Later On

A blog written for those whose interests more or less match mine.

Archive for April 1st, 2007

The finest medical system in the world?

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In a discussion on the “off-topic” forum of a shaving site, we’ve been talking about healthcare in the US and in other, more advanced nations (where universal health insurance has been around for years). A small but vociferous group continues to insist that the medical care in the US is the best in the world, and that a government run system would fail to match the efficiency and effectiveness of the “system” we now enjoy.

I wonder:

Should a hospital be able to handle a medical emergency?

The answer may seem self-evident. But patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance.

That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.

The episode occurred at a small hospital that is owned and run by doctors — one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements.

These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.

Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals.

But the Texas case, and others like it, have invited new scrutiny from regulators and members of Congress about these hospitals’ ability to care for patients who suffer complications after their operations.

While some of these hospitals are large sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. For example, small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient’s recovery.

“The problem with physician-owned specialty hospitals is that decision-making is more likely to be driven by financial interest rather than patient interest,” said Senator Charles E. Grassley, Republican of Iowa, who is a longtime critic of such hospitals.

“You see it in the cherry-picking of patients, and with policies that instruct hospital staff to call 911 for the local community hospital if emergency care is needed,” said Mr. Grassley, a ranking member of the Senate Committee on Finance, which oversees Medicare.

Read the entire article.

Written by Leisureguy

1 April 2007 at 8:14 pm

The rule of law takes another one on the chin

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I blogged this earlier, but David Kurtz has a good comment:

We learn more of the sordid details of the plea agreement of Australian David Hicks, whose five-year detention by the U.S., mostly at Guantanamo Bay among the purportedly most dangerous of the dangerous, ended in a nine-month prison sentence.

The plea agreement, which includes a one-year gag order on Hicks, was not negotiated by the military tribunal’s prosecutors but by the official overseeing the tribunals, reports the Post this morning. In fact, the agreement was reached without the knowledge of the prosecutors, who favored a much stiffer penalty.

Australians have long suspected that the political fortunes of Prime Minister John Howard, who is up for re-election this year, would have some bearing on Hicks’ fate. The circumstances of the plea agreement further cement that notion:

Marine Maj. Michael “Dan” Mori, representing Hicks, took his plea negotiations to Susan J. Crawford, the top military commission official, rather than dealing with prosecutors who were seeking a lengthy penalty, according to both sides in the case. In what became a highly politicized situation involving the Australian government, Crawford allowed Hicks a short sentence in exchange for a year-long gag order, a guarantee that he will not allege illegal treatment at the hands of his U.S. captors, and a waiver of any right to appeal or sue.Though Australian officials have said they were not directly involved in plea negotiations, Mori declined to answer questions about what, if any, influence they had. Australian Prime Minister John Howard, up for reelection this year, has been under public pressure to bring Hicks home. He turned to Vice President Cheney to implore that the case be resolved. Crawford was the Defense Department’s inspector general from 1989 to 1991, when Cheney was defense secretary.

“What an amazing coincidence that, with an election in Australia by the end of the year, he gets nine months and he is gagged for 12 months from talking about it,” said Australian lawyer Lex Lasry, who was in Cuba to monitor the case over the past week.

Could the outcome of the Hicks case be any less legitimate?

On the one hand, you have Hicks being held for five years without trial amidst allegations of torture and other mistreatment, fighting simply to get a fair hearing. His case has become an internationally known example of the Bush Administration’s blatant disregard for basic human rights.

On the other hand, you have the outcome of the case determined not by conventional Anglo-American standards of due process, including evidence presented to an impartial fact-finder, but by the political considerations of the Bush Administration and its ally Howard. Or as a spokesperson for the military commissions candidly told the Post, “Like it or not, the detainees at Guantanamo are from different countries, and that sometimes is a factor.”

It’s another example of politics trumping the War on Terror when it suits the Bush Administration. While you might feel some relief that there is an end in sight to Hicks’ Kafkaesque detention, you can’t help but be left with niggling doubts. Was Hicks a true danger? Perhaps not. But prosecutors thought Hicks would have received a decades-long sentence if the case went to trial. Has Hicks been vindicated? Not at all. The able representation of Hicks by Maj. Dan Mori took advantage of the political situation in Australia to win his client’s eventual release. Mori knew the game that was being played, and played it.

It is a deeply unsatisfying outcome.

Late update: Here’s the Hicks plea agreement. [Thanks to TPM Reader JG for the link.]

Written by Leisureguy

1 April 2007 at 5:13 pm

How the GOP approaches accountability

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The government contractor that set up a billion-dollar-a-year federal reading program for the Education Department and failed, according to the department’s inspector general, to keep it free of conflicts of interest is one of the companies now evaluating the program.

Reading First, part of President Bush’s signature No Child Left Behind education law, provides intense reading help to low-income children in the early elementary grades. RMC Research Corp. was hired to establish and implement the program starting in 2002, under three contracts worth about $40 million.

Recently, the Education Department’s inspector general reported that RMC failed to keep the program free of conflicts of interest. For example, RMC did not screen subcontractors for relationships with publishers of reading programs.

Now, Reading First is in the midst of a congressionally mandated evaluation under a 2003 contract with a team that includes RMC, based in Portsmouth, N.H.

Lawmakers who have been investigating the Reading First program criticized the connection.

“If it’s true that RMC was also hired to evaluate the effectiveness of the very program it was hired to help implement, then the conflict of interest could not be any clearer,” Rep. George Miller (D-Calif.), chairman of the House education committee, said Friday.

“It’s a classic case of the fox guarding the chicken coop,” said Sen. Edward M. Kennedy (D-Mass.), who chairs the Senate education committee.

The inspector general found that federal officials intervened to influence state and local decisions about reading programs, a potential violation of the law.

RMC did not return calls seeking comment. Nor did Abt Associates, a contractor based in Cambridge, Mass., that hired RMC as a subcontractor.

Written by Leisureguy

1 April 2007 at 3:07 pm

Just as you suspected: hacks in high places

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From the Washington Post:

About one-third of the nearly four dozen U.S. attorney’s jobs that have changed hands since President Bush began his second term have been filled by the White House and the Justice Department with trusted administration insiders.

The people chosen as chief federal prosecutors on a temporary or permanent basis since early 2005 include 10 senior aides to Attorney General Alberto R. Gonzales, according to an analysis of government records. Several came from the White House or other government agencies. Some lacked experience as prosecutors or had no connection to the districts in which they were sent to work, the records and biographical information show.

The new U.S. attorneys filled vacancies created through natural turnover in addition to the firings of eight prosecutors last year that have prompted a political uproar and congressional investigations.

No other administration in contemporary times has had such a clear pattern of filling chief prosecutors’ jobs with its own staff members, said experts on U.S. attorney’s offices. Those experts said the emphasis in appointments traditionally has been on local roots and deference to home-state senators, whose support has been crucial to win confirmation of the nominees.

The pattern from Bush’s second term suggests that the dismissals were half of a two-pronged approach: While getting rid of prosecutors who did not adhere closely to administration priorities, such as rigorous pursuit of immigration violations and GOP allegations of voter fraud, White House and Justice officials have seeded federal prosecutors’ offices with people on whom they can depend to carry out the administration’s agenda.

The interim U.S. attorney in Kansas City, Mo., Bradley J. Schlozman, for example, was a deputy in Justice’s civil rights division who helped overrule career government lawyers in approving a Texas redistricting plan pushed by Tom DeLay (R-Tex.), then House majority leader. In January, the White House nominated a permanent replacement, John Wood, who is counselor to Deputy Attorney General Paul J. McNulty. Neither Schlozman nor Wood has been a prosecutor before.

Continue reading.

Written by Leisureguy

1 April 2007 at 2:44 pm

The GOP economy

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Via Kevin Drum, the chart makes it clear what the problem is:

The GOP economy

The chart is from an article in the Wall Street Journal. As Kevin points out, the GOP doesn’t want to actually do anything about the problem, just change the way they talk about it so that people won’t notice.

Until January, President Bush seldom acknowledged the widening gap between the rich and the middle class. Then, in a speech, he declared: “I know some of our citizens worry about the fact that our dynamic economy is leaving working people behind. …Income inequality is real.” He has raised the subject several times since.

This isn’t a sudden change in Mr. Bush’s economic philosophy, but rather a change in tactics forced by the changing political environment, say current and former administration officials and outsiders in touch with the White House.

Top White House economic officials still don’t consider today’s inequality — the growing share of income going to those at the top — an inherently bad thing; they believe it simply reflects the rising rewards accruing to society’s most skilled and productive members. Nor do they see merit in various Democratic proposals to reduce inequality, such as ending Mr. Bush’s tax cuts on the highest-earners, raising the minimum wage, making it easier to form unions and including labor standards in trade agreements.

But Democrats’ takeover of Congress makes avoiding the issue difficult, particularly if the president is to win congressional backing for free-trade pacts and for extending his authority to negotiate new ones.

Read the rest of this entry »

Written by Leisureguy

1 April 2007 at 2:39 pm

GOP embraces authoritarianism

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Really, this is not news, but it’s becoming ever more naked and obvious. The GOP loves totalitarian authority, provided they’re the ones to exercise it. Glenn Greenwald:

Various Republican candidates attended a meeting of Club for Growth, and afterwards, National Review‘s Ramesh Ponnuru spoke to Cato Institute’s President Ed Crane about what they said. This brief report from Ponnuru is simply extraordinary:

Crane asked if Romney believed the president should have the authority to arrest U.S. citizens with no review. Romney said he would want to hear the pros and cons from smart lawyers before he made up his mind.

Mitt Romeny can’t say — at least not until he engages in a careful and solemn debate with a team of “smart lawyers” — whether, in the United States of America, the President has the power to imprison American citizens without any opportunity for review of any kind. But in today’s Republican Party, Romney’s openness to this definitively tyrannical power is the moderate position. Ponnuru goes on to note:

Crane said that he had asked Giuliani the same question a few weeks ago. The mayor said that he would want to use this authority infrequently.

It sounds like Giuliani is positioning himself in this race as the “compassionate authoritarian” — “Yes, of course I have the power to imprison you without charges or review of any kind, but as President, I commit to you that I intend (no promises) to ‘use this authority infrequently.'” Two of the three leading Republican candidates for President either embrace or are open to embracing the idea that the President can imprison Americans without any review, based solely on the unchecked decree of the President. And, of course, that is nothing new, since the current Republican President not only believes he has that power but has exercised it against U.S. citizens and legal residents in the U.S. — including those arrested not on the “battlefield,” but on American soil.

What kind of American isn’t just instinctively repulsed by the notion that the President has the power to imprison Americans with no charges? And what does it say about the current state of our political culture that one of the two political parties has all but adopted as a plank in its platform a view of presidential powers and the federal government that is — literally — the exact opposite of what this country is?

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Written by Leisureguy

1 April 2007 at 2:27 pm

Posted in Election, GOP, Government

Megs in a phototropic mood

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Megs sun 1 Megs sun 2

Though I imagine it’s not the light, it’s the warmth. Still, it’s all part of the electromagnetic spectrum, and Megs understands that. Or not.

At any rate, as I went into the kitchen to get my coffee, there she was: totally relaxed, post breakfast.

Written by Leisureguy

1 April 2007 at 8:16 am

Posted in Cats, Megs

Vermont looking for its own path

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The reader in the Netherlands points out this article, written by Ian Baldwin, publisher of Vermont Commons and Frank Bryan, a political science professor at the University of Vermont and author of “Real Democracy: The New England Town Meeting and How It Works.”

The winds of secession are blowing in the Green Mountain State.

Vermont was once an independent republic, and it can be one again. We think the time to make that happen is now. Over the past 50 years, the U.S. government has grown too big, too corrupt and too aggressive toward the world, toward its own citizens and toward local democratic institutions. It has abandoned the democratic vision of its founders and eroded Americans’ fundamental freedoms.

Vermont did not join the Union to become part of an empire.

Some of us therefore seek permission to leave.

A decade before the War of Independence, Vermont became New England’s first frontier, settled by pioneers escaping colonial bondage who hewed settlements across a lush region whose spine is the Green Mountains. These independent folk brought with them what Henry David Thoreau called the “true American Congress” — the New England town meeting, which is still the legislature for nearly all of Vermont’s 237 towns. Here every citizen is a legislator who helps fashion the rules that govern the locality.

Today, however, Vermont no longer controls even its own National Guard, a domestic emergency force that is now employed in an imperial war 6,000 miles away. The 9/11 commission report says that “the American homeland is the planet.” To defend this “homeland,” the United States spends six times as much on its military as China, the next highest-spending nation, funding more than 730 military bases in more than 130 countries, abetted by more than 100 military space satellites and more than 100,000 seaborne battle-ready forces. This is the greatest military colossus ever forged.

Few heed George Washington’s Farewell Address, which warned against the danger of a permanent large standing army that “can be regarded as particularly hostile to republican liberty.” Or that of a later general-become-president: “We must never let the weight of [the military-industrial complex] endanger our liberties or democratic processes.” Dwight D. Eisenhower pointedly included the word “congressional” after “military-industrial” but allowed his advisers to excise it. That word completes a true description of the hidden threat to democracy in the United States.

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Written by Leisureguy

1 April 2007 at 8:07 am

Posted in Government

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