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THE TYRANNY OF THE LARGE NUMBER! Connolly uses a very large number to hide a tiny goal: // link // print // previous // next //
FRIDAY, NOVEMBER 6, 2009

Digby remembers/We do too: Ten years ago this very week, Congress repealed the Glass-Steagall Act, by giant margins in the House and the Senate. Digby does an excellent job of remembering. To read her report, just click here.

We’re not experts on this matter. But it seems to be conventional wisdom: Repeal of Glass-Steagall opened the floodgates to the financial meltdown which hit home last year.

By most accounts, repeal of Glass-Steagall was a major event. We thought we’d join Digby in remembering! In our case, we thought you might want to recall what Establishment Pundits were discussing in the week when repeal occurred.

Simply put, they were discussing Naomi Wolf—and earth tones, and alpha males. And, of course, oral sex. And the way Al Gore had hired a woman to teach him to be a man:

On Sunday, October 31, 1999, Time released a news report which said that Wolf had been advising Candidate Gore and the Gore campaign. On a rational basis, it’s hard to imagine why this utterly underwhelming news should have provoked a discussion at all. But within the broken-souled world of Establishment Washington, this underwhelming report produced an astonishing “Month of Wolf”—one of the smuttiest, phoniest, dumbest discussions the modern, corporate-owned pundit corps has ever let loose on the world.

Those votes in the House and the Senate took place on Thursday, November 4. By that date, Establishment Pundits were in Day 4 of their smut-laden takedown of Wolf—and, of course, of Candidate Gore, the real target of their witch trial. On November 5, newspapers reported Glass-Steagall’s repeal (see Digby). But so what? In the Washington Post, Ann Gerhart was explaining something much more significant. She was explaining why a book reviewer had spotted beauty products in Wolf’s bathroom back at the start of the decade:

GERHART (11/5/99): Now we know that was because she finally had gotten in touch with her inner slut, according to her third book, “Promiscuities: The Secret Struggle for Womanhood,” which [reported] her own coming-of-age experiences.

It still shocks the conscience to read it today. No, Wolf didn’t say, in that superb book, that she “finally had gotten in touch with her inner slut.” But by now, the pundit corps was bristling with claims that Wolf “has very detailed programs on how a woman can get in touch with her inner slut” (the disgraceful Christina Hoff Sommers, Hardball, 11/1/99) or that Wolf had “urged women to release their inner sluts” (the constantly-loathsome Maureen Dowd, New York Times, 11/3/99). The phrase “inner slut” doesn’t appear in Wolf’s superb book, but it got big play in the Washington Post, helping fuel a feeding frenzy which persisted in the “press” for a month.

The smutty trashing of Naomi Wolf was really a trashing of Gore, of course. The month-long trashing played a large role in the way George Bush reached the White House. (For the record, Bush and his campaign played no role in this month-long display. Nor does it seem that the RNC played a leading role. This was a “mainstream” baby.) This was one of the ugliest, dumbest campaigns the Establishment Pundit Corps ever produced. It was happening ten years ago, as Glass-Steagall was being repealed.

By the way, we know of only two major figures who spoke up in Wolf’s defense: William Kristol and William Safire. Not one of your fiery liberal heroes dared open his or her trap to speak

For our five-part report on this gruesome episode, see THE DAILY HOWLER, 3/10/03. (Though we didn’t get to it all.) And by the way: Promiscuities is a superb book, full of deeply soulful thoughts about the ways boys and girls—and men and women—struggle to relate to each other. Wolf’s account of her first high school love is pure Grade A soul gold.

Crackers! For that very reason, it had to be dragged through the mud.

In Promiscuities, Wolf discusses the way the venturesome girl will be reviled as a slut. The “press corps” worked to make her a prophet—as Glass-Steagall was being repealed, ten years ago this week.

George Bush? He ended up in the White House. Perhaps you already heard.

THE TYRANNY OF THE LARGE NUMBER: On the front page of Wednesday’s Washington Post, Ceci Connolly examined a serious health-reform topic. Her headline seemed to go where rubber meets road:

Health bills too timid on cutting costs, experts say
Proposals make only trims where broader changes are needed, critics argue

Connolly examined the way proposed health reform would effect the costs of health care. But uh-oh! Note the conceptual framework which was lodged right in her opening paragraphs:

CONNOLLY (11/6/09): Democrats in Congress are embracing the spirit of President Obama's call to slow the runaway rise of health-care costs but are shying away from some of the most aggressive techniques for achieving that.

Instead of revolutionizing how care is delivered and paid for, experts say, the legislation being shaped takes a cautious approach to reining in costs.

"The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."

In years past, policymakers tried taming health-care growth with price controls—in government reimbursements and through managed care. The Obama administration has advocated a third way: moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better.

Right from her opening paragraph, Connolly adopts the conceptual framework which has defined this year’s discussion of health care spending. In her work, health care costs will continue to rise (or grow). We are only trying to slow the rate at which they grow.

We’ll still see a rise in health care costs. But it won’t be a runaway rise.

But then, the New York Times adopts this same framework in today’s informative lead editorial about the new Republican health reform proposal:

NEW YORK TIMES EDITORIAL (11/6/09): House Republican leaders have produced their own health care reform bill. Here is the first thing you need to know: It would do almost nothing to reduce the scandalously high number of Americans who have no insurance. And it makes only a token stab at slowing the relentlessly rising costs of medical care.

How does the Times judge the GOP bill? The Times doesn’t think the costs of health care can be reduced, or kept where they are. The Times assumes that costs will continue to rise. The editors complain that the GOP bill doesn’t slow the rate at which those costs will be rising.

We’re trying to “slow the runway rise of costs.” This implies that costs will continue to rise.

Neither Connolly, nor the editors, mentioned a striking fact: The baseline from which our health costs are rising dwarfs the baseline of health care spending found everywhere else in the world. Why is the baseline of our spending two to three times that of everyone else? This question has been disappeared this whole year. It’s AWOL in these two pieces.

We’re only trying to slow the growth in our massive health care costs! Before we see the ubiquity of that framework in Connolly’s piece, let’s consider the tyranny of the great big large number.

Within her conceptual framework, Connolly offers an interesting report. She quotes a string experts; they say that proposed reform plans don’t do enough about slowing the growth in our spending. At one point, she lists four basic concerns. In her fourth and final concern, we find ourselves struggling with tyranny:

CONNOLLY: Now, as the debate reaches a critical juncture, many are worried that the president's ambitious hopes to constrain costs could result in tepid half-measures on Capitol Hill. Among the concerns:

A Senate plan to tax high-priced insurance policies saves far less money—and is less likely to change medical consumption—than eliminating the tax exemption for employer-sponsored coverage.

Proposals on comparative-effectiveness research and a new Medicare cost-cutting commission have been watered down.

An array of Medicare pilot projects aimed at paying doctors and hospitals for quality rather than quantity would take years to be implemented nationally—if they ever were.

None of the bills addresses medical liability, even though the Congressional Budget Office has concluded that tort reform could save $54 billion over the next decade.

In a bit of a non-sequitur, Connolly refers to Obama’s “ambitious hopes to constrain costs.” (In our view, an ambitious person would be hoping to reduce costs, on a major scale, a scale suggested by the foreign experience.) But by her fourth point, we see how sad our pseudo-discussion really is. And we have a head-on collision with the tyranny of the large number.

Is it true? Could tort reform “save $54 billion over the next decade?” We don’t know, but we do know this: That looks like a very large number of dollars. But alas! Viewed in a rational way, that number is really quite small. Crackers! Health care spending in your nation totals roughly $2.5 trillion per year! And it takes a thousand billions to equal even one trillion! In short, that $54 billion would represent an astoundingly small percentage of health care spending “over the next decade.” But then, Lori Montgomery noted this fact last month, when she reported the CBO’s finding on tort reform in Connolly’s own Washington Post:

MONTGOMERY (10/10/09): Congressional budget analysts said Friday that lawmakers could save as much as $54 billion over the next decade by imposing an array of new limits on medical malpractice lawsuits—10 times more than previously estimated.

[...]

[CBO kingpin Douglas] Elmendorf wrote that newly available research prompted CBO to update "its analysis of the effects of tort reform." The agency's conclusion: A package of reforms that included a $250,000 cap on damages for pain and suffering and a $500,000 cap on punitive damages “would reduce total national health care spending by about 0.5 percent.”

The federal government would reap a substantial portion of those savings, the CBO said, primarily through reduced Medicare costs.

Candidly, we don’t know where that “0.5 percent” figure comes from; as a percentage of national spending on health care, it seems much too high. But plainly, we’re talking about very small beans here. How many readers would have known that from reading Connolly’s report?

It’s the tyranny of the large number! Millions, billions and trillions rhyme; this makes them seem like they’re in the same ball park. Sadly, they aren’t. And that projected saving from tort reform falls short of a drop in our bucket.

In this way, you see how surreal the frameworks are which guide our health care pseudo-discussion.

Just for starters, this article’s framework—Let’s slow the growth!—isn’t “ambitious” at all. And by the time we get to Connolly’s fourth point, we’re dreaming of drops in our bucket. But go ahead! Read through Connolly’s report, and today’s New York Times editorial. Everywhere, an odd framework prevails. Connolly, and her experts, and the New York Times editors? They all tell us this:

Crackers! Just ignore the ludicrous size of that baseline—the mammoth spending in which we engage! Instead, let’s join hands with industry and sing Kumbaya! Confusing ourselves with some very small numbers, let’s talk about slowing the growth! Let’s do it with drops in the bucket!

Connolly’s concubines: Everyone has agreed on that framework. Ignore those foreign spending figures! Let’s talk about slowing the growth!

CONNOLLY: Ralph Neas, head of the nonpartisan National Coalition on Health Care, noted that "these bills do very little in terms of reining in long-term cost growth," adding: "There is not enough in the public sector and virtually none in the private sector.”

CONNOLLY: Richard Foster, the chief actuary of the federal Centers for Medicare and Medicaid Services, said lawmakers could achieve far greater savings in the health system if they aggressively pursued research that identifies the best, most cost-effective treatments.

"If you did comparative effectiveness in a way that looked at whether to approve a new therapy because it is cost effective and is an improvement, then you'd have a fighting chance of slowing down the rate of growth," he said in an interview. "Nobody's proposing that."

CONNOLLY: White House budget chief Peter Orszag said in an interview that changing the tax treatment of employer-sponsored health benefits "is among the most important single things that could be done to constrain costs and improve quality.”

“Constrain costs?” What the heck does that mean? Just a guess: It means slow the growth!

Why aren’t we trying to cut our astonishing level of spending? Crackers, please! Don’t even ask! The swells have agreed not to go there!