Night Light

oh, go ahead ...

... and read Michael Bérubé. In fact, read everybody associated with Crooked Timber, for all I care.  Michael has his dominant themes but wanders off-topic and riffs on pretty much everything.  That's the way people expected bloggers to behave in the first place, but the ones I read think they're writing or something.  I'm working on that particular issue myself ...

I once called Michael the Al Jackson, Jr. of blogging, but with all that wandering and riffing I'm thinkin' maybe Elvin Jones.

Jamais Cascio's Open the Future is my favorite "futurist" blog.  Since I'm getting more involved in that world, I always appreciate Jamais' combination of imagination and level-headedness (the latter being in somewhat short supply in that, uh, universe.)

I get some cool NOLA music downloads from Home of the Groove.   It's the place to go for that long-sought-after Prince La La track, and there's good b.g. stuff on the music, too.

Robin Hanson has a really interesting econ-meets-forecasting blog called Overcoming Bias.  Dean Baker's beat is econ-reporting-sux plus a whole lot more (and he's one of the good guys). 

And, for something completely different, there's Botox 4 the Brain.  It's a Christianity vs. Transhumanism site I like to read - provocative and unusual.  I'm agnostic about Transhumanism and pretty much "EC" on the Christianity (as in 'ethical Christian' but skeptical about the supernatural - and with a Jewish/Buddhist background, too).  So I enjoy watching the clash of two perspectives that don't often intersect.  It's a very smart and well-written site, besides.

Consider this my version of twitter's Follow Friday.

Three Reasons You May Be Uneasy With Health Reform

I'm hearing a lot of ambiguity about health reform today from people who support its objectives unequivocally. Providing coverage for those who can't afford it, allowing portability of insurance, ensuring that nobody can be denied coverage for preexisting conditions -- these are inspiring goals.

Still, there's an underlying sense of unease in some quarters. Maybe that's because we haven't taken time to step back and look at the broad, unspoken assumptions behind the legislation being crafted.

There are three principles that have generally gone unstated since the debate began, and which seem to have driven policy design from the start. Some Democrats probably adopted them because of ideology, others from expediency. They are:

1. Private health insurance costs more than public insurance, but that won't be addressed.

The language used by the House Committee on Health and Labor to describe the bill today reads as follows: "The public health insurance option will play on a level playing field with private insurers, spurring additional competition." What that really means is that tying a public option's rates to Medicare -- the so-called "robust" option -- would result in such significant cost savings that it would harm the ability of private insurers to stay in business.(1)

In other words, the political calculus will not allow the creation of a program that endangers the financial viability of private insurance companies. The "level playing field" means "on the level we have now." And, while the President and others insist that the public option is a relatively minor aspect of reform, some of the reluctance to go "robust" stems from the opposite concern: that it could set forces in play that lead to major change.

A small, non-robust public option plan will have difficulty negotiating for better rates than the insurers who dominate most major markets, thanks to their exemption from anti-monopoly regulations. That means consumers will pay more, which leads us to unspoken principle number two:

2. Money saved from the Federal budget tends to come out of people's personal budgets.

"Scoring" and CBO estimates address the government costs for providing healthcare. As we've seen, the simplest way to get a better government "score" is to shift costs from the Federal budget -- borne by all Americans under a progressive system of taxation - back to middle-class households. That's done in a variety of ways, including the so-called "Cadillac tax" (which taxes union members for benefits negotiated in lieu of wages).

When the government restricts access to the public option, that costs middle-class households money. They're less likely to qualify for the lower-cost public plan, and the reduction in competition means they pay more for private-insurance premiums. When the public option isn't "robust," that costs them money too. If biotech drug patents are extended for 12 years, as has been proposed, that will have added costs too. Which leads us to unstated principle number three:

3. Reform will provide great benefit to lower-income people, but middle-class people are likely to bear most of the burden.

If health reform provides coverage to many people that can't afford it today, that will be a major accomplishment. But if President Obama and the Senate have their way, part of the revenue for those subsidies for lower-income people will be financed through a tax on union households. (The House proposes a "millionaire tax" instead.) And those restrictions on who can choose the public option mean that most healthy middle-class workers are being kept in the private-insurance pool. That should keep premiums lower, but at the expense of a cheaper "robust option" for those individuals and their employers.

In other words, people who pay directly or indirectly for their own coverage are being kept in the private-insurance pool partly to keep rates down. The term "cannon fodder" feels too harsh, but it comes to mind anyway.

These three principles have driven the entire debate, even if only unconsciously. That's why so much of the debate has been skewed. For all the talk of "fiscal responsibility," a robust public option probably never had a chance. Why? It violated Principle #1. Paying for health coverage out of general tax revenues was never considered either, because it would violate Principle #2. The "millionaire's tax" is getting pushback from the White House and the Senate because of #3.

There was much talk of the German health system, in which people pay 10% of their income for health insurance. But these proposals don't do that. They cap premiums at 10% of income (or thereabouts, depending on the proposal), but that's not the same thing at all. Under these proposals, if your premiums cost $14,000 a year you'll pay 10% of income until you make more than $140,000 per year. The more money above $140,000 you make, the less you'll pay for healthcare compared to other Americans (on a percentage basis.)

The German system isn't progressive, like regular taxes. It's more like the flat tax Steve Forbes used to talk about. But our proposed system would be regressive for most Americans. What's more, German insurance companies are nonprofit, and it's unlikely Germans face the same out-of-pocket costs people with insurance will have to bear here.

Do these three principles mean whatever amalgam of these two bills we eventually see will be unworthy of support? No. We live in a practical world, not an ideal one. While the final provisions have yet to be developed, we can at least be hopeful that the Dems will hammer out something that's better than the status quo.

We should remember that even Medicare, the crowning social legislation of the last fifty years, has regressive characteristics. Medicare is funded by payroll taxes and premiums, and there are those who would not be able to afford the premiums if not for state subsidies. Medicare recipients can still face significant out-of-pocket costs in some cases. Medicare has been improved substantially since its initial passage, and activists should be planning to push for additional improvements to whatever is passed this year. None of this is a reason to cave in today on the critical remaining issues, like the "Cadillac tax" or some of the more onerous pharmaceutical provisions. But at least it provides some perspective.

This is where we should insert that obligatory cliche about legislation being like sausage-making -- although I'd rather quote Warren Zevon and just say that the process "ain't that pretty at all." Yes, unspoken ideologies and compromises drove this bill. Yes, the president broke some campaign promises. Yes, lobbyists have so much influence that the country didn't get all the reform it deserved.

It's like the old saying says: "Some days you get what you need, and some days you get what you want. But every day you get what you get." If the end product is an imperfect reform bill, one that takes too much from the middle class in order to help those even less fortunate, that won't be what some people wanted. But it will be be an improvement, and they'll know the unspoken ideologies and compromises that shaped it.

Most importantly, they'll know what to work on changing next.

____________________________

(1)There are other issues, too, especially regarding physician income, hospital budgets, and patient access. We recognize that -- but "level playing field" means "no cost advantage through government buying power."

Read more at: http://editorial.huffingtonpost.com/tmp/individual-entry-archive39.html

se habla irony aqui

Let me get this straight:  The Dallas Police Chief is defending his offiers after they illegally arrested some people for not speaking English - which isn't a crime - on the grounds that they misunderstood instructions.

Which were presumably given ... in English. 

From Raw Story (via Buzzflash):

Police officers in Dallas, TX have issued at least 39 citations to drivers in the last three years for the non-existent infraction of not speaking English.

It's not racism, says the police chief.  They just misunderstood something they were told.

Dallas requires taxi drivers to be able to communicate in English, and a similar federal statute applies to commercial drivers, but there is no such requirement for private citizens. Chief Kunkle suggested that the misunderstanding might have arisen when the federal statute was mentioned in instructions for a new electronic citation system.

So the Chief's excuse is that they didn't understand the instructions they were given (orally or in writing - it's not clear which.)  In other words, he's defending them on the basis of their insufficient command of English.

One of the arrest victims gets it right:  ""Brenda Mondragon said her mother is still learning English. She added that she believes Officer Bromley -- who is still in training -- clearly needs more of it."

Hey, Joe

Here's my guess:  In the end, Joe Lieberman won't filibuster the public option.  He's using this threat as leverage so he can win other concessions for the insurance companies in his home state.

Let's see if I'm right.  Not that anyone asked ...

Health Reform: Look How Far We've Come. Now Where the Heck Are We?

The public option is dead: Long live the public option.

Wait. Maybe it is dead. The rocky road to health reform is likely to induce severe mood swings, considering the elation after Harry Reid's announcement yesterday and the gloom after Joe Lieberman's threatened defection today. Maybe the health reform process needs a sign like the ones carnivals put up over the Tilt-a-Wheel: "Must be this tall to ride this attraction."

The public policy option presented by Harry Reid may not meet the consensual definition of "robust," but it isn't the opposite of robust either. We'll need another adjective to describe it if it passes: Hale? Stout? "Ruggedly mild with a hint of oak in the aftertaste?" But while they're working on terminology, Democrats should be mapping their course of action should Sen. Reid succeed. Much of the work will begin, not end, when and if this bill passes.

Putting Sen. Lieberman aside for a moment (and who wouldn't want to?), what can we expect to see if the final health reform bill conforms to Sen. Reid's outline? The crystal ball is somewhat murky, since some of the most critical features of the bill aren't fleshed out yet. But we know that progressives are counting on the public option to be a check on insurance industry abuses, and to slow down the health care cost spiral.

Maybe, maybe not. The public option will only impact the system globally if it has clout (which comes from volume), cost savings, and an attractive package of benefits. How likely is that under the proposed Senate bill? Here's what we can surmise so far:

The opt-out: I was surprised at the anger my last post on opt-outs provoked in some progressives. "Ideological rigidity," said some. I still think the opt-out weakens an already-compromised public option, and that it clashes with some of the moral rhetoric from Democrats. But, as I wrote at the time, "Is a 60-vote, non-reconciliation outcome in the Senate worth (it)? Maybe in the end the answer will be 'yes,' but that question should only be posed after all other options have failed."

Well, apparently they've failed. Now the opt-out is looking like a shrewd tactical move, and let's hope it succeeds. But every such tactical reduction reduces the public option's ability to effect system-wide change. That's not ideology, it's common sense.

A number of people expressed great skepticism when I said that a number of states would exercise the opt-out provision if it were enacted. Now, two short weeks later, even the Democratic candidate in the Virginia governor's race is suggesting he'll opt out if elected. So a public plan that was forecast to win 5% of the expanded insurance market is now likely to gain something less than that.

What will the final number be - 4%? 3%? We don't know. But those progressives who are waxing euphoric need to come back down to earth. Their mission, should this bill pass, will be to keep the number of state defections as low as possible. They can't do that by repeating the old mantra, "people would never be so foolish ..." After all, they said that during the 2004 election, too. Campaigning against opt-outs will be Job #1 if this bill passes. If that happens, then, to paraphrase Joe Hill: "Don't celebrate, organize."

Medicare rates: The Reid plan isn't technically "robust," because it doesn't tie public option doctor/hospital reimbursements to Medicare rates. Again, that may be smart politics - but it weakens the PO's cost-competitiveness. This is a complex issue, but the bottom line is this: If the public option has to negotiate its own rates with health providers, and it's only likely to get an average of 5% in any given market, it's not going to have a lot of clout to get favorable pricing. Sure, it will save on marketing costs, but so will any other insurance plan in the exchange. So how much of a cost-check is it going to be?

To make matters more complicated: If a public option is tied to Medicare rates, that might cause more doctors to drop out (or "opt out") of Medicare. That could create an access problem. But that issue could be managed by giving the public option the flexibility to make exceptions in its rate structure by region and/or type of provider.

Mandates again: There's talk of easing the employer mandate, while keeping the individual mandate. That could get tricky, because it could shift a greater portion of the cost back onto working families. And mandating the purchase of private insurance in states without the public option could be unpopular.

Paul Krugman may be overly sanguine about the likelihood that health reform will be well-received after (or if) its implemented. Those polls showing that the Massachusetts reform is popular among doctors are not surprising, since they benefit when more people have insurance. The fact that only 2.6% of that state's residents remain uninsured sounds good, but that figure was 5.7% before reform. So they've cut their uninsured problem by slightly more than half (55%). Similar results nationwide would leave more than 20 million Americans uninsured (assuming 47 million now), which could be politically unpopular.

And while one poll shows that only 11% of Massachusetts residents polled would repeal reform, that's in a state that lacks the rampant right-wing extremism we see nationally. Other polls there have shown that most people personally affected by the state's reforms are unhappy with them. On the national level, these disaffected people may well turn out to be swing voters, especially after the Media Noise Machine has worked on them.

Benefits Design, Insurance Exchanges, and Cherry-Picking: As Professor Krugman points out, Massachusetts has been proactive in mandating benefits design, showing a level of political will that may be absent on the national stage. If the insurance exchanges do not mandate a decent level of coverage, families who pay those large insurance premiums may still face financial disaster should a major injury or illness take place.

In states where the public option provides more generous benefits than private carriers do, the end result may well be what the insurance industry calls "cherry-picking." That's what health plans do when they design their benefits and administer their plans in ways that make life especially difficult for those who need more care, or who are more likely to need it in the near future. If insurance exchanges aren't given the tools to manage the cherry-picking problem, the public option could become a toxic waste site where for-profit carriers dump the sick and needy. The end result would be a public option that actually costs more than private insurance.

The Keyword is 'Evolution': So, do I dislike the Reid bill? Not at all. I suspect it's the best we're going to get, and we'll be lucky if we do get it. As I've confessed before, I've consulted for health insurers in the past (as well as employers, unions, foundations, tech companies, and others - which I do more often). Part of that job is to point out all the bad things that could happen, so that people can plan accordingly. Each of the above problems can be addressed, but only with awareness and forethought.

The keyword in this planning process is 'evolution.' If a watered-down plan is all we can get - and it looks like it is - it's wise to design it so that it can evolve toward a better system in the future. The public option is one way to do that, by forcing insurers to lower costs or lose market share. Lawmakers are right when they point out that, as its now designed, it's not the most significant part of the program. But if it's there, and we don't eviscerate its cost-saving potential, it can be a powerful lever for future change.

We're likely to see continued voter dissatisfaction after this bill is passed. That can be a good thing, if mechanisms have been put in place that permit quick response to those dissatisfactions when they arise.That's a good reason to support the Wyden Amendment, which would allow anyone to elect the public option.  It's also an argument for improved regulation of insurance company benefits, and for retaining the option of using Medicare rates at some point in the future.  

As for how to handle Sen. Lieberman - Hey, I wish I knew.

Read more at: http://www.huffingtonpost.com/rj-eskow/health-reform-look-how-fa_b_336170.html

Radio show with Bob Cesca and Lee Stranahan

I did a one-hour (slightly longer) radio show last week with Bob Cesca and Lee Stranahan, colleagues & pals from The Huffington Post.  Topic:  health reform.   Here it is:

http://www.blogtalkradio.com/Stranahan/2009/10/15/Agree-to-Disagree-with-Bob-and-Lee

the wrong arm of the law

"Funny how naughty dentists always make that one mistake, isn't it?"

A recent article and broadcast on National Public Radio (US) described the proliferation of specialized police forces in the state of Texas, including one that was operated by the State Board of Dental Examiners.  No true Monty Python fan could read that report without recalling the Eric Idle character known as Lemming of the BDA - "British Dental Association, that is."

There's been some public debate about the growth of  private police forces in North America, Europe,and throughout the world, and some discussion (though not enough) about the creation of private Fire Departments operated by insurance companies in the United States.  But Texas may represent the leading edge of another governmental phenomenon.  The issue there is not so much the outsourcing of a government function as it is the fractionation of that function among competing departments. 

We don't have a word for this phenomenon yet.  Maybe we should call it intrasourcing?

Whatever it's called, the question is this:  Is this part of a wider phenomenon or just a Texas aberration, the product of that state's fascination with the breed of professional they still call (with pre-feminist brio) the "Lawman"?

This is, after all, a state that idealizes its Texas Rangers while maintaining a militia-like hostility to the FBI and all other centralized police forces. The Rangers probably have more power and more prestige than any other State Police organization.  That might be expected to draw the ire of rebel-minded Texans, since most policing is done at the local level, but they love their Rangers down in Texas.

This writer is American enough to appreciate the Rangers' motto - "One riot, one ranger" - and to have a soft spot for Willie Nelson's appearance as an aging Ranger in an old episode of Miami Vice.

But it must be hard even for a Texan to summon up much affection for the "Enforcement Division" of the State Dental Board, which has 10 investigators, three "administrative technicians," and a Director.  According to its website, the Dental Enforcers "investigate complaints against dentists, dental hygienists, and dental laboratories."  The site adds, "Although the Board has no jurisdiction over unlicensed persons, the Board's investigators often help local prosecutors investigate allegations of practicing dentistry without a license or operating an unregistered laboratory."

So NPR may be overstating a little by calling them "a police force." No actual arrests are being made by white-clothed dentists with mirrors on their foreheads, and we may never see a reality show called "D*E*N*T*I*S*T*S."  An earlier article on the topic in the Austin American-Statesman was more balanced when it described the proliferating organizations as "police agencies." Still, in a world where privacy hangs in the balance, it's disturbing to know that investigative agencies have been formed by the State Pharmacy Board, a Municipal Water Authority, and a private Cattle Raising Organization, among others.

Questions of jurisdiction gets complicated by the spread of all these police forces. Consider this excerpt from the American-Statesman piece:

This month, a City of Austin animal control officer was charged with livestock theft for allegedly making off with seven head of cattle belonging to a Caldwell County rancher. But it wasn't Austin police or Travis County sheriff's deputies who made the bust.

Instead, the investigation and arrest were carried out by "special rangers" commissioned by the Texas Department of Public Safety but employed by the Texas and Southwestern Cattle Raisers Association. With the exception of issuing traffic citations, the privately hired rangers enjoy the same privileges as police officers to "prevent or abate the commission of an offense involving livestock or related property."

Public safety is an even more serious concern.  Officers from the Texas Beverage Commission shot and gravely wounded a man who was "driving erratically," in the newspaper's words, despite being unrecognizable as law enforcement in their street clothes and unmarked cars.

Clearly in this, as in all matters, they "do things bigger in Texas."  Two more statistics:  There is one sworn police officer for every 300 people in the state, and the Commission on Law Enforcement Officer Standards and Education monitors 2,615 law enforcement agencies.

Not 2,615 officers - 2,615 agencies.

Something's out of control in the Lone Star state.  Which gets us back to our original question:  Is Texas an exception, or is it the leading edge of a new trend?  In a widely-reported story, a town in rural Montana outsourced the policing of its jail to a private police company last month, unaware that the company's president was - in the words of the Associated Press - "a convicted con artist."  But is there a trend?

An excellent piece of investigative reporting in the Washington Post suggests an answer.  Journalist Amy Goldstein writes:  "The more than 1 million contract security officers, and an equal number of guards estimated to work directly for U.S. corporations, dwarf the nearly 700,000 sworn law enforcement officers in the United States."Some warn," adds Goldstein, "... that the constitutional safeguards that cover police questioning and searches do not apply in the private sector."

Private police forces are not a new phenomenon.  Firms like Pinkerton and Burns routinely provided security forces and even attacked striking workers in the United States in the late 19th and early 20th centuries.  But they had withdrawn into the background until the Republican-led privatization trend of the late 20th and early 21st centuries.  The presence of armed individuals without government checks on their behavior can result in death or injury, as the shooting in Austin illustrates. 

As for the Texas problem - the spread of multiple police forces within a single state - no national study has yet been performed.  But the private-police problem can only be compounded by interagency squabbles over jurisdiction and enforcement.

After reading the Dental Police stories the old theme song kept running through my head:  "Lemming, Lemming, Lemming of the BDA ..."  But the story may not be so funny. Somebody who winds up on the wrong end of, say, a Browning 9mm - a good sized gun for "concealed carry" by private cops in street clothes - may find themselves wondering: Who's the lemming now?

(originally written for 3 Quarks Daily)

A poem

Temple at Kappadisangama

Hey, I adapted a poem.

I've never written poetry.  I've always been too much in awe of the art.  I think I've read too much bad poetry, too.  But I was struck by A. K. Ramanujan's translation of a poem/song written by the 12th century Indian mystic and social reformer Basavaņņa - both for its beauty, and for the archaic terms for instrument parts Ramanujan (an otherwise brilliant translator) used.

Basavaņņa was a 12^th Century itinerant mystic, poet, and singer who led an insurgent religious Shaivite order (followers of Shiva), then went on to become Prime Minister of an Indian state. As Ramanujan wrote, “A new community with egalitarian ideals disregarding caste, class and sex grew up (around him), challenging orthodoxy, rejection social convention and religious ritual.  A political crisis was at hand.”

Early in his wandering he went to Kappadisangama, “where three rivers meet”- that's one river more than Pittsburgh - and adopted his preferred incarnation of Shiva:  Kudalasangaman Deva, “the Lord of the Meeting Rivers.”  He created a literary revolution, Vachana sahitya, which overthrew established forms for direct and easily accessible forms of poetry.  (The name means “that which is said.)   He insisted on the overthrow of the caste system and the rejection of elaborate rituals, refused to worship God in anthropomorphized form, and preferred to  worship by singing.

Gotta love a guy like that.

As for the poem, one night when I couldn't sleep I started playing around with replacing Ramanujan's not-so-accurate musical terms with ones I thought might work better.  Then I thought, What the hell.  Why not just adapt the poem more loosely and make it my own? 

The original poem went like this:

Make of my body the beam of a lute
    of my head the sounding gourd
    of my nerves the strings
    of my fingers the plucking rods.

Clutch me close
    and play your thirty-two songs
    O lord of the meeting rivers!

My adaptation is below:

Shrewd Move: A Way to Understand Obama's Nobel Prize

Do I think the President has "earned" a Nobel Peace Prize?  No.  Does that mean I oppose the Nobel Committee's decision, as David Sirota and some others on the left do?  No.  Why?  It's simple, really:

This prize was designed as behavioral modification.  The Committee has shown an activist bent in recent years, especially where the U.S. is concerned.  The Right is right about that.  But their activism is generally in support of causes I also support.  The award to Al Gore was clearly intended to strengthen Gore's fight against global warming, and it worked.  The award to Jimmy Carter was clearly intended to strengthen the hand of antiwar activists here in the US, and that worked too.

This is not to take anything away from these two leaders, both of whom had done much that was deserving of recognition.  But the Committee's motives seem clear.

It's a little different with Obama's prize.  I think the Committee realizes that the President is a complex and ambiguous personality.  He has enormous gifts, and part of him inclines toward using those gifts oods for lofty goals:  peace, progress in (and with) the Islamic world, and the elimination of nuclear weapons.  He has other, less lofty impulses, too:  for one thing, he has an over-reliance on compromise with people whose motives are less than pure.

So the Committee, in its shrewdness, saw these conflicting aspects of Obama's personality and decided to apply Behavioral Mod 101 by rewarding that part of the President that inclines toward the greatest good.  I think they're betting that this award, and the gratification it brings, will encourage the President to be braver and more forceful in pursuit of his higher aspirations.  I think they're right.

I certainly hope they're right.  That's why I support the awarding of this prize, even though I understand why it has not yet been "earned."  It's designed to be a self-fulfilling prophecy.  Call it the Audacity of Hope.

Facebook Block: Why Is This Impermissible Speech?

I tried to put up my last post on Facebook, with this summary

"Some Democrats and progressives are embracing the new 'opt-out' compromise, but it's costly and it endangers the public option.  Don't compromise too soon, and don't compromise without understanding how much you're giving away. Here's a thought experiment: What if Medicare had been enacted this way?"

Facebook wouldn't let me.  It returned this message:  "Warning:  This message contains blocked content.  Some content in this message has been reported as abusive by Facebook users."

What could possibly have been "reported as abusive" in that paragraph?  I understand banning abusive language, but banning language merely because it has been "reported as abusive" simply means that any user can block the political speech of all others by labelling it "abusive."

What's going on?  What could possibly be "abusive" about these words?

UPDATE:  Forget it. I can't figure it out. I took out the words "some Democrats and progressives are embracing" and Facebook allowed the post. But then I posted those words separately on Facebook, in various combinations and with and without the link. No problem. It's strange.