Sen. Coburn Approves Killing Poor Babies

Yesterday on "Meet the Press" Sen. Tom Coburn said the following:

We talk about neonatal mortality. Where’s the neonatal mortality? It’s not in the private insurance plans, it’s in Medicaid. Well, here’s the government-run program that is failing us in terms of neonatal mortality, and yet we use as an indicator neonatal mortality to say we need more government rather than less.

Rachel Maddow replied, "That is so disingenuous, that's unbelievable."

Rachel is right, although she didn't get to explain why. Medicaid is not a federal government insurance program. It's a joint state/federal program to provide last ditch assistance to people without health insurance to allow them to get treatment rather than die in the streets. Many of the 45 million people without health insurance probably benefit from Medicaid if they have a serious illness, or have a baby. So the people on Medicaid are the people targeted by the new program exactly to do things like allow them to have regular visits to a doctor while they are pregnant, rather than seeing a doctor for the first time when they go to the emergency room to give birth. If it weren't for Medicaid, many more poor babies would die, because mothers would get no medical care at all.

Coburn is basically saying that since people on Medicaid are poor, he doesn't care if their babies die. He would join Sarah Palin in calling for babies of trailer park trash to die so that Palin's Trig and other rich babies can live.

It's the same selfishness expressed in the town hall meeting protests that say, "Don't mess with my Medicare." They worry that their "socialist" government provided health care would suffer if the government tried to provide similar coverage to more people. They are saying I want those other people to die rather than give up my free health care.

Decent, loving people (which should certainly include people who call themselves Christian) would frame the issue as follows: We would like to have decent health care for everybody, not just me. How can we best do that, and how much can we afford? The latter question might also be phrased, how much am I willing to give my neighbor so that he can continue to live.

People screaming, "Don't touch my Medicare," are clearly not Christians.

Will Jobs Ever Recover?

Everybody is celebrating that the number of people who lost their jobs last month was smaller than the number for previous months, and the unemployment figure fell from 9.5 to 9.4 per cent unemployed. Meanwhile the stock market is going through the roof. What this means to me is that in the competition between labor and capital, capital is winning.

The consensus is that businesses are earning more money despite lower sales because they are cutting costs, which mainly means laying off workers.

The laid-off engineers and skilled mechanics may eventually get jobs, but many of them will end up working at McDonald's, Wal-Mart, or in similar unskilled jobs that pay considerably less. This is good news for Wall Street, where executives will hire replacements for them in India or China for much less, thus cutting the bottom line as they begin rehiring at the end of the recession. The recession has been a great opportunity for American business to get rid of higher paid American workers forever, not just during the recession.

Uneven Playing Field: Flash Orders and Oil

The obscene profits and compensation at Goldman Sachs and other banks indicate that the stock and commodity markets are not level playing fields. The big firms have an unfair advantage and they use it. The only argument in favor of allowing them to use this advantage is that they continue to take such huge trading risks that if they were to fail, as many small investors do, they would once again threaten to destroy the world as we know it, as they did at the end of the Bush administration.

Two examples of their unfair advantage have come to light in th4e last few days: flash or high frequency trading orders, which is under investigation by the SEC, and manipulation of the oil futures market, which is under investigation by the CFTC. The fact that both of the matters are under investigation is a welcome change from the Bush administration Of course Goldman Sachs is in the forefront of both of these questionable practices. Matt Taibbi did an excellent job of reporting Goldman’s role in the spike of gas prices last year; now they are at it again.

Malpractice and Healthcare

I am very disappointed that there has been so little discussion of the importance of malpractice liability in the discussion of the cost of healthcare. It may be anecdotal, but my impression is that malpractice liability adds significant costs to medical care. It may be a relatively small percentage, but it’s a small percentage of a huge number. The CBO says malpractice costs are only 2% of overall healthcare costs. It’s hard to know where to go to get unbiased information because tort lawyers are such important donors to the Democratic Party.

My main anecdote is former senator and presidential candidate John Edwards, who became obscenely wealthy as a lawyer suing doctors for malpractice. There is no doubt that the doctors were at fault and that the victims should be compensated, but did the system have to pay for multiple mansions for John Edwards in addition to helping the victims? I think John Edwards is just one of many lawyers becoming rich off malpractice suits. Just watch the TV ads for lawyers trolling for clients who have been injured in various ways as a result of medical conditions.

The only people I’ve heard mention this issue, however, have been Susan Eisenhower on Bill Maher’s show and Mort Zuckerman on “Morning Joe.” I found a transcript of John McCain on Hannity’s Fox News site; so, maybe I just don’t watch enough conservative talk shows. McCain said a neurosurgeon’s liability insurance could cost $200,000 per year. I think ob-gyn insurance is about the same; they are people that John Edwards used to sue.

A 2004 Congressional Budget Office report on the malpractice tort suit issue was non-committal. Its conclusion was:

In short, the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect, either positive or negative, on economic efficiency. Thus, choices about specific proposals may hinge more on their implications for equity--in particular, on their effects on health care providers, patients injured through malpractice, and users of the health care system in general.

It also says that around the time of the 2004 report there were about annually about 5 successful malpractice claims for every 100 doctors, and the average judgment was $320,000, up from $95,000 in 1986. It further says that the evidence is not clear on defensive medicine, the practice of requiring many extra tests to confirm diagnoses. CBO believes that a greater driving factor for extra tests is the extra profit made by the doctors.

It seems to me that it would be better in a reformed healthcare system to go to a system like workmen’s compensation for malpractice claims, and to do more to drive out poor doctors. Even the CBO says it is a relatively small subset of poor doctors who really drive the costs of malpractice insurance through the roof. First, the government should do more to monitor doctors’ performance and eliminate under performing physicians. Secondly, the government could set price for the most common types of malpractice: X dollars for cutting off the wrong let; Y dollars for leaving a clamp in a patient after surgery, etc. Incidents not specifically listed could be arbitrated based on guidelines, rather than litigated by high priced lawyers for contingency fees.