Later On

This is interesting. Steve Benen writes:

Over at "The Corner," Jonah Goldberg highlights this 1961 clip from Ronald Reagan, criticizing Medicare. Goldberg said Reagan’s criticism of the landmark health care program is, nearly a half-century later, "still fresh today."

As Jonathan Chait explained, "This is true, but not in the way Goldberg thinks."

Listening to the recording now, it’s kind of embarrassing to hear how very wrong Reagan’s attacks on Medicare were at the time. In 1961, Reagan was a GE spokesperson, known for his conservative politics. When he lashed out at the idea of Medicare, it wasn’t surprising, but it was the message itself that was so bizarre.

According to Reagan, Medicare would lead federal officials to dictate where physicians could practice medicine, and open the door to government control over where Americans were allowed to live. In fact, Reagan warned that if Medicare became law, there was a real possibility that the federal government would control where Americans go and what they do for a living.

In a line that may sound familiar to Sarah Palin fans, Reagan added, "[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free."

With the benefit of hindsight, we now know these crazy warnings were completely wrong. As Chait put it:

You’d think conservatives would be embarrassed about this sort of talk. After all, can there be anybody who doesn’t live in a militia compound who believes the passage of Medicare represented the death knell of that freedom in America? Does anybody think this business about the government dictating what city doctors live in has come true? Yet conservatives continue to trumpet it.

Why? Reagan’s diatribe is "still fresh" because it’s exactly the same sort of rhetoric conservatives employ against health care reform today. I imagine his readers are supposed to consider it "fresh" because they’re supposed to substitute "Obamacare" in their head every time Reagan refers to Medicare. This allows them to sustain a mental condition wherein hysterical conservative predictions about the last social reform are forgotten in the specific, but remembered in the general and applied to the next social reform.

Reagan’s misguided diatribe from 48 years ago also serves as a reminder that we hear the same arguments from conservatives, over and over again, every time real reform is on the table. Republicans, Fox News, and Limbaugh, for example, reflexively shout "socialized medicine" whenever the issue comes up — just as the right has done for 75 years.

USB-powered chainsaw. (A joke, but carefully done.)

Since my wife’s family remains in Canada, we do a fair amount of mailing across the border, and the customs form issue has been frustrating: whether we pick the small form or the large one, we inevitably seem to pick the wrong one. I at last got an explanation which, if not correct, is at least easy to remember—and I got it from a USPS employee, so it probably is correct. Here’s the rule:

Less than 4 lbs: use the small form

4 lbs or more: use the large form.

Without going into the nature of milk (it’s one form of mucus), some people really, really want to be able to buy raw milk. There are risks associated with that, and apparently the producers of raw milk have not been careful about informing people of the risks. Very interesting post here.

Check it out.

Steve Benen at Political Animal:

Yesterday, Senate Minority Leader Mitch McConnell addressed the costs of health care reform. "If you’re going to do something as comprehensive as the president wants to do," the Kentucky Republican said, "you ought to pay for it."

Jonathan Cohn agrees, but finds McConnell sudden interest in fiscal responsibility interesting.

…It’s important that reform pay for itself. Still, I don’t recall McConnell being quite so insistent about fiscal responsibility when he voted for the Bush tax cuts. Nor do I recall him agitating for tax increases to pay for the war with Iraq. In fact, I’m pretty sure most Republicans had very little use for arguments about fiscal responsibility when it was their initiatives on the agenda.

Gee, could it be that McConnell and the Republicans just don’t care what happens to people when they can’t pay for their medical care?

The record is strikingly clear. When Bush/Cheney slashed taxes by well over $1 trillion, Republicans said there was no reason to worry about paying for it. When Bush/Cheney started the war in Afghanistan, Republicans said there was no reason to worry about paying for it. When Bush/Cheney started the war in Iraq, Republicans said there was no reason to worry about paying for it. When Bush/Cheney added Medicare Part D, Republicans said there was no reason to worry about paying for it.

It’s not that their efforts at paying for it came up short, it’s that they didn’t even try. The notion of fiscal responsibility was simply deemed irrelevant — an inconvenient detail for unnamed people in the future to worry about.

And now, these exact same policymakers are, with a straight face, complaining bitterly about the fiscal habits of Democrats who are — in case anyone’s forgotten — actually trying to pay for much-needed health care reform.

There’s just one angle I’d add to this, though. While Cohn is clearly right about the selective concerns from McConnell and congressional Republicans, let’s also not forget that there are a handful of Democrats who have the same problem. Ben Nelson and Max Baucus, for example, both voted for Bush’s tax cuts, funding for both of the Bush-launched wars, and spending on Bush’s Medicare Part D, without so much as a hint about how to pay for them.

Now, Nelson and Baucus are suddenly deeply concerned about whether the country can really afford health care reform, and in Nelson’s case, whether Democrats should even be allowed to vote on their own reform plan in the Senate.

It’s maddening.

Karen Tumulty at Swampland:

[The Mayo Clinic] isn’t impressed.

Although there are some positive provisions in the current House Tri-Committee bill – including insurance for all and payment reform demonstration projects – the proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite.

In general, the proposals under discussion are not patient focused or results oriented. Lawmakers have failed to use a fundamental lever – a change in Medicare payment policy – to help drive necessary improvements in American health care. Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States.

Why does this matter? Because the Mayo Clinic is so often cited by President Obama, and by health care experts, as the model for providing high-quality health care at a relatively low cost. You can read more about how they do it here.

Malcolm Gladwell in the New Yorker:

In 1996, an investor named Henry de Kwiatkowski sued Bear Stearns for negligence and breach of fiduciary duty. De Kwiatkowski had made—and then lost—hundreds of millions of dollars by betting on the direction of the dollar, and he blamed his bankers for his reversals. The district court ruled in de Kwiatkowski’s favor, ultimately awarding him $164.5 million in damages. But Bear Stearns appealed—successfully—and in William D. Cohan’s engrossing account of the fall of Bear Stearns, House of Cards, the firm’s former chairman and C.E.O. Jimmy Cayne tells the story of what happened on the day of the hearing:

Their lead lawyer turned out to be about a 300-pound fag from Long Island . . . a really irritating guy who had cross-examined me and tried to kick the shit out of me in the lower court trial. Now when we walk into the courtroom for the appeal, they’re arguing another case and we have to wait until they’re finished. And I stopped this guy. I had to take a piss. I went into the bathroom to take a piss and came back and sat down. Then I see my blood enemy stand up and he’s going to the bathroom. So I wait till he passes and then I follow him in and it’s just he and I in the bathroom. And I said to him, “Today you’re going to get your ass kicked, big.” He ran out of the room. He thought I might have wanted to start it right there and then.

At the time Cayne said this, Bear Stearns had spectacularly collapsed. The eighty-five-year-old investment bank, with its shiny new billion-dollar headquarters and its storied history, was swallowed whole by J. P. Morgan Chase. Cayne himself had lost close to a billion dollars. His reputation—forty years in the making—was in ruins, especially when it came out that, during Bear’s final, critical months, he’d spent an inordinate amount of time on the golf course.

Did Cayne think long and hard about how he wanted to make his case to Cohan? …

Continue reading.

So 96% of detainees released go back to their civilian life. Here’s the report in the Washington Independent by Spencer Ackerman:

Via Adam Serwer at Tapped, the New America Foundation has a new report out addressing that slippery, demagoguery-filled claim about Guantanamo detainees “returning” to the battlefield after the Bush administration released them.

Contrary to recent assertions that one in seven, or 14 percent, of the former prisoners had “returned to the battlefield,” our analysis of Pentagon reports, news stories, and other public records indicates that the number who were confirmed or suspected to be involved in anti-U.S. violence is closer to one in 25, or 4 percent.

Worth remembering: this matches the figure that Defense Secretary Robert Gates gave in congressional testimony in January.

It’s becoming ever more evident. Joe Klein in TIME’s Swampland:

Benjamin Netanyahu’s phony flexibility on a two-state solution was always transparent–and it’s now becoming apparent that Israel is the prime impediment to progress in the Middle East. Over the weekend, the State Department asked Israel’s Ambassador Michael Oren to convey U.S. displeasure over continued Israeli settlement expansion in Jerusalem, which Netanyahu rejected out of hand. It also seems clear–according to U.S., Syrian and Israeli sources I’ve spoken with in the past week–that Israel is slow-walking peace talks with Syria (mostly because it doesn’t want to give back the Golan Heights).

The notion that Jerusalem is the capital of Israel seems to me right and fair. But it is also the capital of Palestine. The Likudnik notion that Israel has the exclusive rights to a united Jerusalem seems as foolish as the Palestinian notion that those who were displaced in 1948 still have a right to return to their old properties in Israel.

George Mitchell is returning to the region next week. There is progress–and the promise of real breakthroughs–in several aspects of the peace process: Hamas seems willing to play, the Syrians are far more cooperative, the other Arabs might be cajoled into taking steps toward the recognition of Israel, Iran’s influence in the area has diminished markedly. But not only is the Israeli government being uncooperative, it’s actually becoming more intractable.

No one is saying that …

Continue reading.

Spencer Ackerman in the Washington Independent:

Something else from Attorney General Eric Holder’s apparent decision to seek prosecutions for low-level CIA interrogators (Argh!) over torture: Newsweek reports that the prospect of those prosecutions may suffer from lack of evidence. Here’s a retired career Justice official:

But task-force prosecutors say they ran into a host of problems, including a lack of witnesses and forensic evidence, and declined to prosecute in all but one case. “We wanted to make these cases, but they just weren’t there,” says Rob Spencer, the former career Justice prosecutor who headed the task force until 2006. Ken Melson, who oversaw Spencer’s work and was appointed by Holder as acting Alcohol, Tobacco, Firearms and Explosives director, says the cases were “looked at aggressively” and without political pressure. “I think we made the right decision on these cases,” he says.

Maybe. It’s not crazy to think there were problems with preserving evidence at these locations. After all, CIA officials destroyed nearly 100 videotapes of interrogations.

Meanwhile, Marcy Wheeler catches some fast-and-loose references to the number of “specific referrals” from the CIA inspector general’s office to the Justice Department:

Of course, all three claims are likely true: CIA made no “specific referrals” … “when the report was finished,” but did make five referrals over the course of the investigation. And, once it took a look at the report (and probably once it looked at a bunch of military referrals), DOJ reviewed 20 cases. It’s funny, though, how zero can become five can become twenty as the need for different spin arises.

Make the entire population your enemy. Take a look at Daphne Eviatar’s article:

Reports today that the U.S. military is calling for an overhaul of the Bagram prison in Afghanistan follow weeks of little-reported protests by prisoners there, who since July 1 have refused to leave their cells or participate in video-phone calls with family members, all to protest their indefinite detention, says the International Committee of the Red Cross, which informed families of the protests. Prisoners are reportedly refusing even to meet with the ICRC.

All of this comes on the heels of a district court judge’s ruling at the end of June dismissing a habeas corpus petition by a Bagram prisoner on the grounds that the U.S. government has deemed the prisoners “enemy combatants” and Congress in the Military Commissions Act stripped federal courts of jurisdiction over their cases. In other words, they have no right to federal court review. (The Supreme Court has held that prisoners at Guantanamo Bay have the right to habeas corpus review, but has never addressed the situation of prisoners at Bagram.)

A district court had previously ruled that Bagram prisoners captured outside of Afghanistan do have habeas rights, but the Obama administration has appealed that ruling.

The new Defense Department review of the matter, reported in The New York Times today, appears to be focused not particularly on the rights of Bagram prisoners, though, but on growing worries that abuses in the Afghan prison system — to which the U.S. military transfers many Bagram prisoners — is helping the Taliban recruit new militants.

According to the Times, while the conditions at Bagram have improved since 2002, when at least two inmates died from severe beatings and abusive interrogations in U.S. custody, “conditions worsened in the larger Afghan-run prison network, which houses more than 15,000 detainees at three dozen overcrowded and often violent sites.”

The country’s justice system provides little in the way of due process for those prisoners, either. “Trials” for prisoners, often held at the prisons, involve the presentation of little or no evidence and little opportunity for the prisoners to defend themselves. The U.S. government is reportedly planning to build new courthouses in Afghanistan, but those plans aren’t very far along.

Human Rights First, which has done some of the most extensive work on the Bagram prison and the justice system in Afghanistan, is expected to release a new report on the problems there this week.

Peter Goodman in the NY Times:

From the ninth floor of a downtown office building on Wilshire Boulevard, Jack Soussana delivered staggering numbers of mortgages to homeowners during the real estate boom, amassing a fortune.

By Mr. Soussana’s own account, his customers fared less happily. He specialized in the exotic mortgages that have proved most prone to sliding into foreclosure, leaving many now scrambling to save their homes.

Yet the dangers assailing Mr. Soussana’s clients have yielded fresh business for him: Late last year, he and his team — ensconced in the same office where they used to broker mortgages — began working for a loan modification company. For fees reaching $3,495, with most of the money collected upfront, they promised to negotiate with lenders to lower payments on the now-delinquent mortgages they and their counterparts had sprinkled liberally across Southern California.

“We just changed the script and changed the product we were selling,” said Mr. Soussana, who ran the Los Angeles sales office of Federal Loan Modification Law Center. The new script: You got a raw deal, and “Now, we’re able to help you out because we understand your lender.”

Mr. Soussana’s partners at FedMod, as the company is known, were also products of the formerly lucrative world of high-risk lending. The managing partner, Nabile Anz, known as Bill, previously co-owned Mortgage Link, a California subprime lender, now defunct, that once sold $30 million worth of loans a month.

Jeffrey Broughton, one of FedMod’s initial partners, served as director of business development at Pacific First Mortgage, a lender that extended so-called Alt-A mortgages for borrowers with tarnished credit for Countrywide Financial, which lost billions of dollars on bad mortgages before being rescued in an acquisition.

FedMod is but one example of how many of the same people who dispensed risky mortgages during the real estate bubble have reconstituted themselves into a new industry focused on selling loan modifications…

Continue reading.

Very interesting (and long) article in the Washington Post by Joby Warrick and Peter Finn based on a lengthy series of interviews that they did. The article begins:

In April 2002, as the terrorism suspect known as Abu Zubaida lay in a Bangkok hospital bed, top U.S. counterterrorism officials gathered at CIA headquarters in Langley, Va., for a series of meetings on an urgent problem: how to get him to talk.

Put him in a cell filled with cadavers, was one suggestion, according to a former U.S. official with knowledge of the brainstorming sessions. Surround him with naked women, was another. Jolt him with electric shocks to the teeth, was a third.

One man’s certitude lanced through the debate, according to a participant in one of the meetings. James E. Mitchell, a retired clinical psychologist for the Air Force, had studied al-Qaeda resistance techniques.

"The thing that will make him talk," the participant recalled Mitchell saying, "is fear."

Now, as the Senate intelligence committee examines the CIA’s interrogation program, investigators are focusing in part on Mitchell and John "Bruce" Jessen, former CIA contractors who helped design and oversee Abu Zubaida’s interrogation. These men have been portrayed as eager proponents of coercion, but the former U.S. official, whose account was corroborated in part by Justice Department documents, said they also rejected orders from Langley to prolong the most severe pressure on the detainee. The former official’s account, alongside the recollections of those familiar with events at the CIA’s secret prison in Thailand, yields a more nuanced understanding of their role than has previously been available.

Interviews with nearly two dozen current and former U.S. officials also provide new evidence that the imposition of harsh techniques provoked dissension among the officials charged with questioning Abu Zubaida, from the time of his capture through the period when the most grueling torments were applied.

In August 2002, as the first anniversary of the Sept. 11, 2001, attacks approached, officials at CIA headquarters became increasingly concerned that they were not learning enough from their detainee in Thailand. When the interrogators concluded that Abu Zubaida had no more to tell, Langley scolded them: "You’ve lost your spine." If Mitchell and his team eased up and then al-Qaeda attacked the United States again, agency managers warned, "it would be on the team’s back," recalled the former U.S. official, who spoke on the condition of anonymity to discuss classified information.

The officials who authorized or participated in harsh interrogations continue to dispute how effective such methods were and whether important information could have been obtained from Abu Zubaida and others without them. In March, The Washington Post reported that former senior government officials said that not a single significant plot was foiled as a result of Abu Zubaida’s coerced confessions.

The International Committee of the Red Cross, in a 2007 report made public this year, said the application of harsh interrogation methods, "either singly or in combination, constituted torture."

George Little, a CIA spokesman, said …

Continue reading.

Spencer Ackerman in the Washington Independent:

Building on yesterday’s question of how “precisely” Gen. Stanley McChrystal’s Afghanistan strategy is “synchronized,” take a look at Brandon Friedman’s post at VetVoice. Brandon reads a CBS report about U.S. troops distributing a flyer to two villages in eastern Afghanistan that appears to tell the entire villages they “will be targeted” unless a captured colleague is freed. He observes:

Ultimately, I think whoever came up with the idea to print these things didn’t really think it through. While the likelihood of success using a technique like this is slim, the chance of inflaming the locals even further is much higher. This whole thing seems clumsy and ham-handed, and will almost certainly do more harm than good. I’d love to be proved wrong.

How does threatening villages — even implying that villages will be targeted — comport with McChrystal’s message that mission success is measured by population protection?

For more questions about the “precise synchronization” of McChrystal’s strategy, see Josh Foust in World Politics Review.

Good review of Ryan Grim’s new book by Laura Miller in Salon.com:

Not long ago, I was talking with a couple of friends who are about a decade younger than I am. We got onto the subject of recreational drugs and how my friends had recently sworn off Ecstasy. “I know a guy who used to love it, and he’s quitting, too,” one of them explained. “He’s learned a lot about it and says it’s just too hard on your body.” I remarked that since Ecstasy is the sort of drug most people take only very occasionally, it probably wasn’t as dangerous as something like cocaine, which can be addictive, expensive and lethal. “Oh, cocaine’s not that bad,” said my friend, looking puzzled and leaving me surprised. Hadn’t he ever worked for someone who’d gotten so tweaked on coke that he burned out his septum, emptied his bank account and triggered a heart attack? Hasn’t every journalist worked with someone like that?

Ryan Grim would understand this disconnect perfectly. One of the theses of his new book, “This is Your Country on Drugs: The Secret History of Getting High in America” — a cornucopia of unconventional wisdom about our relationship to mind-altering substances — is that the popularity of drugs waxes and wanes according to a complex sum of factors. One of those factors is the “perceived risk” of using a particular chemical, which also fluctuates. There’s a tendency to idealize new drugs, as the Boston Medical and Surgical Journal did with a recently isolated narcotic in 1900. “There’s no danger of acquiring a habit,” it assured its readers about the drug that had just emerged from the labs of the aspirin manufacturer, Bayer. They named it heroin.

Even when we ought to know better, we don’t. “It takes about seven years,” Grim writes, “for folks to realize what’s wrong with any given drug. It slips away, only to return again as if it were new.” I came of age professionally at a time when older journalists and editors were wrecking themselves on cocaine right and left; as a result, I still think of the drug as equal parts perilous and pathetic, as well as hopelessly uncool. My friend, no doubt, came up during a coke lull.

Read the rest of this entry »

Christopher Weaver at McClatchy:

Dr. David Blumenthal, the Obama Administration’s national coordinator for health information technology, can recall the day he became a true believer in the potential of electronic health records. He was about to order a lung scan when the computer in his Boston hospital alerted him to a similar image already in the file. The patient was spared an unnecessary dose of radiation and the health care system was spared the cost of an unnecessary test.

Such experiences, he said, "suggest… how small victories… can lead us to be better physicians, higher quality physicians." That thinking is informing his actions as head of the Office of the National Coordinator, which wants doctors to use electronic medical records as part of a broader effort to modernize the health care system.

With the stimulus law, Congress laid out two goals — improving the quality of health care and lowering costs. Lawmakers also offered some specific guidance on how to proceed. They wanted the funds to be used to create, for instance, platforms for e-prescribing and for the coordination of care — not simply to buy new software. But other than those few stipulations, Congress left Blumenthal in charge.

For Blumenthal, the most difficult challenge will be to convince doctors that participating is worth it. Even with assistance from the federal government, physicians will have to spend big money on the digital transition. And the return on their investment is murky. Blumenthal must show doctors how this program is good for them by identifying goals for improvements, and ultimately, savings in their practices.

"We really need to be able to sell this…," said Neil Calman, a family doctor in New York, during the June meeting of the advisory panel. "It’s really critical that we show efficiency is achieved."

There is a financial reality that makes this proposition difficult: While preventing hospitalizations, medical errors and duplicate tests would cut into America’s more than $2 trillion of annual health spending, the savings would go to the insurers, policy holders and taxpayers who pay the bills, but not individual physicians…

Continue reading.

Thanks to Constant Reader for this:

Keep watching for the contortionist part of the show.