Beautiful Day

Austin is so hot in the summer that it isn't much fun to be outside. But most of the rest of the year makes up for it. Today is one of those days that I think longingly about in July.

I took my daughters to the Austin Nature and Science Center this morning. It was sunny, probably in the low 70s, with a slight breeze. Perfect. We walked around, dug in the dinosaur pit, crossed the stream a couple of times, looked at a few of the critters they keep there, sat outside to eat lunch. As we were passing back by the stream to leave, we stopped and closed our eyes to listen to the running water and the breeze blowing in the trees. I thought my heart would burst, standing there with my two beautiful girls on such a beautiful day.

"They Told Stories That ..."

The Sinclair Broadcast Group, owner of the WB network and the "fair and balanced" Fox News network, plans to air "Stolen Honor: Wounds that Never Heal", an anti-Kerry piece of propaganda, during prime-time hours next week. The program deals with Kerry's 1971 anti-war testimony to Congress, depicting Kerry as testifying that US forces frequently committed atrocities in Vietnam.

In his testimony, Kerry reported what he had heard at the "Winter Soldier Investigation", a series of hearings from 150 honorably discharged Vietnam veterans in Detroit in January 1971 held by the group "Vietnam Veterans Against the War". Kerry did not speak at the event, which received only moderate press coverage, but he reported what he had heard while there when he testified three months later before Congress in his famous speech that is now the subject of the attacks.

Bush supporters have used excerpts of Kerry's testimony to charge him with accusing his fellow veterans of atrocities and war crimes, but every time they quote him they leave out the crucial phrase, "They told stories that ... ", deliberately creating the false appearance that Kerry was making accusations rather than reporting what he had heard at the Winter Soldier hearings.

It's a lie, and yet polls were actually influenced by the lies of Swiftboat Veterans for Truth, and next week maybe also by the Sinclair group, assuming (as reports seem to suggest) that they put the same deliberate distortion out there to confuse and manipulate their audience.

An unedited excerpt from the transcript of John Kerry's 1971 testimony to Congress that includes, in its full and original context, the statements actually made by John Kerry, is below. Maybe you feel he was still wrong to say them. That's fine -- my point is that we all have an obligation to make certain that our opinions are based on facts and not on deliberate lies - especially at a time when distorting the truth to sway voters has become mainstream, common, and abhorrently unapologetic.

* * * * *

"Several months ago, in Detroit, we had an investigation at which over 150 honorably discharged, and many very highly decorated, veterans testified to war crimes committed in Southeast Asia. These were not isolated incidents, but crimes committed on a day-to-day basis, with the full awareness of officers at all levels of command. It is impossible to describe to you exactly what did happen in Detroit--the emotions in the room, and the feelings of the men who were reliving their experiences in Vietnam. They relived the absolute horror of what this country, in a sense, made them do.

"They told stories that, at times, they had personally raped, cut off ears, cut off heads, taped wires from portable telephones to human genitals and turned up the power, cut off limbs, blown up bodies, randomly shot at civilians, razed villages in fashion reminiscent of Ghengis Khan, shot cattle and dogs for fun, poisoned food stocks, and generally ravaged the countryside of South Vietnam, in addition to the normal ravage of war and the normal and very particular ravaging which is done by the applied bombing power of this country.

"We call this investigation the Winter Soldier Investigation. The term "winter soldier" is a play on words of Thomas Paine's in 1776, when he spoke of the "sunshine patriots," and "summertime soldiers" who deserted at Valley Forge because the going was rough.

"We who have come here to Washington have come here because we feel we have to be winter soldiers now. We could come back to this country, we could be quiet, we could hold our silence, we could not tell what went on in Vietnam, but we feel, because of what threatens this country, not the reds, but the crimes which we are committing that threaten it, that we have to speak out."

Debate Impressions

So far, the Dem-leaning blogs I've scanned are calling it for Kerry and the Repub-leaning ones are calling it for Bush. I lean toward Kerry on this one, but only slightly, and mostly because I thought Bush seemed defensive. This one was close -- much different than the first go-round. Close enough that either side can reasonably claim a win.

As I said, Bush seemed very defensive to me for alot of the debate, but I suspect some people will read that as forceful. He also wasn't as tongue-tied this time. But it seemed to me that his underlying answer to alot of questions was "because I'm the President and I say so" or "I shouldn't even have to be explaining myself, because I am the President". His mischaracterizations of some of Kerry's positions were remarkably blatant, but since most people don't follow up to see what was truthful and what was not, he won't lose any votes over it. Although -- he really should have kept his powder dry on the timber company thing, because it appears that he has already been fact checked:

President Bush himself would have qualified as a "small business owner" under the Republican definition, based on his 2001 federal income tax returns. He reported $84 of business income from his part ownership of a timber-growing enterprise. However, 99.99% of Bush's total income came from other sources that year. (Bush also qualified as a "small business owner" in 2000 based on $314 of "business income," but not in 2002 and 2003 when he reported his timber income as "royalties" on a different tax schedule.)

People tend to tune out the nuances and corrections on policy stuff, but this is exactly the kind of silly thing that sticks. Next week, people will be saying Bush lied about owning a timber company.

Kerry did pretty well, although there were a few times when I was pleading with him via the TV to introduce or expand on certain things. I think he should have hammered Bush on the Duelfer report. He never mentioned Bush's initial opposition to establishing the Department of Homeland Security or his budget proposals for the agency. I thought Kerry's general demeanor came off well, like last time, and he made a few points more strongly and clearly than he did last week (such as tax cuts versus Homeland Security spending).

More Money Works Wonders

The Department of Health and Human Services announced that Medicare beneficiaries who join managed care plans can expect lower premiums and additional benefits due to increased reimbursement rates for the plans under the new Medicare law.

As of March 2004, Medicare Advantage plans will be receiving 107 percent of Medicare fee-for-service costs. That means the Medicare managed care program is costing 7 percent more than the traditional program costs.

As part of the Medicare Modernization Act (MMA), Medicare Advantage [...] health plans will receive payments over and above what they were slated to receive in 2004. The original rate increase, announced by CMS in May 2003, will remain in effect for January-February 2004. The higher payments are intended to help stabilize Medicare Advantage, in which recent drops in enrollment have been prompted largely by two factors: the withdrawal of health plans from the program and higher monthly premiums and cost sharing in plans that have stayed. [...] More specifically, the bill requires plans to use the additional payments to (1) reduce enrollee premiums or cost sharing, (2) enhance benefits, (3) stabilize provider networks and/or (4) put the dollars in a stabilization fund for use later in order to offset potential future premium increases or benefit cuts.

We gave the health plans more money and they were able to reduce beneficiary cost sharing and offer additional benefits. That's great. But why is that news? It isn't like this proves managed care is an inherently better way of delivering Medicare services. We spend more, we should get more in return for beneficiaries. And it isn't like the health plans are demonstrating some "beneficiaries first" commitment we should all be congratulating them for. We required the plans by law to spend the additional money in specific ways.

The real news here is that the government is spending extra money to entice seniors into managed care plans. You may or may not think transitioning Medicare to a managed care system is a good idea, but either way, what's implicit in this is that people who remain in traditional Medicare -- the ones who'll be paying 17 percent higher premiums -- aren't getting any help with their premiums. The Medicare law isn't just providing choices for seniors. It is aligning the financial incentives to make the traditional program less affordable.

Bush has said that "[b]eneficiaries should have the option of keeping the traditional plan with no changes." He "also believes that any improvements in Medicare should not force changes on today's seniors who are satisfied with their current coverage." But these statements are disingenuous at best, when he plans to take funds that could be used to lower costs for all beneficiaries and instead target them to those who opt out of the traditional program.

Don't get me wrong. I am not necessarily anti-Medicare managed care. In fact, done and reimbursed correctly, I think you could do some neat stuff with it. But the Bush Administration seems much less interested in learning the lessons from Medicare+Choice (Medicare Advantage's predecessor) than in pushing an ideological agenda that involves outsourcing it all and restructuring the program as a defined contribution system.

So great. We threw money at a problem and it actually fixed it: more money from the government side = less money needed from the beneficiary side (ie, more affordable premiums). Except that the vast majority of Medicare beneficiaries -- the ones who remain in the traditional program -- still have a problem. Where's the money to make their premiums more affordable?

UPDATE: Ross at The Public Health Press notes that the lower premiums health plans say they will offer sound familiar: "That's what the medical malpractice insurers did when they were flush with extra cash back in the mid-90s, as an effort to lure more docs to their programs."

Prevention of Childhood Obesity Act

I posted an action alert at Open Source Politics about the Prevention of Childhood Obesity Act.

Commercial Alert is asking Americans to contact their Congressional representatives to support this legislation, which would, among other things, ban junk food in schools that receive federal funds. You can read my OSP post for more details.

Hilarious Debate Summary

This is the best summary of the VP debate I've seen yet. Make sure you aren't drinking anything when you read it, because it is rolling-on-the-floor hilarious.

Link via Crooked Timber.

Have A Drink, Grandma

When I worked for the state, part of my job involved long-term care policy and programs. I remember (not quite) joking with the guy who for many years wrote regulations for Texas long-term care facilities and with my boss, who developed Texas' managed care model for the elderly and disabled, about how nursing homes ought to have happy hour. I think I read about a nursing facility for Jewish residents in New York somewhere that actually has a daily happy hour. We all thought that sounded like a great idea. I mean, if you were living in a nursing home, wouldn't you need a drink or two??

Well, it turns out that maybe happy hour is just what the doctor ordered for older women.

A new study at the University of Texas found that elderly women who drank in moderation had better memories, higher mental functioning, less depression, less anxiety and overall better health than women who shunned alcohol altogether. [...]

In their study, the UT researchers asked 182 Central Texas women between the ages of 65 and 95 about their drinking habits. Seventy-seven said they had two or fewer drinks a day; the rest said they never drank. The women — the average age was 75 — took a battery of tests involving memory, cognitive abilities, decision-making, depression, anxiety and daily living tasks, including cooking and taking medications.

The women who reported moderate drinking scored higher on the tests than those who said they never drink.

OK, so there are some caveats - like, they didn't control for every confounding factor and they didn't find a causal relationship between drinking and better scores. But still. When I'm old, they better have a margarita machine in my nursing home.

VP Debate

Kerry v Bush was easy to call. Edwards v Cheney was alot harder. Both men landed a remarkable number of hits and both did a good job of thinking on their feet. But overall I give it to Cheney.

He's a great extemporaneous speaker. Edwards is too, but Cheney's calm, matter-of-fact demeanor comes off better to me than Edwards' folksiness. Cheney was also better with the poker face. Several times you could see on Edwards' face that Cheney landed a punch, and a few times he got a snarky, arrogant look that doesn't tend to sit well with people. Edwards also seemed a little goofy, catching his own flubs like he did. And what was with him, ripping paper while Cheney spoke?

It was close, but Cheney did slightly better.

VoteKids

I have a new post up at Open Source Politics about children's health coverage and a campaign by pediatricians to raise public awareness of Bush's record on this isse.

The Sound Princess

OK, I know going in a public restroom isn't on anyone's list of favorite things. But this is a little over the edge. I mean, come on...Everyone Poops.

Behind The Medicare Bill

The Boston Globe has an article examining the deals that were done to get the Medicare bill passed last year. Its an instructive look at how things actually get done in politics. As the president of America's Health Insurance Plans (the national lobbying group for the health insurance industry) put it:

"All the major issues are settled not necessarily in the open forums, but by leaders in conference committee, when they get together and decide what they are going to do," Ignagni said. "It's pretty standard operating procedure for the Congress."

Austin's own Lisa McGiffert, an analyst for Consumer's Union, is also quoted in the article.

What Kerry Pulled Out

It seems that Kerry may have violated the debate rule about not bringing anything to the podium - notes, etc. The blogosphere is busy conjecturing about what Kerry pulled out of his pocket. Patrick at Yelladog puts the speculation to rest, however.

The Impact of Abstinence-Only Education

A group called Advocates for Youth has conducted an analysis of the ten state evaluations that have been done on abstinence-only sex education. The group also looked at CDC data regarding high school students' sexual behavior between 1991 and 2003. The analysis finds that these abstinence-only programs have done little to reduce rates of teen sexual activity and have actually reduced improvements in safe-sex behaviors:

* None of the programs showed "long-term success in impacting teen sexual behavior."
* Only one program showed "short-term success in delaying the initiation of sex."
* "[I]mprovements in adolescent sexual risk-taking behavior actually took place from 1991 to 1997...[and]...did not continue into the time period between 1999 and 2003—which corresponds to the first years of the abstinence-only initiative."

Some of the specific findings around risky sexual behavior:

* While the proportion of high school students who reported ever having sex dropped 11 percent between 1991 and 1997, there was no statistically significant decline from 1999 to 2003.
* From 1991 to 1997, there was a statistically significant decline in the proportion of male and black high school students who reported current sexual activity (within three months prior to the survey), but that trend did not continue between 1999 and 2003. During both periods, the overall proportion of currently sexually active high school students showed no statistically significant change.
* Between 1991 and 1997, condom use among sexually active young people increased 23 percent. However, the increase in condom use slowed between 1999 and 2003, rising only 9 percent.
* The prevalence of students who reported having had four or more sexual partners declined significantly (14 percent) from 1991 to 1997, but remained unchanged from 1999 to 2003.

The Administration response to these findings is citation of other data analysis by the Heritage Foundation showing that "adolescents who pledge to remain abstinent until marriage have fewer sexual partners and are less likely to experience teen pregnancy, give birth outside of marriage and engage in unprotected sex than those who do not make a pledge." Which is nice, but doesn't actually say anything directly about abstinence-education programs. The Heritage Foundation analysis found that other factors, such as socioeconomic status and religiosity, have an effect on the difference in behavior between pledgers and non-pledgers, but that some difference did appear to be the result of taking the pledge per se. However, there was no analysis linking who takes a pledge to who had abstinence-only education. Thus, assuming a correlation between abstinence-only programs in schools and virginity pledges assumes a whole lot - not the least of which is that all such programs encourage students to take a virginity pledge.

This is the best they can do? I can only conclude that the Administration folks at HHS can't directly refute the Advocates for Youth findings and thus are pulling at straws to defend their position. Once again, ideology trumps fact. How can people vote for that?

UPDATE: And in other news, the House has increased abstinence-only funding by almost 50 percent in the current appropriations bill.

Defining Acceptable

According to the Austin-American Statesman, the State of Texas just released ratings showing that just over half of Austin Independent School District Schools are in the "academically acceptable" category. This means the school meets the minimum state requirements.

[H]alf of a school's students -- in addition to 50 percent of each individual student group -- had to pass the reading, writing and social studies portions of TAKS. Only 25 percent of those groups had to pass science, and 35 percent had to pass math, for a school to be rated academically acceptable -- assuming the schools also met graduation and attendance benchmarks.

In what alternative universe can these standards possibly constitute acceptable? Up to half the students can fail the reading test and up to 65 percent can fail the math test and that's academically acceptable??

Texas miracle, indeed.

Debate Impressions

Overall Performance Kerry gave a much better performance than Bush did. He was poised, confident and well-prepared. Bush seemed defensive, occasionally annoyed and unable to veer from the catch-phrases. He also had numerous deer-in-headlights moments.

Content Any assessment of the accuracy or rightness of either candidate's comments depends largely on your own take on stuff. But from a detail perspective, Bush was rarely able to move away from the talking points. He just didn't come across to me as a guy who has a comprehensive understanding of issues and situations. Kerry did a better job of fleshing out ideas and appearing to have a handle on details. However, I would have liked more from Kerry as well. To a considerable degree, the time limits prevented a comprehensive discussion. But Kerry had some opportunities to go into more detail and he chose to fall back on the high-level message. I know the experts say most Americans don't pay as much attention to content as to other aspects when judging the debates, but to me, this is the heart of it. The failure to go into more detail does a disservice to democracy. Anybody who wants the job ought to be respectful enough of the magnitude of that responsibility to talk in depth with America about their policies and plans. But the President in particular should be ashamed for relying on catch-phrases rather than really fleshing out details, because he's already in the job.

The Sway Factor Owen says in a comment to his post on the debate that what matters is not what the candidates say or how well they perform, but whether or not they sway any voters. This is one I can't judge. The undecided voter - or even the tentatively committed voter - is a mystery to me. As another of Owen's commenters points out, the ideological differences between the two choices in this race are so overwhelming and obvious, that the undecideds are clearly not paying attention.

UPDATE: Peter Robinson, who was blogging the debate along with Arnie Arnesen for the Christian Science Monitor, raised a good point:

Something astonishing is taking place here, something akin to what took place during the OJ Simpson trial. People are looking at the same set of facts and seeing two quite, quite different realities. Kerry sees us losing ground, while Bush is convinced that we're making progress.

Putting the Mock in Democracy

I plan to watch the Presidential debate tonight, but I have very low expectations. After all, it isn't really a debate. It isn't going to delve deep into the details of each candidate's policies. It isn't much of anything except a carefully controlled, quasi-scripted, joint public appearance. The candidates and their respective parties have successfully turned the public's one decent shot at hearing some honest exchange of ideas into nothing but style and spin.

Of all people, Howard Stern has the best take on the debates I've heard yet. I was flipping around the radio yesterday and stopped when I heard him discussing the upcoming debates. He likens the presidential debate to a job interview - an opportunity for the American people to interview the guys who want this very important position. But as he correctly noted, applicants for a job don't get any say-so over who interviews them, what questions will be asked, and any other aspect of the interview.

We should be outraged that the candidates and the two parties control the debates. We should be outraged that they have structured the debates so that they are not debates.

You know how we ought to structure these debates? A moderator (or several) that has a reputation for evenhandedness -- and I'd even let it be someone both sides agree on -- ought to come up with questions that are not shared in advance with the candidates. When a candidate starts to spin or get off topic, the moderator should be able to cut in and make them focus on the question and really answer it. Then they ought to take questions from an audience that is selected at random, with no regard to who they think they'll vote for.

For each question, each candidate should get five minutes to open, five minutes to rebut, and five minutes to close. That's half an hour per topic, which while alot longer than they currently have for a given topic would still give pretty short shrift to some weighty issues. And it means we need more than two or three debates, in order to cover a reasonably wide range of topics.

Here are the Top 10 Secrets They Don't Want You To Know About The Debates, which is long but I've copied it in full because I think its important stuff for people to know (link via Yelladog):

After weeks of political wrangling, Sen. John Kerry and President Bush will square off for the first of three key presidential debates. Both camps have agreed to an elaborate, 32-page contract that spells out everything from the size of the dressing rooms to permitted camera angles.

But the controversy over the debates threatens to overshadow the events themselves. Some citizen groups complain that the Commission on Presidential Debates (CPD) isn't as non-partisan as it should be, and that Kerry and Bush won't be pressed on urban issues. Commentator Connie Rice says that's just the tip of the iceberg, and she's got another Top 10 list -- this time: Top 10 Secrets They Don't Want You to Know About the Debates.

(10.) They aren't debates!

"A debate is a head-to-head, spontaneous, structured argument over the merits of an issue," Rice says. "Under the ridiculous 32-page contract that reads like the rules for the Miss America Pageant, there will be no candidate-to-candidate questions, no rebuttal to your opponent's points, no cross questions or cross answers, no rebuttals, no follow-up questions -- that's not a debate, that's a news conference."

(9.) The debates were hijacked from the truly independent League of Women Voters in 1986.

"The League of Women Voters ran these debates with an iron hand as open, transparent, non-partisan events from 1976 to 1984," Rice says. "The men running the major campaigns ended their control when the League defiantly included John Anderson and Ross Perot, and used tough moderators and formats the parties didn't like. The parties snatched the debates from the League and formed the Commission on Presidential Debates -- the CPD -- in 1986."

(8.) The "independent and non-partisan" Commission on Presidential Debates is neither independent nor non-partisan.

"CPD should stand for 'Cloaking-device for Party Deceptions' -- it is not an independent commission on anything. The CPD is under the total control of the Republican and Democratic parties and by definition bipartisan, not non-partisan. Walter Cronkite called CPD-sponsored debates an 'unconscionable fraud.'"

(7.) The secretly negotiated debate contract bars Kerry and Bush from any and all other debates for the entire campaign.

"Under what I call the Debate Suppression and Monopolization Clause of the contract, it is illegal for the candidates to debate each other anywhere else during the campaign," Rice says. "We need a new criminal law for reckless endangerment of democracy."

(6.) The debate contract effectively excludes all other serious presidential candidates from participating in the debates.

"This is what I call the Obstruction of Democratic Debate Rule, which sets an impossibly high threshold for third-party candidates... Where are we, Russia? Isn't Vladimir Putin wiping out democracy in Russia by excluding all opposing candidates from the airwaves during his re-election campaigns? Most new ideas come from third parties -- they should be in the debates."

(5.) All members of the studio audience must be certified as "soft" supporters of Bush and Kerry, under selection procedures they approve.

"It's not enough to rig the debate -- they have to rig the audience, too? The contract reads: 'The debate will take place before a live audience of between 100 and 150 persons who... describe themselves as likely voters who are soft Bush supporters or soft Kerry supporters.' We should crash this charade and jump up in the middle to declare ourselves hard opponents of this Kabuki dance."

(4.) These "soft" audience members must "observe in silence."

"Soft and silent... In what I'm calling the Silence of the Lambs Clause of this absurd contract, the audience may not move, speak, gesture, cough or otherwise show that they are alive and thinking."

(3.) The "extended discussion" portion of the debate cannot exceed 30 seconds.

"Other than the stupidity of the debate contract, what topic do you know that can be extendedly discussed in 30 seconds?"

(2.) Important issues are locked out by the CPD debate rules and party control.

"Really important but sticky or tough issues get axed, because the parties control the questions and topics," Rice says. "For example, in 2000, Gore and Bush mentioned the following issues zero times: Child poverty, the drug war, homelessness, working-class families, NAFTA, prisons, corporate crime and corporate welfare."

(1.) Fortune 100 corporations are the main funders of the CPD-sponsored debates, and the CPD's co-chairs are corporate lobbyists.

The CPD is run by Frank Fahrenkopf, a pharmaceutical industry lobbyist, and Paul Kirk, a top gambling lobbyist," Rice says. "And the biggest muliti-national corporations write the checks that fund the CPD -- Phillip Morris, Anheuser-Busch and dozens more. The audience may have to be silent and motionless, but the corporate sponsors can have banners, beer tents, Budweiser girls handing out pamphlets protesting beer taxes -- a corporate-sponsored circus to go along with the Kabuki Debates. Could we get a more fitting description of our democracy?"

Structuring the Medicare Drug Benefit

The wrangling has begun over details of the Medicare drug benefit.

CMS has released some draft rules for public comment, which is why we're starting to hear about some of the specifics. The particular issue discussed in the linked article is formularies. Insurance companies and pharmaceutical benefit managers (PBMs) say requiring too many classes of drugs in formularies will minimize their ability to achieve cost savings. The pharmaceutical industry, consumer advocates and doctors say too few drug classes will result in people not having access to needed drugs. Both sides are right, actually.

This issue paper, developed for the Kaiser Family Foundation, looks at how formularies and other cost control mechanisms may affect Medicare beneficiaries' access to drugs. If you're not interested in the details, here's the upshot from the "average patient" perspective:

[T]here is a potential tradeoff between what helps individual beneficiaries at any given time (e.g., being able to obtain the drugs their doctors prescribe) and what helps beneficiaries more broadly (e.g., lower prices and lower premiums). For medical conditions like depression, bipolar disorders, or hypertension, treatment decisions are relatively individualized, that is, the drug that works for one patient may not work for another. For beneficiaries with these conditions, less restrictive formularies or fewer drugs on a high-cost tier may be important to maximizing quality of care. For other medical conditions such as allergies, arthritis pain, or ulcers, the choice of drugs may be less critical. But there are still some patients, especially those with certain accompanying conditions, for whom the preferred drug may not work. The average beneficiary in these circumstances may see reduced premium costs if plans use their market leverage to bargain for the best price among a set of drugs where good evidence on comparative effectiveness concludes that the drugs are generally equivalent. For these drug classes, a good exceptions process may be the key to protecting beneficiaries with special circumstances.

Infuriating

Congressional Democrats should be ashamed of themselves.

At a House-Senate conference committee, Democratic lawmakers abandoned efforts to pay for [extending the Bush tax cuts] by either imposing a surcharge on wealthy families or closing corporate tax shelters.

"I wish we could pay for them, but this is a political problem, and we have people up for re-election," said Rep. Charles Rangel of New York, the senior Democrat on the House Ways and Means Committee. "If you have to explain that you voted for these tax cuts because they benefit the middle class and against them because of the deficit, you've got a problem."

It burns me up, how they can just jettison principle whenever there's an election. Do they really think that one vote for tax cuts will change the minds of people who believe Democrats are reckless tax and spenders?? Give me a break. If you don't stand for something different than the Republicans stand for, what reason does anyone have to vote for a Democrat rather than a Republican?

If the Democratic base were a certain rotund South Park character, this is the kind of crap that would make it say "Screw you guys, I'm staying home" on election day.

It Turns Out There Is A God...

...and He's pissed at Bush voters.

Don't forget to check out the poll.

Link via Crooked Timber.

Just About Worth The Price Of Admission

A spot-on take on the general relevance of political/social commentary blogs:

Blogging is just a cyberspace letter to the editor, instant venting, and little else. It's not "new media" [...] blogs are like newspapers made up entirely of op-eds for the likeminded. Critical thinking is rarely the price of admission, and, speaking of admission, how many blogs would you pay to read?

This isn't to say that all blogs are worthless. Some are thoughtful, some are well written, and some are entertaining. Others have become useful vehicles for raising campaign funds for various causes. But if you were to take the whole blogosphere and separate the wheat (the good blogs) from the chaff (the bad blogs) you'd barely have enough to make a Triscuit.

Speaking chaff-istically, I will only add that some of the wheat bloggers do go out and generate primary source information instead of just regurgitating or spewing forth about what's already out there. CalPundit's interview with Paul Krugman and Charles Kuffner's interviews with various Texas political candidates come to mind. And there are some really smart people blogging who contribute a level of detail and expertise to the mix that you don't typically get in a newspaper story.

And yes, sometimes I do blog in my pajamas.

The Cost of Drug R&D

If you ever wonder about pharmaceutical research and development costs (and I know you do), here's some nifty information Matthew cribbed from the government.

On average, the top nine "branded" pharmaceutical companies spend (as a percent of total revenue):

* 13 percent on research and development
* 31 percent on sales, marketing, general and administration
* 30 percent on cost of goods sold
* 6 percent on taxes, net interest expense and other
* Profit comprises 20 percent of total revenue.

The pharma industry gets alot of help from taxpayers for R&D. Matthew (with the help of a reader) cites $23 billion in drug R&D through the National Institutes of Health, and another $33 billion through the pharma industry. While NIH research is just a starting point for drug development efforts and the industry clearly contributes some hefty resources, it is nonetheless research the industry uses to identify things to pursue. The other way the industry benefits from tax dollars?

The pharmaceutical industry enjoys certain tax benefits for the costs of R&D. A pharmaceutical company can expense R&D costs (reducing taxable income in a given year) rather than depreciate them over time. A pharmaceutical company also receives tax credits that depend on domestic spending levels for certain categories of R&D. Tax credits are a significant benefit to the sector[.]

Doesn't it seem to you that the amount of profit the pharma companies make is a little unfair, given how much help they get from taxpayers and how little tax they pay? I think public investment in R&D makes sense, and I'm not suggesting we decrease it. But - particularly given current budget and population projections -doesn't it seem reasonable for these companies to give some of that profit back to the taxpayers?

It doesn't have to be a money transfer, necessarily. I know how contentious taxes are. But how about, say, allowing Medicare to negotiate for lower prices? No? How about allowing Americans to go out of the country and purchase cheaper drugs? No again? Hmm. How about allowing generics on the market sooner? Still no? Gosh, you drug companies sure seem ungrateful for the help we give you.

The idea that we're going to kill the drug industry by taking steps to lower drug prices doesn't add up. They've got a pretty comfortable cushion. And anyway, they could trim a little from the sales/marketing/admin budget. I don't actually know anything about how they furnish their offices, so while I suspect they aren't the picture of thrift, I will pass on any pronouncement in that area. But I will say that prescription drugs shouldn't be directly marketed to consumers. The appropriateness of a drug is a decision for a doctor.

Reconciling Competing Needs

The parents of a 9 year old boy who has Asperger's syndrome are suing school officials for banning their son from the playground. The school says the child was, among other things, threatening and being rough with other kids.

I feel for this family. To have a child with a disability would be tough, and I totally understand where they are coming from. Socialization is helpful for their son's condition. They want to give him every opportunity to learn and live as normal a life as possible. I would want that too, if I had a child with a disability.

On the other hand, I want to minimize my children's exposure to threats and physical violence. Certainly, most kids exhibit aggressive behavior at times. You can't completely avoid it, and my kids are as prone to it as any others. But most kids are only occasionally aggressive, and with some patient adult guidance (sometimes a challenge to muster) it can be diffused. In any case, I generally think that if your child is having a hard time playing with other kids - meaning, continued aggressiveness that the parent can't diffuse - its only fair to the other kids to remove your child from the situation. I do think trying to determine the underlying reason for the aggressiveness is important, but in this case, the reason is a child's disability. He is thus more prone to the behavior, less able to grasp its inappropriateness, and likely to be less responsive to intervention. His parents say other kids might be banned from the playground for a few days rather then permanently. But when he comes back in a few days, the underlying issue is still there, whereas a child without this disability comes back perhaps in a better mood, perhaps not as tired - the reasons for the aggressive behavior may have passed. At the very least, the child may respond to the threatened loss of playground time by playing more cooperatively.

The parents make the case that the way to improve the child's ability to deal with other kids is to continue putting the child in social situations. I get that. But how do you balance the rights of the other children to feel safe on the playground? If my child were involved, I would want this kid to play somewhere else. As much as I support disability rights and mainstreaming when appropriate, I would have the "not in my backyard" reaction. Is it even possible not to? My priority is making sure my kids are safe and feel safe. I want this other child to get what he needs, just not at the expense of other children.

I'm glad I'm not the judge in this case. Because I just can't see a way to reconcile the needs and rights of this child with those of the other children.

Red States V Blue States

Just stumbled across this neato thing the Philadelphia Inquirer and the Anniston Star (Alabama) are doing. The papers chose two individuals from red-state Alabama and two from blue-state Pennsylvania. Each week the four are asked for their opinions on a different issue. This week the issue is health care. So of course, I read all their responses for this week.

One of the red-staters, Cynthia Sneed, said:

I do know that a large part of our health-care crisis is related to medical care for undocumented workers and that Hispanics are now the majority minority population in America. [...] The Federation for American Immigration Reform's estimate of the national cost incurred by undocumented workers for Medicare and Medicaid is $3.7 billion.

I was surprised to see that Sneed is a professor, with a doctorate in accounting. I would think she'd have a better grasp of numbers. If her estimate of the amount spent on undocumented immigrants is correct, that comes to less than one percent of the President's proposed Medicare/Medicaid budget for FY 2005 ($472 billion). That hardly constitutes a "large part of our health-care crisis". Overall, I found her comments to be a mix of unsupported assertion and statistics that didn't support her conclusion. Unfocused, too.

Red-stater Joe Franklin surprised me by saying he would support a single, government-directed system. While he didn't provide much detail other than to say private companies should actually manage the care, the fact that he supports a government-directed system seems like a big deal to me. Although - it shouldn't, since there is some evidence that most Americans support a universal health system.

Blue-stater Tim Horner shares his family's very positive experiences with the British health care system, and sums up his view of the difference between conservatives and progressives. I started hearing a violin crescendo during his description of progressives, but the general parameters strike me as not so far off base:

Conservatives appeal to our concern for ourselves, our personal income, our personal tax rate, our personal safety, our personal standard of living, our insurance premiums. (This concern for our personal lives also extends to our most intimate life-style choices and personal morality. How touching.) Progressives have a tougher sell because we have to appeal to the selfless side - the side that wants to give to others, make sacrifices so that less fortunate people can have what we have, and make sure that every American has access to quality health care even if it means that we have to support it with our tax dollars.

In times of stress, fear, and unrest, people tend to fall back and "take care of their own." Bush is counting on that, because it is the core of his platform, health care notwithstanding. I believe, however, that there are more Americans who are fundamentally selfless and want to do good for others. I am counting on the fact that there are people who are willing to make sacrifices for the good health and well being of every citizen. I think this is America at our best.

Finally, blue-stater Terri Falbo provides much more detail than the other three in terms of how she would like to the health system work. Sounds like she summarized what's in HR 676 (Conyers, D-Mich): a single-payer system with delivery remaining private. This proposal cuts out the middleman - insurance companies - and establishes state-level entities to develop and implement cost-containment strategies.