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This page contains a single entry from the blog posted on November 9, 2009 8:55 AM. The previous post in this blog was Product review. The next post in this blog is Dialogue, 2009. Many more can be found on the main index page or by looking through the archives.



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Monday, November 9, 2009

No tengo a nadie

Joining the Republicans to vote no on health care reform: Brian Baird, the Democrat from the Lars Larson Show.

Comments (11)

Thank you Brian Baird! You have my support!

Strike 1, Strike 2....

I'll withold judgment until I know what "health care reform" means.

It may mean everyone goes under Medicare, but passing this at midnight on a Saturday augurs not well.

Right now, it looks like "health care reform" means "Senate filibuster."

What's disappointing, is that Senators don't even have to diaper up and read the phone book cover-to-cover anymore to perform a filibuster like back in the day. They just have to announce a filibuster, and then they all go back to their offices and do whatever they do until enough back room moves or adjustments to the bill (read: added pork) are made to get an affirmative cloture vote.

At least obstructionists had to work at it back in the day.

I agree with Brian. Casting aspersions isn't gonna work.

Right on, Brian - !! Much appreciated; you have my support.

Somehow, I doubt that his reasons for a no vote are the same as Kucinich's

Any port in a storm.

And this storm is a doozy!

Pelosi had her 218 or whatever it was on Friday night and released the moderates and Blue Dogs to do as they wished. How else to explain the near simultanious announcements of several "moderates" that they'd be voting no? Best to give him this one vote to placate the crazies in WA-3 than run the risk of turning a relatively safe seat into a toss-up. Pelosi was very shrewd on this. She *might* be smarter than I thought.

This is why the whole thing ought to go down anyway. Unless the bill that comes out of conference is radically better than either the House or Senate bills, we'd be better off with nothing but a chance to turn 2010 into a referendum on Medicare for All:

Marcia Angell, M.D.
Physician, Author, Senior Lecturer, Harvard Medical School
Posted: November 8, 2009 08:02 PM
BIO Become a Fan

Is the House Health Care Bill Better than Nothing?


The House health reform bill -- known to Republicans as the Government
Takeover -- finally passed after one of Congress's longer, less
enlightening debates. Two stalwarts of the single-payer movement split
their votes; John Conyers voted for it; Dennis Kucinich against.
Kucinich was right.

Conservative rhetoric notwithstanding, the House bill is not a
"government takeover." I wish it were. Instead, it enshrines and
subsidizes the "takeover" by the investor-owned insurance industry that
occurred after the failure of the Clinton reform effort in 1994. To be
sure, the bill has a few good provisions (expansion of Medicaid, for
example), but they are marginal. It also provides for some regulation
of the industry (no denial of coverage because of pre-existing
conditions, for example), but since it doesn't regulate premiums, the
industry can respond to any regulation that threatens its profits by
simply raising its rates. The bill also does very little to curb the
perverse incentives that lead doctors to over-treat the well-insured.
And quite apart from its content, the bill is so complicated and
convoluted that it would take a staggering apparatus to administer it
and try to enforce its regulations.

What does the insurance industry get out of it? Tens of millions of
new customers, courtesy of the mandate and taxpayer subsidies. And not
just any kind of customer, but the youngest, healthiest customers --
those least likely to use their insurance. The bill permits insurers to
charge twice as much for older people as for younger ones. So older
under-65's will be more likely to go without insurance, even if they
have to pay fines. That's OK with the industry, since these would be
among their sickest customers. (Shouldn't age be considered a
pre-existing condition?)

Insurers also won't have to cover those younger people most likely
to get sick, because they will tend to use the public option (which is
not an "option" at all, but a program projected to cover only 6 million
uninsured Americans). So instead of the public option providing
competition for the insurance industry, as originally envisioned, it's
been turned into a dumping ground for a small number of people whom
private insurers would rather not have to cover anyway.

If a similar bill emerges from the Senate and the reconciliation process,
and is ultimately passed, what will happen?

First, health costs will continue to skyrocket, even faster than
they are now, as taxpayer dollars are pumped into the private sector.
The response of payers -- government and employers -- will be to shrink
benefits and increase deductibles and co-payments. Yes, more people
will have insurance, but it will cover less and less, and be more
expensive to use.

But, you say, the Congressional Budget Office has said the House
bill will be a little better than budget-neutral over ten years. That
may be, although the assumptions are arguable. Note, though, that the
CBO is not concerned with total health costs, only with costs to the
government. And it is particularly concerned with Medicare, the biggest
contributor to federal deficits. The House bill would take money out of
Medicare, and divert it to the private sector and, to some extent, to
Medicaid. The remaining costs of the legislation would be paid for by
taxes on the wealthy. But although the bill might pay for itself, it
does nothing to solve the problem of runaway inflation in the system as
a whole. It's a shell game in which money is moved from one part of our
fragmented system to another.

Here is my program for real reform:

Recommendation #1: Drop the Medicare eligibility age from 65
to 55. This should be an expansion of traditional Medicare, not a new
program. Gradually, over several years, drop the age decade by decade,
until everyone is covered by Medicare. Costs: Obviously, this
would increase Medicare costs, but it would help decrease costs to the
health system as a whole, because Medicare is so much more efficient
(overhead of about 3% vs. 20% for private insurance). And it's a better
program, because it ensures that everyone has access to a uniform
package of benefits.

Recommendation #2: Increase Medicare fees for primary care
doctors and reduce them for procedure-oriented specialists.

Specialists such as cardiologists and gastroenterologists are now excessively
rewarded for doing tests and procedures, many of which, in the opinion
of experts, are not medically indicated. Not surprisingly, we have too
many specialists, and they perform too many tests and procedures.
Costs: This would greatly reduce costs to Medicare, and the reform would
almost certainly be adopted throughout the wider health system.

Recommendation #3: Medicare should monitor doctors' practice
patterns for evidence of excess, and gradually reduce fees of doctors
who habitually order significantly more tests and procedures than the
average for the specialty. Costs: Again, this would greatly reduce costs,
and probably be widely adopted.

Recommendation #4: Provide generous subsidies to medical
students entering primary care, with higher subsidies for those who
practice in underserved areas of the country for at least two years.
Costs: This initial, rather modest investment in ending our shortage of
primary care doctors would have long-term benefits, in terms of both
costs and quality of care.

Recommendation #5: Repeal the provision of the Medicare drug
benefit that prohibits Medicare from negotiating with drug companies
for lower prices. (The House bill calls for this.) That prohibition has
been a bonanza for the pharmaceutical industry. For negotiations to be
meaningful, there must be a list (formulary) of drugs deemed
cost-effective. This is how the Veterans Affairs System obtains some of
the lowest drug prices of any insurer in the country. Costs: If
Medicare paid the same prices as the Veterans Affairs System, its
expenditures on brand-name drugs would be a small fraction of what they
are now.

Is the House bill better than nothing? I don't think so. It simply
throws more money into a dysfunctional and unsustainable system, with
only a few improvements at the edges, and it augments the central role
of the investor-owned insurance industry. The danger is that as costs
continue to rise and coverage becomes less comprehensive, people will
conclude that we've tried health reform and it didn't work. But the
real problem will be that we didn't really try it. I would rather see
us do nothing now, and have a better chance of trying again later and
then doing it right.

I like Dr. Angell's suggestions, but I disagree with her (and Kucinich's) rejection of the current legislation. If we "do nothing now" as she suggests, we will move into an election year having accomplished nothing on this issue after keeping it on the front burner all year -- and the voters will punish Democrats for it by staying home on election day enabling major Republican gains. This is what happened in 1994 when progressives joined conservatives in rejecting the Clinton plan.

Let's learn from this tactical mistake and take what we can get now, inadequate as it surely is. This way we at least keep some momentum for change on our side and will have a shot at improving the bill later when its faults manifest themselves clearly.


As a lawyer/blogger, I get
to be a member of:

In Vino Veritas

Lange, Pinot Gris 2015
Kiona, Lemberger 2014
Willamette Valley, Pinot Gris 2015
Aix, Rosé de Provence 2016
Marchigüe, Cabernet 2013
Inazío Irruzola, Getariako Txakolina Rosé 2015
Maso Canali, Pinot Grigio 2015
Campo Viejo, Rioja Reserva 2011
Kirkland, Côtes de Provence Rosé 2016
Cantele, Salice Salentino Reserva 2013
Whispering Angel, Côtes de Provence Rosé 2013
Avissi, Prosecco
Cleto Charli, Lambrusco di Sorbara Secco, Vecchia Modena
Pique Poul, Rosé 2016
Edmunds St. John, Bone-Jolly Rosé 2016
Stoller, Pinot Noir Rosé 2016
Chehalem, Inox Chardonnay 2015
The Four Graces, Pinot Gris 2015
Gascón, Colosal Red 2013
Cardwell Hill, Pinot Gris 2015
L'Ecole No. 41, Merlot 2013
Della Terra, Anonymus
Willamette Valley, Dijon Clone Chardonnay 2013
Wraith, Cabernet, Eidolon Estate 2012
Januik, Red 2015
Tomassi, Valpolicella, Rafaél, 2014
Sharecropper's Pinot Noir 2013
Helix, Pomatia Red Blend 2013
La Espera, Cabernet 2011
Campo Viejo, Rioja Reserva 2011
Villa Antinori, Toscana 2013
Locations, Spanish Red Wine
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La Antigua Clásico, Rioja 2011
Shatter, Grenache, Maury 2012
Argyle, Vintage Brut 2011
Abacela, Vintner's Blend #16 Abacela, Fiesta Tempranillo 2014
Benton Hill, Pinot Gris 2015
Primarius, Pinot Gris 2015
Januik, Merlot 2013
Napa Cellars, Cabernet 2013
J. Bookwalter, Protagonist 2012
LAN, Rioja Edicion Limitada 2011
Beaulieu, Cabernet, Rutherford 2009
Denada Cellars, Cabernet, Maipo Valley 2014
Marchigüe, Cabernet, Colchagua Valley 2013
Oberon, Cabernet 2014
Hedges, Red Mountain 2012
Balboa, Rose of Grenache 2015
Ontañón, Rioja Reserva 2015
Three Horse Ranch, Pinot Gris 2014
Archery Summit, Vireton Pinot Gris 2014
Nelms Road, Merlot 2013
Chateau Ste. Michelle, Pinot Gris 2014
Conn Creek, Cabernet, Napa 2012
Conn Creek, Cabernet, Napa 2013
Villa Maria, Sauvignon Blanc 2015
G3, Cabernet 2013
Chateau Smith, Cabernet, Washington State 2014
Abacela, Vintner's Blend #16
Willamette Valley, Rose of Pinot Noir, Whole Clusters 2015
Albero, Bobal Rose 2015
Ca' del Baio Barbaresco Valgrande 2012
Goodfellow, Reserve Pinot Gris, Clover 2014
Lugana, San Benedetto 2014
Wente, Cabernet, Charles Wetmore 2011
La Espera, Cabernet 2011
King Estate, Pinot Gris 2015
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Trader Joe's, Pinot Gris, Willamette Valley 2015
La Vite Lucente, Toscana Red 2013
St. Francis, Cabernet, Sonoma 2013
Kendall-Jackson, Pinot Noir, California 2013
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Abbot's Table, Columbia Valley 2014
Intrinsic, Cabernet 2014
Oyster Bay, Pinot Noir 2010
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Layer Cake, Shiraz 2013
Desert Wind, Ruah 2011
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Stoppa, Emilia, Red 2004
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The Occasional Book

Marc Maron - Waiting for the Punch
Phil Stanford - Rose City Vice
Kenneth R. Feinberg - What is Life Worth?
Kent Haruf - Our Souls at Night
Peter Carey - True History of the Kelly Gang
Suzanne Collins - The Hunger Games
Amy Stewart - Girl Waits With Gun
Philip Roth - The Plot Against America
Norm Macdonald - Based on a True Story
Christopher Buckley - Boomsday
Ryan Holiday - The Obstacle is the Way
Ruth Sepetys - Between Shades of Gray
Richard Adams - Watership Down
Claire Vaye Watkins - Gold Fame Citrus
Markus Zusak - I am the Messenger
Anthony Doerr - All the Light We Cannot See
James Joyce - Dubliners
Cheryl Strayed - Torch
William Golding - Lord of the Flies
Saul Bellow - Mister Sammler's Planet
Phil Stanford - White House Call Girl
John Kaplan & Jon R. Waltz - The Trial of Jack Ruby
Kent Haruf - Eventide
David Halberstam - Summer of '49
Norman Mailer - The Naked and the Dead
Maria Dermoȗt - The Ten Thousand Things
William Faulkner - As I Lay Dying
Markus Zusak - The Book Thief
Christopher Buckley - Thank You for Smoking
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Bill Bryson - A Short History of Nearly Everything
Cheryl Strayed - Tiny Beautiful Things
Sara Varon - Bake Sale
Stephen King - 11/22/63
Paul Goldstein - Errors and Omissions
Mark Twain - A Connecticut Yankee in King Arthur's Court
Steve Martin - Born Standing Up: A Comic's Life
Beverly Cleary - A Girl from Yamhill, a Memoir
Kent Haruf - Plainsong
Hope Larson - A Wrinkle in Time, the Graphic Novel
Rudyard Kipling - Kim
Peter Ames Carlin - Bruce
Fran Cannon Slayton - When the Whistle Blows
Neil Young - Waging Heavy Peace
Mark Bego - Aretha Franklin, the Queen of Soul (2012 ed.)
Jenny Lawson - Let's Pretend This Never Happened
J.D. Salinger - Franny and Zooey
Charles Dickens - A Christmas Carol
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Deborah Eisenberg - Transactions in a Foreign Currency
Kurt Vonnegut Jr. - Slaughterhouse Five
Kathryn Lance - Pandora's Genes
Cheryl Strayed - Wild
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Jack London - The House of Pride, and Other Tales of Hawaii
Jack Walker - The Extraordinary Rendition of Vincent Dellamaria
Colum McCann - Let the Great World Spin
Niccolò Machiavelli - The Prince
Harper Lee - To Kill a Mockingbird
Emma McLaughlin & Nicola Kraus - The Nanny Diaries
Brian Selznick - The Invention of Hugo Cabret
Sharon Creech - Walk Two Moons
Keith Richards - Life
F. Sionil Jose - Dusk
Natalie Babbitt - Tuck Everlasting
Justin Halpern - S#*t My Dad Says
Mark Herrmann - The Curmudgeon's Guide to Practicing Law
Barry Glassner - The Gospel of Food
Phil Stanford - The Peyton-Allan Files
Jesse Katz - The Opposite Field
Evelyn Waugh - Brideshead Revisited
J.K. Rowling - Harry Potter and the Sorcerer's Stone
David Sedaris - Holidays on Ice
Donald Miller - A Million Miles in a Thousand Years
Mitch Albom - Have a Little Faith
C.S. Lewis - The Magician's Nephew
F. Scott Fitzgerald - The Great Gatsby
William Shakespeare - A Midsummer Night's Dream
Ivan Doig - Bucking the Sun
Penda Diakité - I Lost My Tooth in Africa
Grace Lin - The Year of the Rat
Oscar Hijuelos - Mr. Ives' Christmas
Madeline L'Engle - A Wrinkle in Time
Steven Hart - The Last Three Miles
David Sedaris - Me Talk Pretty One Day
Karen Armstrong - The Spiral Staircase
Charles Larson - The Portland Murders
Adrian Wojnarowski - The Miracle of St. Anthony
William H. Colby - Long Goodbye
Steven D. Stark - Meet the Beatles
Phil Stanford - Portland Confidential
Rick Moody - Garden State
Jonathan Schwartz - All in Good Time
David Sedaris - Dress Your Family in Corduroy and Denim
Anthony Holden - Big Deal
Robert J. Spitzer - The Spirit of Leadership
James McManus - Positively Fifth Street
Jeff Noon - Vurt

Road Work

Miles run year to date: 5
At this date last year: 3
Total run in 2017: 113
In 2016: 155
In 2015: 271
In 2014: 401
In 2013: 257
In 2012: 129
In 2011: 113
In 2010: 125
In 2009: 67
In 2008: 28
In 2007: 113
In 2006: 100
In 2005: 149
In 2004: 204
In 2003: 269

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