The bogus "I won't get to choose my doctor" argument against healthcare reform

One of the frustrating things about the healthcare debate is the idea going around that, under "Obamacare," people won't be able to go to the doctor they want to see.

To begin with, this is a huge problem under the existing setup. People without health insurance, of course, can't afford to see any doctor- they're stuck with whoever's in the ER or free clinic. Even many people with insurance can't get the doctor they want. When i was a teacher in LA, I had my pick of doctors so long as they worked at they Kaiser Permanente medical center. Even after the doctors there lost the pathology report on a surgery I had, and one of them nearly killed me because he didn't read my chart properly, I was stuck with them because it was my insurance didn't cover anywhere else. While in Law School, I was using the Beech Street, and I couldn't see a Crohn's specialist because Beech Street wasnt accepted by any doctors in NYC who specialized in that disorder.

The argument against reform is that having a public option will force all the private insurers out of business, so everyone will be stuck with something like Medicare- and I keep hearing from people something along the lines of "everyone knows that most doctors won't even accept medicare, so you'll be stuck with the lousy doctors who accept it." This sounds like a big problem with the public option, until you read something like this from a 2007 study by the Department fo Health and Human Services:

More than two thirds (70 percent) of traditional Medicare enrollees say they “always” get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in Medicare managed care plans and only 51 percent of those with private insurance.

The same study showed higher rates of customer satisfaction from Medicare (and even Medicaid!) enrollees than from private insurance customers. This seems to indicate that, even if you accept the premise (which I don't) that the "public option" in Obamacare will force everybody into a Medicare-like plan, that that plan will be worse than what most people already have.

A (perhaps) novel solution to kidney donation

Like Dante's Peak and Volcano, and Armageddon and Deep Impact, this month we have an interesting pair of long-form magazine articles on kidney donations from the New Yorker and the Atlantic (both very much worth reading- New Yorker's here and Atlantic's here).

The New Yorker article focuses on people who decide, for varying reasons, to donate a kidney to a complete stranger- complete altruism seems to be the uniting theme. The Atlantic article ranges along varying methods of spurring donations, such as exchanges where a husband who's not compatible with his sick wife (pair A) and a mother not compatible with her sick daughter (pair B) swap kidneys- healthy A to sick B, healthy B to sick A. It also looks at more convoluted chain donations where one altruistic donor can kick off a cascade of matching donations- with each donor giving to an unknown recipient.

Both discuss the idea of paying donors- either in immediate cash payments, or perhaps (to be less likely to exploit the desperate) paying in the form of health insurance, or 401k contributions, or college funds. For many people, the idea of paying for kidneys is ghoulish, or raises problems of class inequality, which I can definitely understand- even though it seems that the person selling his or her kidney is unlikely to face any serious health consequences, as the other kidney will grow to assume all the functions of the pair, and kidney disease typically strikes both.

Right now, people waiting for kidneys are on the United Network for Organ Sharing (UNOS) list, where there's a 4-year wait time- many of those on the list will die while waiting, and the rest will spend a lot of time undergoing painful dialysis. What if donating a kidney didn't have to be an altruistic act, but could essentially function like insurance. It would work like this- a healthy person could, at any time, arrange to donate a kidney that would go to whichever matchable person is at the top of the list in the donor's state (the lists go state-by-state). In exchange, the donor would then have the right, if he or she ever needed a kidney, to slot into the list at the top. This right would be assignable, so if person A donated a kidney, but never needed one, she could assign her "cut to the front" right to her husband, aunt, etc (but the right could not be sold or exchanged for anything of value).

Furthermore, if a healthy friend or relative of a person who needed a kidney was willing to donate, but was not a match, he or she could donate to the person at the top of the list, and then immediately assign their "cut to the front" to their sick relation.

I don't think that this would be any less equitable than the current system- and would probably improve things. Some number of people would donate for the "insurance" purpose, and then never have to use it because they or their friends/relatives never needed a kidney- thus adding additional organs into the system that would not be there otherwise. For people that did then use the "cut to the front" for themselves or friends/relatives, it would give the most benefit to sick people who have a large circle of altruistic friends, but that's the case currently, where anyone who has a matchable friend or relative who's willing to donate gets to cut the line.

I know I have some doctors and other smart folks who read this blog- so please feel free to point out to me what the problems are with this idea are- it wouldn't surprise me if this had been thought of (and discarded) before...

Footage of crazy Obama conspiracy theorists shouting their Congressman

Delaware Congressman (and Hamilton alum) Mike Castle, one of the 8 responsible Republicans who voted for Cap and Trade, was recently accosted by a wildly misinformed woman who shouted that Obama is a Kenyan citizen, and then, bizarrely, demanded that Castle lead the crowd in reciting the pledge of allegiance. In an additional weird detail, the woman brought her own birth certificate in a plastic bag, and describes it in detail... perhaps unaware that birth certificates can vary by state.

Note the crowd's reaction when Castle defends the President's citizenship- which has been clearly verified (see here for a ridiculously in-depth look at the Prez's birth certificate).

The "Birthers" as these folks are known, appear to be staking out a pretty strong position within the GOP community, and getting regular play on talk radio and Fox news. Props to Castle for standing up for the truth against a hostile crowd of his own party.

Obama as the "Democratic Ideal"

A bit more on Ross Douthat's Times piece about how Palin, not Obama, demonstrates the triumph of the democratic ideal, because Obama is an Elite and Palin is a regular American.

Ta-Nehisi Coates on the Atlantic notes that there's a real racial bias to who gets to be a "regular American," and that if you pull that out, it's not clear that Palin is any more regular than Obama-

The use of the word neighbor is instructive--Barack Obama hails from the black side of town. And not just any black side of town, but the South Side of Chicago, a place that was the cultural and economic capital of black America for decades. Moreover he isn't simply from our side of town, he actually behaves like the people we know. He gives dap in the manner that we give dap. He plays basketball, our national past-time. He paraphrases Malcolm X. He bops through the Senate chamber. He's married to a black woman, and not just a dark-skinned black woman, but one who is the progeny of working class black Chicago. Before he became president, Barack Obama got his hair cut by the same South Side barber every week, and it looked tight. For black men, that is the democratic ideal.

The Progressive Bloc

Chris Bowers at Openleft describes an interesting emerging strategy among progressive Dems in the House and Senate:

Bowers suggests that, instead of 60 votes in the Senate or 218 in the House, what progressives really need are 12-13 Senators and 45 Reps who are prepared to walk away from legislation unless their demands are met- thus forcing the administration and the Congressional leadership to whip the others hard in order to bring them in line with the progressives.

This works best when there's an easily articulated demand- like the public option in healthcare reform- that the progressive bloc can get behind.

Bowers notes that the inspiration comes from the Senate "blue dogs" and Evan Bayh's conservative dems, who often threaten to side with the GOP and walk away from bills unless their demands for watering them down aren't met.

An additional benefit, that Bowers doesn't really get into, is that this opens up the possibility of tapping the energy many of the most progressive constituents in steeling the spines of their Reps and Senators. For instance, in Manhattan, where I live, most people are represented by Jerry Nadler, Charlie Rangel and Carolyn Maloney, as well as Schumer and Gillibrand- all solid, liberal Dems. I periodically get emails from Moveon and other progressive organizations generally asking me to call my member of congress to support this or that, but it's pointless to do so, because my folks are already on board, and it's equally useless to write/call elected officials who don't represent me.

If, however, the progressive bloc strategy got moving, people like me (and active constituents in deep blue districts and states all over the country, who are likely to be the most progressive) can contact our reps and demand that they walk away from mediocre bills if progressive improvements aren't included. That's a pretty serious font of untapped elected-badgering energy that could be put into play in an organized manner to make sure that Bayh and Baucus aren't running the show in DC.

Brooks admires Obama's "self-mastery"?

Huh? I'm all for sociologically interesting reporting, but today's David Brooks is sort of a whiff:

[...] three stories have dominated public conversation, and each one exemplifies another branch of indignity.

First, there was Mark Sanford’s press conference. Here was a guy utterly lacking in any sense of reticence, who was given to rambling self-exposure even in his moment of disgrace. Then there was the death of Michael Jackson and the discussion of his life. Here was a guy who was apparently untouched by any pressure to live according to the rules and restraints of adulthood. Then there was Sarah Palin’s press conference. Here was a woman who aspires to a high public role but is unfamiliar with the traits of equipoise and constancy, which are the sources of authority and trust.

But it’s not right to end on a note of cultural pessimism because there is the fact of President Obama. Whatever policy differences people may have with him, we can all agree that he exemplifies reticence, dispassion and the other traits associated with dignity. The cultural effects of his presidency are not yet clear, but they may surpass his policy impact. He may revitalize the concept of dignity for a new generation and embody a new set of rules for self-mastery.

What do all these people have in common: Barack Obama, Saarah Palin, Michael Jackson, and Mark Sanford? They're all famous, they're all on TV, they all do things to get on TV, etc.

Could it possibly be that people who have whatever traits were described there in the article as the "dignity code" choose not to live in a way that puts them on television?

What people we admire who don't necessarily aspire to "dignity" in Brooks's meaning? Let me just try to put a few out there. I realize not everyone will agree on these suggestions, but I'm just wondering what allows them to attempt to be subjectively good moral influences without working off the "dignity code?" Rick Warren, Dan Savage, Bono.

There's something missing from today's David Brooks, and I intend to write more later to try to find out what it is.

Palin's problems run deeper than class or gender

I don't really have anything to say about Palin's bizarre departure from the Alaska governorship other than that it confirms my general opinion of her as a loon who's not fit to govern anything.

I do, however, take issue with new Times columnist Ross Douthat's portrayal of Palin as a small-d democratic foil to the "elite" Obama-

Palin’s popularity has as much to do with class as it does with ideology. In this sense, she really is the perfect foil for Barack Obama. Our president represents the meritocratic ideal — that anyone, from any background, can grow up to attend Columbia and Harvard Law School and become a great American success story. But Sarah Palin represents the democratic ideal — that anyone can grow up to be a great success story without graduating from Columbia and Harvard.

Here are lessons of the Sarah Palin experience, for any aspiring politician who shares her background and her sex. Your children will go through the tabloid wringer. Your religion will be mocked and misrepresented. Your political record will be distorted, to better parody your family and your faith. (And no, gentle reader, Palin did not insist on abstinence-only sex education, slash funds for special-needs children or inject creationism into public schools.)

Male commentators will attack you for parading your children. Female commentators will attack you for not staying home with them. You’ll be sneered at for how you talk and how many colleges you attended. You’ll endure gibes about your “slutty” looks and your “white trash concupiscence,” while a prominent female academic declares that your “greatest hypocrisy” is the “pretense” that you’re a woman. And eight months after the election, the professionals who pressed you into the service of a gimmicky, dreary, idea-free campaign will still be blaming you for their defeat.

All of this had something to do with ordinary partisan politics. But it had everything to do with Palin’s gender and her social class.

I'll first note that plenty of female candidates (Hillary, Liddy Dole, Gerry Ferraro) have made it through presidential campaigns without having their children paraded through the tabloids- largely because they had selling points beyond "I didn't abort the special needs child." I'll also note that basically whenever the kids of high-profile politicians do stupid things, they end up in the tabloids.

As far as class goes, Matt Yglesias makes the point that one could reasonably compare Palin with Joe Biden. Like Palin, Biden was a graduate of less-than-first-tier schools (U. Delaware and Syracuse Law). Unlike Palin, neither of Biden's parents went to college. Biden never became rich, eschewed the fancy trappings of the Senate and continued to live in Delaware (and if the Northeast has an Alaska, it's Delaware).

Biden managed to avoid being labeled as stupid and trashy not by dint of his superior social class, but by being generally well informed and appearing to be a legitimate vice presidential candidate. You could say the same about Lyndon Johnson (graduate of Southwest Texas State Teachers' College) or Harry Truman (no college)- regular guys without elite east-coast credentials who succeeded by being smart and tough.

Douthat's article does a disservice to women and to the non-elite-school class (which I imagine Douthat knows a lot about from his time at Hamden Hall, a private Connecticut high school, or maybe from reporting that he did on them while writing for the Harvard Crimson). Palin's problems with the press came from her being an unprepared joke of a candidate- not because she was a woman or because she didn't graduate from Yale.