The Sabotage of Obamacare...

Great article by Norm Ornstein in the National Review.

A preview:

But to do everything possible to undercut and destroy its implementation—which in this case means finding ways to deny coverage to many who lack any health insurance; to keep millions who might be able to get better and cheaper coverage in the dark about their new options; to create disruption for the health providers who are trying to implement the law, including insurers, hospitals, and physicians; to threaten the even greater disruption via a government shutdown or breach of the debt limit in order to blackmail the president into abandoning the law; and to hope to benefit politically from all the resulting turmoil—is simply unacceptable, even contemptible. One might expect this kind of behavior from a few grenade-throwing firebrands. That the effort is spearheaded by the Republican leaders of the House and Senate—even if Speaker John Boehner is motivated by fear of his caucus, and McConnell and Cornyn by fear of Kentucky and Texas Republican activists—takes one's breath away.

Its really worth a few moments of your time.  Click here to read the whole thing...

Source: 

http://www.nationaljournal.com/columns/washington-inside-out/the-unprecedented-and-contemptible-attempts-to-sabotage-obamacare-20130724?wpisrc=nl_wonk_b

Will ACA implementation succeed or fail? - Health Stew - Boston.com

Great read from John McDonough/Health Stew Blog....

"Must read article in the Washington Post this week by Ezra Klein and Sarah Kliff on the implementation of the Affordable Care Act/Obamacare: Obama's last campaign: Inside the White House plan to sell Obamacare. The ACA is the most complex domestic policy implementation in U.S. history, and chances for screw-ups are significant, especially when the opposition is doing everything in its power to encourage screw-ups, and then to blame the Administration for them."

Will ACA implementation succeed or fail? - Health Stew - Boston.com:

How ESPN/ABC News Won the Services of Nate Silver...

 Sunday's Politico Playbook has a interesting write-up on how ESPN/ABC News lured stat whiz Nate Silver to their team, over his former partner, The New York Times. Is this a big deal? Probably. The Times badly wanted Silver to remain on board and was willing to increase their commitment to his work substantially. ESPN, however, also has deep pockets and in the end, Silver decided he liked the offer from the sports network/ABC News combination more than he did from the Times.

 Politico's Mike Allen lays it out...

BEHIND THE CURTAIN - COURTING NATE SILVER : The battle for data whiz Nate Silver, fought secretly and aggressively by several of the nation's top news executives for the better part of a year, was won by ESPN and ABC News (both part of The Walt Disney Company) after the 35-year-old was promised extensive air time, a role in the Oscars (airing on ABC through at least 2020), and a digital empire that may include websites devoted to weather, education, economics and other topics. When it came to money, Silver was aggressive but not greedy, according to people familiar with the negotiations. Instead, he was focused on how he could expand the franchise he had built around FiveThirtyEight (the total number of electoral votes). FiveThirtyEight.com began as a standalone blog in 2008, and became part of NYTimes.com in 2010 as part of a three-year licensing agreement that ends next month.

In a stroke of luck for Silver , the negotiations began shortly after the frenzy over his 2012 forecasts showing President Obama would be easily reelected, which had become a running topic on cable news and late-night television - and even drew a shout-out from the president himself. There was early interest from NBC and Bloomberg. But for many months, Silver's conversations have pitted ESPN/ABC against The Times. Executive Editor Jill Abramson led the Times negotiations, and retaining Silver was such as high priority that publisher and chairman Arthur Ochs Sulzberger Jr. and CEO Mark Thompson were involved. The reasons Times executives were so obsessed with Silver were both financial and psychic:

--On the financial side, Silver was a huge traffic driver for NYTimes.com in political years . On Election Day 2012, The New Republic's Mark Tracy called Silver a "One-Man Traffic Machine for the Times" and "The Times's biggest brand": ""FiveThirtyEight is drawing huge traffic,' ... Abramson told me ... 'What's interesting is a lot of the traffic is coming just for Nate.' ... [E]arlier this year, somewhere between 10 and 20 percent of [visits to The Times's politics coverage] included a stop at FiveThirtyEight, last week that figure was 71 percent. ... Silver's blog has buoyed more than just the politics coverage, becoming a significant traffic-driver for the site as a whole. Earlier this year, approximately 1 percent of visits to the New York Times included FiveThirtyEight. ... Yesterday, it was 20 percent."

--On the psychic side, Abramson and Washington Bureau Chief David Leonhardt, another key player in the drive to keep Silver, saw his brand-within-a-brand as a wave of the future. They wanted Silver to bring his secret sauce to other areas of coverage. And they want to develop other Nate Silvers, in the mold of Andrew Ross Sorkin's pioneering DealBook. So Silver's role as the template increased his value to The Times.

Silver had told The Times that he wanted to expand to weather, economics and anyplace else at The Times that had statistics and numbers he could bring to life. He had already begun doing that, with "Claims on I.R.S. Are Challenged By Probability," which ran in the paper, as did an examination of Chief Justice John Roberts's use of statistics, along with "Health Care Drives Increase in Government Spending" and "Congressional Proposal Could Create 'Tax Bubble.'" In December, Silver had his first front-page story in the print paper.

Early this year , The Times laid out a plan that would give Silver a staff of six to 12 bloggers to focus on a variety of topics, modeled on Ezra Klein's Wonkblog at The Washington Post. The plan was so specific that it named Megan Liberman, an up-and-coming deputy news editor at The Times, as Silver's editor. As recently as last month, some executives at The Times were confident Silver would stay, mainly because they had given him everything he had asked for. Silver is very interested in prestige, and the prestige of The Times was a huge deal to him. But Silver, who first made his name with forecasts for Major League Baseball players, still loves sports. At times, he felt unwelcome in the Times Sports section, and seemed to struggle to fit into its culture. The section is among the most innovative at the paper, but not in the areas that are Silver's wheelhouse.

ESPN's recruitment drive was led by President John Skipper and John Walsh, executive vice president and executive editor, who have brought a more literate style to ESPN and are pushing the organization in a more analytical direction. Silver's youth and credibility were hugely attractive. The model they proposed to Silver was Bill Simmons, "The Sports Guy," who has a personal megabrand within the ESPN brand through his "B.S. Report," blogs and podcasts. ESPN kept Simmons in part by making him editor-in-chief of a new ESPN website, Grantland.com, devoted to long-form journalism. In the quest for Silver, ESPN enlisted ABC News, which could provide a high-profile platform during elections and conventions. And Silver clicked with ABC's political personalities: George Stephanopoulos, Jonathan Karl, Jeff Zeleny and Rick Klein.

ESPN has deep pockets , and the rich, multi-platform offer to Silver, funded mostly by ESPN, is a drop in the bucket. Under the deal, to be announced soon, his flagship will return to FiveThirtyEight.com, which currently clicks through to NYTimes.com. The business model mirrors Grantland's: a strong, independent brand that ladders up to the bigger brand of ESPN (and, in this case, ABC News). Nate will appear on the air on ESPN and ABC, and will get "verticals," or web hubs, devoted to a variety of new topics. He's very interested in education, so there's been a lot of conversation about that. And, of course, weather and economics. His Oscars predictions did well for The Times, and now he'll work for the TV home of the Oscars.

Silver informed Abramson of his decision on Friday. She was none too pleased - a yearlong strategy, up in smoke. And Abramson is sensitive to the perception of Disney raiding The Times: Don Van Natta Jr., who was part of two Pulitzer-winning teams at the Times and produced muscular exposés on the British tabloid hacking scandal, became a senior writer for ESPN at the beginning of 2012. And Times correspondents Jeff Zeleny and Susan Saulny were named ABC correspondents in February. In response for a request to comment, The Times provided a 21-word statement: "We valued our partnership with Nate, particularly during the 2012 election campaign, and we wish him every success in the future."

How Doctors Die (A Must read from the Health Care Blog)

"How Doctors Die," an outstanding essay from The Health Care Blog, looks at how physicians often choose to die, even when they have virtually carte blanche in terms of what they could ask for and receive. An exploration of a common problem. Do I want more care and effort to keep me alive no matter what or do I have limits? What is the effect of trying everything versus trying very little, or focusing on comfort instead of cure?

Written by Ken Murray, MD at USC, its a well written, thoughtful discussion of a controversial and very personal issue.

An excerpt:

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Click here to read the entire article....

Source:

http://thehealthcareblog.com/blog/2012/08/06/how-doctors-die/

Thoughts on the Trayvon Martin/George Zimmerman Ruling...

If you're of the mind that George Zimmerman should've been found guilty of, well something this weekend, you're not alone. A jury of adults sat through the five week trial, listened to all the evidence, and in the end decided he was not guilty of the charges the State of Florida had claimed he was.

As the verdict was announced Saturday evening, social media exploded with strong words from all directions. The Martin sympathizers felt George Zimmerman had gotten away with the murder of a young African American boy who had broke no laws and hadn't initiated the conflict that night. The Zimmerman camp let out a huge sigh of relief as the burden of proof, which apparently hadn't been met according to the jury, largely explained Mr. Zimmerman being cleared of all charges.

I too, chimed in with this on facebook:

It boggles my mind how after being told to not pursue Trayvon Martin, George Zimmerman ignored those instructions and went after him anyway. Something transpired...and TM was shot...and died. 

I know there's likely Civil actions coming up, for which GZ WILL probably pay a pretty penny, but I'm feeling something failed in this process.

Let me be clear. I do not want any man convicted of a crime he hasn't been found guilty of in a Court of Law. I reject the mob mentality that seems to be forgetting that we have due process in this Country. The case, to me at least, seemed to be a difficult one for the State to prove from the start. Reasonable doubt wasn't all that hard to achieve for the defense.

I do think the prosecution seemed to over-reach with its charges of 2nd degree murder and manslaughter, especially given the lack of evidence they had. Some legal experts have suggested that with no eyewitness, no video recording, etc., a lessor charge such as stalking might've been more in order. I won't presume to know why the State of Florida went the route they did. Was there a pressure, direct or otherwise, to pursue the more severe charges against Zimmerman to appease some racial concerns? I don't know...A 17 yr. old kid gets gunned down by someone older and with a different skin color. Perhaps its a fine line. What's the right level of charges? Was it thought they'd aim high and give themselves room to negotiate a plea deal downward? Who knows?

On some level, I feel in my heart that if Mr. Zimmerman had made different choices that night, Trayvon Martin would still be alive. It must also be said that perhaps those words can apply to Mr. Martin as well. I am able to construct a possible chain of events where Martin feared for his safety and decided he needed to fight Zimmerman then and there. Once he started to get the best of the older man, Zimmerman pulls out his gun and shoots Martin to save himself. If Martin had kept walking or done something other than "allegedly" respond at some point in a physical way, might he be alive? Perhaps.

After giving this a lot of thought over the weekend and reading a wide range of opinions on the shooting and verdict, my bottom line is this.

The adult should have showed more restraint, especially after the instructions from the 911 operator. Martin never sought him out to set things in motion. Zimmerman, under the guise of a neighborhood watchman role, saw him walking and then took the steps he did. If I'm asked to excuse an adult for poor restraint and bad judgement, the 17 year boy also gets at least the same courtesy.

Race was clearly a part of this trial but I'm not sure exactly how. Did Zimmerman shoot Martin because he was Black? Maybe, but I can't say for sure. Did the prosecution aim too high so not to appear uncaring to the Black community? Maybe, but I can't say for sure.

There's plenty of outrageous voices from both sides saying some outrageous things since the verdict was announced. On some level, perhaps we wanted it to really be all about race for some reason. Americans have a real appetite for these sort of stories. We'll tune in every night to watch the latest television shows that promise us "up to date information and analysis." If we didn't tune in, and support it - it wouldn't be shown. Period.

I don't even think this is a particularly critical case in terms of gun violence. Bottom line, one person died in this shooting. There have been thousands of other shootings in the country since this one, and we don't know names, places, etc. Again, I think the racial component...however forced...is a big reason why this case came to the forefront.

I'm ok with the jury finding George Zimmerman innocent based on the evidence. I also would've been ok if they'd found him guilty, based on the evidence. As I've said, I think he made several poor choices that evening. If his actions don't meet a criminal threshold, fine...I hope the Martin family pursues their civil prosecution rights and enjoy a different outcome.

A final word on the United States Justice Department filing any hate crimes against Zimmerman. Tread carefully, don't over-reach. If the facts, not suspicions, but the facts justify it, then proceed. To file charges and then fail in securing a guilty verdict would be damaging to overall best interests of the country. A lot of people are going to wonder why the Government would go after someone a Court just ruled was innocent. You better have a helluva strong case and you better present it convincingly. Some will say that perhaps like the prosecution, these charges, should they actually be pursued, might be an example of over-reach.

Please get it right and for the right reasons.

This Week's Ridiculous Weekly GOP Address on Healthcare...

Senator Mike Enzi, (R) Wyoming, says in this week's GOP weekly address that we should scrap the Affordable Care Act because of its partisan construction. I'm not going to shred Mr. Enzi's premise because I'm tired of arguing with people who actually believe President Obama and the Democrats shoved the ACA up the Republican Party's ass and they weren't invited to participate. They were, they said no to almost everything. So, the Dems moved on, and voila! The ACA was born.

Mr. Enzi wants to stop the ACA in its tracks permanently and start anew in smaller steps on health care reform. “We need to focus on common sense, step-by-step reforms, that protect Americans’ access to the care they need, from the doctor they choose, at a lower cost. Providing Americans with access to high quality, affordable health care is something both Democrats and Republicans should be able to agree upon."

The problem is, that healthcare doesn't work like other things. Its not a typical free market entity, plus the pieces are intertwined, out of necessity. Want to kill the individual mandate? OK, but then kiss the pre-existing condition coverage goodbye as well because if you can't promise the insurance companies that everyone is in the boat, then you'll have adverse selection which means only sick people buying insurance which leads to the dreaded "death spiral." The insurance companies can't survive with such a business model, so such a move would clearly be anti-business.

Sen. Enzi, like so many of his fellow Republicans loves to drone on about "we need to focus on common sense, step by step reforms,.." Short on specifics, aren't we? Sure access to care, choosing a Doctor, paying less are all nice ideas, but they won't just happen. Every move effects multiple parts of the health care industry. You can say you want to improve access but there are ramifications. The uninsured in the country are too often the worst risk pool to be found. That's going to cost a TON of money for the insurance companies to cover them, which they won't unless they get something in return. Like a mandate where now everybody healthy, young and well as the sick and older people can pool their premium dollars together to absorb the expenses of the sickest.

Choosing your own doctor isn't that tough of a hurdle to navigate. But, sometimes when insurance companies are up against it, they might elect to work with physician group B versus physician group A, for economic reasons. So, if you have United Healthcare, but they decide to not renew the contract with the practice your favorite doctor works with...you have a choice. Pay out of pocket or find a new doctor. This isn't a new phenomenon, certainly not unique to the age of the ACA. Its been going on for years.

"Paying less" An admirable goal, but how, Mr. Enzi? If we're paying less for our healthcare, that means somebody is making less as well, and that's not a very popular idea. How do you sell that, sir? Again, it sounds great, but who's going to take less for their services?

These remarks from Sen. Enzi are, for all practical purposes, useless in advancing and improving health care in this country. Its a grand waste of our time and his. Its an insult to the people who are seriously trying to improve a dysfunctional healthcare delivery system. It is ridiculous to pine for these things aloud but be willing to do virtually nothing to realistically address the issue. Please stop wasting our time.

You can watch his full remarks below:

Tea Party Polled on Taxes...Are they Informed?

Conservative writer David Frum put together a small polling operation at a Tea Party rally a few years ago and asked a few dozen of them questions about the taxes they pay to the Federal Government.

The results were quite interesting, and worth a look.

Click here to read Bruce Bartlett's take on Frum's findings. Bartlett, a former staffer at the Treasury Department as well as a former member of the Reagan White House, also has served with former Congressman Jack Kemp and Ron Paul in advisory roles.

If you read anything this weekend, read this...

Source:

http://www.forbes.com/2010/03/18/tea-party-ignorant-taxes-opinions-columnists-bruce-bartlett.html

There's a Good Reason Why So Many Terrorists Are Engineers | FP Passport

Fascinating read on why so many terrorists are far from the uneducated, poverty-stricken, losers that some would have us believe. Another well written and informative article from Elias Groll at ForeignPolicy.com...

There's a Good Reason Why So Many Terrorists Are Engineers | FP Passport

Three Voices on the Importance of the Doctor Patient Relationship...*

Three Voices on the Importance of the Doctor Patient Relationship...*

*(Not quite what you think...)

I have watched with concern over the last several months as story after story after story report on new and twisted ways politicians, usually Republicans, have come up with to deter women from obtaining legal abortions. No matter the procedure is, and has been for some time in this country, a legal one. States from Virginia to Ohio, from North Carolina to Texas, have all passed new measures which make obtaining this legal procedure more difficult than it had been. The North Carolina folks were especially creative, sliding the amendments into a motorcycle safety bill of all things. Twenty three States now require an ultrasound before an abortion can be performed, regardless if either the patient or Physician or both do not want it performed. Clearly, the very thing so many Conservatives warned us about during the health care reform that Obamacare would do, is now being brazenly done by, in many cases, the same voices who warned us about the dangers of government interfering between a patient and their Doctor.

Three things I present for your consideration:

#1) Paper from the New England Journal of Medicine (NEJM) dated October 18, 2012 titled, "Legislative Interference with the Patient–Physician Relationship" by a group of five Medical professional societies, (the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons). 

Here's the money paragraph from the paper:

Increasingly in recent years, legislators in the United States have been overstepping the proper limits of their role in the health care of Americans to dictate the nature and content of patients' interactions with their physicians. Some recent laws and proposed legislation inappropriately infringe on clinical practice and patient–physician relationships, crossing traditional boundaries and intruding into the realm of medical professionalism. We, the executive staff leadership of five professional societies that represent the majority of U.S. physicians providing clinical care — the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Surgeons — find this trend alarming and believe that legislators should abide by principles that put patients' best interests first. Critical to achieving this goal is respect for the importance of scientific evidence, patient autonomy, and the patient–physician relationship.

Examples of inappropriate legislative interference with this relationship are proliferating, as lawmakers increasingly intrude into the realm of medical practice, often to satisfy political agendas without regard to established, evidence-based guidelines for care.

#2) Open letter from American Congress of Obstetricians and Gynecologists to Texas Legislators, dated July 9th, 2013. In response to the ongoing efforts to pass oppressive abortion rights laws in Texas.

The main thrust of the letter is summed up here: 

That’s why we’re speaking to the false and misleading underlying assumptions of this and other legislation like it: These bills are as much about interfering with the practice of medicine and the relationship a patient has with her physician as they are about  restricting women’s access to abortion. The fact is that these bills will not help protect the health of any woman in Texas. Instead, these bills will harm women’s health in very clear ways. We’re setting the record straight, loudly and unequivocally, with these simple messages to all politicians: Get Out of Our Exam Rooms...

#3) Women speaking out via video message. This may be the most powerful group of messengers yet. A group of esteemed women, joining forces to decry the intrusion of big government into the sacred territory known as the patient doctor relationship.

Take it away ladies:



Well said, ladies, well said...


Sources:

http://www.guttmacher.org/media/inthenews/2012/01/05/endofyear.html

http://usatoday30.usatoday.com/news/nation/2011-04-06-1Aabortion06_ST_N.htm

http://www.slate.com/articles/double_x/doublex/2013/07/anti_abortion_legislation_in_the_states_will_bills_in_texas_north_carolina.html

http://thinkprogress.org/health/2013/01/02/1383661/virginia-governor-trap-laws/

http://www.theatlanticwire.com/politics/2013/06/ohio-anti-abortion-bill/66442/

http://www.salon.com/2013/07/10/north_carolina_republicans_sneak_antiabortion_provisions_into_motorcycle_safety_bill/

http://www.politico.com/story/2013/07/texas-senate-abortion-bill-94102.html

http://kff.org/womens-health-policy/state-indicator/ultrasound-requirements/

http://www.nejm.org/doi/full/10.1056/NEJMsb1209858

http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Open_Letter_to_Texas_Legislators

Grand Old Party should listen to Karl Rove...

Veteran GOP strategist Karl Rove has a very well written column up in today's Wall Street Journal. He discusses how the Republican party would be well advised to not only increase the white voter turnout, but also the Hispanic, African American and Asian American vote.

If they don't well, things don't look so good...


Click here to read this sensible and rational analysis of a major issue facing the Republican Party...

Source:

http://online.wsj.com/article/SB10001424127887323873904578569480696746650.html

Mixed Feeling on Rapper Yasin Bey (formerly known as Mos Def) Demonstrating Forced Feeding...

I must confess I'm mostly ambivalent about the United States Military Detention Center at Guantanamo Bay in Cuba. One on hand, somebody who has way more information than I do made a judgement call that the guys who have been brought to this facility posed a real and present danger to the United States in some form or fashion. On the other hand, it seems like they've been kept a helluva long time without charges being formally brought in too many of these cases. I know that there are also detainees down there who have been cleared to be released, yet they remain locked up. The whole thing, from our actions in Iraq and to the very mis-managed Afghanistan, has been a bit of a cluster fuck.

I can only imagine what would happen if it was a group of American servicemen plucked out of wherever they were fighting and taken to a detention facility in some other part of the world. Held indefinitely, and for most of them, had no official charges filed against them. We would be up in arms, we'd be marching in the streets, we'd want a rescue mission to be mounted ASAP and somebody would pay  dearly for messing with us.

Don't get me wrong, the guys locked up in Cuba aren't exactly choir boys who were snatched out of a college library. Many of these guys are professional mercenaries in the Middle East and they like to be where the action is. My sympathy for these folks has its limits.

President Obama had promised and in fact announced early on his intention to close the facility, as his predecessor George W. Bush had. It didn't happen. Mostly because it takes money...a big chunk of it...to actually shutter a facility like that. Congress controls the money, they didn't feel like cooperating with this idea, and it went nowhere. And so, here we are.

A few dozen detainees, 29 to be exact, have decided they no longer wish to eat or partake of any nourishment. I imagine they understand the consequences of these actions. The United States military isn't going to stand for these folks refusing to eat and then dying. It wouldn't look good. So, they utilize a procedure called Enteral Feeding. These people will eat, one way or the other...

Basically, a fairly small diameter plastic tube is lubricated with a k-y jelly type substance and then inserted into the inmate's nostril. Its fed deeper and deeper down the throat and ultimately into the patient's stomach. It doesn't sound pleasant to me. The procedure has been banned by the United Nations as a form of torture and a breech of international law. (Didn't President Obama say several times the United States does not torture?, Why, yes he did..."I have said repeatedly that America doesn't torture and I'm going to make sure that we don't torture. Those are part and parcel an effort to regain America's moral stature in the world.")

Rapper Yasin Bey (formerly known as Mos Def), working with a Human Rights organisation called "Reprieve," volunteered to undergo the procedure himself. He's a popular artist and his involvement may lead to a greater awareness and greater pressure on elected officials to intervene to stop it. I understand that. Christopher Hitchens did the same type thing with water boarding several years ago. I applaud social awareness and involvement. Good for Mr. Bey to take some time and try and make a difference.

Watch the video yourself:



I've watched the video several times. Its professionally done and tells the story quite well on what its like to undergo forced tube feeding. I also had my wife, a trained Advanced Practice Nurse (think Nurse practitioner) who has administered this procedure, view it and share her comments. Her experiences were in a traditional nursing home setting. She commented that usually the patients head is tilted in such a way to facilitate the tube progressing down the nasal passage and throat as comfortably as possible. Bey's head was thrashing all about which likely only made things worse for him. Secondly, she says that usually someone has a cup of water with a straw for the patient to sip out of, as that also helps move the tube more comfortably into proper position. There was no sign of that in the video.

Another issue I had was with Bey's reaction near the end of the film. I understand this wasn't fun. But the pleading to stop and then the outright sobbing struck me as something other than genuine. I'm not saying he faked it or even forced it but he wasn't in enemy hands. They weren't going to do anything to him he hadn't expressly approved of earlier. It struck me as a it of over-acting. My wife, the 14 year nursing veteran, said she knew a lot of old women who put this guy to shame. She too thought Bey's actions were over-dramatic.

Forced feeding is nasty enough. The over-emoting took away from the experience for both of us. I fear the resulting conversation going forward may be too much about whether Bey was faking it than the actual issue.

What's my bottom line? Very mixed.

Let's charge these guys with a crime and move forward that way or send them back to wherever we got them from. I say keep Guantanamo Bay open in a different role. A US military base in Cuba probably has have real strategic value that we shouldn't just abandon.

I applaud Mr. Bey's efforts but wish the last section of the video was different. I also wonder if whether the specific procedure the US Military uses is different in terms of head position and the use of a glass of water to help the patient essentially swallow the feeding tube? Maybe the makers of the movie followed it to a T, maybe they played up a certain aspect of it for effect. I'm not entirely sure.

Sources:

http://en.wikipedia.org/wiki/Guantanamo_Bay_detention_camp

http://www.time.com/time/nation/article/0,8599,1872158,00.html

http://www.youtube.com/watch?v=4LPubUCJv58

http://www.guardian.co.uk/world/video/2013/jul/08/mos-def-force-fed-guantanamo-bay-video

http://thinkprogress.org/security/2008/11/16/32392/obama-moral-stature/

http://www.aljazeera.com/humanrights/2013/05/201358152317954140.html

The GOP’s Mounting Woes

Things may look rosy for the Republican Party right now, but as Bruce Bartlett writes, there may be trouble ahead...

Bartlett is always a good and worthy read...

The GOP’s Mounting Woes

The Return of the Debt Ceiling Dance...

Running slightly below the radar of various Supreme Court decisions, hackers and "scandals," we should all remember the debt ceiling showdown looming for the second half (and probably the last quarter) of 2013.

Traditionally, Congress has always approved raising the debt ceiling so the United States government can pay its bills. Amendment 14, section 4 of the Constitution states that "...the validity of the public debt...shall not be questioned." In other words, we promise to pay our bills.

As most of you know, the President can not raise the debt ceiling on his own, the authority to do so lies squarely upon Congress' shoulders to increase that number. Only when President Obama requested an increase did Congress deny his request and force him into negotiations with the possibility of default. This tactic also caused the credit rating of the United States to drop. Not because we've borrowed too much money, but because we find ourselves in a place of acute government dysfunction. If nothing sensible can be agreed to and politics rules the day, it hurts our credit-worthiness around the world.

National Journal has a terrific preview on this. The GOP is already assembling its list of demands of the White House, and since President Obama has already gone on record, though some think he's bluffing, saying he will not negotiate the debt ceiling. Period.

Read the article here...

Sources:

http://www.nationaljournal.com/congress/house-republicans-draft-their-debt-ceiling-playbook-20130707

The Joy Of Old Age (No Kidding)....

Oliver Sacks M.D. writes about his turning 80 with a grace and comfort that many of us should strive for. Mr. Sacks is a Neurologist, a Professor of both Neurology and Psychiatry at Columbia University Medical Center until this year when he took a similar position at New York University. He is also an author, having penned such books as 1973's "Awakenings" which was turned into a movie starring Robin Williams and Robert DeNiro as well as 2007's Musicophilia, Tales of Music and the Brain and 2012's Hallucinations.

Doctor Sacks turns eighty years old this Tuesday and has written a very nice column about this event in today's New York Times.

A short excerpt:

At 80, the specter of dementia or stroke looms. A third of one’s contemporaries are dead, and many more, with profound mental or physical damage, are trapped in a tragic and minimal existence. At 80 the marks of decay are all too visible. One’s reactions are a little slower, names more frequently elude one, and one’s energies must be husbanded, but even so, one may often feel full of energy and life and not at all “old.” Perhaps, with luck, I will make it, more or less intact, for another few years and be granted the liberty to continue to love and work, the two most important things, Freud insisted, in life.

Its not very long, but it is very good.

Go read it....


Sources:

http://www.oliversacks.com/

https://en.wikipedia.org/wiki/Oliver_Sacks

http://www.nytimes.com/2013/07/07/opinion/sunday/the-joy-of-old-age-no-kidding.html?hp&_r=0

Great read from Health Stew...

John McDonough provides consistently high quality analysis of current health care reform issues. Today's column, "The Politics of Spite" is a terrific read.

An excerpt:

Spite. Defined by Merriam-Webster as "petty ill will or hatred with the disposition to irritate, annoy, or thwart," here are two new examples:

First, on June 27th, McConnell and his Whip John Cornyn (R-TX) wrote to the head of the National Football League -- and to the heads of all major sports leagues, including NASCAR -- to urge them to do nothing to help publicize the new health insurance benefits available in January 2014 for millions of uninsured Americans.
The model McConnell fears is the key role the Boston Red Sox played in promoting new insurance benefits available in Massachusetts after our state's 2006 health reform law. It mattered because so many Red Sox fans, in Fenway Park and on TV, are young and uninsured males. Left out of the McConnell letter is any acknowledgement that Massachusetts reform was the model for the ACA?s coverage expansions.
McConnell's efforts will work -- the N.F.L. has already been spooked into denying any interest in educating fans of their new coverage options. Add to this House Republicans' refusal to fund ACA implementation, and add to that public threats against U.S. Health & Human Services Secretary Kathleen Sebelius for encouraging private contributions to Enroll America, the national non-profit educating Americans about the new benefits -- and you have a clear pattern. Republicans will do anything and everything to hinder ACA implementation so that they can later declare the law a failure.

I encourage you to click through and read McDonough's full article and follow his blog regularly...

Source: http://www.boston.com/lifestyle/health/health_stew/2013/07/the_politics_of_spite.html

Women's Right's Take Major Hit In Ohio...

This hypocrisy is stunning.

Last weekend, Ohio Governor John Kasich signed into law our, (I'm a resident of Ohio), new budget. Contained within the new budget were aggressive new regulations concerning women's reproductive rights. These regulations are severe. How severe?

Cue the Maddow Blog from yesterday:

* Rape crisis centers will operate under a state-imposed gag order -- rape-crisis counselors will face new restrictions when telling impregnated rape victims that they can legally terminate their pregnancy.

* The budget effectively defunds Planned Parenthood clinics in the state.

* There's a provision to require women seeking legal abortions to undergo a state-mandated, medically-unnecessary ultrasound -- even if women don't want one, and if their doctor doesn't recommend one. Ohio Republicans proudly declared they want to put themselves between patients and their physicians, prescribing specific procedures for no medical reason.

* Women will also be required to pay for state-mandated, medically-unnecessary ultrasounds they do not want and their doctors do not think they need.

* Physicians will be legally required to deliver a Republican-written speech to women seeking legal abortions. Whether the doctor believes what's in the script, or even wants to say those words to his or her patient, has been deemed irrelevant.

* Clinics that provide abortion services will be required to have transfer agreements with local hospitals, and then bans public hospitals from establishing those agreements, all in the hopes of shutting the clinics down.

* And Republican policymakers in the state decided to redefine the words "pregnancy" and "fetus" in state law -- the budget decides that a woman is pregnant even before a fertilized egg is implanted in the uterine lining. The effect of this policy may prevent a woman from using an IUD in the state of Ohio.

As indicated in the Dayton Daily News link, Gov. Kasich possesses "line item veto" power, meaning that he can get rid of any particular section he wishes to. He used the veto on 22 different things, including rejecting new nursing home funding and more money for the aerospace industry. But not those sections that applied to women's reproductive rights.

The sections that pertain to women's rights were not debated in anyway. No hearings were held regarding them. They were added at virtually the last moment to the overall budget bill. Its stunning to me that our Governor would impose upon the women of Ohio such invasive regulations. State mandated medical procedures against the wishes of both patient and doctors? Incredible.

The Governor has strong feelings about the patient doctor relationship. He said so right on his campaign's website back on October 31, 2010.

Governor Kasich's words:

"Today I signed The Ohio Project’s initiative petition to amend Ohio’s Constitution and preserve Ohioans’ freedom to make their own decisions about health care.

Obamacare must be blocked. We cannot tolerate a government takeover of our health care system and we cannot afford a health care system that creates a massive bureaucracy that raises taxes and punishes small businesses that are already struggling to create jobs.
I believe Ohioans deserve the best health care possible, but Obamacare doesn’t do it. Reform is needed, but it should lower costs, not raise them, and it should keep bureaucrats out of the private relationship between doctors and patients and end the frivolous lawsuits that drive up costs.
Ohioans deserve a solution to health care that doesn’t bring more big government but which preserves their freedom to make their own decisions about their health care. I look forward to working with you to bring about that change."

Nothing else needs said, does it?


Sources:

http://www.daytondailynews.com/news/news/state-regional-govt-politics/kasich-signs-62b-budget-vetoes-22-items/nYZpT/

http://maddowblog.msnbc.com/_news/2013/07/01/19231745-ohios-kasich-approves-sweeping-restrictions-on-reproductive-rights?lite

http://www.kasichforohio.com/john-kasich-obamcare-must-be-blocked/