"Bitch is the new black"

Very funny segment on Hillary, via Salon.

If you say health care isn't important, you're wrong

So says Leavitt in his latest blog post on Medicare, which is in response to the legislation he sent to Congress as a result of the Medicare trustees' report. According to Leavitt:

The problem is we are using more and more regular tax dollars, those usually used on other parts of the budget, to pay for Medicare. So, if you worry about education, you should worry about Medicare. Because, Medicare will get its money before education does. Likewise, if you want good roads, you should worry about Medicare. If you think medical research is an important priority, you should be worried about Medicare. Health care costs paid by the federal government are eroding our capacity in other important areas. (emphasis mine)

An important point. I feel like the media doesn't do a good enough good stressing the importance of Medicare/Medicaid funding and the problems with the funding running out (small details, I know). Which is most certainly the fault of lawmakers for not caring enough. I would consider myself a solid liberal, but at some point, sacrifices in the name of financial stability have got to be made. Democratic lawmakers go on and on about not cutting back services, not cutting benefits, etc., but really, we all have to make sacrifices in order to keep the budget afloat. It needs to be addressed and no one's doing it.

For example, great op-ed this week in the Washington Post on the subject on both refusing to compromise AND my nemesis Barack Obama (Also featured in the last post on the election). Columnist Robert Samuelson writes:

A favorite Obama line is that he will tell "the American people not just what they want to hear but what we need to know." Well, he hasn't so far. Consider the retiring baby boomers. A truth-telling Obama might say: "Spending for retirees -- mainly Social Security, Medicare and Medicaid -- is already nearly half the federal budget. Unless we curb these rising costs, we will crush our children with higher taxes. Reflecting longer life expectancies, we should gradually raise the eligibility ages for these programs and trim benefits for wealthier retirees. Both Democrats and Republicans are to blame for inaction. Waiting longer will only worsen the problem."

Instead, Obama pledges not to raise the retirement age and to "protect Social Security benefits for current and future beneficiaries." This isn't "change"; it's sanctification of the status quo. He would also exempt all retirees making less than $50,000 annually from income tax. By his math, that would provide average tax relief of $1,400 to 7 million retirees -- shifting more of the tax burden onto younger workers. Obama's main proposal for Social Security is to raise the payroll tax beyond the present $102,000 ceiling.

Samuelson goes on the say this isn't just Obama's problem, all politicians do it (agreed). But if lawmakers continue to avoid the problem, and on top on that Democrats win both Houses and the presidency (not trying to say I oppose that situation), what will happen in the future? What happens to the people of my generation (and basically anyone living past year 2019, according to the trustees)? Then what?

**

Very funny.

Bringing it back to health care

In a break from my feminist rantings, I found this post from the Health Affairs blog (in an effort to to read other health care blogs). Frank Opelka, a professor of surgery and vice chancellor for clinical affairs at the Louisiana State University Health Science Center, discusses the problems with the way the sustainable growth rate is currently calculated, a better way that it could be calculated and the problems that would be encountered (and overcome!) in implementing his suggested system.

I'm not going to go into the problems with the SGR (see my previous post on Leavitt's blog post of the subject), but I think Opelka's endorsement of a MedPAC suggestion has merit. MedPAC suggested, as part of a Deficit Reduction Act mandate, that the government create "unique Service Category Growth Rate (SCGR) targets as well as payments based on participation in a system of care," noting, "In each proposal, the goal is to avoid the blunt, lofty economic drivers and provide physician incentives to moderate growth in volume and intensity within a geographic setting, specialty base, or system of care," i.e. regional, rather than a national, targets.

In general, when it comes to measures based on economic indicators (like eligibility guidelines for public programs), I think that regional is always better. It does not cost the same to practice medicine in middle-of-nowhere Nebraska as it does in New York City. Regional just makes more sense.

He adds a bit about incorporating quality measures into the SCGR:

These quality tools could serve as a valuable resource for regions and systems of care to promote evidence-based, efficient care. Physicians, medical groups, and hospitals will need to use the current measurements available for comparison against their peers and national benchmarks. Through payment incentives and a clinically focused approach, regional efforts and systems of care will have a greater opportunity to reach individual providers.

Concluding

The best model for modifying the SGR likely includes both regional targets and assessment of spending by specialty. The true answer lies in changing the reward system so that physicians are rewarded for collaborating and making decisions in the best interest of the patient and the overall health care system. The payment system can no longer pay blindly on volume, but must instead financially encourage providers to remove waste and promote efficient, high-quality care. The SGR is too far removed to change behavior at the individual provider level. Regional and service category proposals will bring the requirements closer to the individual, but it is important that unintended consequences be modeled in advance and offset by mandatory quality targets.

I think Congress is supposed to tackle this sometime this session, although I seriously doubt that they will (seems a bit too complicated for lawmakers to handle). But maybe next session, if Democrats can manage to win control of both houses and the presidency. Even if they don't, someone needs to tackle the SGR revision, and soon.

Pent Up Anger

While out for happy hour last weekend in D.C., my friends and I managed to pick a bar that was part of a Obama supporter bar crawl. Standing around with my roommate, we were approached by bar crawl participants, who asked us if we wanted a sticker. We politely told them no thank you, we support Hillary. Which led to a 30 minute discussion about why I was supporting Hillary (my roommate had escaped by this point). So annoying 1) because I was a happy hour, and 2) because speaking/thinking about Obama makes me uncontrollably angry.

I've been doing a lot of thinking lately about why I hate Obama so much. It's not rational, and I would consider myself a rational person by nature. So why the pent up anger?

The only thing I can come up with is that Clinton's downfall is so obviously in part because of sexism. In the media, in people's minds. The media bugs me the most. I expect everyday people to be ignorant, that's just how it goes. But the media? Our society's opinion leaders? I expect them to hold themselves to a higher standard. But they really have not, and completely represent how sexist is still so prevalent, albeit in a more subversive form than in the past. NOW's president Kim Gandy I think sums up my feelings best in her most recent "Below the Bet" post:

The press have been brutal to Clinton, no doubt about it. Whether consciously or not, too many reporters, commentators, pundits and the like appear unable to critique Hillary Clinton without dusting off their favorite sexist clichés, stereotypes and insults. Some of these remarks seem mild, while others are offensive and truly outrageous. Taken together, they create an environment of hostility toward all women, not just Senator Clinton. At this moment it feels like she is a stand-in for every woman who has ever tried to get ahead and be taken seriously by the powers that be.

For me, it's not just the sexist comments about Clinton, it's also the media's absolute inability to critique Obama. Certainly, he's done something to merit scrutiny. They just won't look.

For example, last week (I started this post awhile ago) I was reading the coverage for Maryland's primaries (where I'm from) in the Baltimore Sun. On the front page, there were three stories: one about Clinton, one about Obama, and one about McCain. The tag lines telling readers where to find the rest of the stories were slightly ridiculous: Clinton's was "campaign," McCain's "GOP," and Obama's was "believer." Believer?? Are you kidding me? How about "Obama" or "Democrat" or something without such a blatantly biased connotation? It's little things (so small you wouldn't even realize that you read it unless looking) like that that really drive me insane. Read Gandy's post for more ingratiating remarks.

I've been collecting articles over the last two weeks that I think either resonate with the sexism problems in the media or in society. Here are the highlights:

• "Between 'inspiration' and health care," Froma Harrop: "From his Chicago headquarters, Obama ended the exhausting Tuesday night with an almost mechanical 'we have to choose between change and more of the same.' ... How odd that when it comes to the Democrats’ top concern, health care, Obama offers very much 'more of the same' -- as in more of 'no universal coverage.'"
• "When women rule," Nicholas Kristof: "In monarchies, women who rose to the top dealt mostly with a narrow elite, so they could prove themselves and get on with governing. But in democracies in the television age, female leaders also have to navigate public prejudices -- and these make democratic politics far more challenging for a woman than for a man."
• "Democrats need to understand that racism and sexism still count in elections," Mary Sanchez: "In the final primary weeks, Democrats should ask themselves this question: Is the U.S. more prone to racism or to sexism? And how should the answer affect party strategy if the goal is a Democratic White House. ... I vote sexist. Hillary haters are much more numerous and vocal than those who can’t stomach the idea of a black man globetrotting for the next four years on Air Force One."
• "A calumny a day to keep Hillary away," Stanley Fish: "The majority of posters agreed with the characterization of the attacks on Senator Clinton as vicious and irrational, but in not a few posts the repudiation of Hillary-hatred is followed by more of the same. ... Comments like these would seem to lend support to the view (voiced by many respondents) that sexism is what ultimately motivates the Clinton bashers. ... If so, they face it from women as well as from men, at least on the evidence provided here."
• "Women hold key to Clinton's fate," Bill Maxwell: "The country has had a number of women who have sought the White House, but none could garner wide support. So far, Clinton has been the most viable, but she is facing the 'damned-if-you-do-and-damned-if-you-don't' syndrome. She cannot be too feminine for fear of appearing weak and not up to the job. She cannot be too wonky or too tough for fear being labeled a 'bitch.'"

***

Since writing this post, there has been a slight shift in the media, although it's too little too late, I think. Here's a couple of opinion piece that (finally) realize that Obama's "hope" might not be all it's cracked up to be:

• "Obama's spell memorizing but empty," Charles Krauthammer: "Democrats are worried that the Obama spell will break between the time of his nomination and the time of the election, and deny them the White House. My guess is that he can maintain the spell just past Inauguration Day. After which will come the awakening. It will be rude."
• "The Obama delusion," Robert Samuelson: "Repudiating racism is not a magic cure-all for the nation's ills. The task requires independent ideas, and Obama has few. If you examine his agenda, it is completely ordinary, highly partisan, not candid and mostly unresponsive to many pressing national problems."