Rallyfication…

Let’s jump right on in, shall we?

Yesterday, President Obama came to town to pitch health care reform in St. Charles.

Opponents to reform staged their own rally to rally support for…um, well…to rally support for not doing anything to reform health care.

Basically, the St. Louis metropolitan area was awash in rallyfication.

This bitch caught some of the rally against rallying support for health care reform on the news and I was struck by a certain theme of state sovereignty.

See, Missouri has a 10th Amendment movement afoot that seeks to establish state sovereignty and one of the key issues supporters are using to make their push is health care reform.

Now, now…I know that you know that I know that you know that the 10th Amendment does not grant absolute sovereignty to states in the union. That would make the union part of the Republic a wee bit fucked. Rather, it grants states the right to control shit that the federal government does not control or regulate. Like most of the Constitution, it lacks specificity…that is a good thing, since we the people don’t want to be limited by the specific definitions of 1790’s American society. But ‘tis that lack of specificity that has some Missourians attempting to break from the union without breaking from the union because they profess to love the union they are declaring sovereignty from.

Trust me, you haven’t lived until you’ve witnessed a sovereignty event that puts forth an argument about how Missouri is our own sovereign government/state/area answerable to no one and no government…and that ends with everyone in attendance pledging allegiance to the United States of America.

Blink.

Yep, it’s really something to behold.

Oh, and these sovereignty folks love to issue non-binding resolutions.

Confession – a bitch finds issuing a resolution that holds no legal power to announce that Missouri doesn’t have to do anything the federal government mandates strange as hell if the foundation of the sovereignty argument is that the 10th Amendment grants Missouri the right to not do anything the federal government mandates.

But, what the hell…go forth and resolve without legal ramification to not do anything the federal government mandates.

It’s not as if Missouri state government has anything else to deal with.

Shit.

It’s enough to make a body long to establish sovereignty from other Missourians.

***logs off pondering the establishment of the Kingdom of Bitchitude in South City***

Crossposted from the Angry Black Bitch.

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Sad When They Don’t Quit in Time. Case in point: Senator Grassley

It is hard to let go, to release one’s grasp on power and privilege. Sometimes a top athlete holds on for additional seasons of declining performance; fans watch sadly–and with some embarrassment–for the player who did not leave with their game intact.

The same holds true for political leaders.

Senator Chuck GrassleySenator Chuck Grassley (R-IA) served the nation and his state well in a career of public service: as an Iowa state legislator (1958-1974), three terms in the House, and five terms in the Senate. As ranking minority member of the Senate’s Finance Committee, even now he holds a pivotal position in determining U.S. law.

His service and principled actions earned my respect. But, his unprincipled remarks have lost that respect.

This summer he told an Iowa senior citizen that if that man wanted health care equivalent to the health care Grassley enjoyed then he should “go work for the federal government.” Turns out Grassley is almost fully funded by the people who would like our health care system to stay just the way it is now.

Sorry, it gets worse:

Last week Grassley attacked the public option aspect of the health care bill, calling it “socialism.” Then he went on to defend his own participation in government farm subsidy programs. His words speak for themselves as he admits that as a congressman he has “lived off the public tit all these years.”

Full Text:

“For the first 16 years I made $3,000 every other year as a state legislator. Now do you expect me to live on $3,000 every other year? No I was a factory worker for 10 years and I was a farmer for that period of time and I farm with my son now. So if you’re trying to make a case that I’ve lived off the public tit all these years, I think you’re saying correctly in the years I’ve been in the Congress but not the years before I came to Congress.” (Watch it above.)

He should have quit while his career was untarnished. Please, Senator Grassley, it’s time to step down.

C-SPAN interview with Grassley

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Health Care: Congress Needs To Share The Benefits

Throughout the entire health care debate it has been incredibly ironic that Congress seems to be forgetting that all citizens are considered equal under the law in the United States and that certain perks that they reward themselves with in terms of enhanced health care options ought to be extended to all citizens. Either that, or Congress itself should dispense with the perks and find their health care in the public market place like the rest of us. From time to time the term elitism gets thrown around in the political discourse, well this is actually a real example of elitism out of control, and elitism beyond any moral standard.

Where in our Constitution does it say that we, the citizens, through our tax contributions will pay for enhanced medical care for our members of Congress, which they will embrace and utilize to the fullest extent, while concurrently with holding access to the same level of accessible health care to all other citizens? Is this what the founders of our country had in mind, an elite governing class that would by virtue of their government health plan receive access to health care that is denied to most Americans? Are we all, who are not in government, just commoners?

Dave Gilson of Mother Jones sums it up in the following item titled “The Real Public Option: Congress’ Private Medical Clinic”:

You can’t say this enough: While members of Congress are busy protecting us from the inefficiency and danger of government-run health care, they’re receiving top-notch taxpayer funded health care—seemingly without complaint. The LA Times recently detailed the benefits: A choice of 10 insurance plans and access to a wide network of doctors and HMOs. Plus, they “get special treatment at Washington’s federal medical facilities and, for a few hundred dollars a month, access to their own pharmacy and doctors, nurses and medical technicians standing by in an office conveniently located between the House and Senate chambers.” ABC News has more on that in-house clinic for lawmakers, officially known as the Office of the Attending Physician:

Services offered by the Office of the Attending Physician include physicals and routine examinations, on-site X-rays and lab work, physical therapy and referrals to medical specialists from military hospitals and private medical practices. According to congressional budget records, the office is staffed by at least four Navy doctors as well as at least a dozen medical and X-ray technicians, nurses and a pharmacist.

Sources said when specialists are needed, they are brought to the Capitol, often at no charge to members of Congress.

Explains a former doc from the Congressional clinic, patients who can’t get treated on-site get referals to top specialists all over the country. “You would go to the best care in the country. And, for the most part, nobody asked what your insurance was.” And the cost? $503. A year.

What we need to be doing is holding our Senators’ and Congresspersons’ feet to the fire on this issue. Our government owes the American people the same options for health care that are available to other industrialized democracies, and from a moral perspective, the same options for health care that they extend to themselves.

If you agree with this, pick up the phone and call your senators and representative, or email them. We need to keep the pressure up. We need to tell all Democratic congress people that this is what we wanted when we put a majority in office and they have a moral and honorable obligation to act at the will of the people who gave them their jobs. Tell them to stop prostituting themselves to the deep pocketed special interest groups, and to do the right and historic thing for their country.

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Segmented representation on health care reform

Legislators are generally beholden to a number of constituencies, including just plain  citizens.  But far too often loyalties lie with other segments of constituents, such as lobbyists, party and other special interests.  Thus my  interests go unrepresented unless I belong to a special interest group.  In the case of health care reform legislation, my Republican senators and Republican U.S. Representative ignore my needs.  The Democratic Party, my party is split into liberals and conservatives.  I often feel left out of the Blue Dogs’ stance.  I cannot afford a lobbyist.  But I do belong to some special interest groups:  Democracy for America, Organizing for America, Social Workers, and the AARP.  And I am a part of the liberal blogosphere community.

So who will represent me in this? All my special interest groups are doing a good job so far, but their power is limited.  For example, DFA’s Howard Dean has been unflagging in his optimism regarding the future of truly comprehensive health care reform that includes a public option.  But he is not in the inner circle of legislative power.  Thank goodness, however, he has been seen smiling and firmly pro-reform on several TV news shows recently including Rachel Maddow on the night of August 20.  Rachel’s tweet cited a recent poll supporting the public option that Dean referenced during his interview.

The group at the fulcrum of change right now numbers 6. The only committee with work left to do is the Senate Finance Committee.  What they are considering is some sort of nonprofit cooperative as the public option. The six “negotiators” plan to meet occasionally during the recess.  And these senators represent only a very small number of the American people.  Following are the 2008 estimated state population figures along with the percentage of the total U.S. population (source Wikipedia).  The senators include:

• Finance CommitteeChairman Max Baucus (D-Montana, Est. pop: 967,440 – .31%)
• Charles Grassley (R-Iowa, Est. pop: 3,002,555 -.98%)
• Mike Enzi (R-Wyo, Est. pop: 532,668 – .17%)
• Olympia Snowe (R-Maine, Est. pop: 1,316,456 – .43%
• Kent Conrad (D-N.Dakota, Est. pop: 641,481 – .21%)
• Jeff Bingaman (D-New Mex., Est. pop: 1,984,356 – .64%).

These figures  total only 8,444,956 people or 2.74% of the total estimated population of the entire United States and its territories.  By sheer force of numbers, not to mention politics, there is no way these six could be considered to be representative of all of us or our wishes.  First I do not live in any of these states and second,  nor does 97.26% of the rest of you.

The House of Representatives’ position right now is the closest match to my own views on what reform should look like. Here, courtesy of Michael J.W. Stickings’ tweet, is a Bloomberg story on what House Speaker Nancy Pelosi is planning when Congress comes back into session.  To quote: “U.S. House Speaker Nancy Pelosi said she won’t be able to pass health-care legislation in her chamber if the measure doesn’t include a government-run insurance plan to compete with private insurers.”

So now we wait for Congress to come back in session.  We wait for the next report of a disrupted town-hall meeting.  We wait for President Obama’s next speech to clear up misrepresentations put out by other special interest groups.  We wait for Labor Day.  And we wait to see what the Senate leadership will decide about legislative tactics that will get us health care reform without the Republicans participating.  How about a cool drink while we wait?

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For The Health Care Jitters

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Myth-busting: Immigrants and Health Care

As the health care debate rages across the US, it appears that some are trying to derail badly needed forward progress by using immigration scare tactics. Some scapegoat immigrants and argue that we should exclude even legal immigrants from our health system. Myths and misinformation abound. In the spirit of Detective Joe Friday who cautioned crime witnesses on the 1950’s TV show Dragnet with a terse: “Just the facts, Ma’am,” consider this data from the Immigration Policy Center.

Myth: The U.S. is spending “too much” on health care for immigrants.

• Insured immigrants had much lower medical expenses than insured U.S.-born citizens according to a July 2009 article in the American Journal of Public Health.  Insured immigrants’ per-person medical expenditures were 1/2 to 2/3 less than the U.S.-born with similar characteristics.
• Recent immigrants constituted 5% of the nonelderly adult population, but were responsible for only 2% of adults’ total health care costs, making their share disproportionately low.

Myth: The vast majority of people in America who don’t have health insurance are U.S. citizens.

• U.S. citizens are the majority of people who don’t have insurance (80%). Noncitizens make up a relatively small portion of the uninsured population.  Legal and undocumented immigrants account for 22% of the nonelderly uninsured.
• U.S. citizens account for most of the growth in the number of uninsured individuals between 2000 and 2006. Citizens represent about 80% of the growth; noncitizens accounted for approximately 20% of the growth.
• The UCLA Center for Health Policy Research found that in 2005 undocumented immigrants made up only a small share of California’s uninsured population.  Nearly four in five of California’s uninsured adults and children were citizens and legal immigrants.

Myth: Contrary to popular belief, noncitizens are significantly less likely to use emergency room services than U.S. citizens.

• According to the non-partisan Kaiser Commission, although noncitizens have poorer access to care and receive less primary health care than citizens, they are also less likely than citizens to use the emergency room.

In 2006, 20% of U.S.-citizen adults and 22% of U.S.-citizen children had visited the emergency room within the past year.  In contrast, only 13% of noncitizen adults and 12% of noncitizen children had used emergency room care.  Don’t believe the myths.  Immigrants use less health care, including less emergency room care, than U.S. citizens.

• A 2006 study published in Health Affairs found that communities with high rates of emergency room usage tend to have relatively small noncitizen populations.  Cities with large immigrant populations such as Miami-Dade County, Florida and Phoenix, Arizona have much lower rates of emergency room use than areas with small immigrant populations such as Cleveland.

For more information on immigrants and health care, see:

• IPC Fact Sheet: Sharing the Costs, Sharing the Benefits: Inclusion is the Best Medicine
• IPC Blog Post: Including Immigrants in Health Care Reform Makes Economic Sense
• Allvoices Post: It’s $mart to Include Immigrants in Health Care Reform

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The President’s bully pulpit could be powerful; why not use it more?

It looks as if President Obama is reluctantly getting more out in front of the health care debate. Many have been urging a more active role in recent weeks as the congressional recess dramas play out on the 24-hour cable channels. The task has been to clear confusion, allay fears and dispel misinformation. And there is nothing like the written word to do that. (Image: Wordle.net)

So President Obama wrote an op-ed piece in the New York Times Saturday telling the nation “Why We Need Health Care Reform.” Retaining the most frequently made points from his speeches and town hall gatherings, the President laid out his main arguments in what sounded like his own “voice.” He used familiar phrases and stories about people he has told before, Steve Benen notes in his excellent analysis describing what will be the strongest elements of the new op-ed. (Hat Tip to Memeorandum and Mark Knoller’s tweets for this information).

Reinforcing the apparent let-Congress-lead stance of the administration, Secretary of HHS, Kathleen Sebelius, according to Reuters, has revealed what we always suspected, that the government-run health insurance option is not an essential to health care reform. She added that the non-profit member-controlled cooperatives being considered by a Senate Committee could also fulfill the goal of creating robust competition for private health insurers, probably to the utter dismay of liberals.  But, the White House is now insisting that nothing has change, according to reporters riding on Air Force One back from the President’s vacation..

Sticking to enunciated principles, rather than sending up an administration bill to Congress, has made President Obama’s leadership open to question by the chattering class. But he seems determined to stick with the legislative process and, typical of his leadership style, is looking to a less immediate time frame for his strategy to succeed. He seems truly confident that something useful that he can sign will pass. He is using his bully pulpit to give credit for small successes to others, to remind the big stake holders of the obligations of their agreements, and to teach the public what they must learn about complex issues.

As if to emphasize the health care reform issue as front and center, an LA sports arena hosted a health clinic of last resort for thousands seeking free health care. The clinic housed in an old sports arena will continue through Tuesday. The clinic, Reuters reports, is run by the nonprofit Remote Area Medical Volunteer Corps as part of its mission to provide free health, dental and eye care in needy spots around the world.” RAM is best known for its work in Third World countries. People have waited in line for days to attend.

The President’s bully pulpit will be used as necessary to do what Mr. Obama sees as his unique role in the political process. He is well advised by his people and he won the presidency by being good at politics. I remain optimistic about what will happen, even if it is less than the 1000% we assumed it had to be.

Bonus Reference: TPM Photo Gallery carried “Behind the Scenes: Summer 2009 at the White House.”

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America’s Biggest Threat: Succumbing To The Lies

How American Public Discourse Is Manipulated Through Fear & Ignorance

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The current debate about national health care is the most recent example of how savvy special interest groups will leverage base human emotions to sway public opinion, as opposed to engaging in honest, rational discussion. This tactic is as old as human life on this planet, hearkening back to parents warning children of the Bogeyman hiding under the bed.

That the tactic continues to be used in the twentyfirst century is indicative of how malleable of a consuming public has been “bred” in this time of constant bombardment via media channels. Rather than promoting the virtues of education, intellectual challenge or human achievement in any realm other than celebrity or conspicuous consumption, contemporary Americans are being trained, or better yet, tamed to respond to shallow images delivered via multimedia, as much as Pavlov once conditioned dogs to respond to short stimuli.

In the 400 odd years since Europeans first began to colonize the North American continent, we have gone from an era where the only media were drawings and printed texts to an era of almost instantaneous electronic distribution, short intellectual shelf life, and almost instantaneous oblivion (making room for the next immediate blast of thrown together “data”) . Where an idea or an opinion took time to be generated and passed from person to person. Where newspapers or handbills had to be printed and then distributed, from hand to hand, in which there was time for recipients to truly contemplate the information before receiving other or contrary information. In which citizens would gather round the pot bellied stove, or on the front porch, or in townhalls where the participatants were truly townspeople, who knew and lived with each other from day to day and could engage in healthy, honest, respectful discourse. We have “progressed” to an era in which the entire process has been sped up, shaped by deep pocketed special interests, truncated, and fed as pablum to a public that is short on attention span but eager for continuous, instantaneous self-gratification. We have bred a species that not only wants to live on “Easy Street”, it doesn’t want to have to do any work to get there, be it labor or intellectual exercise.

So when issues of significance, that can impact all or much of the American constituency do come up, many of those potentially impacted have not been paying enough attention before the issues became too critical to ignore, and are still too lazy, when the issues have come to a head, to do a little extra homework to actually understand all aspects of a given issue, to be aware of real, honest facts and rational arguments, pro or con for the given issue. It’s much easier to tune in one of the many bloviators on television or radio, or read or view any one of literally millions of “facts” and opinions flying around as articles, blog postings, videos, etc. on an Internet where cost and time to distribution is almost non-existent.

Couple the relative ease of distributing any information, idea, or propaganda, whether truthful and factual or not with a constituency that feels marginalized, whether right wing Christian fundamentalists, out-of-work blue collar laborers, or war casualty veterans, and base the premise of the message on that which the constituents fear, regardless if there is any logical connection between that fear and the actual issue, and an adept propaganda operative can make his target audience believe any lie.

This is why it is important for all of us, no matter which side of an argument we are on, to be skeptical of things we hear, to do our own homework, to take some time to educate ourselves about the major issues facing us so that we do not succumb to ignorance or out and out lies such as:

“Death Panels”, debunked here and here and here.

The editorial board of Investors Business Daily in asserting, incorrectly, in their opposition to the health care proposal that:

People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

Apparently IBD doesn’t believe in homework or fact checking, Stephen Hawking is British, the National Health Service is exactly what has sustained his life.

The falacy that the Public Option health insurance plan would be worse for the American public than no affordable private insurance is debunked by the fact that the United States Congress already has their own “government health insurance plan” , it is called the Federal Employees Health Benefits Program. It seems to work just fine.

The lie that the health care bill being considered by Congress would make private health insurance illegal is debunked here. As are the lies about free health care for illiegal immigrants, public money being used to fund abortions or that the government will have direct, real time access to our bank accounts.

Whether the debate is on health care, or war in Iraq. We would all be prudent to consider who the real instigators for or against an issue are and what their motives might be. In the realm of health care, it is apparent that the private insurance industry, (the health care financiers), the AMA and the health care industrial complex (hospitals, diagnostic labs, medical device manufacturers, pharmaceutical manufacturers, etc.) and their powerful lobbies are the forces behind the push on Congress and on the American people to suppress any new health care policy. They simply don’t want to disturb the goose that lays their golden eggs.

I am not advocating for or against the current health care initiative before Congress, I am only suggesting that we all need to take our time, and perform our own Due Diligence, and then express our opinions to our government representatives. We do need to extend health care to most if not all of our population, and the present, private model does not extend that care nor does it even assure that the care being given is the best available.

Mark Fiore best sums up the current national fear and ignorance “debate” on health care:

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Are Tea Party Protesters Racist?

(Image from Dr. David McKalip, Florida Tea Party and Town Hall Protest organizer, founder of “Doctors For Patient Freedom” and “Cut Taxes Now,” and speaker at several GOP “virtual town halls,” sent last week to the Google Tea Party listserv marked “Funny stuff:”)

One of the debates I have been hearing in the background as the Tea Party folks disrupt the town hall meetings about health care is the opinion that the dissent is racist. Hearing it being compared to Goebbels suppression of political discussion in 1930’s Germany are surfacing. People are saying the right wing wouldn’t be so up in arms about policy if our president had a pure Euro-American white heritige. Folks are calling the “teabaggers” (I prefer to call them teabaggee’s) racist. It may be partly true.

What I am going to tell here is filled with an offensive racist term so if you are too sensitive please quit reading and hold your comments as I am just quoting others.

While this is by no means an attempt to lump all of the groups together or label any individuals, I saw first hand Saturday who and what is running the “Tea Party” yellathons in southeastern New Mexico today.
While in KFC enjoying my weekly grease fix 8 people came in and pushed a table next to the booth that joined to the booth I was sitting at. Two of the men went to the counter to order while the rest of the group spread out papers and folders around the two tables. One of the guys looked familiar to me and I tentatively ID’d him as B. W.,an organizer of the Roswell Tea Party folks/rally’s.
Conversation was lively as their plans for the upcoming Alamogordo and Las Cruces Town Hall meetings was getting them all riled up.
The chicken came to the table (only one of the 8 was having grilled..the rest fried. I will get to the point of this menu observation soon) While they all dug in conversation at their table waned. We were 9 of the 18 white and Latino customers in the place (14 white 4 hispanic I counted a minute later. I will also address why this is important as my story goes along).
The roar of a Road King and the humming of a V Star soon came through the windows as two riders stopped for lunch. As the riders dismounted and removed their helmets one of the folks at the adjoining table loudly announced they were black. The one that looked and acted like B. W. said…and I quote, “Figures, niggers coming to get fried chicken.”. (seems there were already 18 non “niggers” in the place when the 2 men came)
Others chimed in with one woman even cat calling to the girl working at the counter, “I didn’t know you started serving watermelon.”.
The term “nigger” was used by these folks even as the men came in and placed their order. I assumed their racist talk would bring wrath from the men but instead they ignored it, eating their small meals of grilled chicken breasts (not fried as the racist right wing fanatics had predicted…and were eating themselves) green beans and potatoes. The talk at the organizing table slowly turned back to planning the shoutdowns and I continued reading my newspaper.
As the riders got up and started to put their protective jackets back on the big guy who rode the Yamaha stepped over to their table.
“Uh-Oh”, I thought.
The huge man loomed over the suddenly nervous group of white Republicans and said, “God bless all of you”. and walked out to his ride.

After the bikers left there was a much more subdued return to their plans for the meetings.

Thats who are organizing here. Probably in many other locations in the country as well.
No wonder I can’t attempt to see things their way.

cross posted at http://alientrucker.com/

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If You Get Confused…Wait! Everyone Else Is

For the working folks who can’t afford health insurance like my friend Hank who barely supports his family of 4 (two daughters 13 and 3 y/o and his lovely, patient wife) on less than $1600 take home a month. His health insurance was just cancelled because of a thyroid problem and now even his family can’t see a doctor.

Medicare is government run heakth care and it covers pre existing conditions.

What is everyone afraid of?

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The future of health care reform —

Who knows what will happen to the biggest item on the Obama agenda for change, health care? No one can tell for certain but a few are willing to hazard guesses. This is the last week Congress will be in session before the summer recess. CQ Quarterly predicts that the Senate Finance Committee will not report out a health care reform package Due to the inability to reach a bipartisan agreement, as well as the press of much other business, work will resume in September. Prediction: A decent bill will be ready for the President to sign before the end of the year. And President Obama will weigh in with his final requirements only late in the game.

Republicans remain uncooperative — Taegan Goddard points out that we are still waiting for the Republicans’ Health Care Plan. It is a safe bet, in my opinion, that there will be none forthcoming. Prediction: What will be forthcoming from Republicans is fear mongering about raising your taxes, plus everything else they can think of to “throw against the wall.”

Progressive Dems vs. Blue Dogs is a continual pull and tug between special interests and voter constituents. Prediction: Progressives will not get a pure public option, but a public plan that is nonprofit “co-op” based. The following piece illustrates that the key swing Blue Dog Democrats could play the largest role in how reform legislation emerges from Congress. To quote Politico.com:

President Barack Obama’s signature proposal, a public plan option to introduce more competition in private markets, would be significantly weakened, reflecting pressure from Blue Cross-Blue Shield plans that dominate many rural states and that were a source of millions of dollars in campaign contributions last year. The small-business lobby, itself a political powerhouse, carved out a larger exemption for operations earning up to $500,000 annually. At the same time, families are asked to dig deeper to afford the promised coverage to be bought through public exchanges.

House Democrats have proposed a sliding scale of subsidies so that new health insurance mandates don’t impose a disproportionate — and ultimately unaffordable — burden on working- and middle-class families. Without that feature, Democrats would risk a serious backlash if costs become too great and households rebel against the health care mandate. And the House maneuvering is important as a preview of the larger battle ahead in the Senate, where the Finance Committee is proposing far less generous subsidies.

The other chamber’s conservative Democrats, such as Senator Max Baucus (D-Mont.), are being heavily lobbied via huge donations from health insurance companies and stand to cast votes this year that will reelect them to the Senate in 2010. Progressive Democrats are already using targeted ads to try to force the adoption of a public option by wavering Democrats from conservative districts. To be sure the debate will get noisier as Congress heads home to hear what the folks in their districts have to say. Prediction: The major ad campaign, featuring things of which you should be afraid will encourage timid constituents to seriously pressure lawmakers to either stop entirely or compromise severely.

Senators will speak from experience — Senator Chris Dodd, who spearheaded the H.E.L.P. Committee’s health care reform bill has been diagnosed with prostate cancer. He sat in for Senator Ted Kennedy, himself ill with brain cancer. Lobbyists have paid tribute to Senator Kennedy’s heroic fight by donating generously to causes that he supports. Prediction: Using their own health care challenges as either spoken or unspoken backdrops to their reform leadership, several key senators, including Senator Specter, will be articulate and passionate spokesmen for significant reform.

Reference: CQ Politics launched the CQ Election Map for 2010 House races.

My all-in-one Home Page of websites where I post regularly: Carol Gee – Online Universe

Technorati tags: news news and politics politics health care congress

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Republicans make their choices , for better and worse.

This kind of behavior makes me angry – Reported by Jonathan Allen of CQ Politics, last Thursday in Congress the clerk of the House was forced to read much of a 54 page motion aloud to an almost empty chamber while House Republican members attended a “beach party” hosted by Minority Leader John Boehner (R-Ohio). Self-centered and petulant, Republicans like this refuse to deal with the realities of their loss of elections.

This kind of behavior makes me proud of Republicans – Every now and then Republicans come to their senses and refuse to go along with the plan of block everything at any cost. Some good examples follow.

• In a fine story by Manu Raju at Politico.com (7/24/09), Republican Senator Lindsey Graham announced that he would be supporting Sonia Sotomayor’s nomination to the Supreme Court. He promptly took an enormous amount of heat for his stance. Republican pundits called him “unreliable, lacking courage and understanding.” Graham responded, “Enjoy life in the minority,” according to the author. To quote Senator Graham,
  

  . . . the South Carolina Republican defended his decision to back Sotomayor by laying out a broad critique of conservative activists who push “ideological purity” and refuse to cooperate with a Democratic Congress and White House.
  “If we chase this attitude … that you have to say ‘no’ to every Democratic proposal, you can’t help the president ever, you can’t ever reach across the aisle, then I don’t want to be part of the movement because it’s a dead-end movement,” Graham said.

  “I have no desire to be up here in an irrelevant status. I’m smart enough to know that this country doesn’t have a problem with conservatives. It has a problem with blind ideology. And those who are ideological-driven to a fault are never going to be able to take this party back into relevancy.”

• Raj wrote an interesting piece the previous day citing subtle criticism by several Republican Senators of their colleague, Senator Jim DeMint’s threat that “if Republicans are able to stop Barack Obama on health care, ‘it will be his Waterloo, it will be his Waterloo, it will break him.” Though certainly not cooperating with Democrats toward a common goal, Senators Lamar Alexander, Mitch McConnell and John Cornyn avoided the harshness of DeMint’s childish vengefulness with their comments:
  

  Alexander and McConnell: Asked Wednesday if he saw things the same way, Sen. Lamar Alexander (R-Tenn.) said: “Of course not.”

  “Every senator is entitled to his own view, but that’s not the view of our caucus,” said Alexander, who, as the Senate Republican Conference chairman, is the Senate GOP’s message man. “I prefer what Sen. [Mitch] McConnell said. This is not about winning or losing; this is about getting health care right. That’s certainly my view.”

  Cornyn: “It’s a distraction,” said Sen. John Cornyn (R-Texas), who, as head of the National Republican Senatorial Committee, is gauging the politics of the debate. “If they’d rather get into a food fight, rather than actually solve problems, I guess [DeMint’s comment] gives them an excuse to do that.”

This kind of behavior is smart – Democratic strategists, with a good deal of political acumen, are using Senator DeMint’s comment as a reallying cry for more support for health care reform. What we are beginning to see is that health care reform will not pass without at least some bipartisan support. We had all better hope that more statesmanship happens, rather than the behavior characterizing too many of the current Republican choices — ones made because of fear and anxiety.

Behind the Links

From the troubled –

“Upstate NY newspaper traces racist web posts to DHS computers*” is from Think Progress (7/25/09). Betmo’s words follow:

“people will truly understand that america is over. you are only as good as your citizens and our citizens continually suck. dhs employees are american citizens and if they were told to write the comments it’s bad. if they did it on their own- it’s even worse. it means that power went to their heads.”

“Sanford family back on vacation#,” is from Yahoo! News (7/23/09). Jon observes, “This guy takes more vacation days than shrub did!”

“It’s Not Sarah’s Fault…Just Ask Her#,” is from Yahoo! News (7/21/09).

From the Congress –

“Bachmann, Other GOP ‘Mother Bears’ Decry Health Care Reform, Long Fast-Food Lines#,” is from The Huffington Post (7/24/09).

“Anti-gay, pro-abstinence legislator had affair with intern#,” is from The Raw Story (7/24/09). Jon observes, “Another one bites the dust.”

“Drug Firms Pour $40 Million Into Health Care Debate#,” is from NPR (7/23/09).

Hat Tip Key: Regular contributors of links to leads are Betmo*, Diane~ and Jon#.

Blogs: My news and political blog is at South by Southwest. My general purpose/southwest focus blog is at Southwest Progressive. And Carol Gee – Online Universe is the all-in-one home page for my websites.

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Health Care Reform: More Than Insurance

It seems, from what I have read, heard and seen in the media, that the health care reform initiative that President Obama would like to see implemented boils down to whether or not the government expands its role in providing health care insurance benefits to the entire populace, as opposed to just those who are currently eligible for Medicare, as an alternative to for profit (non-government) insurance providers, which are selective in those consumers they will insure. The two major goals of the Obama initiative are to make health insurance available to the entire populace (the so called public option), not just that segment subsidized by deep pocketed employers, and to, theoretically drive down the costs associated with health care services using the leverage of a government managed and government scaled reimbursement system.

That the public option is an important moral imperative for our country should be a given, everyone should have access to adequate health care, no matter where they fall on the economic spectrum. However, no one should be so naive as to believe that universal access to health insurance will cure all of the ills of our health care system. Access to health insurance is no guarantee of quality health care or cost effective health care.

Atul Gawande, a surgeon and staff writer for the New Yorker, has a piece in the recurring series ANNALS OF MEDICINE, titled “THE COST CONUNDRUM“, which anyone with an interest in acquiring a complete picture of how health care is delivered, and abused, in the United States must read. In trying to get a grasp on the causes of the explosion in health care costs in the United States, Gawande traveled to McAllen, in Hidalgo County in Texas. Hidalgo County has the lowest household income in the country, just $12,000 per capita, the other record that McAllen holds, is that it is the second most expensive city, behind Miami, in the United States for the delivery of health care services. Gawande took his time and was quite thorough in his quest to learn about what makes the health care economy in the McAllen area tick, interviewing business people, average citizens, doctors, hospital administrators and other health services providers and touring medical facilities.

The article goes in to quite a bit of detail covering the gamut of what Gawande found, with the unavoidable conclusion, that the delivery of health care services in McAllen is dominated by an economic agenda, focused on over use of the available technology which has dumb’d down the diagnostic processes used by doctors while increasing revenue for the providers, rather than a public health agenda, that would be focused on providing the most effective health care in terms of cost and outcome, to the patients. In one passage in Gawande’s article he describes sitting around a dinner table with other physicians who practice in McAllen, and some of the conversation that resulted:

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill. And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

“Oh, she’s definitely getting a cath,” the internist said, laughing grimly.

Gawande did not just talk to doctors, he also spent a lot of time interviewing hospital administrators, and gained admissions such as the following:

“In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” he said. But in McAllen, the administrator thought, that percentage would be a lot less.

He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said. They were innovative and aggressive in finding ways to increase revenues from patient care. “There’s no lack of work ethic,” he said. But he had often seen financial considerations drive the decisions doctors made for patients—the tests they ordered, the doctors and hospitals they recommended—and it bothered him. Several doctors who were unhappy about the direction medicine had taken in McAllen told me the same thing. “It’s a machine, my friend,” one surgeon explained.

At the very extreme end of the medical practice spectrum, Gawande learned:

Then there are the physicians who see their practice primarily as a revenue stream. They instruct their secretary to have patients who call with follow-up questions schedule an appointment, because insurers don’t pay for phone calls, only office visits. They consider providing Botox injections for cash. They take a Doppler ultrasound course, buy a machine, and start doing their patients’ scans themselves, so that the insurance payments go to them rather than to the hospital. They figure out ways to increase their high-margin work and decrease their low-margin work. This is a business, after all.

In every community, you’ll find a mixture of these views among physicians, but one or another tends to predominate. McAllen seems simply to be the community at one extreme.

In a few cases, the hospital executive told me, he’d seen the behavior cross over into what seemed like outright fraud. “I’ve had doctors here come up to me and say, ‘You want me to admit patients to your hospital, you’re going to have to pay me.’ ”

“How much?” I asked.

“The amounts—all of them were over a hundred thousand dollars per year,” he said. The doctors were specific. The most he was asked for was five hundred thousand dollars per year.

He didn’t pay any of them, he said: “I mean, I gotta sleep at night.” And he emphasized that these were just a handful of doctors. But he had never been asked for a kickback before coming to McAllen.

When Gawande left McAllen and returned home, his conclusion was that:

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

The health care delivery climate in McAllen, is all too familiar to myself, and is likely becoming more of the norm throughout the country. I reside in Southern California, in 2006 I had my first major hospitalization and spent 10 days as a patient in a major hospital in Los Angeles County. During that time I was subject to a wide range of diagnostic tests including multiple X-rays, ultra sounds, CAT scans, EKG’s, blood tests six times a day, analysis of urine and stools, etc., very few of which found anything but the pneumonia that I was admitted for. In a hospital of this size they have a full staff around the clock, and they would utilize all of that staff time, day or night, to administer their diagnostic testing and monitoring. There is an axiom, that if you want to get some sleep, a hospital is the last place you want to be, and I can attest to the validity of that.

Upon reflection. it seems to me that a lot of the testing that was performed on me was overkill, but while it is occurring, when you are not well, running fevers, when you are drugged up, you are on oxygen and receiving inhalation therapy every few hours, when lab technicians have poked the veins in your arms and hands so much that they are just a mass of black and blue, from shoulders to finger tips, you just sort of “go along with the program”, you are not capable of removing yourself as an impartial party, away from the fray, observing and making value judgments, you just turn yourself over to the professional care givers.

So they did cure me of the pneumonia, but I ended up with a really nasty infection in my digestive tract (due to the hospital doctors’ choice of drug therapy for the pneumonia) that stayed with me for the next eight months. And my insurance carrier received a bill from the hospital for $100,000 for their services. The insurance company negotiated a settlement with the hospital for about $30,000, which might shed some light on how much of my treatment in the hospital was diagnostic overkill as opposed to being curative. And I still incurred eight months of the joys of multiple daily occurrences of explosive diarrhea and the costs to deal with it, outside of the initial hospital bill.

In comparison and contrast to what Gawande found in McAllen, and my own personal experience, Gawande also discussed his experiences with the Mayo Clinic:

I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

“I’ll be there,” the cardiologist said.

Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay.

The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients.

Gawande makes the point that the Mayo Clinic (originally in Minnesota, but which now has a footprint in Florida), and also others who embrace similar values in how they deliver health care services are not the unique exceptions that some would think:

The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

The message that we all should take away from Gawande’s observations is that the segment of our population that represents our health care infrastructure is no different than the rest of us, some are driven by altruism and a need to heal, comfort and care for their fellow man, some are excited by the science and their ability to devise ways to attack that which afflicts human life, some may be to some extent disillusioned and feeling trapped in to working only to repay the high cost of their medical education and the cost to maintain their families comfort; and some may be giving in to human greed, unable to resist an opportunity to make a quick buck. That to varying degrees, the medical profession has lost sight of its fundamentals.

It seems to me that the current emphasis of President Obama’s health care initiative is too simplistic. While providing access to health insurance to all Americans is of course a “must have”, we cannot ignore how we fundamentally deliver health care in this country. We cannot allow the practice of medicine to morph from patient education, prevention and healing in to the application of technology, at the cost of losing the doctor patient human connection.

The Obama health care initiative would better serve the people if it included mandates for the provision of health care modeled after the Mayo Clinic. With reimbursement rules that rewarded ethical, effective medical practice and which penalized medical practice based upon volume and revenue generation. One way to provide incentive would be for the government to fund medical education, to create a system where those considering entering the medical profession not have to be held back because of the high cost of a medical education. In return, newly trained doctors would be required to join medical practice groups that replicate the Mayo Clinic model, and remain there for a set minimum number of years.

Medical practice groups that emulate the Mayo Clinic model, that can demonstrate that they provide medical care superior to the norm, at costs that are less than the norm, could be incented with tax rebates. Medical practices that rely upon diagnostic testing as their primary revenue source should be taxed at a higher rate. Medical practices that deliver cosmetic services, should assessed sales taxes.

The Obama administration, through its health care initiative, should go the extra mile, not just working to assure all Americans of health insurance, but to actually contain costs and to require the delivery of quality, effective health care that focuses on the well being of the patients, not the revenue streams of medical service providers.

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Health Care Overhaul — Get on Board the Train

Different legislative tracks intersect at several points – cost, control, consumer needs, care-giver interests and collegiality. Republicans are almost universally skeptical. Democrats are very divided about health care reform between liberals and moderates. How fast the legislation can move through Congress depends on how fast the committees can complete their work. President Obama wants a vote in the Senate by August. The President now active in the debate using the town hall as his forum. So far the American Medical Association is opposed to a public option. And it is fairly apparent that a single payer plan is out of the question.

“The health care industry has a huge stake in reform” opines J.P. Green of the Democratic Strategist: “They will fight the public option, but they know that some form of expanded government health coverage is inevitable.” To quote Politico’s Carrie Budoff Brown, “The public insurance option remains the single biggest obstacle to a bipartisan bill, snarling the parties – and wings within each party – in a debate over the power of government, the role of the free market and the need to cover the uninsured.”

A big part of the division in the Senate is associated with the so-called “public plan.” Senators in the cross-hairs of several active advocacy groups include Ben Nelson of Nebraska, Mary Landrieu of Louisiana, and Kent Conrad of North Dakota. Other moderates with whom groups must contend are Evan Bayh of Indiana, John Tester of Montana, Tom Carper of Delaware, along with Blanche Lincoln and Mark Pryor of Arkansas.

Floor strategies in the Senate are not yet settled. The reconciliation process, needing just 51 votes is still on the table. Two senators, Kennedy and Byrd, are absent due to illness, and the Minnesota seat is still empty. Senator Chris Dodd is acting in a leadership role for Senator Ted Kennedy’s Health, Education, Labor and Pensions Committee, which has, quoting Politico:

. . . released a 615-page bill, but details on the most contentious issues, such as the public insurance option and the employer mandate, were left out for now . . . The bill calls for insurance market reforms, a prohibition on insurers’ denying coverage to sick people, a mandate on individuals to own coverage and the creation of marketplaces where people can compare and buy coverage.

In the U.S. House of Representatives – According to Patrick O’Connor and Chris Frates of Politico, House Speaker Nancy Pelosi and Majority Leader Steny Hoyer’s top aides have prepared a joint memo indicating the unity of their leadership positions. To quote:

House Speaker Nancy Pelosi and Majority Leader Steny Hoyer are double-teaming powerful chairmen and rank-and-file members to save health care reform from a repeat of the Democratic Party infighting that helped kill it in 1994.

. . . Pelosi and Hoyer urged Education and Labor Committee Chairman George Miller (D-Calif.), Ways and Means Committee Chairman Charles Rangel (D-N.Y.) and Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) to heed the concerns of moderate Democrats.

. . . Waxman, Miller and Rangel — along with their respective aides — are trying to draft legislation in concert with each other so their committees will take up the same bill later this summer.

In the House, moderates include Blue Dog Democrats, constraining any public health plan option, and members of the New Democratic Coalition. Again, the public option provides a variety of sticking points for them including cost, Medicare rules. Rep. John Dingell of Michigan is a respected leader who has “offered a universal health care bill every year since he came ot Congress in 1955,” the authors reported. To quote:

Toward the end of Tuesday’s caucus meeting, he rose on his crutches and told the audience that this measure has the promise of becoming a legacy like Social Security — a program his father helped create in the 1930s.

As he closed, he told members they should have the courage to move forward, eliciting a standing ovation from his fellow Democrats. Pelosi announced Tuesday that the bill will bear Dingell’s name.

. . . House Democrats expect to introduce actual legislation next week, Waxman and others said Tuesday. The preliminary goal is to move legislation out of the committees by the Fourth of July and then clear the House by the August recess, setting up a fall showdown with the Senate over a final bill.

Health Care Reform will happen this year, in my opinion. The train has already left the station. In fact change is already happening. The Children’s Health Insurance Program (CHIP) is now the law of the land. Health Information Technology reform is being funded by the President’s Stimulus monies. And the President will soon sign the bill to mandate tobacco regulation by the FDA. If all of us work hard, a new era can emerge. But it could also easily get derailed. It is going to be an interesting ride.

References:

• “Can Health Overhaul Heal the Economy,” by Alex Wayne of Congressional Quarterly (6/3/09).
• “Axelrod Fuels Democratic Message Machine for Health Care Overhaul,” by Drew Armstrong of Congressional Quarterly (5/13/09).

[Original Post date - June 12, 2009]

See also Behind the Links, for further info on this subject.

Blogs: My general purpose/southwest focus blog is at Southwest Progressive. My creative website is at Making Good Mondays. And Carol Gee – Online Universe is the all-in-one home page for all my websites.

Technorati tags: news news and politics politics health care reform obama congress U.S. Senate U.S. House

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universal healthcare

people- this is the 21st century. there is no excuse for people dying because they don’t have insurance- the only reason we have such a system is greed, greed, greed. we do not have the greatest healthcare system in the world- far from it. we are near the bottom. there is absolutely no reason that america should not provide every man, woman and child in this country with basic healthcare. no reason. all of us have experienced the drug pushing, misdiagnoses, arrogance, indifference, etc. of doctors and other healthcare providers. we have lived through the drug recalls- although some have died and there is no excuse other than greed. this should not be. our country would do better to understand that socialism is not a dirty word and that a proper blend of capitalism and socialism would insure our ability to live to ‘pursue happiness’ that is our human right according to thomas jefferson. there are millions of stories and i am going to share one i got from my buddy happy in nevada:

kwikkick’s diary

update on kwikkick

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