Entries from July 2009

The Dog Ate the Dems Homework

July 31st, 2009 at 5:11 pm 6 Comments

At 9:55 am (EST) on September 11th, medical just after the second World Trade Center was struck, discount Jo Moore, former British press officer sent an email to her colleagues which read “It’s now a very good day to get out anything we want to bury. Councillors’ expenses?.”  It is in her honor that I identify one story every Friday afternoon that our wonderful government tried (and failed) to bury.

The story Washington’s P.R. people will be working hardest to bury or bring to light (depending on which side of the aisle they are on) concerns what won’t be done at the end of this last day heading into the Congressional recess.  President Obama made it very clear from day one that he had three major legislative priorities, all of which he publicly pushed lawmakers to complete prior to Congress’ August recess.  He wanted to pass an effective stimulus bill, he wanted to pass cap-and-trade legislation, and he wanted to pass comprehensive healthcare reform.

The Democratic dominated Congress failed the President.  The House and Senate did manage to come together and pass the $787 billion dollar omnibus stimulus package, however the effects of the little stimulus money that has been spent thus far have been minimal and the president has already begun hearing calls from within his own party for a “second” (it would really be a third stimulus package… but whose counting anyway?) stimulus.  But let’s generously call the stimulus a “victory” for President Obama.  The economy is showing signs of life (although unemployment remains high… and will continue to grow even as the economy emerges from its slumber since unemployment is a lagging indicator).  The economy didn’t collapse and without the stimulus it may well have. So we will say that this makes Obama one for one on major promises.

His second priority was comprehensive cap-and-trade legislation to curb carbon output.  Congress hardly provided the president with what he was looking for. The House bill, Waxman-Markey, is an incredibly diluted bill.  For example, the president was insistent that carbon credits be auctioned off, yet the House bill gives them away for free.  The bill barely got past the House (219-212) despite the Democrats considerable numbers advantage.  The Senate not only will not vote on the bill before recess, but many experts wonder whether the bill can get past the Senate at all.  So Obama is now one for two.

Finally, the Obama Administration talked and talked and talked about comprehensive healthcare reform and how it “could not wait.”  Obama continuously insisted that Congress pass healthcare reform before the August hiatus, however it was not to be.  The House has a proposal ready, however not only are Republican members of the House unhappy, the powerful coalition of Blue Dog Democrats, without whom the bill cannot pass without any Republican votes, have essentially said that unless amended, they won’t vote for the bill.  Nancy Pelosi and Rahm Emanuel wanted a vote before this afternoon, but they will not get it.

The Senate, the more deliberative and bipartisan (and intelligent) of the two chambers of Congress, has also moved slowly.  Two healthcare bills are eventually expected to emerge from committee, one primarily authored by Senator Ted Kennedy, and the other (and more important of the two) by Senator Max Baucus. Baucus has refused to move forward without bipartisan support, and more work will be needed after the recess before anything is ready.  In other words, no health bill before the August deadline and now the media and Republicans have an entire month to take shots at Democratic plans.  Thus healthcare is also, at least so far, a loss for the president.  One for three.

With the stimulus bill being second guessed, the cap-and-trade bill facing defeat, and healthcare reform in limbo, the president has found out the hard way that the legislative process does not lend itself to campaign promises.  The president may yet emerge victorious on healthcare and time may vindicate him on the stimulus bill (he will almost certainly lose the battle in the Senate on cap-and-trade) but at least for the next month, Democratic lawmakers and the Obama administration will be desperately trying to change the narrative to focus on anything but those deadlines that they failed to meet.

A Terrorist on the Faculty?

July 31st, 2009 at 4:29 pm Comments Off

The Middle East dispute may seem interminable, find but its shadow conflict – the one being waged on university campuses – appears every bit as complex and insoluble.

The latest round in Canada involves Hassan Diab, sovaldi sale an Ottawa-based lecturer who for a number of years has had a part time appointment teaching Introduction to Sociology at Carleton University’s summer program. French authorities have asked for his extradition from Canada, accusing him of being the Popular Front for the Liberation of Palestine terrorist that blew up a Paris synagogue in 1980. Four people died in the bombing on Rue Copernic, and the incident signaled a wave of attacks against Jewish targets that brought the ongoing Israeli-Arab fight home to European Jews in a startlingly new way.

In November 2007, French authorities, acting on information supplied by German intelligence and gleaned from the files of the old East German Stasi, put out a warrant for the arrest of a Lebanese-born PFLP operative named Hassan Diab. In October 2008, the fugitive was identified as the Ottawa academic and he has been fighting against extradition in the Canadian courts ever since.

Dr. Diab’s defense is, quite simply, that Hassan Diab is a common Lebanese name and that they’ve got the wrong man. French police have supplied some dated witness statements and, possibly some supporting forensic evidence, but as of now it is not clear how the case will come out. The fact that the primary information comes from East German secret police files – not a favored source for most western courts – lends an element of uncertainty to the entire legal proceeding.

Meanwhile, Carleton University announced that Diab would be teaching Soc. 101 this summer. He has offered the course before, the university argues, and there has never been an incident or complaint. The hiring of Diab for the summer course, in turn, prompted a predictable outcry from B’nai Brith Canada, who accused the university administration of poisoning young minds with the teachings of a terrorist. The university then relented, replacing Diab with a full time faculty member.

What a university should do with an accused terrorist on its staff is not an easy question.

Diab’s defenders, of course, point out that the professor is innocent until proven guilty and should be treated as such by his employer. Jewish student websites, on the other hand, have warned prospective enrollees away from yet one more venture into the landmine infested area of anti-Israel academia.

The National Post, Canada’s most conservative newspaper, has reported that there is no indication that Diab has been a political activist since starting his Canadian teaching career, or that he has been particularly engaged with the Palestinian cause. Indeed, in one of its funnier observations, a Post editorial points out that this might make Diab the only sociology teacher on a Canadian campus not to be obsessed with the Palestinians.

All of this comes during summer session, the one season in which Canadian university life usually takes a break from the Middle East campus battles. But with campuses now in a permanent state of occupation and intifada, even the summer hudna is now at an end.

Have the Birthers Duped the GOP?

July 31st, 2009 at 2:11 pm 162 Comments

A poll released by Kos/Research 2000 found that 28% of Republicans believe that President Obama wasn’t born in the U.S. and that another 30% of Republicans “aren’t sure” whether or not the President was born in the U.S.

OK, it’s a Kos poll. OK, too, given the age of the GOP base, it may be that respondents were confused about the legal status of a Honolulu birth. “Hawaii a state? When the hell did that happen?”

If the poll is to be believed, only 42% of Republicans believe that the President of our country was born in the United States.

It’s hard to believe that 58% of Republicans take seriously the conspiratorial mutterings of a handful of obvious nutcases. What the poll numbers suggest instead is hard-core sore loserdom.

Republicans have to know that birtherism is factually incorrect, ignorant, and idiotic. Ladies and gentlemen: please, get a grip on yourselves.  If you don’t like the fact that Democrats are in power, engage in intelligent criticism. There’s a lot to criticize! But fruit-cake xenophobia will not defeat this President.  It’s nonsense and it needs to stop.

You Read It Here First on NewMajority

July 31st, 2009 at 10:49 am 11 Comments

Nine days ago, ampoule NewMajority’s Tim Mak discussed the advantages of nuclear fuel reprocessing:

Considering the benefits, pills nuclear fuel reprocessing warrants attention, reflection and research… If the United States is serious about reducing its greenhouse gas emissions, it will need to expand nuclear generation – and if nuclear is to fulfill its promise, fuel reprocessing is essential.

Last night, Energy and Commerce Committee Ranking Member Joe Barton and U.S. Rep. Fred Upton introduced a bill that authorizes the use of the Department of Energy’s Nuclear Waste Fund to recycle spent nuclear fuel.

According to a press release obtained by FrumForum.com, Rep. Fred Upton said:

We must restore some sanity to our nation’s nuclear policy, especially in light of the Administration’s foolish diversion from Yucca Mountain. France, Britain and Japan have all enjoyed great success using recycling technology originally developed in the United States, yet we are still hamstrung by Jimmy Carter’s misguided decision to halt recycling here at home… With current technology, an individual’s lifetime share of spent fuel is about the size of a soda pop can, but with recycling we’ll reduce that volume to the size of a Kennedy half dollar. In addition to the environmental benefits, nuclear recycling would create thousands of high paying jobs here at home.

You can read the entire bill here.

Beers of the Presidents

David Frum July 31st, 2009 at 9:24 am 30 Comments

What we learn from the Obama-Gates-Crowley summit: Bud Light must poll better among Obama’s target demographic of white working-class men than Miller Light. Once again, Biden cannot fake it: He doesn’t care what the polls say, he’s having a Buckler. Professor Gates’ first choice was a Red Stripe, but on second thought he seems to have decided that the Jamaican brew was too black, and switched to the Boston local favorite, Sam Adams. Officer Crowley allowed himself a little private joke. He had Blue Moon, described as a Belgian-style “white beer.” It’s made by Coors, underwriters of the Heritage Foundation.

Boots on the Ground, Not Jets in the Sky

July 31st, 2009 at 9:20 am 110 Comments

The House of Representatives is now deliberating over whether to appropriate money to build additional F-22s beyond the 187 already funded. The Senate recently rejected a similar measure. President Obama has pledged to veto any defense spending bill that provides for additional F-22 aircraft, advice and the White House this week reiterated its veto threat.

The debate has taken on an outsized symbolic importance that far exceeds the $1.75 billion involved. Liberal critics of defense spending see Gates and Obama as bravely trying to break the supposed stranglehold of greedy defense contractors and parochial politicians.

For conservative supporters of a robust national defense, shop the congressional attempt to build more F-22 fighter jets is a much-needed and long-delayed pushback against ill-advised weapon systems cuts by Secretary Gates and President Obama.

This is one debate where both sides are right. Congressmen and Senators want more F-22s not because they have seriously grappled with the defense budget, mind but as a reprehensible act of pork-barreling. Why else would liberal Democrats like Senators Edward M. Kennedy and Christopher Dodd of Connecticut support more money for the F-22?

It also happens that there is a serious and substantive case to be made for procuring additional F-22s. The Air Force has made clear that it accepts the current 187 plane limit only because of budget constraints. Since Gates and Obama have capped the defense budget to support greater domestic social-welfare spending, the Department of Defense must make difficult funding choices.

But why has the defense budget been artificially capped? Why is spending on weapon systems being cut even as the rest of the federal budget is ballooning? How come, last spring, lawmakers weren’t decrying this constrained defense austerity budget? Why did they acquiesce in a defense budget top-line number that is inadequate, and which promises, over time, to reduce defense spending to an historic low as a percentage of gross domestic product?

The answer: because our lawmakers, Democrats and Republicans alike, really aren’t much interested in the defense budget or in U.S. military requirements. That’s why their howls of outrage over the F-22 now ring hollow. And that’s why it is difficult for Iraq War veterans such as myself to get much exercised about this latest pseudo-controversy.

As a former Marine, I see a defense budget that for decades has been badly biased against the ground forces who do the actual fighting and dying in modern-day conflicts. Indeed, as the commander of the Joint Forces Command, Marine Corps General James N. Mattis has observed, 89% of U.S. military casualties since 1945 have been suffered by infantry units.

Yet, as the former commandant of the Army War College, Major General Robert Scales has noted, since the early 1990s, some 70% of the American defense investment, or more than $1.3 trillion, has been earmarked for missiles and fixed-wing aircraft.

The F-22 has not been used in either Iraq or Afghanistan. Yet, instead of arguing over truly deleterious defense cuts like Gates’ cancelation of the Army’s Future Combat Systems (FCS) vehicles, some in Washington are in a tizzy over an aircraft that may have utility in a distant, hypothetical and, in my judgment, highly unlikely, future conflict with China. By contrast, if the FCS vehicles were built and now available, the Army would send them immediately to soldiers in Iraq and Afghanistan.

I’d have more sympathy for the F-22 advocates if ever they voiced even minimal support for ground-force modernization for the Army and the Marine Corps, and for the grunts on the ground.

Does the Public Like Obamacare More Than Clintoncare?

July 30th, 2009 at 8:23 am 16 Comments

Bob Shapiro, author of two important books on public opinion (The Rational Public, 1992, with Benjamin Page, and Politicians Don’t Pander, 2000, with Lawrence Jacobs) sent me this report he just wrote with Sara Arrow, comparing public opinion for Obama’s health care initiative with opinion in 1993-94, when Bill Clinton’s health plan crashed and burned. They write:

The increasingly favorable climate of public opinion for health care reform that Clinton had in 1993 eroded enough by 1994 to dissipate any strong push on the public’s part for reform . . . All signs on the surface were that Obama took office in January 2009 with the same–or an even greater–impetus for health care reform. . . . It would therefore not be surprising to find–and there was every reason to expect–that Obama would have behind him even a more favorably disposed public than Clinton had to help move reform legislation forward. But has this been the case? Our best estimate is, overall, probably not, and this explains the battle that Obama has faced in getting public support to help the reform effort along through Congress or to offer approval later of any landmark legislation that is passed and implemented.

Shapiro and Arrow look at 18 survey questions on health policy, comparing average responses in 2009 to those in 1994. They define change in opinion as a shift of six percentage points in the balance of opinion in one direction or another. This is what they found:

* 5 questions where opinion was more favorable to health care reform in 2009 than in 1994: Does the health care system need to be rebuilt? Do you think the president’s reforms will decrease the amount you’ll pay for medical care? Do you think the Democratic party is more likely than the Republicans to improve the health care system? Do you approve of the way the president is handling health care policy? Do you favor the president’s plan?

* 4 questions where opinion was less favorable in 2009 than in 1994: Do you favor national health insurance, which would be financed by tax money? Would you be willing to pay higher taxes so that everyone can have health insurance? Would you be willing to pay more–either in higher health insurance premiums or higher taxes–in order to guarantee health insurance coverage for all Americans? Do you think the federal government should guarantee health care for all Americans?

* 1 question with a change whose direction is ambiguous: More people think that the country spends too much on health care, which is either in favor of Obama’s plan (national health care as a cost-saving move) or against it (if national health care is viewed as an extra public expenditure).

* 8 questions where public opinion is essentially unchanged.

In balance, then, Obama has faced a public opinion climate similar to Clinton’s in 1994.

As we’re all aware, opinion is volatile on these issues: support of health care reform does not necessarily translate to support for any particular policy. And a lot depends on Congress, where the Democratic majorities have a strong interest in seeing their party succeed. When translating opinion to policy, though, Shapiro and Arrow seem to have a good point when they write,

While the reports in the press of public support for major changes have been accurate (though varying from opinion poll to opinion poll, depending on how the survey questions were asked), they did not examine fully how current public opinion compares to what Bill Clinton faced in 1993-1994.

Time for Steele to Drop the Stereotypes

July 30th, 2009 at 8:22 am 55 Comments

Michael Steele has discovered a new tool for recruiting more blacks to the Republican Party: chicken and potato salad. Seriously! When I initially heard about Steele’s remarks, try I laughed in disbelief and told the person explaining it to me: “No, ampoule way.” Well… then I watched the clip on YouTube.

A Hoosier Access reporter asked the RNC Chairman the following question at the Young Republicans convention in Indianapolis in July:

“I wanted to ask you regarding your inclusion of diverse populations in the Republican party. What is your plan moving forward?”

Steele responds: “My plan is to say y’all come. Cause a lot of you are already here.”

Unidentified person shouts: “I’ll bring the collard greens.”

Steele adds: “There you go. I got the fried chicken and the potato salad.”

I’m surprised someone didn’t say they’d bring the watermelons. The assumption in this food banter is all black people are the same, they love to sop up collard greens, fried chicken and potato salad.  What’s ironic is moments after making these comments, Steele says the Republican party “welcomes and embraces” people of different backgrounds. Not with comments like that you won’t.

In fact, the person who told me about the remarks is a young, white Republican who found the comments “off-putting” at best. She went on to explain that she thinks it demonstrates Steele’s struggle with being a black Republican while at the same time acting as the voice of a party most uncomfortable with discussing issues of race and diversity. If Steele, as the first black chairman of the RNC can’t be effective in recruiting more black voters, then who can?

Numerous opportunities have arisen over the summer for Steele to recast the GOP as a more tolerant, dare I suggest, compassionate party of diversity. But he has remained strangely silent this summer on such topics as the racist comments uttered by various GOP folks and most recently the Gates arrest.

Steele’s remarks and the outcome of the Young Republicans Convention, where racist Audra Shay was elected its new chairman, doesn’t bode well for the GOP’s future. Someone commented to me that sadly the state of the Young Republicans is just a mirror image of what’s going on in the Grand Old Party. This person even said recently, while attending an event at the Heritage Foundation with a woman in her fifties, that the woman glanced around the room, shaking her head and remarked, “I guess we’re just going to have to wait until all these old people die off for the party to change.”

The party’s outward image doesn’t look like the welcome mat for diversity. Just for kicks I visited the Young Republican National Federation website. Its leadership is almost exclusively white and its promotional video “This is my party” is pure vanilla, no chocolate or strawberry in sight.

The GOP needs to move into the MODERN world: stop viewing ethnic groups through stereotypes, tune into what’s really important to voters and identify issues where the GOP shares common ground with groups. Leave the finger licking good comments to Colonel Sanders and get the PARTY started, y’all hear?

“Salaried” Doctors No Better Than Fee-for-Service

July 30th, 2009 at 6:53 am 12 Comments

One of President Obama’s plans for reducing healthcare costs is to mimic the way Cleveland Clinic or Basset Health Care compensates physicians — salaries rather than so-called fee for service. There is no question that the absence of incentives to aggressively hold down costs contributes to healthcare inflation. Superficially, paying physicians with a salary sounds nice but it ignores the way physician care is assessed and the way the dollars flow even in large integrated healthcare organizations. Putting it another way, salaried physicians still get paid for what they do.

The Medicare fee schedule is the Rosetta stone for physician reimbursement. Here is the formula for the Medicare fee schedule:

Budget Neutrality Adjustor Values
Year 2006 & Earlier: N/A
Year 2007: 0.8994
Year 2008: 0.8806
Year 2009: N/A

Non-Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Non-Facility PE RVU  * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor

Facility Pricing Amount =
[(Work RVU * Work GPCI) +
(Facility PE RVU * PE GPCI) +
(MP RVU * MP GPCI)] * Conversion Factor

Fortunately, Medicare helps by clarifying all this:

The Medicare physician fee schedule amounts are adjusted to reflect the variation in practice costs from area to area.  A geographic practice cost index (GPCI) has been established for every Medicare payment locality for each of the three components of a procedure’s relative value unit (i.e., theRVUs for work, practice expense, and malpractice).  The GPCIs are applied in the calculation of a fee schedule payment amount by multiplying the RVU for each component times the GPCI for that component.” To achieve cost controls, there is the budget neutrality factor which is supposed to reduce the value of each activity measured by the formulas. It has been rescinded by Congress every year.

Got that? Welcome to our world.

What this all means is that Medicare pays physicians a fee based on the amount of work, the amount of malpractice risk, the amount of facilities costs associated with that activity, and a geographic factor to reflect increased costs, mostly in urban vs. rural settings for each and every patient encounter. Private insurance companies pretty much have adopted the Medicare fee schedule and pay physicians in pretty much the same way as Medicare.

The Cleveland Clinic and any other healthcare facility has to actually earn the dollars it pays physicians and the way it earns the money is to bill Medicare (and all the other insurance plans, public or private) through this fee for service system. Therefore, while physicians can be salaried, the money that pays their salary comes from the amount of work they do and is carefully assessed by each institution by measuring those “relative value units” that Medicare created. Most institutions that employ physicians (and a very large fraction of U.S. physicians are employed), use the number of RVU’s to determine what physicians are paid. Not doing it this way would be crazy for otherwise the individual who cared for 75 patients a day would have the same compensation as someone who sees 10 patients a day even though they were each in the same specialty.

Therefore, even if physicians are salaried, the salaries will be based on activity and the revenue to the institution or practice that hires the docs will be based on how much they do. Salaries are not enough to change the dynamic. Real healthcare reform might pay physicians prospectively to care for a whole population of patients and let them and the patients decide what treatments and approaches make sense. How to accomplish this is not simple. True reform, and not some superficially attractive approach as has been advocated by reformers who really do not understand the healthcare system is the real “end game”. It won’t be created by tinkering with the cost of health insurance.

Quit Whining!

David Frum July 30th, 2009 at 6:45 am 3 Comments

Read all of the articles in Frum’s Quit Whining! series here:

Quit Whining!
July 27, 2009

The United States in 2009 is living through the fiercest challenge to market institutions and limited government since the mid-1970s. Defenders of free institutions will need the utmost energy, courage and perseverance for the work ahead. And yet at just this moment, the prevailing tone among those defenders is one of the most extreme despair.

* * *

Quit Whining 2
July 28, 2009

In the last post, I noted how unreal it was for conservatives to lament the demise of liberty in the aftermath of the most beautiful efflorescence of liberty in a century. Pessimism is misplaced as a matter of fact. It’s a betrayal of conservatism’s own achievements.

* * *

Quit Whining 3
July 28, 2009

I’ve addressed why the liberty v. tyranny trope self-betrays conservative history and why it corrodes America’s constitutional norms. But that’s not the bottom of it. Today’s conservative despair also sabotages our effectiveness in practical politics.

* * * *

Quit Whining 4
July 29, 2009

Perhaps – as some critics of this series have argued – I am too complacent in the face of an unprecedented attack on American liberties. To quote one passionate writer, who has sold many more books than I ever have or likely ever will: Our experiment in democracy could be closed down by a process of erosion. It is a mistake to think that early in a fascist shift you see the profile of barbed wire against the sky.

* * * *

“Moron” “Idiot” “Lardass” “Fraud”: Mark Levin Replies
July 29, 2009

My series on conservative despair mentions Mark Levin among others. Here the talk-show host responds with his familiar suavity of manner and elegance of language.