Tuesday, August 11, 2009

Health Care Reform

by Dr. Elaina George

When I read that the president had met with CEOs and other top representatives of the largest health insurance companies, hospitals and pharmaceutical companies before healthcare reform was crafted by Congress, I had my doubts about the direction of health care reform confirmed.

I already had reservations about whether we would get true reform when the very members of Congress who were tasked to lead the crafting of the bill had received hundreds of thousand of dollars from the very entities that were the major cause of the problem – the health insurance industry, big PhRMA, and for profit hospitals.

No wonder we have been seeing commercials sponsored by big PhRMA in support of the current health reform bill. It appears it is quid pro quo for the administration’s deal to cap their concessions at 80 billion dollars over 10 years. NY Times Article
If I were a drug company executive or stockholder, I would be happy to support a bill that keeps the government from importing cheaper medication from Canada, and locks it into buying brand medication instead of cheaper generics. (The discounts that Big PhRMA is willing to extend only apply to brand name drugs – the most expensive choice.)

The health insurance companies who also support the healthcare reforms proposed by the President also stand to gain. Although they did not promise to make any concessions, they benefit by receiving more people to pay premiums since there is a mandate that everyone carry insurance (public or private) or face monetary sanctions. Market forces will draw people who are sicker and don’t have the economic means to the public option leaving private insurance companies with members who are younger, healthier and have the ability to pay the premiums.

Why Aren't We Undergoing Another Great Depression?

Paul Krugman's answer:

Averting the Worst: So it seems that we aren’t going to have a second Great Depression after all. What saved us? The answer, basically, is Big Government.... [T]he economic situation remains terrible... we’re... nine million jobs short of where we should be. And the job market still hasn’t turned around....

For all that, however, the latest flurry of economic reports suggests that the economy has backed up... from the... abyss. A few months ago the possibility of falling into the abyss seemed all too real.... [I]n the 1930s the trend lines just kept heading down. This time, the plunge appears to be ending after just one terrible year. So what saved us from a full replay of the Great Depression? The answer, almost surely, lies in the very different role played by government.

Probably the most important aspect of the government’s role in this crisis isn’t what it has done, but what it hasn’t done: unlike the private sector, the federal government hasn’t slashed spending.... All of this has helped support the economy in its time of need, in a way that didn’t happen back in 1930.... In addition to having this “automatic” stabilizing effect, the government has stepped in to rescue the financial sector. You can argue (and I would) that the bailouts of financial firms could and should have been handled better... while acknowledging that without these bailouts things would have been much worse. The point is that this time, unlike in the 1930s, the government didn’t take a hands-off attitude while much of the banking system collapsed. And that’s another reason we’re not living through Great Depression II.

Last and probably least, but by no means trivial, have been the deliberate efforts of the government to pump up the economy... the American Recovery and Reinvestment Act... was too small. Nonetheless, reasonable estimates suggest that around a million more Americans are working now than would have been employed without that plan — a number that will grow.... All in all, then, the government has played a crucial stabilizing role in this economic crisis. Ronald Reagan was wrong: sometimes the private sector is the problem, and government is the solution.

And aren’t you glad that right now the government is being run by people who don’t hate government?...

[W]e appear to have averted the worst: utter catastrophe no longer seems likely.

And Big Government, run by people who understand its virtues, is the reason why.

The loose end in Krugman's article is why there weren't more Great Depressions back in the old days, before big government. The answers, I think, are two:

Business cycles are a disease of the post-agricultural economy--of the nonfarm economy. If you look back at the nonfarm unemployment rate before 1930, things look not as bad as the Great Depression but still pretty bad.

Most countries had a form of "big government"--a military large in size relative to its nonfarm economy and an activist, interventionist central bank--reaching far back into the past.

The U.S. was the only major industrial power without an activist, interventionist central bank before 1913--but the U.S. Treasury did give the baton to run monetary policy to the Morgan-Belmont syndicate in the 1890s and to Morgan in 1907, so we were not always without an activist, interventionist central bank.

And the U.S. looks like the worst as far as pre-1930 business cycles are concerned, with 1874 and 1885 matching 1893 in terms of nonfarm unemployment and industrial distress.

Health Care Reform and the Big Lie: Your Doctors Want to Kill You for Money

What will it take to remove end-of-life counseling from its current role as a political football in the scrum over health care reform?

Match Sarah Palin's "death panel" attack with claims that she wants old people to die slowly and in pain? Meet Newt Gingrich's assertion that health care reform is wrong because the government cannot be trusted with accusations that he hates our (government!) soldiers and wants to kill the VA and Medicare?

Nah. Let's try facts.

Palin's crazy Facebook posting (and did you ever expect the phrase "Facebook posting" to turn up as a primary source in a serious political discussion?) is far from the most dangerous recent commentary in this context. I'd give that nod today to the Washington Post's Chuck Lane. He offered a column on the subject this week that carries the patina of reason -- as Palin's screed does not.

I admit that I'm not "objective" on this topic. As I've written here earlier, I've watched my wife during her career in long-term health care, in nursing homes and in hospice work. And I've faced what could have been a couple of end-of-life episodes with my own dad . Plus I've actually read both the relevant section in the House bill (search for 1233) and the relevant section in the Medicare code.

So let me lay my high card on the table: Posturing that is calculated to score political points but is likely to make some people afraid of counseling, hospice, and their own doctors is nothing less than evil.

In reading Lane's column, I was reminded of a Peter, Paul and Mary concert I attended many years ago. They were about to sing "Puff the Magic Dragon." And they alluded to an accusation from years before that the song was actually about smoking pot. They "confessed" that was true. And in the national interest, they were going to expose another song with drug-promotion hidden in the lyrics:

"Oh, say can you see. 'C' as in cocaine . . ." And so on. The point being that words can be twisted into a meaning that may not actually be there.

So let's turn to Lane's column. In it he attacks a provision in one of the current health care reform bills that would authorize Medicare to pay a doctor for a consultation with a patient about end-of-life issues.

He starts with a nod toward reason, acknowledging that there is no basis for claims that this is tantamount to legalizing euthanasia. (As Patricia Murphy has pointed out here at PD, an amendment already accepted would make it illegal for counselors to promote or even list suicide or assisted suicide as an option.)

Lane goes on:

I was not reassured to read in an Aug. 1 Post article that "Democratic strategists" are "hesitant to give extra attention to the issue by refuting the inaccuracies, but they worry that it will further agitate already-skeptical seniors."

If Section 1233 is innocuous, why would "strategists" want to tip-toe around the subject?

Perhaps because, at least as I read it, Section 1233 is not totally innocuous. . . .

Section 1233, however, addresses compassionate goals in disconcerting proximity to fiscal ones. Supporters protest that they're just trying to facilitate choice -- even if patients opt for expensive life-prolonging care. I think they protest too much: If it's all about obviating suffering, emotional or physical, what's it doing in a measure to "bend the curve" on health-care costs?

As with Puff, sometimes things may simply mean what they appear to mean: End-of-life is a politically fraught issue because merely talking about it makes people afraid. Try it. Sit down with your friends or family -- particularly if you include folks past, say, 65. Strike up a chat about dying and see how far you get. Search for an easy political upside to that conversation.

Why would this issue be addressed in a bill that is, in part, about reducing health care costs? Because most responsible medical authorities believe that patients and their families who are better informed about what medicine can and cannot do for the dying are more likely to choose alternatives that are, on average, less expensive than what happens today. Emphasis on the phrase "more likely to choose."

Back to Lane, and we need a large chunk here to be fair to him:

Though not mandatory, as some on the right have claimed, the consultations envisioned in Section 1233 aren't quite "purely voluntary," as Rep. Sander M. Levin (D-Mich.) asserts. To me, "purely voluntary" means "not unless the patient requests one." Section 1233, however, lets doctors initiate the chat and gives them an incentive -- money -- to do so. Indeed, that's an incentive to insist.

Patients may refuse without penalty, but many will bow to white-coated authority. Once they're in the meeting, the bill does permit "formulation" of a plug-pulling order right then and there. So when Rep. Earl Blumenauer (D-Ore.) denies that Section 1233 would "place senior citizens in situations where they feel pressured to sign end-of-life directives that they would not otherwise sign," I don't think he's being realistic.

What's more, Section 1233 dictates, at some length, the content of the consultation. The doctor "shall" discuss "advanced care planning, including key questions and considerations, important steps, and suggested people to talk to, an explanation of . . . living wills and durable powers of attorney, and their uses" (even though these are legal, not medical, instruments); and "a list of national and State-specific resources to assist consumers and their families." The doctor "shall" explain that Medicare pays for hospice care (hint, hint).

"Hint, hint"? I'm pretty sure that's the point I could literally feel my blood pressure elevate. He is suggesting nothing less than that your doctor will be inclined to push you into a premature death, only because he could bill Medicare for the cost of an hour or so of conversation.

Perhaps Lane himself is seeing the wrong doctor.

But let's be civil. We need to trace what the bill and current law actually say. The bill, which is a long way from becoming law, would add to Section 1861 of the Social Security Act, subsection (s)(2). It's a section that includes a long list of things that Medicare will currently pay for.

Here are a few: home dialysis supplies and equipment, prescription drugs used in immunosuppressive therapy, qualified psychologist services, prostate cancer screening tests, colorectal cancer screening tests, screening for glaucoma, ultrasound screening for abdominal aortic aneurysm, kidney disease education services, leg, arm, back, and neck braces, and artificial legs, arms, and eyes.

And so on and so on. Does Lane believe that doctors have an unwarranted incentive to push patients into installing a fake eye or taking dialysis or getting their colon scoped because current law pays for it? Seriously?

New Jersey Voters Say Corruption Major State Issue, Poll Finds

Aug. 11 (Bloomberg) -- Almost all New Jersey voters say corruption is a serious problem in the state, and more people associate Democrats with political bribery than they do Republicans, a Quinnipiac University poll released today found.

Two-thirds of voters said the July 23 federal corruption arrests of 44 people in New Jersey embarrasses them as residents of the state. About the same percentage of voters said the arrests don’t make them less likely to vote for Governor Jon Corzine, a Democrat, in November, according to the poll.

The Republican candidate for governor, former U.S. Attorney Christopher Christie, leads Corzine among likely voters, 51 percent to 42 percent. In a July 14 survey, Christie led Corzine 53 percent to 41 percent. Democrats outnumber Republicans in New Jersey, and voters in the state haven’t elected a Republican to statewide office since 1997.

Voters say 50 percent to 15 percent, with 34 percent undecided, that they associate Democrats more than Republicans with political corruption in New Jersey. Independent voters blame Democrats 56 percent to 9 percent, while 28 percent of Democrats blame their own party, the poll found.

“Is corruption a big problem? Wow, is it!” Maurice Carroll, director of the Quinnipiac polling institute, said in a statement. “Almost everyone in New Jersey thinks so. And two- thirds feel personally embarrassed to live in a state where politicians are pictured in handcuffs.”

Three New Jersey mayors and two state lawmakers were among the 44 people arrested last month in a federal bribery and money laundering investigation. All three mayors were Democrats, while one assemblyman was a Democrat and the other was a Republican.

NJ Gov Poll: Green Shoots For Corzine?

New Quinnipiac poll finally has a tiny bit of good news for beleaguered Democratic Governor Jon Corzine. Corzine still has a dismal approval rating (36%) and still trails his Republican challenger Chris Christie by a wide margin (9 points), but both numbers are up slightly from Quinnipiac's survey last month.

Christie (R) 51 (-2 vs. last poll in July)
Corzine (D) 42 (+1)

Overall, Christie now leads Corzine by 12.1% in the RCP Average.

Corzine's 36% approval rating is a three point improvement from last month, while his disapproval rating dropped two points to 58%.

These slight improvements come amid one of the biggest corruption busts in New Jersey history. According to the Quinnipiac survey, 71% of voters say corruption is a "very serious problem" in New Jersey, with another 22% declaring it a "somewhat serious problem." Additionally, when asked which party is more associated with the corruption issue, 50% said the Democrats, while only 15% said Republicans and 34% said they didn't know.

Despite those numbers, when asked if the recent arrest of many New Jersey Democrats on corruption charges made them less inclined to vote for Corzine, 67% said "no" while only 28% said "yes."

Lastly, Corzine does lead Christie by six points (42-36) on the all important question "who would you rather spend an afternoon at the Sandy Hook beach with?"

Arlen Specter validates the mobster heckling him

Recently converted Democrat Arlen Specter, who less than year ago was a Republican "moderate", let some disruptor bring his town hall meeting to a dead stop. He did demand that the guy leave. But then he stood there while the nasty old white guy berated him. When the guy finally shut up and left, Specter validated the FOX interpretation of the Republican mob movement, saying, "We've just had a demonstration of democracy."

I would say he did two things right. He had security and police there ready to deal with disruptors. And he called the guy on his action and demanded that he leave. Both were good ideas.

But then Specter undercut the good effects of his actions by restraining the police and security from expelling him and letting the guy stand there and rant, bringing the meeting to a halt and trying to intimidate others in the crowd with his belligerence. No, Sen. Alleged Democrat Specter, that was not "a demonstration of democracy". That was a display of you validating the Republican mob tactic by allowing to shout and rant to his heart's content. Having the guy summarily removed would have sent the right message in the context of today's national campaign of Republican mob intimidation. In the eyes of the mob movement, that guy achieved his purpose.

U.S. Soldier Among Three Charged in Texas With Killing Drug Cartel Member Who Was a Gov Informant

Here’s a new twist in the violent drug war. A U.S. soldier is involved in this killing. Then again, nothing should come as a shock at this point. Border patrol agents are on the take. Mexican police are getting wiped out.

EL PASO - A U.S. Army soldier is one of three men facing murder charges in the killing of a Juárez cartel member who was a law enforcement informant.
Crimes Against Persons Unit detectives arrested Ruben Rodriguez Dorado, 30, Christopher Duran, 17, and Fort Bliss soldier Michael Jackson Apodaca, 18. All men are being charged with murder.

Apodaca was in a camouflage uniform as he and the other men were escorted by homicide detectives and uniformed officers out of El Paso Police Headquarters shortly before 1 a.m. today to be booked into the El Paso County Jail.

The handcuffed men walked out quietly. One of them shook his head no when asked if he had anything to say. Another tried to hide his face from a video camera.

Apodaca was transported in the back seat of a patrol car while Dorado and Duran were driven away in the back of a sedan.

The three are accused of killing Jose Daniel Gonzalez Galeana, who was shot eight times the night of May 15 as he walked up to the front of his upscale home in the 1300 block of Pony Trail Place on the East Side.

Gonzalez, 37, ran a trucking business and was a midlevel member of the Juárez drug cartel working as a government informant. A motive for the killing had not been released but police had previously said it was believed to be drug related.

In the investigation, detectives learned Dorado planned and organized the homicide. He hired Duran and Apodaca to commit the murder.

More arrests are expected.

The Gonzalez homicide is the first suspected cartel-related killing in El Paso since a war among drug suppliers erupted in Juárez last year.

Border Protection Agency Unveils Prototype for New Vessel For High-Speed Chases

-- U.S. Customs and Border Protection on Monday unveiled a prototype vessel for high-speed pursuits of smugglers ferrying people and drugs from Mexico, Canada and the Caribbean.

The 43-foot boat is faster, more stable and carries about twice as much fuel as CBP's current vessels, which were rolled out from 2001 to 2005.

The $875,000 prototype comes with infrared cameras and sensors that give detailed images as far as the horizon goes. Currently, agents often use goggles, which detect things only as far as the naked eye.

CBP hopes to get funding to replace its fleet of about 65 vessels used for high-speed chases that are stationed in the Gulf of Mexico, Puerto Rico and the Virgin Islands, Florida's Atlantic coast and in the Pacific Ocean near the borders with Canada and Mexico.

Authorities say heightened enforcement on land borders has fueled an increase in human and marijuana smuggling by sea, particularly in the San Diego area from launching areas near Tijuana, Mexico.

The rickety smuggling vessels favored in San Diego generally can only hit speeds of about 20 mph, but they tend to travel at night far from shore and often elude capture.

"It's like looking for a can of soda in a gigantic pool," said CBP spokesman Juan Munoz Torres. "Sometimes you catch them, sometimes you don't."

Authorities have arrested 130 people suspected of crossing the border illegally by sea in the San Diego area since October, including 22 Mexicans who were found Monday on a 20-foot boat near Torrey Pines State Beach in ritzy La Jolla.

There were 136 suspected illegal immigrants arrested during the previous 12 months and only 44 the year before, according to U.S. Immigration and Customs Enforcement.

Authorities seized 52,000 pounds of marijuana in boats off of San Diego's shores since October, compared to about 9,000 pounds the previous 12 months and 10,000 pounds the year before.

Kayakers rested their paddles and turned their heads as the vessel prototype zipped past them under cloudy skies of San Diego's Mission Bay, a summer vacation mecca where smugglers have been found to mix with fishing and pleasure boats. A plastic model of an M-48 machine gun was planted on a side ledge.

A screen showed a vessel about a mile away with a man hoisting a fishing rod in the Pacific Ocean, indicating to agents that there was no threat and they didn't need to waste any time determining who was aboard.

The prototype, made by Nor-Tech Hi-Performance Boats of North Fort Myers, Fla., carries 600 gallons of fuel and reaches 75 mph, compared to a top speed of 60 mph for the current fleet.

The seats carry special shock absorbers to make for a smoother ride. The boat weighs about 21,000 pounds, compared to 14,000 pounds on the current boats.

Court Denies NY Times Access to Wiretap Document for Prostitution Ring Patronized by Eliot Spitzer

Let’s forget the legal arguments here. For entertainment sake, how can the court deprive the public the pleasure of seeing these sizzling documents?

The New York Times has not shown “good cause” to unseal wiretap applications in the investigation of a prostitution ring once patronized by former New York Gov. Eliot Spitzer, the 2nd Circuit ruled Friday.

A three-judge panel in Manhattan overturned U.S. District Judge Jed Rakoff’s order granting the Times access to sealed wiretap applications and orders in the Emperors Club investigation
The 2nd Circuit also held that the newspaper does not have a First Amendment right to view the requested documents.

Clinton: 'My husband is not secretary of state, I am'

Secretary of State Hillary Clinton reportedly became annoyed after an audience member at a town hall in Congo asked her what her husband thought about an international relations issue.

"My husband is not secretary of state, I am," the AP reported an "obviously annoyed" Clinton said. "If you want my opinion, I will tell you my opinion. I am not going to be channeling my husband."

A male Congolese student asked her what "Mr. Clinton" thought of World Bank concerns about a multi-billion-dollar Chinese loan offer to the Congo.

"You want me to tell you what my husband thinks?" the AP said she "incredulously" replied.

Before Secretary of State Clinton traveled to Africa, former President Bill Clinton traveled to North Korea on what the White House described as a "private humanitarian mission" to secure the release of two captive American journalists.

Pedro Martinez Will Start Wednesday vs. the Cubs

Courtesy of the Twitter account of CSN’s John R. Finger (@jrfinger for those not knowing) comes the news that the greatest pitcher of your lifetime, Pedro Martinez, will make his season debut for the WFC’s as they take on Notre Damer Jeff Samardzija and those Chicago Cubs Wednesday Night at Wrigley (on ESPN).

The other news to come out of the reshuffling of the starters is that Grampa Jamie Moyer has been relegated to the ‘pen. Which basically means he might see some action if we’re down 7 runs in the 4th inning, or up 9 in the 7th. I kinda feel bad for the old guy.

Jennifer Hudson Welcomes Baby Boy

In a year that has been marked with hardships for Jennifer Hudson, it is wonderful news to report that she had a baby boy! David Daniel Otunga, Jr entered the world yesterday (August 10th) and is the first child for the singer and academy award winning actress with her fiance, David Daniel Otunga.

Hudson never officially announced that she was expecting a baby, but it became obvious when she appeared at the Michael Jackson memorial in July.

Congratulations to the new family.

US missile hits Mehsud's Pakistan stronghold

ISLAMABAD — A U.S. missile slammed into a suspected Taliban camp in a lawless Pakistani tribal region Tuesday, intelligence officials and Taliban commanders said, killing anywhere between six and 14 people, a week after a similar strike reportedly took out the group's leader.

Washington and Islamabad have said they are almost certain that last Wednesday's drone strike killed Pakistan's most wanted man, Baitullah Mehsud, even though Taliban commanders have insisted their leader is still alive.

The government publicly opposes U.S. missile strikes, saying they anger local tribes and make it more difficult for the army to operate against the Taliban. But criticism has been muted against last week's attack on Mehsud, who is suspected of masterminding the 2007 assassination of former Prime Minister Benazir Bhutto and dozens of other suicide bombings.

Tuesday's missile hit a compound in Mehsud's stronghold, South Waziristan, near the Afghan border, two intelligence officials in Islamabad said.

Two other intelligence officials, based in northwestern Pakistan, said the strike had killed 14 militants. All four spoke on condition of anonymity because they were not authorized to speak to the media.

However, Taliban spokesman Azam Tariq said the missile had hit a house, not a militant hide-out.

"Today, an American missile hit a home in South Waziristan," he told an Associated Press reporter by telephone. "Only innocent civilians were living there, and six of them died."

Tariq also repeated assertions that Mehsud was still alive. "I have said it again and again: Baitullah Mehsud is safe. He is in good health," he said.

Differing claims from the Taliban and state authorities about the same event have become commonplace — and most are impossible to verify. The tribal areas are off-limits to foreign journalists and poor security also makes it very difficult for Pakistanis to report there.

Analysts suggest it could be in the interests of top commanders in Mehsud's Tehrik-e-Taliban Pakistan to deny their leader is dead until they can replace him. Mehsud brought various militant factions under a unified if loose command that posed a major threat to Pakistan's security forces, and his death would be a major blow for the Taliban.

The U.S. rarely acknowledges or discusses the missile strikes, which are carried out by unmanned drone aircraft, but the pace of such attacks in the tribal areas has increased in the past year.

Two Taliban sources told an AP reporter that at least eight drone aircraft had been flying over known Mehsud areas in South Waziristan for the past three days, and that the Taliban was being very cautious of its movements for that reason. Both spoke on condition of anonymity because they could not discuss such issues publicly.

Militant commanders are said to have been holding shuras, or meetings, to discuss who should succeed Mehsud as Taliban leader, but it was unclear whether Tuesday's missile strike targeted such a gathering. A Mehsud deputy on Monday denied reports of infighting over the succession — allegations repeated by the government Tuesday.

"The current position is that their men are scattered, and they are fighting with each other," Interior Minister Rehman Malik told reporters.

As confusion swirled over Mehsud's fate, violence continued to batter the northwest.

At least a dozen rockets slammed into the main city of Peshawar early Tuesday, sending panicked residents fleeing their homes. At least two civilians were killed and 10 others wounded, police official Nisar Khan said.

Taliban militants often target security outposts in the countryside, but rocket attacks against cities are rare.

"It is an act of terrorism, but we don't know who the attackers were," Khan said.

Hours later, militants attacked a paramilitary Frontier Corps base outside Peshawar, and three militants were killed in the gunbattle, the military said in a statement.

Separately, Frontier Corps troops on an operation clashed with militants in the Khyber tribal region, leaving 17 militants dead, the corps said in a statement. It said six militant bases and an ammunition dump were destroyed. The casualty figure could not be independently confirmed.

Pakistan's military has been winding down a three-month offensive against the Taliban in the Swat Valley, elsewhere in the northwest, although clashes still break out there.

The army said Tuesday that a soldier was killed during a clash with militants in Swat while authorities arrested 29 suspected militants — including three who turned themselves in — during separate search operations.