National Championship Game Under Way


I can tell that the BCS National Championship Game between Florida and Oklahoma is underway. I know this by looking at the site meter. Lately whenever Tim Tebow is in a big game the number of hits jumps tremendously on this post from last year about Florida quarterback Tim Tebow winning the Heisman Trophy.

Most of the hits come from searches due to Tim Tebow being pictured with a girl then rumored to be his girl friend. As there is so much interest in her among college football fans, I have posted a new picture of her above. (Or at least a girl which people have claimed is the same girl. Some have actually looked at their faces and and argue that instead of being the same girl it is actually model Lucy Pinder.)

Go Gators! I have no stake in this game, other than perhaps bragging that before Michigan collapsed they did beat Florida in the Capital One Bowl last year. Therefore I might as well root for Florida as a good game by Tebow will result in increased traffic to the blog.

Update: Florida wins 24-14.

PUMA vs. Wingnut


During the election campaign I often described many of the Clintonitas as being just another wing of conservatism. They might have disagreed on some issues, but they showed the same mindset. Doug and John at Balloon Juice seem to have also caught on to this. They are starting a new feature at the blog, PUMA versus Wingnut:

Compare a really stupid statement/post from wingnuttia with a really stupid one from the PUMAsphere, then debate which is stupider.

Sarah Palin Is Wrong About Caroline Kennedy, You Know


I hope Tina Fey agrees to return to Saturday Night Live to satirize the latest interview (video above) given by Sarah Palin. Besides trying to shift the blame for her own failings to Fey and Katie Couric, Palin tries to drag Caroline Kennedy into this:

Gov. Sarah Palin (R-Alaska) believes Caroline Kennedy is getting softer press treatment in her pursuit of the New York Senate seat than Palin did as the GOP vice presidential nominee because of Kennedy’s social class.

“I’ve been interested to see how Caroline Kennedy will be handled and if she will be handled with kid gloves or if she will be under such a microscope,” Palin told conservative filmmaker John Ziegler during an interview Monday for his upcoming documentary film, “How Obama Got Elected.” Excerpts from the interview were posted on YouTube Wednesday evening.

“It’s going to be interesting to see how that plays out and I think that as we watch that we will perhaps be able to prove that there is a class issue here also that was such a factor in the scrutiny of my candidacy versus, say, the scrutiny of what her candidacy may be.”

Class issue? Class has nothing to do with it. Nobody cares about the class differences. If anything, being upper class might subject Kennedy to more scrutiny than someone in the upper middle class such as Palin. Her problems came about because of her lack of thought about the issues and inability to answer questions, not her socio-economic class.

Besides Caroline Kennedy hasn’t exactly been receiving very good press. Reviews of her interview with The New York Times were hardly favorable. The press has been full of stories counting how often she says “you know.”

There are also tremendous differences between the two cases. Kennedy is hoping to be appointed Senator while Sarah Palin hoped to be one heartbeat away from the presidency. The standards for VP are much greater than for a Senator. Nobody cared that Dan Quayle was an intellectual lightweight until he went from the Senate to become vice president. We don’t worry that one day a Senator will be handed the nuclear football.

Caroline Kennedy has been underwhelming in her public appearances but she still comes out far ahead of Sarah Palin in terms of essential knowledge. Kennedy has written books on privacy rights and the Bill of Rights. Sarah Palin has shown that she doesn’t even understand what the First Amendment means.

Palin is simply showing that, despite her other limitations,  she has learned the first rule of conservative argument: when all the facts are against you, ignore the facts and just start attacking other people.

The Lessons of Medicaid vs. Medicare

Health care reimbursement is so complicated that not many really understand it. Many people do not understand the differences between Medicare (a federal program which covers the elderly and disabled) and Medicaid (a combined state and federal program which covers the poor, including acting as a secondary insurance for the elderly poor). Some of those who are aware of this don’t realize the tremendous differences between the two programs, leading to poor suggestions for expanding health care coverage such as expanding Medicaid to more people.

It is good to see a blog post from someone who does realize the fundamental problem with Medicaid. In linking to an article at The Wall Street Journal, Megan McArdle writes:

In the Wall Street Journal, Scott Gottlieb of AEI excoriates Medicaid’s wacky reimbursement strategy, which seemingly consists of lowballing everything until the only people who will accept Medicaid patients are Medicaid mills that make up the deficits through fraud.

There is a little hyperbole here but Megan basically understands the system. I won’t say that every physician who takes Medicaid is practicing fraud. Some doctors are willing to lose money, and some are such poor businessmen that they don’t realize how much they are losing. Megan is essentially correct as the options for those who accept Medicaid are to lose money or to commit fraud to make it worth their time and cover the overhead. As a  consequence of these equally unacceptable options, the article Megan cites demonstrates how this results in poorer outcomes for Medicaid patients:

Accumulating medical data shows that Medicaid recipients’ poor health outcomes aren’t just a function of their underlying medical problems, but a more direct consequence of the program’s shortcomings. Take the treatment of serious heart conditions, which are among the most closely evaluated Medicaid services.

One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50% more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare. The authors suggest this may be a result of poorer long-term, follow-up care. Like other similar studies, this one tried to control for the other social and medical factors that are believed to influence patients’ clinical outcomes.

Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals. Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients. This procedure to open blocked heart arteries has become standard care, with ample evidence showing it improves outcomes.

The same trends can be observed in other diseases. For example, a study of adults with cancer published in the journal Cancer (2005) found that patients on Medicaid were two to three times more likely to die from the disease even after researchers corrected for differences in the location of the tumor and its stage when diagnosed.

This is hardly a rational model for expanding health care. Megan concludes:

It seems to me that there is no good reason for Medicare and Medicaid to be two separate programs.  Housecleaners are surely no less deserving of decent medical care than Palm Beach retirees, yet we arduously separate the two programs so as to lavish extra care on the more affluent class of beneficiaries.  It’s no good saying that the Medicare recipient earned theirs through contributions, because they didn’t–people in the system now are net beneficiaries, not contributors.   It’s just that on average they’re whiter, they speak better English and their subsidized lifestyles are considerably better upholstered.  I’m not sure why any of these entitles them to a better grade of publicly provided healthcare.

Ultimately the disparities between coverage provided to Medicare and Medicaid patients should be eliminated, but I don’t think this is realistic at the moment. Hopefully this will be addressed in any system of universal health care which is ultimately developed. In the mean time, I would also prefer that Medicaid not be used as the solution for the increased number of people recently left without health care coverage.

Gottlieb concludes his op-ed by writing:

The troubling evidence about the quality of Medicaid patients’ services is a cautionary tale for Mr. Obama as he sets about to administer more of our health care inside government agencies. Turning Medicaid around should be the least we demand before turning over more of our private health-care market to similar government management.

While we have Medicaid, along with problems with the VA system which could be used a strong argument against increased government involvement in health care, we also have the opposite with Medicare which often provides better care at a lower price than private insurance. The lesson of Medicaid is not that government cannot be involved in health care, but that it is essential that any government program be done right.

The Bush Administration’s Most Despicable Act

Joe Klein picks out the Bush administration’s one most despicable act:

“This is not the America I know,” President George W. Bush said after the first, horrifying pictures of U.S. troops torturing prisoners at the Abu Ghraib prison in Iraq surfaced in April 2004. The President was not telling the truth. “This” was the America he had authorized on Feb. 7, 2002, when he signed a memorandum stating that the Third Geneva Convention — the one regarding the treatment of enemy prisoners taken in wartime — did not apply to members of al-Qaeda or the Taliban. That signature led directly to the abuses at Abu Ghraib and Guantánamo Bay. It was his single most callous and despicable act. It stands at the heart of the national embarrassment that was his presidency.

The details of the torture that Bush authorized have been dribbling out over the years in books like Jane Mayer’s excellent The Dark Side. But the most definitive official account was released by the Senate Armed Services Committee just before Christmas. Much of the committee’s report remains secret, but a 19-page executive summary was published, and it is infuriating. The story begins with an obscure military training program called Survival Evasion Resistance and Escape (SERE), in which various forms of torture are simulated to prepare U.S. special-ops personnel for the sorts of treatment they might receive if they’re taken prisoner. Incredibly, the Bush Administration decided to have SERE trainers instruct its interrogation teams on how to torture prisoners. (Read “Shell-Shocked at Abu Ghraib?”)

Klein points out that such tactics do not work and considers possible punishment for those who supported such policies:

It would be interesting, just for the fun and justice of it, to subject Rumsfeld to four hours in a stress position — standing stock still with his arms extended, naked, in a cold room after maybe two hours’ sleep. But that’s not going to happen. Indeed, it seems probable that nothing much is going to happen to the Bush Administration officials who perpetrated what many legal scholars consider to be war crimes. “I would say that there’s some theoretical exposure here” to a war-crimes indictment in U.S. federal court, says Gene Fidell, who teaches military justice at Yale Law School. “But I don’t think there’s much public appetite for that sort of action.” There is, I’m told, absolutely no interest on the part of the incoming Obama Administration to pursue indictments against its predecessors. “We’re focused on the future,” said one of the President-elect’s legal advisers. Fidell and others say it is possible, though highly unlikely, that Bush et al. could be arrested overseas — one imagines the Vice President pinched midstream on a fly-fishing trip to Norway — just as Augusto Pinochet, the Chilean dictator, was indicted in Spain and arrested in London for his crimes.

If Barack Obama really wanted to be cagey, he could pardon Bush, Cheney and Rumsfeld for the possible commission of war crimes. Then they’d have to live with official acknowledgment of their ignominy in perpetuity. More likely, Obama will simply make sure — through his excellent team of legal appointees — that no such behavior happens again. Still, there should be some official acknowledgment by the U.S. government that the Bush Administration’s policies were reprehensible, and quite possibly illegal, and that the U.S. is no longer in the torture business. If Obama doesn’t want to make that statement, perhaps we could do it in the form of a Bush Memorial in Washington: a statue of the hooded Abu Ghraib prisoner in cruciform stress position — the real Bush legacy.

If Obama were to pardon Bush, Cheney, and Rumsfeld we would probably see protests reminiscent of when Gerald Ford pardoned Richard Nixon. (I believe I still have one of the Monopoly -style Get out of Jail Free cards offering a free, full, and absolute pardon which were being distributed at the time to mock Ford’s act.) Seeing Klein put it this way, it would be a totally different situation with a totally different effect. Still this would disappoint those who fantasize about Bush, Cheney, and Rumsfeld being brought to justice and raise unnecessary protests against the Obama administration.

Obama Appoints Cass Sunstein To Handle Regulatory Reform

Barack Obama was supported by many independents, along with those who wanted a change from the Republican policies but weren’t necessarily supporters of Democratic orthodoxy, believing that Obama would govern significantly different from Hillary Clinton. While I was not going to judge Obama based upon his appointments before taking office as opposed to by what he does in office, it did raise some concern that so many of his appointees were from the Clinton administration. I continued to have hope that Obama’s policies would still show significant differences, even if he was often forced to rely upon appointees from the only recent Democratic administration. Today’s appointment of Cass Sunstein, author of Nudge: Improving Decisions about Health, Wealth, and Happiness, provides greater hope that the Obama administration really will be listening to different ideas.

Sunstein was appointed to head the Office of Information and Regulatory Affairs, suggesting that we might really see changes in how government regulation is viewed. The Wall Street Journal raises a past interview with Sunstein:

In an interview with The Wall Street Journal last year, Mr. Sunstein said Mr. Obama was intrigued by “law and behavioral economics” as an approach to regulation that would avoid ideological extremes.

Mr. Obama believes in “doing law in a way that’s realistically based on human behavior,” Mr. Sunstein said. “He’s a University of Chicago Democrat, so he’s very attuned to the virtue of free markets and the risks of free-market regulation. He’s not an old-style Democrat who’s excited about regulations” for their own sake.

Mr. Sunstein said the Earned Income Tax Credit, which provides money to the working poor, was “a way of lifting people out of poverty” superior to old-style welfare payments.

I did find it amusing during the campaign when Obama was attacked as being a socialist for suggesting policies along these lines by some conservatives considering that such ideas are variations of the negative income tax initially advocated by Milton Friedman.

Besides the influence on government regulation, the appointment of Cass Sunstein will result in another potential benefit. Sunstein will presumably be bringing his wife, Samantha Power, to Washington. This will be of value should Obama require any reminders that Hillary Clinton is a monster, along with maintaining the Austan-Power influence on the Obama administration.