Saturday, May 28, 2011

Men say they are civilized, for the most part (by Suzie)

When news breaks that a powerful man has abused a woman, I doubt most women think, "Men treat women so well that the only possible explanation is that the man was corrupted by power." Instead, what I generally hear is: "Men are pigs."

Last week in the NYT, Benedict Carey asked the wrong questions in "A Sexist Pig Myth." Discussing Dominique Strauss-Kahn and Arnold Schwarzenegger, Carey asks and answers: "Does power turn regular guys into sexual predators? The answer in most cases is no, say social scientists and therapists who have long experience working with men." All the experts he quotes are men.
... only a minority of men feel entitled to have their way to dominate others, to humiliate them if provoked. These guys usually know who they are, and the people around them sure do. They were grabbing waitresses or pulling the wings off flies well before becoming chairman of the board. ...
For most of human history, men have treated women much as they pleased, and powerful men routinely collected wives and lovers, feeling free to maim or kill those who offended. The social norms, criminal laws and progressive culture of the West evolved in part to check such abuses, and most men not only observe those rules but also, as the attitude surveys show, internalize them.
Western civilization didn't evolve to give rights to women, and in various times and places, it took rights away. Carey's statement is about as simplistic as saying "all men are pigs."

At first, he seems to distinguish between "regular guys" and those with power, as if regular guys have no power over anyone. To many people, pursuing women -- seduction, harassment, etc. -- and the desire to dominate others are the marks of a regular guy. What sets DSK and Schwarzenegger apart from regular guys is not their behavior, but their fame.

Their alleged offenses are crimes against women, of course, but more specifically, they are crimes against women in the labor field. Some women decline jobs, or do their jobs differently, to avoid harassment, including being grabbed and raped. Let's not forget that this is economic discrimination.

In regard to Schwarzenegger, I'm thinking of the accusations that he assaulted women on movie sets, not the housekeeper with whom he had a longterm relationship. DSK has a similar history of abusing women. Katha Pollitt recounts some of it in a hilarious column, which also mentions the outrage of French feminists.

Some of DSK's supporters also rallied around child rapist Roman Polanski. Meanwhile, New York prosecutors were quick to note that, if DSK had successfully fled -- he was arrested on a plane to Paris -- France would be under no obligation to return him, just as they refused to return Polanski.

Others see U.S. treatment of DSK as revenge against France for protecting Polanski, but they may not know how the U.S. criminal justice system works.

Former feminist Naomi Wolf has sympathy for DSK. As in her defense of accused rapist Julian Assange, she points out that the criminal justice system operated differently than if these two had been regular guys. No kidding. That's because they are famous, with rich and powerful backers. She compares the DSK case to the recent one in which two NY officers were acquitted of rape against a drunk woman they were supposed to help. Expect the system to act differently when two of their own are accused. But don't use that as an excuse for authorities to treat DSK better.

"... policy outcomes can be advanced nowadays, in a surveillance society, by exploiting or manipulating sex-crime charges, whether real or inflated. In other words, ours is increasingly an age of geopolitics by blackmail," Wolf writes.

I have a solution: If men want to advance their policies, they should not commit crimes against women.

Memorials: Three Views [Anthony McCarthy]

Buying Toys for Dead Children

The sad, disturbing case of the little boy whose body was found in the town next to mine has been all over the news. His funeral is being held today. Before he was identified and his mother arrested all kinds of assumptions were made about what had happened, none of those I heard or read remotely close to what is believed now. The real story was far less sensational and far sadder than anyone I'd heard imagined. A case of unavailable help for people who needed it desperately.

Even before the little boy was identified one of those bizarre "memorial" conglomerations of flowers, objects, apparently even food was assembled near where he was found. It was a useless gesture by people who had no connection to the case except what they heard on TV. I don't know where that practice came from or where it began but it is something entirely bizarre to me. I don't remember it happening here before about fifteen years ago.

Trying to think about what it means hasn't produced anything except that it's a desire to participate in some kind of celebrity inspired by the substitute for culture that TV provides. Maybe it's the same kind of substitute for reality that people believed they had as they talked about the case before any real information was known to them.

Certainly there are more meaningful things to do than to buy a teddy bear for a child who is dead and putting it on the side of the road where it's quickly going to turn to trash. It does nothing for anyone, not the child who is dead, not for any living children. I don't understand it and I doubt there is much there to understand. I wonder how many of the people who do those things are the same kind of people who would watch mental health services eliminated by the same kinds of politicians who are all about empty gestures and mawkish, dishonest piety. Maybe they'd nod vaguely in agreement that it was a good idea to lower taxes, just as TV told them they should.

Here is a piece I wrote shortly after I began blogging:


The past twenty years has been unusual in number of monuments erected. The memorial movement unquestionably began with the dedication of the Vietnam Memorial designed by Maya Lin. Memorials to veterans and others will be one of the lasting legacies of our generation. It being Memorial Day weekend it might be time to talk about two monuments in particular, one extraordinary in its absence, the other to be discussed later.

Wars are horrible as veterans and their families know, despite movie bravado to the contrary. Even those of us whose family members came home ambulatory and able to lead some kind of normal life know that its effects are permanent. Pretending that the survivors aren't the victims of a horrible experience isn't any service to them or the truth. Even the best movies are inadequate to show what it's really like. An experience that huge and over that period of time can't be condensed into two hours. No monument can give a sense of the sacrifice some of war's victims give ever day they and their family members live.

Among the most numerous victims of a war are civilians whose deaths and injuries are reduced by our media and those it serves in a series of the most offensive euphemisms ever coined. "Collateral damage," is the most often cited. It's easy for people sitting in studios and hearing rooms in DC and New York to let those be the final words on the subject. But as we are seeing in Iraq today the victims brushed away here are remembered somewhere else. And more than a handful of those who don't forget them want revenge in our blood. Today's economic reality, transportation and the ocean of weapons provided by arms manufacturers and dealers make that revenge not only possible but increasingly likely.

Will it take a national monument of the mall to remember the myriad of civilian victims of all wars? Our civilian dead and those who die in our actions abroad? Whatever it takes, the public relations induced amnesia that blots them out of our national discussion has to be broken through. Most importantly it's matter of morality. Our souls. It's also a matter of our own security. Ignoring them will cost us in blood again.

In definitive contrast to this absence is a monument of a different stripe altogether. One which ubiquitously blights the face of our country. I hear that a recent example was set up by Senator Larry Craig on C-Span's Washington Journal last week. In discussing possible laws to prevent the funerals of veterans from being disrupted, a measure endorsed here last week, he repeated one of the right's favorite lies. He said that it was needed to keep anti-war protesters from dishonoring dead veterans and their families. In the quote I saw he gave no examples of this happening. I'm told that the moderator didn't challenge the lie. As my piece last week said, the most prominent disruptions and threatened disruptions of funerals have come from the Phelps family. An obvious right-wing, "christian" fundamentalist group which has more in common with the Senator from Idaho than it does with the most aggravatingly tone deaf anti-war groups in the world.

We had one of these incidents in my state last month so the m. o. is fresh in our memory. A week of worry for the family as they prepared for the funeral. A week of publicity for a right wing hate group. A region braced for the spectacle of a funeral being turned into a diatribe of anti-gay hate by outsiders. And then the cancellation. Why take the bother of traveling when you can get the publicity free. Lying about this being done by anti-war groups provides the hate group with more cover than they probably would welcome.

Republicans and conservatives have spread these lies, from the urban myth of returning Vietnam veterans enduring a rain of anti-war spittle to this fabrication. And their motives are entirely corrupt. Their motive is to cover the coffins of returning soldiers with lies . They dishonor their memory more than all the complete, combined antics of the lunatic fringe that plagues real anti-war efforts. The media is an active participant in the lies.

John Ashcroft's covering of "The Spirit of Justice" was an action of symbolism so appropriate that he didn't get it. The Republican Party is covering up the dead of their war in an act of cynicism that dishonors all of the war dead and their families. And they not only get it, that's the plan.

Note: Larry Craig had yet to show just how much of a whited sepulcher he was when this was written.

My Grandfather: Vesna Parun

My grandfather sits in front of the house and leaves fall.

He looks at the figs that dry on the stone,

while the sun, very orange, vanishes behind the small vineyards

I remember from childhood.

The voice of my grandfather is golden, like the melody of an old clock,

and his dialect is rich, filled with restlessness.

The legend of “Seven Lean Years” follows right after the “Our Father,” short and eternal.

One day, there was no more fishing.

Now, there is war.

The enemy surrounds the port for miles around.

The whole tiny island trembles in eclipse.

All her sons disappeared in search of war wages—

a long time ago.



They’ll board them next for Japan.

It’s possible they’ll stay forever with their heads among the bamboo.

This is the second winter that they’ve marched non-stop.

Even the fish sound gloomy in their chase.

One grandson is fair and good, yet, we’ll find him in the snow one day

when the mountains are tired.

The girls sing as they prepare the picnic soup.

The children squat on the floor, very frightened

of the boots of the elegant old man.

One mother thinks of the sons and father who became a Malayan.

Strange, how this family has been scattered over four continents.

These big brawny people sound like children in their letters.

My grandfather stares at the red sun in the vineyard,

worn to silence, because death is near—old fisherman of the sea.

Foreign greed; strange hunger. Freedom is a bit of breadcrust.

Ah, tell the earth that watermills should run faster!

A storm took away leaves; whatever’s right shall be.

So, the young boys die, and the old men warm up their sorrows,

staring at the horizon.

Translated by Ivana Spalatin and Daniela Gioseffi

Note: I'd never heard of Vesna Parun until a couple of weeks ago when I read some of her poems in Esperanto translation. She was a very well known Croatian poet for much of the past century until her death last fall. She's often compared to Anna Akhmatova in what I've been able to read about her.

Some of her poetry deals with war. This one is on a subject that doesn't get discussed in the U.S. much these days, the wider meaning of war for the families and communities not directly involved. Here it's mostly rote repetitions of conventional civic religion, propaganda for militarism.

Finding out about major writers who wrote in languages with a relatively smaller number of speakers is always interesting, it makes you realize that it's not all about English and other "major" languages and what those cultures and traditions carry. And it makes you wonder what other thoughts you don't have access to, worlds that are secret to you.

Reading a poet in translation makes you wonder how much of what you're reading is the original poets thinking and how much of it is the art of the translator but the inspiration for the end result must have been present in the poem being translated. It makes you wish you had direct access but it's impossible to read every language and it's impossible to have the same kind of experience as someone who grew up learning the language and its culture. It would be a lot harder to go to war against them, if you could do that. Though the Balkan wars of the 1990s prove that even that's not enough when people are sold the lies of nationalism. Which is growing more dangerous here in the United States as well. Memorial day carries dangers due to its purpose in these days of corporate government.

posted by Anthony McCarthy

Friday, May 27, 2011

"[A] more female aesthetic.” (by res ipsa)

Badminton has a new dress code:
To create a more “attractive presentation,” the Badminton World Federation has decreed that women must wear skirts or dresses to play at the elite level, beginning Wednesday. Many now compete in shorts or tracksuit pants. The dress code would make female players appear more feminine and appealing to fans and corporate sponsors, officials said.
And I did not know this, but apparently lots of Muslim women play badminton, so ...
Women will still be allowed to wear shorts or long pants for cultural and religious reasons....
Well, that's nice.
...But these garments must be worn beneath a dress or skirt, which could be cumbersome.
Possibly cumbersome. Definitely sexist.

Back in the day when I first started to work in offices, the boss (a woman), issued a memo saying that women must wear pantyhose. Remember hose? Ick. They were itchy. They were hot. They were expensive. (Leggs would have taken a chunk out of the $14,000/year I was earning at the time.). One brave assistant (there were about twenty of us, all but one female) approached the boss who wouldn't relent. Then she approached H.R., which was a joke. And so she told everyone she was headed downtown to have a chat with the E.E.O.C. ... and the memo was immediately rescinded.

Doubly aggravating about the badminton thing is that Federation isn't even bothering to mince words. They're instituting the rule because they want the players to look like babes so as to attract (male) fans and corporate sponsors. The End.

Just as an aside, I'm never going to misspell "badminton" again.

Thursday, May 26, 2011

Child Abuse in the Catholic Church. Again.

Yet another child-abuse case in the Catholic church:
The latest sex-abuse case to rock the Catholic Church is unfolding in the archdiocese of an influential Italian Cardinal who has been working with Pope Benedict XVI on reforms to respond to prior scandals of pedophile priests.
Father Riccardo Seppia, a 51-year-old parish priest in the village of Sastri Ponente, near Genoa, was arrested last Friday, May 13, on pedophilia and drug charges. Investigators say that in tapped mobile-phone conversations, Seppia asked a Moroccan drug dealer to arrange sexual encounters with young and vulnerable boys. "I do not want 16-year-old boys but younger. Fourteen-year-olds are O.K. Look for needy boys who have family issues," he allegedly said.
These cases always cause certain arguments to crop up, having to do with the causes of the apparently widespread child abuse in the Catholic church and with the ways to fix the problem. Thus, we are told that it all started with the permissive sexual culture of the 1960s or that it is caused by the enforced celibacy of the (all-male) priesthood.

But it is less seldom that we connect the problem of sexual child abuse by so many priests with the assumed authority of this church (and of other religious organizations in several religions) to define what sexuality should mean for other people. If sex is allowed only for procreation within marriage, shouldn't the church walk its talk?

And when do we connect the dots from this to the church's view of women as essentially without any reproductive rights, given the church's disapproval of contraception or of abortion? Never mind. Most people don't seem to find anything odd in the fact that it is theoretically celibate men who decide on all this.

Meanwhile, in Kansas: Plan for Getting Raped as For Flat Tires

The local Republicans have been busy on the forced-birth front:
Kansas legislators approved a ban Friday on insurance companies offering abortion coverage as part of their general health plans except when a woman's life is at risk, capping a string of for abortion rights opponents in the four months since sympathetic Gov. Sam Brownback took office.
Remember Brownback? He sure remembers women, those aquaria for unborn babies.

But what is truly fascinating about this article is the end:
And Rep. Barbara Bollier, a Mission Hills Republican who supports abortion rights, questioned whether women would buy abortion-only policies long before they have crisis or unwanted pregnancies or are rape victims.
During the House's debate, Rep. Pete DeGraaf, a Mulvane Republican who supports the bill, told her: "We do need to plan ahead, don't we, in life?"
Bollier asked him, "And so women need to plan ahead for issues that they have no control over with a pregnancy?"
DeGraaf drew groans of protest from some House members when he responded, "I have spare tire on my car."
"I also have life insurance," he added. "I have a lot of things that I plan ahead for.
Bolds are mine.

Schedule your pap smears, plan your budget and don't forget to buy extra coverage for future rape consequences! After all, we keep spare tires in the car!

I don't really know what to call this man. A rotting anal plague?
Via Think Progress.

Who Is Going To Bear the Costs of Caring For the Elderly?

Josh Marshall writes about the hidden side of the Medicaid program and the way Ryan's budget proposal would change it. As Josh notes, few people realize that Medicaid doesn't just cover the health care expenses of selected groups of low income people. It also pays for the majority of nursing home care in this country:
It's the part about turning Medicaid into flat-amount Block grants. Most people go right on by that part - "it's poor people, has nothing to do with me, so we'll cut dental and podiatry and vision coverage, etc. for poor people (as California Medi-Cal\Medicaid did a year or two back). That's too bad, terrible, but we'll save lots of money." But actually, as the link shows, Medicaid pays the bill for 66% of all nursing home residents. And these aren't the indigent - most\many of them are the result of middle-income people who have already run through their own money paying for their nursing home costs, and then become eligible for Medicaid. If Medicaid doesn't pick that up anymore, who's left? The children of the residents? Who are trying to send their kids to college and saving for their own retirement? Not that Paul Ryan cares, but essentially, states will need to choose between basic healthcare for low-income people and nursing home care for formerly-middle-income people with no money left. Who wins, you think?
All this may come as a surprise to many. It is not Medicare which covers long-term nursing home care for the elderly but Medicaid. If Medicaid funds for that are cut, who is going to pay?

Three additional aspects of this problem affect women directly:

First, women are the majority of nursing-home residents, due to their longer life expectancy.

Second, women are the majority of the employees in nursing homes and thus will face most of the job losses which might come about with reduced public funding of nursing home care.

Third, women are the largest group among informal (read:unpaid) care-givers. If nursing-home care becomes impossible to afford, who do you think will be expected to quit their jobs in order to become full-time unpaid caregivers? Mostly women.

And of course there are women (and men) who wish to assume the informal care-giving role. But the Ryan budget proposal isn't about supporting those individuals. After all, an informal care-giver without a paid job might no longer qualify for health insurance herself, and she would certainly have difficulty saving money for her own retirement.

Wednesday, May 25, 2011

More Sluts

Ed Schultz, a liberal talk-show host, has called Laura Ingraham, a conservative talk-show host, a right-wing slut (and later a talk slut) in a recent program:

Laura Ingraham has the honor of having written one of the worst books I have ever read. But that doesn't make her a slut.

The problem with that particular slur is that its effect is directly dependent on classifying women based on their sexual behavior. A slut is bad because sluts "give it away." To specify that one is talking about "talk" rather than sexual acts doesn't really make a difference. It still smears other women while appearing to attack only one of them.

Sometimes slurs like this become general slurs, used against all people, and the connection to one particular group fades away. But I don't see "slut" as having reached that position.

On Jared Loughner

Jared Loughner, the man who killed people at a Tucson rally for Gabrielle Giffords, has been found mentally incompetent to stand trial. Still, as @theharryshearer notes, he was found competent enough to buy a gun.

Kathy Hochul's Victory

Hochul, a Democrat, won a special House election in New York's 26th Congressional District, a fairly Republican one. And now we all read the tea-leaves about what this might mean for the future:
There's going to be a lot of debate about whether Kathy Hochul's victory tonight means anything moving forward or not. I think it does. I think it is the first step toward the very real possibility that Democrats take the House back next year. Our national polling has been suggested that for almost three months now and this is the first tangible on the ground evidence backing that up.
Perhaps. But one thing I have learned in the years of blogging politics is to admit that the future is misty and full of invisible beasts which might eat us all. Or eat the other guys.

Still, there's reason to believe that the Ryan budget proposal didn't exactly help the Republican candidate in that election:
Special House elections cannot predict the future, but they can influence the present. That’s why what happened in New York’s 26th congressional district Tuesday is a problem for the Republican Party.
Call it a wake-up call or a major setback. Whatever, the victory by Democrat Kathy Hochul in a heavily Republican congressional district, in a race in which Medicare was a major issue, reinforced the reality that the GOP plunged into a debate over entitlements reform without a strategy for winning the battle for public opinion.
That article goes on to talk about the rapidity with which the Republicans assumed a mandate after their last House victory. That "mandate" is not about jobs and the economy but about cutting government spending and about destroying the unions, by the way.

And, naturally, about banning abortions. Republicans appear to spend lots and lots and lots of time on that particular mandate.

Tuesday, May 24, 2011

Head Colds in May Should Be Illegal

So I figured out why I was so irritable and so tired (achoo!), and why doing exercise felt like carrying the whole earth on my shoulders and why writing felt like trying to etch a letter into marble using nothing but finger nails. The reason is embarrassingly trivial. Achoo.

But isn't it odd how those lack-of-energy symptoms come first?

Meanwhile, in Saudi Arabia

Manal al-Sherif was detained by the police for driving a car:
Human Rights Watch urged Saudi authorities on Tuesday to release a female activist who led an online campaign against the country’s driving ban and posted a video clip showing herself behind the wheel.

Saudi clerics insist the ban protects against the spread of vice and temptation, because women drivers would be free to leave home alone and interact with male strangers.

The activist, Manal al-Sherif, and other women started a Facebook page called “Teach me how to drive so I can protect myself,” urging authorities to lift the ban. They posted a video clip last week of al-Sherif driving a car in the eastern city of Khobar.

She was briefly arrested on Saturday, but on Sunday she was detained again and charged with “violating the public order.”
Mmmm. And check this out:
There is no written Saudi law banning women from driving, only fatwas, or religious edicts, by senior clerics that are enforced by police. The Saudi daily Al-Watan, which is owned by a member of the ruling family, claimed that al-Sherif broke down in “an episode of crying” during an interrogation and blamed the campaign on “women from outside the kingdom.”
Which is to prove that women are too emotional to drive and too easily influenced by evil outsiders, such as all the women in every single other country who have the right to drive a car.

Things To Read

Gail Collins, in "The Year of Living Adulterously", writes something which strikes a bell with me:
As to Governor Daniels, the voters are unlikely to give a fig about the interesting past of his wife, Cheri. But if he wants to protect her from the embarrassment of being asked about it 24/7, perhaps he could just declare her off limits. The news media has generally respected those kinds of rules when it comes to presidential candidates’ children, as long as said offspring don’t show up on reality shows or as teen-abstinence ambassadors for a shoe store foundation.
Of course, a wife who is off limits would not be able to campaign for her husband. I think that would be terrific. Finally, we could end the tradition that a presidential candidate’s spouse is running for something, too. If we want a first family to obsess over, we should just hire a king and queen.
That would be a great improvement. As I have mentioned before, political spouses (usually wives) really do have a job but one they don't get paid for.

Juliet Williams points out something we have talked about on this here blog: That there is a difference between being a ladies' man and a rapist, and a difference between adultery and the latter, too.

And French feminists don't quite appreciate some of the French reaction to the Dominique Strauss-Kahn case.

Monday, May 23, 2011

You Know You Need A Vacation When

You have to go and kick the garage door because an ad is stating: "Learn a New Language in Just Ten Days!", even though you first tried to calm yourself by creating a language which indeed could be completely mastered in such a time period (Ogg have rock. Ogg bang. Bang, bang! Ogg mate, yes? This side up?)!

Once More on Kanazawa

I probably have written a book on his ideas on this blog. If you have missed them you can check them out. The first series on him starts here, the second series starts here, and there are other posts scattered all over the archives, too many to link to.

It wasn't much fun to wade in the primeval slime with Kanazawa, and the only reason I did it was that fresh-air-and-sunlight cure for bad ideas: Turn the rock over and see the creepy-crawlies flee. But I had no impact whatsoever.

Still, Kanazawa may have finally gone too far with that most recent blog post.
There is a petition to get him kicked off the Psychology Today blogs, and even a fairly mainstream blog post on Kanazawa's various hatreds.
Added later: Another petition can be signed here.

Peter G. Peterson, A Poor Boy Done Well

Atrios posted today about the Peter G. Peterson Foundation, a creation of Pete Peterson himself, the son of a poor Greek immigrant who is now a billionaire and into fiscal prudence, and who wants to save the greatness of this country from too large a government. The list of participants in the Foundation's latest fiscal summit includes our very favorite columnist, David Brooks! A known expert on economics.

But I want to write about something slightly different :

In the comments to that post, chichimec linked to an older interview with Peterson which had this gem:
P.P.: Look, part of it is because I'm a Depression baby, and I had parents who emphasized economical living to excess. We had to turn off the lights in every room in the house at all times—turned off the heat in the winter in the living room—and my father kept his last car, I think, 15 years or some damn thing, and he gave away a lot of money to his family back in Greece, plus the local community. So I'm not being critical of the current boomers, because if I were a boomer, I might feel that way. I am a Depression baby. Giving back was part of my upbringing. So when I put a billion dollars in this foundation, it's perhaps some measure of my passion and sincerity that this wonderful country is to a certain extent in peril. And I am willing to pay more taxes. I would love to see it as part of a major spending reduction package. And I told you that I've been supportive of increasing marginal rates, and I'm also a fiscal conservative. I know enough about the numbers to know that it's not going to solve the problem, as attractive as it may sound politically, to tax the rich. I'm quite willing to be taxed more. I would just raise the question, If you're going to increase taxes, how are we going to have the least distorted effect on the economy, and shouldn't it be fair? In other words, what is the argument for just picking on private equity partnerships from this maze of partnerships in the country? If people believe that carried interest shouldn't be taxed at the capital gains rate, well, then, why not tax all the partnerships? What is the fairness of the tax policy?

The bolds are mine, and it is the bolded sentence I wish to talk about. It appears to be received wisdom on the right that taxing the rich more is not enough to fix the problems of "runaway big government." But why is it not enough? Remember that it's not the number of rich people which matters here but the amount of money they have as a group.

And on that fifteen-year old car? Mine can vote next year! Lovely thing he is! Allows rally racing and parking on a dime.

I do think the rich don't know how the other 99% live.

Overheard (by res ipsa)

The scene: just now, on the subway.

Dramatis personae: two teenage boys (unsure of age -- if they're younger than twenty or so, they all look sixteen to me), me.

NO. 1: Sometimes I want a girl for everything: to chill with, to talk to, to take to my mother's for dinner, to have sex with.
NO 2: /nods
NO: 1: But sometimes I want a girl for just sex.
NO 2: /nods
NO: 1 But that's androgynous.
NO 2: /shakes head
NO: 1: Misdrogynous.
NO: 2: /shakes head
NO: 1: Misogynist!
NO 2: /looks at me, smiles

Sunday, May 22, 2011

Deductibles, copays, profits, and the deep end of your pockets (by Skylanda)

Once upon a time, if you wanted to see a doctor you shelled out cash, a chicken, a handful of gold coins, a promise of future services in return, whatever the exchange medium du jour, and you saw a doctor. Then along came medical insurance, wherein you bet ahead of time on the probability that you might need services in the future. Then along came HMOs, PPOs, and finally today: the highly profitable health insurance company, and an ironic throwback to the past - ever-increasing cash costs on the part of the consumer in the form of premiums, deductibles, and copays.

The increase in consumer contribution for insurance products has a profound effect on the utilization of health care, and ultimately, how much that care costs. A double-edged sword is an understated metaphor in this case; a medieval battle axes might be a better analogy: all edges and pointy parts and blunt ends that cut and bludgeon in several different directions at once.

The first and most obvious effect is that people tend to use services less if they have to pay for it themselves, and more if it’s free. This effect alone swings both ways: on one hand, people may over-utilize health care services if they have no part in paying for their care; on the other hand, people may under-utilize services if they do not have the basic funds to pay the share asked of them. This plays out in some interesting ways in the doctor’s office: it is not unusual for patients on zero-copay plans to ask for prescriptions for over-the-counter medications like ibuprofen (which costs pennies per pill out of pocket) because it is free if they have scrip in hand; there is also the often remarked-on (but rarely witnessed, and most likely apocryphal) phenomenon of Medicaid patients hitting up a second or third urgent care if they don’t get antibiotics from the first, because it costs them nothing but time to do so.

Conversely, a patient on a high-deductible (or high-copay) plan is likely to under-utilize services, and this is often a far more dangerous – and ultimately expensive – proposition. This is the patient who avoids a primary care copay for a respiratory illness only to end up in the emergency department with pneumonia, or the patient who puts off a recommended colonoscopy only to end up with colon cancer that could have been removed as a polyp if preventive care had been pursued. Insurance companies often limit their liability on these cases by setting lifetime limits, and otherwise capping how much they may have to shell out for early care delayed.

A similarly tangled net of motivation surrounds compliance with treatment that individuals pay for or receive for free. Set the financial bar too high, and patients are unlikely to follow doctor’s suggestions at all; however, there is also a reverse effect: if you make a person pay a little for their medication, they may place more value on it than if they got it for free. Some studies (albeit with major confounders) suggest higher rates of compliance for more expensive medications, not lower rates, because people don’t throw away stuff they’ve invested in.

Throw another twist onto this mire: some services have several equivalent varieties that come at highly variable cost, and the way in which you proportion out that cost to the consumer profoundly affects the services they engage in. You can pay, for example, less than $5 a month for a generic cholesterol drug; you can also pay over a hundred dollars a month for brand-name Lipitor or Crestor, and most patients would be hard-pressed to tell you on what grounds you should choose the $5 version or the $100 version. Most insurance companies align their own financial good with overall cost-control by charging the patient more for the expensive stuff, as most patients do not need the expensive stuff for basic conditions like allergies, blood pressure, cholesterol, and early diabetes care. But the pharm companies end-run this planned utilization by handing out coupons that cover the copay for branded drugs like these…a superficially charitable act which really serves to shift cost off the consumer for drugs that the average patient should not require in the first place. Most patients would choose the $5 version over the $30 copay for the $100 version – but if their copay goes to zero for the expensive stuff, the best deal becomes the one that costs the system far more than it should, even if the individual saves a few bucks. (This is also the principle behind free samples of branded medications: get people comfortable with the expensive stuff so that eventually they prefer it to the cheap stuff.)

One more layer of complexity, please if I may: in an era of increasing deductibles and copays, paired with one of the harshest economic environments in the last half-century, the net effect on health care utilization by increases costs to the consumer is not additive – it is exponential. Under usual economic modeling, adding a hundred dollars to the cost of a medical product would simply shift demand a little bit – a few people would rationally drop out of the market, wait, put off, decide they don’t need a service. Under the current circumstance, the confluence of unemployment, higher premiums, higher deductibles and high-deductible plans has created something explosive: a whole class of people who are “insured” but who (by choice or force) receive no care at all – or who undergo radical economic hardship any time a health issue arises. This is a small but significant part of why the major insurers have seen record profits for three years running even in the midst of a radical downturn in the rest of the economy, and no small part of why these are not popular players on the health care stage: with high-deductible plans, they are able to collect premiums on plans that patients will not, or cannot, ever utilize.

The overall question then becomes: how do we set copays and deductibles to best motivate consumers and providers toward maximal utilization – that is, using resources judiciously but without impairing necessary care?

First of all, high-deductible plans are almost always a bad idea. They are often the province of older workers waiting on the Medicare years, who can (if not comfortably) cough up the $5000 deductible for a major illness. It just so happens that this is the same population for whom preventive care is ramping up – and at least in my experience, it is the patients with high-deductible plans who put off mammograms, colonoscopies, routine lab screenings, and care for early signs of disease because these so rarely seem justified given the 100% out-of-pocket cost. Conversely, younger consumers tend to need less routine services, but also tend to have less fluid cash or savings they can dip into to meet that large deductible. The only time these plans work well is when the patient is merely lucky: healthy, and happens to stay that way until some better insurance product falls into their hands.

Second, transparency of cost of is vital to cost control. Consumers should know how much their care costs, and if equivalent options at various prices are available, the cheap ones should cost less to the consumer unless there is compelling reason why they need the more expensive one: as unpopular as this may be, this is key to reigning in cost control nationally, and cannot be avoided.

Third, we can use evidence-based modeling to set premiums, deductibles, and copays to best effect optimal utilization for different population groups. You better bet the insurance companies have past human behavior in mind when they raise rates by double digits even in the harshest of economic times; similar approaches can be used to set sliding scales for contributions from people on various ends of the scale, especially in the vast government insurers: Medicare, Medicaid, Tricare, the Veterans Administration, S-CHIP, and the like. Some people should be paying nothing for care, because even a five-dollar copay on their part may be disastrous for them and the rest of us (eg. adults living in urban homeless shelters, where the most innocent cough can be a red flag for tuberculosis). Sliding up the scale, others should be throwing in a little or even alot more: it prevents overuse, and gives that little kick of compliance that may otherwise be missing.

Overall, health care cost distribution should depend on the same parameters we would like to think that all medicine should be based on: rational, sane planning rooted in the evidence we have, adjustable to a constant stream of feedback, and bent of servicing the health of the greatest number of people possible…parameters which alternately dovetail and clash with the profit motive that drives a majority of insurance providers today. Finding ways to bend these priorities away from profit alone and back around toward the achievement of optimal health outcomes…that is the crux of the issue.

Cross-posted from my recently re-located and re-launched blog, now found at America, Love It or Heal It.

Geri Allen Trio

The Experimental Movement

Geri Allen - Piano
Dave Holland - Bass
Jack DeJohnette - Drums

I'd like to come back as Geri Allen next time.

posted by Anthony McCarthy

A Guest Post By Anna: A Literary Canon of Women Writers, Part One: Before the Common Era

(Echidne's note: This post is the first in a Sunday series about women writers by Anna.)

As you know, many attempts to create a canon of Great Literature leave women's writing out. So I thought it might be helpful to create a canon solely of Great Literature written by women. I certainly don't claim this is the final authority, and if you want to make your own canon I think that would be excellent. But I thought this might be a starting point for people who wonder where all the great women writers are, or whose teachers just can't think of any literature by women worthy of being included in the class.

I have organized the canon by the chronological order of the authors' births. The first post in this Sunday series covers the authors we know about who were active before the beginning of common era:

Enheduanna  (2285-2250 BC): She was an Akkadian princess as well as high priest of the Moon god Nanna (Sin) in Ur. She was the first known holder of the title "En Priestess", a role of great political importance which often was held by royal daughters. Her Sumerian Temple Hymns are regarded as one of the first attempts at a systematic theology. A translation of them (she wrote in Sumerian) is available in Princess, Priestess, Poet: The Sumerian Temple Hymns of Enheduanna,  by Betty De Shong Meador (2010).  Enheduanna is the world's first known author; that is, the first author whose writings have come down to us today and whose authorship we are certain of.

Sappho (approx. 630-570 BC): The translation of her poems (she wrote in ancient Greek) Sappho:  A New Translation by Mary Barnard, is particularly good. Her poetry was well-known and greatly admired throughout antiquity (although little of it survives today) and later Greeks included her in their list of nine lyric poets. She set her poetry to music, and there is a charming story that Solon of Athens heard his nephew sing a song of Sappho's over the wine and, since he liked the song so much, he asked the boy to teach it to him. When someone asked him why, he said, "So that I may learn it, then die." A few centuries later, the famous Roman poet Horace wrote in his Odes that Sappho's lyrics were worthy of sacred admiration.
I apologize if the writers in this series turn out to be rather white, straight, able-bodied, and American/European centric etc, but information about marginalized writers can be hard to come by. Suggestions for additional writers and works that might be included are welcome in the comments.

Fools Who (didn't) Get Taken Are The Least of The Problem [Anthony McCarthy]

Harold Camping's apocalypse didn't happen and so I need a topic to write about. All of those worldly ills still need to be addressed, all of those issues to be dealt with are still pending.

It's an error of category to think that Camping's second announcement of the end of time is a religious happening. It was a scam and a PR campaign of exactly the same type as those mounted by Glenn Beck, right down to the Armageddon theme. So, now we can look at it and ask some questions as to what, if anything, should be done about it other than the flood of futile derision that is as useless a distraction as those signs and billboards announcing the end came yesterday.

Mass communication of the kind that radio and TV bring, verbal and pictorial communication that doesn't require much effort or thinking is what makes the size of these scams possible. That's been known since the first decade of radio. Its propaganda potential was one of the most obvious things about it, which is why as seemingly unlikely a President as Herbert Hoover saw the need to regulate its use. It was never regulated tightly enough to prevent its abuse in the United States, demagogs, con men and every other kind of crook has used it all along, many of those pitching their con with religion but many others with "cutting edge science". Long time readers of my posts will remember "Dr." Brinkley who quite literally cut.

Some of the reports I heard said that Camping made more than 70 million dollars from his Family Radio network despite his victim base being quite small in the world of broadcasting. I haven't seen figures to compare his audience to that of Beck or the myriad of mostly secular right wing gold and survivalist peddlers that infect the public airwaves. I don't see any reason that such an operation couldn't be regulated to prevent the worst of abuse but, as con men always find a way, their lawyers would find work arounds to get money from a targeted audience of dupes. So that's probably not the level at which it can be restricted.

I don't know if it would be possible to at least restrict the licensing of stations and networks to put a buffer between license holders and the oily crooks that use them. Forcing station owners to reject the worst of it or to lose their licenses would seem possible, having a broadcast license isn't a right, after all. I would also favor doing away with the artificial distinction between broadcast and cable. Cable has grown to the extent that all of the malignant potential of broadcast has gone over wires.

The People and their right to effective, realistic self-government is superior to any commercial "rights" held by corporations and other crooks. I think that eventually the choice comes down to forcing the media to serve the public or the death of democracy. One thing that can't be split into ever tighter bandwidths is the attention that voters have to absorb accurate information. Any kind of lie or distraction that takes up their time should be considered as deducted from the limited daily requirement to allow democracy to function. That's the choice that we'll eventually have to face unless we want to face an entrenched despotism in which we're all set up to be victimized in just the same way that those pathetic Rapture-rubes have been. Not facing up to that as the real lesson of Camping's con job puts us all into that category.