Tuesday, December 31, 2013

Closing Thoughts on 2013, Opening Thoughts on 2014...

Closing Thoughts on 2013, Opening Thoughts on 2014...

2013 was a year of frustration for just about everybody. President Obama's year was especially so on a variety of issues from the botched Healthcare.gov rollout to the handful of "mini-scandals" involving the IRS, the Justice Department tapping various reporters phone lines, the Edward Snowden revelations regarding the NSA activities, the remnants of the FBI's operation called "fast and furious," to large question marks surrounding our foreign policy in no less than three countries (Afghanistan, Israel, and Syria.) Make no mistake, we also haven't heard the end of the Benghazi tragedy, as you can count on it being kept alive at least through the 2016 General Election.

As we pivot to 2014, it appears the issues with the Healthcare.gov website have been mostly corrected and signups through the month of December have been robust. While that's good news for the Obama Administration, it doesn't mean there's calmer waters ahead. Its a fairly safe bet when those first patients start walking into emergency rooms early on the morning of January 1st, there's going to be many questions on who has insurance, who thinks they have insurance but who doesn't. What physicians and hospitals are no longer "in network?" Are the cyber connections needed for a smooth transition from the old days to the new days under Obamacare up and running correctly? Glitches can be expected and their presence won't mean the entire program is a failure. Nor will the stories that we're bound to hear about people and families telling their stories of anger and frustration because something didn't work the way it was supposed to. Other large social programs such as Social Security, Medicare and Medicaid all experienced growing pains when they were rolled out. All figured those problems out and are wildly popular and in no real danger of being eliminated any time soon. The fact that social programs need tweaked from time to time is to be expected.

When the White House wasn't defending itself against this or that story, there were a few successes. The defeat of the Defense of Marriage Act was a landmark ruling for same sex couples and it seems every month another state votes in same sex marriage rights. Eighteen States or 36% of the country has passed such legislation onto its books with more to follow in 2014.

With the defeat of gun legislation in the Senate back in April, it was understood that 2013 would not be a year for much progress on that front. Despite the ongoing efforts of the Sandy Hook parents and other gun control advocates, the votes just aren't there, despite what polling tells us in terms of most Americans supporting enhanced background checks in the purchase of a gun. Which is too bad. I don't and I suspect President Obama doesn't want to take away the average gun-owners pistols or hunting rifles. We just want to make sure only the people who should get a gun, are able to. I think that gun reform will only happen in a time when some large event like the Sandy Hook shooting hasn't happened. In the aftermath of such an event, emotions on both sides are running too high and compromise is almost impossible. To be clear, there is no gun reform conceivable that would've stopped Adam Lanza. We also shouldn't craft gun reform policy on the emotions of a tragedy such as that. Cooler heads and calmer times will make for better policy outcomes.

The outrage that Mr. Snowden kicked up with his revelations on the NSA surveillance programs certainly hasn't gone away nor will it any time soon. Questions abound from is the FISA Court really a serious entity and not a rubber stamp for requests (I say it is a serious body) to the following: Since our communications data from cell phones, emails and other internet activity is compiled on some level, whom do we trust most to oversee it? A publicly funded government agency or a profit seeking private enterprise? As unseemly as it seems, I'd rather have the Government browsing through this type info than I would Verizon, AT&T or Sprint. Truth is, they're all doing it. By the way, I say Snowden is a criminal, a traitor and should be prosecuted to the fullest extent of the law. He is no patriot. He endangered a great many of our citizens and put this country at large at risk.

A few words about Syria. Chemical weapons are clearly taboo around the world and the vast, vast majority of countries have signed treaties rejecting their use. As well they should. On the other hand, a death is a death and it eludes me how anywhere from several hundred to 1400 death from chemical weapons is a stop the press, prepare for war type event but a death toll in excess of 100 thousand Syrians not to mention upwards of 9 million who have been uprooted from their homes and are now refugees seems to barely register on Mr. Obama's foreign policy radar. With virtually all the moderate Syrians gone, the country has become hell on earth for those who have remained.

2013 wasn't exactly a banner year for Congress, to be sure. Approval ratings in the single-digits make President Obama's mid 40's look positively wonderful. Second terms are always rough on Presidential approval ratings, so don't get too excited if Obama's numbers don't bounce back. He's not far from lame duck status. Speaker of the House John Boehner finished stronger than he started as the efforts of Paul Ryan and Patty Murray found some common ground (but no compromises) on a new budget bill. Next year will see the start-up of the mid-term election campaigns so I suspect we'll see some additional bi-partisan legislation so both sides can claim "...a willingness to reach across party lines and do what's right for the American people, blah, blah, blah..."

You know who had a great 2013? Pope Francis. Big time...

2014 will be a somewhat similar year to 2013 in terns of Washington DC. With the passing of each month on the calendar, President Obama will only become weaker and weaker. Given Congress' obstruction toward the White House when Obama was at his most powerful, I can only imagine how bad it will get once we hit the 2014 mid-terms. Look for the President to come out of the gate strong and ambitious in the new year. He's got until November to accomplish his next set of goals. After the midterms, he'll be at his weakest.

Speaking of mid terms, I think the Democrats will lose a few seats in the Senate but hold onto majority status, the Republicans will gain a few seats in the House. More interesting in my mind will be the coming fights between the Republican establishment and the Tea Party members. Look for the House to welcome a few more Tea Party legislators to its ranks in January 2015. (Get the popcorn...)

On a positive note for the administration, if Obamacare continues to see good enrollment numbers and can minimize the early snafus and ensuing negative media coverage, the GOP will find itself in a bad place of still wanting to get rid of the Affordable Care Act. The optics of such a strategy will be of one party trying to take away something that is helping a great number of people with no clear replacement solution in place. (GOP ideas such as selling across state lines, HSA's and tort reform are not solutions, they just sound like good ideas until you understand the problems with all of them. Selling across state lines leads to adverse selection which leaves the people who need insurance the most in the worst position to get it, HSA's are great if you can afford them, but too many Americans simply can't and Tort reform addresses about 1.5% of all health care spending. It just doesn't do much for that many.)

I think there's a less than 50% chance that President Obama succeeds in raising the minimum wage. If he surprises me, he wins....if Congress blocks him, they've just handed the Democratic candidate for President in 2016 a major talking point.

Sunday, December 29, 2013

The Latest From Health care Triage

Despite what you hear these days about the good old days, things really aren't all that bad today. Lots of things are better today than they were 10-20-30 years or more ago...

Dr. Carroll explains...

Looking back at the First World War, Could it Happen Again?

Worthwhile read from The Economist on the idea that past can be prologue. Specifically, are their parallels between the First World War and current times?

An except:

Yet the parallels remain troubling. The United States is Britain, the superpower on the wane, unable to guarantee global security. Its main trading partner, China, plays the part of Germany, a new economic power bristling with nationalist indignation and building up its armed forces rapidly. Modern Japan is France, an ally of the retreating hegemon and a declining regional power. The parallels are not exact—China lacks the Kaiser’s territorial ambitions and America’s defence budget is far more impressive than imperial Britain’s—but they are close enough for the world to be on its guard.
Which, by and large, it is not. 
Read the entire article here... 


Wednesday, December 25, 2013

A Message From Reasonable Conversation...

From the editorial staff of Reasonable Conversation, we wish everyone a...


Bill & Tim

Sunday, December 22, 2013

Holiday Medical Myths Debunked...

By who else?

Dr. Aaron Carroll, with this week's Healthcare Triage:

Was 2013 A Good or a Bad Year for the Affordable Care Act?

Roughly a week left in 2013, and the year end reviews are popping up everywhere. Was it a good year? A bad year? Who knows?

To the more specific question was 2013 a good or bad year for the Affordable Care Act or "Obamacare" as its often referred to, I say it was a very good year.

Some of you may ask how on earth could anyone consider 2013, with its bungled rollout of the exchanges, with its poorly-worded "if you like your plan, you can keep your plan..." not to mention its last second changes exempting certain slices of the population from the individual mandate while forcing most to still carry health insurance, etc. a "very good year?"

I say it was a very good year because, for the most part, the ACA is moving forward toward its goal of decreasing the number of uninsured Americans. Yes, it stumbles at times, looks down-right awful at times, makes no sense at times, but it lives on. Remember the 48 or 49 attempts by Congress (let's give credit where credit's due, the House)? Virtually none of them stood a chance against the majority controlled Senate or Mr. Obama's White House of really getting rid of it. Those votes were symbolic, and played to the base and almost no one else. I'm not sure how big of a bang the last 15 generated compared to the first 15, but hey, Speaker Boehner gets to run the show in the House (wait, did I just type that?) and if he wants to spend the House's time and our money holding these "for show only" votes, who am I to object?

The ACA has problems. Some pretty big ones, in fact. The private insurance market is in chaos, the rollout of the Healthcare.gov website has been well chronicled and fairly assessed as a rank amateur disaster by many and people seem to dislike Obamacare more than they like it. Far too many states, mostly in the South have (so far) rejected the Medicaid Expansion which leaves many poorer people and families on the outside looking in as far as accessing health insurance coverage.

As long as the ACA is moving, albeit imperfectly, towards full implementation and its goals, its been a pretty good year. Here's my reasoning. Every year that Obamacare continues to draw breath reduces the likelihood that it will be repealed anytime soon by the Republican Party. Had Mitt Romney defeated President Obama and at the same time, the Democrats lost control of the Senate, while the GOP maintained control of the House, the chances are very good the Affordable Care Act would've been shown the door. None of that happened, here we are, two years later and millions of young people are staying on their parents health insurance. Millions are benefiting from the increased access to preventative care services. Millions are benefiting from the expansion of Medicaid in many states, providing some with health insurance for the first time in their lives. Hospitals are well on their way toward re-engineering their operations with a nod toward quality of care and less so fee for service and quantity of care. Even the health insurance companies are mostly behind the ACA. Sure, they probably don't appreciate how President Obama stuck them with some headaches in the individual market over the last six weeks or so, but business models have been over-hauled. Changes in policies, procedures and products have all been planned for and are being implemented at a not insignificant cost to the insurance companies themselves. As Sam Cooke sang years ago, "a change is gonna come..." Is there a rational case anyone can really make to see all of the above done away with or reversed? Seriously?

I don't agree with those pundits who love to cite the website issues or the ensuing slow signup rate as an indication of  the official and permanent failure of Obamacare. We won't know how successful this change will wind up being for a few years. How many young people will sign up? How fast? What other problems that we don't know about yet will surface? What tweaks to the law, that once were routine for the Congress but now are most definitely not, will or won't be put into place? How many and how soon will states who have so far rejected the expansion of Medicaid change course and accept the Fed's offer? We can't know all of these things right now.

Most of the issues you've read about in the last few months will, in the end, get sorted out. Slowly but surely, things will get smoother with the occasional problem needing attention. Whether or not the GOP ever becomes part of the solutions is a question for another day. I suspect Conservatives in moderate or swing states will be the first to try and help out as a show to their constituents of their ability to legislate in a bi-partisan way. Mind you, the risk of these moderates being primaried by Tea Party candidates is real and will happen in many cases. How many elections these challengers from the right will actually win is unknown, but so far, their record is mixed.

While the doom and gloom reporting from some media sources and talk show programs will almost certainly continue. (I just can't conceive of Rush Limbaugh or Sean Hannity reversing their course on this and ever coming out in even a modified support of the ACA.) More and more people will sign up for coverage. More and more people will benefit from having health insurance. More and more people will avoid seeing coverage cancelled or treatments terminated mid-course because of plan limitations. Medical bankruptcy rates should begin to decline. A lot of good is going to be realized across the United States even while we shake our heads at website issues, unintended consequences and a host of other blunders we haven't even thought of yet.

If projections are accurate and the Republicans hold on to the House and walk away with a stronger Minority in the Senate, there's still President Obama and his veto pen just waiting in the West Wing. There is ZERO chance Obama would ever kill his own landmark health care reform.

That brings us to 2016 and another Presidential election. Odds are it will feature Hillary Clinton and somebody (Brian Schweitzer-D Gov. Montana, perhaps?) up against god knows who from the GOP. Regardless, by 2016 there will be another two full years of ACA signups in place. The healthcare cost curve will likely continue to bend in a favorable fashion and the screwups in the individual marketplace from 2013 will seem like ancient history. If the platform for the GOP is going to be a version of "let's take something away from millions of people we'd like to vote for us and still get them to vote for us" well, that'll be quite something to watch.

2013 was a very good year for the Affordable Care Act simply because it suffered no fatal blows. The patient continues to survive and get stronger every day. If the ACA was considered in "critical condition" prior to the Supreme Court vote back in early June of 2012, we might today classify it in "fair condition, but the prognosis is good as the patient is improving."





Tuesday, December 17, 2013

Healthcare Triage: Survival vs. Mortality Rates...(What's it really mean?)

The latest episode of Healthcare Triage.

As many of our readers are middle aged, we're (as a group) starting to get diagnosed with more and more conditions and diseases. If you've followed Reasonable Conversation, you know we devote a lot of our attention on healthcare reform and policy. We've all heard the terms "Survival Rates" and "Mortality Rates" tossed around, but what do they mean and what's the difference. As we get older, its going to be useful to understand how the terms are most often used, what they tell us and how politicians often mis-ise them to make their political points.

 The preview from Healthcare Triage:

 Almost every time someone wants to proclaim the US to be the "best in the world" in health care, they point to survival rates. Those refer to the percent of people who live a certain amount of time after they've been diagnosed with a disease. But there are real problems in using survival rates to compare the quality of care across systems. The metric people should be using is mortality rates. And when we compare mortality rates, we don't look nearly as good. Why is this important? Glad you asked. We answer in this week's episode.


 Subscribe to their You Tube channel to watch all Healthcare Triage episodes...

Friday, December 13, 2013

Conservatives speak up for Mandela

With the death of Nelson Mandela, some American conservatives haven't spoken highly of South African leader, particularly in reference to his background that included flirtations with violence and Communism. But there are other voices on the right taking the opposite view, recognizing his transcendent leadership and principled fight against oppression.

Try this from an article by longtime Mandela supporter Newt Gingrich:

Some of the people who are most opposed to oppression from Washington attack Mandela when he was opposed to oppression in his own country. After years of preaching non-violence, using the political system, making his case as a defendant in court, Mandela resorted to violence against a government that was ruthless and violent in its suppression of free speech.

As Americans we celebrate the farmers at Lexington and Concord who used force to oppose British tyranny. We praise George Washington for spending eight years in the field fighting the British Army’s dictatorial assault on our freedom.
Patrick Henry said, “Give me liberty or give me death.” ...
Doesn’t this apply to Nelson Mandela and his people?
Some conservatives say, ah, but he was a communist.
Actually Mandela was raised in a Methodist school, was a devout Christian, turned to communism in desperation only after South Africa was taken over by an extraordinarily racist government determined to eliminate all rights for blacks.
I would ask of his critics: where were some of these conservatives as allies against tyranny? Where were the masses of conservatives opposing Apartheid? In a desperate struggle against an overpowering government, you accept the allies you have just as Washington was grateful for a French monarchy helping him defeat the British.
Finally, if you had been imprisoned for 27 years, 18 of them in a cell eight foot by seven foot, how do you think you would have emerged? Would you have been angry? Would you have been bitter?
Nelson Mandela emerged from 27 years in prison as an astonishingly wise, patient, and compassionate perso …
 As much as any person in our lifetime he had earned our respect and our recognition.

Before you criticize him, ask yourself, what would you have done in his circumstances?


There is this from the Washington Times:

Communists were right to support both the African National Congress and the cause of ending apartheid. Conservatives were on the wrong side of history on the issue. The true conservative position on apartheid should have been to oppose it...

The oppression of blacks under apartheid was far more morally odious than the oppression that the Founding Fathers opposed — and fought the Revolutionary War to destroy. It is repulsively hypocritical to maintain that Nelson Mandela was a terrorist for fighting for the freedom of his people, while reverencing the Founding Fathers of America for doing the same thing — under an indisputably less oppressive regime.


Finally, conservative columnist Deroy Murdock admits he had been wrong about Mandela in the National Review:

Like many other anti-Communists and Cold Warriors, I feared that releasing Nelson Mandela from jail, especially amid the collapse of South Africa’s apartheid government, would create a Cuba on the Cape of Good Hope at best and an African Cambodia at worst...

Nelson Mandela was just another Fidel Castro or a Pol Pot, itching to slip from behind bars, savage his country, and surf atop the bones of his victims.


Far, far, far from any of that, Nelson Mandela turned out to be one of the 20th Century’s great moral leaders, right up there with Mahatma Gandhi and Dr. Martin Luther King Jr. He also was a statesman of considerable weight. If not as significant on the global stage as FDR, Winston Churchill, and Ronald Reagan, he approaches Margaret Thatcher as a national leader with major international reach.


RIP Madiba.

Links to the quoted articles:

Newt Gingrich

Washington Times

Deroy Murdock/National Review:

Monday, December 9, 2013

How is Obamacare Paid For? (The Details...)

Healthcare Triage devotes this week's issue to explaining, in less than 7 minutes, exactly how the Affordable Care Act is paid for. Dr. Carroll, take it away:

 (Reasonable Conversation dedicates this post to our friend and faithful reader, Mr. Keith Baklarz...)

Thursday, December 5, 2013

Nelson Mandela Dies...

Nelson Mandela
July 18, 1918 - December 5, 2013

The Associated Press has a detailed obituary:

Former South African President and anti-apartheid revolutionary hero Nelson Mandela has died at his Johannesburg home. He was 95.
He had returned home on September 1 in a critical condition after being in a Pretoria hospital for almost three months -  the fourth time he had been admitted to hospital since December. He had battled a series of lung infections and respiratory illnesses in the past few years.
Mandela, who spent 27 years in prison after being found guilty of being sabotage and conspiracy to overthrow his country's government before being released in 1990, became South Africa's first democratically elected president, holding office from 1994 to 1999.
One of the world's most famous people, he has long been a figurehead for racial unification, following his efforts to heal his own country after centuries of division.
News of his death has prompted an outpouring of grief from all corners of the world.
Mandela had a history of lung problems, after falling ill with tuberculosis in 1988 toward the tail-end of his prison term before his release and subsequent presidency.
While doctors said at the time the disease caused no permanent damage to his lungs, medical experts say tuberculosis can cause problems years later for those infected.
The Nobel laureate had an acute respiratory infection in January 2011.
Following the chaos that surrounded his stay at a public hospital then, the South African military took charge of his care and the government took over control of the information about his health. It released little, mostly saying early in his last hospital stay that he was in a "serious but stable condition'', but in late June it said he was "critical but stable''.  In July the government denied that he was in a vegetative after a lawyer for some of his family told a court his life support system should be shut off.
Mandela was one of the most revered leaders of the 20th century and his legacy will forever be the abolition of apartheid in South Africa.
The man endearingly known throughout South Africa as Madiba - his Xhosa clan name, which literally translates to grandfather - cemented his place in history when he became the first democratically elected president - black or white.
As a founder of Umkhonto we Sizwe (Spear of the Nation), which was the armed wing of the African National Congress (ANC), Mandela was a militant anti-apartheid activist from a young age.
He was sentenced to life in prison after being charged and convicted of sabotage in 1962.
Left to the mercy of the prison guards in a white supremacist South Africa, his release 27 years later in 1990 set in motion the cogs of an anti-apartheid movement that had the backing of much of the world.
His release was all the more astonishing for a total lack of animosity toward his captors. In a speech on the day of his release, Mandela quoted his own words, which he spoke at his trial in 1962:
"I have fought against white domination and I have fought against black domination. I have cherished the ideal of a democratic and free society in which all persons live together in harmony and with equal opportunities.
"It is an ideal which I hope to live for and to achieve. But if needs be, it is an ideal for which I am prepared to die."
Four years later apartheid in South Africa had ended and in 1995 Mandela became the first elected president - ending the irony behind the name the Republic of South Africa.
His presidency was spent building what his inaugural address called a "rainbow nation at peace with itself and the world".
As the ANC party under Mandela began to dismantle the racial divide, his attention turned to the issue of HIV/AIDS, which according to the World Health Organisation, affects about 6.5 million people in South Africa.
But the crusade was more personal for Mandela, who lost his eldest son in 2005 to the disease at the age of 54.
After his departure from politics, Mandela also sought to step away from the public eye with appearances in recent years becoming fewer and farther between.
His last public appearance was in 2010 when South Africa hosted the FIFA World Cup.


Blogging, as you've probably noticed has been fairly light the last few weeks. Mostly the reason for this is the annual increase in my performance schedule. From mid November through New Year's Day, my schedule essentially doubles. Which doesn't leave much time for writing...

I have been reading, however, lol...

Of late I've been very frustrated with:

*The Healthcare.gov rollout, which defies all logical understanding. Obama and his team did themselves no favors by not being more hands on and more open to the true feelings and concerns of their IT team. The "you can keep it if you like it" mispeak/lie will hang around Obama neck for a while. Yet another unforced error by our President.

*The GOP's bogus reaction to people losing their insurance. First of all, its a fairly thin slice, less than 10% of the entire health insurance market, who lost their coverage. Secondly, where exactly was the GOP's outrage the last ten years or so as the individual market routinely tossed people off their plans when they felt like it? If it didn't outrage you then, it shouldn't outrage you now.

*I've given a lot of thought to the question of raising the minimum wage and I agree with many voices on the left that it should be increased. Several states have raised their minimum wage levels (Oregon and New Jersey to name two.) I suspect in time more and more will follow suit.

*I'm still looking for the first conservative to make the connection between Iran being allowed to sell its oil on the world market and lower gas prices here in the United States. As so many right wing armchair economists have told me for years, increased supply means a dropping of prices, which was the basis for increasing domestic oil production. Well, Iran is now allowed to sell its oil on the world market, which increases supply and look what happened to our gas prices. Down significantly the last few weeks. How about that?

*My partner Tim Dickinson is away on assignment until after the first of the year.

*Blogging will be light through the first of the year...basically, I'll post when I can...

Happy Holidays!


Sunday, November 24, 2013

Healthcare Triage #5: Turkey Doesn't Make You Sleepy...

You've heard the notion that eating a lot of turkey makes a person sleepy because of the Tryptophan it contains, right?

Well, its wrong...

Here's Doctor Aaron Carroll explaining the whole thing...

Go eat turkey! Happy Thanksgiving!

Wednesday, November 20, 2013

Why Do Presidents Even Bother To Reform Health Care?

Terrific read from David Blumenthal at The Commonwealth Fund on the incredible difficulty that several presidents have encountered in trying to reform our failed healthcare system. From Truman to Johnson, from Carter to Obama, one has to ask themselves, why bother?

It's called:

Reflecting on Health Reform—The Presidential Health Care Curse: Why Do They Bother?

Last week the Commonwealth Fund released its 13th cross-national survey documenting health care experience in the developed world. Based on responses from more than 20,000 individuals in 11 countries, the survey shows unequivocally that the United States has the worst health insurance among industrialized nations. Whether you’re talking administrative hassles, out-of-pocket expenses, costs of administration, complexity of policies, or adequacy of coverage, the U.S. consumer gets a bad deal. 
The system is not only bad, but getting worse. Every year, more people lose insurance as they or their (usually small) employers get priced out of the health insurance market by rising premiums. The Commonwealth Fund biennial health insurance survey shows that 55 million Americans are now uninsured and, equally telling, another 30 million are underinsured, meaning that they spend more than 10 percent of their income on medical expenses despite having health care coverage (5 percent if their income is under 200 percent of poverty). The U.S. has more uninsured and underinsured citizens than the entire population of Germany, where, by the way, private insurance organizations compete, no one is uninsured or underinsured, and the economy is thriving. 
Good stuff...go read!!!

How Doctors Die: Showing Others The Way...

Powerful article in today's New York Times from NPR's Dan Gorenstein on how some Physicians are preparing themselves for death. They have many the same fears the rest of us do, but there is one significant difference in how they approach their end of times than how many of us do.

An excerpt:

There is no statistical proof that doctors enjoy a better quality of life before death than the rest of us. But research indicates they are better planners. An often-cited study, published in 2003, of physicians who had been medical students at Johns Hopkins University found that they were more likely than the general public to have created advance directives, or living wills, which lay out specific plans for care if a patient is unable to make decisions. Of the 765 doctors studied, 64 percent had advanced directives, compared with about 47 percent for American adults over 40.

Read the full article here:


JFK's "President And The Press" Speech...How Would It Play Now?

This Friday marks the 50th anniversary of the assassination of our 35th President, John F. Kennedy. There is plenty of coverage across many media platforms of late to mark the occasion. I'll leave it to my readers to seek out their preferred source for this content.

This morning, I gave attention to a speech President Kennedy gave on April 27th, 1961 at the Waldorf Astoria in New York City to a meeting of the American Newspaper Publishers Association. The gist of the speech focuses on what President Kennedy felt the role of the press was in terms of covering his Administration. He had taken the oath of office on January 20th, 1961, so had served a fairly short time. To my knowledge, these remarks were his first extended comments directed toward the press.

Its an interesting speech Kennedy titled "President And The Press." Throughout the speech, care is taken to praise as highly important, valuable and necessary, the role of the press in our Country.

"Without debate, without criticism, no Administration and no country can succeed—and no republic can survive. That is why the Athenian law-maker Solon decreed it a crime for any citizen to shrink from controversy. And that is why our press was protected by the First Amendment—the only business in America specifically protected by the Constitution—not primarily to amuse and entertain, not to emphasize the trivial and the sentimental, not to simply "give the public what it wants"—but to inform, to arouse, to reflect, to state our dangers and our opportunities, to indicate our crises and our choices, to lead, mold, educate and sometimes even anger public opinion.

Kennedy continues:

"No President should fear public scrutiny of his program. For from that scrutiny comes understanding; and from that understanding comes support or opposition. And both are necessary. I am not asking your newspapers to support the Administration, but I am asking your help in the tremendous task of informing and alerting the American people. For I have complete confidence in the response and dedication of our citizens whenever they are fully informed."

It is quite obviously a dramatically different time that the press operates in today. Exponential growth of its industry as a result of the internet, which has resulted in an explosion of "information" websites, blogs and bloggers, as well as the expansion of our television viewing options brings us to a place never before visited by the American people. Intuitively, most agree that more and better access to information is both important and desirable. Are there limits? Can the press be compared to an automobile? Speed is good but isn't there a degree where too much acceleration poses more of a threat than a benefit? Of course. Society has decided that for the vast majority of our roads and highways there will be a limit to be observed and penalties applied if a motorist elects not to.

Similarly, today's "news" media doesn't deliver "just news" (pun intended.) An intoxicating blur between information and entertainment aka "infotainment" I say has done far more harm than good. Too many viewers see no distinction between the two forms and are worse off for it. To confuse Glen Beck with Chris Wallace, to confuse Ed Schultz with Andrea Mitchell, to confuse Sean Hannity with Ed Henry, etc. has its price. While television, radio, the web are mostly revenue seeking and revenue driven enterprises, the audiences tuning in/clicking on their favorites too often seem not to be aware of the difference or perhaps not to care. Either way, its a sad state we find ourselves in. 

Kennedy asks his audience the basic question of is additional restraint to be expected from our media when it comes to matters of national security? He does not answer his question, rather leaving it to his listeners to consider it and do as their conscience guides them. A conscience that Kennedy seems to have a confidence in producing the right decision. (Boldface mine.)

"That question is for you alone to answer. No public official should answer it for you. No governmental plan should impose its restraints against your will. But I would be failing in my duty to the Nation, in considering all of the responsibilities that we now bear and all of the means at hand to meet those responsibilities, if I did not commend this problem to your attention, and urge its thoughtful consideration.

On many earlier occasions, I have said—and your newspapers have constantly said—that these are times that appeal to every citizen's sense of sacrifice and self-discipline. They call out to every citizen to weigh his rights and comforts against his obligations to the common good. I cannot now believe that those citizens who serve in the newspaper business consider themselves exempt from that appeal.

I have no intention of establishing a new Office of War Information to govern the flow of news. I am not suggesting any new forms of censorship or new types of security classifications. I have no easy answer to the dilemma that I have posed, and would not seek to impose it if I had one. But I am asking the members of the newspaper profession and the industry in this country to reexamine their own responsibilities, to consider the degree and the nature of the present danger, and to heed the duty of self-restraint which that danger imposes upon us all."

I wonder aloud today, how such a speech would be received today? I suspect not very well. A percentage of media outlets would find it to be quite acceptable, while others would find it offensive and set out with its consumers a mission of objecting to a President of the United States attempting to, albeit with clever words, censor the Fourth Estate. 

I am reminded of a famous quote by one of our earliest journalistic heroes, Edward R. Murrow. Allowing myself some light editing, I suggest his words address my primary concern rather well: (Boldface mine.)

We will should not walk in fear, one of another. We will should not be driven by fear into an age of unreason, if we dig deep in our history and our doctrine, and remember that we are not descended from fearful men — not from men who feared to write, to speak, to associate and to defend causes that were, for the moment, unpopular. This is no time for men who oppose Senator McCarthy's methods to keep silent, or for those who approve. We can deny our heritage and our history, but we cannot escape responsibility for the result. There is no way for a citizen of a republic to abdicate his responsibilities. As a nation we have come into our full inheritance at a tender age. We proclaim ourselves, as indeed we are, the defenders of freedom, wherever it continues to exist in the world, but we cannot defend freedom abroad by deserting it at home. The actions of the junior Senator from Wisconsin the media have caused alarm and dismay amongst our allies abroad, and given considerable comfort to our enemies. And whose fault is that? Not really his. He didn't create this situation of fear; he merely exploited it—and rather successfully. Cassius was right. "The fault, dear Brutus, is not in our stars, but in ourselves." 

(H/T to Tim Farley/POTUS Sirius/XM Channel 124)


Thursday, November 14, 2013

President Obama Screws This Up...Let me count the ways....

Sarah Kliff of the Washington Post the details on the proposed "fix" from President Obama to address those policy holders who have recently lost their coverage.

Its a mess.

The whole thing is a god-damned mess.

A few thoughts:

1) No excuse for this. Many pro-ACA people were looking forward to a reasonably competent rollout on October 1st. The expectation wasn't perfection, but something usable that most people could access and find a reasonable experience awaiting them. Didn't happen. Now, a lot of people who were apprehensive about this idea in the first place are even less inclined to give it a chance. True, many don't really get a choice, but my God, does it look silly and amateurish. The White House knew this time was coming and fucked it up anyway. All that crap we listen to on a daily basis about how Government doesn't anything very well just got a whole lot stinkier.

2) Another thing this White House screwed up royally was in permitting Mr. Obama to repeat over and over again that "if you like your health insurance, you can keep your health insurance." I don't buy that no one thought about the small percent of consumers for whom this would not hold true. I think the White House realized it would perform poorly politically and just decided to procrastinate on dealing with it. Wrong move.Perhaps the White House did try to warn the POTUS and he ignored them. Who knows? Regardless, almost nothing of this sort improves by being ignored. Again, you look foolish at best and a liar at worst on this one.

3) Lest I give the loyal opposition a pass, I also don't believe that no one from the Republican party who realized this issue for the 5% individual market really gives a crap about them staying insured. No voices proposed any solutions, they were too busy voting on full repeal votes in the House or shaving bits and pieces of the law wherever they could. They were perfectly happy to let this crash and then raise holy hell, rather than exert pressure on the Administration months ago to avoid this. The blind squirrels found themselves a nut, finally after months of looking for them.

4) The media is also doing itself no favors with Obamacare. I know that the happy stories don't play nearly as well as the disaster stories do, but give me a break, would you? Many of the disaster stories have already been debunked, but again, perception is reality. More damage done.

5) Surely I'm not alone today in telling President Obama, the White House, both parties, etc. you are ALL at times simply pathetic. This sort of performance doesn't fly in the private sector and as the guardians of our Country, we deserve better than this. We really do. How much of this is political game playing and how much is incompetence, I can't say other that that I suspect there's plenty of both to go around.

I still support the ACA. More than a million Americans are on their way securing new health insurance as a result of the ACA and that is a good thing. It will improve, certainly. Some day, these frustrations will be behind us. But until then...

Please get your heads out of your asses, would you?



Wednesday, November 13, 2013

Do Republicans Really Want People to Keep Their Old Insurance?

We all know the rollout of President Obama's signature legislative achievement has been a disappointing combination of both pathetic and laughable. Aside from the website debacle, we have the mess of "if you like your insurance, you can keep your insurance." A few additional words added to that quote from Mr. Obama would've made life a lot easier for the President's team.

Republicans and conservative media are really hammering the POTUS on the "promise" he made several times. We see a regular dose of people with cancellation letters telling their stories on Fox News. Gloom and doom are here, friends...

The White House has its work cut out for them. The need to figure out a way that they can permit this 5% of insured, the individual market as its known, to keep the coverage they most recently had? Its almost a certainty that additional subsidies would be needed to help pay for the continued coverages.

We'll find out pretty soon just how bad the GOP really wants these folks to keep their own insurance. If President Obama proposes an additional level of subsidies and the Republicans say no to the required money to fund it, the tables will turn quickly, won't they?

If the GOP says, no, we can't spend any more money on the ACA, that will take the White House of the hook.

Which is what I predict will happen over the next six weeks.

Tuesday, November 12, 2013

Why Obamacare’s Troubled Rollout Might Force the Cooperation Health Reform Needs

Excellent piece by The Incidental Economist's Harold Pollack.

Why Obamacare’s Troubled Rollout Might Force the Cooperation Health Reform Needs

An excerpt:

The administration and its supporters made some serious errors. Yet they didn’t commit the only or the most epic failures here. News media are also making sowing public confusion. Major outlets repeatedly misreported stories of coverage cancellations within the individual and small-group marketplace. A series of stories described the predicament of specific people whose insurance was apparently cancelled, and who now apparently face massive premium increases because of health care reform. Anecdata always has the potential to mislead. Consumers with individual or small-group policies that have been cancelled are a tiny proportion of the insured, and are also a small proportion of those most affected by health reform. Many of the cancelled plans were incredibly limited, and would not have protected people from financial ruin in the event of serious injury or illness. Many people whose coverage was cancelled are eligible for subsidies on the new health insurance exchanges or are now eligible for Medicaid. Some are young adults who can enroll on a parent’s group plan.
A striking proportion of supposed ACA horror stories fall apart entirely when subjected to scrutiny. A particularly egregious example: On October 11, Sean Hannity featured featured six ostensible victims of Obamacare. Each of the six stories proved fell apart upon straightforward fact-checking conducted by Salon’s Eric Stern. To my knowledge, Hannity has run no correction.

Monday, November 11, 2013

A Graphic Depiction of What Our Soldiers Are Being Subjected To In These Senseless Wars.

There is a new book out that is especially topical today. Ann Jones' new book, "They Were Soldiers: How the Wounded Return from America's Wars—The Untold Story" ($12.95, Haymarket Books)

A summary from the publisher:

Ann Jones shines a much-needed light on the dead, wounded, mutilated, brain-damaged, drug-addicted, suicidal, homicidal casualties of our distant wars, taking us on a stunning journey from the devastating moment an American soldier is first wounded in rural Afghanistan to the return home. Beautifully written by an empathetic and critical reporter who knows the price of war.

Read a short, but powerful excerpt about a surgeon's first surgery on a soldier who had stepped on an IED in Afghanistan:

His first surgical patient, three days after he arrived at Bagram, was a young soldier who had stepped on an IED, triggering an upward blast that destroyed his legs and left his pelvic cavity “hollowed out.” His urinary system was in shreds. His testicles were destroyed. His penis was attached to his body by only “a little thread of skin.” That first surgery, the doctor said, was “emotional” for everyone on the surgical team. “The others hadn’t seen anything like these injuries for a while,” he said, “and I had never seen anything like it. To have to amputate that boy’s penis and watch it go into the surgical waste container—it was emotional.”
In two months at Bagram, the urological surgeon had done 20 similar surgeries, though that was the worst. Injuries confined mainly to the testicles are “easier,” he says, but for the soldiers they are brutally serious. Most soldiers who survive blasts that require high-level amputations of their legs also suffer severe injury to the scrotum and ruptured testicles. Surgeons can debride and clean the scrotum, and in many cases salvage at least part of one testicle and put it back. Keeping even part of his genitals is a psychological break for the soldier, but since the testicles produce testosterone, he still faces the inevitable ill effects of a deficient supply—a long and imperfectly understood list headed by osteoporosis, metabolic syndrome, cardiovascular problems including coronary artery disease and atherosclerosis, erectile dysfunction with its attendant psychological difficulties, low sperm count impairing fertility, obesity, depression, and a lifetime seesaw of hormonal treatment.
The full excerpt as published in the Alternet article, provides a fascinating and detailed look into what the experience is actually like. If you read my earlier post from this morning, THESE men and women reach the threshold for hero in my book.



All Vets Are Not Created Equal...

Veterans's Day, 2013...

I never served.

I didn't want to serve when I was of age.

Now in my 50's looking back, I think the experience would have been far better than I thought it would at the time.

Every year, we honor those fellow citizens who have served in our country's military. The accolades and praise are highly deserved for many. To volunteer to do a job where you are directly involved in high risk, high danger tasks isn't for everyone. When the job description includes avoid the bad guys trying to kill you in places most of us can't find on a map, it becomes a thing like no other.

To all the front line soldiers, infantry, engineers, etc. who are in harm's way on a constant basis, huge thanks to you guys. I don't quite subscribe to the overused phrase "they're fighting for our freedom" but that's more of a political issue. These guys/gals follow orders, do really hard/dangerous stuff and too often pay a high price for doing so. PTSD is at epidemic levels, far too many vets are seeing shamefully hard times upon discharge, too many families are paying the price for their loved ones serving the country. The issue of military suicides is beyond shameful and our leaders need to spare no expense at making these folks whole again. Period.

I can't however, in good conscience, group the folks I've just described with everyone in the military. Those folks who work in safe environments, often stateside in support positions, don't warrant the same recognition that the front liners and risk takers deserve. I've never been able to portion out the same respect for a sax player in the Air Force band as I do a sniper taking point in Iraq. Big, big difference to me.

I support everyone who works for our military and appreciate what they do. I reserve special and higher respect for those who went to work on a daily basis with a real fear that they may not live to see the next one. Again, putting all politics aside, these guys/gals are pretty admirable folks.

To say everyone in the military is a hero on days like today, I think does a real dis-service to the real heroes in uniform. To make this distinction shouldn't make one less a Patriot, either. Just a realist.

Happy Veterans Day!

Saturday, November 9, 2013

Obamacare By The Numbers. ..

Sarah Kliff of the Washington Post uses some easy to read graphs to illustrate the President's new health care program. A fresh look I haven't seen done as well any where else.   


Friday, November 8, 2013

Ezra Klein on President Obama's "apology" and why the Private Insurance Market is a Mess...

Ezra Klein had a top rate piece this morning on the "apology" President Obama gave to the American people via a sit-down interview with NBC's Chuck Todd last night. Klein believes the President owed an apology for his now infamous "if you like your coverage, you can keep it" quote that we're all sick of. Klein also makes a sound case as to why Obama was exactly right to reform the individual insurance market.

An excerpt:

"The individual market -- which serves five percent of the population, and which is where the disruptions are happening -- is a horror show. It's a market where healthy people benefit from systematic discrimination against the sick, where young people benefit from systematic discrimination against the old, where men benefit from systematic discrimination against women, and where insurers benefit from systematic discrimination against the uninformed."

The article is very much worth your time...

Go read....



Monday, November 4, 2013

What is Health Insurance, and Why Do You Need It?: Health Care Triage #2

The latest from Dr. Carroll and Health Care Triage: In this episode, Carroll gives an overview of what health insurance is, a short history of what's been tried in the United States and what we're looking at going forward under the Affordable Care Act.

If you enjoyed this, please subscribe to his You Tube channel so you can follow along as they release new videos every Sunday afternoon.

Friday, October 25, 2013

Republicans Should Give Sec. Sibelius a Medal...

  MANY of us are left shaking our heads at the mis-management the Obama Administration has displayed with regard to the roll out of the Affordable Care Act's website site, www.healthcare.gov. We're learning of massive lack of vertical communication, an apparent state of denial within the White House after a test run of a mere one hundred subjects choked the system in the days before October 1st's national debut. It's unimaginable to me how the upper-most members of the Administration didn't know there were major issues with the website and there was big trouble ahead.

  This isn't the first crisis I've shaken my head at how the White House handled things. The "Beer Summit" fiasco, the President waiting too long to produce his birth certificate to put the loonies at rest and I'm one that thinks the Bhengazi affair could've been handled better.

  On the other hand, the ruckus the Republican Party is raising about the Affordable Care Act's website woes is a thing of beauty. The calls for heads to roll, the lamenting of no apologies being offered, etc. is just too much to take.

Ezra Klein in Thursday's Wonkblog covered the topic beautifully:

The classic definition of chutzpah is the child who kills his parents and then asks for leniency because he's an orphan. But in recent weeks, we've begun to see the Washington definition: A party that does everything possible to sabotage a law and then professes fury when the law's launch is rocky.
On Tuesday, Rep. Paul Ryan became the latest Republicans to call for HHS Secretary Kathleen Sebelius to step down because of the Affordable Care Act's troubled launch. "I do believe people should be held accountable," he said.
Okay then.
How about House Republicans who refused to appropriate the money the Department of Health and Human Services said it needed to properly implement Obamacare?
How about Senate Republicans who tried to intimidate Sebelius out of using existing HHS funds to implement Obamacare? "Would you describe the authority under which you believe you have the ability to conduct such transfers?" Sen. Orrin Hatch demanded at one hearing. It's difficult to imagine the size of the disaster if Sebelius hadn't moved those funds.
How about congressional Republicans who refuse to permit the packages of technical fixes and tweaks that laws of this size routinely require?
How about Republican governors who told the Obama administration they absolutely had to be left to build their own health-care exchanges -- you'll remember that the House Democrats' health-care plan included a single, national exchange -- and then refused to build, leaving the construction of 34 insurance marketplaces up to HHS?
How about the coordinated Republican effort to get the law declared unconstitutional -- an effort that ultimately failed, but that stalled implementation as government and industry waited for the uncertainty to resolve?
How about the dozens of Republican governors who refused to take federal dollars to expand Medicaid, leaving about 5.5 million low-income people who'd be eligible for free, federally-funded government insurance to slip through the cracks?
The GOP's strategy hasn't just tried to win elections and repeal Obamacare. They've actively sought to sabotage the implementation of the law. They intimidated the people who were implementing the law. They made clear that problems would be exploited rather than fixed. A few weeks ago, they literally shut down the government because they refused to pass a funding bill that contiained money for Obamacare.
The Obama administration deserves all the criticism it's getting for the poor start of health law and more. Their job was to implement the law effectively -- even if Republicans were standing in their way. So far, it's clear that they weren't able to smoothly surmount both the complexities of the law and the political roadblocks thrown in their path. Who President Obama will ultimately hold accountable -- if anyone -- for the failed launch is an interesting question.
But the GOP's complaints that their plan to undermine the law worked too well and someone has to pay border on the comic. If Republicans believe Sebelius is truly to blame for the law's poor launch, they should be pinning a medal on her.
  There is plenty of blame to go around. On one side we have incompetence on the other, we have obstruction, ill-will, and an obsessive selfishness the scale of which I've never witnessed before.

 I have little patience for either side, but the whining from the Right is just too much...

They all seem like jerks today...





Thursday, October 24, 2013

Congressman Grayson's Tasteless KKK Reference...

Congressman Alan Grayson's recent fundraising email to prospective contributors is a disgrace. In it, he posts a picture of a burning cross that represents the "T" in Tea Party. Grayson is also quoted to say" at this point, the tea party is no more popular than the KKK."

While I don't consider myself a fan of either group, to equate the tea party with a hate group is a bit of a stretch. I know of no example where there are duly elected congressman with full and wide spread endorsement from the KKK. On the other hand, there are dozens of elected congressman who can thank the tea party movement for their current positions.

(Click on the image below to enlarge it...)

Not that long ago I felt the Democratic Party had two bright, youthful faces that would surely play a prominent role in party politics on the national level. Both seemed energized, determined, smart and capable of providing some fresh leadership on an otherwise somewhat short bench. Certainly when compared to the GOP's bench of future leaders Rubio, Paul, Ryan, Christie, Cruz, etc. 

Their names were Anthony Weiner and Alan Grayson and I was wrong.

Weiner has too hard of a time keeping his privates to himself, and wasted a second chance. He's done. Grayson seems to be one you can count on to throw gasoline on a fire, instead of devising ways to extinguish it. To my mind, a KKK reference is in the same ballpark as a Hitler reference is. Its stupid, its over the top and it diminishes the person saying or writing it.

The Republican Party will, I think, sort through its current issues eventually. The Democratic Party doesn't seem to have many folks ready to step up on the national stage and lead in the post-Obama era. While I think there's a good chance Hillary Clinton will run and receive the Party's nomination in 2016, I'm not so sure she will be the slam dunk many progressives feel she is. Mrs. Clinton has some explaining to do when it comes to Bhengazi and pounding the table and barking "what does it matter" (while taken out of context) is going to be front and center in opposition media ads. Count on it.

Mr. Grayson, had he played his cards more along the lines of Minnesota's Senator Al Franken, who has mostly quietly tended to his business and proven to be a serious member of the Senate, could have been a factor going forward in Democratic politics. He will not.

Instead, Mr. Grayson will be a sideshow.

For more of Mr. Grayson "thoughtful" remarks, I direct you to the follow video collection:



Monday, October 21, 2013

Who's Really To Blame for Rising Health Care Costs?

Josh Moon from the Montgomery Advertiser writes:

Let me break some bad news: You’re being played

 A small number of people with their own self interests in mind are running a con game on you concerning the health care reform. They’ve convinced you — and it wasn’t hard to convince some of you — that Obama’s goal is to limit your health care choices, redistribute your wealth and control your lives.

Moon lays out in clear and concise fashion where the blame is better placed for increasing health insurance premiums. Rather than understand (more importantly accepting) that insurance companies have been increasing our rates for over a decade while the "free market" did its magic, too many people are quick to point the finger at President Obama's Affordable Care Act. Which is ironic because for the first time in memory the insurance companies now have limits to how much they can increase the premiums on health care plans. They also have to justify their increases. They also have to spend a minimum of .85 of every premium dollar on actual health care (as opposed to marketing, advertising, executive compensation, etc) or refund people some of their money.

Two things strike me as headshakers in this ongoing debate. The irrational refusal to accept that the free market hasn't served us well enough and that the ACA isn't to blame for everything that is wrong in the world of health insurance today.

Moon makes his case in less than two pages, give it a read here...

Source: http://www.montgomeryadvertiser.com/article/20131020/NEWS01/310200036/Josh-Moon-s-Just-Saying-Who-s-really-blame-rising-health-care-costs-?fb_action_ids=10200793236018749&fb_action_types=og.recommends&fb_ref=artsharetop&fb_source=other_multiline&action_object_map=%7B%2210200793236018749%22%3A343759305761441%7D&action_type_map=%7B%2210200793236018749%22%3A%22og.recommends%22%7D&action_ref_map=%7B%2210200793236018749%22%3A%22artsharetop%22%7D&nclick_check=1

Thursday, October 17, 2013

Worthwhile Read This Morning on Reducing the Deficit...

Economic journalist and financial strategist Barry Ritholz has a great article up on his Big Picture Blog this morning where he discusses how we can reduce our deficit and questions some of the loudest voices real intentions/motivations.

An excerpt:

If you are truly concerned about deficit, then what you must do is (eventually) raise taxes and cut spending — that is how you balance the budget.
Current deficit is now ~$550B, down from over $1T.
If the tax cuts from 2001, 2003 were repealed, half of that deficit goes away.
If the FICA cap is lifted from $113k and allowed to rise to $250k or $500k, SS is solvent for 75 years.
If the US no longer spent the equivalent of the next 20 countries COMBINED on Defense, a huge chunk of the deficit goes away.
The US now spends 2X what most developed nations spend on healthcare. If you are concerned about the long term debt, than you must develop a system that radically lowers US health care costs, bringing them into line with what other industrialized nations spend.
Makes sense to me. 
There's more, of course. Read the whole thing here...