Trigger Warning! The Rape Game

Anthony McCarthy sent me the link to a blog post about an Internet rape game that has been sold in Japan (though it looks like such games might now be banned there, too):

Unfortunately, the Japanese production house Illusion seems to think it provides quality entertainment. In 2006 they released 'RapeLay,' after the previous titles 'Battle Raper' and 'Artificial Girl.' The premise… well, ready for this?

Players stalk a female character as she waits for a train in the subway station. Apparently, you can even virtually pray for a gust of wind that blows up her skirt to peek at her underwear and fondle her body while she tries to fight back. Sure sounds familiar so far–can anyone say post-traumatic stress?

Next, the goal is to rape the woman… followed by her two virgin daughters (pictured on the cover above). According to Persia:

One of them resembles a girl of about 10 and, horrifically, you can see tears coming out of her eyes. "Sniff… sniff… I w-w-want to die," is one of the comments she's automated to cry.

It still gets worse. Players invite friends to participate in gang-raping the children and if the woman becomes pregnant, she must be forced to have an abortion. Otherwise, she becomes more visibly pregnant with each subsequent rape. Should she finally have the baby… GAME OVER.

The comments to the linked post are interesting to read, because they bring up many of the old questions about whether 'thought crimes' are crimes at all, whether games like this are no worse than murder games (are those legal?) or war games (where the other side is at least armed).

But the most relevant comments are the ones who ask what the impact of such games might be. If people who play them don't actually get encouraged to rape women and children in real life, the thinking seems to go, then there's nothing really wrong in such games (though of course one would always avoid people playing them). What this boils down is that we must first show real rape victims and to show, very clearly, that they became victims only because the rapist played rape games first.

I doubt that such a study could be carried out unless there were a very large number of extra rape victims in a relatively short length of time, because of the problems inherent in conducting such studies. For instance, people likely to play these games are probably already more misogynistic and fascinated by the idea of rape. Otherwise, why would they play the games in the first place? Given that tendency, how would one go about proving that it is the games themselves which increase the likelihood of real-world rapes and not the pre-existing qualities of the individuals? That would require a comparison group of potential rapists who don't play these games. See how tricky all that research can be?

What arguments like the ones attached to the quoted post usually miss is the possibility that games of violence, including games of rape, make violence look more acceptable, more run-of-the-mill, more like a game. Such effects would be hard to capture in a study, yet they could be the way these games change the risks for women and children.

As an aside, I find it fascinating that so many commenters on that thread state very clearly that they would avoid anyone who chooses to play these games. But of course we have no idea who it is who plays these games, so nobody gets ostracized by all the virtuous ones among us. As long as such 'games' are played secretly they have no social disapproval attached to them.

Terry O'Neill elected NOW president (by Suzie)

I wrote about this election Friday. Here's more about O'Neill from NOW, including:

"NOW is the organization that fights for the rights of all women no matter the circumstances of their birth, their race or sexual orientation, no matter if they live in poverty or are trying to escape violence," said NOW President-Elect Terry O'Neill. "My experience with domestic violence, as an abused wife left me humiliated and embarrassed. I only began to talk about this publically five years ago as I realized that to keep quiet was to continue the abuse. I want to empower women and telling my story does just that. Women are fed up with persistent inequality and are ready for change. I am honored and eager to lead NOW in making that change."

The AP notes her age first and then her skin color, along with those of her opponent, Latifa Lyles. Other attributes got left by the wayside, presumably because AP didn't think readers were interested in any more.

The Indianapolis newspaper had a longer story. If you wonder why it quickly shifts focus to a man, it's probably because the reporter was looking for an angle, but it's an old and tired angle. Reporters in the 1800s were marveling at men's support for women's rights.

Here's an article from Maryland, where O'Neill is based. Here's NPR.

At BlueOregon, Kristin Teigen attacks Clinton supporters who criticized NOW President Kim Gandy for strongly supporting Obama after the primary. Gandy endorsed Lyles. Teigen writes that NOW remains strong and vital despite differences of opinion. But after her candidate lost, she updated the blog to say:

Sadly, Latifa Lyles lost the presidency tonight by a mere 8 votes, leaving many progressive, multi-issue, diverse feminists looking for a new home for their money and energy.

Valhalla, at Corrente, says:

I have to admit, I'd pretty much written NOW off a long time ago as an DC-insider suck-up organization. And Kim Gandy's choice of Obama-worship over substantive advocacy for women last year would have been a turn-off in any case. But the recent election of new NOW president Terry O'Neill has allowed me, well, a bit of hope.

Reclusive Leftist was joyous (and my thanks to her for bringing the election to my attention).

Greta Von Susteren hails the victory, saying NOW may reach out to all women now, no matter what their politics. (Huh?)

Veronica at Viva La Feminista live blogged the convention, and she supported Lyles. She says, "The Sarah Palin supporters swung this election." Feel free to suggest other links in comments.

Happy Fathers' Day

To all the fathers who might be reading here (*makes a very surprised face at the idea*). Cab Drollery has a link to a great photo gallery of good fathers in the wider animal realm.

Well, the pictures are great. Some of the texts aren't terribly clearly though out. For instance, though it's true that in many species it's the female who does all the parenting it's also true that in a very large number of species (insects, say) parenting doesn't amount to much from either parent and yet in others it's the herd or the pack which at least contributes to the parenting of all its young. But whatevah.

I Never Promised You A Rose Garden

That old song goes well with the current political will to strip the health care change proposals from any mention of that nasty "public option" possibility. How far have we fallen! Wasn't it only a few months ago when a public insurance option seemed a certainty and even a single-payer system could be dreamt about?

Well, all that turns out to be the proverbial rose garden, the one we were not promised. Honest. And this is true, despite the fact that the majority of Americans surveyed in almost all the recent polls do want a public option. The most recent poll results:

Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.

The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.

Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents' own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.

That paradox was skillfully exploited by opponents of the last failed attempt at overhauling the health system, during former President Bill Clinton's first term. Sixteen years later, it underscores the tricky task facing lawmakers and President Obama as they try to address the health system's substantial problems without igniting fears that people could lose what they like.

Nate Silver has a good post on various health care opinion polls. His conclusion is that the majority of people do, indeed, want a government-provided insurance option to be included.

So why are the politicians so veryvery scared of that possibility? Draw your own conclusions, after checking out where the funding comes from and who meets whom at Washington D.C. cocktail parties. Or I may just be nasty here.

Nausea in Iran

Trigger Warning: Violence


She died in front of my eyes, on a video from Iran, a video I hadn't intended to click on and then it was too late. I'm bent over double with nausea. She was a young woman, demonstrating against her government. Now she is a young woman, dead. It's not a movie and she will not rise again, laughing while wiping off all that ketchup from her face. It's real. It's for good. And it's wrong, on so many levels.

My nausea is unimportant. But not the general nausea of these events, the nausea elicited by those Americans who use all this for political gamesmanship, turning it all against Obama or for Obama, checking first on blogs which side they should be supporting, checking if they should be for the demonstrators or for Ahmadinejad, based on the overall political value of each package. And I wasn't that far removed from those types of thoughts. Because on some level the total package does matter, of course, and on some level it's the clerics who are going to keep almost all the power, whatever the results of this election. And I wasn't at all certain that women's rights in Iran would be improved from their current level, whoever won the election.

But then she dies in front of my eyes and it doesn't matter how much I tell myself that people, women and men, are killed all the time for their political beliefs, all over this damn planet. She got butchered on the street, just like that, for demonstrating. And still the Iranian women go out there:

I also know that Iran's women stand in the vanguard. For days now, I've seen them urging less courageous men on. I've seen them get beaten and return to the fray. "Why are you sitting there?" one shouted at a couple of men perched on the sidewalk on Saturday. "Get up! Get up!"

Another green-eyed woman, Mahin, aged 52, staggered into an alley clutching her face and in tears. Then, against the urging of those around her, she limped back into the crowd moving west toward Freedom Square. Cries of "Death to the dictator!" and "We want liberty!" accompanied her.

There were people of all ages. I saw an old man on crutches, middle-aged office workers and bands of teenagers. Unlike the student revolts of 2003 and 1999, this movement is broad.

"Can't the United Nations help us?" one woman asked me. I said I doubted that very much. "So," she said, "we are on our own."

Saturday Critter

The backstory to these pictures is as follows: FeraLiberal (who took the pics) climbed on the roof to clean the gutters (and to take pics). Pippin The Cat decided to come and supervise by climbing a nearby tree and then jumping from it to the roof.

Find the cat (by Suzie)

This is my dear departed Boots, lying in the liriope. ETA: For those with poor screen resolution, she was very much alive then.

Sex & humiliation (by Suzie)

Remember the stories that suggested female bullying was just as bad than male bullying because boys got it out of their system in quick fights, while girls inflicted mental cruelty?

Maybe not. Exhibit A: The “animalistic brutality” of “the boys' middle school locker room,” as described in this newspaper article, written after a 13-year-old accused four classmates of rape. The reporter quotes Susan Lipkins, a psychologist and author of "Preventing Hazing: How Parents, Teachers and Coaches Can Stop the Violence, Harassment, and Humiliation," who says half of the reported cases involve sexual assault. The reporter adds: “That's because anal penetration is the ultimate form of humiliation.”

Because it’s associated with gays? Yes, in part, but I’m sure the boys accused of using a broom handle and hockey stick don’t consider themselves gay. Apparently, penetrating isn’t humiliating; being penetrated is. Being penetrated makes you someone’s bitch, someone’s woman.

If boys think anal penetration is the ultimate humiliation, what does that say about the trendiness of anal sex among heterosexual adults?

If I ever want to NOT be in the mood, all I have to do is read a lad mag like Details, which ran this story in 2007 about the popularity of anal sex among heterosexuals. (The link is not safe for work.) Actually, the article is about men penetrating women, never women penetrating men, as in the popular video “Bend Over Boyfriend.” In the article, some men say they like anal sex because it’s a score they can brag about with other men, or they feel like they’re dominating the woman.

As long as sex is seen as a way to dominate others, to humiliate them, to prove superiority, we can’t escape rape.

NOW election (by Suzie)

The national NOW conference begins today, with a new president announced on Sunday. The Associated Press reports:

Delegates will be choosing between Latifa Lyles, a 33-year-old African-American who has been one of [President Kim] Gandy's three vice presidents, and Terry O'Neill, 56, a white activist who taught law at Tulane University, who was NOW's vice president for membership from 2001-05, and who most recently has been chief of staff for a county council member in Maryland's Montgomery County.

As a young black woman, Lyles says, she can change the perception of NOW, whose members are predominantly older and white. Maybe she can, but NOW has had other officers who were women of color, and people seem to forget that. Here are its founders. The second president of NOW, Aileen Hernandez, was black. She was elected in 1970.

In the AP article, Jessica Valenti, founder of Feministing.com, says young women would be more excited if Lyles was elected.

"When you think of NOW, you think of white middle-class feminism — 70s feminism," Valenti added. "A lot of younger women are tired of seeing the same kind of leadership over and over. ...They're getting excited about smaller, local feminist organizations, more youth-led, doing more cutting-edge work."

In Salon, Judy Berman also favors Lyles, criticizing NOW for lagging behind in technology. She thinks Lyles, who uses Facebook and Twitter, will change all that. She suggests O’Neill’s tactics will be outdated.

Former NOW President Patricia Ireland notes that Lyles is part of the current NOW administration, endorsed by Gandy. She asks: Why didn’t Lyles initiate more technological change as a vice president?

I want young women involved in feminism, but I’m uncomfortable with the idea that it is natural for young women to prefer other young women, and that youth = cutting edge. It would be equally insulting for a woman of my age to suggest that older women are better and that older women would be more excited to elect one of their own. (I identify with what Katha Pollitt wrote recently: I was too young for the second wave, but apparently, too old for the third wave.)

Ireland argues that NOW must be more willing to confront other progressives and the Obama administration. I'm all for that, no matter who wins.

Dan Froomkin Fired?

That's what I read at the Politico. Is Froomkin not popular enough? Is he too lefty? What's going on here? How many liberal writers does the Washington Post have?

I have always liked Froomkin's columns, because they are crunchy (information filled), nutritious (fact filled) and spicy (opinion filled). So I'm sad now.

On Fathers

I'm listening to a public radio program about good fathers, though I doubt the participants think of themselves that way. It's all very touching. It also made me ask myself how one copes with being without a father altogether, either because one just isn't around or is around but doesn't act as a loving parent. What is it that one needs to patch up, if anything? How does one cope later on? And is this different from daughters and sons?

All this could be asked about absent mothers, too, but it's more common for fathers to be absent, either in flesh or in spirit. Are the scars from that experience (if there are any) painful or not? And how does one learn to be a good (or really good enough) parent in general?
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Added later: This post isn't really about the gender of the parent that might be missing but about the idea that a person is in some sense choosing not to be present, a person which the society judges should be present.

Oh The Silliness

That's what I sighed after reading about the new bipartisan health care proposal:

In an attempt at bipartisanship, three former majority leaders of the U.S. Senate, Tom Daschle, Howard Baker, and Bob Dole, offered their solution today to the biggest obstacle to achieving health care reform -- a public option.

"While I feel very strongly that consumers should have the choice of a national, Medicare-like plan, my colleagues do not. . . But we were concerned that the ongoing health reform debate is beginning to show signs of fracture on the public plan issue, so in order to advance the process of developing bipartisan legislation and to move it forward, it's time to find consensus here," Daschle said.

"We've come too far and gained too much momentum for our efforts to fail over disagreements on one single issue," he said.

Let's rewind this movie. Let's go back to the starting point which is a country with nearly fifty million people without health insurance and the highest percentage of Gross Domestic Product spent on health care in any country (of any size) in this world. THESE are the two major problems to be grappled with. How does the bipartisan proposal work this?

Well, we get some ideas from this:

Daschle, Dole, and Republican Howard Baker released a bipartisan plan yesterday that would tax some employer-provided health insurance premiums, require individuals and large employers to buy health insurance, and create public insurance pools run by states instead of the federal government.

...

In a bid to blunt Republican opposition to setting up a government-run insurance plan for those without coverage, Dole, Baker, and Daschle suggest giving states, instead of the federal government, the option of establishing insurance-purchasing pools. These pools would extend coverage to everyone regardless of their health status or ability to pay, Daschle said.

Under the group's plan, taxes on employer-provided insurance premiums would vary according to regional differences in healthcare costs.

The tax on benefits would generally start when annual premiums exceed about $15,000, using as a model the benefits packages of federal employees.

What this version of the public option guarantees is that all the 'bad apples', the high cost cases, will end up in those state funds. That makes the average premia in them rise and that, in turn, makes the public option unattractive to most individuals. Also, the public option will look like it's a failing one, because it will have gathered all the expensive cases and so it will cost a lot.

Add to that the tendency of some states to cover such programs much less well than other states (just think of Medicaid), and you can be assured that the public option will fail to gain any popularity.

I haven't done the work to find out if this proposal requires private insurance companies to take on some percentage of high-cost cases, but I doubt that very much. Indeed, the whole proposal sounds less bipartisan than it sounds Republican, because it includes all their major points: taxing health insurance benefits and not demanding anything at all from the insurance industry.

Senator Cuntface

The title was taken from comments to this YouTube video about Senator Barbara Boxer asking to be called not ma'am but Senator by Brigadier General Michael Walsh:





And the Christian Science Monitor, usually a calm-and-collected kind of place, had this to say on Boxer's behavior:

Brigadier General Michael Walsh appeared before the Senate Committee on Environment and Public Works yesterday to discuss the restoration process of the New Orleans' levee system due to the damage created by Hurricane Katrina.

There's still a lot of work to be done. Billions of dollars have been spent and there are no permanent structures in some areas that would prevent such a disaster from occurring again.

Obviously Committee Chairwoman Barbara Boxer has a right to be concerned with this. After all, it's her committee.

Did she voice her concern?

Absolutely. But what got her most rankled was when she wasn't addressed properly. It seems that "ma'am" — a term deemed appropriate by a Military Protocol guide — isn't good enough for the senator. She demands the title "Senator". So much so that she interrupted his testimony to scold him for the apparent lack of respect.

Respect my authoritay

When beginning to address one of her questions, Boxer Senator Boxer immediately cut him off to correct him.

"You know, do me a favor," Boxer Senator Boxer demanded. "Could say 'senator' instead of 'ma'am?'"

"Yes, ma'am," Walsh answered.

"It's just a thing, I worked so hard to get that title, so I'd appreciate it, yes, thank you," Boxer Senator Boxer continued.

"Yes, senator," he said.

And on my short tours of some larger blogs I find general agreement on this particular topic: Boxer is an ass or worse. So I have to write about the other side to all this.

A woman of Boxer's age has had plenty of experiences of sitting in a room with other dignitaries, hearing how they are called by their last names while she's called Barbara. I'm absolutely certain of this. She has probably also had experiences where it seems that people are trying very hard not to use her proper title while using the proper titles of others in the room. Which reminds me to check what General Walsh called other Senators in the room. If he called them 'Sir' then 'Ma'am' is perhaps justified on the basis of military use. If he called them 'Senator' then not.

I once talked with a medical researcher, a physician, who told me about his time at the ER. Once the physicians there had a big row, having to do with the female physicians' refusal to be called by their first names in front of the patients. They insisted on being called Doctor LastName.

This, to the male physicians, was a sign of arrogance and bitchiness. The resulting quarrel was not good for smooth cooperation, so the man I talked with was called in as an arbiter.

What he found out was this: It was the custom of this ER to call nurses by their first names and physicians by their last names (which in itself tells us something interesting). When the male physicians insisted on calling the female physicians by their first names the patients assumed that they were also talking to a nurse, not a physician. This made the female physicians works harder.

The point of this story is not argue that Senator Boxer's work is made harder by her being called ma'am, but to point out that the experience of women is often very different from the experience of men and that there may be reasons why Senator Boxer is sensitive to this particular question of proper titles.

More On Family Values And Senator Ensign

Steve Benen writes about Ensign's adultery and its consequences:

Ensign has also been a fierce opponent of marriage equality, and supported a constitutional amendment to ban gay marriage. In 2004, the Nevada Republican lectured his colleagues, "Marriage is the cornerstone on which our society was founded. For those who say that the Constitution is so sacred that we cannot or should not adopt the Federal Marriage Amendment, I would simply point out that marriage, and the sanctity of that institution, predates the American Constitution and the founding of our nation."

And did I mention that Ensign is a longtime member of the Promise Keepers, a conservative evangelical group that promotes strong families and marriages?

Mmm. The point about discussing Ensign's private life is of course that he is a hypocrite by demanding in his political role others to act in ways which he himself cannot maintain. But I'm more interested in Steve's assumption that the Promise Keepers promote strong families and marriages.

In a way they do, but the written materials of the Promise Keepers tell us that this comes at a steep price: The willing subjection of women to male leadership, not just in religious matters (the man is the priest of the family) but in everything having to do with family life, including family finances. And women are not allowed to attend the Promise Keepers' meetings (or at least were not allowed when I followed the movement more closely). To me it looks like a system where men are promised something (you get to be the boss!) in exchange for otherwise better behavior as a husband and a father.

Watch On The Wild Side

It can be a useful exercise, to watch what the conservatives are talking about. Here are some of the universal themes of the fight against health care reform:





Fear. That's what's for dinner in Wingnuttia every day. If it's not Islamic terrorists we are supposed to fear it's socialism in health care. The idea that someone else might decide on your health care consumption! Not that it ever happens today.

And the video at this Media Matters blog tells you how abortion is discussed on Fox. It's not only opinions across the aisle that differ but also what is seen as facts.

The Deep Question Of The Day

Why does Senator Ensign need to apologize publicly for his affair but not for having belonged to Promise Keepers?

I'm half serious.

Bloggers Are Famous!

Who knew? I didn't, what with living in the forest all alone on top of my pillar, but Eric Boehlert has written a whole book about bloggers: Bloggers on the Bus: How the Internet Changed Politics and the Press. Maybe he could send me a review copy? Sniff.

Amanda is participating in a conversation about this book at TPM Cafe's Book Club. I wonder if she will ask why all the political books these days have those very very long titles, almost Victorian. Like in: Wingnuts Stink. Being the Chronicles Of A Hermit Snake Goddess Pretender, With Appendices Containing Recipes for Chocolate Covered Ants.

More soberly, blogging IS an interesting phenomenon. One day we are going to read in history books how people used to blog before Twitter which was before the Whole Body Experience Internet Games which was before the End Of The World As We Knew It. Or something similar.

We should all be proud of living in the wild west era of the cyberspace. Especially the trolls. I bet no trolls will be allowed in those Whole Body Experience games of the future.

What Is Funny?

One of you sweet and erudite readers once pointed out that much humor is aggressive, intended to attack someone in a way which has an in-built defense: I was only joking!

Something like that must be at work when people make sexist or racist jokes. We have examples of the latter from a few conservative sources: First one wingnut made a gorilla joke about Michelle Obama. Then another passed on an openly racist joke about Barack Obama. Both joke-makers have apologized or near-apologized, by the way.

What makes those jokes racist is of course the fact that they are not just about the Obamas but about all people of color, just as sexist jokes are not only about the woman superficially attacked but about all women. Likewise, what makes jokes like that 'funny' is the person's ultimate agreement on whatever racist or sexist premise the jokes use as their launching point and the delicious shock one gets when the premise is expressed openly. Or so I think.

But of course I have no sense of humor, being a feminazi with the intention of turning all men into eunuchs. Hence the shearing scissors hanging off my belt and my inability to laugh at funny jokes.

What's funny is this: Jokes about other groups can be very funny even when they are based on silly group stereotypes, as long as the group being made fun of is roughly equal in power with the group the joke-teller belongs to. The British joking about the French doesn't come across as really insulting and neither do those old jokes about a world of either heaven or hell based on which European country provides the lovers, police officers and chefs, because nobody is earnestly ranking those countries in terms of power, ability and such.

The funniness of jokes can get pretty complicated when we introduce people of a particular group telling demeaning jokes about their own group, say, or when friends kid around about the racial, gender or ethnic groups of each other. Mostly the premise of those kinds of jokes is a more intricate one than in the former case, because the laughter may be double-layered: At first one laughs at the surprise of the joke coming from that person and then one laughs at the premise itself. Or perhaps not. It could be that we internalize all sorts of crap and find ourselves laughing with our enemies?

Mirror, Mirror On The Wall..

Shakespeare's Sister has a good series on beauty. She points out that you can never be beautiful enough, and that made me immediately think of the Evil Queen in Snow-White.

The Evil Queen's desire to be the most beautiful woman in the world is not subjected to any kind of analysis in the fairy tale. We are never told why she is that way, though I guess we are to assume that she is just thoroughly evil, that nobody would treat her at all differently if her beauty suddenly wilted. She is simply a woman driven by her own vanity, aging and ruthlessness. Fairy tales...

Ancestress Blogging

The Costs Of Health Care. Part IV: Whom To Blame?

Is it the malpractice suits where careless and greedy individuals suck the system dry so that obstetricians stop practicing altogether due to the high insurance premia and all doctors over-prescribe tests in the form of defensive medicine? Is it all those illegal immigrants crawling across the border nine months pregnant, with other babies strapped to their backs, so that they can come and use American health care?

That's what the wingnuts would have us believe. But in fact the effects of malpractice suits and malpractice insurance are minor when compared to the overall health care costs, and this even includes the so-called defensive medicine. Likewise, illegal immigrants are too few to account for the high costs of health care, even if they suddenly decided to act like the worst right-wing stereotypes.

Sadly, the left is not doing any better. Almost every conversation I read about this topic blames the pharmaceutical companies or the greedy health insurance system for the high health care costs, or most generally, just the profit motive. But prescription medications only account for roughly ten percent of health care costs and many health insurance providers are not-for-profit organizations. HMOs are predominantly not-for-profit. There are still more beds in not-for-profit hospitals than in for-profit hospitals, and roughly half of all nursing homes run on the not-for-profit basis.*

On the other hand, that old myth about the kindly physician practicing all alone from his or her office is both highly valued on the left AND a description of a for-profit entrepreneur. It's as if we all wear blinders when discussing health care.

Looking for a culprit may not be terribly useful, but for those who wish to do that, let me point out that the largest cost item in the U.S. health care is hospital use. Indeed, if we lump nursing homes and hospitals together as institutional care we note that more than half of all health care spending goes there. The next largest source of expenditure is physician services.

Now, such an accounting approach to health care doesn't tell us much about whom we might want to blame. But it does point out those areas where even small percentage savings in costs could mean large piles of actual dollars saved.

An alternative way of approaching this question is to note that the largest health care expenditures usually take place in the year immediately preceding a person's death. It is terminal care which is expensive, for obvious reasons. It's probably equally obvious why addressing the high costs of end-of-life care is fraught with ethical and legal problems of all types.

I'm not convinced that any of these simple approaches are terribly useful, because the real reasons for the high U.S. health care costs are complicated. Really. The world, in general, is complicated. But looking at the incentives the current system provides all the various participants might be useful to do. How do the private firms compete in health care? Why isn't competition lowering prices? Do we pay physicians in a way which gives them incentives to spend money inefficiently? Do we use paramedics and other health professionals in the best possible way? What incentives do we give patients who are insured or uninsured? And so on.

I suspect that all those simple scapegoats I listed at the beginning of this post are partly chosen because they wouldn't only offer us simple solutions to the high costs. They would also offer almost painless solutions! Just get rid of those greedy malpractice suits! Just get rid of those greedy insurance companies! Note how nothing of value needs to be cut when the stories have those plot.

In reality something of value will have to be cut. The task is to find out the least valuable bits to cut or at least to prevent from growing. Sort of like economic surgery.




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*The best general source of data on health care in the United States is Health. United States. It is available on the net here, and I consulted the Chart Book (including Tables 116 and 127) of the most recent version (2008) for some of this data. Other data I pulled out of my memory.

The earlier parts of the series can be found here: Part I, Part II and Part III.

Slutty Stewardesses And Nasty Women Justices

The 'slutty stewardess' has to do with David Letterman's Sarah Palin jokes. Yes, I know all this is old stuff and we have moved on to some other interesting sex scandal. Heh heh heh. Nudge, nudge.

If you were lucky enough to avoid learning about all this, you can watch a summary by Olbermann here:





It's annoying that the video contains my major point which is that the 'slutty stewardess' joke wasn't only about Sarah Palin but about stewardesses, and that's what is wrong with the joke. It wasn't funny unless you think that you know what a 'slutty stewardess' looks like, that some stewardesses in fact are slutty, and all that is something we can agree about and laugh at. Nudge, nudge. - Of course some pilots (mostly guys) have a very slutty reputation, too, but we tend not to make jokes about that occupational group. Or many other dominantly male occupational groups with possibly slutty members. Whatever 'slutty' might mean here. I assume it means easily beddable.

Actually, that the video contains my main point isn't annoying, but a Very Good Thing, because it gives me hope that some guys out there in Media Land are learning. And some gals, too, I hope, because we all know what the culture expects us to laugh at. It would be nice for the progressive blogosphere to learn that it's possible to dislike Sarah Palin's policies and to make fun of them without cracking misogynistic jokes. Or denying the fact that Letterman's joke was sexist.

Well, stewardesses are sometimes slutty, I have learned. I have also learned that female justices are unusually nasty, and that applies to Sonya Sotomayor:

Serious props to NPR's Nina Totenberg today. Rather than simply reporting about "concerns over Sonia Sotomayor's temperament" or allegations that she's a "bully," Totenberg actually compared audio clips of questions asked by Sotomayor and those asked by her male colleagues -- or those who would be her colleagues if she is confirmed for the Supreme Court. And -- surprise! -- Sotomayor is no "meaner" than your average justice. She is just femaler.

Yes. We do have different expectations about women and men, and this isn't totally due to some crackpot evolutionary psychology popularizations in the media (though those don't help). We expect women to be Nice (and Invisible in public spaces). We expect Good Women not to be Too Nice (nudge, nudge). And we think that making sexist jokes about women in politics doesn't have anything to do with our own inner misogynists.

On Iran

I'm not an expert on this topic, but I recommend reading as much as possible. Don't miss Juan Cole's series of posts on the Iranian elections.

The outcome of these elections also matters for women's rights in Iran. Ahmadinejad is not exactly a fervent feminist, and neither are the clerics in charge.

Extra Sunday Cute

Pics by Doug

Running From the Law. A Guest Post By Liz O'Donnell

I'm on the lam. Running from the law. What did I do? Nothing yet -but I
might.

You see, I am a mother and I just might cause permanent and ongoing harm to
others. So if I were someone, like let's just say, John Woodcock, Jr., U. S.
District Court Judge in the District of Maine, I'd throw the book at me.
Lock me up and throw away the key.

Last month Judge Woodcock sentenced a pregnant woman to 238 days in prison, instead of the more typical time-served sentence for her crime. Quinta Layin Tuleh, from Cameroon, was in court for having fake immigration documents. But Woodcock sentenced her for being HIV-positive and pregnant. He was quoted by the Bangor Daily News as saying, "My obligation is to protect the public from further crimes of the defendant and that public, it seems to me at this point, should likely include that child she's carrying. I don't think that the transfer of HIV to an unborn child is a crime technically under the law, but it is as direct and as likely as an ongoing assault.And so I think I have the obligation to do what I can to protect that person, when that person is born, from permanent and ongoing harm."

Woodcock's so-called reasoning was that he was protecting Tuleh's unborn child, as he felt the mother was more likely to receive medical treatment for HIV in prison than out on her own. Tuleh's attorney had arranged medical care for her at a nearby facility.

But why stop at fetuses? If Woodcock can protect an unborn baby by incarcerating the mother, why won't he protect all of the already born children too? Certainly, the prison system can do a better job caring for them than most mothers can.

Take my kids for example. They are in danger and need to be protected from me. Tomorrow, I might drive over the speed limit with them in the car on our way to the library. I might coerce them into jaywalking with me when I walk them to school. And there is a very good chance that in the near future I will feed them fast food which contributes to childhood obesity, malnutrition and an overabundance of cheap plastic toys in my living room.

So really, is it that preposterous to think that people like Woodcock might want to protect my kids from me? After all, behind bars I can't drive more than 55 miles per hour and I will be cut off from my Happy Meal supply.


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Added by Echidne: For more on this story, go here.

And The Climax Of Teh Cute

Doug's Sasha taking a nap.

Night Thoughts

While looking for a particular Finnish song on YouTube (the song will be found at the bottom of this post) I noticed that the YouTube comments in Finnish contain lots of woman-loathing. A mild example:

Tosi ihana! Kaunis ääni, ja ihanaa että kerranki joku miespuolinenki laittaa näitä omia tulkintojaan tänne...? Ja hieno kappale! En oikee perusta noista "me singing"-videoista missä tytöt kiekuu millon kuinkaki karmeesti bändien biisejä ja tää on siis erinomaista vaihtelua sellasille! :D

Rough translation:

Truly fine! A beautiful voice, and it's great that for once someone of the male sex puts his own interpretations here...? And a fine piece! I don't really like those "me singing" videos where girls cock-a-doodle however horribly the songs of bands and this is therefore an excellent change from that!

The particular song this was attached to is available on You Tube sung by three men and two women (based on my quick count), and I'm 100% convinced that there are more songs by men than by women on You Tube overall.

I noticed that comment because right before that one I saw a comment telling us that it was MEN (capitalized) who died for Finland in WWII and thus deserve to be the top dogs, and I immediately started thinking about how it was also men who attacked from the other side and men who decided on that war in the first place and how this particular man (born 1959) had nothing to do with the war but still wants to be revered for it.

In any case, none of this is terribly important. But it's a fact that there are very few places where I can go on the net without being prepared for expressions of anger aimed at my group. The same must be doubly true for women of color.

For another example of these sudden ugly encounters, I was reading a biography of Bertrand Russell, to relax, and learned that his book On Marriage And Morals argued that women are, on average, stupider than men and that blacks are, on average, inferior to whites. He refused to remove the statement about women, saying that it's not a good idea to flatter women, but he did later remove the statement about blacks and whites. The Wikipedia tells me the latter though it fails to mention his comment about stupid women altogether and naturally therefore also whether it was ever removed.

Here's the song I was looking for: "On Suuri Sun Rantas Autius"





It's great background music for sobbing.

Degrees of privilege (by Suzie)

Last week, a reader wondered how I could see value in the concept of privilege in general terms if I saw problems in the particulars. Let me illustrate my reasoning with the idea that whites have racial privilege in regard to the accumulation of wealth because their race hasn’t prevented them from buying homes. Houses and land have greatly appreciated in value, for the most part, so that children could inherit from their parents. That’s important to understand when you look at disproportionate poverty among people of color. But this does not explain the circumstances of every individual, of course.

On my father’s side, the family had little or no property in Russia, at least in part because of discrimination against Jews, and my father inherited no money. Thus, my grandparents showed up in the U.S. with less white privilege packed away in their knapsack than did other whites.

In Russia, as elsewhere in Christian countries, Jews faced discrimination as foreigners and infidels before people invented racial classifications. Scholar Robert Coles says race prejudice began in Russia around the time of the birth of Alexander Pushkin, the acclaimed poet born in 1799, whose great-grandfather was born in Africa.

Many people now consider Jews (like my father) to be white, but white supremacists don’t. Anyone who forgot that got a reminder this week when the nut attacked a Holocaust museum, killing a guard.

ETA: Thanks to the anonymous reader who just corrected me. I added in the phrase "like my father" to clarify. Of course, Jews can come from any ethnic background and be any skin color. Here's an interesting article at Kos.

Culture and privilege (by Suzie)

        A lot of interesting comments were made on an earlier thread about bullfighting, and I encourage you to go back and read it if you’re interested in the concept of privilege. One suggestion was that someone who is not part of a culture should take care to discuss it in the terms preferred by people who live in that culture.

        I have mixed feelings. I understand that people are more likely to listen to me if I speak their language. If I’m talking to a woman who has no problem with “female circumcision,” for example, I may offend her by calling it “female genital mutilation.” On the other hand, calling it “female circumcision” may encourage an inaccurate comparison to male circumcision, both in the effects and the reasons for the procedures.

        A couple of readers suggested that an outsider who refused to use terms commonly employed in their culture was exercising his own cultural privilege. But I don’t see how that jibes with the definition of privilege from critical race theory.

        Is this a way of saying: Because you don’t live here, you have the privilege of not needing to understand my culture? If someone in Brazil used her own terms to critique something in Mexico, would she be exercising Brazilian privilege? Or, does it only apply if one culture has advantages, or is widely perceived to have advantages, over another?
        A reader who accused the writer of privilege called this an Anglo-American blog, perhaps because it is an English-language blog in the U.S. or because Echidne is a non-Hispanic white who lives in America. Echidne is Finnish, and I don’t know how she feels about the word “Anglo,” but I dislike it because I know of no English ancestors, and my mother’s mother was staunchly Irish. I feel like others outside of Irish culture have imposed “Anglo” on us with no concern for our colonial history.
         The reader suggested Northern Europeans have privilege over Southern Europeans. That makes me wonder how we judge privilege in this case. If we judge privilege by per-capita income, Northern Europe does win out.

         Sometimes people recount history when talking about privilege, noting how one group colonized and/or enslaved another. In European history, however, people in the South (i.e., Romans) conquered people in the North. Greece, Spain and Portugal also established dominion over other lands.

        Perhaps cultural privilege relates to stereotypes used against Southern Europeans. But it's not like Northern Europeans aren't stereotyped as well. Think of the stereotype of the feisty Irish redhead.

        I'm interested in your thoughts, as this series on privilege continues.

The Court of the Patriarchs (by Suzie)

This is from Zion National Park in Utah. Patriarchs have presided over courts -- royal and judicial -- for so long that it's such a pleasure when a woman can be seated in one. 

On Widget, Sasha and Socks

This is Widget, Sasha's new big brother. Widget is still a puppy, too, though in that long-legged stage. Both Widget and Sasha belong to Doug whom we have to thank for the pics.





And here's Sasha meeting a sock.

Whatevah!

Remember this article by Frances Kissling I linked to in an earlier post? It's about the woman Obama appointed to head the Department of Health and Human Services' Center for Faith-Based and Community Initiatives, and still well worth a read.

Now Kissling has gotten a response on a Catholic blog. What fascinates me about that response is how it ends:

Of course, none of this is Kissling's concern. She merely wants to takedown a pro-life Democrat who represents a new generation of women, a generation tired of the "Stay away from my ovaries!" pro-choice shouting that Kissling made famous. The good news is that the President is evidently listening to Kelley not Kissling. The bishops who are about to meet in San Antonio should note that fact. And, we pro-life Democrats should make sure the White House knows that we applaud the selection of Kelley for such an important and sensitive position.

It's that idea of feminism as old, outdated, stuffy shit. BOOOOORRRIIINNG! This is a very common argument from the anti-feminists, and so is painting pictures of feminists as out-of-touch, ugly, desperate and no longer fashionable.

The reason I find it so fascinating is that the argument is totally superficial and really shouldn't work. Who cares if feminists are ugly as hell if they improve women's lifetime earnings by reducing discrimination in the labor markets? Who cares if they shout as long as women themselves get to keep the right to determine their own fertility patterns? Who cares what was in fashion and wasn't in fashion? Would you say that breast cancer treatment is so old-hat, so yawn-inducing, so not worth discussing, just because it and the disease it tries to cure have been around for a long time? That these arguments are used against feminism really only shows one thing to me: Women's rights are still seen as something silly, something flippant, something that can be easily stigmatized as man-hating or as not being in fashion and so on.

You can see this best by reversing the argument in the above quote: Would pro-life Democratic women really ask everyone to please poke around in their ovaries? Would they invite us all to do so provided we stop shouting?

Nah.

Women And Politics In Iran

The Iranian elections have made several newspapers write about the role of women's rights in Iran. Such pieces are not enough to make an uninformed reader into an informed one. Discussing the obligatory dress code for women may stand as short-hand for the lack of women's rights, of course. But I would have liked to read a piece which discusses the unequal treatment of women in families, in law, at work and in education more than these articles allowed. This is because I have learned that many in the West are not informed on those questions.

Here are some quotes from the articles, to get us going. First the Wall Street Journal:

In this election, the three candidates challenging President Mahmoud Ahmadinejad, whose tenure has included a crackdown on women's-rights activists, have tried to set themselves apart from the incumbent by focusing on female voters.

"Iranian women can be a major force and now candidates are realizing our support can deliver them victory and credibility," says Elahe Koulaee, a professor of political science at Tehran University and a former parliament member.

The top reform contender, Mir Hossein Mousavi, broke the taboo of mixing personal life with politics by campaigning with his wife, Zahra Rahnavard, an artist and scholar who has been dubbed Iran's Michelle Obama by local media.

Presidential candidate Mehdi Karroubi, a reformist cleric, has said he is against forcing women to wear the Islamic veil. He recently debated with his team the number of cabinet posts women should fill. Mr. Karroubi's top advisers lobbied for the foreign ministry, speculating that when relations with the U.S. normalize, the new foreign minister could shake hands with Secretary of State Hillary Clinton.

...

Last year, Mr. Ahmadinejad's government introduced two bills that would impose a tax on a woman's dowry and make it easier for a man to practice polygamy. The bills were dropped after an uproar and pressure from women's-rights activists who marched to the parliament by the tens of thousands, demanding to meet with lawmakers.

The BBC:

For women backing Mr Mousavi, or the other reformist candidate Mehdi Karroubi, they know equality has limits. It is an issue of rights: the right to study what they choose; to have a say if their husband wants to take a second wife; to do jobs they are qualified for.

"I'm a graduate from one of our country's best universities," Sara tells me in Isfahan in a quiet voice tinged with palpable frustration. "But I still can't do everything I want. I can't say everything I want."

Many young Iranians attend University and 65% of them are women.

Trained as an architect, Sara has found she is allowed to design buildings, but supervising her projects on site can be difficult, and sometimes its forbidden.

Finally, Reuters:

"Whoever comes to power has to respond to the demands of the women's rights movement," said rights campaigner Sussan Tahmasebi. "We are no longer invisible."

Activists say women in Iran are subject to discrimination that makes them second-class citizens in divorce, inheritance, child custody, legal matters and other aspects of life.

Under Ahmadinejad, there was an attempt to push women back into the "private sphere and promote them as mothers and wives," Tahmasebi said.

Iran says women in the country are better treated than in the West, where it says they are often seen as sex symbols.

Iranian women are able to hold most jobs and, unlike in Saudi Arabia across the Gulf, they can vote and drive.

But activists say dozens of campaigners have been detained since they launched a campaign in 2006 to try and collect one million signatures on a petition demanding greater women's rights. Most of them were released after a few days or weeks.

The president of Iran is of course not the ultimate holder of political power and I doubt that the Islamic clerics who do hold that power would let very large changes take place in the rights of women. It's also true that the vast majority of Iran's women are probably not in a position to even think about their general rights to a job or such, given that what happens to them is determined by the culture in their local villages and the will of their families.

And More Cute

This is like very slow sex, isn't it, this stretching out of the puppy pictures? Here's Sasha (Doug's puppy) again, this time in the jungle created by shoes. For those who are worrying, this series WILL end on Friday.

Hiding Behind Masks

Atrios posted Shepard Smith discussing the hatred he sees in his e-mail messages:





All kudos to him and the Fox News for allowing this to be aired. The validation of hatred is something I have thought about a lot. That's one bad change that the cyberspace has allowed: We walk through it masked, with a false sense of anonymity, we open our mouths and out spew all the resentment, fear and hatred we must bar in during our everyday lives. It's as if we didn't say it, after all. Some cyberspace creature did it and there's no flesh in that space, no flesh that can bleed, no bodies that die. What's perhaps worse, we may learn to take others spewing as something innocent, just a way to let off steam.

Or that's how it sometimes feels. You can find websites which specialize in White Supremacy or Male Supremacy or hatred of the Jews or of the Muslims, and those who participate there get validated in their anger and in their stereotypical beliefs, not corrected, not helped to see their grudges from a wider perspective, not made to begin the slow process of understanding.

It's not debate I want to limit or even strong feelings and language. It's the self-perpetuating enforcement mechanism which I see as dangerous, combined with more and more isolation in the sources that people use for their news, more and more of ganging up against the 'others', more and more scapegoating. The e-mails and blog comments shot into the silent space that is the news media isn't a solution to all this but perhaps part of the problem, because the masks are still on and because the lines are drawn for battle and not for debate. All that contributes to the process of 'othering' the opposition.

The masks in the title of this post are not necessarily bad, of course. Neither do I mean to attack Internet anonymity, for example, but the general feeling one easily gets that the voices in the cyberspace are not attached to real people, that what one says doesn't somehow matter as much as saying the same thing out in the street or in someone's living-room. Though locker-room talk is perfectly fine, for some reason.

I'm not sure if this makes any sense, and I wish to stress that my concerns are only about a small percentage of cyberspace exchanges. A much, much smaller percentage still would actually engage in violence because of the extra support they perceive from various websites. Still, talking about this is something we should do.

The Obama Effect?

From Atrios:

I didn't catch who was speaking on the phone to MSNBC, but he said this kind of violence can be attributed to what he called "the Obama effect," basically racist nutjobs being driven insane by President Obama.

I'm somewhat optimistic that there are fewer of these people than one might fear, but...

I presume that this refers to the Holocaust Museum murder, but it could equally well refer to the killing of Dr. Tiller. Cast your mind back to the nineties, if you can (if not, Google the Oklahoma bombing), and you might agree that there's a tendency of extremist aggressors to get more desperate when societal trends don't go their way. These people are not many. I sincerely hope that no talk show host or blogger or columnist tries to wind them up the way they did before the Oklahoma bombing.

More Of Teh Cute

Doug's Sasha who will grow into a very big girl. But note how perfectly she matches the floor in color? The necessary tactile contrast between her fur and the slick wood makes it perfect.

This is fun. Maybe I should start a cuteness blog? Instead of the stick-knitting-needles-in-your-eye-sockets blog I have now.

I Don't Like You Anymore

A new USA Today poll suggests that Republicans are not happy with their very own party:

In thinking about the Republican Party's troubles, consider this: One-third of Republicans now say they have an unfavorable opinion of their party.

There's no such dyspepsia among Democrats. Just 4% have an unfavorable view of their party.

The findings of a USA TODAY/Gallup Poll underscore the perilous state of the GOP. Over the past three years, Republicans have lost control of the White House, the House of Representatives and the Senate, and they're now struggling to forge a unified response to the popular new Democratic president.

What makes some Republicans so unhappy? It's hard to tell from that short summary of the findings (and I'm too lazy to look up the data). Perhaps the unhappy people would like to see their party more extreme? Perhaps they are pining for the good ole times, about six months ago, when America was strong?

Or do they want their party to be less extreme? But those folk have probably already fled the party.

This topic is related to what happens when some poll finds that people think the country is on the wrong track: Many writers feel that their particular complaints have been vindicated. Thus, progressive bloggers use these results to indicate that Americans would like to turn left and conservative bloggers use the same results to indicate that Americans would like to turn right. It would seem simple enough to add a question about the manner in which the country has gone off the track, to give us a bit more information. Of course this particular poll may have that question which would let us know more about it later, as the newspaper promises.

Brainy Echidna Proves Looks Aren't Everything

All Is Revealed! Here:

That rain also wipes away signs of echidna foraging and denning. It took Mr. Opiang months of searching before he found his first echidna. Then he discovered that if he followed trails of freshly dug nose pokes at night — the holes that echidnas made with their beaks as they foraged for earthworms — he could find a den where a sated echidna would be hiding. He learned to grab them under the stomach, where there were no spines. "If you hold them against yourself, they're friendly and they won't struggle," he said.

On the Internet nobody knows you use nose pokes...
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Thanks for bk for the link.

Your Daily Overdose of Cute

Courtesy of the puppy Sasha (who's going to grow into a half-mastiff) and her human, Doug.

Every Sperm Is Sacred

That's a Monty Python song (do watch the video). Interesting how we never discuss sperm rights in the abortion debates. Or do we? Don't go that way, Echidne, this is a serious post.

So Ross Douthat has written a beautiful, almost elegiac, column on abortion, with the title "Not All Abortions Are Equal." The title is meant to make you subconsciously think that women's equality is irrelevant for this topic which is defined by Mr. Douthat and concerns the way we can save people like Dr. Tiller from getting murdered.

That way is to give in to the demands of extreme anti-abortion fanatics so that they stop killing people:

If abortion were returned to the democratic process, this landscape would change dramatically. Arguments about whether and how to restrict abortions in the second trimester — as many advanced democracies already do – would replace protests over the scope of third-trimester medical exemptions.

The result would be laws with more respect for human life, a culture less inflamed by a small number of tragic cases — and a political debate, God willing, unmarred by crimes like George Tiller's murder.

God willing, indeed. Let's apply the same arguments to the Islamic terrorists: If we only gave them what they want they would stop terrorist acts against the West! Let's do that! Surely Osama bin Laden would allow us to micromanage some parts of our own lives as women? Surely?
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An update: Dr. Tiller's clinic is no more.

Me And McCaughey

Traveling is hazardous to your health because polite guest manners sometimes require that you sit silently while watching Fox News (instead of hammering the television screen to smithereens as all ethical people would do). That happened to me last Saturday evening. I was stuck listening to Betsy McCaughey frightening us to death by implying that WE ARE ALL GONNA DIE if Obama changes the U.S. health care system at all.

My blood pressure rose enough to cause bright red steam to come out of my eyes and nostrils, true, so perhaps McCaughey has a point. Her other points are biased ones, though. Here's an example:

Gigot: The Obama administration is making a kind of a core argument on health-care reform. It's saying if we insure more people, bring more people under government subsidies, we can save money. Save money--is that possible?

McCaughey:: No, it is very important that everyone has coverage. But it will not save money. Once people are insured, according to the nonpartisan Congressional Budget Office, they will use about 70% more health services than they currently do. The most problematic area of this effort is this: The president wants to slow the flow of dollars into the health-care system.

Gigot: Right.

McCaughey: That's going to force cuts in hospital budgets, fewer nurses on the floor, less diagnostic equipment available, and waits for treatment.

Note Gigot's first misleading summary. Nobody argues that giving more people health insurance would reduce the costs of health care, rather the opposite. But that's what Gigot says. Once you erect a strawperson it's easy to light it with a match and that's what McCaughey does.

In fact, the Obama plan I have read (which may be changing, of course) aims to cut costs by preventive care, by better use of technology and - most importantly - by increasing competition through a public insurance alternative. These proposals may not work, true, but to confound them with the increases in access is just unethical.

Then McCaughey goes on to argue that Cuts Must Be Made And They Will Cause Your Death, without giving any evidence on that. In any case, nurses are already scarce in quite a few hospitals and waiting times for treatment can be long even in a merry capitalist market. Besides, I thought that cutting the fat is what corporations always love doing? Why is it suddenly the case that there is no fat? Note also all those uninsured people who are already kept waiting and waiting and waiting for basic health care services.

Another example of McCaughey's remarkable method of presenting evidence in a biased way is this:

Gigot: But if you talk to the Obama administration people, they say, Look, we spend 18%, almost one out of every five dollars of this whole economy, on health care. And they say, That's too much, because the costs are rising. We've got to get this under control.

McCaughey: Well, actually--

Gigot: Are you saying that's not the right direction for policy?

McCaughey: No. Americans spend more on health care than Europeans, for example, because they earn more. Ninety percent of the difference in spending is due to higher per capita incomes in the United States. And we spend more, but we also get more. For example, American women have mammograms more frequently. Their breast cancer is detected sooner and treated faster, and they have much better survival rates than in most parts of Europe.

This is fun! McCaughey got that ninety percent figure from Uwe Reinhardt's 2001 article, I think, but she doesn't explain it correctly. It's true that health care spending is correlated with income. After all, richer countries can afford to spend more. But this doesn't mean quite what McCaughey implies. Here's a more recent graph from Reinhardt:





What does it mean? This:

You'll notice that there is enormous variation in health spending per capita in different countries within the O.E.C.D. But the graph also indicates that there exists a very strong relationship between the G.D.P. per capita of these countries (roughly a measure of ability to pay) and per-capita health spending. The dark line in the graph is a so-called regression equation (whose precise mathematical form is shown in the upper left corner).

That line tells us something important about the relationship between a country's wealth and its health care spending.

Just knowing the G.D.P. per capita of nations helps us explain about 86 percent of the variation in how much different countries pay for health care for the average person. Canada, for example, on average spent only PPP$3,678 on health care per person in 2006, which is about 55 percent of the amount the United States paid per person. But Canada's G.D.P. per capita in 2006 was also smaller than the comparable United States figure, although not that much smaller (it was 84 percent of the American level).

The line helps us estimate that roughly $1,141 of the $3,036 difference between Canadian and American health spending per capita – or 38 percent — can be explained by the underlying difference in G.D.P. per capita alone.

An additional insight from the graph, however, is that even after adjustment for differences in G.D.P. per capita, the United States in 2006 spent $1,895 more on health care than would have been predicted after such an adjustment. If G.D.P. per capita were the only factor driving the difference between United States health spending and that of other nations, the United States would be expected to have spent an average of only $4,819 per capita on health care rather than the $6,714 it actually spent.

I love this stuff, I do. What about her second point that Americans get more from their health care system than Europeans do? Some do, of course, and medical research in this country is excellent. But over forty million people have no health coverage, and the U.S. doesn't do as well in all conditions as it does for breast cancer.* Then there's that little matter of lower life expectancies in the U.S. than in the comparison countries, though of course the reasons are complicated and not only about the health care systems.

You can read through the rest of the McCaughey interview and find lots of other similar points, including the blind assumption that all technology in health care is good and useful and saves lives, however it is used and even if it only helps with diagnosis but not with the consequent treatment. Then you can have red steam coming out of your eyes, too.
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*I think some of the breast cancer success story has to do with the very active publicity campaigns and political work carried out by volunteers in that field in the U.S.. Note also that a recent study compared the U.S. with several other countries in terms of disease management for a wide range of diseases. This study (which I can't find to link to right now) found that the U.S. did well in some fields, especially in breast cancer, and not so well in some other fields.

Women under-represented in clinical trials (by Suzie)

This is a news release from the University of Michigan, and I'm posting it verbatim because I think it's really interesting.

Women are under-represented in clinical cancer research published in high-impact journals, according to a new study by researchers at the University of Michigan Comprehensive Cancer Center.

Taking into account the incidence of particular types of cancer among women, studies included a smaller proportion of women than should be expected. The analysis looked specifically at studies of cancer types that were not gender specific, including [sarcoma,] colon cancer, oral cancers, lung cancer, brain tumors and lymphomas.

The authors looked at 661 prospective clinical studies with more than 1 million total participants. Results of this study appear online in the journal Cancer and will be published in the July 15 print issue.

“In the vast majority of individual studies we analyzed, fewer women were enrolled than we would expect given the proportion of women diagnosed with the type of cancer being studied. We’re seeing it across the board in all cancer types,” says study author Reshma Jagsi, M.D., D.Phil., assistant professor of radiation oncology at the U-M Medical School.

“It’s so important that women are appropriately represented in research. We know there are biological differences between the sexes, as well as social and cultural differences. Studies need to be able to assess whether there are differences in responses to treatment, for example, between women and men,” she adds.

The National Institutes of Health’s Revitalization Act of 1993 explicitly calls out the importance of including women in clinical research, noting that clinical trials should enroll adequate numbers of women to allow for subgroup analysis.

The U-M researchers found that studies reporting government funding did include higher numbers of women participants, but the impact was modest – 41 percent, compared to 37 percent for studies not receiving government funding.

Traditionally, researchers were told not to include people of vulnerable populations in their studies. This group included women of childbearing age. “By protecting them from research, we’re excluding them,” Jagsi notes.

Previous studies have found some barriers to clinical trial participation are lack of information, fear and a perception of interfering with personal responsibilities, such as child care.

“Sometimes participating in research studies can be time intensive. Women today are often stretched very thin trying to deal with the balance between domestic responsibilities, their cancer diagnosis, and often a career as well. They may be particularly likely to find clinical trials too burdensome. In that case, researchers should consider providing compensation to help with transportation or child care expenses,” Jagsi says.

This under-representation of women is not necessarily the result of conscious decisions, points out senior author Peter Ubel, M.D., director of the Center for Behavioral and Decision Sciences in Medicine at U-M.

“Clinical researchers are not purposely trying to exclude women from their studies. All the more reason they need to consciously and earnestly revise their recruitment methods to give more women a chance to volunteer,” Ubel says.

Methodology: The researchers looked at all original clinical cancer research published in five top oncology journals and three top general medical journals in 2006. The journals included were the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, the Journal of Clinical Oncology, the Journal of the National Cancer Institute, Lancet Oncology, Clinical Cancer Research and Cancer. Articles were analyzed to determine factors including the number of participants, gender of participants, type of cancer and funding source.

The percent of women was summarized in two ways: The overall percent of women from all studies; and the average percent from each study that were women. The first method gives greater weight to larger studies, while the second method allows each study to have equal weight. Women’s representation was lower than expected, based on general population incidence data, according to both analyses.

Thank You

From the bottom of my cold reptile heart! I was able to pay for my conference hotel room and my meals with the funds you sweeties donated (Washington D.C. is expensive). Those three days are the seeds which I shall now water with my tears and then awesome trees will sprout, full of apples of wisdom! If you get my meaning.

More seriously, I have lots of new ideas about the media and the blogs and what's been wrong with this blog (partial answer: lack of sexual titillation which is what draws clicks on even political blogs). Mmm.