Gail Collins proclaims the first ten years of the new millennium “the Decade of Medical Backtracking.”

Somewhere between the reports that Pap smears and tests for prostate cancer aren’t all they were cracked up to be and the news that a high fiber diet doesn’t do anything to prevent cancer, the health establishment began looking decidedly nonomniscient. Then this week, a federal task force reported that most women don’t need annual mammograms. Even more fascinating, they suggested that doctors stop telling their female patients to self-examine their breasts for lumps.

[...]

Every rational American wants qualified experts to keep re-examining current medical practices. The only thing that bothers me about the mammogram report is all the emphasis on the “anxiety” that might follow a false-positive. We live in a time when we are constantly being reminded that a fellow plane passenger might be trying to smuggle explosives in his sneakers. We can manage anxiety.

I am going out on a limb to say that the real problem with a test that creates a lot of false-positive results is that it leads to a lot of other medical procedures, some involving hospitals. Unless you are genuinely sick, there is no more dangerous place to be hanging around than a hospital.

And let’s not forget the longer-term changes of mind on things like silicon breast implants, artificial sweeteners, and the danger of eating eggs.

Collins is right that we want medical science to constantly challenge prevailing assumptions and give us their best guess as to the truth.  I continue to wonder, however, about the rigors of medical scholarship, which seems to frequently draw wide conclusions based on studies of very small, self-selected samples.

In a much discussed post, Ezra Klein produced a series of graphs showing that Americans pay more for office visits, scans and imaging, drugs, and other aspects of health care — often, far more — than is the case in Canada or Western Europe.

There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same — the volume of procedures, the days we spend in the hospital, the number of surgeries we need — but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.

In other countries, governments set the rates that will be paid for different treatments and drugs, even when private insurers are doing the actual purchasing. In our country, the government doesn’t set those rates for private insurers, which is why the prices paid by Medicare, as you’ll see on some of these graphs, are much lower than those paid by private insurers. You’ll also notice that the bit showing American prices is separated into blue and yellow: That shows the spread between the average price (the top of the blue) and the 90th percentile (the top of the yellow). Other countries don’t have nearly that much variation, again because their pricing is standard.

Bernard Finel, recalling a series of posts and comment threads from a while back, observes,

James Joyner has argued that in order to reduce health care expenditures we need to make a choice — we can’t have it be better, faster, and cheaper.  Yes, we can.  The reason we can is that the choice isn’t simply between better, faster, and cheaper, it is between better, faster, cheaper, and more profitable.  If you cut profits — for medical insurance providers, for medical malpractice insurance providers, for med-mal attorneys, for doctors, for hospitals, and for drug companies — you can have better, faster, and cheaper.  The problem is that our system is essential optimized for profits — our goal is not to make people healthy but to make people wealthy.

That’s true up to a point, although some of this is simply the Find The Umbrella phenomenon combined with arbitrary itemizing of costs.  (Maybe the scans are $900 because they can bill that much for it while something that they’d otherwise bill more for is capped because the insurance companies won’t reimburse above a certain rate.)

Beyond that, as Dave Schuler points out, there’s no good reason to think OUR government is going to hold down costs in the same way the social democracies have.

I see no reason to believe that even if we went to a single-payer system that the federal government would be willing to lower healthcare prices so that we’re spending what France, Germany, or the Netherlands is. Despite the legislative mandate to do so that’s been around for about ten years they haven’t lowered Medicare reimbursement rates. Every year they postpone that painful choice and, indeed, they’re preparing to do so again.

And, indeed, as Kevin Drum acknowledges, nothing in the bills before Congress will do anything at all to reduce costs.

Via Kevin Drum, I have learned that current Senate version of the health reform bill would provide for insurance payments for Christian Science prayer treatments–and probably other “spiritual” treatments as well.

Reporting from Washington – Backed by some of the most powerful members of the Senate, a little-noticed provision in the healthcare overhaul bill would require insurers to consider covering Christian Science prayer treatments as medical expenses.

The provision was inserted by Sen. Orrin G. Hatch (R-Utah) with the support of Democratic Sens. John F. Kerry and the late Edward M. Kennedy, both of Massachusetts, home to the headquarters of the Church of Christ, Scientist.

The measure would put Christian Science prayer treatments — which substitute for or supplement medical treatments — on the same footing as clinical medicine. While not mentioning the church by name, it would prohibit discrimination against “religious and spiritual healthcare.”

Ugh. You know, it’s bad enough that insurance companies are already wasting money paying for quack treatments like chiropractic “adjustments” and acupuncture, but this isn’t just the camel’s nose under the tent–it’s the camel in the tent, spitting and defecating over everything.

If we’re going to be serious about controlling health care costs, we have to stop covering quack treatments just because they might make people “feel better.” Chiropractors, acupuncturists, homeopathists, faith healers, reflexologists and the rest of that pseudoscientific lot are committing fraud: they claim they can heal, but they cannot.

It’s bad enough that we allow them to practice at all. It’s terrible that some insurance companies are idiotic enough to pay for such treatments. It is a derogation of the governments’ duty to its citizens that some states license these trades. But evolving a national health care system that preserves this quackery in law and ensures they get taxpayer dollars is absolutely criminal.

One of the few roles of government that I think folks from every political stripe can agree on is that the government should protect citizens from fraud. It’s not supposed to help people perpetrate fraud.

(cross posted to Heretical Ideas)

President Obama has declared that the swine flu, which is much less prevalent and deadly than the ordinary influenza virus, is an “epidemic” and a “national emergency.”  Silly as it sounds, it was the right call.

President Obama has declared H1N1 swine flu a national emergency, clearing the way for his health chief to give hospitals wider leeway in how they handle a possible surge of new patients, administration officials said Saturday. The president granted Health and Human Services Secretary Kathleen Sebelius the power to lift some federal regulations for medical providers, including allowing hospitals to set up off-site facilities to increase the number of available beds and protect patients who are not infected.

Obama said in the declaration that the “rapid increase in illness . . . may overburden health-care resources.” White House officials played down the dramatic language, saying the president’s action did not stem from a new assessment of the dangers the flu poses to the public. Instead, officials said the action provides greater flexibility for hospitals that may face a surge of new patients as the virus sweeps through their communities. The declaration allows Sebelius to waive certain requirements under Medicaire and Medicaid, privacy rules and other regulations.

“The H1N1 is moving rapidly, as expected,” White House spokesman Reid Cherlin said Saturday. “By the time regions or health-care systems recognize they are becoming overburdened, they need to implement disaster plans quickly.” The Centers for Disease Control and Prevention reported on Friday that the flu was spreading widely in at least 46 states and had already caused the hospitalization of at least 20,000 Americans. More than 1,000 deaths have been attributed to the virus and more than 2,400 additional deaths were probably associated with it, officials said.

NYT adds:

The department first declared a public health emergency in April; Ms. Sebelius renewed it on Tuesday. But the separate presidential declaration was required to waive federal laws put in place to protect patients’ privacy and to ensure that they are not discriminated against based on their source of payment for care, including Medicare, Medicaid and the states’ Children’s Health Insurance Program.

As a practical matter, officials said, the waiver could allow a hospital to set up a make-shift satellite facility for swine flu patients in a local armory or other suitably spacious location, or at another hospital, to segregate such cases for treatment. Under federal law, if the patients are sent off site without a waiver, the hospital could be refused reimbursement for care as a sanction.

Some are terming this “fear-mongering” and hysteria. And it’s true that this is neither “epidemic” nor an “emergency” in any ordinary senses of those words.  But these are the magic words the president has to invoke in order to bypass the bureaucratic rules preventing faster dissemination of the vaccine.   This is something I would like to see changed because the headlines will in fact create some hysterical reactions.  But it’s the system Obama has to work within for now.

Others are questioning why, if this is such a big deal, the Obama girls haven’t been vaccinated. But the Obama girls aren’t in the high risk categories that would permit them to get the vaccine right now.   My 9-month-old is in that category but our pediatrician doesn’t yet have a supply. 

In Fairfax County, Va., officials had planned to have swine flu clinics at 10 different locations on Saturday. But the county did not receive the number of doses it requested, and was forced to offer the vaccinations only at the government building. People began lining up with camping gear the night before to get vaccinations. Merni Fitzgerald, Fairfax’s public affairs director, said officials were aiming to administer 12,000 doses of the vaccine to those most at risk for serious complications from the H1N1 virus, mainly pregnant women and children 6 to 36 months. But that did not stop some other high-risk patients. “I lied and told the doctors I was pregnant,” said Theresa Caffey of Centreville, who has multiple sclerosis and nurses her 11-week-old son, Joshua. “I’m religious. I don’t lie. But it’s not about me. It’s for my son. It’s safer for him if I have the antibodies.”

People would be going crazy if the Obama girls were jumping the line ahead of the very small children and pregnant women who have been deemed the most critical to inoculate early.

Photo credit: Paul Sancya/AP.

On his new policy blog at True/Slant, E.D. Kain provides a good defense of the Wyden-Bennett Act.

In Congress, however, we get bad compromises, not good ones, which is why we have the Baucus bill, which is neither as cost-effective, as close to universal coverage, or as fundamentally game-changing as Wyden-Bennett. Indeed, there is little to be enthusiastic about in the Baucus plan, which jealously protects the anti-competitive status-quo from any real changes, and thus – despite any analysis the CBO might put forth – does very little to challenge the fundamental problems which have led to such staggering health care cost increases in the United States.

There was, however, still a chance that the Baucus bill could be amended to bring more competition and cost-savings on board, and once again it’s the incorrigible Senator from Oregon, Ron Wyden, who introduced the Free Choice Act in the Senate Finance Committee. Basically Wyden’s proposal would open up the new health care exchanges to everybody no matter their employer’s coverage and no matter the size of their business.

Read the whole thing. Frankly, I’m baffled that the Republican Party hasn’t picked up Wyden-Bennett. It’s a much better reform proposal than the awful Baucus bill–which, awful as it is, still manages to be better than the status quo–and it’s also a more-market oriented reform. It’s not my ideal, but it’s a vast improvement. This would be a golden opportunity for the GOP to both steal the Democrats’ thunder and improve our hideous health care system. It’s win-win.

Instead, the Republican Party seems to be focused on simply opposing Obama, and the only significant “reform” being offered is the constant, anti-responsiblity drumbeat of “tort reform”: i.e. making physicians a special class of Americans who get to be protected from the consequences of their negligence.

I’m getting the distinct sense that Slate’s Double X spin-off is some sort of elaborate spoof rather than a smart, female-centric magazine.  Yesterday, via Julian Sanchez, I came across their insipid advice column saying it pushed the “limits of friendship” to expect one’s friends to not leave you for dead after you’d been administered a date rape drug.  Today, via Jason Kottke, I see that they’re experimenting with drinking like the cast of “Mad Men” to see how it would impact running their insipid magazine.

Apparently, these women have no previous exposure to alcohol, no understanding of how alcohol affects the human body, and no concept of elapsed time as portrayed on a one-hour drama.

The gals are completely hammered after a single morning Bloody Mary and act like a bunch of sorority girls at the ensuing meeting. (Scientific disclaimer:  Not having witnessed their meetings otherwise, this may be completely normal and not an effect of alcohol.)  This, despite the fact that they’re still drinking said beverages during the meeting. (Incidentally, I don’t recall any of the boys of Sterling Cooper drinking Bloody Marys during the workday — much less during morning staff meetings.)

The gals then have martinis at lunch. This is completely kosher: Roger Sterling did this frequently during the first two seasons of the show. But, unlike the silver haired name partner in the fictional advertising firm, the ladies of our virtual magazine are now completely unable to have coherent conversations.

Now, I tend not to drink much during the workday. On rare occasions, I’ll have a beer or two at lunch and sometimes I’ll do some more writing after a 5:00 martini on a Friday. Afterward, I function reasonably well doing intellectually demanding work. Then again, I’m not a novice drinker. And, like the more serious drinkers on “Mad Men,” I’m well over 200 pounds. It’s not polite to talk about women’s weight but I will boldly conjecture, having seen the video, that Hanna Rosen, Emily Bazelon, and the other Double Xers go considerably below that.

This, naturally, matters. Consider these charts from Virginia Tech:

Leave aside the issue of legal limits for operating a motor vehicle, which are the subject of some controversy. We see that small women are generally “significantly affected” by the first drink and even women in the 140-pound range are quite heavily intoxicated by the third drink in a relative short period. By contrast, a 200 point man doesn’t reach the .10 level until the 6th drink!  And notice that there are two charts:  There’s no gender equality in this game.

Rosen says “The Mad Men do this 40 times a day.” No. They don’t.

My wife chides me all the time for picking nits with logical inconsistencies in television shows and movies, telling me I should just suspend my disbelief because IT’S JUST A TV SHOW. So, perhaps I shouldn’t cast any stones on that front. Still, I’m fully cognizant of the fact that a one-hour television episode typically does not represent one hour in real time. Indeed, violating this convention is what made “24″ novel. A typical “Mad Men” show takes place over a week or more.

Don Draper and Roger Sterling might have six drinks over the course of a very long workday that extends deep into the evening. But they’ll have had maybe 2 or 3 in the course of a two hour lunch, be completely sober in time for the 5′oclock cocktail, and then pace themselves throughout a long evening during which they’ll have a very heavy meal rich in protein. Metabolically, there’s no reason they can’t maintain that pace indefinitely without being significantly impaired.

Overall, the show does a realistic job of portraying alcohol and its abuse. The junior staffers, apparently not having built up their tolerances, are frequently rather inebriated on the show by the end of the day. As the Double X ladies giggle about over lunch, one of the senior execs is depicted as a drunk who winds up fired after embarrassing himself because of his problem. Another major character is a recovering alcoholic who falls back off the wagon to his peril. Early in the current season, an executive is maimed and his career ruined by a stupid, alcohol-inspired act of an employee.

It’s not all fun even on a show that seems to glorify the good old days of being able to drink at work.

NewsBusters‘ P.J. Gladnick has dug up a 2007 speech by former Clinton labor secretary Robert Reich that purportedly “reveal[s] the brutal truth about what liberals ultimately have in store for the public with their health care plan.”

I’ll actually give you a speech made up entirely, almost on the spur of the moment, of what a candidate for president would say if that candidate did not care about becoming president. In other words, this is what the truth is and a candidate will never say, but what a candidate should say if we were in the kind of democracy where citizens were honored in terms of their practice of citizenship and they were educated in terms of what the issues were and they could separate myth from reality in terms of what candidates would tell them:

“Thank you so much for coming this afternoon. I’m so glad to see you and I would like to be president. Let me tell you a few things on health care. Look, we have the only health care system in the world that is designed to avoid sick people. And that’s true and what I’m going to do is that I am going try to reorganize it to be more amenable to treating sick people but that means you, particularly you young people, particularly you young healthy people…you’re going to have to pay more.

“Thank you. And by the way, we’re going to have to, if you’re very old, we’re not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It’s too expensive…so we’re going to let you die.”

Any rational analysis of the costs of our health care system will come to this conclusion:  The lion’s share of the lifetime health care costs for most Americans is spent in the final months of life managing death.  If we’re going to control costs, that’s the most logical place to look.

The problem, of course, is that we’re not purely rational beings.  As Reich notes at the beginning of the quoted remarks above, this is a political non-starter.  A goodly number of liberal politicians may well believe this.  President Obama almost certainly does.  But saying so publicly — much less trying to pass this into legislation — would be political suicide.  So it ain’t happening.

One could argue, I suppose, that something like Reich’s honest plan would be a natural long-term consequence of adopting a British-style national health care model.  But that’s simply not on the table right now or in the foreseeable future.  Americans won’t put up with that sort of system and its elected leaders — who aspire to be its re-elected leaders — aren’t going to push for it.

Instead, we’re likely to see some expansion of the present, insurance-based system with the taxpayers on the hook for most of the people who don’t currently have insurance and those of us currently possessing insurance paying substantially higher premiums.  To be clear: I don’t like any of the bills that have a serious chance of becoming law, preferring a bad status quo to a boondoogle that fails to address its core flaws.  But we’re not looking at a secret plot to enact Reich’s desire to control costs by letting granny die a little early.

James Capretta does a back of the envelope calculation on the Baucus health care reform bill and concludes that it would be like having a 70% marginal tax rate on the low income.

According to CBO, family coverage in 2016 is likely to cost about $14,400 under the so-called “silver option” in the health-care reform plan sponsored by Senate Finance Committee Chairman Max Baucus. In the Baucus plan, a family of four at the poverty line (about $24,000 in 2016) would have pay to about $1,400 toward coverage, with the federal government paying the other $13,000 on their behalf. In addition, the government would also provide $3,500 to reduce the family’s deductible and co-payment costs for health services. Thus, the new entitlement provided by the Baucus bill would be worth a whopping $16,500 for a family at the poverty line.

As incomes rise, however, the Baucus bill cuts the value of the entitlement. A family with an income at twice the poverty line, or $48,000 in 2016, would get $9,072 in federal assistance for coverage — still a substantial sum. But it’s $7,400 less than the family would get if they earned half as much. The Baucus plan thus imposes an implicit marginal tax rate of about 30 percent ($7,400/$24,000) on wages earned by families in this income range.

And that would come on top of the high implicit taxes already built into current law. Low-wage families with children also get the Earned Income Tax Credit (EITC). The EITC boosts incomes for those with the very lowest wages, but it is also phased-out as incomes rise. Past a certain threshold (about $21,400 in 2016), the EITC is reduced by $0.21 for every additional $1 earned. Throw in the individual income tax rate (15 percent) and payroll taxes (7.65 percent), and the effective, implicit tax rate for workers between 100 and 200 percent of the federal poverty line would quickly approach 70 percent — not even counting food stamps and housing vouchers.

That is a substantial marginal tax rate, and would serve as a disincentive towards working towards getting higher paying jobs. I also agree it would be a good idea if the CBO were to do a much more thorough analysis of this bill to verify these calculations.

Update: Via Greg Mankiw I see that the CBO has released some analysis on incomes, premiums, and so forth under the Baucus bill, and for the upper incomes there are marginal tax increases, not sure about low income earners. Also, if you are single you will get hit pretty hard even when your income goes from $26,500 to $32,400, the implicit marginal tax rate on that income due to the change in premiums is 24%. Then add on for payroll taxes, income taxes and so forth.

There is also this CBO policy brief that discusses the issue,

New subsidies might be created to cover the costs of private health insurance, and they could be gradually reduced over a specified income range in a variety of ways—with different implications for marginal tax rates and work incentives. Those subsidies could be gradually reduced at a uniform rate, causing implicit marginal tax rates to rise by the same amount for all recipients in the phase-out range. For example, a proposal might provide families whose income was at the federal poverty level (roughly $23,000 for a family of four in 2013, the year in which many proposals would take effect) with fully subsidized health insurance valued at $15,000. That subsidy might be gradually reduced as income increased, and families whose income was above 400 percent of the poverty level ($92,000) might be ineligible for any subsidy. In that case, marginal tax rates would go up by about 22 percentage points for all families whose income was between 100 percent and 400 percent of the poverty level.

A 22% marginal tax rate on households with income between 100% to 400% of the poverty level could reduce incentives for those households to decision on how much to work. If taking on a new job means less leisure time as well as a higher marginal tax rate a person might decide not to take the job even if the pay is higher.

And as Greg Mankiw points out, if people respond to these implicit changes in the marginal tax rates by working less, then it is possible that in the future GDP is lower and that payroll taxes are also lower. Thus exacerbating our already serious problems with Social Security and Medicare.

Tyler Cowen passes along a paper [PDF] which finds that “every death of a helmetless motorcyclist prevents or delays as many as 0.33 deaths among individuals on organ transplant waiting lists.” The study is titled “Donorcycles:  Do Motorcycle Helmet Laws Reduce Organ Donations?”

On balance, I oppose helmet and seatbelt laws on the grounds that the negative externalities imposed by the reckless behavior in question doesn’t outweigh the loss of individual liberty, given how rare serious crashes are.   The organ donation issue obviously moves the needle further in that direction. For those unconcerned about liberty, of course, saving 0.33 lives at the cost of 1.00 lives is a bad tradeoff.

Regardless, however, the “Donorcycles” concept would be a good one for one of those PSAs that networks are required to air in exchange for use of the public airwaves.  A satirical ad wherein those who chose to ride without a helmet are thanked for their generosity in helping meet the demands for organs might well be an effective tool for persuading people to change their behavior.

Ezra Klein enjoys cooking and endorses “Naked Chef” Jamie Oliver’s notion that we’d be a healthier society if we cooked our meals at home rather than eating so much high calorie fare at chain restaurants.  Still, he notes,

The problem is that the evidence suggests meals aren’t driving the rise in obesity — snacks are. A 2003 paper by economists David Cutler, Ed Glaeser and Jesse Shapiro looked at an array of different ways to measure caloric intake, and found that most meals aren’t getting much bigger. Dinner, in fact, might be getting a bit smaller. The big increase in caloric intake actually came between meals. In 1977, Americans reported eating about 186 calories outside of mealtimes. By 1994, that had rocketed to 346 calories. It’s likely even higher now. That difference alone is enough to explain the changes in our national waistline. And it won’t go away if we begin cooking dinners but still are purchasing 20-ounce bottles of Coke at the office.

Matt Yglesias agrees and argues that we should be “cultivating cultural taboos against prepared food,” by which he means prepackaged items ranging from sodas to chips to candy bars to microwave burritos.  But, since we all know that these things are “bad” for us if consumed more than occasionally, that’s going to be hard.  We eat this junk because it’s convenient, tasty, and cheap — not because we think it’s nutritious.

Evidence indicates that you could modestly improve public health and raise a nice chunk of change with a soda tax. Presumably something similar would apply to taxing chips and candy and so forth. You could fund a grapes-promotion program with the money. Or, you know, a robust national network of free clinics at which people could receive basic health care treatment and nutritional advice.

Who is it that isn’t aware that grapes are better for you than Snickers bars and Doritos?  We don’t need a grape-promotion program, we need grapes to be instantly and cheaply available in the same way that chips and candy bars are.   That’s pretty hard to do, given the relative perishability of said items.   And, frankly, people are still likely to prefer a Snickers to a bunch of grapes in between meetings.

Taxes on sodas and snack foods might indeed promote healthier eating.  But only by artificially raising prices and making it harder for poor people to eat what they want.  And it’s not as if they’re going to instead decide to have a boneless chicken breast wrap and some Evian; they’ll just be a little hungrier and less happy. (Snickers, I’m reliably informed, really satisfies.)  The net result will be more misery for the least well off.  And, of course, less freedom.

UPDATE (Dave Schuler)

The work of anthropologists and archaeologists, especially Robert and Linda Braidwood, has increasingly demonstrated that our species has preferentially sought out the food source with the highest level of fat in our environment for, essentially, as long as we’ve been a species. Policies based on changing that in the near term whether through advertising, social pressure, or taxation are doomed to failure. We’re just not built that way.

Update (Steve Verdon):

The thing about this issue that interests me is its connection to the health care debate. I’ve discussed before how using life expectancy as a measure of the efficacy of a countries health care system is a dubious measure. This highlights why. Is obesity bad for health outcomes? Yes. But is it something the medical industry can do much about? No. This is a behavioral issue that impacts things like health outcomes and life expectancy.

A new study finds that living to 100  will soon be commonplace:

If current life expectancy trends continue, more than half of babies born in rich nations since 2000 will live to 100 years of age, and they’ll have less disability than elderly people in previous generations.  That’s the conclusion of researchers who found that increases in life expectancy evident in rich nations since 1840 show no signs of slowing.

“The linear increase in record life expectancy for more than 165 years does not suggest a looming limit to human lifespan. If life expectancy were approaching a limit, some deceleration of progress would probably occur. Continued progress in the longest living populations suggests that we are not close to a limit, and further rise in life expectancy seems likely,” Kaare Christensen, of the Danish Aging Research Center at the University of Southern Denmark, and colleagues wrote. Their study appears online Oct. 1 in The Lancet.

During the 20th century, huge increases in life expectancy (30 years or more) occurred in developed nations. Even if health conditions don’t improve, 75 percent of babies born in rich nations since 2000 can expect to live to 75, the researchers concluded.

Their analysis of data from more than 30 developed countries revealed that death rates among people older than 80 are still falling. In 1950, the likelihood of survival from age 80 to 90 was 15 percent to 16 percent for women and 12 percent for men, compared with 37 percent and 25 percent, respectively, in 2002.

I actually think this projection is too conservative, in that advances in medical science at increasing faster than before.  Improvements in trauma care, for example, have been extraordinary and the spread of extraordinary emergency response even to remote areas should prevent countless needless deaths.

And then there are improvements in safety engineering and consciousness.  Kids wear helmets and pads to undertake even routine activities like riding a bicycle, which would have been unthinkable a generation ago.  And we keep kids in car seats until they’re roughly 30 years old now, providing protection from crashes previously known only to Richard Petty.

There’s talk of living to 150, which seems fantastical now but may be closer to the mark than the more pessimistic 75/75 total.

Rather amusing video of 365 days of photos of a rather out-of-shape fellow, John Stone, as he undergoes a workout and diet regimen.

According to the linked website, he actually did this in 2003 but has kept it up.

Via Jayvie Canono

The big news surrounding President Obama’s latest heathcare speech is that South Carolina Republican Rep. Joe Wilson shouted “You lie!” in response to the claim that illegal immigrants would not be covered under universal coverage:

AP (”Obama heckled by GOP during speech to Congress“):

The nastiness of August reached from the nation’s town halls into the U.S. Capitol on Wednesday as President Barack Obama tried to move his health care plan forward.

South Carolina Republican Rep. Joe Wilson shouted “You lie!” after Obama had talked about illegal immigrants. It wasn’t the only interruption during Obama’s speech to a joint session of Congress in the House of Representatives. Earlier, Republicans laughed when Obama acknowledged that there are still significant details to be worked out before a health overhaul can be passed.

Wilson’s outburst caused Obama to pause briefly before he went on with his speech. Overhead in the visitors’ gallery, first Lady Michelle Obama shook her head from side to side.

Carl Hulse, NYT (”In Lawmaker’s Outburst, a Rare Breach of Protocol“):

In an angry and very audible outburst, Representative Joe Wilson, Republican of South Carolina, interrupted President Obama’s speech Wednesday night with a shout of “You lie!”

His eruption — in response to Mr. Obama’s statement that Democratic health proposals would not cover illegal immigrants — stunned members of both parties in the House chamber.

Democrats said it showed lack of respect for the office of the presidency and was reminiscent of Republican disruptions at recent public forums on health care. “It is outrageous,” said Representative Joseph Crowley, Democrat of New York, who said it reminded him of the “antics that are being used to disrupt and fog what is going on.” After the speech, Rahm Emanuel, the White House chief of staff who sat a few rows in front of Mr. Wilson, said he immediately approached senior Republican lawmakers to encourage them to identify the heckler and urge him to issue an apology quickly. “No president has ever been treated like that. Ever,” Mr. Emanuel said. Other Democrats said they did not want to dwell on the outburst or allow it to overshadow what they saw as an effective address by the president. But they also said it bolstered their contention that some Republicans were not interested in constructive dialogue, and they noted that Democratic plans specifically barred coverage for illegal immigrants.

Republicans also said the heckling was out of line. “I think we ought to treat the president with respect,” said Senator Mitch McConnell of Kentucky, the Republican leader, “and anything other than that is not appropriate.”

Mr. Wilson seemed rattled in the wake of his comment, and quickly left the chamber at the end of the speech. His office later issued an apology, saying: “This evening I let my emotions get the best of me when listening to the president’s remarks regarding the coverage of illegal immigrants in the health care bill. While I disagree with the president’s statement, my comments were inappropriate and regrettable. I extend sincere apologies to the president for this lack of civility.” Mr. Wilson also phoned the White House and reached Mr. Emanuel, who accepted an apology on behalf of the president.

Critical body language and murmurs of disapproval are typical at presidential addresses and part of the political theater. But members of both parties were trying to recollect such a pointed attack from an individual lawmaker at a presidential address and noted that a similar remark could draw a formal reprimand if delivered at a routine session of the House.

The apology was appropriate and, I’m guessing*, sincere.  Such outbursts are inappropriate in civil debate, let alone when directed at the only elected representative of the nation as a whole.  Bill Clinton was treated with more respect while under formal impeachment charges.

While Wilson’s frustrated cry was inexcusable, however, it’s at least understandable.   After all, Obama was indirectly calling him a liar.  And being untruthful.  From the speech:

Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren’t so cynical and irresponsible. It is a lie, plain and simple.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I’m proposing would not apply to those who are here illegally. And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.  [emphasis added]

This, incidentally, was the from the prepared remarks, not off-the-cuff flourish.  The president was deliberately poisoning the well, claiming that his opponents are dishonorable and ill-intentioned.  And, as AllahPundit and Mark Tapscott point out, the bill will of course cover illegal aliens.   Even the Congressional Research Service says so.

“Under H.R. 3200, a ‘Health Insurance Exchange’ would begin operation in 2013 and would offer private plans alongside a public option…H.R. 3200 does not contain any restrictions on noncitzens—whether legally or illegally present, or in the United States temporarily or permanently—participating in the Exchange.” CRS also notes that the bill has no provision for requiring those seeking coverage or services to provided proof of citizenship.

Indeed, as an Obama official interviewed on NPR this morning admits, the administration has moved the ball in the other direction, removing existing restrictions requiring people to provide proof of citizenship to get various federal benefits on the grounds that they were too onerous and causing those legitimately eligible to give up or be denied.  That may well be the right thing to do (I don’t know the specifics well enough to render definitive judgment) but it nonetheless vitiates the claim that there’s some magic wall to prevent the twelve million-odd illegal aliens from gaining access.

Beyond that, simple logic tells you that illegal aliens will be covered under any system of universal coverage.  Aside from the plain meaning of the word universal,  we have laws in this country requiring unquestioned treatment at emergency rooms for anyone who shows up.  The Supreme Court ruled more than a quarter century ago in Pyler v. Doe that the Equal Protection Clause requires that children of known illegal aliens be given free elementary and secondary education in public schools.  It’s hard to justify a rationale that requires paying to educate children while denying them health care.

UPDATE: Phillip Klein points to a 2005 Media Matters piece noting that Congressmen expressing displeasure with presidents by booing has been going on for some time.  I suppose yelling, “You lie!” is worse than booing but it’s worth noting that the idea of Congress as a bastion of civility is being  oversold.

UPDATE 2: Via Taegan Goddard, I see that PolitiFact has a longish piece arguing that “Obama can make a pretty thorough case that reform doesn’t apply to those here illegally. We don’t find the public option argument enough to make the case that Obama ‘lied.’ We rate Wilson’s statement False.”  I invite you to read it for yourself but I find it unpersuasive.

Politifact misapprehends how our system works, operating from the premise that laws only do what they specifically say.  And since the law doesn’t say illegal aliens are covered, QED, they aren’t.  In reality, new entitlements operate in a very complex existing ecosystem.  Unless the law not only excludes illegal aliens but provides very strong provisions for actually doing so — and it does not — the reality is that illegal aliens will be covered.

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*Before this morning, the only “Joe Wilson” I knew was married to Valerie Plame.  I gather from the news accounts, though, that he was surprised and flustered by the outburst and embarrassed at the spectacle he’d created.

Weekend Caption Jam Linkfest. . .

• Rodney is still a little nuts.
• Wizbang landed chinese — Won Wing Lo.
• Wyatt Earp has the Magnificent Six.
• Cowboy Blob lost his beer goggles
• RT’s Ponderings has been canned.
• Blonde Sagacity has a real head banger.
• Military Times is keepin’ cool

Other Humor:
Icanhascheezburger welcomes you to the kitteh cult.
V the K always has the best pictures at Caption This!

To join in, start a Caption Contest at your blog, edit it to add a link to this post, and then send a TrackBack. If your blog doesn’t automatically generate one, use the Send TrackBack feature below. For more information, see this post.

Charles Krauthammer proclaims “Obamacare Version 1.0 is dead” and helpfully proposes a version 2.0.  Basically:  No public option, no death panels end-of-life counseling, softpeddle government “best practices,” abandon cost-cutting, and guaranteeing universal coverage.

What’s not to like? If you have insurance, you’ll never lose it. Nor will your children ever be denied coverage for preexisting conditions.

The regulated insurance companies will get two things in return. Government will impose an individual mandate that will force the purchase of health insurance on the millions of healthy young people who today forgo it. And government will subsidize all the others who are too poor to buy health insurance. The result? Two enormous new revenue streams created by government for the insurance companies.

And here’s what makes it so politically seductive: The end result is the liberal dream of universal and guaranteed coverage — but without overt nationalization. It is all done through private insurance companies. Ostensibly private. They will, in reality, have been turned into government utilities. No longer able to control whom they can enroll, whom they can drop and how much they can limit their own liability, they will live off government largess — subsidized premiums from the poor; forced premiums from the young and healthy.

It’s the perfect finesse — government health care by proxy. And because it’s proxy, and because it will guarantee access to (supposedly) private health insurance — something that enjoys considerable Republican support — it will pass with wide bipartisan backing and give Obama a resounding political victory.

Krauthammer admits that “The financial and budgetary consequences will be catastrophic” but figures it’s a smart way to force people to swallow real socialized medicine because, when the bills come due, “the only remaining option will be to give up the benefits we will have become accustomed to. Once granted, guaranteed universal health care is not relinquished. Look at Canada. Look at Britain. They got hooked; now they ration. So will we.”

Dave Schuler thinks this would “carefully preserve most of the worst features of our present system.”

There are virtually no incentives at any level for controlling costs. Unfortunately, since we already pay nearly twice as much for healthcare per capita as an other OECD country and in this form healthcare reform would do nothing to change that, that would all but certainly result in stunting the growth of every sector of the economy other than healthcare which employs fewer people per dollar spent than most other sectors of the economy do (that’s what it means when you say that pay is higher in one sector than in another). See my previous post this morning.

So far as I can tell, Krauthammer is being serious here.  But it may be the weirdest thing he’s ever written.

Update (Steve Verdon): My own personal view is that either way we will not address the real issue with health care, the costs. People are too obsessed with the side shows and partisan point scoring to tackle the actual issue. As such, things will continue on their unsustainable course for awhile, then “reform” will be forced on the country due to the unsustainable trajectory we are on. What will happen then? I don’t know, other than it probably wont be good.

Update (James Joyner):  Ronald Bailey thinks Krauthammer is merely “predicting” rather than advocating this chain of events. That makes more sense although the irony is clearly too subtle as I’m still not getting it. 

Meanwhile, Ezra Klein argues that “We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.” But, as Bailey explains, that’s not what rationing means.