PCM commented on the diary post Over Easy: Massachusetts OIG concludes Annie Dookhan acted alone by Crane-Station.
¡Hola! Crane-Station: To make browsing easier on the eyes, try using one of these browser extensions: Evernote Clearly or Readability. They do their best to strip out unnecessary marginalia and display only the main text (and inline images, and sometimes comments) in a larger font — with wider margins and a more restful background, depending on how you [...]
PCM commented on the blog post Cannot stop kicking a poor person and succumb to good policy
I repatriated from France over 30 years ago, and the near-complete absence of mandatory worker rights, benefits, and protections in this country still leaves me slack-jawed. I gather the theory is that individual workers, in a “free market,” are able to bargain for the benefits they really want and need. And that, I suppose, is why American software workers work fifty- and sixty-hour weeks without overtime pay or comp time and frequently have to forgo taking the full amount of their measly vacation time (often without comp pay) — that is, if they don’t want to be first in line to be fired “at will.” And obviously, food-handling workers at grocery stores, restaurants, and fast-food chains have even less bargaining power than six-figure software workers.
For what it’s worth, Germany instituted mandatory sick pay for many workers in … 1883. Now, virtually all German workers get it. Ditto for French workers.
PCM commented on the blog post Annapolis Police Chief Cites Parody Story About Marijuana Overdoses in Testimony
This is almost as good as the Republican state legislator who railed against Planned Parenthood’s new $8 billion Abortionplex in Topeka, Kansas.
Thank goodness we have a diverse, vigorously adversarial press whose sources and journalists are never prosecuted, intimidated, or co-opted by the State; an educated, well-informed citizenry that isn’t too preoccupied with economic survival to monitor and engage with its own government; a democratically representative Congress that exercises its oversight powers in the people’s best interests; and a federal judiciary committed to protecting civil liberties. Because otherwise, those jingling, shiny keys might actually succeed in distracting everyone.
er, I mean,
Kiriakou is educated, articulate, and well represented, and he has a vocal, articulate support base. He has been able to keep his case in the public spotlight. Imagine what jailers get away with when they retaliate against prisoners who don’t have these advantages.
[N]o one in the George W. Bush “administration” was even brought up on charges for the willful and malicious revelation of the covert op CIA identity of Joe Wilson’s wife.
Scooter Libby was sentenced to 30 months in prison and a $250,000 fine for obstructing the investigation into Valerie Plame’s outing. Dubya commuted the prison term, and I have no doubt that the unindicted perpetrators and co-conspirators Libby was shielding have since steered enough business his way to more than cushion the blow of the fine. But, hey! He still had to do probation!
For whatever reason, I’m recalling a line from John le Carré’s A Perfect Spy to the effect that the only decent diplomat is a deaf Trappist…
PCM commented on the blog post Dems Bank on the Lesser of Two Evils Strategy for Health Care
And again, by calling Democrats the world’s oldest political party, you bring a smile to my lips as I conflate it with the world’s oldest profession. And it’s just so perfectly apt in the case of the ACA…
PCM commented on the blog post ‘Why Have You Gone to Russia Two Times in Three Months?’—Heathrow Customs Agent Interrogates Snowden Lawyer
Look, I don’t know why Jesselyn Raddack chose to transit through the UK rather than through another country whose government is less hostile to freedom of the press, democratic accountability, and the right to counsel. Maybe it was cheaper. Maybe it was more convenient. And maybe it was for the same reason Glenn Greenwald is thinking of returning to the United States: to give an imperious government more rope to hang itself with, in the court of public opinion as well as in courts of law. If the last, she scored a modest success. Unlike David Miranda’s detention and dispossession, the harassment and intimidation she suffered probably did not rise to the level of independently actionable violations of the European Convention on Human Rights, but they do help establish a pattern of goonish behavior toward dissident journalists and lawyers on Britain’s part.
But while I don’t know for sure why Jesselyn chose to pogo-stick through the lion’s den, I am reasonably certain that the commenters attempting to denigrate her for being naïve or incompetent are trolls, sock puppets, and/or spies working for “national security” interests.* Given her personal experience as a persecuted whistleblower, her professional experience as a whistleblower attorney generally, and her representation of Edward Snowden specifically, I am sure she is entirely aware of how thoroughly she is being monitored and entirely aware of what precautions to take. Besides, anyone who has ever heard her speak at any length would dismiss those laughable smears out of hand.
*For a partial guide to their tactics, do visit the link CTuttle provided @ 45. You can find Part 3, Eight Traits of the Disinformationalist, here. You can find Part 4, How to Spot a Spy (Cointelpro Agent), here. And you can find Part 5, Seventeen Techniques for Truth Suppression, here. Note: If you have spent much time in online political forums and in meatspace “dissident” groups, you have probably already figured out a good half of it on your own.
I sure hope Minnesota Democrats are different from Washington State Democrats. Democrats have controlled state government in Washington for most of the past 30 years and we still have the most regressive tax system in the country. Washington Democrats can be counted on to be progressive on social wedge issues that the beancounters at Microsoft, Amazon, Boeing, [...]
I have a little more background for you on France’s health insurance system. The system relies on patient co-insurance, with patients generally responsible for 30% of provider charges. (The co-insurance rate is higher for medications deemed less effective and for most specialist consults sought without a GP referral, and lower in a diverse number of circumstances as well as in all of Alsace-Moselle, due to that region’s German history.)
That being said, patient co-insurance is subject to relatively low daily, monthly, and annual caps — an order of magnitude lower than the ACA’s — and most French people still have more-or-less reasonably priced medigap insurance that covers all of most of their share of costs. Moreover, people enrolled in Couverture maladie universelle (CMU)– a Medicaid-like program that in 2000 finally extended insurance coverage to 100% of the population, bringing in illegal immigrants, the homeless, and others who had fallen through the cracks — are exempt not only from co-insurance but also from the additional symbolic 1€ copay.
But more relevant to Anya Schiffrin’s article is that, last I checked, 39 “serious or long-term” conditions were exempt from co-insurance entirely. In other words, French national health insurance picks up 100% of the tab for patients suffering from these conditions … and cancer is among them. Since Anya’s dad was apparently covered by French national health insurance, her family should not have been saddled with any out-of-pockets for her father’s treatment. (I’m not sure on what grounds the 18€ copay for the 45-minute consult with the GP snuck through. Maybe it’s because the patient wasn’t present. But to Americans whose copays for a GP consult routinely exceed a French GP’s entire fee, an 18€ copay seems so inconsequential as to barely be worth mentioning.)
My mother was treated for and died of cancer here in the US. Even with excellent (by US standards) Medigap insurance and, in the last six months, Medicare’s hospice benefit administered by a pretty wonderful hospice team, the level of support my mom and our family received was quite poor compared to the support Anya’s dad got from “plain-vanilla French health insurance.” I’m glad her family got to actually appreciate the time they had left together instead of spending it being amateur home healthcare aides, sifting through piles of bills, and fighting off vultures and leeches.
On another personal note, I’ve lived, worked, received medical care, and even been hospitalized in both France and the United States. I could relate a number of anecdotes contrasting my experience in the two countries — wrangling with a Seattle hospital for three months to get the $30,000 out-of-pocket for a single gamma-knife treatment down to $10,000 would certainly be one of them — but I’ll just share my carefully considered, non-hyperbolic overall conclusion instead: In France, the healthcare system’s primary goal is to provide the best possible care to everyone who needs it at the most reasonable overall cost, at a very affordable cost to the patient, and with the least logistical stress to the patient. In the United States, the primary goal of most healthcare “stakeholders” — insurance companies, pharmaceutical companies, hospitals, diagnostic labs, device makers, ambulance services, nursing homes, and yes, specialist MDs — is to drain as much money as humanly possibly from the most lucrative patients they can sink their claws into. (Off the top of my head, the Veterans Health Administration and community health clinics are the most notable exceptions to this broad assessment.)
In this connection, several years ago, before I “cut the cord,” I caught an episode of David Letterman where he was telling the audience about a retinal detachment he had suffered during a recent vacation in France. He still seemed to be in disbelief when he described how he was admitted to the ER without a wallet biopsy, transferred to Opthalmology within 20 minutes, and got his retina lasered back into place by a young specialist shortly after that. But most of all, he was stunned by the bill, which he said was around $120 [since he didn't have French insurance] … and that they didn’t seem to care whether he paid it or not. [When foreigners incur hospital bills below a certain threshold, French hospitals don't bother trying to collect them -- at least not back then.] I don’t remember exactly how he concluded the story, but I think he just shook his head and said that the French seemed to be doing something right. I’d like to think he reached the same conclusion I have but knew there was no way he could say it out loud on American commercial TV.
PCM commented on the diary post Thomas Friedman Escaped and Is Writing About Economics Again by Dean Baker.
Please tell me that Friedman talked to a taxi driver and had lunch at a restaurant as part of his investigative process.
In my opinion, the biggest threat to France’s healthcare system is the emergence of balance-billing. I’m too lazy to do something from scratch, so I’ll just copy and paste an email I sent to a state PNHP board member a couple of years ago. The only update I can provide is that President Hollande did in fact endorse something like the secteur optionnel compromise. Anyway, here you go:
It seems that more and more French specialist MDs, especially new ones, are charging fees well above standard national health insurance rates:
“Développement excessif” des honoraires libres chez les médecins spécialistes – LeMonde.fr
Hôpitaux publics : une enquête dénonce l’ampleur des dépassements d’honoraires – LeMonde.fr
From what I understand — and I’m not 100% clear on the details — it used to be that French doctors could either be conventionné (under contract with national health insurance) or non conventionné (not under contract). Contract doctors could not charge more than standard rates and national health insurance would cover their bills. Non-contract doctors could charge whatever rates they wished and national health insurance would not cover their bills.
Since 1980 (under a right-wing government), however, there have been two subsets of contract doctors: secteur 1 doctors, who bill out at standard rates, and secteur 2 doctors, who can bill whatever they want but get national health coverage at standard rates. The purpose of this move was to increase physician incomes without raising national health insurance system costs — in other words it offloaded the costs onto patients. Because of the predictable surge in patient out-of-pockets and the difficulty of finding doctors who would accept standard rates, new secteur 2 contracts were limited to specialists with special qualifications starting in 1990 (under a left-wing government). In certain specialties and cities, however, the number of secteur 2 physicians has once again soared to the point that GPs are having trouble finding secteur 1 specialists to refer their patients to.
In a 2009 reform effort, politicians chickened out of challenging secteur 2 head on. Instead, there have been talks among the national insurance system, the doctors’ unions, and private medigap insurers on setting up a third category of contract physicians between the first two, the secteur optionnel. The proposal thus far is that secteur optionnel physicians would have to bill 30% of their procedures at standard rates and that the rates for the balance of their procedures could not exceed standard rates by more than 50%.
The bottom line of all of these developments is that they decrease national health insurance coverage and cost control and increase patient exposure to significant out-of-pocket costs. It is also creating a two-tiered system, with delays for secteur 1 patients and prompt service for secteur 2 patients. This appears to be consistent with Nicolas Sarkozy’s desire to increase the role of private medigap insurers — the largest of which is headed by his brother Guillaume — in France’s healthcare financing system. It’s a regressive development that, if left unchecked, I suspect will lead to declining average outcomes and more unequal outcomes.
In the meantime, the national insurance fund is supposedly investigating 250 cases of unusually high fees, which it plans to refer to the French Medical Board for disciplinary hearings. The fund itself is also planning to set up standards and mechanisms for reducing or eliminating coverage for physicians who charge excessively high fees:
L’assurance maladie propose de sanctionner les dépassements excessifs – LeMonde.fr
The tail end of the email is kind of obiter dicta, but I’ll throw it in in case anyone’s interested:
In other developments, the pilot program of best-practices-based incentive payments for GPs was a success and it has been extended to all physicians. Fewer than 1% have opted out. (This is not surprising, since it can net participants up to ~$12,000 extra per year, whatever qualms they may have about the system’s crude measures. For now at least, participants don’t give up any of their existing fee-for-service income by remaining in.) In the longer term, both major political parties claim to favor ultimately replacing the insurance system’s current fee-for-service model with a payment method based on multiple factors, including procedures, capitation, and outcomes. As always, the devil will be in the details.
Les médecins se convertissent au paiement à la performance – LeMonde.fr
PCM commented on the diary post French Fries and Freedom Ticklers: America Loves France Again! by JP Sottile.
You’re only saying that because you don’t understand what Hollande is really up to. He’s actually playing eleven-dimensional pétanque. ;-)
Nice one. (Well, it was new to me.)
Oh, and also, “Suck it, Haiti!”
PCM commented on the blog post Another Reminder Why the Filibuster Needs to Be Eliminated
When the Democratic Senate majority eliminated the filibuster for appointment confirmations (other than for the Supreme Court) in the middle of the 113th (current) Congress, it confirmed that it could have eliminated the filibuster for anything and everything at any point in the last five years. Every time a Democrat attempts to point at Senate Republicans for abusing the filibuster and obstructing some purported Democratic agenda, you should be paying closer attention to the three fingers pointing back at Senate Democrats.
Serious, important people don’t seem to pay any attention to CBO studies, either.
The CBO has projected that under the ACA, the percentage of GDP devoted to healthcare would increase from 18% to over 20% by 2019, while leaving 30 to 31 million entirely uninsured and many tens of millions badly underinsured with bronze and silver plans. Until quite recently, Switzerland was estimated to be the second most “medically expensive” country in the world,* spending just under 12% of GDP on healthcare while providing virtually 100% of the population with silver-plus insurance. If we apply the percentage-point difference between Swiss and US healthcare spending to US GDP, we can estimate that under Obamacare, the monopoly profit the US for-profit health sector is gouging from Americans will rise from around $880 billion a year to just under $1.2 trillion a year.** And yet, serious, important people are still crowing about how Obamacare is going to “bend the cost curve.”
But the CBO’s projections are not the only ones being ignored. Last summer, economist Gerald Friedman of UMass-Amherst released a funding study of HR 676, Expanded and Improved Medicare for All. HR 676 would provide platinum-plus coverage with a universal provider network to every man, woman, and child in the US. Under it, Friedman projected that 95% of Americans would spend less money on healthcare than we do now and that the country would save around half a trillion dollars a year in the aggregate from the outset. But not even the Congressional Progressive Caucus paid attention to it. I think they’re too busy trying to defend their vote for Obamacare as a “step in the right direction.”
*Switzerland has apparently been overtaken in healthcare spending by oil-rich Norway. France and the Netherlands are also now in the same general spending tier as Switzerland. Switzerland, incidentally, is expected to hold a national referendum (probably in 2015) on whether to switch from non-profit multi-payer to public single-payer.
**That extra $290-billion-a-year skim is what Big Health bribed and extorted Congress to deliver, and it didn’t even cost them a penny on the dollar.
PCM commented on the diary post Vicco, Ky, Stays in Spotlight, Endorses Single Payer, HR 676 by Kay Tillow.
This is heartening news. Now all we have to do is to get John Conyers and the rest of the Congressional “Progressive” Caucus — every last one of whom stabbed their supporters in the back by voting for the Patient “Protection” and “Affordable” Care Act — to fight for their own damn bill, which is [...]
PCM commented on the blog post Democratic Establishment Lines Up Behind Hillary Clinton For 2016
How shall I put this? If Hillary is the Democratic nominee in 2016 and the Republican nominee is a genetically engineered hybrid of Augusto Pinochet, Josef Mengele, and Satan who was educated at the University of Chicago and the School of the Americas, a lifelong member of the Atlas and Federalist Societies, and an advocate of abortion clinic bombings, I will still be voting Green or Socialist.
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