McCain’s Medical Plans Make Matters Worse For the Insured and Medicare Patients While Failing To Help The Uninsured

There’s already been a lot of criticism of John McCain’s health care plan around the liberal blogosphere, including these posts from Steve Benen and Ezra Klein. One peculiar thing about McCain’s plans is that he manages to both ignore addressing the real problems of those who have lack affordable coverage and makes things worse for those who do.

McCain does briefly mention the problems of those who cannot obtain affordable insurance in the individual market but offers no real solutions. This is where the most serious problems arise. There are certainly problems which need to be addressed for those who receive coverage through employers, but those having the most serious problem are those who have to buy insurance on their own, especially if they are older or have illnesses which the insurance companies would prefer to avoid covering. Not only does McCain fail to address these problems, but he wants to throw even more people into the individual market by taking away employer supplied health care. The tax breaks he offers to individuals will hardly replace their coverage, or allow those without coverage to be able to afford it.

Not only does McCain’s plan manage to make matters worse for those with employer-paid insurance, but he also wants to worsen coverage for those on Medicare. He is very vague but whenever he has spoken about Medicare he describes a plan which sounds like moving from fee for service to a capitated plan. Fee for service is far from perfect as it includes incentives to perform too many procedures if each is paid individually, but as Winston Churchill has described democracy, this is the worst form except the others which have been tried.

Megan McArdle criticized McCain’s plan by writing:

The problem is, it’s heavier on theory than practice. Every health care economist in the country wants to pay for health rather than treatments. The problem is, health is very hard to measure–as David Cutler told me, “Health care and education are the two fields where output is hardest to measure. It’s not surprising that costs in those areas are increasing much faster than inflation.” When output can’t be measured, input will be.

Medical care, like education, is also dependent on inputs from the clients. You will have a frantic political battle from doctors against any proposal that makes their income dependent on how many of their diabetics really give up the corn chips.

Capitated plans which pay a fixed amount per patient as opposed to paying for each procedure have been a disaster. They have had mixed results when dealing with young, healthy patients but have been a failure in dealing with elderly patients. Megan is correct that one problem in payment based upon outcomes is that factors such as noncompliance with medical advice increases the cost. If we must deal with a noncomplaint patient who winds up developing more problems we naturally expect to be paid more for the extra work–not less as under McCain’s plan.

The problem goes beyond matters of compliance. In the Medicare population, elderly patients with chronic medical problems inevitably age and get worse. Or else they die. McCain’s plan encourages health care systems to avoid covering people as they get older and sicker, or to allow them to die. Naturally doctors who would prefer to treat sick patients tend to feel uncomfortable dealing with such plans–and patients should feel even more uncomfortable with such a system.

Changing Medicare in such a way would also greatly exacerbate the problem of a shortage of primary care physicians. Capitated plans typically pay primary care doctors a set fee per patient but are more often forced to pay specialists, who often are not involved in the case on a continuing basis, on a fee for service basis. Such a change in Medicare will make doctors even more reluctant to practice primary care. Instead they would prefer to be the cardiac surgeon who is still paid well for doing the bypass surgeries for the patients who require heart surgery because they could not afford or find sufficient primary care and preventative services.

Democrats who have proposed changes in health care have often faced scare tactics from the right. As the vast majority of people, rightly or wrongly, are happy with their insurance coverage, it has been effective to make people fear that change means losing what they now have. McCain’s horrible health care ideas provide an opening for Democrats to now win this debate as it is McCain who proposes making things worse for those who now have employer-paid insurance or Medicare.

Creationist Claims Science Kills People

The Anti-Defamation League has issued a statement condemning the creationist movie Expelled:

New York, NY, April 29, 2008 … The Anti-Defamation League (ADL) today issued the following statement regarding the controversial film Expelled: No Intelligence Allowed.

The film Expelled: No Intelligence Allowed misappropriates the Holocaust and its imagery as a part of its political effort to discredit the scientific community which rejects so-called intelligent design theory.

Hitler did not need Darwin to devise his heinous plan to exterminate the Jewish people and Darwin and evolutionary theory cannot explain Hitler’s genocidal madness.

Using the Holocaust in order to tarnish those who promote the theory of evolution is outrageous and trivializes the complex factors that led to the mass extermination of European Jewry.

John Derbyshire provides an example of what those behind this movie are claiming:

In an interview with the Trinity Broadcasting Network, Ben Stein said the following amazing thing in an interview with Paul Crouch, Jr.

Stein: When we just saw that man, I think it was Mr. Myers [i.e. biologist P.Z. Myers], talking about how great scientists were, I was thinking to myself the last time any of my relatives saw scientists telling them what to do they were telling them to go to the showers to get gassed … that was horrifying beyond words, and that’s where science — in my opinion, this is just an opinion — that’s where science leads you.

Crouch: That’s right.

Stein: …Love of God and compassion and empathy leads you to a very glorious place, and science leads you to killing people.

Crouch: Good word, good word.You can see the whole shameful thing here. It’s a pity Crouch didn’t invite the Rev. Jeremiah Wright into the studio for a three-way conversation. It would have elevated the tone.

I also recently quoted Derbyshire’s comments on Expelled here. P.Z. Myers presents this video in response to Stein’s view that “science leads to killing people.”


Obama Takes Lead in New Jersey Poll

Barack Obama lost to Hillary Clinton by ten points in the New Jersey primary, but since then support has shifted towards Obama. A Monmouth University/Gannett New Jersey poll shows Obama now leading by seven points.

This doesn’t change the results of the primary but it does counter the idea that momentum has shifted towards Clinton. This also seriously undermines Clinton’s big state argument by which she claims to be more electable due to having won the primaries in several large blue states. This helps demonstrate that having lost to Clinton in a primary does not mean Obama cannot become successful in the state. The poll also shows that both Obama and Clinton would beat John McCain.

Why Obama Joined Trinity

Obama’s decision to join Wright’s church has turned into a political problem. Norm Scheiber looks at why Obama probably did join this church as opposed to other, more conservative churches in the area. He quotes from David Mendell’s biography of Barack Obama:

Wright remains a maverick among Chicago’s vast assortment of black preachers. He will question Scripture when he feels it forsakes common sense; he is an ardent foe of mandatory school prayer; and he is a staunch advocate for homosexual rights, which is almost unheard-of among African-American ministers. Gay and lesbian couples, with hands clasped, can be spotted in Trinity’s pews each Sunday. Even if some blacks consider Wright’s church serving only the bourgeois set, his ministry attracts a broad cross section of Chicago’s black community. Obama first noticed the church because Wright had placed a “Free Africa” sign out front to protest continuing apartheid. The liberal, Columbia-educated Obama was attracted to Wright’s cerebral and inclusive nature, as opposed to the more socially conservative and less educated ministers around Chicago. Wright developed into a counselor and mentor to Obama as Obama sought to understand the power of Christianity in the lives of black Americans, and as he grappled with the complex vagaries of Chicago’s black political scene. “Trying to hold a conversation with a guy like Barack, and him trying to hold a conversation with some ministers, it’s like you are dating someone and she wants to talk to you about Rosie and what she saw on Oprah, and that’s it,” Wright explained. “But here I was, able to stay with him lockstep as we moved from topic to topic. . . . He felt comfortable asking me questions that were postmodern, post-Enlightenment and that college-educated and graduate school-trained people wrestle with when it comes to the faith. We talked about race and politics. I was not threatened by those questions.” …

But more than that, Trinity’s less doctrinal approach to the Bible intrigued and attracted Obama. “Faith to him is how he sees the human condition,” Wright said. “Faith to him is not . . . litmus test, mouth-spouting, quoting Scripture. It’s what you do with your life, how you live your life. That’s far more important than beating someone over the head with Scripture that says women shouldn’t wear pants or if you drink, you’re going to hell. That’s just not who Barack is.”

Scheiber concludes:

So, if you buy Wright’s account–and it rings pretty true to me–it was his intellectualism and social progressivism that won Obama over. Certainly it’s hard to imagine that someone like Obama, who came from a progressive, secular background, would have felt genuinely comfortable in a socially conservative, anti-intellectual church. The problem for Obama is that the flip-side of these virtues was a minister with a radical worldview and a penchant for advertising it loudly.

Obama’s decision to join the church had nothing to do with Wright’s more controversial views, regardless of which sermons Obama actually heard. The radical views expressed by Wright have nothing to do with Obama’s views or how he would govern and should not be a factor in the election.

Indiana Independents and Republicans May Decide Primary

The Howey-Gauge Poll suggests that the Indiana Democratic primary will be decided by independents and Republicans as Democrats are evenly split, with independents favoring Obama and Republicans backing Clinton:

There appears to be two kinds of Republicans: the “Obamacans” as the Illinois senator likes to call them – earnest Republicans deeply disappointed in their own party’s performance on the budget, economy, social issues and the Iraq War – and the Rush Limbaugh Republicans who are planning to crossover to vote for Sen. Clinton because they perceive her to be the weakest rival to U.S. Sen. John McCain in the November election.

Howey-Gauge shows that self-identified Republicans favor Clinton 50-44 percent, while independents favor Obama 54-38 percent. “The Democratic primary is going to be decided by non-Democrats,” said Gauge Market Research pollster Holly Davis. “To be determined is which group – Republicans or independents – are going to decide this race.” An indicator as to the kind of havoc Republican voters could create comes on the Iraq War issue. Those favoring immediate withdrawal favor Obama 49-46 percent. Those favoring the current troop levels favor Clinton 58-39 percent, but, Davis notes, “That number is strongly influenced by Republican crossovers.”

Clinton Appearing On The O’Reilly Factor

Hillary Clinton will be appearing on The O’Reilly Factor show tomorrow night. Just as Obama handled his appearance on Fox News Sunday as a regular interview, Clinton does not intend to “take on” Bill O’Reilly. Of course if she did, O’Reilly wouldn’t stand a chance. Remember what Terry Gross did to him when O’Reilly was a guest on Fresh Air?

There was a lot of criticism of Barack Obama for appearing on Fox News Sunday and Move On, which also criticized Obama, has already issued a statement criticizing Clinton:

With no plan to call out Fox’s Republican agenda, Senator Clinton’s appearance on ‘The O’Reilly Factor’ does nothing more than legitimize a network that will then use that credibility to smear Democrats and progressive ideas in 2008. She’s pandering to a small audience that is not persuadable.

Right now the major priority for each candidate is attracting votes and, as much as we might like them to, neither candidate is currently concerned with taking on Fox. As long as they have a sizable audience the candidates will appear. I am happy that the Democrats refused to hold a debate on Fox but I never had any illusions that they would continue to remain off of Fox for the entire campaign.

It might have made more sense for Obama to appear with Chris Wallace, who has criticized some of the excesses at his own network, as opposed to Clinton appearing on O’Reilly’s show. Despite his usual conduct on his show O’Reilly actually did conduct some good interviews with John Kerry in the past, so it is understandable that Clinton would go. Besides, viewers with limited education who have no qualms about compromising liberal positions on social issues and civil liberties sure sound a lot like Hillary Clinton’s base.

The interview might be interesting. I’ll watch, but will also make a latte to drink while watching as an act of protest.

Obama Repudiates Wright


It probably didn’t come as a surprise to anyone that Obama acted to further distance himself from Wright  today (video above) following Wright’s recent public statements.  Ben Smith has posted the following quotes from Obama’s press conference:

“I have spent my entire adult life trying to bridge the gap between different kinds of people. That’s in my DNA, trying to promote mutual understanding to insist that we all share common hopes and common dreams as Americans and as human beings. That’s who I am, that’s what I believe, and that’s what this campaign has been about,” Obama said.

“I am outraged by the comments that were made and saddened by the spectacle that we saw yesterday,” he said.

“The person that I saw yesterday was not the person that I met 20 years ago,” he said. “His comments were not only divisive and destructive, but I believe that they end up giving comfort to those who prey on hate, and I believe that they do not portray accurately the perspective of the black church.”

“They certainly don’t portray accurately my values and beliefs,” he said.

“If Reverend Wright thinks that’s political posturing, as he put it, then he doesn’t know me very well and based on his remarks yesterday, I may not know him as well as I thought either.”

“I gave him the benefit of the doubt in my speech in Philadelphia, explaining that he has done enormous good in the church,” he said. “But when he states and then amplifies such ridiculous propositions as the U.S. government somehow being involved in AIDS; when he suggests that Minister Farrakhan somehow represents one of the greatest voices of the 20th and 21st century; when he equates the U.S. wartime efforts with terrorism – then there are no exuses. They offend me. They rightly offend all Americans. And they should be denounced, and that’s what I’m doing very clearly and unequivocally here today.”

“It is antithetical to my campaign. It is antithetical to what I’m about. It is not what I think America stands for,” he said.

At least it is fortunate that this is happening in April and not in October. The election is about Barack Obama and his views, not about Rev. Wright, but there is no doubt that this could be damaging to Obama’s campaign. Hopefully by distancing himself from Wright in this manner now this story will be ancient history by November.

Disney Risks New Scandal From Revealing Pictures

Disney is once again facing a potential scandal over one of their starlets posing in a revealing picture. Miley Cyrus (Hannah Montana) posed with a sheet covering her topless chest for Vanity Fair (above). The picture, taken by Annie Leibovitz, was not seen as a problem when taken but is now raising concern due to the young age of the audience for Hannah Montana.

It is doubtful that this single picture, which is rather tame, will have a significant effect. While they are bound to be more careful with a star which is aimed at the 6 to 14 year old audience, Disney has faced far more serious cases of their female stars having revealing pictures taken. Last September pictures of High School Musical star Vanessa Hudgens with full frontal nudity wound up on line. Not to be left out, her High School Musical rival Ashley Tisdale (below) has also had a some less revealing but still not standard Disney “nipple-slip” pictures appear on line.

These cases are trivial compared to the two most prominent sleazy former Disney starlets. Former Mouseketeer Britney Spears and Lindsay Lohan, who has appeared in Disney movies such as the remakes of Parent Trap and Freaky Friday, have been photographed in manners which guarantee a permanent exile from the Magic Kingdom. Incidentally, Britney will be returning to How I Met Your Mother on May 12, presumably to once again be upstaged by Sarah Chalke.

Creationists vs. Western Civilization

John Derbyshire of National Review wrote this column on Expelled which is highly critical of the creationist/intelligent design movement. For example, he wrote:

When talking about the creationists to people who don’t follow these controversies closely, I have found that the hardest thing to get across is the shifty, low-cunning aspect of the whole modern creationist enterprise. Individual creationists can be very nice people, though they get nicer the further away they are from the full-time core enterprise of modern creationism at the Discovery Institute. The enterprise as a whole, however, really doesn’t smell good. You notice this when you’re around it a lot.

Derbyshire goes on to give examples, as well as recommending the Expelled Exposed website from the National Center for Science Education. Derbyshire sees this attack on evolution as an attack on our culture and Western civilization:

The “intelligent design” hoax is not merely non-science, nor even merely anti-science; it is anti-civilization. It is an appeal to barbarism, to the sensibilities of those Apaches, made by people who lack the imaginative power to know the horrors of true barbarism. (A thing that cannot be said of Darwin. See Chapter X of Voyage of the Beagle.)

And yes: When our greatest achievements are blamed for our greatest moral failures, that is a blood libel against Western civilization itself. What next, Ben? Johann Sebastian Bach ran a slave-trading enterprise on the side? Kepler started the Thirty Years War? Tolstoy instigated the Kishinev Pogrom? Dante was a bag-man for the Golden Horde? Why not go smash a few windows in Chartres Cathedral, Ben? Break wind in a chamber-music concert? Splash some red paint around in the Uffizi? Which other of our civilizational achievements would you like to sneer at? What else from what Waugh called “the work of centuries” would you like to “abandon … for sentimental qualms”? You call yourself a conservative? Feugh!

For shame, Ben Stein, for shame. Stand up for your civilization, man! and all its glories. The barbarians are at the gate, as they always have been. Come man the defenses with us, leaving the liars and fools to their lies and folly.

Not surprisingly many right wingers have been attacking Derbyshire over this. He responded at The Corner:

What I am doing is, heaping well-justified abuse on the heads of people who, for “sentimental qualms” and from a position of ignorance, trash scientific method, the greatest achievement of our civilization.

And uniquely of our civilization. A mature scientific theory is as much a glory of our civilization as is a cathedral or a university; and it is uniquely of ours. Other civilizations had temples, universities, systems of government, literature, philosophy; but only we of the West came up with scientific method, and the whole world owes the innumerable fruits of that method to us.

I am a huge fan of Western civilization. Thus, when people — well-educated people, who ought to set an example for the general — sneer at and spit on these majestic creations of the human intellect, I get mad. They are taking sides with barbarism. They ought to be ashamed of themselves. Ben Stein ought to be ashamed of himself. And no, I won’t sit through his wretched movie.

Derbyshire got it right in seeing that intelligent design is not an alternative science as the creationists claim. It is an attack on the scientific method, an attack on reason, and yes, an attack on Western civilization. Creationists are the ultimate reactionaries who would return us to the mindset of the dark ages. I noted this previously in this post which responds to a conservative who provided a good example of this mindset when he claimed, “We have reached the end of the Age of Science.” Fortunately there are conservatives such as Derbyshire as well as liberals who are willing to defend science and reason against the attacks from the religious right.

Obama Wins Superdelegate and Takes Lead in Senate Endorsements

Earlier in the race it was about delegates. Currently the Clinton campaign stresses the popular vote. At one time Hillary even jokingly suggested gong by bowling scores. Although the Clinton campaign changes the metric by which they claim Clinton should get the nomination there’s one measure which they won’t be using for now–endorsements from their fellow Senators. The endorsement today by New Mexico Senator Jeff Bingaman now gives Obama the lead (14 to 13) over Clinton.  In endorsing Obama Bingaman wrote:

Our nation faces a daunting number of critical challenges: reasserting America’s leadership in the world, meeting our needs for energy independence, addressing global warming, making healthcare accessible and affordable, positioning our economy to effectively compete globally, and extricating ourselves from the war in Iraq, to name a few.

To make progress, we must rise above the partisanship and the issues that divide us to find common ground. We must move the country in a dramatically new direction.

I strongly believe Barack Obama is best positioned to lead the nation in that new direction.

The race for Senate endorsements will continue as eighteen Senators still have not made an endorsement. The endorsements to date are under the fold.