;)
Thursday
May292014
The Commentariat -- May 30, 2014
Obsolete videos & related text & link removed.
Michael Shear & David Joachim of the New York Times: "The secretary of the Department of Veterans Affairs, Eric Shinseki, apologized to veterans and lawmakers on Friday for the agency's mismanagement of the nation's veterans hospitals as he prepared to meet with President Obama, his job on he line, over the widening scandal. 'After Wednesday's release of an interim inspector general report, we now know that V.A. has a systemic, totally unacceptable lack of integrity within some of our veterans' health facilities,' Mr. Shinseki told a conference of the National Coalition for Homeless Veterans." ...
... Richard Oppel & Abby Goodnough of the New York Times: "At the heart of the falsified data in [the] Phoenix [VA hospital], and possibly many other veterans hospitals, is an acute shortage of doctors, particularly primary care ones, to handle a patient population swelled both by aging veterans from the Vietnam War and younger ones who served in Iraq and Afghanistan.... The inspector general's report also pointed to another factor...: pressures to excel in the annual performance reviews...." ...
... Jonathan Topaz of Politico: "President Barack Obama says he will have a 'serious conversation' with Veterans Affairs Secretary Eric Shinseki about his 'capacity' to adequately handle the problems in the department. [The remarks were made during an interview with] Kelly Ripa and Michael Strahan that was taped on Thursday and aired on Friday. Shinseki on Friday is expected to deliver to the president an internal audit on the situation at the VA." ...
... Russell Berman of the Hill on why Boehner & Cantor aren't calling for Shinseki's ouster: "It's not that House Republican leaders think Eric Shinseki is doing a good job as secretary of the scandal-ridden Department of Veterans Affairs. It's that they think his ouster could give President Obama an easy way out of a widening crisis." ...
... OR, as Jake Sherman & John Bresnahan of Politico put it, "John Boehner and Eric Cantor don't want to make the Veterans Affairs scandal about Eric Shinseki. They want to make Barack Obama responsible."
Ron Nixon of the New York Times: "The House Appropriations Committee on Thursday passed an agriculture budget bill that included nearly $21 billion for child nutrition that would allow schools to opt out of White House nutritional guidelines passed in 2012. The vote was 31 to 18." Because, um, serving nutritious meals is too ha-a-a-rd.
Wowza! Denver Nicks (Not a Pro B-ball Team) of Time: "House lawmakers advanced legislation Thursday that boosts funding for the federal system of background checks for gun purchases, less than a week after a gunman's rampage in a California college town reignited debate over gun control.... The amendment passed 260 to 145." ...
... Mellow! AP: "The GOP-controlled House voted early Friday in favor of blocking the federal government from interfering with states that permit the use of medical marijuana. The somewhat surprising 219-189 vote came as the House debated a bill funding the Justice Department's budget. The amendment by conservative GOP Rep. Dana Rohrabacher of California -- the first state to legalize medical marijuana -- came as almost half the states have legalized marijuana for medical uses...." CW: This vote is a shocker: it is both intellectually consistent with the GOP's states-rights philosophy AND it's sensible & humane.
Paul Krugman: "Everything we know suggests that we can achieve large reductions in greenhouse gas emissions at little cost to the economy.... You might ask why the Chamber of Commerce is so fiercely opposed to action against global warming, if the cost of action is so small. The answer, of course, is that the chamber is serving special interests, notably the coal industry -- what's good for America isn't good for the Koch brothers, and vice versa -- and also catering to the ever more powerful anti-science sentiments of the Republican Party." ...
... Andrew Kaczynski of BuzzFeed: "House Speaker John Boehner said Thursday that he's 'not qualified to debate the science over climate change' while slamming the Obama Administration proposed plans to deal with rising global temperatures." CW Think about the logic there. ...
... Dumb & Dumber. Darren Goode of Politico: Apparently ignorance is now a GOP talking point. ...
... Ignorance of the Science Is No Excuse. Emily Atkin of Think Progress: "Donald. J Wuebbles, a distinguished professor of atmospheric sciences and coordinating lead author ... on the recently released National Climate Assessment, said that report was written by scientists and other experts specifically so that members of Congress could understand climate change and how it affects the country. With that report available, he said, climate change should be 'readily understood by any policymaker.'" ...
... Jonathan Chait: "When the history of this presidency is written, it will record that bold, progressive reforms dramatically reshaped the face of government, thanks to the vision, creativity, and political will of one man. And that man is Mitt Romney. President Obama already has Gina McCarthy, who designed Romney's cap-and-trade program in Massachusetts, running the Environmental Protection Agency for him.... The [Obama] administration's new regulations of power plants, due for release Monday, will be designed to expand the structure Romney built." Read the whole post. It's funny. And a reminder that President Obama is just as liberal as Mitt Romney.
Jamelle Bouie in Slate: President "Obama is a talented politician, but in his five years as president, he's made major political mistakes. The 2011 debt ceiling crisis was a huge debacle that threatened the global economy, and it owes itself -- in part -- to Obama's decision to negotiate the debt limit, bucking precedent and sparking a spiral of Republican intransigence.... If there's another failure in the cards for Obama, it's immigration. Since 2009 the president has pressed for comprehensive immigration reform at the same time that he's increased border security.... President Obama still thinks he can get immigration reform from a recalcitrant GOP.... Like the push to negotiate the debt ceiling, this is an insane calculation.... It's hard to overstate the human cost of Obama's deportation policies."
Dan Roberts of the Guardian: "America must change its 'suck-it-up culture' when it comes to responding to head injuries, President Barack Obama said at a White House event on Thursday, during which he revealed his suspicion that he himself sustained concussions as a young athlete." CW: Great. Now Karl Rove can claim Obama is brain-damaged, just like Hillary:
Lindsey Bever of the Washington Post: National spelling bee brings out the racists. Turns out only very, very white kids are entitled to spel rite. Also, only very, very white children are American children.
More on reparations by Jelani Cobb of the New Yorker. CW: Yo, Jelani. Shouldn't those Indian-Americans receive reparations, too?
Neil Irwin of the New York Times: "Six days after The Financial Times launched an attack on the data behind Thomas Piketty's much-debated tome on inequality, 'Capital in the Twenty-First Century,' Mr. Piketty has offered his first detailed response to the newspaper's criticism. The short version: He doesn't give an inch." ...
... Update: Here's Picketty's full response.
Ellen Nakashima & Barton Gellman of the Washington Post: "The Obama administration and former intelligence contractor Edward Snowden offered divergent accounts Thursday of his efforts to raise concerns about National Security Agency activity more than a year ago, as each side tried to shape the debate over whether the massive leak of classified information was avoidable." The Guardian story, by Dan Roberts, is here. Snowden's e-mail & the response are here. ...
... CW: This is weird. Charles Pierce doesn't seem to understand the difference between reporters & sources. If you bring me evidence that your boss is doing something "irregular" & I publish your stuff, you can get fired or maybe even successfully sued; I suffer no adverse consequences. If Ed Snowden reveals NSA secrets, & the WashPo publishes them, Snowden can be prosecuted; WashPo reporters & editors suffer no adverse consequences. Somebody buy Pierce a copy of the First Amendment. There's no guarantee of Freedom of the Sources. (And, no, freedom of speech doesn't cover Snowden, et al., either.)
Guns are mostly for hunting down politicians who would actively seek to take your freedoms and liberty away from you. Google 'Hitler, Mao, Kim Jung Il, Castro, Stalin' just for starters. -- Samuel Joe the Plumber Wurzelbacher, who clearly needs psychiatric supervision & probably a visit from the Secret Service
Kate Tummarello of the Hill: "The broadcast industry plans to sue the Federal Communications Commission (FCC) over its decision to crack down on resource-sharing deals between broadcasters. On Friday, the National Association of Broadcasters (NAB) will ask the D.C. Circuit Court of Appeals to overturn a March FCC vote that requires broadcasters to unwind many of their advertising sales resource sharing arrangements, according to a source familiar with the matter."
Racism Pays! James Rainey of the Los Angeles Times: "Former Microsoft chief executive Steve Ballmer appears to have won a frenetic bidding war for ownership of the Los Angeles Clippers, with a $2-billion offer that would set a record price for an NBA team.... The sale price would be almost four times the previous NBA franchise high: the $550 million paid earlier this month for the Milwaukee Bucks.... The tentative deal still must receive the blessing of Donald Sterling, who has waxed and waned on the question of whether he would allow his wife to sell the team he has controlled for more than three decades."
A Singular Reality Chek. Politico Gets It. This article by Ken Vogel in Politico Magazine is interesting mostly for the first few grafs about President Obama & for its final paragraph. It seems to me that when even a top Politico reporter acknowledges -- even highlights -- the oligarchic takeover of U.S. politics, we're on the verge of a journalistic realignment.
Retreat of the Troglodytes. Juliet Eilperin & Robert Costa of the Washington Post: "Republican candidates have begun to retreat in recent weeks from their all-out assault on the Affordable Care Act in favor of a more piecemeal approach, suggesting they would preserve some aspects of the law while jettisoning others.... The moves also come as senior House Republicans have decided to postpone a floor vote on their own health-reform proposal -- making it less likely that a GOP alternative will be on offer before the November elections...."
Maggie Haberman of Politico: "Hillary Clinton offers a detailed account of the deadly attack on the American embassy in Benghazi -- and a pointed rebuttal to Republican critics who've laced into her over the incident -- in a much-anticipated chapter of her forthcoming book, 'Hard Choices,' obtained by Politico. 'Those who exploit this tragedy over and over as a political tool minimize the sacrifice of those who served our country,' Clinton writes in the gripping chapter, 'Benghazi: Under Attack.'"
Congressional Race
Aviva Shen of Think Progress: "An Arizona Republican running for Congress argued that Democrats commit nearly all the mass shootings in the country. Gary Kiehne, a rancher looking to unseat Rep. Ann Kirkpatrick (D-AZ), made the claim when asked about gun rights at a Republican primary debate on Saturday. 'If you look at all the fiascos that have occurred, 99 percent of them have been by Democrats pulling their guns out and shooting people,' Kiehne said. 'So I don't think you have a problem with the Republicans.' Kiehne also boasted that he had 'more guns and ammo than any one of my competitors.' Kiehne's claim that 99 percent of shootings were committed by Democrats is completely false, yet continues to be a persistent myth on the radical right.
... AND/OR ... Right Wing World
Brian Tashman of Right Wing Watch: "Family Research Council senior fellow Ken Blackwell yesterday linked the Isla Vista mass killings to marriage equality laws, which he claimed are destroying the culture."
... SO -- Married Gay Democrats???
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Reader Comments (16)
Way down near the bottom of the NYT article on VA's medical care problems is the core fact any "fixers" should acknowledge:
"Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges, said the department’s doctor shortage came down to a simple fact: “It’s just harder to attract physicians to care for more challenging patients while paying them less.”
The answer to this (besides hiring more docs and paying them more) will be to change the standards of care, so that Nurse Practitioners, who also don't come cheap, will be able to take on "less challenging" patients, as appropriate. Triage, plus applying non-physician skilled care for routine clinic appointments, goes a long way to alleviating the doctor shortage.
But, remember the iron triangle. You can have any two: low cost, high quality, rapid access. You can't have all three. When Congress balks at the cost of quality care, but still wants rapid access, the standard of care has to drop (which is not necessarily bad, if it means that a clinic does a good job of triage.)
@Patrick writes, "The answer to this (besides hiring more docs and paying them more) will be to change the standards of care, so that Nurse Practitioners, who also don't come cheap, will be able to take on 'less challenging' patients, as appropriate."
Apparently the VA already relies too heavily on nurse practitioners. From the same NYT report: "A subsequent investigation by the Department of Veterans Affairs concluded last fall that indeed the Jackson hospital did not have enough primary care doctors, resulting in nurse practitioners’ handling far too many complex cases and in numerous complaints from veterans about delayed care."
I'm not surprised there's a shortage of doctors at the VA; analysts have been predicting/remarking on doctor shortages for years. The current patient caseload for each doctor, however, is clearly unacceptable: nearly twice what it's supposed to be.
I doubt lower pay is the main reason the VA can't attract doctors. It's the caseload. Many people are willing to take slightly lower pay for better working conditions & a more stable future. That's a main attraction of civil service. Obviously, if you eliminate the traditional, attractive aspect of a government job, pay becomes more important.
I'm not sure if Shinseki didn't know about the doctor shortage & the unacceptable caseload or if he didn't have any idea that a doctor shortage would, um, lead to longer -- sometimes life-threatening -- wait times for potential patients. He should have been the one raising red flags -- not Arizona Republic & CNN reporters. There's an implication in the story that the VA higher-ups were not too concerned about hiring doctors.
I also don't know if Congress has failed to fund enough for medical personnel. Government shortcomings are seldom the fault of one person. But some wag pointed out the other day that it would be helpful to have more of a firebrand head the VA -- someone who would come in yelling for more funding where it was needed & would yell at subordinates for performance failures.
Finally, it's well worth remembering that long wait times to see a doctor are not limited to the VA. Many private patients have the same experience.
One problem may be that wait times at the VA are more "institutionalized" than they are in private practices. If I call for an appointment to have a mole removed, the scheduler might pencil me for an appointment two months out. If I say the mole looks just like the one that was a fast-growing cancer & I want to see the doctor sooner, it's pretty certain I'll get an appointment within the next few days. Patient testimony may not count as much at the VA. The VA appointments clerks probably aren't exactly triage experts.
Marie
Re: Science class for Congressional climate change deniers.
Gents, Ladies; come on in and take a seat. Sit anywhere. Today I am going to get you up to speed on this climate thing that everybody is talking about. My name is Professor JJG and I have be asked to explain a complex situation to you on a non-scientific level. After all, you're not really a bunch of lab rats are you, ha ha? Everybody settled? Come and join the group, Rep. Rubio. In the front of the class you will see a Weber grill, just like the one you have at home. I'm going to load it up with charcoal, like this; a little more, that should be enough for all of you, and start it on fire. Now I'm going to shut and lock all the windows and leave the room. This wet towel I have here will be stuffed under the door so please don't try and open it. Just in case I will lock it from the outside. Now each one of you represents one billion people, I know, Rep. Cruz, a billion is a big number, you can pretend you represent all the fine people of Texas. The classroom represents our little world; made by God, of course; in seven days, six, if you count Slacker Sunday; right you are, Rep. Ryan. Ok,everyone get comfortable. I'll come back in a few hours and see if you have learned anything. Yes, I will bring hotdogs for the grill. Concentrate, class; if you feel like you are getting sleepy, I know, school can make you tired, take a little nap. I'll turn off the light on the way out. Remember, deep breaths; study, study. I think you may get it.
@JJG: Sounds a lot like John Belushi explaining the weather to shut-ins. One of the most hilarious SNL segments evah.
Marie
JJG, Thanks for the broad morning smile, which I needed after the Bouie take on Obama's immigration "failures," which I found as ridiculous as The Fence Itself. Bouie seems to have discovered that it's very hard to negotiate successfully with terrorists. Wonder when he figured that out?
@Ken Winkes: Isn't Bouie's point that Obama hasn't figured out he can't negotiate with House "terrorists"? Bouie himself seems to have figured this out a long time ago.
Marie
JJG,
Maybe after your demonstration they'll finally understand that Weber is not climate.
The VA powers that be in their manipulation of wait times reminds me of another unfortunate incident--Vietnam and the emphasis on "body count." It never made any sense to me then, and it still doesn't. I remember one incident where a unit had killed 12 actual VC (weapons and all). Their battalion commander ordered them to report 24. Nothing but civilians at My Lai? No problem. Add them to the body count. The mania for body count led to who knows how many unnecessary deaths.
Body count apparently came from the British experience in Malaysia, where the guerrillas were foreigners and their numbers were fixed. In Vietnam, our behavior created even more VC. Ergo, there was an endless supply of Viet Cong. In spite of this stupidity there were commanders who got medals and promotions out of inflating the numbers. One captain I knew served in a division whose commander so flagrantly manipulated the numbers that the junior officers laughed about it. It must have worked, because the commander got his third star.
In the case of the VA, it didn't take long for management to figure out that reducing wait times got one bonuses and promotions.
@JJG. Of course there's no need to bring up the distinction between CO and CO2 since chemistry is one of those science things that doesn't exist anyway.
Isn't valence one of those doohickeys that fits over a window?
The Politico article on the Koch's politician salad bar (rich people line up and put pols on their plates) is a reminder of how tenuous is our system of government. We have become accustomed to thinking that not only is this the best system of government in the history of the world, but that it will also be around forever.
Poorly remembered history besets us all. Marcus Aurelius reminds us to "Look back over the past, with its changing empires that rose and fell, and you can foresee the future, too."
Rome was around for centuries but not in the same form. After winning independence from its Etruscan masters, early Romans founded a republic. Citizenship was a prized commodity but only the rich and connected got to rule in the Senate.
The Kochs of those days held enormous political control. Plebeians held lower level positions in government but the wealthy ruled until Sulla kicked their asses around the forum. Sulla (commonly referred to as "the Dictator") was a savvy but brutal politician and general. He tore up the Senate and allowed the Plebes (known as tribunes) to serve with equal distinction. Caesar, after him, introduced further reforms but by this time (also due to Julius' own personal penchant for power), the patricians had had enough.
But killing Caesar invited in the excesses of Empire. Augustus who declared himself deified, treated wealthy senators like pet poodles. And there they remained, lapping the feet of long lines of inept emperors, planning their petty plots until Rome passed into decrepitude.
Parallels between ancient Rome, republican Rome, the Rome of empire and the current version of the United States aren't exact, but lessons are there to be drawn. The control of the wealthy was kept in place for centuries by their money, but by that time, Rome was fighting off enemies from all sides because the Senate made rules for its members. Laws were passed for their benefit first and Rome second. Or third. Or, sometimes, not at all. Sound familiar?
Sulla saw the problems in being at the mercy of rich solipsistic amateurs who looked out for themselves. Unfortunately for Rome, he was too late coming. And neither he nor even Caesar could foresee the rise of the ultimate amateur hour, when emperors ruled.
Next stop, impotence, insignificance, disgrace, and downfall. And don't forget another parallel with Rome. According to Gibbon in his epic "Decline and Fall", another major reason for Rome's demise, in addition to its reliance on ignorant idiots in charge, was religion.
Rich people, ignorance, and religion.
Again, sound familiar?
Unwashed,
And if you had two windows side by side, wouldn't you need a covalence?
Marie,
You're right. I just expressed annoyance and didn't say all that was on my mind.
Of course the R's are the terrorists in the immigration fight, as they are in so many others. The issue is what to do about terrorists in your own government. Bouie thinks Obama has handled the situation wrongly. I thought his analysis superficial and unfair.
I took Bouie's point to be that deportations should cease now that what Obama should have known long ago is obvious to all, and maybe by implication that because the R's obduracy should have been evident to Obama long ago, the deportations should have stopped even earlier. Maybe.
The problem I have with his argument beyond its questionable substance is the question of timing. After all, the President has also been negotiating with the public at large, portraying himself as "reasonable," mostly successfully I think, in contrast to the crazy opposition; and that public, the majority of whom remain anti-(undocumented) immigrant, is not limited to Latinos. Given that reality, when exactly should deportations have stopped or stop? When in the complicated context of the last six years did Obama make his "mistake.?"
Furthermore, if the President did halt deportations now, would that improve the Democrats' standing among all likely voters or just among Latinos? And does Bouie think that continuing to deport Latinos will cause them to turn en masse to the R's in 2016? I'm skeptical of that.
Maybe my reaction to Bouie was simply: it's easy for opinionators and would-be-pundits (I include myself as a minor member of that tribe), to indulge in shoulas and oughta when you don't have weigh all the options, lead a political party, or hope to be elected.
Marie, I usually defer to your wisdom, but the MD v. NP issue at the VA is complex ... and the problem as stated (your quote) is NP's being assigned too many "complex" cases because of an MD shortage. So, clearly, they need more MDs. They also need better assignment routines so that "complex" cases don't go to NPs.
But the entire US medical standard of practice still calls for MD attention in many cases where NPs are totally adequate. That's going to change, and not just at the VA, because there are not enough primary care MDs (generally, the lowest paid/most overworked) in the country, or properly spread about the country, to take care of the growing population of covered outpatients - medicare, medicaid, ACA, private insurance and VA.
I have no problem seeing an NP or an RN for the type of things that bring me into my (employer-provided insurance) provider's clinic. Diagnostic systems are pretty good now -- my MD looks at her laptop more than at me when we have a consult. It is not hard at all to use diagnostic algorithms where an NP can do the consult and refer any problem alerts to an MD; and most treatment for most outpatients is a prescription, which an MD could be able to write based on an NPs recorded recommendation. So, look for more NPs and better triage.
@Ak. I knew I could count on you.
Hey! 580+ years ago today, uppity bitch Joan of Arc was burned at the stake. I thought you'd want to know.
JJG and Akhilleus.
"Weber is not climate".
Have you two been rehearsing?