17 August 2012

Voter Suppression Upheld in PA.: SHAMEFUL

Not much time for a detailed comment, except to say the Judge's decision in Pennsylvania Commonwealth court to uphold a law that admittedly could disenfranchise 9% of the state's electorate, to address an essentially nonexistent "problem," and the Minority Leader of the legislative body publicly admitted that the motivation of the law was political, i.e., to skew the election in that state for partisan purposes, is just breathtaking. I used to say the Republicans wanted to turn the clock back to McKinley, having gone so far right that merely obliterating the New Deal wasn't enough for them, they had to do away with the Progressive Era reforms as well. Now, it seems, they want to go all the way back to the era of the backlash against Reconstruction, of the 1870s and 80s, when Rightist judges were upholding things like poll taxes and literacy tests for voting.

This is truly shameful. It makes me wonder, and not for the first time, if we really are witnessing the death of the American Republic. 

13 August 2012

Reforming Medicare and Health Care Costs

A friend wrote about the enormous cost of a recent hospital stay, and an anecdote about another friend whose elderly parent incurred over $1 million, billed to Medicare, in the last month of his life.

Here's my comment:

This is why our share of GDP for medical care in the USA is 18%, the highest in the developed world. A lot of it has to to do with the "boutique" nature of American medicine. Specialists choose their own treatments, follow their own preferred regimens, there are no economies of scale, no standardized competitive selection of products and proven effective, and cost-effective, medication. What I would propose to counter Ryan Romney Right Wing Extremist Slash it and Burn It, were I involved in policy for the Obamians would be something like this:

Medicare will transition to supporting major treatment only in not for profit institutions which agree to adhere to medical best practices, to be devised by regional conference boards made up of elected top specialists and medical technology experts, chosen by the doctors and nurses themselves. These conference boards will approve standard regimes for all the most commonly prescribed procedures and medicines, and set cost controls based on competitive bidding. (No more knee replacements that range from x to 5x in price when the technology was standardized a quarter century ago). Also, there needs to be a set up of continual consultation and oversight to make sure that every ICU patient (since this is where a lot of the money goes) is monitored for best outcome, adherence to patient health care directives, and efficient use of resources. (No more specialists coming in and ordering a raft of tests that have already been done).

There are times when medicine is terribly expensive because of undiagnosed problems, difficulty and unavoidable cost of rare treatments, etc., but MOST of the excess cost comes from inefficiencies and excessive use of costly services, devices, and medications when the need is dubious or non-existent.

With these reforms, which would effectively spread into the general population and private health insurance, and with Medicare's historically low administrative costs, it should be possible to get a real handle on escalating health care costs. Medical technology is expensive, and no one wants to return to the days when if you got really sick you died; in other words, we all WANT to spend a certain chunk of GDP for necessary medicine; what's needed is to control inefficiency and excess, of which almost all informed observers seem to agree there is a great deal. Especially excess cost, and in that respect the presence of a profit motive is an inherent conflict of interest and needs to simply be excised from publicly supported medical care.

It would be politically difficult because FOR PROFIT Big Med has a lot of pull in Washington, but many big hospital groups have reorganized as not for profit, and it can be done. With regional video monitoring and automatic best practices consultations, costs can be brought down, and here's the thing... when this has been done (notably in Boston), the outcomes improve.

I believe in "Health Care is a Right, not a Privilege," but I also believe that the public has a right to make sure its money is wisely and reasonably spent. 

The issue of unnecessary CYA testing and procedures, often cited by Rightists, can be addressed as well. I would impose some reasonable caps on damages, the way we've done it in California since the late 1970s, and also change the standard of care, from negligence equals anything that falls below what amounts to the ideal standard, which is the way it is now, to negligence can only be found when it can be shown that the care provided was below what a reasonably well trained health care provider would reasonably have been expected to have done in like circumstances. This would reduce malpractice awards and medical practices mainly designed to avoid liability as an engine of high health care costs.

*See "Big Med" in the current issue of the New Yorker.

06 August 2012

The Amazing Success of the Landing of Curiosity on Mars, August 5, 2012

The amazing success of the Mars Science Laboratory Curiosity's descent and landing on Mars last night should be more prominent in our country's affairs right now: proof that, whatever our economic malaise and challenges to our educational, scientific, and technological preeminence, our nation can still produce triumphs of the sheer human drive to go out and find out what's out there.

And to those who love to knock California, and Southern California in particular, I would like to point out that one of the main parts of NASA that's producing the most amazing results for the least money (JPL) , and the most promising private enterprise space developer (SpaceX), are both located here, despite the fact that the big military contractors that did most of the development of the space technology industry back in the 50s-70s have abandoned our area. All of the Mars landers were built and guided from Pasadena, California, and this robotic space exploration is some of the most innovative and thoroughly thought-out in advance technology the world has ever seen. 

If you take a look at nasa.gov/mars and see just how complex and original in concept the landing of the compact-car sized Curiosity on Mars, 14 light-minutes away, actually was, you should feel a certain amount of awe. This thing had to work entirely on its own; in a complex and zero fudge factor series of operations, that simply could not be controlled from Earth. They actually turned off the transmitter before entry into the thin Martian atmosphere, because by the time the signal reached Earth that entry had begun, the landing ... or crash... of the vehicle had already happened. Fortunately, it was a spectacularly successful landing, and even those of us Americans who had nothing to do with this, other than contributing about half the price of a movie to the enterprise as taxpayers, should feel just a bit of pride in the sheer determination to get this done that resulted in this success. Maybe we don't usually pay a lot of attention, but this is a moment when we should. 

Why is Mars important, some may ask. You might as well ask why knowledge is important, why civilization is important. It is our essence as human beings to look over the next hill, to wonder what's over the horizon, to wonder how we might fashion tools and technology to evolve our life into something better. Exploration of space, and the answering of fundamental questions, are one of the frontiers of this essential human endeavor. We abandon that quest only if we are giving up, choosing extinction over growth. Yes, it is that basic, in my view. 

More specifically, the Mars Science Laboratory, for the first time since Viking (the other landers were heavily geared towards geology), will perform experiments that may well answer the question Was there ever life on this other Solar System World? If so, what kind of life? We now have reason to speculate (not believe just yet), that terrestrial life just might have actually originated on Mars, since it appears that Mars once had the temperate, liquid water, protective atmosphere, and protective magnetic field environment (since failed due to the planet's smaller size and distance from the sun)... that could have made the evolution of life possible. And here's the kicker... it had that environment earlier in the evolution of the Solar System than Earth did. Since life seems to have appeared on Earth almost immediately after it became possible, the conclusion that life just might have migrated here on one of the many trans-Earth orbit impact ejecta from Mars cannot be ruled out. In fact, it looks quite plausible. Curiosity will likely give us considerable information that will shed light on all these issues. 

Then, can there be any doubt that eventually, humans will travel to Mars? It has been a dream for well over a century. Only the collapse of our entire civilization could prevent it from eventually happening. So this important mission, which will help answer many important questions that need answering before human travel to Mars could be feasible, is just essential.

Congratulations to JPL, and NASA for this important milestone in human exploration.

03 August 2012

An (I hope) reasoned comment on the whole sad, stupid Chick Fil-A controversy

Two points on the whole sad, stupid Chick Fil-A controversy. (Besides that the food looks entirely inedible; we fortunately don't have this place here, and I quickly rejected it when I encountered them in Florida not long ago).

1.  Offending your customers is stupid. The appropriate response is to not give the business your custom. (I was very saddened to see long lines of people rallying behind the hate-filled, discriminatory, and narrow-minded comments of the CEO that started all of this, but, again, the appropriate response is withholding business, or boycott).

2.  It's overreacting to try to penalize the business legally, so the mayors who said they will "block" Chick Fil-A from locating in their cities were overreaching. On the other hand, where there are city franchises or other choices of contractors for public venues, I think legislatures have every right to take the public image of a business as favorable or unfavorable to non-discrimination into account. And what Rahm Emmanuel, for instance, said, that the chain's values (as stated by its CEO; he didn't qualify his comments as speaking only for himself), were "not Chicago's values"; well, those kinds of remarks are just as protected by the First Amendment as the CEO's remarks in the first place. There was a similar reaction to the anti-health care remarks of Whole Foods' CEO (a notorious libertarian)... people have every right to say "Whole Foods values are not our city's values" in response, and to not shop there, even organize boycotts. What they probably don't have a right to do is categorically ban their stores from locating in their jurisdiction because they disagree with the stated political views of the CEO.

Why this is important is that with roughly half the country in thrall to Rightist propaganda about "excessive government control" and all of that nonsense, it's generally a good idea not to hand them an issue on a platter, so to speak. 

02 August 2012

Lying, Cheating, Stealing Right Wingers

As usual, our favorite Right Wing Presidential campaign displays disingenuous lack of contact with reality, and outright hypocrisy. During the primary season, Romney was happy to cite the Tax Policy Center's studies as "impartial," but when the selfsame reported that his tax plan to cut tax rates by 20% (with hugely disproportionate benefit to the top half of 1% or so) would necessarily mean tax changes that amounted to a huge tax increase for 95% of Americans, his campaign just called it a "joke," but failed to produce any analysis that showed otherwise.

These people lie, cheat and steal, and expect to be congratulated for it, and handed the keys to power. I say, like hell.

01 August 2012

Popular/Electoral Vote picture in current polls -- Focus on the Do Nothing Congress!

The popular vote/electoral vote disparity I was on about earlier this week has gotten even weirder. These early polls may not mean much, but the PollTracker weighted average is now 47.3/47.2 in favor of Romney (a dead heat), but the electoral vote, based on leads in state polling, has Obama with 310, Romney holding with 191 (270 wins).

I still say that the Congressional balance is just as important as the presidential election this year. I would like to see Obama going on a broad scale offensive, along the lines of "Republicans have blocked every attempt we've made to move forward. We can't afford to extend the Bush tax cuts for the highest wealth of the richest and corporations when our country needs important investments to recover the economy. Mr. Romney's plan increases taxes on 95% of Americans while cutting taxes even further for the richest Americans, and he has endorsed virtual elimination of Medicare in the Heartless Paul Ryan budget plan. The Affordable Care Act will ensure access to health care for the vast majority of Americans, and all the obstructionist do-nothing block-everything Republicans in Congress can come up with is over thirty pointless, futile bills to repeal this law, while passing bill after bill that will never become law to cut back on women's health care, repeal the important financial reforms we passed to prevent another financial collapse, and refusing to pass even the most basic needs like the Transportation bill. We need your support not only to keep the White House but to get rid of this Do-Nothing Congress and end the deliberate obstruction of the Republicans so the people's business can get done again!"