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I was running out the door for work last week when I heard Diane Sawyer give a teaser about John Stossel's^ take on health care waiting times in the US.

I finally got around to looking at it. Sure enough, it's a hit piece. He's good about saying where he gets his facts, but he didn't think about what he was reading. I guess that's what happens when you have Pollyanna looking over your shoulder.

Way down deep in his report Stossel says that the average person in the US pays 12.5% as their share of the total health care expenditures which is on page 12; but he didn't factor in what healthy people, Medicaid, Worker's Compensation, SCHIP and Medicare Advantage does to that statistic. Then there's another issue with premium payments......and don't forget the unisured that pay 100% of their care and just don't get much care at all!

I think one of the more facinating parts of his statisitcal cherry picking is that he had to ignore page 8 where it says that 31% of the spending is contributed by households before he got to page 12 with a fact more to his liking.

see what I mean?

It's in the eye of the beholder.

First I'll start with the waiting times. The best place to refute that is the CommonWealth Fund's report: Mirror, Mirror where the US comes out dead last with Canada on waiting times and that a country with universal health care, Germany comes out first. I guess Stossel et al either didn't see that report or didn't want to include it (it messed up his bias).

Then as I read further he quotes the president of AHIP, Karen Ignagni as she prevaricates says:

Polls show that while people dislike the insurance industry in general, 87 percent of people with health insurance are happy with their coverage. Only 3 percent of health insurance claims are denied, she says.

Apparently Stossel didn't get the memo on AHIP. The stat she quotes is accurate, but she fails to mention all the other stuff in that poll like 85% of the respondents worry about affording health care over the next few years or that 28% of the respondents had family members that had to delay or go without health care within the last year. What Ms. Ignagni doesn't say is that poll shows the unease most people have with our health care system and that it is impossible to accurately poll emotional feelings. That poll told me that people understand they are a catastrophe away from being unable to meet medical costs and becoming uninsurable.

Then Stossel goes on to quote a darling of the CATO Institute, P. J. O'Rourk as a health care expert.

This story needs parity.

Our current (2006) benchmark stats are:
The US spent $2.35 trillion on health care
That's about $7,835 per capita
That's about $31,340 per family of 4
12.5% of $7,835 = $979.17
12.5% of $31,340 = $3,917.50

Now compare this to Medicare premiums only:Medicare Part B Premium = $93.50/mth
Medicare Part D Premium = $57.53/mth
Medicare Part B + D Premium = $1,812.36 per year
Medicare Medigap premium average $160/mth
Medicare Part B + D + Medigap = $3732.36 per year per Medicare enrollee
These are costs before the patient even walks in the doctor's office door!
That's almost 2-4 times the $979.17 (12.5% of $7,835).

Now compare to a family of four with decent insurance & no corporate contribution:Monthly premium medical only = $1,100/mth or $13,200/year
Monthly premium medical w/junk dental & vision = $1,200/mth or $14,400/year

That's 3.67 times $3,917.50 (12.5% of $31,340)

Now compare to a family of four with decent insurance and 40% company contribution:Monthly premium medical only = $660/mth or $7,920/year
Monthly premium medical w/junk dental & vision = $720/mth or $8,640/year

That's about 2 times $3,917.50 (12.5% of $31,340)

Now compare these figures with US Census poverty table 1 or Table 2.

This is the median income (per capita) level for 2006:

PER CAPITA INCOME5 (page 14 of the pdf)
------------------------ 2005 ------------------------------- 2006 ----------------------------------
----------------------- people ----- median $'s--------- people ---------- median $'s--------
Total2. . . . . . . . 293,834,000    $25,857          296,824,000            $26,352

50% of the population made $26,352 or less in 2006
12.5% of $26,352 = $3294

Mr. Stossel, sometimes the government's sites will publish what looks like conflicting data, so as a researcher, you have to dig deeper to get a clear picture. That 12.5% figure you used for your story doesn't paint an accurate picture. The first rule of statistics is to ask what the percentage represents. (i.e. That's 12.5% of what?...exactly?) You didn't do that. You needed to look around the sites a little more. For instance, theres a government report with this interesting factoid figured out in 2005 about the 2002 health care.:

Half of the population spends little or nothing on health care, while 5 percent of the population spends almost half of the total amount. In 2002, the 5 percent of the U.S. community (civilian noninstitutionalized) population that spent the most on health care accounted for 49 percent of overall U.S. health care spending (Chart 1, 40 KB). Among this group, annual medical expenses (exclusive of health insurance premiums) equaled or exceeded $11,487 per person.

In contrast, the 50 percent of the population with the lowest expenses accounted for only 3 percent of overall U.S. medical spending, with annual medical spending below $664 per person. Thus, those in the top 5 percent spent, on average, more than 17 times as much per person as those in the bottom 50 percent of spenders.+

Average someone with no insurance that ignores their chronic health problems and only gets care for acute, can't be ignored health problems pays:

100% of $664

with someone with catastophic problems with the total medical costs of "X" that pay "y" of their costs which would be:

Total Patient contribution = $11,487 = y
------ y -------- x% --------------- x $'s -------------------------------
if $11,487 =   1% then $1,148,700.00 are the total medical expenses
if $11,487 =   2% then    $574,350.00 are the total medical expenses
if $11,487 = 2.5% then   $459,480.00 are the total medical expenses (i.e. multi-drug resistant Tb/yr)
if $11,487 =   3% then    $382,900.00 are the total medical expenses
if $11,487 =   4% then    $287,175.00 are the total medical expenses
if $11,487 =   5% then    $229,740.00 are the total medical expenses (i.e. transplant surgery only)
if $11,487 =   6% then    $191,450.00 are the total medical expenses
if $11,487 =   7% then    $164,100.00 are the total medical expenses
if $11,487 =   8% then    $143,587.50 are the total medical expenses
if $11,487 =   9% then    $127,633.33 are the total medical expenses
if $11,487 =  10% then    $114,870.0 are the total medical expenses
if $11,487 =  11% then    $104,427.27 are the total medical expenses
if $11,487 =  12% then      $95,725.00 are the total medical expenses
if $11,487 = 12.5% then $91,896.000 are the total medical expenses
if $11,487 =  15% then      $76,580.00 are the total medical expenses
if $11,487 =  20% then      $57,435.00 are the total medical expenses
if $11,487 =  30% then      $38,290.00 are the total medical expenses
if $11,487 =  40% then      $28,717.50 are the total medical expenses
if $11,487 =  50% then      $22,974.00 are the total medical expenses
if $11,487 =  60% then      $19,145.00 are the total medical expenses

That's quite a slope going there. If you are uninsured and part of that 5% that utilizes 50% of all medical services rendered, you either get medically needy Medicaid or you're dead.

Ok, here's a list of questions I think you might have (if you're still with me) with snarky answers):

  1. Are premium dollars being factored into the per capita out of pocket spending stat? Probably not. The source tables are unclear.
  1. Why don't analyst's admit that insurance is paid for by their members? The math makes their head ache and destroys their propaganda.
  1. Why aren't the expenditure tables subsected by acuity, poverty or at least income? Too hard to extract the data.
  1. Why aren't insurance premiums considered a health care expense? The IRS does.

So, John Stossel you served your Disney masters well. ABC will retain advertising revenue from pharma, insurance companies and the like, but you let your viewers and readers down.

---------------------------------------------------------------------------------------------------- ----
^ The story posted at ABCnews.com lists Andrew Sullivan as a co-author.

One of my sources referenced this as their source:
+ Conwell LJ, Cohen JW. Characteristics of people with high medical expenses in the U.S. civilian noninstitutionalized population, 2002. Statistical Brief #73. March 2005. Agency for Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/... Accessed April 7, 2006.

here's the web sites I reviewed for this diary:

http://abcnews.go.com/...

http://www.chcf.org/...

This document

http://www.cms.hhs.gov/...

http://www.census.gov/...

http://www.cms.hhs.gov/...

http://www.wpsic.com/...

http://www.commonwealthfund.org/...

http://www.kaisernetwork.org/...

http://www.medicalnewstoday.com/...

http://www.healthcoalition.ca/...

ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/Health_US/hus06tables/Table124.xls

http://www.census.gov/...

Sometimes I think I lose mojo, because I research too much!

Originally posted to JDWolverton on Fri Sep 21, 2007 at 11:29 AM PDT.

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Comment Preferences

  •  12.5% of my tips will not be enough mojo (14+ / 0-)

    Second rule of statistics:
    Figures don't lie, but liars figure.

    If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

    by JDWolverton on Fri Sep 21, 2007 at 11:24:22 AM PDT

  •  Well, what do you expect from John Stossel? (7+ / 0-)

    The guy's a barely-disguised conservative masquerading as a journalist.  Hell, he only got his position because, after Gerlado Rivera resigned, "20/20" was short one douchebag with a porn start mustache.

    "We must move forward, not backward, upward not forward, and always twirling, twirling, twirling towards freedom." - Kodos

    by Jon Stafford on Fri Sep 21, 2007 at 11:26:16 AM PDT

  •  Stossel is... (5+ / 0-)

    ... (as my mother used to say) as useless as tits on a bull.

  •  John Stossel and the (not) invisible hand,, (3+ / 0-)
    Recommended by:
    SarahLee, smkngman, junta0201

    of the marketplace:  http://www.youtube.com/...

    "Our enemies are innovative and resourceful,,,they never stop thinking of ways to harm our country and neither do we" G W Bush

    by irate on Fri Sep 21, 2007 at 11:32:06 AM PDT

  •  Give him credit (0+ / 0-)

    He is not blindly believing Micheal Moore's propaganda "documentary." I watched Sicko, and was outraged until I did research. I encourage you to visit www.therealcuba.com Why will we believe Moore's accounts over someone who has actually been a Cuban citizen?

    I consider myself a democrat, but we have to be real. I would encourage everyone to read this article: http://www.newsbusters.org/...

    Before you anyone starts going on about "newsbusters", it does present another side of the story. I would encourage everyone to read prwatch.org and newsbusters.org for opposite opinions spectrums of the same news, and form your own conclusions.

    •  I don't think of Michael Moore as a health care (6+ / 0-)

      expert either, but he did a good job of presenting a provocative documentary that got people talking. The facinating part of SICKO! is that so many people could relate to what he was showing. That's what Moore does. He creates an emotional appeal.

      My hopes for SICKO! are to get people to do their own research. Go to the government sites and look for yourself. I gave you enough links, don't take newsbusters word for it either. Look for yourself.

      Incidentally the WHO stats Moore used can be found at:

      www.who.org

      If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

      by JDWolverton on Fri Sep 21, 2007 at 11:53:21 AM PDT

      [ Parent ]

      •  Exactly (0+ / 0-)

        my point. A FRENCH health care expert said that his countries system is on the verge of being in shambles. I would tend to believe him, over the WHO (who puts france at the top of the list.) Wouldnt you? I do not support John Stossel's political views nor do I support Micheal Moore's political views. I thank Moore for making a film that got a debate started on the issues important to many Americans. Moreover, I commend John Stossel for telling the other side of the story with a calm and rational tone. The last thing we need is ranting and raving. That gets nothing accomplished.

    •  Bah (4+ / 0-)
      Recommended by:
      SarahLee, otto, smkngman, KansasLiberal

      all doctors hate public health care.  Ask any head of the CMA, British equivalent, AMA, or French equiv.

      Patients love it though.

      •  Baby boomers (4+ / 0-)

        since they talk about them in the article you posted, here's some info on Canada's dealing with baby boomers.

        http://www.cbc.ca/...

        Aging baby boomers not a major burden to health-care costs: report
        Published: Wednesday, September 12, 2007 | 10:15 PM ET
        Canadian Press: JULILAN BELTRAME

        OTTAWA (CP) - Canada's aging population will have little impact on the cost of maintaining a viable national public health-care system over the next 40 years, says a new report.

        The report by the Canadian Centre for Policy Alternatives seeks to debunk the "myth" of runaway costs as baby boomers enter their final years. The 33-page research paper from senior economist Marc Lee predicts the aging baby-boomer generation will add less than one per cent to health-care costs each year. And it says the cost of maintaining the health-care system well into the future will be easily met by economic growth.

        All those 'projections' of baby boomers destroying health care fail to take into account the growth of GDP in the same time frame.

        Oops.

      •  From the doctors postin here (1+ / 0-)
        Recommended by:
        chibi xandra

        in support of HR 676, I don't believe your statement about all doctors hating public health care is accurate.  I think that most doctors wanting all individuals to be able to receive real health care do support public health care - they just want to make it better.  Best way to do that is to enlarge the risk pool with everyone - single payer.  I know that my father did when he was alive and practicing.

    •  Third world (5+ / 0-)

      Cuba is a third world country.  

      What you don't understand is that Moore isn't comparing the country of Cuba with the United States.

      He was simply making the point that a third world country like Cuba is able to cover all of its citizens, yet we can't.  

      If you'd like to compare ourselves to all third world countries, feel free.  It won't be a very fair comparison.  

      However, if you compare the healthcare systems in other industrialized countries, we lose.  Almost across the board, we lose.  We lose in longevity, we lose in infant mortality, and most importantly we lose in cost and efficiency.  Our system is more expensive than all other systems, and we get less in return.  The cost is nearly twice per capita that of countries like Germany, France, and Italy.  That includes our 47 million uninsured people.  

      Your Mom buys your bling

      by otto on Fri Sep 21, 2007 at 12:07:18 PM PDT

      [ Parent ]

      •  You make valid points (0+ / 0-)

        You are right. I don't know what the French Health Care expert's motives were. One thing I do know however is that since human nature is to be greedy, if we lower the incentive of people to be doctors (high pay), then we will reduce the supply of doctors (fewer people willing to invest their time into long schooling.) It is suprisingly uncommon to see doctors willing to open free clinics out of the kindenss of their hearts.

        Regarding the issues of lower life expectancy, we as Americans also lead very unhealthy lives compared with other industralized nations. http://www.jointogether.org/...

        I am not supporting socialized medicine, nor am I supporting free market medicine.

        No economist (socialist, or capitalist) will deny that governments and free markets do not mix. If one wants to debate complete socialised medicine, then that is fine. The same holds true for complete free market medicine. I am willing to listen to both sides. The plans we have been hearing from our frontrunners only include more government meddling in a somewhat free market industry.

        Let's keep this thread going. It is nice to find non-argumentative threads when there is a slight differnce of opinon.

        •  The us requires physicians to take 4 more years (1+ / 0-)
          Recommended by:
          chibi xandra

          of school than most countries.

          Our med school programs need revising too.

          If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

          by JDWolverton on Fri Sep 21, 2007 at 01:51:32 PM PDT

          [ Parent ]

        •  Hummm (2+ / 0-)
          Recommended by:
          JDWolverton, chibi xandra

          [...] if we lower the incentive of people to be doctors (high pay), then we will reduce the supply of doctors (fewer people willing to invest their time into long schooling.)

          Well we need to figure out how to help more people get into medical school and out without such high student loans.  

          NPR: Americans Graduate Medical School in Cuba

          Weekend Edition Saturday, August 4, 2007 · Eight U.S. students graduate from medical school in Cuba in July – the second class of Americans to do so. Cuba's leader Fidel Castro established the program seven years ago, offering full scholarships to foreign students willing to practice in underserved areas. Although the U.S. has banned trade with Cuba, the State Department has not opposed the program

          Washington Post: The Cuban Solution

          Back when Melissa was a premed student at Howard University, studying in the dark was never an issue. But this isn't Washington. This is Cuba, where Melissa, Revery and 95 other Americans are studying medicine in a country that's been an anathema to the United States for almost five decades. Thanks to Fidel Castro, their education is free. But that doesn't mean they aren't paying a price for turning to Cuba in their quest to become doctors. They've given up creature comforts most Americans take for granted, struggled to master hematology and other complicated subjects in a foreign language, and have no guarantees they will get a chance to practice medicine in the United States.

          Right now, though, Melissa, 25, and Revery, 26, aren't thinking about any of that. Melissa, a third-year student, says she has to do well on this test because the professor is on her case. Cuban doctors place a premium on basic skills -- interpreting breath sounds from a stethoscope, for instance -- that have been deemphasized in the high-tech world of U.S. medicine. Not long ago during rounds, Melissa's professor exploded at her when he asked for a diagnosis of a patient, and she replied that the lab results weren't back yet.

          "Are you planning to become a doctor or a lab analyst?" he growled. "Tell me what you heard and felt and saw."

          From discussions at The Student Doctor Network forum:

          This is in reference to the quality of Cuban-trained physicians.

          During my clinical rotations here in Puerto Rico, I have had the opportunity to work with several Cuban-trained doctors and they have all been outstanding. They haven't had it easy as they had to basically escape from Castro.

          In Cuba, once you finish medical school, you are required to enter a Family Medicine residency and serve as a family doc. If you want to do something else (Surgery, OB-Gyn, Peds, IM, etc) then you have to do another residency on top of FM. After all that, if you come to the mainland US or PR, then not only do you have to pass all of your boards, but you must repeat a residency in your chosen specialty. These folks do not have it easy, but I find they are some of the most dedicated physicians who are eager to teach and share what they know.

          That forum thread has some other interesting comments.

          Medical School Scholarship Program
          at the Latin American School of Medical Sciences, Havana, Cuba Program overview:
          http://www.ifconews.org/...

          Anyway - I think we could have all the doctors and nurses we needed if some adjustment to current US med school practices were made.  

        •  I can tell where your coming from (2+ / 0-)
          Recommended by:
          SarahLee, smkngman

          There is socialized medicine where the government pays the doctors and healthcare providers- that exists in England. It also exists in the US- the VA.  

          There is single payer, which is a more common system of  healthcare.  It exists throughout most European countries, and Canada.  There is some downward pressure on wages of doctors, but they also have a guaranteed payment, which means that they get to cut a large chunk of their budget which would normally go towards collections and other bill payment procedures.  

          Single payer also exists in the US- in the form of Medicare.  Medicare is not a perfect system, however it reduces the bureaucratic overhead to 3 or 4%- as opposed to 25% overhead in the for profit healthcare arena.  

          http://www.pnhp.org/...

          The above PNHP link has some good numbers on single payer.  

          Overall, we would save money, and insure more people under a single payer system.  

          Your Mom buys your bling

          by otto on Fri Sep 21, 2007 at 01:56:11 PM PDT

          [ Parent ]

    •  Your comment assumes (3+ / 0-)
      Recommended by:
      SarahLee, smkngman, JDWolverton

      that movie goers accept Sicko as a documentary.  I haven't considered Moore a documentarian since Bowling for Columbine (one of the best movies of the year, imo, but not a documentary, again imo).

      Sicko raised important issues and shed light on our moral decay regarding health.  The movie helped to put healthcare as the most important domestic issue in the 08 election (at least for Democrats).

      •  I agree (0+ / 0-)

        I applaud Micheal Moore for making a film that opens up a debate, As I think most do. Conservatives get so caught up in "Micheal Moore...anything out of his mouth is liberal nonsense." That is ignorant. Regardless whether one agrees with Moore's film, it cannot be refuted that his controversy has sparked discussions on very real, and very important issues.

    •  Which Democrat will you be voting for? (0+ / 0-)

      In your local race in 2008?  

      Your Mom buys your bling

      by otto on Fri Sep 21, 2007 at 12:12:28 PM PDT

      [ Parent ]

  •  5% take 50% of the healthcare resources. (2+ / 0-)
    Recommended by:
    JDWolverton, chibi xandra

    That would certainly be rebalanced under national health care.  I can't imagine it'd end well for much of that 5%, though, but that's a policy decision.

  •  Where are the wrestlers when you need one. n/t (1+ / 0-)
    Recommended by:
    JDWolverton
  •  He's Absolutely a Propagandist (6+ / 0-)

    One of his programs I turned off was one that purported to show that liberals were selfish when it came to charitable giving and conservatives were the more generous. The first piece of supporting evidence he gave was to measure the one day take of two Salvation Army kettles, one in San Francisco, one in Fargo. Lo and behold, Fargo took in more. Of course what Stossel didn't mention is that gay people and their friends don't give to the Salvation Army because they discrimate against gays.

    I wonder if the contributions had been to Planned Parenthood which city would have been more generous?

    There have been other times where I actually agreed with Stossel's conclusion but considered his evidence to be completely bogus.

    It turns out news delivered on a for-profit basis is a bad business model for democracy.

    by George Lynch on Fri Sep 21, 2007 at 11:56:16 AM PDT

  •  en fuego, JD! n/t (3+ / 0-)
    Recommended by:
    otto, JDWolverton, chibi xandra

    Diversity is the key to economic and political evolution.

    by MarketTrustee on Fri Sep 21, 2007 at 12:12:49 PM PDT

  •  Stossel (4+ / 0-)

    It seems like Stossel is doing high school level internet research.  

    "Hey, now that looks like it supports my previously determined viewpoint!  I'll use that one, and put a couple big words like juxtaposition in there.

    Your Mom buys your bling

    by otto on Fri Sep 21, 2007 at 12:15:46 PM PDT

  •  One of Stossel's main points was supported (0+ / 0-)

    by the study cited by the diary author.

    Americans were the most likely to say they had access problems related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services. In other countries, like the U.K and Canada, patients have little to no financial burden, but experience long wait times for such specialized services.

    I imagine, that not being able to quickly get to a specialist, like an oncologist, is what most Americans are afraid of.

    It would also be interesting to see how Britain would fare in that survey. Given that they have more heterogenous population, more similar to the US.

    Another point argued by Stossel was that the universal healthcare systems do little if any R&D. The US supplies almost all of the inovation in medical technology and drugs. And, that this R&D is expensive.

    •  I guess they did include britain. nt (0+ / 0-)
    •  MOST R&D is paid for with govt. grant money (3+ / 0-)
      Recommended by:
      SarahLee, KansasLiberal, chibi xandra

      in the US.

      Waiting times are an issue in the US. Anyone who wants gastric bypass surgery is going to wait a year to get it. A woman who schedules her mammogram must call for an appt. 6 months in advance. If you have acute bursitis, plan on seeing the doctor next week. These are current waiting times in the US for people with insurance.

      BTW,
      I don't say Stossel is all wrong. His sources are accurate.
      I'm saying he's a spin doctor. He points out only his side.
      If you regularly read my diaries, you might have noticed I've posted a couple where I've been flamed for my position on health care.

      You might have noted that the Karen Ingnagni bio page is from the CommonWealth Fund's site. She's not all wrong either.

      If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

      by JDWolverton on Fri Sep 21, 2007 at 12:29:56 PM PDT

      [ Parent ]

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