EYES WIDE SHUT: Nothing to look at, the author said!

WEDNESDAY, AUGUST 14, 2013

Part 2—Where’s the outrage: Like you, we can see the announcement already.

Next April, the judges will issue their happy statement, conferring a joy on the world:
PULITZER COMMITTEE (4/15/14): For a distinguished example of explanatory reporting that illuminates a significant and complex subject, demonstrating mastery of the subject, lucid writing and clear presentation, using any available journalistic tool, Ten thousand dollars ($10,000).

OR:

For a distinguished example of investigative reporting, using any available journalistic tool, Ten thousand dollars ($10,000).

Awarded to Elisabeth Rosenthal of the New York Times for her penetrating look into the high cost of medical care in the United States.
The process is already under way! Starting on June 2, Rosenthal has published three lengthy front-page reports in her future award-winning series, PAYING TILL IT HURTS. But how odd! In the process of winning the Pulitzer Prize, Rosenthal’s series of front-page reports has produced exactly no public discussion.

Last week, Rosenthal guested on Fresh Air. Aside from that, we find no sign that she has been mentioned by the national press corps at all.

Her series deals with the massive looting which characterizes American health care—and her series has been appearing on the front page of America’s most famous incompetent paper. And not only that! This massive looting helps explain a wide set of societal ills—stagnant wages; the lack of international competitiveness by some important American industries; the failure to achieve full health care coverage; the problems of federal deficits.

In the normal practice of American health care, massive, ginormous amounts of money disappear every year. At least in theory, Rosenthal’s series is exploring this remarkable problem.

And yet, even at The One Liberal Channel, her name has gone unmentioned as she has published her three lengthy front-page reports. The children employed by the corporate bosses have shown no interest in this high-platform series.

The channel’s relentlessly misused viewers haven’t been told that they’re being looted in this remarkable way. Instead, they get to hear that O’Reilly’s a racist and that Governor Ultrasound was given a watch by a somewhat kooky but marginal benefactor.

They get to hear a bunch of fake facts about the Zimmerman trial. They get to hear grandpa prove his street cred as he states his pointless view of the “Bulgah” trial.

They get their routine servings of weiner. They hear predictions of events three years hence, which they then see mocked by The Daily Show. But they don’t hear a word about this series, which (we predict, though perhaps incorrectly) is going to win a Pulitzer Prize next year.

So it goes as the various children of our various news orgs pretend to create a progressive and/or liberal politics. As they stuff money into their pants, they have extremely good health care and very large wages, just like the previous generation—folk like McGrory and Matthews and Collins and Weisberg—who refused to discuss the Gore-Bradley health care debate of 1999, preferring to focus on the color of the suit in which Gore was disturbingly clad.

And on the number of buttons on his suit jacket! Here’s how McGrory began her column about the first Gore-Bradley debate, which turned on the basic structure of American health care:
MCGRORY (10/31/99): Vice President Albert Gore came to his fateful encounter with newly menacing challenger Bill Bradley carrying heavy baggage. He was wearing an outfit that added to his problems when he stepped onstage at Dartmouth College: a brown suit, a gunmetal blue shirt, a red tie—and black boots.

Was it part of his reinvention strategy? Perhaps it was meant to be a ground-leveling statement—"I am not a well-dressed man." It is hard to imagine that he thought to ingratiate himself with the nation's earliest primary voters by trying to look like someone seeking employment at a country music radio station. Maybe it was the first step in shedding his Prince Albert image.
All that is true. Also this: Maybe McGrory should have been fired, extremely rudely, the very next morning, quite early.

McGrory had received her Pulitzer Prize in 1975. Years later, she had easy work at very good pay—and she had excellent health care.

McGrory didn’t seem to care about those rubes who did not. As it turned out, neither did Sam or Cokie. When we watch Our Darling Rachel clowning each night about Ultrasound’s Rolex, we get the impression that this journalistic “gruesomest generation” is perhaps being reborn, packaged with a different politics concerning the “social issues.”

That different politics cons us rubes, as Darling Rachel, like those before her, lets us see how little she cares about the bread-and-butter issues which don’t affect her cohort. Or so it can sometimes seem!

(Did you see her making her chicken noises last night? It was just good solid fun, as the looting continued.)

The silence surrounding the Rosenthal series constitutes a remarkable primer in the workings of the modern plutocrat con. (Let them eat charges of racism!) That said, we’d have to say that Rosenthal has practically begged for this state of affairs, in which no one discusses her detailed series of high-profile front-page reports.

Rosenthal’s series concerns the high cost of our American health care. In each of her three reports, she has provided beaucoup details about the high cost of some particular medical procedure—colonoscopy, hip replacement, even childbirth itself.

In each report, she offers a blizzard of detail about how much such a procedure can cost over here as opposed to in (consult your gazette). In her first report, she even flirted with the idea of noting the overall size of the looting which is going on in this country as the seven-figure gang distracts us with tales about kooks.

Throughout that first report, Rosenthal discussed the Yapaleter family, which was struggling with the very high cost of a colonoscopy. At this point, she briefly flirted with the idea of blurting the overall truth:
ROSENTHAL (6/2/13): The more than $35,000 annually that Ms. Yapalater and her employer collectively pay in [health insurance] premiums—her share is $15,000—for her family's Oxford Freedom Plan would be more than sufficient to cover their medical needs in most other countries. She and her husband, Jeff, 63, a sales and marketing consultant, have three children in their 20s with good jobs. Everyone in the family exercises, and none has had a serious illness.

Like the Yapalaters, many other Americans have habits or traits that arguably could put the nation at the low end of the medical cost spectrum. Patients in the United States make fewer doctors' visits and have fewer hospital stays than citizens of many other developed countries, according to the Commonwealth Fund report. People in Japan get more CT scans. People in Germany, Switzerland and Britain have more frequent hip replacements. The American population is younger and has fewer smokers than those in most other developed countries. Pushing costs in the other direction, though, is that the United States has relatively high rates of obesity and limited access to routine care for the poor.

A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.

''In the U.S., we like to consider health care a free market,'' said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ''But it is a very weird market, riddled with market failures.''
In that passage, Rosenthal flirts with describing the massive scandal involved in her subject matter. She flirts with the idea of telling her readers about the massive looting involved in our health care arrangements—about the fact that Americans spend two to three times as much on health care, per person, as citizens of other developed nations, while receiving no improvement in health outcomes.

The scandal, and the size of the looting, are remarkably easy to capture. They were already there, for all to see, in these basic data, which we won’t bother updating:
Total spending on health care, per person, 2007
United States: $7290
France: $3601
Germany: $3588
United Kingdom: $2992
Italy: $2686
Spain: $2671
Japan: $2581 (2006)
Those were astonishing data. They’ve always been amazingly easy to type, but major newspaper like the Times have just kept forgetting to do it, even in 2009, when they spent an entire year pretending to discuss this gigantic problem.

By 2009 (click here), France and Germany were actually spending slightly more than half as much as we were. But in these figures, it’s easy to see the puzzle, and the obvious scandal, which lie at the heart of this outrageous national story.

Three to five thousand dollars, per person, were disappearing into the maw of our health care arrangements each year, as compared to the health care spending in other large developed nations. Multiply by five to determine the size of the looting being visited on the Yapalanters!

An obvious scandal is easily spotted in those remarkable data. But such basic data have never appeared in the blizzards of minutia which have been churned in Rosenthal’s detailed reports.

At times, Rosenthal almost seems to be trying to hide the size of this obvious problem. The Yapalanters’ $35,000 in annual premium payments “would be more than sufficient to cover their medical needs in most other countries?”

That's true, of course. But after Rosenthal gets her Pulitzer, let’s hope she’s honored by the people who distribute the Absurd Understatement Awards.

Those very basic data have been missing from the Rosenthal series. Missing too is the sense of anger and alarm such data might occasion. Rosenthal is discussing a gigantic problem, but she never sounds like a person who knows that. Nor does she quite sound like a person who wants her readers to know.

On Friday, we’ll show you how CNN sounds while discussing a much smaller scandal. Tomorrow, though, we’ll examine a puzzle in Rosenthal’s latest report.

On August 4, Rosenthal discussed the (mammoth) cost of a hip replacement. The procedure costs so much in this country, she says, that Michael Shopenn, 67, of Boulder, journeyed to Brussels for his.

As William Bennett used to say, “Where’s the f**king outrage?” Rosenthal seems to describe a truly astonishing state of affairs. But given her notable lack of affect, we’re still not sure if we understand what she actually said.

Tomorrow: Can that possibly be what she said?

Friday: This is how CNN sounds

You're right, it was that debate: You're right! The debate which McGrory so crassly blew off was in fact the same debate at which the press corps, crammed into a press room at Dartmouth, jeered and hissed “almost every time Al Gore said something,” for the full hour.

We got a phone call from Dartmouth that night describing the children's astonishing conduct. We described that astonishing conduct right smack dab from Day One.

Eventually, three major figures—Tapper, Pooley and Mortman—all described this astounding behavior. But in real time, and in the years since, it has almost never been mentioned. Meanwhile, people like McGrory and Collins got busy mocking Gore's performance, including his horrible wardrobe, of course. Health care got thrown down the stairs by these overpaid people, who had it.

Your favorite liberals didn't say boo about any of this. Why do you think that is?

By the way, did you see Our Darling Rachel making her chicken noises last night? As William Bennett used to say, same exact f**king idea!

29 comments:

  1. "Last week, Rosenthal guested on Fresh Air. Aside from that, we find no sign that she has been mentioned by the national press corps at all."

    Not sure how TDH is defining "national press corps," but googling news for Elisabeth Rosenthal shows more interest than the above statement implies. That said, it would be better if there were a bigger response--especially from the political establishment.

    TDH has long been a voice of reason on the topic of US healthcare. It's great to see a media outlet like the NY Times at long last publishing similar viewpoints.

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  2. Why wasn't "Michael Shopenn, 67, of Boulder" getting Medicare?

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  3. My wife and I lived in France as legal residents (not visitors) from 2002 to 2005.
    Not only did we qualify for French national health insurance (Assurance Maladie), we were REQUIRED to have it.

    The last job I had in the US was in a small auto repair ship with an owner and 12 employees.
    My wife was a school teacher, so she had health insurance.
    The owner had us covered, we shared costs.

    I paid about $150.00 a month for good coverage, as did all the single males.

    The married man with two kids had to pay $800.00 a month for the same coverage, so he opted out. His family had NO insurance.

    Co-pays were $20.00 - $30.00 - $50.00, with lab work and imaging from $20.00 to $50.00 co-pay.

    In France, my wife and I were both covered for $90.00 per month. When the USD fell against the Euro, the quarterly cost went down commensurately.
    Co-pays were $6.00. Lab and imaging, no charge.
    Hospital emergency-room, admissions, and out-patient fees were $0.00. That is not a typo.

    Drug prices were reimbursed at 75%, which changed to 70% while we were there.

    BTW. Just a guess, but Michael Shopenn may not have been collecting Social Security when he was 65, so he would have had to enroll for Medicare during a specific time period, but didn't. The process is complex and confusing. He may have been working at a job that had some coverage, but not hip replacement coverage.


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  4. The price quote was from a hospital. A major factor in that is very simply that quoted hospital prices are fantasies, with no real connection to the amount that hospitals expect to collect.

    The vast majority of hospital patients do not pay their own bills; they are paid, and more importantly, negotiated by insurance companies or the government, both of which have their own ideas of how much they are willing to pay - and the hospitals know that they have to accept those rates.

    So the obvious problem is the people without insurance, who actually do receive bills with the hospital numbers. Naturally, many of them panic, look for ways to raise the cash, or in some cases, sue. $18 per Tylenol is common.

    But the hospitals know that they will not collect those numbers.

    A very instructive blog post some months ago described how one person responded. He knew he couldn't pay the bill (around $10,000, I think), and kept putting off dealing with it. Naturally, he expected a collection agency to come after him.

    What actually happened, though, was that a year-and-a-half later, the hospital billing department asked him if he would be willing to settle the bill for about $150. Naturally, he lept at the chance.

    Much more commonly, those in the know negotiate with hospitals, offering some much smaller amount to settle the bills, and usually successfully. But you have to know that you can do it, and how. Hospital bills are not like almost any other debt. Most people with insurance never have to deal with them.

    So the bottom line is that the hospital charge sheet is a fantasy document, and it is simply not the case that procedures actually cost so much more in the US. The problem is that the hospitals ASK for so much more, with no expectation that they will get it, and yet sometimes they do because the system requires patients to know more than they should have to.

    ReplyDelete
    Replies
    1. Actually, the "total spending on health care" numbers quoted above -- and the large insurance premium payments by made by insureds and employers -- tell us that procedures *do* actually cost so much more in the US.

      Delete
    2. When comparing numbers at that level, you need to be sure that the conditions are comparable. If one population buys fleets of Mercedes and another buys fleets of Chevys that does not demonstrate that it costs more to build a care in one area than another - only that one population chooses to purchase higher-level autos. If one population gets into many more accidents than another, their cost of autos and repairs will go up - and once again says nothing about the relative cost of building autos.

      To have an honest comparison between nations, you need to look at many factors, including trade-offs between care and neglect, and rates of injuries and illnesses. Just assuming that everybody is the same is not likely to result in accurate or meaningful comparisons.

      Delete
  5. Poo Poo Platter (Serving the same Dump-lings since 1999)

    Well, where to start with this rehash of Somerby's special sauce, the horrible treatment of Al Gore by the press after his debate with Bill Bradley back in a previous century.

    First, let us note for the historical record, for those who believe in polls, that Al trailed Bill by more than the margin of error in New Hampshire going into the first debate which somehow today managed to become a focal point of a post about a current NYT series. Despite the savage depiction of him by the elite media, he won the New Hampshire primary and went on to be the Democratic nominee. He even went on to win the General election at the ballot box.

    (Second, Mr. Somerby engages in quite an enormous amount of the old media spinning himslef when he describes that evening in October of the prior millennium thusly:

    "the first Gore-Bradley debate, which turned on the basic structure of American health care:

    The event was actually formatted as a town hall. And neither Gore nor Bradley did much to offer a debate on the structure of American health care. Many issues were discussed in response to audience, rather than press, questions.

    Gore managed to turn a question into a point of attack on Bradley's health care proposal, which more closely resembled universal health insurance coverage than did Gore's plan. The issue in the debate was whether Bradley's proposal cost more than he estimated and would, as Gore charges, devour the entire budgetary surplus.

    Even if covered in full by every pundit following the "debate", what was discusssed had nothing to do with the structure of American health care nor the issue of high cost raised in the excellent Blumenthal articles.

    You are right Bob. Liberals have said little about the abysmal performance of the press back then. The press is saying too little about the high cost of health care now. And your readership, it would seem by commentary volume measurement, would rather flap their gums and assert that a trial proved Trayvon Martin stalked George Zimmerman for four minutes than talk about this issue.

    ReplyDelete
    Replies
    1. "And your readership, it would seem by commentary volume measurement, would rather..."

      YAWN!

      By Poo Poo volume measurement, a lot less of your Poo Poo is what this readership would actually like.

      Delete
    2. "You are right Bob. Liberals have said little about the abysmal performance of the press back then. The press is saying too little about the high cost of health care now. And your readership, it would seem by commentary volume measurement, would rather flap their gums and assert that a trial proved Trayvon Martin stalked George Zimmerman for four minutes than talk about this issue."

      Translation: Yeah...Yeah..Who cares if you talk about liberal concerns such as health care and corporate media collusion, you still aren't talking smack about Republicans.

      Delete
    3. Anon

      I think I have heard your reaction described before:

      "In what kind of world does a.... commenter.... sit quietly by while famous old howlers like these get repeated to the public? Answer: In a colonial world, where the wisdom of the people is constantly undermined by the fatuous favorite tales of a whole gang of old Cotters."

      CecliaMc

      I am glad to see Bob talk about the NYT's articles about health care. I just don't think reliving press coverage of a 1999 debate adds much to it, particularly when the tale is spun with such errant embellishment by a one man crusader against such spinning.

      If either of you have anything factual to rebut me with other than my offense of pointing out the drool on the codger's bib, let me know.

      PPP

      Delete
    4. No, you're not very glad, Poo-poo. Otherwise a foray into how seriously the subject of health care (and the candidates' positions) was treated by the media would garner a more measured reaction reaction than 'yeah, the media sucks at informing us about our candidates and our national issues, but you hotdogged it on Gore."

      Then you go on to diss the commenters here.

      Unless, this dog starts throwing around partisan insults you just aren't going to let him rest.

      Delete
    5. Sorry CeceliaMC. I could care less what degree of partisanship Bob Somerby does or does not show. I share a great deal of contempt for the same media characters he does. I just don't act like them when I accuse them of acting like others.

      Delete
    6. If you were indeed concerned about the media and about issues you wouldn't be nitpicking Bob and the other commenters here.

      TDH talks about health care and it's coverage and that's not good enough for the guy who wanted substance.

      As it stands, you're solely interested in finding fault with this blog. That's all you're here for.

      Delete
    7. >>> nail on head award to:

      AnonymousAugust 14, 2013 at 3:18 PM

      "I am glad to see Bob talk about the NYT's articles about health care. I just don't think reliving press coverage of a 1999 debate adds much to it, particularly when the tale is spun with such errant embellishment by a one man crusader against such spinning.

      I am glad to see Bob talk about the NYT's articles about health care. I just don't think reliving press coverage of a 1999 debate adds much to it, particularly when the tale is spun with such errant embellishment by a one man crusader against such spinning."

      Delete
    8. >>> not sure of the grammar, but on substance the runnner up to the first annual nail on head award is:

      AnonymousAugust 14, 2013 at 5:20 PM

      "I (unlike the lord of darkness) just don't act like them when I accuse them of acting like others." ['lord of darkness' mine]

      Delete
  6. The Republicans HAVE a position on healthcare in the US, and I quote, "Obamacare is a train wreck." Period.

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    Replies
    1. Well, it is more descriptive than their position when the bill was before Congress, which was "Let's start over with a clean sheet of paper."

      Delete
    2. That's the way to start. Then you move on to programs that give consumers the same tax incentives that businesses receive so that they can own their policies rather than their employers, and then watch the garment rending commence.

      Delete
  7. October 99 LA Times Headline:

    Gore Skewers Bradley Health Insurance Plan
    Politics: In tactical shift, vice president brands rival a left-leaning 'insurgent,' ridicules proposal as 'throwback.'

    By 2002, Gore was calling for single-payer, but back when he was campaigning for President his stated views were quite different.
    http://www.commondreams.org/headlines02/1115-07.htm

    To the extent that this TDH post calls for more media attention to the costs and effectiveness of healthcare by analyzing international data, this is a very good post. The tie-in back to 1999 is a distraction at best and wrong-headed at worst--it's unhelpful to anyone.

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    Replies
    1. How is it "wrong-headed and unhelpful to anyone" for the blogger to write about what he considers to be media malfeasance in ignoring the specifics in a health care policy debate in '99, and in ignoring them now?

      The media handling of the issue may not be YOUR interest, but that doesn't make it "unhelpful" for everyone else.

      Delete
    2. This post can be about A) comparing US healthcare costs to other nations' or B) why Al Gore didn't get elected. It can't realistically be about both without compromising focus (and logic). Al Gore didn't lose because reporters failed to communicate Gore's popular healthcare program.

      Delete
    3. Not only is it logical to detail why the health issue is of national importance while making the point that poor coverage is essentially media malfeasance, it's imminently logical.

      You might as well argue that customer service is important for Amazon,com, but concerns about a UPS and FedEx strike are a distraction.

      Delete
    4. Perhaps Cecelia Mc one could argue that customer service is important for Amazon.com
      without arguing that the media failure to cover differences in UPS and FedEx management and union counteroffers prior to the 1999 strike signals a societal paralysis akin to pre Republican Ireland.

      Delete
    5. CeceliaMc,

      I see your point, sort of...but isn't that Gore/Bradley debate the worst possible example TDH could give? I mean TDH has bashed the Bradley candidacy for many years now, but on that issue even Gore himself would now favor Bradley's position over the one he had espoused back in 1999.

      I can't believe that TDH is arguing that the media should have focused more on healthcare so that Bradley would have been the Democratic nominee. So I still think that aspect of the post confuses the overall point about healthcare expenses in the US.

      Delete
    6. And I suppose Dickens could have said "It was the best and worst of times" and One Day in the Life of Ivan Denisovich could have been something along the lines of The Little Engine That Could.

      These are the blogger's thoughts, arguments, deliberations, and conclusions. If you find them boring then why don't you go read Democratic Underground, and let the rest of us be intrigued.

      Delete
    7. Well, it's good that you can't believe that, Trollmes. You may be so incapable of ascertaining the point about media malfeasance that you think Gore should have considered his debate treatment as a political favor, but at least you know the blogger isn't that clueless.

      Delete
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