at all, while squeezing
older, less healthy people remorselessly so they either pay for most of
their care out of pocket or get priced out of the insurance market
completely (thus becoming a burden for taxpayers).

Braly in her testimony assured the subcommittee that even with the latest
California rate increases, "a 40-year-old woman in Los Angeles can obtain
coverage with a $1,500 deductible for as low as $156 per month."

She didn't specify what kind of coverage. So let's check out what her
company offers. Leaving aside whether that 40-year-old woman might have a
preexisting condition that would drive up her premium or make her
uninsurable -- anything from diabetes to a history of hay fever -- the
insurer's California package with a $1,500 deductible requires the customer
to pay up to 70% of the cost of "covered services," including routine
mammograms and Pap tests, plus as much as $500 a day for hospital stays.

Maternity isn't covered at all, so our 40-year-old Angelena better have
gotten her lifetime childbearing out of the way before picking up the phone
to sign up.

"Our plans fit the way you live," the CoreGuard brochure says. What it
really means is: You better fit the plan, or you're out of luck.

Shouldn't that have been on the agenda at the Washington summit?,0,1011707.column


Anthem Blue Cross
Our plans fit your plans

Anthem Blue Cross CoreGuard Benefits for California

Deductible: choices of $750 to $20,000 (with a second deductible for
Out-of-Network services)

Coinsurance (In-Network): 50%
Coinsurance (Out-of-Network): 70%

Inpatient Services (In-Network): 50% Coinsurance plus $500 Copay per day (3
Inpatient Services (Out-of-Network): 70% Coinsurance plus $500 Copay per day
(3 days)

Comment:  When WellPoint's CEO Angela Braly boasts that a 40 year old woman
can purchase $1,500 deductible coverage from them for only $156 per month,
it's important to see how they define that coverage.

Although Angela Braly didn't state which $1,500 deductible plan has a
premium "as low as $156," let's look at the Anthem Blue Cross $1,500
deductible CoreGuard plan as an example. Under that coverage, a 40 year old
woman would have to pay twelve monthly premiums, the first $1,500 of
In-Network care, the first $1,500 of Out-of-Network care, one-half of
allowed In-Network charges after the deductible (coinsurance), 70% of
allowed Out-of-Network charges after the second
deductible (coinsurance) (Anthem Blue Cross paying only 30% of allowed
charges!), an additional $500 per day for up to three days for
hospitalization (a copayment on top of the coinsurance!), all maternity care
(Anthem Blue Cross paying nothing!), and... well... you get it.

When Anthem Blue Cross promotes this product as a $1,500 deductible plan,
they are being so deceptive that it is dishonest. They call these "look
alike plans" - it looks like a $1,500 deductible plan, but it isn't. The
patient is paying most of the health care costs while Anthem Blue Cross
pretends that this is insurance.

The more sophisticated insurance purchaser might look at this plan and
recognize that it is almost worthless except that it has an out-of-pocket
maximum of $3,500 for the year. So maybe it is worth the premium as a
catastrophic plan, limiting losses to $3,500. But look closer. The fine
print excludes the deductible from counting towards the out-of-pocket costs,
so it is really $5,000, but only for In-Network services. Another $9,000
($7,500 plus $1,500 deductible) has to be paid for Out-of-Network services
as well. So the exposure is the total of monthly premiums, the In-Network
$5,000, the Out-of-Network $9,000, all Out-of-Network costs in excess of the
allowable charges, and any services, such as maternity care, that are not a
benefit of the plan. This is another one of those
you're-covered-if-you-don't-get-sick plans.

To show how ridiculous this can be, using the same benefit guide (link
above) for a family with a $10,000 deductible plan, the out-of-pocket
maximum looks like it is $7,000, but it is actually $17,000 for In-Network
services ($7,000 plus $10,000 deductible), plus $25,000 for Out-of-Network
($15,000 plus $10,000 deductible). In addition to this $42,000, the family
must pay monthly premiums, all Out-of-Network costs in excess of the
allowable charges, and any services that are not a benefit of the plan (no
maternity benefits for a young family!).

Angela Braly admits that WellPoint, the largest mega-insurer in the nation
in terms of enrollees, cannot control health care costs, and neither can the
rest of their industry. Their solution to keeping premiums affordable is to
shift more of the health care costs to the individuals and families who need
care, defeating the purpose of risk pooling.

Michael Hiltzik has asked the right question: What do we need insurance
companies for, anyway?