Read it at the Standard.
Friday, December 28, 2007
Posted by The Editor at IP at 4:24 PM
Posted by The Editor at IP at 4:24 PM
Thursday, December 27, 2007
Monday, December 24, 2007
The polling on the Republican race in both Iowa and New Hampshire is muddled enough that there seems to be little of which we can be certain, at least until the votes are counted. There is definitely a school of thought however, which holds that if Huckabee wins Iowa, then there will be a rapid effort on the part of economic conservatives to coalesce behind a candidate who can beat him. And if either Romney or McCain wins New Hampshire -- as right now seems quite likely -- then that person may be the one. (Plus, McCain really seems to be building up a head of steam.)
Keep that in mind as you read Patrick Ruffini's assessment of how to take down John McCain in New Hampshire. The logic seems sounds to me:
I think the answer here is to attack his strength. Muddy the waters and contaminate his message. Call into question his maverickness. Brand him with the tagline “Independent… When It’s Convenient.” Remind people that right before “rediscovering” his maverick roots, he was running as a standard Bush-issue Republican, taking cash from lobbyists, shilling for Cablevision, and running as George W. Bush’s rightful heir.
In New Hampshire, McCain brands himself as a longtime critic of our Iraq strategy. And yet for four years, he was one of the war’s staunchest defenders. He criticized Don Rumsfeld, and yet he campaigned strongly for President Bush in 2004, who could have fired the Defense Secretary at any moment and was ultimately responsible for the strategy. McCain is smart enough to know that the buck stops at the President’s desk, yet he conveniently “forgot” this just in time to run for President. Is McCain somehow implying — in a Republican primary — that the President was being manipulated by his own Secretary of Defense and Vice President? If so, he’s echoing the left’s insulting rhetoric...
I would envision a series of ads around this theme launching right after Christmas — tease them on the Web on the 26th and start running them on the 27th. Do one on some sort of questionable post-Keating quid-pro-quo that’s evocative of the Drudge hit of last week without referencing it directly. Then play back his pro-war rhetoric, in contrast to his disingenuous claim of being a war critic (it’s not that he didn’t criticize — it’s that he wants New Hampshire voters to think he was exclusively a critic before the surge).
Attacking off the beaten path is unexpected, throws him off balance, and is more likely to make him lose his cool. Save the immigration and taxes stuff for Michigan and South Carolina. It’s time to deflate McCain’s tires a bit with New Hampshire independents and buck up Obama, giving us a non-McCain nominee and dragging out the Democratic primary for as long as possible.
If Huckabee wins Iowa, Romney wins New Hampshire, and some third candidate wins South Carolina, that should muddy the waters pretty completely, right? Of course, right now Huckabee is winning South Carolina. If he wins there, then things have to coalesce pretty quickly anyway, don't they?
Sunday, December 23, 2007
The Los Angeles Times covers a medical case they portray as extremely complex and difficult -- one where doctors and an insurance company were forced to decide whether to provide a liver transplant to a leukemia-stricken 17 year old girl. The expensive procedure had a fair chance of extending the girl's life for at least 6 months, but there were no guarantees.
Cigna ultimately reversed their initial decision and elected to cover the procedure, but by the time the approval letter reached the family, they had taken their daughter off of life support:
Doctors treating Nataline told the family and Cigna in a letter that patients in similar situations have a 65% chance of living six months if they receive a liver transplant. Doctors had qualified Nataline for a transplant Dec. 6 and a liver became available four days later, the family said. But the transplant was not performed because Cigna had refused to approve and pay for the procedure, they said.
Cigna turned down the transplant, calling the procedure experimental because it was not supported by enough medical literature as safe or effective in such cases. The family's benefit plan does not cover experimental treatments. But this week, after receiving an appeal from the family and UCLA doctors, the company reconsidered.
Arlys Stadum, a Cigna spokeswoman, said the insurer submits all transplant requests to physicians with transplant expertise for review. Every request that is refused has been seen by at least one expert physician, she said.
In explaining the reversal, she said, "It was really just looking at how complex the decision was..."
"We are making this decision on a one-time basis, based on the unusual circumstances of this matter, although the treatment, if provided, would be outside the scope of the plan's coverage and despite lack of medical evidence regarding the effectiveness of such treatment," Garnsey wrote.
Dr. John Roberts, chief of the transplant service at UC San Francisco, said Cigna faced a difficult decision in the case, based on the facts presented by the UCLA team.
Roberts said his center generally will not accept a patient without a 50% chance of living five years. According to UCLA's letter to Cigna, patients like Nataline had a 65% chance of living six months.
"The problem that they got into is, here's a situation where she didn't have very long to live," he said. "Probably in this situation, they're probably better off to say, 'The transplant center really feels like this is the right thing to do, let them go ahead.' "
The standard of care for this particular situation is "going to be pretty hard to know," Roberts added. "I think it's a very difficult decision for both the transplant center and the insurance company."
This sounds like a terrible case. As a parent, there's no doubt that I would want for my daughter any procedure that might save or extend her life. I'd protest, blog, call my Congressman, go to the news -- do whatever it took to try to get the necessary treatment for my child.
By the same token, no medical system can afford to provide every conceivable procedure to ever needy patient. At some point, caregivers need to assess the chance of success, the risks, the cost of a given procedure, and decide when a given procedure simply doesn't have enough of a chance of success to warrant providing it. This is the way it is in the real world.
But that's not the way it is in John Edwards' world. When John Edwards is President, it seems that any patient will be entitled to any procedure he or she wants. And Edwards won't 'negotiate' with the people who try to control cost and keep the system solvent. It seems he'll rule by fiat:
Nataline Sarkysian died last night at UCLA Medical Center after complications arose from a bone marrow transplant to treat her leukemia. Her insurance provider, CIGNA Healthcare, first denied the potentially lifesaving transplant, but relented after a loud public protest and outrage. By that time, though, Sarkysian passed away before the procedure could be performed.
"Are you telling me that we're gonna sit at a table and negotiate with those people?" asked a visibly angered Edwards, challenging the health care companies. "We're gonna take their power away and we're not gonna have this kind of problem again."
Edwards also told the audience of about a hundred people at the Score Pavillion in Nevada, Iowa, that it will take a fighter (i.e. him) - and not a negotiator (ii.e. Obama) - to take on large insurance companies like CIGNA.
We've all heard horror stories from Britain, Canada, Japan, or some other wealthy nation with national health care. Experience shows pretty clearly that single-payer systems have plenty of flaws -- with health care rationing high on the list. As the Cato Institute explained it:
Wherever national health insurance has been tried, rationing by waiting is pervasive, putting patients at risk and keeping them in pain. Single-payer systems tend to leave rationing choices up to local bureaucracies that, for example, fill hospital beds with chronic patients, while acute patients wait for care. Access to health care in single-payer systems is far from equitable; in fact, it often correlates with income—with rich and well-connected citizens jumping the queue for treatment. Democratic political pressures (i.e., the need for votes) dictate the redistribution of health care dollars from the few to the many. In particular, the elderly, racial minorities, and those in rural areas are discriminated against when it comes to expensive treatments. And patients in countries with national health insurance usually have less access to critical medical procedures, modern medical technology, and lifesaving drugs than patients in the United States.
Far from being accidental byproducts of government-run health care systems that could be solved with the right reforms, these are the natural and inevitable consequences of placing the market for health care under the control of politicians.
It makes intuitive sense that many decisions about care for people near death will be difficult and painful. Regardless of whether it's the insurance company or the taxpayer paying the bill, at some point a decision needs to made as to when to cease curative therapies. Leave it to an ambulance-chasing shuyster like John Edwards to claim that it will suddenly be easy.
A final comment: the LA Times article mentions that one of the reasons the case attracted so much attention is that the family turned to a DailyKos contributor to help publicize it. (I have no argument with that; as I mention, I too would do whatever it took.) Any surprise that Edwards is attentively reading DailyKos?
The State of Maine -- and a number of others -- have decided that there's one class of private property that reverts to the state if it is not used within two years. If the class of property were a car, or a home, or a piece of real estate, we would never stand for it. Elected officials would get tossed out of office if they tried to confiscate those. But apparently the states feel that there's at least one sort of property that's different: gift cards.
Maine officials say the issue is consumer rights and some of the billions of dollars in unused gift-card value whose ownership cannot be determined should revert to the public instead of retailers.
“There is a windfall of sizable proportions here that Maine law wants to return to the consumers, and that the national retailers want to hold on to,” said Lemoine, who has sought — without success so far — to get large chains to pay up.
The retail industry says the Maine law is simply a money grab.
“States have no legitimate claim to that money whatsoever,” said Craig Shearman of the National Retail Federation. “This is really a situation where states are seeing revenue shortfalls, and they’re looking for ways to put their hands in somebody else’s pocket to cover their tax situations...”
Nationally, unused value is expected to drop to $7.8 billion this year from $8 billion last year. Most gift cards issued by retailers have no expiration date, and Maine is among the states that prohibits expiration dates on the cards.
Note the attempt at misdirection by the way: if you fail to use a gift card for 2 years, the state considers it a card 'whose ownership cannot be determined.' That's silly of course. The ownership of the balance is no less certain than a card that's been outstanding for a week. In either case, all that anyone can determine with certainty is that it hasn't been used. There's no way to tell who has the card, of course.
It's also ironic that the state of Maine makes it illegal for retailers to put expiration dates on the cards -- since the state is effectively doing exactly that. After two years, the card expires (for the consumer) and the balance is transferred to the state.
Why stop here? Why not seize bank accounts with no activity for two years? Or real estate? Why not set up a program for consumers to give unwanted Christmas gifts to the state? What exactly is the difference?
At what point does the state magically assume some right to step in between gift giver and recipient, and decide that the recipient no longer wants the gift?
I prefer honest taxes.
One more question: how is it that this does not constitute interference with interstate commerce -- a power reserved in the Constitution to the federal government?
A friend gave Mars Needs Moms to my daughter, and I was stunned at how cool a gift it is. Berkeley Breathed is the cartoonist who brought us the seminal cartoon Bloom County, as well as the subsequent spinoff Opus -- which is not nearly as good. This book however, is touching. And the artwork is extraordinary. Breathed clearly devoted a great deal of time to getting exactly the look he wanted. Here's a sample:
Breathed is a bit odd, but this book is well worth getting. And that's good, because several of our friends will be getting it.
First it was Venezuela, spending $4 billion on Russian fighter planes, Kalashnikovs and perhaps even submarines. Then it was Brazil, in August announcing a 53% increase in its military budget for 2008, the biggest such increase in more than a decade. The competition is still in the early stages but when two of Latin America's nouveau riche oil powers start splashing out on weapons, alarm bells ring over an arms race.
The regional expert at Jane's defense analysis however, seems to be unconcerned -- for now at least -- about the potential for Chavez's buildup to spark cross-border hostilities:
"Venezuela," says Joyce, "comes fairly low down the list." But Chavez does give a face to the race and an impetus for nationalistic Brazilian politicians to vote for an increase in the military budget. Indeed, part of the proposed new funds will go toward resuscitating the country's dormant arms industry. "We had 1% [share] of the world's arms market in the 1970s and 1980s," says Reserve Colonel Geraldo Lesbat Cavagnari, coordinator of the Strategic Studies Group at Unicamp university. "We need to recuperate that industry and invest in it. That means producing for the Brazilian armed forces."
Brazil and Venezuela are not the only South American nations looking to beef up their militaries however. Chile, Argentina, Peru and Ecuador are increasing their spending as well:
Chile leads with annual expenditure to the tune of 3 billion US dollars funded mainly by the Copper bill, the country’s main export, which earmarks 10% of the red metal earnings for the Armed Forces equipment. Chile so far has purchased F-16 fighter bombers, German Leopard 2 tanks (considered the best in the world) plus refurbished frigates for its surface fleet and two brand new submarines...
Peru and Ecuador recently purchased jets and tanks and increased their defense budgets. Argentina has defense experts visiting Europe searching for the “best buy”, which indicates that the country is in the process “of increasing military expenditure in the short term”.
The experts seem to agree that this is nothing to worry about -- at least in the short term. But with Hugo Chavez at the center of this, you have to be concerned about the down-the-road potential for conflict among competing nations. This is especially true given the serious problems Chavez has encountered with regard to Argentina, Bolivia, Brazil, and other nations:
But for all his spending, his influence over regional affairs appears stuck. Many of his projects, such as a regional oil pipeline, are gathering dust on the drawing board. Others, such as a plan to create a regional lending institution called Bank of the South, are unlikely to live up to his grandiose vision. Venezuela's relations with neighboring Colombia, meanwhile, are deteriorating fast.
Bolivia, by far Mr. Chávez's most successful foreign project, has started to unravel. A Chávez-inspired constitutional rewrite has split the country and prompted several key states to threaten to secede.
Yesterday, tens of thousands of Bolivians in eastern, energy-rich provinces celebrated a declaration of autonomy from the central government. A rival rally was held in the capital, La Paz, heightening tensions in the Andean nation.
Read the whole thing. It's clear that Chavez has hit a wall -- at least for now. What will he do next? It's hard not to be concerned about the potential for real international trouble, given the instability of the man at the center of the storm.
Check out Patrick Ruffini:
Lazy Fred is no more. The dude’s had 5 events in Iowa each day the last week. Some of those events were canceled because of a blizzard today, others received less than rave reviews, but you can’t argue that Fred is confounding the pundits with a bruising schedule when it matters most. That kind of thing counts in Iowa, and as a result of that and the inevitable Huckaslide, I’m predicting he places a surprisingly strong third and stays in the race.
Given the manifest problems with the other leading Republican candidates, all Republicans ought to at least agree that the party's interest would be best served by seeing Fred advance in the primaries. Once the field is winnowed somewhat, the voters may make a better judgment about which of the leaders is best suited to carry the Republican banner.
I missed this on Friday, but White House spokesman Tony Fratto addressed the glut of earmarks in the end-of-year omnibus bill. He indicated that OMB Director Jim Nussle is reviewing whether the executive branch can disregard earmarks included in report language, rather than statute. He also did a great job of laying out why earmarks re so bad:
...part of what he asked [Nussle] to do was to review all the options. We may not have tools to deal with earmarks. It may be largely an issue for, again, for Congress to deal with. We don't have a line-item veto, of course. But that's something that the OMB Director will take a look at.
Look, I mean, this is -- we talked a lot about earmarks. The Democratic Congress, when they came in, talked about earmarks and I guess -- maybe we need a 12-step group to deal with earmarks. They took the first step of admitting that they have a problem. I think one of the other steps is you have to make amends. So we'd like to see more amendment making...
Look, earmarks present a huge problem for government. Congress sets out lots of standards for programmatic funding. They appropriate the money, and then they tell agencies certain requirements. The agencies go through elaborate regulation and policy regulation processing, grant processing on how they're supposed to distribute money, how it's supposed to be merit-based, what priorities ought to be. States go through an equally rigorous effort to set priorities for funding that they get from the federal government.
And so to then have Congress come in and identify the projects that individual members think ought to be the number one priority, after agencies and state agencies go through all this time and effort and public rule-making to try to get it right, causes real problems for how you spend money. And in some cases -- I think we talked about this when we were talking about earmarks during -- when the Minneapolis bridge collapsed, that earmarks were noted as a particular problem because states go through this process -- in fact, they're required to do it, to list their top spending priorities for transportation projects. And sometimes earmarked funds don't get spent because they're not in the correct order of the list that a state puts together. So it causes lots of problems for agencies that are out there trying to spend money and really trying to do the right thing, based on merit and based on standards of regulation, that have been promulgated publicly, and commented on, and published in Federal Registers.
The White House is certainly talking right about this. It would be very disappointing if, after appropriate review, they were to conclude that they do not in fact, have the authority to disregard earmarks that are not written into the statute.
Of course, as the Heritage Foundation's Brian Riedl points out, it's not clear that the White House has the authority -- at least in this case:
The appropriations bills' texts contain several sections stating that a certain amount of a program's budget "shall be available for projects and in the amounts specified in the explanatory statement described in section...." This may effectively make many of the earmarks in the conference reports legally binding. The White House, as well as Members of Congress, should investigate whether that is the case. If they determine the conference reports' earmarks remain non-binding, then President Bush should issue an Executive Order cancelling all 11,331 earmarks and requiring thatall government grants be distributed by merit or statutory formula.
More from me on this here. And also check out Mark Tapscott, Glenn and Club for Growth.
On the other hand, Don Young and Ted Stevens defend earmarks to a local paper... Young has this to say:
“You show me a congressman who says, ‘I’m not going to have any earmarks, and I’m not going to listen, and I’m not going to provide,’ and I’ll show you a short-timer.”
Right. Just look at the failed careers of earmark opponents like John McCain, John Boehner, Tom Coburn, Jeff Flake, and others. It's also worth noting another earmarks defense offered by Young:
“People think their taxes go up and that spending gets bloated. It’s not true,” Young said. “If the money wasn’t earmarked for the state, it would be spent somewhere else.”
This is pure speculation on Young's part. Earmarking has become so central to the process that it's impossible to say whether earmarks come out of a set pot of money that Congress would spend regardless, or whether federal spending is padded to account for the waste. If earmarking were ended, it would be up to Congress -- not just Don Young -- to determine whether spending fell overall, or whether the federal government spent the same amount of money, but merely allocated it according to merit.