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January 12, 2005

Why Oh Why Are We Ruled by These Liars? (Harold Myerson Is Shrill Department)

Harold Myerson writes:

washingtonpost.com: President of Fabricated Crises: Some presidents make the history books by managing crises.... But when historians look back at the Bush presidency, they're more likely to note that what sets Bush apart is not the crises he managed but the crises he fabricated. The fabricated crisis is the hallmark of the Bush presidency. To attain goals that he had set for himself before he took office -- the overthrow of Saddam Hussein, the privatization of Social Security -- he concocted crises where there were none. So Iraq became a clear and present danger to American hearths and homes, bristling with weapons of mass destruction, a nuclear attack just waiting to happen. And now, this week, the president is embarking on his second great scare campaign, this one to convince the American people that Social Security will collapse and that the only remedy is to cut benefits and redirect resources into private accounts.... Social Security is not facing a financial crisis at all. It is facing a need for some distinctly sub-cataclysmic adjustments over the next few decades that would increase its revenue and diminish its benefits.

Politically, however, Social Security is facing the gravest crisis it has ever known. For the first time in its history, it is confronted by a president, and just possibly by a working congressional majority, who are opposed to the program on ideological grounds, who view the New Deal as a repealable aberration in U.S. history, who would have voted against establishing the program had they been in Congress in 1935. But Bush doesn't need Karl Rove's counsel to know that repealing Social Security for reasons of ideology is a non-starter. So it's time once more to fabricate a crisis. In Bushland, it's always time to fabricate a crisis. We have a crisis in medical malpractice costs, though the CBO says that malpractice costs amount to less than 2 percent of total health care costs.... We have a crisis in judicial vacancies, though in fact Senate Democrats used the filibuster to block just 10 of Bush's 229 first-term judicial appointments With crisis concoction as its central task -- think of how many administration officials issued dire warnings of the threat posed by Saddam Hussein or, now, by Social Security's impending bankruptcy -- this presidency, more than any I can think of, has relied on the classic tools of propaganda....

Posted by DeLong at January 12, 2005 09:54 AM

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"this presidency, more than any I can think of, has relied on the classic tools of propaganda...."

What's next? The Sudetenland crisis?

Posted by: Billmon at January 12, 2005 10:18 AM

A lot more people have to be saying this. Just about everyone with any interest in American politics has been lied to in the past four years, to their great disadvantage. This has got to be a leading point in any political discussion for anyone who is not on the payroll.

And finding out who is on the payroll and what they are getting has to be another leading point.

Posted by: sm at January 12, 2005 10:35 AM

Bush is right about medical malpractice. There is a crisis even if the CBO estimates malpractice costs less than 2% of health spending, because that 2% comes directly from MDS who are generally not able to pass it along to their patients. This cuts profits, so MDs take off for states that have tort reform, retire early or stop offering risky services. It is a crisis of access to physicians, not a crisis of total costs.
If you drive from the Bay Area to Seattle on Interstate 5, do not get into an accident on Siskiyou Summit on the Oregon Border on a Thursday or every other weekend. As of a few months ago, Medford has no neurosurgeon on-call on those days. In my own town the brain surgeon has stopped operating on brains. He'll be happy to do your low-risk laminectomy, however.

Posted by: JRossi at January 12, 2005 10:55 AM

Changes in insurance certainly have an impact on doctors' willingness to take on clients, perform certain procedures, work in certain areas. Same is true for changes in Medicare. Citing problems with access to medical treatment and then laying it all at the feet of malpractice actions just isn't right.

Medical malpractice suits are part of the mix, but just making it harder for those injured by malpractice to win compensation seems a pretty weak answer. There is some evidence that low income people - those who have little other recourse - are more likely to sue for malpractice than other income groups. They seem to sue becuase they few other options. Perhaps if we had some other way of assuring a decent future to the poor whose lives are made worse by medicine rather than better, the malpractice issue would solve itself.

Posted by: kharris at January 12, 2005 12:03 PM

Why? Cause more people voted for him than voted for the other guy.

Posted by: Randy Charles Morin at January 12, 2005 01:14 PM

Back in the summer of 2002 the Wall Street Journal did a front page story on the "malpractice crisis." Their finding was that insurance companies are upping their premiums because their investments weren't paying off like they were in the 1990's. As a former plaintiff's attorney I will attest that these types of cases are extremely difficult to win and the vast majority go no where. Doctors have discovered that they can share their hate of "trial lawyers" with the public so everyone can hate them together.

Posted by: matt at January 12, 2005 01:39 PM

As a Brit living in the US, I've got my own view of this. Were I in the UK and was injured due to a medical treatment, I'd be unlikely to sue unless there were some really gross negligence, and even then not so much for the money. Here in the US, I'd be very likely to sue. Why? Because there's a safety net in the UK - it's hard to fall all the way down, whereas in the US everyone but the mega-rich is one accident, job-loss or illness away from total financial ruin. Because if your potential to earn in the future is even slightly diminished, you need to get the money now.

If people felt secure, then there wouldn't be the need to sue, let alone the desire. If they felt they could trust the FDA (my Doctor explicitly says he has no idea if they can be trusted due to their closeness to BigPharma) not to approve drugs BP know cause heart attacks, for example, if they felt their income was relatively secure and not vary by 20% on average every year, if medical bills didn't keep rising 20% a year, or the medical services companies try to screw you for every cent (tell me those bills aren't insane), and the insurance companies try to get out of paying each and every one (oh, we never received that claim), if politicians didn't keep telling them they'll be no SS for them - then they might feel secure enough not to have to sue for malpractice.

The 'so called free-market' is to blame - when the rich blatantly make their money screwing the poor, exactly what do you expect the poor to do? And it's better them sue than to riot and chop off your head.

Posted by: MadJock at January 12, 2005 02:14 PM

I've been a harsh critic of Bush in my own right, but this just says that he's a politician. Let's not forget that Kerry painted the outsourcing trend as a crisis.

[And *I* was the one who was quoted in the Wall Street Journal saying that Kerry's demagoguery on outsourcing might well come back to bite him in the butt. I have street cred!]

Posted by: fling93 at January 12, 2005 03:12 PM

As far as physicians leaving for tort reform states, because of lower malpractice premiums, it just ain't so. TX, OK, and OH all have severe tort deform and their rates have been up 35 to 80% over the last 2 years. In Fl the leg. considered malpractice caps if the insurance goons agreed to premium caps, the insurance industry said no dice. Where I live, a community of 75,000 people, with a great hospital and excellent quality of life, we have 6 neurosurgeons. We also have no tort reform at all. Drs. live somewhere for a lot of different reasons.

Posted by: Dick(no, not that one) at January 12, 2005 04:34 PM

"in the US everyone but the mega-rich is one accident, job-loss or illness away from total financial ruin."

So it would seem the neocons true goal is to devolve all financial risk to the working classes.

Posted by: Tenuous Leemployed at January 12, 2005 04:46 PM

k harris. I'm all for assuring a decent future for the poor whose lives are made worse by medicine. How exactly do you propose to do that while maintaining access to physicians? And remember the clock is ticking because doctors are getting out by the week. A solution in a few years just won't do. Here's the tradeoff: The US can have enough doctors or it can have a virtually unlimited right and inclination to sue those doctors, but it can't have both.
Matt, insuring MDs against malpractice is a fool's business. Recently, insurers in NY state have been paying out $1.44 in claims for every $1 in premiums. Sound profitable?
Madjock, your take is exactly on the mark. When people are stressed and put upon, they lash out. There's also socialization. Americans who don't sue when they can are social patsies.

Posted by: JRossi at January 12, 2005 04:48 PM

Tort reform.

Capping damages is wrong. This is limiting your right to collect when damage is done to you. I've read that the insurance rates started to go up when the stock market went down, and that jury awards in malpractice suits have not gone up. Also, I read 5% of physicians are responsible for 55% of malpractice awards. I agree there is something wrong in the class action system, but I think modest proposals can address this, such as a pre-trial review by a panel of experts and requiring the loser to pay lawyer's fees.

Posted by: Unstable Isotope at January 12, 2005 06:26 PM

If you want tort reform then try some tort reform. Award caps isn't true reform. The constant refrain from the Republican corner is that they want to end frivolous lawsuits. How does a cap on awards do this? Something I'm not clear on...is the system for civil as well as criminal trials defined in the Constitution or are the states and federal government free to redesign them? To what extent? Why not try to redesign the system if possible? I've seen how the system works from the viewpoint of juror on a malpractice case. The last day of the trial they settled. While I could see the viewpoint of the relatives who sued I made a point of asking the doctor's attorneys to tell their client that I felt that he'd done a good job and there was no way I would have found against their client.

Posted by: Jim S at January 12, 2005 07:41 PM

What jrossi et al from the fringes would like is to be in a world free from responsibility or care. Doctors complain a lot about the insurance business, but more for the fact that the insurance companies are utterly inefficient in paying off claims. Here the doctors are offering discounts for cash clients simply because one doctor has to pay on average 5 people in order to get paid on claims and process the paperwork. Insurance companies have no incentive to be efficient, no need to be responsible in any fiduciary area, may arrange kickbacks, special pricing and the like without passing on any savings to customers, and never seem to have to pay up on claims if it is cheaper to litigate the plaintiff to death using in-house lawyers.
Maybe there are no brain surgeons in southern Oregon because they so rarely encounter significant amounts of brain tissue in their patients. Snap! But seriously, it can't be that profitable-the market can't bear that density of specialists in that region. And doctors are very rarely seen driving old Chevettes or using second hand golf clubs, not the ones complaining about torts. They need a reality check via H1b visa powered health cooperatives. People are already flying to India for surgeries, and I almost went to Vancouver BC for some skull restructuring.
No one will fix anything until they are made to. Bush won't do it. dems can't do it. So the GOP will screw itself and us to death again rather than do the right thing through leadership.

Posted by: bigfoot at January 12, 2005 10:01 PM


Your follow-up questions to me have mostly been answered in intervening comments. There is a mythology about doctors fleeing to tort-reform states that is not born out by the facts. There is a mythology that insurance costs are up largely due to malpractice risks, but that is also not born out by the facts. As I maintained in my first response, there is more at work in limiting access to medicine than just legal action. My point about the skew in the malpractice plaintiff population toward the poor is better expressed in MadJock's comment.

These are complex issues. Sadly, we don't handle complex issues well. That leaves us vulnerable to self-interested demagogs, peddling solutions that won't improve general welfare, but will make them richer. We need to avoid jumping to the conclusions these selfish types offer.

Posted by: kharris at January 13, 2005 06:03 AM

Meanwhile,the "free market" champions move to stop those who would interfere with “the invisible hand” (that puts money in their pockets)

TORONTO (AP) -- Internet sales of prescription drugs to U.S. consumers could be banned by Canada if a proposal being drafted by health officials is approved….
The pharmaceutical industry, which donated heavily to Bush's re-election campaign, vehemently opposes reimporting drugs, a practice that undercuts their U.S. sales.

Representatives of both the U.S. and Canadian governments say Bush discussed the issue with Prime Minister Paul Martin when he visited in the fall, sparking accusations Bush pressured Martin to change Canadian policy --


And so it goes….

Posted by: JackNYC at January 13, 2005 06:59 AM

With crisis concoction as its central task...

Vernor Vinge has given us a useful term for this style of government: disaster management. That is, managing people by creating and exploiting disasters.

Posted by: Darius Bacon at January 13, 2005 07:00 AM

But consider the definition of a racketeer as someone who creates a threat and then charges for its reduction. Governments' provision of protection, by this standard, often qualifies as racketeering. To the extent that the threats against which a given
government protects its citizens are imaginary or are consequences of its
own activities, the government has organized a protection racket. Since
governments themselves commonly simulate, stimulate, or even fabricate
threats of external war and since the repressive and extractive activities of
governments often constitute the largest current threats to the livelihoods
of their own citizens, many governments operate in essentially the same
ways as racketeers.

[Charles Tilly "War Making and State Making as Organized Crime", p. 171; from "Bringing the State Back In" ed. By Peter Evans, Dietrich Rueschemeyer and Theda Skocpol, Cambridge Univ. Press, 1985]

Posted by: Eubulides at January 13, 2005 07:29 PM

just a comment about the poor sueing more often for malpractice....

i'd like to point out that this occurence is possibly a result of the culture of the poor. the same cultural cues that send pensioners out to buy lotto tickets also drives the under-employed to call up all those numbers on day-time TV for various lawyers promising to get something for any sort of suffering they've possibly experienced. they see the tabloid shows pointing out the ridiculous judgements that others have received, and they do think of lawsuits as a genuine path to financial independence. unfortunately, they're also acting as spoilers for the system by mucking it up for more legitimate claims and injuries.

i think a pre-trial assessment would be nice to deliniate between cases involving "innocent" human error (which should be arbitrated) and those that do involve gross negligence (which should not be subject to damage caps), but of course with any system involving subjective review, the devil's in the details.....

i'd also think it'd be nice if punitive damages were never awarded directly to the plaintiff or his lawyers, but instead sent somewhere where it may do more general good....like an organization to deal with the relevant problem involved in a case or to research programs like NIH, NSF, etc. (but NOT directly back to the general government fund....it must be earmarked to fund units that don't have any ability to exercise "true" power over the many....and has no power to guide the outcome or selection of judgements)

Posted by: who at January 13, 2005 08:12 PM

OK, this may be a bit off-topic here, but has anyone seen this from the Fed?

The dollar starts rising against the euro at a time when it was taking a beating. The economy can be touted as picking up so that your average worker looking at the rhetoric of SS reform will think that there's an upswing in economic activity.

That, plus the artificially inflated market figures, will give the false impression that things are really hunky-dory and there is every reason in the world to let him and his buddies take their portion of the payroll taxes to invest thim in private savings accounts.

What I cannot get out of my mind is the, not only was this increase in payroll taxes that was enacted in 1983 meant to shore up the trust fund for the eventuality of all the boomers retiring (which wasn't and isn't going to happen in one fell swoop), but the AMT was also passed around this time and in 2002, Bush was talking about doing away with that tax and returning the money, retroactively, that big ass corporations had paid. That tax was the only reason Reagan's initial tax cuts went through and here is Georgie Boy trying to give back all of that money on top of his massive tax cuts which have brought us to the brink of bankruptcy.

Add to that the Savings and Loan bailout that occurred under Bush 41, another Bush theft from the US Treasury, and you have the basics of how this family views the American economic system: All the money that is generated by American workers belongs to the Bush family and its courtiers. End of story.

Talk about propaganda.

Posted by: matt at January 15, 2005 03:26 PM

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