Medicaid cuts versus slower growth!

WEDNESDAY, JUNE 28, 2017

The New York Times tries to explain:
Is human life a vale of tears? A mere entertainment arranged by the gods?

We ask for a very good reason. In this morning's hard-copy editions, the New York Times tried to explain the endless debate about those "Medicaid cuts."

The key word there is "tried."

Do journalists at our biggest news organs have any skills at all? You'd think the answer would have to be "yes."

The gods who rule this vale of tears may have a better idea.

The analysis piece to which we refer was written by Alan Rappeport—and no, he isn't a kid.

He graduated from Emory in 2001. One year later, he got a master's degree from the Columbia School of Journalism.

In 2006, he got a master's degree in economic history from the London School of Economics. After spending five years at the Financial Times, he started at the New York Times in April 2014.

Rappeport has a gauzy resume. He didn't have the slightest idea how to settle the endless dispute he'd been asked to resolve.

The scribe had been asked to settle a question. The basic question was this:

Does the Senate GOP health care bill involve cuts in the Medicaid program, as Democrats say? Or are Republicans simply slowing the rate at which the program will grow?

It's stunningly easy to explain this matter. Unless you work for the New York Times, in which case it can't be done.

Before we look at Rappeport's piece, let's settle this tiresome question. As a courtesy, we'll start with the rather silly but technically accurate claim the Republicans have been making. From there, we'll move to the Democrats.

When Republicans say there are no cuts, this is what they mean: They mean that total spending in the Medicaid program would continue to rise from its current level under their proposal.

(We can't swear that that is true. But that is what they claim and that is what they mean.)

X number of years from now, the federal government would be spending more dollars on Medicaid than it is spending this year. That's what the Republicans mean when they say they aren't imposing a "cut."

When Democrats say there very large cuts, this is what they mean: Among other things, they mean that spending won't rise quickly enough to keep up with inflation, or even to come close. More dollars will be spent as compared to this year, but those dollars will pay for fewer services.

In the case pf the GOP plan, it seems that those dollars will pay for far fewer services. But it isn't entirely easy to get clear on such facts, given the staggering lack of skill within our upper-end press corps.

Does the GOP plan involve Medicaid cuts? Or are they simply slowing the rate of growth? Rappeport was asked to untangle this endless conundrum. This is the way he began:
RAPPEPORT (6/28/17): Republicans, under fire for proposing health care legislation that would reduce Medicaid funding by hundreds of billions of dollars, have embraced an old argument that taking money from a program is not a “cut.”

At first glance, the new pitch to make their strategy more palatable seems at odds with the numbers. The Congressional Budget Office said on Monday that the “Better Care Reconciliation Act” would reduce Medicaid spending by $772 billion over a decade. By 2026, Medicaid enrollment would drop by 16 percent among people under the age of 65.

So, are there cuts or not?
Sigh. Right in his opening sentence, Rappeport has assumed the answer to his question. Republicans would say they aren't "taking money from [the Medicaid] program." Right from the start, Rappeport treats it as a given that they actually are.

Republicans would say they aren't "taking money from [the Medicaid] program?" Absolutely! They would say that they're spending more money, in future years, than was spent in the program this year!

On that basis, they would say that their proposal adds money to the Medicaid program. They'd also say, with obvious justice, they aren't "embracing" the claim that Rappeport puts in their mouths.

In his second paragraph, Rappeport again blows past the basic Republican claim, silly though it may be. Did the CBO really say that the Republican proposal "would reduce Medicaid spending by $772 billion over a decade?"

Sad! Rappeport provide no quotation of any such CBO statement. He also provides no link to any such CBO statement. But if the CBO made some such statement, they would have been comparing the amount of spending the Republicans propose to the amount of future spending which would occur under current law.

Should a person refer to some such proposal as a "cut," a "reduction?" We're sorry, but that's a semantic question to which there's no ultimate answer.

How should a journalist deal with a semantic dispute of this type? He should simply explain the facts of the case! Here goes:

Under the GOP plan, spending would rise by a small amount as compared to this year. But it wouldn't come close to keeping up with the rate of inflation, thereby causing significant cuts in nationwide Medicaid services.

Dollar spending would rise by a small amount. The number of Medicaid recipients would have to be substantially cut. Those are the basic facts of the case. How hard was that to explain?

For the nation's upper-end journalists, this amazingly elementary matter is much too hard to explain. It isn't just Rappeport who gets tangled today. On the next page in the hard-copy Times, Margot Sanger-Katz (Yale 2002, CSJ 2003)bungles the very same question:
SANGER-KATZ (6/28/17): Contrary to statements by Kellyanne Conway and other Trump advisers that the bill contains no overall cuts to Medicaid, the budget office offered a chart highlighting the spending reductions for the program. It says explicitly that “states would not have substantial additional flexibility” under the bill’s Medicaid reforms, a typical selling point for a plan that would push more fiscal risk to state governments. It says that a waiver program for state insurance regulations would increase the deficit and would not reduce the uninsured rate in every state. In addition, the analysts wrote, “waivers would probably cause market instability in some areas.”
Sad. Sanger-Katz doesn't link to the chart to which she refers, nor does she actually quote any statement by the CBO. That said, the "spending reductions" to which she refers will qualify as "reductions" only if she compares future spending under the GOP plan to future spending which would occur under current law. In the end, she is simply adopting the semantic framework preferred by one of these sides.

Unless you're an upper-end journalist, it isn't hard to explain the basic facts of this case. Year by year, spending will rise by a small amount under the GOP bill. But because those small increases won't come close to keeping up with inflation, major cuts in Medicaid services will be required.

Spending will rise a small amount. There will be large cuts in Medicaid services. It's amazingly easy to state those facts. They leave the semantic confusion behind.

A journalist should know how to do that. But over the years, we've come to see that our journalists have almost no skills.

They know how to stick to a story-line; that tends to be where the skill set ends. Perhaps the gods find this amusing.

We know of no way to tell.

Meanwhile, for extra credit: Emory, Yale, CSJ, LSE? What are they teaching these kids?

MANUFACTURED THEFT: The $1.5 trillion question!

WEDNESDAY, JUNE 28, 2017

Part 3—Amazingly, Rosenthal asks:
Right at the start of her widely-ignored new book, Elisabeth Rosenthal asks the question which virtually never gets asked.

She starts by describing the crazy way Americans get billed for medical procedures. "In no other industry do prices for a product vary by a factor of ten depending on where it is purchased, as is the case for bills I’ve seen for echocardiograms, MRI scans, and blood tests to gauge thyroid function or vitamin D levels," Rosenthal writes.

The passage appears on page 2 of her new book, An American Sickness.

"The price of a Prius at a dealership in Princeton, New Jersey, is not five times higher than what you would pay for a Prius in Hackensack," Rosenthal writes as she continues. "The price of that car at the very same dealer doesn’t depend on your employer, or if you’re self-employed or unemployed. Why does it matter for health care?"

At this point, we're still on page 2 of this book. On page 3, Rosenthal starts to resort to the language of corporate crime as she describes these peculiar billing practices.

As she does, she asks a fundamental, foundational question. It's a question which never gets asked:
ROSENTHAL (page 3): We live in an age of medical wonders—transplants, gene therapy, lifesaving drugs and preventive strategies—but the health care system remains fantastically expensive, inefficient, bewildering, and inequitable. Faced with disease, we are all potential victims of medical extortion. The alarming statistics are incontrovertible and well known: the United States spends nearly one-fifth of its gross domestic product on health care, more than $3 trillion a year, about equivalent to the entire economy of France. For that, the U.S. health system generally delivers worse health outcomes than any other developed country, all of which spend on average about half what we do per person.

Who among us hasn’t opened a medical bill or an explanation of benefits statement and stared in disbelief at terrifying numbers? Who hasn’t puzzled over an insurance policy’s rules of co-payments, deductibles, “in-network” and “out-of-network” payments—only to surrender in frustration and write a check, perhaps under threat of collection? Who hasn’t wondered over, say, a $500 bill for a basic blood test, a $5,000 bill for three stitches in an emergency room, a $50,000 bill for minor outpatient foot surgery, or a $500,000 bill for three days in the hospital after a heart attack?

Where is all that money going?
"Where is all that money going?" At this site, we've been asking that foundational question for years.

Already, on page 3, Rosenthal has asked that foundational question. Truth to tell, it's the most basic question in all of American governance.

That question lies at the heart of the basic problems our federal government can't seem to resolve. It's a question which, by common agreement, essentially never gets asked.

Warning! We're not saying that Rosenthal asks this question in the most skillful way. For our money, she presents that foundational question in a way which is hopelessly murky.

Speaking the language of corporate crime, she has already suggested that our health care systems is built on a foundation of "medical extortion." But she offers a clumsy account of the vast sum which is disappearing into the maws of this system every year.

Is our health care system really based on acts of "extortion?" As a doctor's kid, as a doctor herself and as a health care reporter, has Rosenthal really "had a lifetime front-row seat to a slow-moving heist," as she declares on page 4?

Do American hospitals constitute "an extractive industry" (page 24), whose behavior can be compared to that of bank robbers?
According to Rosenthal, that's where all that money is going! But on page 3, she does a fairly lousy job establishing her basic foundational question.

Where is all that money going? In the following passage, Rosenthal describes the money to which she refers—the money which is being looted out of our health care system. In our view, this is very murky work:

"The alarming statistics are incontrovertible and well known: the United States spends nearly one-fifth of its gross domestic product on health care, more than $3 trillion a year, about equivalent to the entire economy of France."

It would be hard to establish her basic question in a less compelling way. Let's note a few problems:

First, those alarming statistics are not well known among the American public. Go ahead! Stop a hundred pedestrians today. Ask them what portion of our "gross domestic product" is spent on health care each year.

Ask them how many dollars our nation spends on health care each year. Ask them to compare that amount to the entire economy of France!

You're going to get a lot of stares if you start posing those questions. Rosenthal does a terrible job describing the amount of money which is getting looted in the course of the "slow-moving heist" she admirably describes.

Rosenthal asks the foundational question: "Where is all that money going?" It seems to us that this would be a much better way establish the size of the problem:
Per capita spending, health care, 2015
United States: $9451
Canada: $4608
France: $4407
Japan: $4150
United Kingdom: $4003
Good God! Five thousand dollars per person per year is disappearing into the maws of that slow-moving heist! That's the mountain of missing money to which Rosenthal's question refers.

Those numbers dramatize Rosenthal's rather bureaucratic claim (see above): other nations' health systems "all...spend on average about half what we do per person." In the course of a 400-page book, Rosenthal never presents them.

At any rate, those remarkable data help us see why our nation has so much trouble providing health care to all its citizens. Because of all that looting, a year of health care costs more than twice as much in this country as it does everywhere else!

In our view, Rosenthal does a very poor job establishing the size of this looting. On the other hand, she aggressively asks the foundational question, the question which never gets asked:

Where's all that money going?

That is our government's foundational question. That question underlies our endless health care debacle and our federal deficit problems.

Rachel and Lawrence know not to ask it. Rosenthal asks the question straight out, right on page 3 of her book!

Having asked the foundational question, Rosenthal proceeds to an anecdotal answer. Her story starts on page 11, at the start of her Chapter 1.

Her story involves Jeffrey Kivi, a high school chemistry teacher in New York City with a potentially disabling condition called psoriatic arthritis. Absent treatment, the condition could leave Kivi "unable to work and even walk."

Enter our "extractive" health care system! Rosenthal starts her story in the fairly recent past:
ROSENTHAL (page 11): About fifteen years ago, important new arthritis drugs hit the market. His rheumatologist, Dr. Paula Rackoff, said he was a good candidate. The medicine worked wonders: every six weeks, a drug called Remicade was infused into his veins in an outpatient clinic at Beth Israel Hospital, where Dr. Rackoff practiced. The treatment cost $19,000 each visit, but Mr. Kivi, as a New York City civil servant, has excellent insurance under EmblemHealth. He paid nothing himself.
"The results were transformative," Rosenthal writes. Kivi was able to continue his life and his career.

For ourselves, we were already wondering, at this point, why a one-day, outpatient treatment would cost anything like that much. As it turns out, that shows how clueless we are.

In 2013, Dr. Rackoff moved her practice about fifteen blocks to NYU Langone Medical Center. Kivi began going there for the exact same treatments. Only one thing had changed:
ROSENTHAL (page 12): At first, [Kivi] was impressed by the Langone Center for Musculoskeletal Care, where services were distinctly more upmarket...

But the charges that started posting on his insurance Web site, as submitted by NYU, shocked him: the first three-hour infusion at the new hospital, in may, was billed at $98,579.98, the second in June at $110,410.82, and from July on they were billed at $132,791.04. It was the same dose as always, in the same form, prescribed by the same doctor.
Where was all that money going? Rosenthal describes what happened when she and Kivi tried to find out.

Why was a $19,000 treatment now being billed at $132,000? According to Rosenthal, "When Mr. Kivi complained to the NYU billing office, a patient-care representative offered a range of nonexplanations." She quotes Kivi describing the curious things he was told, then reports her own experience:
ROSENTHAL (page 13): When I tried to pick up the investigation where Mr. Kivi left off, the explanations got even less convincing. The public affairs department told me Mr. Kivi was an "outlier" because he was getting aggressive treatment and he is large. Remicade is dosed according to weight and, at over six feet and nearly four hundred pounds, Mr. Kivi does get a relatively large dose. But even so, the wholesale price of Mr. Kivi's dose of Remicade should have been about $1,200, a drug researcher at another hospital told me.

As we slid down the rabbit hole of medical pricing, things only got darker and darker...
The treatment had cost $19,000 fifteen blocks down the street. Fifteen blocks to the north, the billing price jumped to $132,000. The insurance company ended up paying $99,593.27 for each treatment.

According to Rosenthal, these are the types of "heists" which occur within our own homegrown "extractive industry." Presumably, she featured this heist because it's especially dramatic.

That said, when heist is piled upon heist, $5000 per person per year disappears within our health care system. As a result, our nation, alone among its peers, becomes a pitiful helpless giant.

We become a clownish society locked in clownish "health care debates" of the type we're currently experiencing. Clownishly, we can't provide universal health care, and we can't seem to get control of our federal budgets!

Despite their fiercely progressive views, Rachel and Lawrence won't talk about this on their popular "cable news" programs. Instead, they entertain us with a succession of chases, for example against a governor who once said that he enjoyed touching his girl friend's breasts.

Our darling Rachel won't talk about this. Does anyone understand why?

Tomorrow: Rosenthal ignored, disappeared

How to say what a "news channel" wants!

TUESDAY, JUNE 27, 2017

Stoddard conquers death:
If 15 million fewer people are insured next year, will premature deaths occur?

To state the obvious, yes, some will. Insurance, and health care, are like that!

Still and all, the bosses at Fox don't want such things said on the air. A. B. Stoddard seemed to know that when she appeared on the channel last night.

Stoddard was part of "the all-star panel" on last night's Special Report. When guest host Bill Hemmer set her up, Stoddard knew how to play:
HEMMER (6/26/17): Nancy Pelosi had a stinging statement just about an hour ago, "People will die If Trumpcare becomes law. Trumpcare is a prescription for unspeakable suffering. We are in a life or death battle for families across America."

Loaded! A.B.?

STODDARD: It is her specialty this week, if you've been listening to her the last few days, fighting to retain her minority leader position.

The Democrats have done this, Chuck Schumer's Senate, there's a lot of dramatic—

Every single time the Republicans put votes up to repeal Obamacare during the Obama era, the Democrats used the same kind of language about their replacement plan, that repeal was going to kill people. It's really not new. The problem is for President Trump, no one believes that the Democrats are obstructing this.

They know that the Republicans are fighting amongst themselves, that they have created a partisan process, a narrow restrictive procedure that will give them a simple majority vote that Pence could break a tie with and become the 51st vote. And they are fighting among themselves. So it's really—

HEMMER: Do you think it's going to happen this week or not?

STODDARD: You know, I don't think it has to. I think they would prefer it. The leaders are trying to pretend it has to happen this week, but I think they would let it up. But it's not going to slip past August 1.
It was a skillful play.

"It's really not new," the cable guest said. The Democrats have always used that same kind of language!

It was a skillful cable news play. You'll notice that she never said that Pelosi's statement was wrong.

It's all part of being a "cable news" guest! Increasingly, the game is played this way on Our Own Cable Shows, as well as on shows Over There.

Sullivan, Maddow reject Lewis Carroll!

TUESDAY, JUNE 27, 2017

Big star slimes Kushner, spares Bernie:
We're so old that we can remember when Alice's retort to the Queen of Hearts was considered instructive, perhaps even cutting edge.

It came by way of Lewis Carroll. Alice's historic push-back went exactly like this:
"No, no!" said the Queen. "Sentence first—verdict afterwards."

"Stuff and nonsense!" said Alice loudly. "The idea of having the sentence first!"

"Hold your tongue!" said the Queen, turning purple.

"I won't!" said Alice.
Sentence first, verdict later? At one time, everyone learned that you don't do that, courtesy of Lewis Carroll!

In everyday life, related concepts have long been understood, even by Us Over Here. You're innocent until you're proven guilty! You aren't guilty of a crime just because you've been charged!

We're so old that we can remember when liberals believed such concepts. Now, thanks to the mental derangement of a major cable news clown, we're moving in a truly heinous direction.

Today, we liberals swear by Rachel in MaddowLand, where a person is guilty of a crime even before he's been charged! In MaddowLand, you're guilty if you hire a lawyer, depending on which tribe you're from.

Maddow continued her ongoing horrible conduct at the start of last evening's program. Jared Kushner has hired a new lawyer, she purringly said in a four-minute opening segment. By rather clear implication, that seemed to mean that he's guilty as charged—even though, at the present time, he actually hasn't been charged!

Kushner is guilty without being charged! Our multimillionaire corporate Rhodes Scholar now trains us to "reason" this way.

Guilty without being charged? Alas! Our Own Tribal Tool has the soul of a modern-day Tailgunner Joe. In truth, she's been playing this game for quite a few years. But we liberals love our tribe so much we can't seem to see what she does.

Yesterday, the disorder spread to this column by the Washington Post's Margaret Sullivan. The column started with a brief profile of Amy Siskind, our tribe's latest source of abject dumbnification.

In fairness, Siskind has done everything right in her life. She spent twenty years on Wall Street, making oodles of Wall Street dough, before she retired to Larchmont, from which location she now devotes herself to dumbing our tribe way down.

At present, that involves her "Weekly List." Yesterday, Sullivan described this offering in her column while committing a ripe journalistic offense.

Let's start at the beginning of Sullivan's column. Last year, Siskind seems to have been one of the savants who didn't realize that Candidate Clinton actually might lose. The aftermath went like this:
SULLIVAN (6/26/17): Shortly after Donald Trump was elected president, Amy Siskind took one of her occasional trips to Val-Kill, the Upstate New York home of Eleanor Roosevelt.

“I needed a Zen moment,” Siskind, who had campaigned for Hillary Clinton, told me. “And that is a place that inspires me.”

Soon afterward, Siskind began keeping what she calls the Weekly List, tracking all the ways in which she saw America’s taken-for-granted governmental norms changing in the Trump era.

The project started small, read by friends and with only a few items a week.

By Week 9, though, the list had gone viral.
Poor Siskind! Stunned by Candidate Clinton's loss, she started compiling a Weekly List. As our tribe's heroic resistance grew, her weekly hand-wringing took off.

In yesterday's column, Sullivan quoted three examples from a recent Siskind list. Sullivan had 85 items from which she could choose. The fact that she included the item we highlight is journalistically astounding:
SULLIVAN: As time went on, the list grew much longer and more sophisticated. Here are three of her 85 items from mid-June:

*“Monday, in a bizarre display in front of cameras, Trump’s cabinet members took turns praising him.”

*“AP reported that a company that partners with both Trump and (son-in-law) Jared Kushner is a finalist for a $1.7bn contract to build the new FBI building.

*Vice President Pence hired a big-name “lawyer with Watergate experience to represent him in the Russian probe.”

Now, in Week 32, every item has a source link, and rather than just a few items, there are dozens.
Good God! With 85 items from which to choose, Sullivan chose the item built upon this concept:

You're guilty even before you've been charged! If you merely hire a lawyer, you'll get slimed by our righteous tribe, with a Watergate reference thrown in.

It's bad enough that an amateur like Siskind would include an item like that on her list. It's astounding to think that, with 85 examples to choose from, Sullivan would decide to run that item in the Washington Post.

Like millions of Democratic officials before him, Vice President Pence had hired a lawyer. According to Sullivan, Pence's action represents one of "the ways in which she saw America’s taken-for-granted governmental norms changing in the Trump era!"

When Pence hired that lawyer, CNN's Jeffrey Toobin made the world's most obvious point. Hiring a lawyer at a time like this is a "non-event," he said. When a large investigation is underway, you'd be crazy not to do so.

Lewis Carroll understood such ideas; we modern "liberals" do not. Incidentally, Siskind links that item back to Maddow's increasingly disordered TV show. Maddow's destroying many brain cells in our sad post-liberal world.

Last night, Maddow was at it again, opening her program with a four-minute rant about the fact that Kushner has hired a lawyer. Every possible insinuation was offered as part of the tribal stew.

Might we note another hire—a hire Maddow has chosen to skip? We refer to the hire described in this report in yesterday's Washington Post:
WEIGEL (6/26/17): Sen. Bernie Sanders (I-Vt.), who has retained counsel as the FBI investigates whether his wife, Jane Sanders, committed fraud to acquire a 2010 loan for a now-shuttered Vermont college, predicted Saturday night that the probe would be a political fizzle.

“This was a story that just, amazingly enough, came out in the middle of my presidential campaign, initiated by Donald Trump’s campaign manager in Vermont,” Sanders said in an interview, between rallies in Pennsylvania and Ohio organized to defeat Senate Republicans’ health-care bill. “That’s about it. I don’t think it’ll be a distraction.”
Bernie Sanders has hired a lawyer! Maddow fans, let's lock him up!

You won't hear this outrage described on the Maddow Show, nor is there any reason why you should. That said, Maddow increasingly seems deranged. For years, she has longed to lock them all up. Increasingly, she is dumbnifying the liberal world as she pursues this Queen of Hearts impulse.

Increasingly, Maddow seems to be dragging others down. Sullivan had 85 items from which to choose, and she chose that slimy denunciation of Pence—because he hired a lawyer!

Long ago, Alice knew this was wrong. Today, in our badly declining tribe, we self-impressed, utterly hapless liberals are walking away from such norms.

Don't let the children watch: Last night, Maddow opened her show with four minutes of her trademark McCarthyism.

Escort the children from the room. After that, brace yourself and just click here. Insinuations 'R her!

MANUFACTURED THEFT: Elisabeth Rosenthal channels Russell Mokhiber!

TUESDAY, JUNE 27, 2017

Part 2—The language of corporate crime:
We met Russell Mokhiber in the fall of 1994.

Displaying admirable prescience, Mokhiber attended our award-winning show, Material World, at the Washington Improv.

Later in the run, he returned for additional edification, Ralph Nader and Joan Claybrook in tow. The upshot?

Among the three major contenders in Campaign 2000, only George W. Bush had failed to laugh—and of course to learn—at the award-winning exposition!

Who is Russell Mokhiber? Then, as now, he was one of Washington's leading chroniclers of "corporate crime." In 1999, Diana Henriques actually wrote a whole column about him at the Washington Post:
HENRIQUES (9/26/99): What the police blotter is to the world of street crime, Russell Mokhiber's weekly newsletter is to corporate America.

For the last 13 years, the Corporate Crime Reporter has been itemizing misdeeds committed by highly esteemed members of the Fortune 500: antitrust violations, environmental crimes, Medicare fraud, financial swindles and the neglect of workplace hazards.

After so many years on the mean streets, Mr. Mokhiber's opinion of the nation's most admired corporate citizens is somewhat jaundiced.

''Corporate crime is crime without shame,'' said Mr. Mokhiber, who works in a one-man office in the National Press Building here. ''It's gotten to the point where when a corporation pleads guilty to some criminal act, the stock goes up.''

[...]

A lawyer and a longtime follower of the consumer advocate Ralph Nader, Mr. Mokhiber first drew a bead on the corporate world in 1988 with his book, ''Corporate Crime and Violence: Big Business Power and the Abuse of the Public Trust.''
The New York Times also profiled Mokhiber that year. Did something get into the water?

We thought of Mokhiber a few weeks back as we perused a new book. The book was written by Elisabeth Rosenthal, a well-informed person who generally lacks Mokhiber's street-fighting profile.

Who is Elisabeth Rosenthal? Her publisher, Penguin Random House, profiles her at her book's site. For twenty-two years, she was a reporter, correspondent, and senior writer at The New York Times.

Today, Rosenthal is editor in chief of Kaiser Health News, an independent journalism newsroom focusing on health and health policy.

She wasn't always a journalist. Rosenthal started out as an MD from Harvard Medical School, trained in internal medicine. Her new book, An American Sickness, "is a shocking investigation into our dysfunctional healthcare system," Penguin Random House accurately says.

Rosenthal is a deeply experienced person who isn't a street-fighting radical from the Nader school. As we started reading her book, we thought of Mokhiber because of the way, in her opening pages, she adopts the language of corporate crime in describing our health care system.

This very week, the health care "system" her book describes will be all over the nation's front pages. On our corporate "cable news" channels, top stars will pretend to discuss it.

As this happens, Rosenthal's horrific book is withering on the vine. Despite its author's unassailable pedigree, the book is producing zero public discussion, a point we'll consider all week.

Rosenthal's book is being widely ignored. That may be because of the way its author adopted the language of corporate crime in discussing our "health care system."

In what ways does Rosenthal channel Mokhiber? Right on page one, in her opening sentence, the dignified author says this:
ROSENTHAL (page 1): In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.
"The American medical system...attends more or less single-mindedly to its own profits?" Can Elisabeth Rosenthal say that?

We think you're asking a very good question. But trust us, that's barely a start.

As she continues, Rosenthal repeatedly describes the working of our health care system in the language normally used in the description of crime. This may help explain why wealthy corporate employees on cable channels will never, not in a million years, discuss the things Rosenthal says.

In what ways does she talk Mokhiber's talk? "Faced with disease, we are all potential victims of medical extortion," she says on page 3. By page 4, she's offering this:
ROSENTHAL (page 4): Part 1 of this book, “History of the Present Illness and Review of Systems,” charts the transformation of American medicine in the last quarter century from a caring endeavor to the most profitable industry in the United States—what many experts refer to as a medical-industrial complex. As money became the metric of good medicine, everyone wanted more and cared less about their original mission. The descent happened sector by sector: insurers, then hospitals, doctors, pharmaceutical manufacturers, and so on.

First as the child of an old-fashioned doctor—my father was a hematologist—then as an MD, and finally during my years as a health care reporter for the Times, I’ve had a lifetime front-row seat to the slow-moving heist.
She's had a front-row seat at a slow-moving heist? She's speaking the language of crime.

In her very next paragraph, Rosenthal adopts the language of corporate insult. She says the "big players" in our "medical-industrial complex" "spend more on lobbying than defense contractors."

In the process, they persistently "default to the most expensive treatment for whatever ails you," she says, describing a process which almost sounds a small tiny bit like fraud.

Comparisons to the military-industrial complex don't literally entail the use of the language of crime. That said, they come rather close. And at the start of Chapter 2, still on page 24 of her book, Rosenthal lets it fly.

She approvingly quotes a health care expert who compares the operation of American hospitals to the work of our nation's most famous bank robber. Then she quotes another expert making an ugly allusion.

Why do hospitals charge so much? This is what Rosenthal says:
ROSENTHAL (page 24-25): "It's like asking Willie Sutton why he robs banks; that's where the money is," said Dr. David Gifford, a former director of the Rhode Island Department of Health. Market economists I've spoken with variously refer to hospitals as "sharks" or "spending machines."...

A longtime finance executive with major American hospitals describes his field as an extractive industry...
Rosenthal doesn't identify that longtime finance executive, who she proceeds to quote. The executive goes on to describe an array of players who are "at the trough" as hospitals execute their various heists.

"This is not a healthcare system, it's an industry," this longtime executive says, "and at every point there's away to make money."

Some of this language is simply the language of corporate denigration. But some of this is, quite clearly, the language of corporate crime.

We thought of Mokhiber as we read it. Beyond that, we pondered the fact that you will never hear these topics discussed by your favorite TV stars on the partisan entertainment channels billed as "cable news."

Rosenthal hails from Harvard Medical School and the New York Times. She hails from the very top of our major elites—and she speaks the language of corporate crime when she describes our health care system, which she calls "An American Sickness."

Its practitioners are staging a rolling "heist;" they engage in repeated acts of "extortion." They are compared to Willie Sutton, one of our most famous criminals.

Rosenthal makes these statements from the highest peaks of our modern elites. That said, she won't be speaking with Rachel or Lawrence this week. All week, we'll ponder the reasons for that.

We'll also ponder the startling data you won't be seeing on your favorite cable programs this week. You won't be asked to marvel at these data, or to ponder the extent to which your nation is a helpless, pitiful giant in thrall to a large group of extractive players:
Per capita spending, health care, 2015
United States: $9451
Canada: $4608
France: $4407
Japan: $4150
United Kingdom: $4003
Miraculous Finland: $3984
Those are among the world's most remarkable data. According to those remarkable data, $5000 per person per year disappears into the maws of our "health care system."

Especially in a week like this, those are among the world's most instructive data. But how strange! All this week, as in all other weeks, our big news orgs will refuse to present or discuss them!

To Rosenthal, those numbers portray the fruit of a widespread heist by an extractive industry. At this site, we've long said that those data represent a matter of widespread "looting."

This week, we'll also say that those numbers are the fruit of manufactured theft. That said, you won't be seeing those numbers this week. Why doesn't Rachel present them?

We've been trained to adore her and trust her. Why won't she stop aping Tailgunner Joe and tell us about this instead?

Tomorrow: Rosenthal disappeared

Rosenthal's first seven pages: To read the Introduction to Rosenthal's book, you can just click here.

You'll be reading pages 1-7 of her book, including the passages we've posted.

Fiddling while Obamacare (possibly) burns!

MONDAY, JUNE 26, 2017

Who's delusional now:
In our view, Margaret Sullivan's column in this morning's Washington Post is little short of remarkable.

That said, it's so remarkable that it's depressing to contemplate. Let's leave it for tomorrow, even as we lump it in with this remarkable column at the new and improved Salon.

We'd have to say that Sullivan's piece is tragically, cataclysmically tribal. We had a somewhat similar reaction to this new post by Josh Marshall.

Marshall discusses the latest attack/claims by Donald J. Trump. He then quotes someone explaining, in a fully plausible way, why Trump behaves as he does.

Why does Trump behave as he does? Marshall's explanation makes perfect sense. But then, he ends his piece this way. Who's semi-delusional now?
MARSHALL (6/26/17): The only real addition to the story is that this [kind of aggressive behavior] is a lot easier to pull off with other real estate developers than it is to powerful players in Washington, especially after they’ve seen the swindle a few times. Trump’s inability to get the same results as he’s used to with this approach is basically the story of his presidency so far.
"Trump’s inability to get [good results] with this approach is basically the story of his presidency so far?"

Consider:

On the day that assessment appears, Trump is amazingly close to getting Obamacare disabled. He has also largely been affirmed by the Supreme Court, which is acting in the face of the tribal insistences we have uniformly pushed concerning the matter at hand.

(The only complaints came from three conservative Justices, who think the Court's lenient action today was too hard on Trump.)

What Marshall says makes perfect sense, except to the extent that it doesn't. We may be days from a truly horrific defeat (or not) but, if we might borrow from Dylan, we still think we're on the side which is hugely winning!

Tribal certainty can conquer all! Who seems to be possibly ever-so-slightly out of touch with reality now?

People, we're just saying: This TPM headline sits mere inches from Marshall's report:

"The vote could come down to just a handful of lawmakers"

To us, that says we could be close to an era-defining, ginormous defeat. Or not! But when does this perilous state of affairs harsh our delusional mellow?

Stephanopoulos battles with Kellyanne!

MONDAY, JUNE 26, 2017

The press corps' low skill levels:
Would the Republican Senate's health care bill produce large Medicaid cuts? Or would it simply slow the rate at which the program would grow?

Last Wednesday, we spotted the New York Times' Robert Pear reverting to "slow the growth." He did this above the fold on the Times' front page. To review our post, click here.

As always, your Daily Howler keeps banging out results! Two days later, Pear flipped. Front-page headline included:
PEAR AND KAPLAN (6/23/17): Senate Unveils Health Bill With Deep Medicaid Cuts, Similar to House Version

Senate Republicans, who for seven years have promised a repeal of the Affordable Care Act, took a major step on Thursday toward that goal, unveiling a bill to make deep cuts in Medicaid and end the law's mandate that most Americans have health insurance.
We're not even saying which formulation was preferable! But Pear couldn't seem to pick one.

At any rate, how about it? Is the Senate GOP cutting the Medicaid program? Or are they simply slowing the rate at which the program will grow? The nation's leading journalists have been flummoxed by this rhetorical structure since at least 1995, when they spent a year being bollixed by this same question with respect to Newt Gingrich's Medicare plan.

Our press corps has few analytical skills. Yesterday, no one was more buffaloed than George Stephanopoulos, host of ABC's This Week.

We haven't partied with Stephanopoulos since July 4, 2000. Still, when you've partied with someone on such an occasion, you always feel like a friend.

We'd like to say that George came through. This time, he actually didn't.

Stephanopoulos was speaking with Kellyanne Conway. She banged Obamacare around, but George then asked her this:
STEPHANOPOULOS (6/25/17): So you've laid out the problems with Obamacare. A lot of senators have questions about the Senate bill, particularly those cuts in Medicaid. More than $800 billion.

I want to show the president's first speech, when he announced for president.

TRUMP (videotape): Save Medicare, Medicaid and Social Security without cuts. Have to do it.

STEPHANOPOULOS: The president, right there, said no cuts in Medicaid. He has several Tweets on that same subject.

This bill has even more Medicaid cuts than the House bill. Why is the president going back on his promise?
He thought he had Kellyanne over a barrel. But sad!

She said there were no Medicaid cuts—that they were just slowing the rate of the program's growth. In reply, this was the best George could do:
CONWAY (continuing directly): These are not cuts to Medicaid, George. This slows the rate for the future and it allows governors more flexibility, with Medicaid dollars, because they're closest to the people in need.

Medicaid's imperative, its founding was meant to help the poor, the sick, the needy, the disabled, children, some elderly, women, particularly pregnant women. We are trying to get Medicaid back to its original moorings and—

STEPHANOPOULOS: Kellyanne, I don't see how you can say that the cut, more than $800 billion in savings is not cuts. And don't do— You don't have to take my word for it. It's the Republican senators you're facing right now who have that problem, led by Senator Dean Heller in Nevada. He said he's voting no. Also, Senator Susan Collins.

Here was, here's what they said:

HELLER (videotape): First, it doesn't protect Nevadans on Medicaid. Second, the cuts to Medicaid threatens critical services in Nevada, services that a lot of Nevadans depend on.

COLLINS (videotape): I cannot support a bill that's going to make such deep cuts in Medicaid that it's going to shift billions of dollars to our state government.

STEPHANOPOULOS: So these senators are the ones saying these are Medicaid cuts. Is the president prepared to put more money back into Medicaid?
Even after all these years, he couldn't explain his own claim. Instead, he pointed to Heller and Collins, saying they called it a cut.

There's a term for that—missing in action.

Back in the 1990s, it was easy to explain the claim that the GOP was proposing "Medicare cuts." For future years, their bill proposed levels of Medicare spending which fell far short of the spending required to maintain the existing level of Medicare services.

Inevitably, that would require cuts in Medicare services. In that way, the Gingrich Congress was proposing "Medicare cuts."

Is the McConnell Senate proposing Medicaid cuts? Stephanopoulos said it was, then failed to explain his statement. Kellyanne tossed some gorilla dust around, and George was soon moving on (text below).

Our upper-end press corps has almost no skills. They display this fact again and again, but just keep rolling along.

Tie goes to the spinner: Did Stephanopoulos ever explain his claim about those "Medicaid cuts?"

We'd have to say he didn't. He and Conway wrestled around for a while. Eventually, he quit on this:
STEPHANOPOULOS: Again, it's the Republican senators calling this "cuts." It's the experts calling this "cuts." There's no way you can say—

CONWAY: And you know why that is?

STEPHANOPOULOS: —$800 billion in savings are not cuts.

But I don't want to dwell on that, because there are other important issues we have to focus on here as well.

The president has made a big effort on opioid addiction. He says he really wants to do something about it, including in his address to Congress earlier this year. Let's take a look at that...
For the record, the analysts screamed when Stephanopoulos turned to the always useless "savings v. cuts" formulation.

George didn't want to dwell on his claim about the Medicaid cuts. In the end, all he had is what two Republican senators (out of 52) had said.

Kellyanne volunteered to explain why they said what they said. That's when George said, "No mas."

In our modern journalism, there's a term for a wrestling match like that: "Tie goes to the state of constant confusion." A major journalist should be able to explain his seminal claims. Yesterday, George couldn't do it.

You saw us explain those old "Medicare cuts." Why wasn't ABC's biggest star—he's entirely bright—prepared to be more like us?

MANUFACTURED THEFT: Birds' eggs yes, health care $$$$ no!

MONDAY, JUNE 26, 2017

Part 1—Chomsky's thesis in action:
We humans!

Despite embarrassing limitations observable through the annals of time, we can develop a ton of information— though only in situations where the sharing of facts and information is culturally allowed.

This noteworthy fact came to mind as we read Friday morning's Washington Post. On page A3, the Post reported the latest facts about the various shapes of the eggs laid by different species of birds.

Youngish Ben Guarino had received the assignment, and he had hammered it out. He seemed a good choice for the task.

No, we don't do name jokes here. But before arriving at the Post, Guarino had been an associate editor at a news org named The Dodo!

Now, his editors had assigned him the task of keeping the public informed. In reaction, Guarinoa had produced a clean, crisp, highly informative, fact-festooned news report.

Why do the eggs of various birds display so many different shapes? According to the Post's report, scientists have aggressively studied the question and have acquired some good solid facts.

Banner-width headline included, the Post was now reporting those facts:
GUARINO (6/23/17): Why are birds' eggs shaped like eggs? Scientists say they've figured it out.

If a Hollywood exec dreamed up an egg, it would look like a chicken's: immensely popular, with an unblemished complexion. But the universe of wild bird eggs is far weirder and more diverse than the oval products on the supermarket shelf. Hummingbirds lay eggs shaped like Tic Tac mints—"perfect little ellipses," per ornithologist and evolutionary biologist Mary C. Stoddard. Sandpiper eggs come to peaks, in the manner of teardrops. Owls plop out tight spheres not unlike table-tennis balls.

A team of evolutionary biologists, physicists and applied mathematicians says it knows why eggs come in so many different models. In a report published in the journal Science on Thursday, the scientists linked egg shapes to birds' flight behavior. Stronger fliers, like swallows, had elongated or pointy eggs. Birds that couldn't fly so far or fast had rounder, more symmetric ones.

"Eggs are not just something we buy at the grocery store and cook up in an omelet," said Stoddard, an author of the new research and a professor at Princeton University. The story of eggs is the story of vertebrate life on land, she explained...
Hummingbird eggs are like Tic Tac mints? We pictured our favorite, the late Ed McMahon:

"I did not know that," he surely would have said.

Guarino presented a full-length report about the various shapes of eggs. After citing a howler by Aristotle, he described what we humans frequently do, though only in situations where knowledge and information are culturally allowed:
GUARINO: Stoddard and her colleagues took a more refined approach than dead Greek philosophers. They photographed 50,000 eggs representing 1,400 bird species, all specimens housed at the Museum of Vertebrate Zoology at the University of California at Berkeley.

They mapped the bird eggs on a spectrum, from the spherical and symmetrical to the elongated and pointy. If there exists a Platonic ideal of a bird egg, an ovum shaped most like all the others, it is not laid by a chicken but by a small warbler called the graceful prinia. Prinia eggs, Stoddard said, are slightly more oblong but "substantially more asymmetric."

What's more, egg shapes really aren't about the shell, she and her colleagues found. Rather, the filmy membrane just beneath the shell dictates the overall shape of the egg. When a bird begins creating an egg, the animal pumps the egg through an oviduct, a passageway of glands like a factory line.

[...]

Armed with the knowledge that organ shape played a crucial role, the scientists scoped out the relationship of eggs across the bird family tree. "In this final mega-analysis, we were able to test for the first time, on a global scale, these different hypotheses," such as the effect of flight ability or cliff-dwelling behaviors.
The Post's report continued from there. All in all, Stoddard's team had busted its ascots compiling this flotilla of facts. The Washington Post now reported those facts, just as a paper should so.

This is what big newspapers do—but only in the types of cases where knowledge of facts is allowed.

The Post was sharing all the facts about the shapes of eggs. That said, there are major topics concerning which the Post won't perform this way.

Neither will your favorite stars on corporate liberal cable. By apparent common consent, there are certain topics concerning which the most basic facts will be disappeared, in accordance with the group dynamic which lays the egg known as Hard Pundit Law.

Way back in 1988,
Edward Herman and Noam Chomsky described this counterintuitive process through their use of the term "manufactured consent." Presumably, this helps explain why you rarely see Chomsky quoted in the Post.

In what areas will the Washington Post work to conceal basic facts? One such bill may come due this week. We refer to the general topic of American health care and, more specifically, to the question of health care spending and "costs."

By way of background, we liberals face a possible embarrassment of historic proportions this week. As Kevin Drum explained last Friday, the Republican Senate may pass a bill which would, with the assent of the House and Donald J. Trump, dismantle Obamacare.

This giant embarassment may not occur, but it certainly could. If it does, it will mean that the liberal world has been left for dead by the craziest person who ever got within a hundred miles of the Oval Office, and by his helpmates in Congress.

You're going to see many pseudo-discussions of this matter this week. On your favorite cable channels, your favorite corporate stars will offer endless speculations about the way some Republican solons may vote.

Rachel will be mugging and clowning, helping you learn to adore her more fully. But on cable news, and in the Washington Post, you won't be exposed to the data shown below, which underlie ever syllable uttered in this gong-show pseudo-debate:
Per capita spending, health care, 2015
United States: $9451
Canada: $4608
Australia: $4420
France: $4407
Japan: $4150
United Kingdom: $4003
Finland: $3984
Those data are among the most striking found anywhere in the world. They're among the world's most revealing data—and they're among the least reported.

They form the background to everything occurring this week. Presumably for that reason, you aren't allowed to see those data, or to hear them discussed.

In all the discussions of health care this week, you won't encounter those data. According to Herman and Chomsky, public consent is being manufactured with respect to health care spending. On that basis, discussion of those remarkable data isn't allowed to occur.

Peculiar, ain't it? In Friday's Washington Post, you were buried beneath a pile of facts about the shapes of eggs. The newspaper told you what we've learned from the latest "mega-analysis."

But how strange! All last week, you didn't see those remarkable data about health care spending. Over the course of the past many years, presentation of those astonishing data hasn't been allowed.

The liberal world may absorb one of the most appalling defeats in American political history this week. (Or not. If we do, we will remain serenely sure of the brilliance of our own side.)

As we stare down the barrel of that debacle, those basic data about health care spending are kept from public view. Chomsky explained this long ago, which explains why he isn't allowed.

Why aren't we being shown those data? Why doesn't Rachel share them with us, along with her repeated complaints about the fact that Governor Bentley liked touching his girl friend's breasts?

If we're allowed breasts and the eggs of birds, why can't we get those astonishing data? We'll be exploring that question all week.

Spoiler alert:

To all appearances, Noam Chomsky—he isn't "Chomsky the God"—answered that question decades ago. In this case, the process Chomsky described has served to enable a giant, massive and very large case of manufactured theft.

Tomorrow: Elisabeth Rosenthal and the language of corporate crime