Thursday, May 28, 2009

When did "doctors" become "docs"?

During the various hearings on health care reform, my ear has been assaulted by the word "docs". When, exactly, did "doctors" become "docs"? No, I am not a doctor, but, quite frankly, "docs" seems to me to be rather insulting or, at least, condescending.

Kathleen Sebelius - unwilling to commit to anything

The other day I saw a rebroadcast (C-SPAN) of a hearing in early May, 2009 (Charles Rangel's committee) on health reform and it was yet another disappointment. The administration has no plan. Sebelius just wants to "work with Congress". Even on the issue of doctor-owned hospitals, which she has elsewhere condemned because they are not cost-effective (there's a real conflict of interest that encourages unnecessary and costly tests), she waffled.

Most of the things she talked about, like "encouraging" hospitals to implement checklists to lower infection rates, are fine - but there don't seem to be any sticks or carrots, for that matter. Who, for example, is going to make sure that insurance pays for outcomes rather than tests?

As with the credit card "reform" bill, all we are likely to see is more tinkering around the edges that will leave insurance companies with huge profits and citizens with too-expensive health care.

Saturday, May 23, 2009

Cheney's Fear

I'm not the first person to point out that Cheney is afraid of a lot of things. Remember his "undisclosed location" while Pres. Bush eventually returned to the White House after 9/11? Then there was his asking Google to "hide" his official residence from Google Earth (no such privilege for the White House).

This fear was on hand again in his most recent speech with his picture of terrorists waltzing into the U.S. with a nuclear weapon (something even countries like Iran and Korea seem to have trouble producing) and the need to do everything to prevent such a thing happening. This is his "1%" theory: if there is even a 1% chance of something bad happening, all measures to prevent (well, non-economic measures: consider the consequences if Conservatives applied this rule to climate change) are justified.

Think about this for a minute. Short of locking up everybody in prison, there is no way to make the country 100% safe. And if Gitmo is any example, our ability to identify potentially dangerous people is rather low. (So far, over s 500 or the some 800+ detained have been released - by the Bush Administration.)

Although I deplore pop psychology, I can't resist indulging in it. Cheney has suffered 4 heart attacks. Is it possible that Gitmo and torture are the price America has paid for a Vice President scared beyond reason of dying?

Wednesday, May 20, 2009

Terrorists in your backyard jails?

To listen to both Democrats and Republicans about closing Guantanamo and transferring those terrorists to U.S. jails, one would think that we were talking about supernatural aliens.

Now, I've not made a study of terrorists, but those guys who flew into the World Trade Center weren't super-human. And they didn't take down the towers with other-worldly weapons. And they could have been stopped by ordinary people.

Moreover, there are, I understand, only a couple hundred left of the "worst of the worst" - who have, it appears, been there for years. It is unlikely that they know much of anything worthwhile at this point or, for that matter, would be trusted by their former associates if they went home.

As for our jails: I know Conservatives like to complain about how we baby criminals, but most U.S. prisons today aren't much better than what could be found in Dickens' England - and some do hold prisoners who are every bit as dangerous and violent, I would suspect, as any of the prisoners at Gitmo.

If our top-security prisons are incapable of preventing terrorists from escaping and doing harm, isn't the logical follow up conclusion that maybe they are not sufficiently secure to handle our native criminals?

But, then, that has been the problem all along. Gitmo, the abandonment of habeas corpus, the military "tribunals" were all created by men who fundamentally disapprove of America's judicial system as it exists, who fundamentally still believe (in spite of conviction rates exceeding 90%) that our court system babies criminals and ignores victims, who think that the law unnecessarily hamstrings the police. Gitmo was created by people who still think the Miranda ruling was judicial activism at its worst, who don't think that the accused have a right to counsel.

Isn't it time for somebody, somewhere in the media to confront the fear-mongering and the fundamental disconnect that created Gitmo and keeps it alive?

Friday, May 15, 2009

Obama to the Left: So What Choice Do You Have

In watching Obama back away from many of his campaign promises, might the Left conclude that Obama is to the Left as Bush was to the Far Right: more lip service than action?

Yes, the Shrub did actually support a lot of the right wing agenda but, to a large extent, Republicans have never given the far right religious component of the party what it has most wanted because, of course, Republicans know that that constituency has no other place to go.

So it is with the left and Obama. Regardless of his poll numbers in 2012, he will be the Democrat's nominee. The Republican is bound to be more conservative. So Obama can break every promise he has ever made and all the Left can do is complain.

The main question, however, is about Obama's continuing tendency to cave in. Remember all those pieces of the Stimulus Package he put in to please the Republicans? For which he got zip?

Then there's health care. He never promised what Hillary did - universal coverage - but month by month his criteria for reform have shrunk until they are limited to "lowering costs" and "improving access". In short, tinker around the edges and call it reform.

Guantanamo is still open. The pictures won't be released. Military tribunals are back. (Military tribunals, for those who don't know, are designed to convict. There is no presumption of innocence.)

His justice department continues, in court, to defend Bush positions.

Torture? Let's just forget the past, shall we? Cheney feels no compunction about attacking Obama, but Obama refuses to attack the Bush administration.

Leftists may ask themselves why. We Hillary supporters know why. Obama, like Bill Clinton, seems pathologically incapable of fighting for anything. Not being a psychologist, I don't know if this is because Bill and Obama simply don't like conflict or because there is simply nothing about which they feel strongly enough to be willing to fight for it. Maybe a bit of both.

The Left wanted Obama. Now they've got him and it turns out that he is, as anybody who had checked into his political history or listened to him campaign would know, Bush Light.

Wednesday, May 13, 2009

The Media and Dick Cheney - Let Him Talk

I'm baffled by all this blather, esp. by liberals, about the ethics of Dick Cheney's criticizing Obama.

Cheney's a citizen. He has a right to criticize. I don't care if it's usual or not for former VPs and POTUSes. (Heaven knows, I wish Gore had opened his mouth more than once rather than retreating into a cave.)

Let him talk. Period.

Health Care Reform - And they said Hillary's plan was too complicated?

Well, I watched another hearing on health care reform yesterday, and it will take a bill at least a hundred pages long, and an army of administrators, to implement everything that is being suggested.

The elements of reform:
1. Build on employer health insurance because many companies support it. (Could it be because health insurance benefits are tax-advantaged and are, thus, less expensive to provide than higher salaries?)

2. Competition (except from a public plan). People admit that the current system is flawed but, when push comes to shove, they do not seem to fully grasp that we have had a free market, competitive health insurance system for 60 years and that is the system that is not working. They insist that this flawed system must be preserved.

3. Require or not that self-insured companies provide employees with choice by somehow associating them with health care exchanges. And what about the companies that offer only a couple choices?

4. Health care exchanges (or not). Weren't these the centerpiece of Hillary-care?

5. Pay for bundled services rather than for individual services. (And just who will implement or enforce this?)

6. Cap (or not) the tax-free status of employer-provided health insurance. Lots of ideas here: regional caps, income caps, phased in caps over x number of years so, eventually, the differences are based solely on different COLs. Grassley thinks this would be unconstitutional. Some witnesses pointed out that COL differences exist even with a single state. Arkansas doesn't want to pay for New York's higher COL (where, of course, everybody's salary or wages are adjusted upwards anyways). Who would design these? Who would be responsible for enforcing these? What kinds of changes would have to be made to the income tax rules? How about the administrative effects for multi-state corporations?

7. Incentives for best practices. Again, great idea - but who sets the best practices and who enforces them.

8. Use health savings accounts.

9. Health IT. Obviously, paper records don't make a lot of sense. But health IT is a lot harder to implement than many seem to think, to say nothing of simply being used (every time I go to Kaiser, I'm asked the same question about drugs I'm allergic to. I've provided that information at least a hundred times.) Data format and data definition issues can be extremely difficult to solve. In addition, as one witness pointed out, hospitals may not want record interoperability because that would make it easier for doctors to move patients from one hospital to another.

10. Put a "tax" on bad behaviors such as smoking or overeating.

11. Tax credits or tax deductions.

12. Rein in costs before expanding coverage.

13. Expand coverage before reining in costs.

14. The Massachusetts experience gets nothing but high marks, but I've read criticisms from Mass. doctors who would much prefer single payer. Not a word about those criticisms.

15. A public plan option? There is some support, but the key seems to be in making it so unattractive that private insurance companies won't lose any customers. (It seems not to have occurred to anybody in power that if a public plan option would attract citizens away from private insurance companies that maybe the problem is with the latter rather than the former. And that it is the insurance companies which should be expected to change their policies.)

16. Preserve (?) the ability of citizens to keep the doctors they like. Again, selective awareness operates here. Employees who lose or change their jobs often lose access to the doctors they have because their health insurance options change.

17. In all of these hearings, I've not heard a single word about the dozens of forms doctors must complete, the army of clerks they have to hire, the hours they must spend on the phone trying to get a procedure paid for. I've not heard a single word about the portion of a health care premium that goes to the insurance company's administrative costs (mainly for denying coverage), executive salaries, or profits.

18. American exceptionalism. Baucus insists that we need a uniquely American solution. (I think he read a New Yorker article). No witness has ever been asked to explain why European nations pay less for health care but get better results. Are Americans a unique species? Is it impossible for us to learn anything at all from the experiences of different countries? Except for some negative comments about Canada and England re those awful wait times, nobody pays any attention to any system outside the U.S.

I've no doubt forgotten some of the other requirements. But the key to all of this sturm und drang seems to be that private insurance companies must be preserved at all costs.

As I said in an earlier post, real health care reform is DOA. We are doomed to lots of tinkering around the edges that will not provide universal coverage and that won't reduce costs (except, of course, by denying coverage).

Health Care Reform - DOA?

During the past couple of months, I've seen Q&A with Sen. Baucus, Grassley, and Hoyer (on C-SPAN) - and it is clear that not only is single payer DOA but so is a Public Plan Option. Obama himself appears lukewarm in his support (with each new statement by Obama on health care, it appears that his minimum requirements become broader and less meaningful) - but then I don't think there is anything Obama is truly willing to fight for.

It looks as if we'll get the worst of all possible worlds: a mandate to buy insurance based on a poverty level that bears no resemblance to reality with cut-rate policies that probably won't be worth the premiums anyways.

What I find especially frustrating is that Democrats continue to echo Republican insistence that individuals must be responsible for their own health care (lose weight, exercise, etc.) but never say a word about how Insurance company administrative costs (8-14% not including what individual doctors must do to fill out dozens of forms for diff. companies) and profits (all those high executive salaries) contribute to high health care costs.

Oh, Grassley is also dead set against comparative effectiveness; he doesn't want doctors to be reimbursed based on "govt" guidelines. Again, I've heard no Democrat point out to him that insurance companies spend millions (billions?) of dollars finding all kinds of reasons to deny coverage.

Torture - The Questions Not Asked

One of the most frustrating aspects of the debate on torture, besides the essential point that the United States of America has been for years now debating the fine points of what constitutes torture and what does not, is the absence of what seems to me to be the most basic and logical questions about the logical consequences of the arguments in favor of torture.

Lindsey Graham believes that torture is defined by
1. it's effectiveness. If it works, it isn't torture.
2. the target. If the target is a terrorist (e.g., a bad person), it isn't torture.
3. perceived danger. If Americans are threatened, it isn't torture.

Where do these assumptions leave us?
Under Graham's assumptions, the Spanish and Italian Inquisitors were justified in torturing Jews. They were, after all, heretics and the "killers of Christ". Under his assumptions, Jean D'Arc deserved her treatment. She was a heretic. Under Graham's assumptions, the Germans and Japanese were justified in torturing Allied soldiers and spies who, after all, had important knowledge about allied plans that would directly kill thousands upon thousands of German and Japanese citizens. The Vichy French were justified in torturing French Partisans, for the same reason.

Think about the fire-bombing of Dresden and Tokyo. Hiroshima and Nagasaki. Using Graham's definitions, the Germans and the Japanese would have been well within their rights to torture any person, soldier or civilian (e.g., a spy), who might have had knowledge that would help those nations protect their cities and citizens. (For all we know, had the Japanese understood what an atom bomb could do, they might have surrendered. We didn't give them the chance. We didn't even give them time to contemplate the effects of Hiroshima before we dropped another bomb on Nagasaki.)

If a nation's being in danger is the sole justification required, then every nation in every war, whether conventional or guerrilla, is justified in torturing anybody it captures who may, and I emphasize may, have knowledge that could limit or prevent the loss of life on the side of the questioner. Indeed, followed to its logical conclusion, guerrillas and rebels (such as the Viet Cong and the North Vietnamese) are justified in using these techniques against the people they capture, for exactly the same reason.

If preventing loss of life is the primary justification, why don't we let police pick up potential criminals and torture them? Or use these "enhanced interrogation techniques" against people who have been arrested? The U.S. had and has a number of very violent people who have committed or who might commit horrendous crimes. Shouldn't our police have been permitted to use these techniques on the unibomber? Or on Timothy McVeigh, the Oklahoma City bomber? What is the difference between these people and Al-Kaeda?

Under Graham's propositions, the Russians were justified in torturing Francis Gary Powers. He was, after all, a spy (not a soldier captured on the battlefield). The North Koreans were justified in torturing the sailors of the USS Pueblo.

Another Grahamism: well, maybe we shouldn't do these things but let's not tell our enemies. Excuse me? Maybe I've watched too many World War II movies, but didn't a number of enemy forces surrender to American troops at least in part because they knew they would be treated well?

If any of these "enhanced interrogation techniques" were applied against American soldiers or citizens by a foreign government would we consider them to be torture? Of course. Unless memory fails me, we have routinely objected to even such "mild" techniques as solitary confinement, sleep deprivation, noise, etc. when used against Americans. A definition of torture that is dependent on the target rather than the action is meaningless.

Torture Works?
If torture works, then the confessions of Americans captured by the North Koreans and the Vietnamese were not false, not coerced. They were true. After all, torture works.

Women in Salem, submitted as I recall to "mild" techniques such as multiple pin pricks, confessed to consorting with the devil. I suppose there may be some Christians believe this to be possible, but I suspect that most of us would conclude that these women were not telling the truth.

Legal Opinions
If all it takes is a legal opinion to sanction torture, then perhaps the Allied Forces owe the lawyers and judges convicted at Nüremberg pardons. After all, they were not relying on legal "opinions". They were enforcing the laws, the laws mind you, of a legally elected government.

Enemy Combatants
I loathe this term. Like the redefinition of what constitutes torture, it's only purpose is to remove those captured from the protections they would have as prisoners of war.

It is my understanding that most of the people at Guantanamo were captured on battlefields. We invaded Afghanistan. It doesn't matter whether that invasion was justified or not. Don't the residents of Afghanistan have a right to defend their country? Does that right disappear because they don't wear military uniforms? If that's the case, the British were justified in torturing the American rabble who had the nerve to rebel against the King.

The Definition of Torture

Under the Bush definition that anything short of organ failure isn't torture, where does that leave us?

It means it is legal to batter, break bones, use electric shocks against genitals, rape with or without physical instruments, pull out fingernails and toenails, burn the skin with cigarettes, etc. What would the U.S. government do if a foreign country used any of these techniques against an American found illegally in that country and believed to be engaged in activities which would result in the loss of life? Would we say "fine, as long as there is no organ failure or death"?

The Innocent
Hundreds of Guantanamo detainees were released by the Bush Administration because they were innocent. Think about that. They were imprisoned and subjected to "enhanced interrogation techniques" for years - and they were innocent.

Under torture, the guilty have choices. They can hold out until that mythical "ticking time bomb" goes off. They can issue repeated lies until that mythical "ticking time bomb" goes off. They can dribble out half-truths. They can tell the truth.

But the innocent have no choice but to lie, to create fantastical stories that will stop the pain because they have nothing to confess.

Given the numbers of prisoners released from Guantanamo, it would appear that our ability to accurately identify truly dangerous people is rather low.

I realize this doesn't matter to the supporters of torture. They operate under the 1% criterion. It's OK to torture 99 innocent people in order to get possibly useful information from one guilty person.

The torturers
Tell me, would you like to live next door to a person who spent his or her days torturing? Would you like your son or daughter to marry a person whose job is to torture? Would you feel comfortable having a torturer babysit your children? And, finally, what kind of people are capable of inflicting pain on another human being (OK, dentists and cancer specialists excepted) day in and day out? Would you want to be friends with them?

Am I nuts or shouldn't at least some of these questions be asked by the people who oppose torture?

American "Exceptionalism"

What is all comes down to, of course, on the part of those who approve of "enhanced interrogation techniques" (Newspeak of the highest order), is that Americans are different. Because we are "good", we can torture. Because our enemies are bad, they deserve to be tortured. Unfortunately, I don't know of any nation or group of people who can't defend torture on these very grounds.

p.s. Would somebody please send Lindsey Graham a copy of 1984?

p.p.s. If we put every American male over the age of 10 in jail we would probably reduce crime by what? 95%? Women and children could walk the streets in safety. Almost all physical abuse would end. So would most drug trade (yes women are users but most organized crime members are men). We wouldn't even have to torture them. Just hold them until they are too old to do any harm.