A mandated free lunch?

I continue to read conservative columnists/bloggers attacking the contraceptive mandate on the grounds that there's no such thing as a "free lunch". But of course, it's not free, because in order to get your "free" lunch (health insurance including contraception), you're giving up a similarly priced but worse lunch (health insurance without contraception) to get it, as previously discussed.

One of the better conservative arguments I've read on the subject was on The Health Care Blog. The author points out that "If insurers saved money handing out contraception for free in the first place, they would have started to hand it out for free years ago."

So why don't they? It has to do with how long a beneficiary is with a particular health insurer. I honestly had a lot of trouble finding a statistic for that, so let's look at the average time a worker spends working a particular job; I think it works as a stand-in given that most people get their insurance through their employer. This article from the Wall Street Journal estimates that the typical worker will spend 4.1 years.

With that fact in mind, a health insurance company doesn't give a shit about how expensive your health care will be 5 years from now. This undoubtedly skews the cost-benefit analysis of insurance companies on the question, if they don't have to worry about health costs for health care during school years for the children who result from their limited coverage. More generally, it's also why there are still health insurance companies that don't pay for other preventative measures like the HPV vaccine, or as I describe it to patients, the cervical cancer vaccine. If you're not the insurer that is responsible of paying for a lifetime of Pap smears and a possible bout of cancer, it's not in your interest to pay the hundreds of dollars to provide the HPV vaccine.

For an individual insurance company, giving free contraception might not make any sense, because they would probably lose money. But if every insurer does it, the costs throughout the entire system go down. This is why the ObamaCare mandate includes a requirement for contraception and other preventative services without a copay.

The fractal primary campaign

I've always liked fractals. From Wikipedia, "Fractals are typically self-similar patterns, where self-similar means they are "the same from near as from far."

The defining state primaries of this season have been microcosms of the larger race. The overriding story of the entire campaign has been the steady stream of flavors of the month who rise up to challenge Romney, only to have Romney overwhelm them with superior resources. Santorum rose up in Iowa only to be smacked down in the next several races. Gingrich won in South Carolina only to be devastated by negative ads in Florida. Santorum racked up impressive but delegate-poor wins in the Midwest a few weeks ago only to lose in a heads-up match in Michigan.

Last night's Super Tuesday elections were another example of the self-similar campaign. At the start of the night, as at the start of the campaign, Romney was looking like a prohibitive favorite. He won big in Virginia, thanks to poor organization by his opponents resulting in only Ron Paul appearing on the ballot alongside him. He also won early wins in Massachusetts and Vermont. But his early momentum was blunted by fairly early wins by Santorum in Tennessee, Oklahoma and North Dakota. I found myself thinking that Santorum might actually carry the night, if he could maybe carry Ohio and Alaska, with Paul perhaps winning the caucuses in Idaho. But, as he's vanquished quick-rising challengers before, Romney wound up carrying a majority of delegates awarded on the night, including a close win in Ohio.

Zooming in on the fractal campaign even more reveals more self-similar patterns in the Ohio results. Romney led early in the night, only to have Santorum overtake him and lead for much of the night. Santorum was doing well among the rural, more conservative counties, while Romney was winning big in Cuyahoga and Hamilton counties, which are urban, usually Democratic areas (zooming out briefly, most of the states Romney has won were also blue states won by Obama in '08). Romney ultimately overtook Santorum just after 11pm last night, just as he pulled ahead of Santorum in the polls in the few days right before the election.

Projecting the patterns of the campaign forward, it appears even more clear that Romney will ultimately be the nominee. By preventing Santorum from getting any momentum-building surprise wins while also racking up a majority of the delegates, Romney continues his solid but not awe-inspiring performance. He will continue to use his superior resources to go on to victory, but it won't be overwhelming. He's probably going to struggle in the upcoming elections in Alabama, Mississippi, Hawaii, Kansas, Missouri, Illinois and Lousiana, with Gingrich likely doing well in the South, Santorum in the Midwest, and Ron Paul at the caucus in Hawaii.

False equivalence

I'd been mentally preparing a post about the false equivalence some conservatives are drawing between Rush Limbaugh's recent comments and those made by liberals like Ed Schultz or Bill Maher, with Schultz calling Laura Ingraham a slut and Maher calling Sarah Palin a, well, a word I don't even like to type but that starts with C. But Josh Marshall over at TalkingPointsMemo.com beat me to it, so give it a read.

Please vote (carefully)

It's Election Day in Ohio, where most of my readership resides, so I'll be brief. I'd just like to remind you that you don't have to vote in every single race on the ballot. If you don't know anything about either candidate running for probate judge or whatever, just leave it blank. "Random" voting is how Cuyahoga County winds up with tons of judges with Irish names and 4 named Russo. So find a voter guide from your local newspaper and do a bit of reading before heading to the ballot box. Or just vote for the issues and more major offices.

Romney's unexplained conservativism

After a two-day detour to Rush-ville, we're back to talking about Romney's lack of biographical explanation for his 20 year rightward trend. Apart from naked political ambition, there is no other justification given for his conservativism, and I think that's most of the reason that the Right hasn't embraced him. With Rick Santorum, you understand the source of many of his views. For instance, he caught a lot of flak for coming out against prenatal testing, on the grounds that it would encourage abortions if a disease such as Down Syndrome is discovered. Given that Santorum has a daughter with Trisomy 18 (extra copy of chromosome 18, where Down Syndrome is an extra copy of chromosome 21), his views on the issue make sense.

If Romney had a similar story, conservatives could trust him more. As it is, we have statements from all over the map over the past 20 years. Even recently, he has occasionally made statements that call his conservativism into doubt, such as his initial statement opposing the Blunt amendment or his recognition that cutting spending would at least temporarily slow the economy. If he's elected President, how could anyone, conservative or liberal, claim to know what Romney will do when it really matters. He might return to his more moderate/liberal roots when the fate of the world is at stake.

For a movement demanding ideological purity, like the Tea Party, you have to have either a long history of demonstrated adherence to dogma, or a biographical explanation to justify your lack of such a record. Romney has neither, and because of it he is incapable of being truly accepted by the GOP.

Rush's utterly inadequate apology, continued

In Part 1, we started breaking down Rush's "apology" which fails to show any actual contrition. Now, the thrilling conclusion:

Where do we draw the line? If this is accepted as the norm, what will follow? Will we be debating if taxpayers should pay for new sneakers for all students that are interested in running to keep fit?

Well, yeah! If you can save $100 in health care spending by spending $50 on shoes, it would be silly to not do it. But that's more of an argument about the issue, not Rush's insult, so it's not particularly relevant. Except that Rush took over half of his "apology" to defend his position on the issue, not to just apologize and move on. Rush continues:

In my monologue, I posited that it is not our business whatsoever to know what is going on in anyone's bedroom nor do I think it is a topic that should reach a Presidential level.

Again, it's not our side that sought to carve out special rules for one particular type of medicine. And it's not only a matter of anyone's bedroom. Rush, Georgetown and other conservatives are unreasonably focused on the sexual/reproductive aspect of these medications. As Ms. Fluke testified, and as Kerri pointed out on Facebook, there are other reasons for a woman to need hormonal therapy. Rush concludes:

My choice of words was not the best, and in the attempt to be humorous, I created a national stir. I sincerely apologize to Ms. Fluke for the insulting word choices.

Rush seems to think that the only thing he's done wrong here is using the particular words "slut" and "prostitute". It is the choice to personally attack a young woman, and that he demonstrates a complete lack of knowledge of the subject. It was not a poor word choice, but a conscious decision to repeatedly, over the course of several days, slander an honorable woman who has done nothing more than passionately advocate for her classmates.

His demonstrated lack of understanding of what he has done wrong, and his failure to show true contrition, makes his "apology" meaningless. I will continue to boycott any and all of his sponsors, as well as Clear Channel radio stations, until he shows actual understanding, gives a real apology, and takes steps to keep from repeating the behavior in the future.

Rush's utterly inadequate apology

Within a few hours of yesterday's post, Rush issued an "apology". Guess he just didn't think he could stand the heat now that The Political Doctor was on the scene!

Let's go through Rush's "apology":

For over 20 years, I have illustrated the absurd with absurdity, three hours a day, five days a week. In this instance, I chose the wrong words in my analogy of the situation.

This was not a matter of just wrong words. It's not like the only things wrong with his statement were the "slut" and "prostitute" words. He chose to 1) show his ignorance of the issue by thinking that because someone might have more or less sex, that they'd have to spend more or less on birth control, 2) blatantly mischaracterize Ms. Fluke's testimony by saying she talked about needing contraception coverage because she has so much sex, not that her classmates had medical issues that required hormone therapy that they were unable/dissuaded from getting due to Georgetown's policy, and 3) to continue and indeed escalate the personal attacks for the next several days, only backing off when a backlash to his comments led to a boycott that hit him in the pocketbook. Continuing on:

I did not mean a personal attack on Ms. Fluke.

Calling someone a prostitute and a slut who has too much sex and needs to keep her knees together is a strange way to show you don't mean a personal attack. He absolutely meant to attack this woman, and he should own up to it. Something like a "It was absolutely wrong of me to attack Ms. Fluke in this way. I am working with my therapist/minister/whatever to address my own issues which contributed to this. I will make an $x donation to the charity of Ms. Fluke's choice and suspend myself from my EIB (his production company) broadcast for y weeks" would actually show remorse, not these empty words. Rush continues:

I think it is absolutely absurd that during these very serious political times, we are discussing personal sexual recreational activities before members of Congress.

It is not our side that brought personal "sexual recreational activities" into the argument. ObamaCare established a principle that any and all preventative medical therapies which are justified by the medical literature, common medical practice, and the decisions patients make with their doctors should be covered without a copay. It is Republicans/conservatives who raised the need for an exception in the case of birth control, even though someone's personal health choices can't damn someone else to hell. Moving on:

I personally do not agree that American citizens should pay for these social activities.

So fucking what? Even if taxpayers didn't want to cover your oxycontin or your cochlear implant that you needed as a result of your addiction, it's none of their business. Not to mention these insurances are paid for by the beneficiary via their work, or, in the case of Georgetown Law School, not paid for in any way by anyone but cash from the beneficiary.

What happened to personal responsibility and accountability?

What Republicans are advocating is a prohibition on a private citizen and her health insurance company from making a change to their agreement, without the citizen's employer needing to be involved at all, to cover contraception instead of pregnancies and babies and surgeries for huge ovarian cysts caused by untreated polycystic ovary syndrome. Ms. Fluke was advocating for the right to change one's own, personal policy.

That's the halfway point of Rush's "apology", and I've gotta go to the maple sugar festival in Burton, Ohio, Pancake Town USA. So we'll finish the other half when I get back this afternoon.

Rush needs to go

Rush Limbaugh is by most objective measures an awful human being. But he outdid himself this week, and his sponsors need to be boycotted until he is off the air. And, frankly, I think this could be a controversy that could have major repercussions for the Republican Party as a whole. Here is a description of the controversy from Rush himself.

To briefly summarize, a Georgetown (Jesuit/Catholic university in Washington, DC whose health insurance policy doesn't cover contraception) law student named Sandra Fluke testified before Congress about the hardships faced by classmates who need hormone therapy for conditions like polycystic ovary syndrome. Rush responded by saying:

"What does it say about the college co-ed Sandra Fluke, who goes before a congressional committee and essentially says that she must be paid to have sex, what does that make her? It makes her a slut, right? It makes her a prostitute. She wants to be paid to have sex. She's having so much sex she can't afford the contraception. She wants you and me and the taxpayers to pay her to have sex. What does that make us? We're the pimps."

Let's forget for the moment that Rush seems to think that you'd need to pay more for contraception if you have more sex, which is true for condoms but not for most forms of contraception. Ms. Fluke was testifying about the medical conditions of her friends and colleagues and the health implications for them if Republican policies were put in place. Rush responded with the most blatant case of slander in the history of the world.

He is a monster. He has no place in civil discourse and has no business broadcasting across the country. This is not a matter of an off-color joke that got out of hand. He has continued to slander Ms. Fluke for the rest of the week. He also said to Ms. Fluke "and the rest of you Feminazis, if we're going to pay for your contraceptives and thus pay for you to have sex, we want something for it. We want you to post the videos online so we can all watch." He also offered to pay for "as much aspirin to put between their knees as they want," echoing comments by Santorum big-money supporter Foster Friess, previously discussed here.

THE FOLLOWING LINKS CONTAIN SEXUALLY EXPLICIT IMAGES! DON'T CLICK ON THESE LINKS AT WORK! DON'T CLICK ON THESE LINKS AT WORK! By the way, someone really needs to educate Rush, Friess and the rest of their ilk that just because you keep your knees together doesn't mean you can't get pregnant. DON'T CLICK ON THESE LINKS AT WORK! DON'T CLICK ON THESE LINKS AT WORK!

Rush's comments betray the true feelings of many (though not all, I'll grant) who oppose Obama's plan to ensure quality preventive health care for all Americans. An ongoing boycott of Rush's advertisers can allow the huge majorities of people in this country who use and/or support the use of contraceptives to rake Rush and his ilk over the coals on this issue, which is more fundamentally important to many women than any other issue of the campaign.

Rush is constitutionally incapable of apologizing or ever admitting he is wrong. He will continue to insist that Ms. Fluke and women like her are "sluts" and "prostitutes" because they use contraception, and given his status in the conservative movement, millions of conservatives will continue to defend him. By keeping the issue in the news, Rush will take the Republican Party down with him.

Here's a list of sponsors of Rush's program:
Carbonite
Lending Tree
LifeLock
ProFlowers
Sears
TaxResolution

Please comment if you know of other sponsors.

Romney needs some tragedy

Mitt Romney is, objectively, a political chameleon. In 1994, when liberal Republicans still roamed New England, he tried to out-liberal Teddy Kennedy, tellling (.pdf) the Log Cabin Republicans that "as we seek to establish full equality for American's gay and lesbian citizens, I will provide more effective leadership than my opponent," and "we must make equality for gays and lesbians a mainstream concern. My opponent cannot do this. I can and will." Then in 2002, as the old concept of the moderate-liberal Yankee Republican was in its death throes, Romney tacked to the right and was elected as a moderate governor. Once he decided he would run for President, he continued moving rightward, pulling out of a multi-state cap-and-trade program and being a pro-life governor despite running as a pro-choice candidate. In the 2008 campaign, he ran as a center-right candidate, just to McCain's right. This time around, after the rise of the Tea Party, he portrays himself as "severely conservative".

It would be one thing if Romney had a great personal story to help voters understand his political shifts, with moments of crisis leading to changes in his views. But instead Romney projects the image of a man who has never had any tragedy in his life at all. He was born to a father who ran a large auto company and later became governor and a mother who was a candidate for U.S. Senate in 1970. He went to good schools and wound up making hundreds of millions in venture capital. He's been married for 42 years and has five good-looking sons and five good-looking daughters-in-law.

As a reasonably informed voter, I am not aware of any true moment of crisis in his entire life. Instead of a compelling personal narrative that would explain his growing conservativism, he appears as an out of touch rich guy who makes $10,000 handshake bets, hangs out with NASCAR team owners, owns multiple Cadillacs, and pays a lower tax rate than most Americans. His political shifts therefore appear nothing more than callow political opportunism.

Bluntly ridiculous

Today, the Senate voted down an amendment to ObamaCare put forth by Sen. Roy Blunt (R-MO). The Blunt amendment (.pdf) would have allowed any employer to refuse to cover any health care service just by saying the service is "contrary to the religious beliefs or moral convictions of the sponsor" of the plan. Were the amendment adopted, there would be absolutely no restriction placed on which services an employer can refuse to cover. They could refuse to cover diabetes, blood pressure and cholesterol medicines because to do so would encourage gluttony and sloth. They could refuse to cover HIV testing and treatments because they believe AIDS was sent by God to destroy the homosexuals. They could refuse to cover antibiotics because fuck you that's why.

Now, it's true that an employee could choose to quit and find a new job that has better coverage. But switching jobs isn't easy. It takes months to find a new job. If you've got a medical condition that requires care, you might not have months to wait.

This all comes back to your health insurance being an earned benefit, just like your paycheck, with which you can do what you want without endangering anyone's immortal soul. 48 senators, including 45 of 46 Republicans who cast a vote, chose to stand on the side of the rich people with the shitty argument who are not materially affected by the issue instead of the people whose very health and survival depend on having access to medical care. We'll see if there's a political price to pay.