The Best of A Bunch of Bad Options

As the Public Option continues to decay in the Senate, I think my preferred alternative would be a triggered public option, with most of the parameters written by mainstream Democrats. But Chris Bowers tells me that ain't gonna happen. So now it looks like folks are dusting off the idea of letting those near retirement age buy into Medicare. This idea, which has been kicking around since at least the Clinton administration, is better than almost anything else being discussed on both politics and policy. After all Republicans have spent the last week claiming to be the champions of Medicare by fighting to preserve every dollar spent on Medicare, showing reckless disregard for the program's solvency and no particular interest in trying to find savings that won't have an impact on health outcomes. I'd love to see the press conference where Mitch McConnell tries to explain why he doesn't want younger than 65 to have access to this lovely government program.

The alternatives are just grim. We're down to some strange idea of a plan being run by the Office of Personnel Management. Except it wouldn't be administered by the government in any real way; it would just be outsourced to a non-profit or a collection of non-profits. It's totally unclear that this would accomplish anything as a cost control measure; it wouldn't do much to improve Americans' confidence in government action; and it would insure even fewer people than the other crippled public option compromises on the table. The trigger alternative, as Bowers suggests, won't lead to a particularly robust public option. But Medicare is a program people like. Giving the people more of it seems worthwhile.

Friday Obama Caption Contest & Kitsch Cover

Original caption:
"Aboard Air Force One, President Barack Obama discusses his Afghanistan speech with Ben Rhodes, Deputy National Security Advisor for Strategic Communications, en route to the U.S. Military Academy at West Point in West Point, N.Y, Dec. 1, 2009."


Here's Anna Terheim covering Fleetwood Mac's "Little Lies":

Less Cancer Screening is a Technocracy, not Discrimination

To be very clear about this, there have been nearly equivalent studies showing that early prostate cancer screening doesn't do much to reduce prostate cancer mortality. No one said anything about these studies giving men an excuse to take the a heteronormative "tough it out" approach and avoid seeing a doctor. Dana Milbank didn't write columns with quotes from stunned advocacy and awareness groups. Prostate cancer survivors in the Senate like John Kerry and Chris Dodd didn't demand amendments that mandated full first dollar coverage for current levels of PSA screening (in fairness, Senator Mikulski has rolled back the language to allow the hope of some flexibility hear, if at some point the relevant agency can change their recommendations without creating a firestorm on Capitol Hill or in the White House). Tom Coburn didn't start making shit up about how the Democrats would tax your ... well, I think my readers have gotten the picture.

America has two problems relating to breast-cancer screening. One is the inequity in access to screening; poor and/or non-white women are less likely to get screening than middle-class and/or white women. The other is that those women who do get screening receive frequent and early screening that ends up detecting a larger number slow-growing, non-fatal than peer countries. In addition, mammograms in general produce a lot of false positives, so we're putting lots of patients through a lots of anxiety and unpleasant treatment that's not saving very many, if any, lives. In the UK, women at standard breast cancer risk (no BCRA, no family history of breast cancer) are guaranteed one mammogram every three years starting some time between 50 and 53 (women at elevated or high risk are guaranteed US levels of screening). France (which has the #1 quality health care system in the world) offers breast cancer screening starting at age 50 every two years. Germany? Same as France. The rest of the industrialized world seems to think that the harms caused by early screening—and let's be clear on this, complications due to treatment of a non-fatal cancer are definitely harm—outweigh the benefits. This isn't discrimination, this is going where the evidence is taking us. Yes, that line has abused by pro-discrimination types throughout history. But that doesn't mean that every time it's used, there's discrimination afoot.

Ring The Alarm / And I'm Throwin' Elbows

Item one: "Sen. Ben Nelson told reporters today he will filibuster the health care bill if it doesn't contain an abortion amendment similar to Rep. Bart Stupak's amendment that passed attached to the House health care bill last month."

Item two: "Sen. Susan Collins (R-Maine) has asked top administration officials to make certain changes to the Senate health care bill as part of discussions that suggest her vote is up for grabs"

My crude read is that this is the White House's way of telling Ben Nelson (and Evan Bayh and Joe Lieberman and the rest of them) that they won't get to hold the bill hostage. They've never been particularly committed to the public option, and the Senators from Maine have actually been pretty good on affordability issues. Threatening to go elsewhere for the last two votes is a good way to make temper the demands of the moderates.

Pop quiz: a public option with Stupak rules? Or a crappy trigger without Stupak? Discuss.

Donkeylicous Everywhere

Because one blog clearly isn't enough, and because I can't bring myself to be on DoD conference calls with Real Journalists and say "Hi, this is Nicholas Beaudrot from Donkeylicious", I'm doing a day's worth of guest blogging over at Attackerman. Here's my first post on what "July 2011" really means.