May 2009 Archives

A Health Care Review

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Dr. Atul Gawande has written an article in The New Yorker which is a must read for any who are interested in the discussion about health care in the US. He delved into the cost of the health care delivery in McAllen, Texas. A location which is "one of the most expensive health-care markets in the country", second only to "Miami--which has much higher labor and living costs. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. The explosive trend in American medical costs seems to have occurred here in an especially intense form."

Dr. Gawande spent a lot of time digging into what's happening in McAllen, interviewing a lot of people at different levels and locations in the health care industry there. He spends some time comparing it to activity in Grand Junction, Colorado and the Mayo Clinic which now has a satellite clinic in Florida, one of the most expensive health care states, which has become "the most efficient one in the [Mayo] system" with the "same high-quality, low-cost results as Rochester".

The story Dr. Gawande tells of the fragmented, for-profit activity, unregulated activity in McAllen in a frightening one for US health care consumers. It's a very grim picture if it represents the future of our health care system. He concludes with this recommendation.

...McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers--whether public or private--would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don't form these organizations.

This will by necessity be an experiment. We will need to do in-depth research on what makes the best systems successful--the peer-review committees? recruiting more primary-care doctors and nurses? putting doctors on salary?--and disseminate what we learn. Congress has provided vital funding for research that compares the effectiveness of different treatments, and this should help reduce uncertainty about which treatments are best. But we also need to fund research that compares the effectiveness of different systems of care--to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological, questions. And we would do well to form a national institute for health-care delivery, bringing together clinicians, hospitals, insurers, employers, and citizens to assess, regularly, the quality and the cost of our care, review the strategies that produce good results, and make clear recommendations for local systems.

Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can't do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone--because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

Go read the whole thing. It will be time well spent in gaining a better perspective on what's at stake and what can be done about it.

Newsweek Q&A: Obama on Dick Cheney, War and Star Trek

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The president's read on Dick Cheney in this Newsweek interview is pretty interesting. He actually makes the point that Cheney had lost credibility in the prior administration and that he's trying to re-litigate issues he already lost out on.

What's your reaction to Vice President Cheney's ongoing [criticism]? He's not quite twittering your administration [ laughter ] but he's coming fairly close.

You know, Dick Cheney had a strong perspective about national security. It was tested in the early years of the Bush administration, and I think it resulted in a series of very bad decisions. I think what's interesting is that, in some ways, Dick Cheney actually lost these arguments inside the Bush administration.

And so he may have won early with Colin Powell and Condi Rice, but over the last two or three years of the Bush administration, I think there was a recognition among Republicans and Bush administration officials that these enhanced interrogation techniques that were being applied--that they had applied early on--were potentially counterproductive; that a posture of never talking to our enemies, of unilateral action, of framing national security only in terms of the application of force, often unilateral--that that wasn't producing.

And so it's interesting to me to see the vice president spending so much time trying to vindicate himself and relitigate the last eight years when, as I said, I think, actually, a lot of these arguments were settled even before we took over the White House.

The president's comments on his daughters dating while being guarded by men with guns and on Startrek are pretty interesting too.

It's time to eliminate DADT

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What a waste. The Air Force is tossing out their 25 million dollar aviator, Lieutenant Colonel Victor J. Fehrenbach. Via Huffington Post:

Lieutenant Colonel Victor J. Fehrenbach, a fighter weapons systems officer, has been flying the F-15E Strike Eagle since 1998. He has flown numerous missions against Taliban and al-Qaida targets, including the longest combat mission in his squadron's history. On that infamous September 11, 2001, Lt. Col. Fehrenbach was handpicked to fly sorties above the nation's capital. Later he flew combat missions in Iraq and Afghanistan. He has received at least 30 awards and decorations including nine air medals, one of them for heroism, as well as campaign medals for Kosovo, Afghanistan, and Iraq. He is now a flight instructor in Idaho, where he has passed on his skills to more than 300 future Navy, Marine Corps, and Air Force weapons systems officers.

Since 1987, when Fehrenbach entered Notre Dame on a full Air Force ROTC scholarship, the government has invested twenty-five million dollars in training and equipping him to serve his country, which he has done with what anyone would agree was great distinction. He comes from a military family. His father was a retired Air Force lieutenant colonel, his mother an Air Force nurse and captain. Lt. Col. Fehrenbach has honored that tradition.

And the Air Force is about to discharge this guy, a virtual poster boy for Air Force recruiting, because he is gay? Someone has to be kidding. This is sheer madness.

Lt. Col Fehrenbach was eloquent on his own behalf on the Rachel Maddow Show:

This follows the Army National Guard booting out a West Point graduate, Arabic linguist and Iraqi war veteran, 1st Lieutenant Dan Choi because he was willing to publicly state that he was gay. Rachel interviewed him after that appearance. Choi's report of how his subordinates, peers and superior officers reacted is a strong indication that DADT has way outlived its usefulness.

MADDOW: In terms of the good order and discipline allegation, what has been the reaction that you got from your fellow troops, from your unit after you told them that you are gay? Was there upset, was there discord? Were there any negative consequences to your ability to function as a group?

CHOI: Two weeks after I appeared on the show, we had National Guard training. Basically, we went to marksmanship qualification. We shot our rifles. And I was leading some of the training as officer in charge, telling them to cease fire or fire, and I thought, for four days, nobody was saying anything, so maybe they don't watch TV or maybe they don't read the "Army Times." But at the end of the training, so many people came up to me, my peers, my subordinates, people that outranked me, folks that have been in the Army -- and this is an infantry unit, infantry men that -- coming up to me and saying, hey, sir, hey, Lieutenant Choi, we know, and we don't care. What we care about is that you can contribute to the team. And what leaders do, they look to see how can they make the best team before they go to war.

There are retired Brigadier Generals and Admirals who came out as gay in 2003 and made the point that DADT is not only pointless, it's harmful to the US Armed Forces and its military readiness. They were joined by other senior retired officers and former Pentagon officials.

The three officers also joined 13 other retired senior military leaders in issuing a statement condemning the military's gay ban.

'There is one inescapable conclusion-- 'Don't Ask, Don't Tell' does not work and should be repealed,' they said in a statement to SLDN. The statement goes on to say that, 'Today, no credible evidence exists to support a continued ban. Indeed, all studies, including those commissioned by the Pentagon, have come to that conclusion.'

There are many more stories, letters to the editor, articles and blog posts attesting to the fact that DADT is wrong, hurtful and way past its expiration date. Col. Daniel Tepfer's (Ret.) op-ed in the Dayton Daily News is one of them. But I think the most eloquent one I've seen recently is this comment on Steve Benen's post about Lt. Col. Fehrenbach. One of Fehrenbach's fellow airmen took the time to post this comment and I think it says it all.

I am a 26-year active duty senior master sergeant stationed in the National Capitol Region...additionally I am an unwavering Christian conservative (not the crazy type).

Lt Col Fehrenbach was my supervisor while I was stationed at Pensacola Naval Air Station and I must say he was one of the best supervisors I have ever known. Obviously, I am not aware of all the facts concerning this situation. However, on a professional and personal level, Lt Col Fehrenbach is an honorable and highly effective Air Force leader. I know based on my extensive experience in the Air Force, he was on the right track to get promoted to Colonel. His service to our country should never be overlooked and soiled because of who he loves or what he does outside of duty.

I support Lt Col Victor Fehrenbach 100% and will pray that our institution will make the right decision to allow him to continue to serve with honor and dignity.

"He that is without sin among you, let him cast the first stone."

Ray Verret

Posted by: Ray Verret on May 20, 2009 at 11:31 AM

President Obama, listen to Senior Master Sergeant Ray Verret. As commander in chief you can change this now. Put out a stop-loss order for men like Fehrenbach and Choi.

To our leaders in Congress and in the Pentagon, do the right thing. Don't stall. Don't waffle. Don't hedge. Don't calculate for maximum political advantage. You're hurting our military and its ability to perform its duties by denying it access to individuals who are superbly qualified and have proved their abilities in distinguished services which has been recognized by numerous awards. Go read Colonel Tepfer's letter and think about the human side of the equation for the many thousands of service men and women and their partners, family and friends who are forced to deny basic truths about their existence in order to serve our country.

It's time to act.

@blogdiva and MoDo

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We all know by now (at least if you're active in the blogosphere you know) that Maureen Dowd swiped some of Josh Marshall's work for her Sunday column in the NY Times. Copied it right down to the commas. And all the chatter about MoDo has brought some interesting stories including this one from my friend Liza Sabater, the blogdiva of Culture Kitchen and always entertaining twitterer at @blogdiva

Pete Souza's Photos

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Via Huffington Post, new photos of the Obamas.

At the end of April, White House photographer Pete Souza released a huge slideshow featuring 300 of the best behind-the-scenes photos of Obama's young presidency. Now Souza has added over a hundred new pictures. Included in the set are shots of the president doing everything from meeting with Al Sharpton and Newt Gingrich to playing with his dog.

Mouse over the top of the slideshow to see more options, and click on a photo to view its caption. The newest photos appear at the end.

Imprisoning journalists

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It's great that Roxana Saberi has been released. And yes, anyone who's listened to the news on NPR or any of the cable news shows knows about it. Funny though that we haven't heard about any of the journalists the US is holding without trial on a daily basis, much less a weekly or even monthly basis, from any of these same news sources.

Glenn Greenwald points out the hypocrisy in the media's coverage in this post:

Saberi's release is good news, as her conviction occurred as part of extremely dubious charges and unreliable judicial procedures in Iran.  And, as Ambinder suggested, her release most likely is a positive by-product of the commendable (though far from perfect) change in tone towards Iran specifically and the Muslim world generally from the Obama administration.  But imprisoning journalists -- without charges or trials of any kind -- was and continues to be a staple of America's "war on terror," and that has provoked virtually no objections from America's journalists who, notably, instead seized on Saberi's plight in Iran to demonstrate their claimed commitment to defending persecuted journalists.

Beginning in 2001, the U.S. held Al Jazeera cameraman Sami al-Haj for six years in Guantanamo with no trial of any kind, and spent most of that time interrogating him not about Terrorism, but about Al Jazeera.  For virtually the entire time, the due-process-less, six-year-long imprisonment of this journalist by the U.S. produced almost no coverage -- let alone any outcry -- from America's establishment media, other than some columns by Nicholas Kristof (though, for years, al-Haj's imprisonment was a major media story in the Muslim world).  As Kristof noted when al-Haj was finally released in 2007:  "there was never any real evidence that Sami was anything but a journalist"; "the interrogators quickly gave up on asking him substantive questions" and "instead, they asked him to spy on Al-Jazeera if he was released;" and "American officials, by imprisoning an Al-Jazeera journalist without charges or meaningful evidence, have done far more to damage American interests in the Muslim world than anything Sami could ever have done."

In Iraq, we imprisoned Associated Press photographer Bilal Hussein -- part of AP's Pulitzer Prize-winning war coverage -- for almost two years with no charges of any kind, after Hussein's photographs from the Anbar province directly contradicted Bush administration claims about the state of affairs there.  And that behavior was far from aberrational for the U.S., as the Committee to Protect Journalists -- which led the effort to free Saberi -- documented:

Hussein's detention is not an isolated incident. Over the last three years, dozens of journalists--mostly Iraqis--have been detained by U.S. troops, according to CPJ research. While most have been released after short periods, in at least eight cases documented by CPJ Iraqi journalists have been held by U.S. forces for weeks or months without charge or conviction. In one highly publicized case, Abdul Ameer Younis Hussein, a freelance cameraman working for CBS, was detained after being wounded by U.S. military fire as he filmed clashes in Mosul in northern Iraq on April 5, 2005. U.S. military officials claimed footage in his camera led them to suspect Hussein had prior knowledge of attacks on coalition forces. In April 2006, a year after his arrest, Hussein was freed after an Iraqi criminal court, citing a lack of evidence, acquitted him of collaborating with insurgents.


Right now -- as the American press corps celebrates itself for demanding Saberi's release in Iran -- the U.S. continues to imprison Ibrahim Jassam, a freelance photographer for Reuters, even though an Iraqi court last December -- more than five months ago -- found that there was no evidence to justify his detention and ordered him released.  The U.S. -- over the objections of the CPJ, Reporters Without Borders and Reuters -- refused to recognize the validity of that Iraqi court order and announced it would continue to keep him imprisoned.

One finds only a tiny fraction of news coverage in the U.S. regarding the treatment of al-Haj, Hussein, Jassam and these other imprisoned journalists as has been devoted to Saberi.  It ought to be exactly the reverse:  the American media should be far more interested in, and opposed to, infringements of press freedoms by the U.S. Government than by governments of other countries.  Yet the former merits hardly a peep, while the latter provokes all sorts of smug and self-righteous protests from American journalists who suddenly discover their brave commitment to press freedoms when all that requires is pointing to a demonized, hated foreign government and complaining.

There's more. Be sure to check out the information included in his updates to his post.

And to the news media, why don't you turn your investigative reporters loose on some of the stories behind the imprisonment of these other journalists? Or is it only American journalists held by foreign governments that are worthy of your coverage?

Items of Interest

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~ One of my web designer friends highlighted this interview on twitter:
Bright Green: Worldchanging Interview: Wangari Maathai. They're both interesting women.

~ My friend Ilona Meagher highlighted this study: Study: Communities must do more for vets

~ Way to go, Rosa. Don't let the IG off the hook.

~ Read to the end of this TPMCafe blog post for what's not being said in mainstream media about the OPR and the efficacy of its investigation.

~ Interesting stat via McClatchy: 1 in 5 Americans are wireless only

Wireless-only households jumped at a record pace of almost 3 percent in the last six months of 2008 and now are 20.2 percent of the total, the Centers for Disease Control and Prevention reported Wednesday.

Items of Interest

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~ Jeffrey Rosen of The New Republic has posted an outstanding example of smear journalism which is now being eagerly propagated through out the right-leaning media and wingnut bloggers. My initial reaction is that it is horrid journalism as well as being both racist and sexist. Glenn Greenwald offers more particulars on its inaccuracy as does law professor Darren Hutchinson. Even Wonkette gets how bad a post it is. And FDL points out just how tough a fight those poor white males must endure to gain adequate representation on the Supreme Court. And last but not least, a former clerk speaks up on Judge Sotomayor's behalf [via Ambinder].

~ My husband read "Going Dutch: How I Learned To Love the European Welfare State" in NYT magazine this weekend. It's an interesting and provocative read. It's certainly earning comments elsewhere in the blogosphere.

Ezra Klein's are certainly worth some time.

It turns out that there's a bit of a paradoxical relationship between believing your country has a lot of economic mobility and your country actually having a lot of economic mobility.

~ Matt Yglesias got it right in this comment about an ADL of Israeli Jews (no Israeli non-Jews) and their attitude towards a preemptive strike on Iran. [via]

Just as food for thought, what would the ADL say about a poll showing a large majority of Iranians supported the idea of military action aimed at destroying Israel's nuclear facilities?

~ Interesting article about Desiree Rogers in the WSJ magazine, of all places. Don't bother with the comments though unless you really like reading ignorant and racist slander.


~ Jane Hamsher highlights an exchange of letters between Glenn Greenwald and wingnut Clark Kincaid. Greenwald's response is a zinger.

Respect for the Rule of Law

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David Waldman points out what's really significant about Alberto Gonzale's response to Dan Abrams' question about the release of the torture memos. Here's what Gonzales said:

They may be necessary in the future. And by disclosing it, means you take them off the table and they can never be used again.

Here's some excerpts from what Waldman wrote with an assist from Andrew Sullivan in selecting some of them.

They may be necessary in the future.

Let's unpack that. Republicans are unapologetic about the use of torture. We knew that. Republicans think it might be necessary again in the future. We probably knew that, too. But it's the implications of that statement I think Congress and Democrats in particular are unprepared for.

First, it is a reminder of the fact that while the U.S. is supposedly not currently engaged in such practices, they've been suspended under executive order. It is, in short, a reminder that the United States only honors its legal and constitutional prohibitions against torture when the chief executive wills it to be so. And politically, that appears to mean we only honor those obligations when Democrats are elected to the White House.

As tiresome as it can sometimes be to see people frame matters so that it all comes down to one issue and one issue only, I find myself returning to this one again and again. Whether or not torture is your issue. Or wiretapping. Or indefinite detention. Or signing statements. Or anything, really -- environment, global warming, abortion, health care, taxes, terrorism, the war. No matter what your issue is, at heart, you're dependent on a continuing and consistent respect for the law. Because without it, none of your work on politics and policy is worth anything the moment the White House falls to someone who's not you.
You can pass all the environmental laws you like, but if it's accepted as a legitimate tenet of Republican governing philosophy that all of those laws can be safely ignored or otherwise set aside, you'll have gained nothing from your work with a friendly Congress and administration.
And if you can set aside all statutory and constitutional law on something like torture, I'm unsure what barriers you think remain in the way of doing the same on any other issue...
They are telling you they will torture again in the future. They have already told you that it is their belief -- their interpretation of the four corners of the Constitution -- that they have the right to order it if they can win just one national election (versus Democrats' constant scrambling to win 300+ localized contests).
There is nothing "backward looking" about giving serious consideration to a live threat that has just been renewed.

David's post was cross-posted at Daily Kos.

Torture: If Charles Graner is in jail...

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Albert Mora was featured prominently in a NYT article that discussed torture and what should happen or not happen now with regard to what may or may not have been done by the Bush administration and those attempting to carry out its directives.

The article opened with this:

Alberto Mora says it's "politically unthinkable" to criminally prosecute the top Bush administration officials who sanctioned torture. He also says it's "legally unthinkable" not to hold them accountable.

And then goes onto to somewhat hazily discuss the pro's and con's for each viewpoint. The author does point out that there were a great number of senior officials in the Bush administration and in the military who were not in favor of torture though none of them managed to stop it or convince the advocates within the Bush administration that it was wrong or for that matter, ineffective.

But Andrew Sullivan's one-liner in response sums it up so succinctly and so well.

If Charles Graner is in jail for following orders, why is no one accountable for giving them?

Precisely. Are we a nation of laws or not?

Items of Interest

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~ Maureen has a winner in this column, "How Character Corrodes".

~ Thanks JNS. These auto warranty calls are so irritating.

~ What recession really means, courtesy of one of Andrew Sullivan's readers.

~ It seems Andrew Sullivan inspired Obama's reference to Churchill and torture during his press conference the other night. Marc Ambinder says that someone confirmed the reference. [via]

~ CJR does a little 'connecting the dots' on the WSJ's scoop about the NY Fed president and his highly questionable behavior. Of course, WSJ put it behind the firewall so you're really reduced to reading the CJR article and its excerpts. Let's hope the right people in government have a subscription to the WSJ and get to read the whole story.

~ Sen. Inhofe, climate change denier extraordinaire, surprises us all by joining Al Gore in his call for an investigation into soot and its impact on our environment. [via]

~ Not highly significant but nonetheless amusing: It seems there's a blog devoted to covering how the media handles printing corrections to errors which have appeared in their newspapers. This particular post describes an Irish paper's lengthy discourse on how 'public' turned into 'pubic'. [via CJR]

Dan Malloy turns the table on Fox News

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Connecticut Bob was at a meeting with Dan Malloy, mayor of Stanford, last Friday night and posted this clip about Malloy's experience with Fox "News".

Dan Malloy appeared at the Milford Democratic Town Committee meeting and covered a variety of issues in great detail as part of his potential run for governor to an appreciative gathering.

During the Q&A portion of the talk, Mike Brown asked Dan about his famous appearance on "Fox & Friends". Malloy launched into an amusing anecdote (video below) that explained the sad and pathetic attempt at a very typical FoxNews "gotcha" that distorted the facts for their own political agenda.


Malloy's experience is completely congruent with Michael Smerconish's experience which he described during an appearance on CNN's Reliable Sources [via Crooks and Liars]. Now that Malloy has described the background, here's the actual interview on Fox.



Mayor Malloy did a terrific job of controlling the narrative despite Doocy's repeated attempts to distort the agenda.

Rerouting Air France flight in the air to avoid US airspace

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The "No Fly List" strikes again. This time it forced Air France to reroute a flight from Paris to Mexico City, adding 4 hours and a stop in Martinique to refuel just so a journalist who's been highly critical of US government tactics in South America would not fly through US airspace.

I hope that the NY Times, Washington Post, McClatchy, NPR or another US media outlet pursues this story (translated here) and gives us more information on what happened and why. Here's what happened in the journalist's own words.

Once again it sounds like American paranoia has gone a little bit too far though I'd like to see what "justification", if any, is offered by the US government for such an action.

Another Consequence of Torture: More Americans Killed

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Brandon Friedman of VoteVets has a post that rightly must be viewed in its entirety. I cannot disagree with his conclusion.