Ouch, the stupid

Picking on Mallard Fillmore strips is pretty low-hanging fruit, but sometimes I just cannot help myself.  Like yesterday’s strip:

Seriously?!  The reason for domestic violence is all because liberals have ruined civility or gender roles or something like that?  The key word here is the now hit women.  Right, as if domestic violence is something new.  It’s just astounding that Tinsley does not seem to realize that we’ve always had domestic violence and that social norms and reporting are what have changed, not liberal ideas causing men to hit women (for the better!).  I suspect the average middle-schooler is smart enough to figure this out.

Third World America

Very interesting article in The Atlantic about America’s poor infant mortality rates.  Apparently, a substantial portion of our much-worse-than-average for advanced nation rates of infant mortality is about what we actually count as infant mortality.  Hooray, we’re not as bad as it seems.  On the other hand, digging into the data reveals a powerful indictment of how we do things here in the US:

In other words, American babies are mostly fine while they’re in the hospital and during their first days at home—but over time, that changes.

Or rather, it changes for some of them. The effects of socioeconomic status on health have been well-documented, and infant mortality is no exception: Unsurprisingly, the states with the highest rates are also among the poorest. “IfAlabama were a country, its rate of 8.7 infant deaths per 1,000 would place it slightly behind Lebanon in the world rankings,” Christopher Ingraham recentlynoted in The Washington Post, while “Mississippi, with its 9.6 deaths, would be somewhere between Botswana and Bahrain.” [emphasis mine]

When the researchers took socioeconomic status into account, they found no significant difference in mortality across the three countries among babies born to wealthy, well-educated women. Lower down the socioeconomic ladder, though, the differences became stark; children of poor minority women in the U.S. were much more likely to die within their first year than children born to similar mothers in other countries.

“I don’t think we have a deep understanding of what’s going on there,” Oster admits.

We may not have a “deep” understanding, but we sure know that massive inequality seems to make for more dead babies who otherwise would have lived.

Chart of the day

Jonathan Cohn with 7 charts that show Obamacare is working.  Here’s two:

Several factors seem to be at play, including the recession. For that reason, it’s likely that spending will start to accelerate a bit as the economy recovers. But most experts now think the “new normal” is lower inflation, because the health care industry is becoming more efficientat least partly in reaction to new incentives that the Affordable Care Act introduced.

One sign that those incentives is working is a dramatic decline in the number of hospital readmissions. The decline began just as hospitals started facing new financial penalties, enacted as part of Obamacare, for high readmission rates. Whatever the cause, it’s clear that health care spending isn’t accelerating rapidly, as critics predicted would happen once Obamacare became law.

Federal health spending

Say what you will about Obamacare’s architects, but they took their fiscal responsibilities seriously. The law calls for new spending, since the government now has to underwrite the costs of both an expanded Medicaid program and all those subsidies for people buying health insurance. But for every dollar in new spending, there is at least one dollar in either new revenue or new spending cuts. The net effect, according to the Congressional Budget Office, is to reduce the deficit.

So, does this mean that all those who preached ruinous doom and gloom will recant?  Or at least that journalists will not take them seriously on this issue?  Yes, and unicorns.

Cotton and farming

I recommended Molly Ball’s excellent profile of the likely next Senator from Arkansas, Republican Tom Cotton.  Cotton’s one problem is that he is from Arkansas and voted against the Farm Bill.  His solution?  Lie shamelessly and keep on lying after being called out by fact-checkers.  Chait is on the case:

Cotton’s opponent, Mark Pryor, has assailed him for this vote. Cotton has shot back with an ad claiming that this only happened because “President Obama hijacked the farm bill, turning it into a food stamp bill.”…

Faced with his controversial vote against the farm bill, Cotton has urgently fashioned himself as an agri-supremacist. He has urged the locals to ignore the judgment of fact-checking journalists who pronounce his ad false: “I don’t think liberal reporters who call themselves fact checkers spent much time growing up on a farm in Yell County growing up with Len Cotton, so I think I know a little bill more about farming than they do.” Cotton’s identity as a onetime farmboy, by this argument, lends him a superiority in any dispute over farm policy that overrides even the facts themselves. Cotton perhaps first developed this epistemological theory while studying philosophy at Harvard.

Cotton goes further still. Molly Ball, in an engrossing profile, reports that Cotton argues against food stamps because its recipients live high on the hog: “They have steak in their basket, and they have a brand-new iPhone, and they have a brand-new SUV.” As an argument against food stamps, this is laughably false: The program offers a benefit averaging $1.50 per person per meal, and its beneficiaries are quite poor [emphasis mine]

Cotton is just evil.  The man is Harvard-educated.  Surely he knows how utterly misleading his characterization of your typical food stamp recipient is.  Rather, he would just seek to demonize poor people for his own political power.  Love Chait’s conclusion:

The snag in Cotton’s rapid path to national power turns out to be that his ideology is just a little too consistent. But he has found the solution. He is running not quite as a principled foe of government, but instead as a committed opponent of redistribution. Government is bad insofar as it gives money to the poor and vulnerable. Tom Cotton is going places in the Republican Party.

The case against the Supreme Court

Law professor and scholar Erwin Chemerinksy has written a new book about the Supreme Court.  Some particularly interesting excerpts from Dahlia Lithwick’s interview with him about it:

Your argument for the failure of the court rests largely in the criticism that the most central role of the Supreme Court is to “enforce the Constitution against the will of the majority.” I imagine that a lot of your critics would disagree with that assessment. I imagine others would contend the Roberts court does protect minorities, say, when it protects the rights of billionaires to contribute to campaigns, or of religious Christians who don’t want to fund contraception. What makes you so certain that acting as a counter-majoritarian check is the defining role of the court?

I think that there are two important questions here. First, why believe that a pre-eminent role of the court is to protect minorities? To me, it goes to the question of: Why have a Constitution? Why should a democracy be governed by a document that is difficult to change? It is not to protect the majority; they generally can protect themselves through the democratic process. It is minorities who cannot protect themselves through majoritarian democracy. I believe that the Constitution exists especially (though not exclusively) to protect the rights of minorities of all types.

Second, who is a minority? That is a difficult question. The key, based on my definition above, is those who are unlikely to be able to protect themselves in the majoritarian process. Examples include racial minorities, criminal defendants, the homeless, prisoners. Billionaires obviously are very able to protect themselves in the political process.

Also, I have been railing against John Robert’s “balls and strikes” ever since he said it.  Loved to see Chemerinksy strike it down and extend the metaphor:

It is a grossly inaccurate description of what Supreme Court justices do. Supreme Court justices do not simply call balls and strikes. They determine the rules and the strike zone. Justices have tremendous discretion in the cases coming before them, and the descriptions of Roberts and Sotomayor portray it otherwise. Every Supreme Court decision makes the law. When the court decides whether states can prohibit marriage equality, that will make the law whichever way the court describes it. John Roberts and Sonia Sotomayor would have been confirmed almost no matter what they did at their confirmation hearings. Each gave the American public a very misleading sense of what the court does.

Screwed in the ER

Yet another excellent NYT story on how various health care entities are always finding new ways to screw us over.  The latest?  In-network Emergency Rooms that hire out-of-network Emergency physicians.  Yep:

Patients have no choice about which physician they see when they go to an emergency room, even if they have the presence of mind to visit a hospital that is in their insurance network. In the piles of forms that patients sign in those chaotic first moments is often an acknowledgment that they understand some providers may be out of network…

But even the most basic visits with emergency room physicians and other doctors called in to consult are increasingly leaving patients with hefty bills: More and more, doctors who work in emergency rooms are private contractors who are out of network or do not accept any insurance plans…

While patients have complained of surprise out-of-network charges in hospitals from some other specialists — particularly anesthesiologists, radiologists and pathologists — the situation with emergency room doctors is even more troubling, patient advocates say. For one thing, patients cannot be expected to review provider networks in a crisis, and the information to do so is usually not readily available anyway. Moreover, the Texas study found that out-of-network fees paid to emergency room physicians eclipsed the amount of money paid to those other specialists…

The average salary of an emergency room physician was $311,000 in 2014, rising from $247,000 since 2010 — a period when many other types of doctors experienced declines in salaries, according to Merritt Hawkins, a physician staffing firm.

Read the article for the depressing details of patients who thought they were doing everything right only to get saddled with outrageous medical bills.  Even better, though, is Drum’s rant in response:

This is a great scam for everyone. Presumably hospitals save money because freelance ER docs cost them less. And the ER docs cost less because they know they’ll be able to run the ol’ out-of-network scam on lots of patients, thus raking in the bucks. It’s a win-win.

As a result, during a period of economic stagnation that produced zero wage growth for everyone else, ER docs are now making $64,000 more than they did four years ago. And they’re doing this by preying on the most vulnerable, most easily scammable members of society: folks who are flat on their backs and almost by definition unable to understand what’s going on around them. Not that it would matter if they did, of course. The law provides no recourse even if you don’t like this system. That’s the way things roll in the American health care system.5

If this kind of stuff doesn’t make you pop a vein, I’m not sure what would. It’s right on a par with the telemarketing ghouls who prey on senior citizens with dementia. Except that these guys wear white coats and are welcomed into all the best country clubs.

I’m going to go out on a limb here and suggest this just doesn’t happen in other modern nations with rational health care systems (and substantially more government involvement).

We’re 51!

From the Greensboro News & Record.  Ugh.

Among the 50 states and the District of Columbia, North Carolina ranks as the worst state for teachers, according to a new ranking by WalletHub.

The personal finance website analyzed data along 18 categories to come to its rankings.

The metrics it looked at included looks at states’ median starting salaries, unemployment rates and teacher job openings, among other factors.

Here is where North Carolina ranked in several categories:

  • Average starting salary, 41,
  • Median annual salary, 47,
  • Unemployment rate, 38,
  • Ten-year change in teacher salary, 51,
  • Pupil-to-teacher ratio, 32,
  • Public school spending per student, 48,
  • Teachers’ wage disparity, 43, and
  • Safest schools, 40.

I enjoyed all the comments about how it is the Democrat’s fault that the ten-year change in teacher salary is 51.  And whereas Democrats can take a portion of the blame, Republicans have controlled the legislature (and the budgeting process) since 2011 and we have seen our teacher salary ranking decline rapidly in recent years.

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