By Dan Kennedy • The press, politics, technology, culture and other passions

Not fat, not a lady, but Nate Silver is singing

This may be the last polling analysis of the Massachusetts Senate race worth paying attention to before the voting starts tomorrow. According to Nate Silver, Republican candidate Scott Brown now has a 74 percent chance of winning. As recently as last night, Silver very tentatively gave Democrat Martha Coakley a 58 percent chance.

What happened? A series of polls throughout today that just got worse and worse for Coakley. Silver explains:

Coakley’s odds are substantially worse than they appeared to be 24 hours ago, when there were fewer credible polls to evaluate and there appeared to be some chance that her numbers were bottoming out and perhaps reversing. However, the ARG and Research 2000 polls both show clear and recent trends against her. Indeed the model, which was optimized for regular rather than special elections, may be too slow to incorporate new information and may understate the magnitude of the trend toward Brown.

What I like about Silver is that he’s not a pollster — rather, he’s someone who looks at a wide range of polls and makes sense of them. His record in the presidential campaign was outstanding.

This is very bad news for the Coakley campaign.

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  1. Scutch

    If Brown does win tomorrow, how long before he is cast aside as a RINO and a traitor to the “Conservatives.”

  2. Harrybosch

    Reading the bile on #masen and thinking about the Republican rallying cry / fig leaf of doing “tort reform” before health care as their method of keeping costs down.

    But where are these “outrageous” settlements against doctors that are increasing the cost of insurance?

    Is it possible that these are just reasonable settlements for people who have been wronged, or money to provide lifelong healthcare as a result of a doctor’s screwup?

    Isn’t it our experience that the vast majority of juries usually get things just about right?

    And don’t these insurance companies who provide malpractice insurance somehow manage to siphon billions of dollars a year in profit anyway?

    Not to mention the lawyers who are taking a third of any settlement?

    Course the ultimate irony is that these citizen jurors supposedly handing out these settlements — from all cross-sections of society — are the same “common man” whom the Republicans put on a pedastal.

  3. lkcape

    No, Silver was wrong. Coakley’s chances of winning were 26% just 24 hours ago.

    Silver just didn’t recognize it.

    And it’s not important what Silver thinks, no matter what he or Dan says.

    No matter which way you intend to vote, please do.

  4. mike_b1

    @harry, speaking from personal experience, the two major factors driving up health care costs are:

    1. The cost (and time) of entry. A physician will spend 4 years as an undergrad, 4 years in med school, and another 3 to 5 in residency (more if, for example, you do a surgical subspecialty track, in which case tack on another 1 to 3 years. So you, Dr. X, have now spent 11 to 16 years in higher education. Compare that to an MBA (4 undergrad plus 2 grad) or a lawyer (4 undergrad plus 3 grad), etc., and then consider a) the cost of all that schooling and b) the money that person (who likely is among the more intelligent and capable in the workforce pool) could have made had they chosen a different career.

    In the case of my wife and several of her colleagues, she left med school more than $150,000 in debt. And that doesn’t begin to add in all the wages missed because she was studying instead of earning. I would estimate that, in all, she started her medical career $410,000 or more to the bad, totaling up what she owed and what she could conservatively had earned had she gone directly into the workforce and stayed there. Someone — the patients — need to pay for all that training and lost income (risk).

    2. The cost of malpractice insurance — not to mention, the cost of litigation — which is generally at least $1 million per physician, and considerably higher once you get into the specialties. (And that does not include the additional personal liability insurance most physicians take out because the person whose car they scratched in the parking lot finds out they were dinged by a doctor and *wham* up go the lawyer’s fees.

    In my estimation it is those two factors, and not the occasional outrageous jury award, that drive up the cost of health care.

  5. Nial Liszt

    Change and Hope! This has become a referendum/Prop. 2 override, send a message vote where the Mass. electorate usually shifts decidedly rightward. When does Lurch stand for re-election? 57-41 on Tuesday.

  6. MeTheSheeple

    MikeB1: The cost of malpractice insurance is at least $1 million? Per year, per physician, is what you mean? What?

    Please check your figures again and look at the growth; there have been plenty of reports on the subject. I remember a big surge in premiums some years back wasn’t because of devastating lawsuits, but because the insurance companies’ investments were faring badly. This is a small percentage. Really.

    In re: opportunity costs for education: You’re darn right. I think that’s probably why stuff like the Physician’s Assistant (PA) are getting more popular and more accepted. There’s also an advanced nursing degree that lets them write prescriptions as well. I haven’t seen anything evaluating the effectiveness of those programs, but I haven’t looked.

    Oh. Remember to vote!

  7. Harrybosch

    Thanks for the thoughtful response, Mike. Three other factors that come to mind are

    1) Doctors practicing “defensive medicine,” routinely scheduling expensive tests only to forestall being accused of missing something an expensive test might have found,

    2) The need for public companies involved in health care to deliver greater and greater profits to their shareholders, higher executive compensation, etc. etc.

    3) The disconnect between what people pay and the treatment they get. There is no incentive for an insured person to minimize costs. What do they care what it costs? They’re not paying for it anyway.

    Pulling numbers out of the air, the way I see it, “tort reform” might bring down 1/2 of one-percent the overall cost of healthcare.

    Despite your loathing of trial lawyers, the answer lies elsewhere, Republicans.

  8. mike_b1

    @MetheSheeple: I’m looking specifically at the costs per physician (and not taking into account the basic business overhead such as bricks and mortar, etc.).

    So in response to your question, let me clarify: Every physician at MGH, which is where my wife practices, has a minimum $1M malpractice insurance policy. (In addition, many have separate insurance to cover their private practice.) Whereas I can’t speak for the coverage by certain specialties, I suspect some are considerably higher.

    Keep in mind relatively few doctors are actually sued in a given year, and even fewer lose (one family member of mine has been sued once in 50 years of practice and the attempt barely made it past the clerk). Taken as a whole, the premiums add up, while making little demonstrable improvement in health care (some studies suggest the opposite is true — that doctors end up ordering unnecessary tests as a CYA, driving up costs further).

  9. mike_b1


    In hurry this a.m. I think my above response addressed no. 1.

    In response to no. 2: There are lots of private practices (clinics) that face what you describe. The clinics typically are physician-owned: each practitioner buys into the practice (1 doctor, 1 share) and shares in the profits.

    Like many hospitals, MGH is a not-for-profit [it’s a teaching hospital and classified as a 501(c)(3)]. I think the same is true for many, if not most, of the major hospitals in this country. Besides the tax exemption, not-for-profits usually have access to lower-cost equity capital. (As an aside, Parkland Hospital in Dallas, which is where JFK was declared dead, is a not-for-profit.)

    Re 3, an insured person does have certain incentives to hold down costs. That co-pay? That’s one. And while $10 or $15 or $20 doesn’t seem like a lot, it has proved to be a significant factor in keeping people home. Second, the insurers themselves govern this by refusing to pay, delaying payment (a BCBS favorite), or paying (far) less than the actual cost of treatment.

    In one MGH practice I’m aware of, they collect on less than 20% of their bills. That’s not 20% of the total billed, that’s 20% of the actual bills submitted! What other business could survive like that?

    Finally, the law mandates that a hospital cannot turn away based on ability to pay anyone who comes to an ER. That one center is the source of significant losses. And the uninsured are well aware of this, and end up clogging ERs for treatment that could be handled far more cheaply and efficiently by other practices. For this reason alone, the health care reform bill is a godsend, IMO.

  10. ben

    I wonder how many Obama voters actually are going a different direction 14 months later or is it just that many (particularly young and minorities) are staying home because they were never really into politics and participation to begin.

  11. Joey

    Let’s just call a spade a spade, folks– if you do have a townie accent or you don’t have a college degree, you’re voting for Brown. If you don’t have the accent or you do have a college degree, you’re voting for Coakley. I’ve lived in Massachusetts all my life, and have found no better determinant of political preferences than the townie accent.

    I bet Democrats now rue the day they nominated Coakley instead of Mike Capuano, one of the few intelligent, liberal Democrats out there who also still has the accent. He’d have creamed Brown.

  12. This is not a referendum on ObamaCare. This is an excellent campaigner against a subpar campaigner. Nothing more.

  13. Peter Porcupine

    Mike – I was treated at MGH for years (Drs. England and Perlo) and when they retired, it took a loooonnngg time to find a replacement, as they are in an expensive specialty.

    That said – look at MassHighway, or better still, Registry of Motor Vehicles, and tell me that management model will save money – bureaucrats in charge of health care?

  14. Harrybosch

    “And the uninsured are well aware of this, and end up clogging ERs for treatment that could be handled far more cheaply and efficiently by other practices.”

    With respect, you make it sound like a racket, with the uninsured just waiting to get sick so they can go and “clog up” a crowded ER where they’ll no doubt wait five hours to get treated.

    Not sure exactly how the Health Care Reform bill resolves this problem.

    Are they removing the mandate that requires ERs to treat anyone that comes in?

    Seems to me that’s one way to resolve it.

  15. Harrybosch

    “I bet Democrats now rue the day they nominated Coakley instead of Mike Capuano”

    In today’s column, Howie Carr does you one better:

    You want irony? Do you realize that if the state Democrats hadn’t changed the Senate succession law twice in the past five years, they wouldn’t be in meltdown mode this morning?

    Their lame (soon-to-be) lame-duck governor could have appointed whatever stiff he wanted.

  16. Dunque

    Gee, Joey, can’t for the life of me figure out where people come up with these specious charges of liberal elitism.

    As I have often said those of the liberal persuasion like people as a concept, not as a reality. When they start thinking for themselves they quickly morph from noble working class to the mobocracy.

    Foxed, this is a referendum on the entire Obama agenda compounded by a sub-par candidate. As I have said before her true nature has been revealed in the heat of the campaign.

  17. mike_b1

    PP, The notion that government = bureaucrats doesn’t hold water. Yes, most legislators are lawyers — which makes sense to those of us who prefer laws to be written by those who have studied and understand the Constitution. But look within the systems — nationally or locally — and you generally will find subject experts are the ones running things. The top cop? A former policeman. The Education Czar? A former teacher. And so on and so on. Does that mean every system works well? Of course not. But far more companies fail than survive, so I’m not about to trust my welfare and tax dollars to any old Joe with an MBA on his resume.

    Health care makes up 55% of our government spending. That’s unsustainable. We know that. So the system has to change. Will this method work? Nobody knows for sure. But the existing method does not work.

  18. Harrybosch

    “Foxed, this is a referendum on the entire Obama agenda compounded by a sub-par candidate.”

    Agreed, however disgust with local politics and politicians and the status quo are at least as motivating a factor.

    A 25% increase in the sales tax.
    State Representatives photographed shoving money in their bra.
    Speaker after Speaker of the House resigning in disgrace.
    An inept Governor who promised property tax relief and didn’t deliver.
    Appointment of cronies to six-figure do-nothing jobs.
    Pension abuse.

    The list goes on and on.

  19. Nial Liszt

    **This is not a referendum on ObamaCare. This is an excellent campaigner against a subpar campaigner. Nothing more.**

    Foxed: Voters don’t turn out in 2x or 3x the originally expected numbers to vote against a “subpar campaigner.”

  20. mike_b1

    @Harry: I would disagree with most of your list. There is every reason to be just as disgusted with Scott Brown as with anyone else running for office today, for example.

    In Mass. today, I think people are voting their wallets. Workers have been reeling for the past five-plus quarters and they haven’t seen the light at the end of the tunnel. They have been led to believe health care reform will cost them more. I doubt one person in 100 know what the federal gov’t spends on health care right now, but they always assume all the breaks are going to the other guy. The electorate is pissed off, sure, but it’s not because they’ve been paying attention. This is a sad day for Massachusetts not because of who is getting elected and who isn’t, but because it shows the ugly side of the electorate: “I want mine; screw everyone else.”

  21. mike_b1

    @Dunque: “can’t for the life of me figure out where people come up with these specious charges of liberal elitism.

    That’s quite the mouthful there. Irony much?

  22. Harrybosch

    “I would disagree with most of your list.”

    Might as well disagree with the world turning or the sun coming out. Hard to disagree with facts.

    Doesn’t mean Brown or the Republicans don’t have their own baggage.

    But it’s hard — for most of us, anyway — to disagree with facts.

  23. Dunque

    Mike_b1 says “This is a sad day for Massachusetts not because of who is getting elected and who isn’t, but because it shows the ugly side of the electorate: “I want mine; screw everyone else.”

    Actually if you consider the voting in light of the Louisiana Purchase and the Cornhusker Kickback it’s a protest against that attitude, not an endorsement of it.

  24. Joey

    >>Gee, Joey, can’t for the life of me figure out where people come up with these specious charges of liberal elitism.

    Well, I came to liberal elitism after years of hard work and observation, thank you very much. Less educated people have townie accents. I had one too, and then I went to college– thanks to government-backed loans, might I add. Now I make 10 times more than I ever would have in my previous career as a house-painter.

    But if today’s tea-party types want to abolish programs like that, and wallow in poverty while the educated managers ship their jobs overseas to cut costs and earn a bonus… I don’t like it morally, but hey, majority rules. Vote Brown, folks. I could use the extra cash for a nice vacation.

  25. George Williams

    I am a life-long Democrat (I voted for McGovern, Humphrey, Carter), have a graduate degree and a bit of a townie accent. I am voting for Brown because of Obama’s health care and what “Marcia” Coakley has done while DA and AG.

  26. Cassie

    Martha Coakley is the Massachusetts version of Sarah Palin.

    Not very informed on the issues and a terrible campaigner.

  27. mike_b1

    @harry: I don’t disagree those things happened. But it’s a stretch of Pacific proportion to say that voters are basing their decisions today on a whether Diane Wilkerson took a bribe. Consider how few voters can even name DiMasi, let alone know what he is alleged to have done. Then keep in mind that 25% of Massachusetts voters expect ACORN to try to “steal” the Senate seat — even though they don’t know who or what ACORN is. We aren’t talking about Mensa here.

    So it begs the question, on what survey are you basing your opinion?

    This, I believe, is the overriding factor: 90% of the populace thinks the recession is not over.

  28. mike_b1

    @George Williams: No offense, but I’ve read a version of that same “statement” so many times in the past month, I have to believe it’s a cut-and-paste.

  29. Kevin

    George, you hit the nail on the head precisely. Coakley was horrible as the AG so why would I think she would be any good in the Senate. She got along to get along and did not do her job in light of the staggering amount of corruption going on in the State House and the Mayoral email scandal.

  30. Harrybosch

    “So it begs the question, on what survey are you basing your opinion?”

    I don’t understand the question. I presented a list of facts that might tend to make voters less likely to vote Democrat today. I could list dozens more.

    You, on the other hand, mock the voters as “ACORN”-frightened idiots with short memories.

    Might I suggest that it’s just that sort of arrogance that the voters are rebelling against today?

    Of course that’s just my opinion. I could be wrong.

  31. mike_b1

    @Harry, geez, sometimes we seem to communicate so well and other times it’s like whispering into a tornado.

    Again, I don’t dispute those things happened. What I am asking is whether you have seen a survey that says “these are the reasons why voters opted for Candidate X?” Because everything I have seen says, as Carville so aptly put it, “It’s the economy, stupid.” And if 90% of the population remains convinced the economy is in the toilet, then it stands to reason that’s still the main factor, and all the rest of the political hijinks (which have always been around, by the way) are just so much noise.

  32. Harrybosch

    “and all the rest of the political hijinks (which have always been around, by the way) are just so much noise.”

    What you call “noise” I call a culture of corruption.

    Guess we’ll just have to agree to disagree.

  33. mike_b1

    @harry, not so sound pompous, but “noise” is a stats term that means random disturbance. In other words, the economy is the signal, and the other issues are just filler.

    You seem to want to argue whether corruption is, well, corruption. No argument here. But I have yet to see a single poll that says that’s why the race is breaking for Brown. Everything I’ve seen screams “money in my pocket.”

  34. AM

    Dan, what’s your take on the (in)effective Globe op-eds regarding Brown? Beyond endorsing Coakley, just about every columnist lashed the guy in the week leading up to the ballot, yet he’s doing very well (this written before the race was called). I read several of the columns, and there was great fact-based evidence against Brown, particularly those citing his performance in office, yet I noted people lining up to support him just the same. Any thoughts on other media that tipped the scales toward Brown? It’s too simplistic to pin Coakley’s slide on not being out shaking hands over Christmas week.

    • Dan Kennedy

      @AM: We opinion-mongers appeal to no one except those who already agree with us. I wish it were otherwise.

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