The People's Republic of California

Since moving here last year I've been trying to get a handle on the circus that is California politics. Even for someone such as myself, well-versed in the political arena thanks to my mediocre undergraduate public education, trying to get a handle on all the issues is akin to trying to grapple a greased pig on a trampoline. Here is a brief rundown on the latest trainwreck that's occurring between the executive and judicial branch...

In November 2008 Californians narrowly approved (51%) a ballot measure to ban gay marriage in the state, thanks in large part to the insidious influence and financial backing of the Mormon church and other conservative religious groups. Prop 8 effectively overturned a California Supreme Court ruling that said same-sex couples have a constitutional right to marry.

On August 4th 2010 Judge Vaughn Walker overturned Proposition 8 after concluding that the law lacked any rational justification and denied equal rights to same-sex couples. Protect Marriage, a conservative religious coalition that defended Prop 8 before Judge Walker has appealed to the 9th US Circuit Court of Appeals. This is where things get interesting...

Walker has questioned whether Protect Marriage has the legal standing to appeal the ruling, citing that usually only elected officials have the authority to defend state laws in court. This may result in Prop 8's supporters being barred from appealing Walker's ruling to the 9th Circuit. Both California's Attorney General, Jerry Brown, and Governor Terminator have repeatedly stated that they will decline to defend Proposition 8 in court.

That's karma, bitches.

But conservatives are a persistent bunch, and accordingly the Pacific Justice Institute filed suit on behalf of a Los Angeles-based minister seeking to compel the State to defend Prop 8 in court. The Third District Court of Appeals in Sacramento dismissed the suit without comment on Monday. PJI said they would file an immediate appeal the state Supreme Court in hopes of obtaining a reversal on the ruling before the September 11th deadline for action on the Proposition 8 case.

Did you get all that? A constitutional provision that overturned a state Supreme Court ruling, was itself overturned by a District Court; appealing that decision may prove impossible due to supporters being barred from appealing, and the state refusing to do, but the state may yet be forced to defend Prop 8 if an appeal to force them to do so is successful, after initially being dismissed by a Court of Appeals. I've created a diagram to help you understand...

Joe Biden Gets Excited...

...about Amtrak and health care reform mostly. And Barack Obama. Those guys love each other.

What's best is that Biden can go from quoting Virgil (5:30) one moment, and then whisper to BarryO, "this is a big fucking deal!" (5:58) within earshot of the microphones surrounding him. How can you not love that?

Joe, you can be my conductor any day.

Health Care Reform was sooo Last Year

What!? The healthcare reform bill passed? No f@#$ing way!

I thought the government gave up on that around the time the final season of LOST started... I hear Rahm Emanuel is a big fan. Despite being someone who passionately believes we need serious reform (much more than is what included in this bill) and who 'studied' political science as an undergrad, even I was almost completely checked-out of the ongoing debate that so many thought was over once those liberal yahoos in Massachusetts elected Scott 'Pickup Truck' Brown.

Well it seems the Democrats realized that their ship (the S.S. November Election) was sinking whether they pushed a reform bill through at the last minute or not, so I'm glad they gave it the 'ol college try (where did that phrase come from? no one tries in college). Apparently Obama will sign the bill into law on Tuesday, while the Senate presumably squawks about the alterations the House made before those additional elements can also become law.

BUT: I still hate Nancy Pelosi. Here's why...

... 'nuff said.

Anyways, glad things are moving forward. Here's a few links if you care what this 'groundbreaking' bill is going to do for (or as the Republicans would say 'to') this country.

• Kaiser Health News: Consumer's Guide to Health Care Reform
• NPR: Immediate Effects of the Health Bill Passing
• NAACHO: Key Public Health Provisions in the Health Care Bill (hooray public health!)
  

Chips & Whiskey Do Not a Dinner Make

But they'll do in a pinch...

While we're on the topic, if you've ever considered a career in diplomacy and don't feel like taking the Foreign Service exam, read this.

I introduced former Secretary of Labor (and current public policy professor) Robert Reich to a moderate sized crowd of people tonight. Ignoring that I almost called the Dean of Public Health by his first name as I took the stage and only occasionally glanced at the audience as I read my pre-formed dribble, I think I did ok. I hate public speaking.

If you're not familiar with Reich's work, this video just about sums it up...

The Chowdah Economy

I'd like to call attention to some comments from New York Governor David Paterson that were in a recent Politico article about the 2 or 3 New York politicians actually sticking their necks out for 'Wall Street'.

"In New York, Wall Street is Main Street," Paterson told a receptive audience at the Museum of American Finance in December. “You don’t hear anybody in New England complaining about clam chowder. If you say anything about oil in Texas, they’ll string you up near the nearest tree. We need to stand behind the engine of our economy in New York and that engine of economy is Wall Street.”

A few points regarding this... First, its 'chow-dah', and its better than that red crap you serve in your state. Second, three-quarters of New England's economy is based on commercial machinery, instruments, chemicals, and transportation equipment. Third, New York City has five Main Streets. And lastly, David Paterson, you are an ill-informed asshole hoping to win re-election as governor of New York despite having the lowest-ever approval ratings for a governor of that state... sounds like you're looking for some handouts to finance your campaign.

Addendum:

For the record, no one in New England complains about clam chowdah because its fucking delicious.

Health Care Reform Part Deux: Delivery

Progress! That's what I'm making on my promise to write about the big picture with health care reform. As I outlined several posts ago, there's a lot more to fixing our broken-down jalopy of a health care system than just making sure everyone has insurance (and we can't even get that done). Insurance, when implemented properly, can make care affordable to everyone, but we need to take a look at the care we're getting. How far does our dollar take us? Health insurance reform is going to do very little to stem the rising costs of care. Making reforms in the health care delivery system is where we can hope to really make care more affordable and sustainable. Its going to be a long journey though...

As much as the pharmaceutical industry is making a killing in this country, its not where the majority of money in the health care system is directed. But its a big part and I'll get to that shortly. Where is most of it going? To doctors! Who'd have thought...

The root problem to a lot of our overspending lies with a payment system called 'fee-for-service'. Essentially this means that for each scan, test, and diagnostic a doctor orders for a patient, they get paid. And in an age where everyone wants every scan performed to rule out the possibility of each infection and cancer known to man, the costs from this type of system really add up. If I was going to give your car a tune-up and went ahead and replaced the windshield, slapped on new tires, and repainted it, in addition to what you would have expected, such as changing your oil, you'd probably be upset when it came time to pay the bill. Well our health care payment system works in much the same way. We don't pay based on health outcomes, we pay based on each step a doctor takes to get us there, whether is forwards, backwards, or sideways.

Now I don't want to seem like I'm accusing all doctors of blatantly profiteering at the expense of their ignorant patients. I certainly feel that in a payment system such as this, there is a certain subtle, unconscious factor regarding profit incentives to consider, but I'd be a really bad psychiatrist, so I'm going skirt that issue. As mentioned before, many patients actually demand such courses of action. We increasingly live in an era where people are more educated about their health through mechanisms such as WebMD, which leads to a lot of self-diagnosis. Patients show up to their doctors offices armed with articles and ideas about what's ailing them before a doctor can even examine them. In this type of climate doctors are obliged to order a plethora of tests due not only to patient demands, but also out of fear that they will be sued if they miss something that an extra test may have discovered. This is what is referred to as 'defensive medicine', and operating under duress and out of fear is no way to practice medicine.

Tort reform (making it harder to sue doctors) is one of the Republicans' few pet issues when it comes to health care, and I have to say that I agree with them on this one for the most part. I think their claims regarding the cost-effect it will have are overblown, but in the long run tort reform will reduce doctor's fears of being sued and assist in the reduction of over-testing patients. This, however, is just one small piece of the puzzle.

First of all, we have too many people showing up to their doctors' offices very sick, as is highlighted in a recent CDC report on patients not receiving or delaying seeking care due to the cost. Lack of insurance coverage is one thing that keeps people from getting regular treatment, so insurance reform will hopefully help to alleviate some of this problem. But even when people are insured we see this problem. A major cause of this is the simple fact that there are far more 'specialists' (surgeons, dermatologists, cardiologists, etc.) than 'general practitioners' (family doctors). Specialists, on the whole, earn a lot more money than physicians, making these jobs more attractive to medical students with large debt loads. But its detrimental effects are twofold: (1) there are fewer physicians to give patients primary, preventative care (i.e. regular check-ups and good health advice) that would keep them from developing conditions requiring specialists, and (2) it creates a very large pool of individuals who stand to profit from people having serious conditions.

Now I'm not saying that specialists want to see patients get sick so they can make money (though for hospital administrators its great business), but it is easy to see that our system is not aligned with our goals. Preventative care is far less expensive than specialized care, such as chemotherapy and surgery. We need to create more incentives for medical students to enter the general practice field and create more incentives for students unwilling to tackle the commitment of medical school to pursue careers as nurse practitioners, who in many states can provide much of the same type of care that a general practice doctor can.

In addition to increasing our focus and incentives for preventative primary care, we need to do a better job of coordinating that care. What will this look like? Doctors will increasingly work in group, rather than private practices. Institutions such as Kaiser Permanente are great examples of this model. Kaiser does everything in-house. They provide the insurance, they own the hospitals, and they contract with a doctors' group that works exclusively with them. They coordinate care and negotiate prices within their own structure to help keep costs reasonable and efficiently track a patient's health.

In terms of changing our payment methods, there are a few ideas floating out there that warrant some examination. 'Fee-for-performance' and 'episode-of-care' are perhaps the most promising. Fee-for-performance is pretty much what it sounds like... namely doctors are not paid per test performed, but based on overall health outcomes. Episode-of-care means that rather than paying for treatment at a hospital, the going home and having a relapse of some sort, and having to go back to the hospital and pay again, you would only pay once for whatever it is that ails you, and if the hospital fails to take care of that properly, they eat the additional cost. These methods obviously incentivize quality care rather than overtesting.

And lastly, I told you we'd get back to the pharmaceutical industry, which accounts for roughly 14% of medical expenditures in the U.S.. Big Pharma is far-and-away the most profitable industry within the Fortune 500 companies. There is a lot of truth to the argument that we in the United States subsidize pharmaceuticals for the rest of the world; there is no government regulation of drug prices and we pay from 50-100% more for the same drugs as they do in other developed nations such as Canada, France, and Britain. Drug companies will regularly point this out and say that unless we can force other countries into higher prices, the rates in the U.S. are necessary to sustain very expensive research & development (R&D) of new drugs. This is true, but what they don't mention is that they spend about twice that much on marketing and promotion of their products, as detailed here.

As with much of the rest of our health care system, the incentives in the drug industry are misaligned. The industry focuses primarily on therapeutic drugs that people will have to take for the rest of their lives to control certain disease states. Even worse, the proportion of designer drugs (like Viagra) continues to rise. People take these sorts of drugs every day, for long periods of time, ensuring that sales will continue and profits grow. Contrast this to the idea of producing and marketing vaccines, usually a one-time-only products, and you can see why investment in vaccines doesn't make much financial sense. And when much of the vaccine-preventable disease burden is concentrated in the developing world (i.e. no money), the incentives for vaccine research decline even further.

To take a step in the right direction we need to promote the use of generic drugs (inexpensive reproductions of brand-name drugs once their patent expires) and reign in the practice of pharmacies drastically inflating their cost, as shown here. Additionally, we need to ensure that insurance companies provide incentives to purchase these cheaper generics, such as covering their full cost and only a fraction (or none) of the cost of the more expensive brand name drugs. It has been shown that when given the choice (equal copays for generics and brand-names) consumers will almost always choose the more expensive brand-names, contributing to our inflated health care costs. As for vaccine development and the developing world, that's a problem for another post entirely.

As you can tell by the extreme length of this post, there are a myriad of ways that we can begin to reduce our health care costs in this country, and universal coverage is only the first tiny step forward. These reforms will take years, and even decades, but research into these reforms and new programs to test them are already beginning to occur. It is up to the American public to be as informed about the potential of these ideas as it is about the potency of Viagra.

Catharsis

I'm not in a great mood tonight, so when I decided to check Politico's website one more time tonight (I do it several times per day), I was naturally infuriated by the arch-enemy of logic, the one and only Sarah Palin, who has cast her lot in with the 'birther' movement. You can read more here.

"I think the public is still rightfully making it an issue" she says. No, Sarah, you are making it an issue. You are not the public. All the proof you could want is documented here, and as you can tell by the exasperated comments of Hawaii public health officials, this attempt to discredit the President of the United States is pathetic.

Sarah, I say this from the bottom of my heart and with the utmost sincerity... fuck off. I have no problem with those with opposing viewpoints, there are millions and millions of them, and I respect a great many of their viewpoints that are validated by personal experiences, religious convictions, and political theory. You, however, are a distraction to constructive political discourse in our nation, where there is precious little to begin with. You are an ill-informed, self-important bimbo who ought to meet the same fate as those wolves you shoot from helicopters. I pity your family who you have put through hell for your own personal gain and I can only hope that God is as merciful as my fellow Episcopalians like to think he is.

Glacial Pace

Sen. John Ensign

Yes, in regards to the next two parts of my series on health care reform I'm moving about as fast as Congress, its pitiful really. But they're almost done, so I'll continue pretending that people read this and actually care.

It has been an important day however, so I had to make a few quick notes:

• The Congressional Budget Office released a report saying the Dems' health insurance reform plan would reduce premiums for the majority of people buying insurance on their own (non-employer based) and that little would change in regards to pricing for those getting it through insurers. Not perfect, but certainly a plus for the good guys (i.e. those fighting for health insurance reform... not the Dems as a whole). You can see the CBO's report here or read about it in the devious liberal media.
• John Marcotte's petition to add a proposition called the '2010 California Marriage Protection Act' to California's next voting cycle might sound like more conservative prejudice, but rather its a satirical attempt to ban divorce in California. You can see his website here.
• The Republican party continues to implode and John Ensign refuses to resign over his extra-marital affair for the most noble of reasons. Didn't he demand Clinton resign over the Lewinsky scandal? Oh, yes... yes he did.
  
• They're all guilty: I've never liked Nancy Pelosi. Add another reason to the list... she spends too much government money on flowers. Follow the link to see more examples of line items released in the quarterly listing of House office expenses.
• And lastly, God obviously blessed this year's Haji (I'm thinking he does that every year, but anyways) as the dreaded massive outbreak of H1N1 that was feared never materialized, with only 5 deaths attributed to the disease. Unfortunately, a new strain of MRSA has emerged with a mortality rate of nearly 50%.
  

UC Berkeley Student Fee Protests!

This is a test... I've just learned how to post text, photo, and video to WSD via my cell phone. Hooray 21st century!

Part I: Health Insurance Reform (Finally!)

Like so many amateur bloggers out there I continually disappoint my imaginary readers by failing to follow up on posts in a timely manner. I'm referring to my intended 3-part series on health care reform that has been delayed due in large part to my starting a new research position and the massive protests here at UC Berkeley (more on all that soon).

So, I promise, its coming... really soon. All of it. Seriously.

In fact, here's Part I: Health Insurance Reform

Please be forewarned, this is not intended to be a up-to-date analysis of the latest House or Senate bill. Those damn things change every other hour as our elected representatives are busy making sure there isn't anything drastic enough in there to upset anyone, ever, about anything. Its like ripping all the teeth out of T-Rex: not nearly as effective, what's he going to do, get you with those gimpy little arms? Ha! Yeah right...

What this is intended to do is review several of the key components to effective health insurance reform that are currently being debated (and a few ignored). The next two posts will focus on what needs to happen once we complete the slow, painful crawl towards passing an insurance reform bill.

So, the big thing about the current proposal is that the Dems, and even some Republicans think we ought to have universal coverage, meaning every legal citizen of the United States should be covered by some sort of health insurance plan. The current proposal going forward is to have individual or employer mandates, basically requiring that people have health insurance by law, much in the same way that most states require that drivers have auto-insurance. An individual mandate would mean that each person is personally responsible for acquiring their own insurance, either through their employer, a private plan, or via government programs like Medicare and Medicaid for those that qualify. An employer mandate would mean that employers must provide health insurance for their employees through one of the aforementioned means, the way many businesses currently do. There would be certain exceptions for small businesses and the like due to the cost-burden that comes with this. Some argue this would stifle growth in an already hurting economy, others say (and its been proven) that over the long-term, at least, the costs are simply passed on to the employees in the form of lower wages.

Depending on the final version of the bill, both employers and individuals who do not have insurance will face fines. The government intends to provide subsidies to businesses in the form of tax breaks so that they can afford to provide insurance to their employees, as well as direct subsidies to individuals in the lower-income brackets who cannot afford insurance on their own. The insurance industry is currently all about this plan, because it adds millions of customers to its base. Much in the same way that hot-dog vendors would be really psyched if the government suddenly passed a law saying everyone had to eat hot dogs, or face a fine.

What the insurance companies do not want to see is the emergence of a public option. This is where much of the contention over the final bill lies. A public option would be an OPTIONAL government-run health insurance plan (like Medicare and Medicaid) that anyone could purchase. It would essentially provide competition to private health insurers and force them to keep their costs low, since the government wouldn't be worried about making profits. Much in the same way that the Post Office competes with companies like FedEx and UPS. This public option would, ideally, be financed by the premiums it charges for its customers. An analysis by the Congressional Budget Office determined the bill passed by the House (H.R. 3962) would actually reduce the federal deficit over 10 years. Of course the Dems have been very strategic about what they put in the bill so the price tag comes out at a politically palatable number, meaning some spending related to health care will likely be passed in separate bills. I'd be more comfortable, at this point anyways, that the entire plan will come out roughly even, give or take a few billion dollars.

I'm not going to make exhaustive arguments about why I think there should be a strong public option, since you can easily find those with a Google search. I will, however, say that major health insurers, on average, spend 16-20% of their budget on overhead (pretty inefficient by most standards) and since 1970 the number of health care administrators in the U.S. (not confined solely to insurance companies, but hospitals and other providers as well) has risen 3000% (yes, three-thousand) while the number of physicians in the U.S. has risen just 200%. Something to think about... I'll delve into that more in the next post.

But anyways, the public option would become part of a 'national insurance exchange' and compete with private insurers. But what in God's name is an insurance exchange? Professor Jacob Hacker of Yale's political science department describes it as such...

"It’s a place where individuals can go and shop for a health plan. Today, large employers can select from a choice of plans that spread risk and reduce administrative costs because of the large work force. But the options available to small employers are much more expensive. And individuals find it very difficult to get coverage. The exchange would make a range of more affordable options, including a public plan, available to individuals and employees of small businesses." The full Q&A with Dr. Hacker regarding the insurance exchange can be found here.

There are also those out there who are communist enough to want to go even further than a public option; they want a single-payer system, such as the British National Health Service (NHS). Essentially this would mean that the government is more or less the sole provider of insurance. This is not a political reality on the national stage, but there are certainly reasonable arguments in favor of this type of system. California is one state where there is considerable momentum behind the idea of a single-payer system. While politicians on the national stage don't want to touch anything this toxic for fear of being labeled a Marxist-Nazi, we may see experiments in this type of system on a state level in the coming decade.

Lastly, making these structural reforms is important, but efforts also need to be made to reduce operating costs of insurance companies (remember the overhead cost thing?). If the government is going to force millions more into the arms of insurance companies, they ought to make sure that all that money is being spent efficiently. The same applies to the government, both to its potential public option, and its current Medicaid and Medicare programs. There are several provisions within the current bill aimed at reforming Medicare and making it more efficient, and while many out there would have your grandmother thinking that Obama is going to destroy Medicare, this is hardly the case.

There you have it folks, health insurance reform. We've taken the first steps, but we're a long way off from acheiving anything. The Senate has to force a bill to the floor to be voted on, and even if something gets passed with the unlikely help of a few key 'centrist' democrats and the ever-agitating Joe Lieberman (just another reason to hate Connecticut), the House-Senate conference committee to hammer out final legislation promises to be a circus in its own right.

Parts 2 & 3 of my health care reform series will be posted by weeks' end... but don't hold me to that.

Health Care Reform? We Haven't Even Started...

For months we've been inundated by what the media refers to as the 'Health Care Debate'; politicians, lobbyists, tea-party protesters, and media pundits trying to influence how we're going to achieve health care reform. Well, we haven't even scratched the surface. To be honest we haven't even begun talking about true health care reform, merely health insurance reform. And while there have been some modest proposals and a bit of discussion outside the realm of health insurance, the real debate that needs to occur has largely been relegated to the sideline.

With both houses of congress actually making moves to get bills out of committee and onto the floor, it is crucial to remember that when a health insurance reform bill passes, and one will, the job is not yet done. While we may actually see some fairly meaningful insurance reform occurring by 2013, the real change that needs to take place will take decades and will depend not on the commitment of the Obama administration, Harry Reid, Nancy Pelosi, or any other individual or group of politicians, it will depend on the public's ability to continue to demand the change that the majority of population knows is necessary.

So what really needs to occur in order for this painstaking health insurance reform push to mean anything? I'm going to break it down from my perspective across a series of posts in the next few days. In my opinion, true health care reform needs to occur in three ways: (1) health insurance reform, (2) health care delivery reform, (3) food reform.

Health Insurance Reform Includes...

• Universal Coverage and no exemptions based on pre-existing conditions
• A robust public option and state-based experiments in single-payer systems
• An inclusive, national insurance exchange
  
• Personal and employer mandates
• Death panels
  
• Subsidies for low-income populations and tax-exemptions for small businesses
• Reduction in insurance overhead costs and cost-saving measures to Medicare

Health Delivery Reform Includes...

• Reduction in prescription drug costs and greater incentives towards use of generics
• Payment method alterations and the elimination of 'fee-for-service'
• Movement towards group practice and local/regional coordination of care
• Increase in and incentives for primary care doctors and nurse practitioners; reduction in specialists
• Socialist-Fascist bureaucrats to the staff the death panels
• Effective use of deductibles to control unnecessary spending
• Tort reform and medical courts to reduce 'defensive' medicine
  

Food Reform Includes...

• Increase in food labeling measures for nutrition facts and ingredients
  
• Tighter quality controls, greater transparency, and decentralization of the meat-processing industry
• Experimental taxes on sugary drinks and other unhealthy foods
• Greater nutrition education and other measures to counteract the obesity epidemic
• Higher taxes on the overweight and obese (that's 2/3 of the population you know)
  

Can you spot the outliers in each set of reforms? In my next three posts I'll attempt to break down and expand upon each step in the process. We'll also ponder how it is that Fox News can manage be such stalwart defenders of the public's interest... a truly amazing news organization they are.

The Socialist Plot Thickens!

The Greek Socialist party has won the Greek national elections, unseating the conservative New Democracy party. Socialist leader George Papandreou lead his party to victory by advocating a $4.5 billion stimulus package and cracking down on tax-evaders, a crime which costs Greece roughly $30 billion annually.

Sound like anyone you know?

Obviously Papandreou is taking his socialist marching orders directly from the the Obama White House, as evidenced by this press release from the Greek Embassy earlier this year... Soon the entire Medditeranean region will be littered with universal health care, free education, and Nazis. Yes, Nazis. Thank god American conservatives have enlightened us all in revealing that Obama is both a socialist AND the next Hitler. Because Hitler was a socialist... and that makes total sense.

On a totally unrelated note, I remembered reading about this study that conluded that conservatives are more biologically inclined towards fear. Food for thought.

Thus concludes my Sunday Sarcasm post. Thank you Steve Smith #2 for scoring me 24 points in my fantasy league today. I'm officially making a motion that Steve Smith of the Panthers be relegated to #2, and you promoted to #1.

Protests!

The Huffington Post had a special featuring the funniest protest signs from this year. This one obviously takes the cake... the rest can be seen here and are well worth your time.

Speaking of protests, I made my way over Sproul Plaza on the UC Berkeley campus today for a rally protesting budget cuts, layoffs, furloughs, and tuition increases to the UC system... While I expected a few hundred protesters, it turns out the police estimated that there were about 5,000 union workers, staff, faculty, and students there. Many professors cancelled class and hundreds of students staged walkouts in solidarity with the striking unions.

The rally began noon and by 2pm the crowd had begun marching through the UC Berkeley campus, eventually making its way to Addison & Shattuck, where it stalled traffic for roughly 30 minutes before moving back up to Bancroft & Telegraph where it held a sit-in for a good portion of the afternoon. As of 8:30pm organizers had occupied Wheeler Hall and chained the doors shut as they contemplate their next moves.

Newsworthy coverage of the event can be found here and here. The website for the protest organizers can be found here. The website for UC President and budget-cut extraodinaire Mark Yudof can be found here.

Below are pictures from the rally at Upper Sproul Plaza and the march through campus taken from my mediocre camera-phone...

Thursday Morning Charlie Foxtrot: Kerry is French, Obama Claims Presidency of the World

Is it just me or has all that 2004 campaign hooplah about John Kerry being a Francophile finally come true? That look on Kerry's face is priceless: bored, smirky, and pompous. Slap a beret on his head and a cigarette holder in his mouth and he could run for mayor of Paris.

Obama addressed the U.N. General Assembly this week, stating "... We have also re-engaged the United Nations, we have paid our bills, we have joined the human rights council... and we address our priorities through this institution." He went on this week to secure a commitment from Russia for possible sanctions on Iran if they fail to make progress in October 1st negotiations regarding thier nuclear program, chaired a UN Security Council session during which a measure strengthening nuclear nonproliferation was unanimously passed, continued to goad the Israelis and Palestinians towards restarting the stalled peace process, and now he'll be running off to the G-20 summitt being hosted in Pittsburgh.

You'd think getting poor people some health care in the richest country in the world be easy after that... But I guess when the opposition is claiming that gay marriage is a path towards socialism and that Playboy makes men gay then I guess you've got your work cut out for you.

At least all the articles lauding Glenn Beck as the most influential lunatic in the country have started to subside....

A Manifesto on Marketplace Balance [Doesn't That Sound Thrilling?]

This is a response to a recent Op-Ed in the Wall Street Journal sent to me by a friend, along with a quote from a political science professor he once had that stated, "the number one goal of ANY bureaucracy is NOT to achieve it's goal but rather to perpetuate itself and grow." I ended up getting a bit carried away in my thoughts on the subject. Greg states that his life experience certainly validates this claim, and I think few in this country would be willing to take issue with that remark. Still, I think it provides an excellent framework to view the health care debate through in hopes of finding some reasonable middle ground, which sadly is some very scarce real estate right now...

I would agree with the notion that once created, bureaucracies, like any other organization (or organism for that matter) have a goal of sustaining themselves, and in many cases, growing. However, I would argue the point that none truly seek to achieve their goal. Do I feel that the people at the DMV are sitting there saying to themselves, "We must get these registrations processed! How dare these people be forced to wait!" - certainly not. But in institutions where there is a moral imperative (health care, for instance) I would say there is a great deal of passion for the work at hand. Having worked in such a bureaucracy at the Rhode Island Dept. of Health, I can say with firsthand experience that from top to bottom, most (certainly not all, but I what organization could claim this?) of the folks that I have had the pleasure of working with are passionate about what they do.

While I see a danger is bureaucracies growing without check, I also see a danger in the large corporations dominating our country growing without check. Were all insurers local, small businesses (or even regional, there is a certain economy of scale necessary in such a business) I would see less of a need for government to balance the odds. But when corporations grow to the extent where they dominate markets, and become their own private bureaucracies where people are just numbers and dollar signs (I'm not saying it would be any different for a government plan) I see the need for the government to offset this imbalance. Corporate dominance is just as, if not more frightening to me than big government. I have witnessed its effects very acutely in the last few years. The notion of a free-market America where entrepreneurs can flourish and passion and ideas abound is under serious threat from big business in this country. Corporate influence in Washington has exploded since the late 1970's and has reached a fever pitch in the last few years. Our country cannot expand into new industries and technologies because lobbyists block legislation required to make those new industries competitive (solar panel production comes to mind). When new ideas do break through, they're bought out and added to these companies portfolios to increase their market price.

The true America, the independent America, middle-class America is being choked and squeezed for all its worth by a multitude of corporations, and the government in turn responds in its typical manner of expansion and regulation. This game has been played throughout history, but only this decade on such a grand scale.

My liberal leaning acknowledged, in the wake of a catastrophic financial collapse brought on by deregulation, my trust is won only marginally by a public option for health care. In my mind, while concern over government expansion is legitimate, the government nevertheless still answers to us, the voters. Corporations answer only to shareholders, whose primary interest is only profit.

There is a classic and historic concern for checks and balances in government, but we have reached a point where government must weigh as a balance to business. I do not support the one-sidedness of a single-payer, fully-nationalized system such as the British NHS, rather a system more modeled on that of France, but with greater market freedoms that will ensure the U.S. can continue to do what it does best, namely advancing the use of medical technology. Yes, France, that friend that everyone loves to hate. The inspiration for 'Freedom Fries' and other Euro-phobic nonsense. Their health care system is arguably the best in the world. Does this mean we should mimic it? Certainly not, but I feel that we can take a cue from our brie-eating friends across the pond and adapt their system to meet our needs.

Despite the constant fear of a 'government takeover', this takeover would impinge upon only an estimated 5% of the current 'corporate takeover' that we now enjoy. The public option is just that, an option. The key is balance, because in the escalating battle between big business and big government, my biggest fear is either one declaring victory.

Health Care Reform: The Breakdown

So, its been pointed out to me recently that less than a year ago 70% of Americans favored a public option for health care... my oh my, how a worthless media establishment, pissy obstructionist Republicans, corporate-beholden Blue Dog Democrats, pushy liberal-zealot Democrats, and a President that thought he could get these fools to compromise have shifted the debate so far from where it should be is just downright depressing. And the insurance companies and their shareholders are laughing all the way to the bank.

WAKE UP AMERICA!

If you do not favor health care reform I really want to know why. I can fathom people's arguments about not wanting a public option, I may not agree, but there are arguments against it that are based in logic (mentioning the establishment of death panels or a mysterious government bureaucrat getting between you and your doctor discounts any logic you think your argument might have). Death panels? Seriously? And anyone with private insurance who gets to spend good quality time with their doctor, I assure you, you are a rarity. Most people go through doctor's offices like they were in line at the deli. Health care reform is much bigger than a public option. Sure thats a big component of what some would like to see pass, but there's a lot more that will have a huge impact on the current system.

I'm looking forward to Obama's speech (in ~20 minutes) tonight because I hope that he'll be able to use his deft ability to orate to clear the air and put this debate back on track. Key word here being 'debate'. Senator Mitch McConnell's (R-KY) proposal to 'skinny this thing down' (referring to the large text of the legislation currently proposed) and Rep. John Boehner's (R-OH) assertion that “It appears that the president is going to double down tonight and try to put lipstick on this pig and call it something else," do nothing to contribute to debate... and these are the Senate and House minority leaders! If Republicans are so adamnt about killing this legislation, I'd like to see what they propose instead, because if they're ok with the status quo, there's something terribly wrong.

As many (including an article in the New York Times today) have argued, if Republicans shifted from being simply obstructionist (with the exception of a few, thanks Olympia Snowe!) to actually showing a willingness to compromise, they could actually get some of their proposals into legislation, and it would give Obama leverage against the more liberal members of the Democratic Party, who at this point, are Obama's only hope to get anything passed.

Seems like a no-brainer to me... deny liberal Dems their communist agenda AND have a say in what has the potential to be one of the most historic pieces of legislation of a generation? Come out and play Republicans!

Never thought I'd be saying that...

I was going to break down all the different elements of proposed legislation, but I think that will be better done tomorrow once the air clears and we see where things really stand in this debate.

A Preamble to the Healthcare Debate

I've got big plans to break down current proposed health care reform legislation and make it palatable to the average American, who would rather not wade through hundreds of pages of legalese... this, however, is still in the works. But I did want to set the stage for discussion on health care by bringing up a point that I feel is lost in the current debate taking place. Keep in mind that this is a moral argument, not a practical one.

Can we all step back a moment and look at our health care system with fresh eyes? I think that everyone - Democrat, Republican, independent, and apathetic alike - can manage this, but it truly does take a stretching of the imagination. It is exceedingly difficult to detach oneself from the constant media onslaught (both wanted and unwanted) that penetrates the psyche via television, newspapers, Facebook, Twitter, and is then recycled via word-of-mouth.

But imagine that you had no preconceptions of how health care in this country should function... how would you set it up? Now, we don't live in a moralistic society, though some would like to pretend we do when it suits their political purposes (more on that later). So let us be practical in our aspirations for establishing our brand-new, first-ever health care system. Lets go with the assumption that at least a slight majority of Americans don't really trust the government (I think that's a safe bet) and that being a capitalistic, free-market economy, we're more comfortable with creating some private health insurance companies... Done.

These companies need workers, they have overhead to pay, and of course, they have to pay the medical bills for all their consumers. They hire some brilliant mathematicians and actuaries and find out what they need to charge their customers to stay financially viable. Sounds pretty reasonable to establish rates that will bring in at least a bit of profit.

So why is it that health insurance companies have, on average, increased premiums by 87% in the past six years, while profits from the 10 largest publicly-traded companies has risen 428% between 2000 and 2007. Why have the over 400 corporate mergers involving health insurance companies in the past 13 years, that have resulted in 94% of insurance markets becoming highly-concentrated (re: near monopoly), according to the American Medical Association, been allowed to take place? Mergers resulting in an anti-competitive marketplace where companies can thrive and shareholders can demand that profits continue to increase doesn't sound like free-market America.

So I ask, why is it that we allow insurance companies to be publicly traded at all? Stepping back to our newly-created health insurance company scenario, why can't this company function at a level where it earns steady, moderate profits? Why do we have to introduce investors to an industry that has the power decide between life and death? Why do we resist reforming a system that is set up to reward those who deny medical coverage to sick people? Shareholders in any company want to see employees cut costs and increase profits... cutting costs in the health insurance industry means killing human beings. Perhaps that seems like a harsh statement, but perhaps most of the people working at these companies are too far removed to truly grasp the consequences of their actions... Wendell Potter would agree.

An estimated 18,000 people die every year because they do not have health insurance. And while that may not be the cause of death listed on their death certificate, it is certainly the reason. Living without health insurance is the socio-economic equivalent of living with the AIDS virus. No one dies of AIDS, they die because AIDS has so utterly destroyed their immune system that opportunistic infections, be they pneumonia, tuberculosis, any other number of ailments can kill them almost instantly. People without health insurance are some of the most vulnerable. When you know a simple visit to the dentist for a toothache, or a trip to the ER to have a dislocated shoulder properly set, is far beyond your means, you simply don't go.

This is why our health care system is as costly as it is. Anyone working in the health care field (and most people with a little common sense) will agree that preventative care is the cheapest, most efficient way to keep our country healthy. When 46 million people don't have that option, things get awfully expensive.

Where to Find $12,000,000?

With URI dealing with a $12 million reduction in state funding this fiscal year, a problem compounded by rising energy costs and the constant threat of further budget cuts as the state of Rhode Island battles an estimated ~$350 million deficit this year, everyone at the university has been forced to find ways to cut costs. Whether it's improving facilities to make them more energy efficient, raising tuition, or the unfortunate loss of several of our varsity athletic programs, URI's administration is being forced to 'do more with less' at a time when our school has grown at an unprecedented rate. 

Having been at URI for several years and having also worked for a state office this summer, I've seen firsthand how much our state's budget crisis has affected state workers and institutions across the board. I could rant all day about how Governor Carcieri should be doused in water and beaten with a sock full of flour for failing to recognize the potential that URI has to generate revenue for the state, and failing to make the intelligent investments in higher education that nearly every other state in our nation sees as absolutely critical. But instead, I decided to come up with a few creative solutions of how URI could potentially regain some of those lost millions... 

• We name academic buildings and residence halls after donors right? I propose we sell the rights to name each individual dorm room on campus for a donation of $500. I'd love to remind anyone living in 312 Merrow that it was once my room, back when cockroaches were the problem as opposed to being tripled up. 
• And while we're on the topic of selling naming rights, why not attract corporate sponsors for each college or academic department? The Exxon/Mobil College of Environment and Life Sciences... The Frito Lay Nutrition & Food Sciences Department... the list could go on and the potential for irony seems endless. 
• URI 101 classes have mandatory community service... why not turn that community service into actual hard-labor? University College could pimp out all those freshman as cheap labor to landscapers, construction companies, and all those nearby sod farms at harvest time.
• If parking services really wants to strike fear into the hearts of commuters, simply put a little clause in the fine print of all parking sticker purchases that gives URI the right to auction off any towed cars... at the very least freshman would stop parking in the commuter lots. 
• Athletics was forced into the position of having to cut men's tennis, men's swimming & diving, field hockey, and gymnastics... Maybe we could afford to retain some of those teams if we started imposing fines on any unsuccessful athletics programs that we still have left.
• Speaking of athletics, maybe we could actually make use of the Ryan Center to draw in some revenue... Based on the fact that I'm charged a substantial 'Ryan Center Fee' every semester on my school bill for a facility I've only been in a handful of times, I'd say its not currently a very successful economic venture. 
• URI could also take a page from all the airlines' playbook and start adding obnoxious up-charges on any minor convenience... you want to use a mouse with that desktop at the computer lab? $2... Want to access the on-campus wireless? $0.10/min... You want a second-helping at Hope? That'll be a $3 charge... 
• And lastly, URI should tap its most valuable resource... its students. I propose that any URI graduates making over $80,000/year be subject to a hefty annual royalty payable to their alma mater. After all, URI made them what they are today, right?

As students have undoubtedly been reminded, while we can't get rid of Gov. Carcieri until 2010, there's plenty of local representatives that you can hold accountable for allowing the millions to flow out of URI's budget. The voter registration deadline for Rhode Island is October 4th, and since students at URI live here the majority of the year, regardless of where they're from, they can register to vote in Kingston (or Narragansett if you live off-campus). 

Super Tuesday: Kinetic America, Potential Energy

In the face of $4.00 per gallon gasoline prices, the American public has been inundated with calls from various political, economic, and social sector figures, each with plans and ideas to solve America’s energy crisis. Whether it has been John McCain and George W. Bush’s call for the lifting of the Federal moratorium on offshore oil drilling, Al Gore’s plea to switch to carbon-free electricity production within the next decade, or any of the other myriad plans being advocated to the public, it is quite obvious that our energy production and consumption habits must change, and they must change quickly.

Unfortunately the topic of energy reform has become so politicized that it is difficult for most citizens too see through the political posturing, the partisan blame game, and the half-truths created by the energy industry. There are a variety of alternative energy sources that, used in conjunction, can greatly reduce America’s reliance on foreign oil, and petroleum in general.
While there are certainly untapped oil reserves in the U.S., as well as abroad, it is a fact that the vast majority of the largest oil fields have already been discovered and are currently being utilized. Only smaller and smaller oil fields are left to be found and exploited, with the cost of building the infrastructure to pump the oil from these fields rising as the reserves become smaller and smaller. Barring a monumental global investment in building more pumps and refineries, it is likely that 2005 was the year of peak global oil production - output has fallen every year since, as a result of the aforementioned factors.

Several politicians, Bush and McCain being the most prominent, have advocated lifting the Federal ban on offshore oil drilling, as well as the restrictions on speculation in Alaska’s ANWR. In an election year, such a proposal must be met with skepticism. While many politicians would like to make Americans believe that oil is sitting on our doorstep, just waiting to be pumped from the Earth, the matter is far more complex.

There are two Federal moratoriums on offshore drilling that currently prevent oil companies from accessing what the Department of the Interior estimates to be roughly 19 billion barrels off the Atlantic and Pacific coasts, as well as in the Gulf of Mexico. The first moratorium was enacted by Congress in 1981 and must be renewed every year as part of the Interior Department spending bill to stay in effect. The second moratorium was imposed by George H.W. Bush in 1991 after the Exxon-Valdez oil spill. This executive moratorium was recently lifted by George W. Bush through a presidential order.

Many Republicans are pushing for a vote to lift the Congressional moratorium as well, while Democrats are advocating a plan that would push oil companies to explore much of the land (and sea) that they are already leasing from the government, but have yet to tap into. Even if a Congressional moratorium on offshore drilling were lifted, any new exploration must be approved by the States whose territory exploration might take place in. With many State-level officials, most notably Arnold Schwarzenegger (otherwise a McCain supporter), Governor of California, opposed to such plans, the prospect of offshore drilling seems unlikely. Opponents on the state level cite a range of environmental concerns, and perhaps even moreso, concerns over how such exploration could affect tourism to costal areas, a valuable component of many states’ economies.

Even if new exploration were to take place, it would be several years before any such exploration would translate into true production and potentially lower prices at the pump. Even T. Boone Pickens, the 80-year old Texas billionaire oilman, dubbed the recent Republican attempts to convince the American public that more drilling would reduce gas prices as, ‘totally misleading’. Remember that this is the same man who helped Republicans in the 2004 election by giving nearly $3 million to finance the infamous ‘Swift Boat’ attack ads against John Kerry.
At the other end of the spectrum from the drilling advocates sits global warming’s greatest nemesis, former Vice President, Al Gore. Last week Gore, in a speech delivered in Washington, called on the United States to forsake oil consumption and make a concerted, national effort to achieve carbon-free energy production within the next decade. In addition to averting further contributions towards global warming, which Gore claims has the potential to produce millions of ‘climate refugees’ and cause serious political and economic instability worldwide, he cites the nation’s tangled foreign policy as requiring urgent revision. “We’re borrowing money from China to buy oil from the Persian Gulf to burn in ways that destroy the planet. Every bit of that has got to change.”

For all of his lofty goals, Gore fails to bring the discussion down to the level of specific planning and initiatives. Over the past 25 years he has done perhaps more than anyone to bring the world’s attention to the problem of climate change and the burning of fossil fuels, but much of Gore’s effectiveness stops there. He no longer holds public office, and while he certainly earns a comfortable living, he does not possess the financial capital to make the type of investments in alternative energy that he is advocating. Gore is a mouthpiece to push those who have the means to actually make such investments towards action. And while climate change is still debated by some, Gore’s campaign can do nothing but benefit from high gasoline prices, which may draw the attention of far more of the American public than his warnings of environmental catastrophe ever did.

This is where individuals such as T. Boone Pickens enter the fray. At 80 years old, the geologist who built his wealth by pumping oil out of the ground seems like an unlikely champion of alternative energy; however, patronage of his sort is exactly what the drive towards energy independence needs. Pickens has recently spent $58 million on a media blitz to promote his energy plan for the United States – a plan that includes a $1 trillion proposal to build wind farms across the American Midwest, from North Dakota to the Texas panhandle, one of the most wind-rich areas of the world. And Pickens’ plan is not just talk… he has recently invested nearly $10 billion in the construction of what will be the nation’s largest wind farm, north of Sweetwater, in the Texas panhandle.

Wind farm construction is part of his larger strategy to reduce America’s dependence of foreign oil (roughly 70% of our country’s supply), and free up natural gas reserves to be used as transportation fuel. Indeed, there are a good deal of natural-gas powered vehicles produced by major automobile manufacturers, but few are purchased within the confines of the United States. This writer recalls driving a natural gas powered Ford F-150 in the summer of 2004 during a stint as a Park Ranger in Bristol, RI. There was little, if any, noticeable difference in the function of the vehicle, the only downside being the 15+ mile drive to refuel at one of Rhode Island’s only 3 natural gas refueling stations. This highlights the necessary change in infrastructure that would have to accompany a shift from oil and this change will certainly come at a cost. But as Pickens likes to point out, the $1 trillion investment in wind farms is a one-time investment, whereas our $700 billion addiction to foreign oil is an annual cost.
At the moment natural gas is significantly cheaper than oil, with natural gas selling in Rhode Island at $2.57 per gallon, compared with prices of gasoline hovering around $4.00 per gallon. In other parts of the country natural gas is even cheaper. Natural Gas can provide an easy alternative transportation fuel, especially in the realm of commercial vehicles, where other technologies (such as electric) have not evolved to the point where they can power large machinery.

But the solutions to the nation’s energy problems do not end with the Picken’s Plan. Americans must realize that it is an imperfect plan, as most are bound to be, and it is merely one man’s effort to create a stronger, more stable America. Other alternatives that can help reduce our dependence on petroleum include the prospect of biofuels, such as ethanol. And while there has been much debate about ethanol’s role in rising food prices worldwide, as essential food crops are turned into fuel instead, there are two companies, INEOs Bio of the U.K., and Coskata of Warrenville, Illinois, who both claim to be on the verge of producing ethanol on a commercial scale without the use of food crops.

Instead of crops such as corn, both companies are pioneering techniques to transform municipal waste into ethanol by heating the waste with a limited amount of oxygen in order to create a carbon monoxide/hydrogen gas. This mixture is then fed to certain bacteria capable of transforming it into ethanol. On top of that, the process uses as little as 1/4th the amount of water needed to grow ethanol crops. Coskata is hopeful that they will achieve a $1 per gallon production cost.

When you consider all this in conjunction with the constant push for more hybrid and electric personal vehicles (Toyota is on pace to sell 200,000 of their Prius models in the U.S. this year), the enormous potential of the American southwest in terms of solar power, potential that rivals the Great Plains states’ potential for wind power, the continuing increase and developments in recycling, and the dizzying array of everyday ‘green’ items like compact fluorescent light bulbs, there seem to be few limits to the alternative energy resources that we can harness.
America can, and will, solve its energy crisis, it is only a matter of time. With $4.00 per gallon gas perhaps being the tipping point for American society, more and more people will turn to alternatives such as hybrid cars and public transportation. As always with our capitalist society, once conditions begin to adversely affect our pocketbooks, then the potential for real change is upon us. Hopefully with more investors in the energy sector emulating the Pickens Plan that change will come soon.

Sources:

Drilling’s Lure
NYT Editorial Board
The New York Times – July 15th, 2008

Democrats Dig in as G.O.P. Presses for Oil Exploration in Protected Areas
By Carl Hulse
The New York Times – July 11th, 2008

Gore Calls for Carbon-Free Electric Power
By David Stout
The New York Times – July 18th, 2008

The Oil Man Cometh
By Timothy Egan
The New York Times: Op-Ed – July 24th, 2008

From Garbage to Gas Tank: Trash as Biofuel
By Jessica Marshall
Discovery News – July 23rd, 2008

Super Tuesday: Where You Frum?

Tonight on The Daily Show With Jon Stewart, Stewart interviewed David Frum, a former speechwriter for George W. Bush, and author of "Comeback: Conservatism That Can Win Again". Aside from the fact that Frum has a slightly distracting stutter, and looks frighteningly like Chris Kattan, it was actually interesting to hear what he had to say. His message is basically that Republicans need to quit bullshitting people and denying that there are problems with health care and pushing tax cuts that don't help the middle class. Somewhat refreshing. Unfortunately he's advising Giuliani. Take note that an earlier portion of the show focused on the borderline insane amount of times Giuliani invokes the phrase '9/11'. Including during his response to questions about Hillary Clinton's supposed 'breakdown'. Here's a few lines from the interview:

Stewart: Who are you advising in this campaign?

Frum: I'm giving advice to Rudy Giuliani.

Stewart: Ok, I'm Giuliani. You're my guy, I come to you and say 'the old conservatism, that's not working. What do I believe?'

Frum: You believe that the Republicans are the party of the great American middle. The party of national security. They are the party that believes in responding to the concerns that people have, which are that their health care system is broken, income is not rising, the tax cuts that we offer don't make a difference to people in the middle, and that a lot of our national security ideas have not delivered the national security that people need.

Stewart: So when he hears that, does he say to you, 'da...uh... 9/11!'.

Another gem from later in the interview, when the discussion turns to Mike Huckabee's success, and the Republican's fear of him winning the primaries...

Stewart: Is this cynical by the Republican party? They use the evangelical bloc to kinda put them over the top... its almost like... do you watch the Simpsons?

Frum: I'm afraid to say, yes.

Stewart: Ned Flanders. Yeah thats great, you like having him around because he'll do all the leg work, but when it comes down to it you want President Homer.

Frum: I don't think we want President Homer.

Stewart: We have President Homer.


Other important notes:

• After her defeat in Iowa, Clinton bounced back to beat out Obama in the New Hampshire primaries 39% to 36%. Fuck New Hampshire. At least they picked McCain over Romney.
  
• I'm convinced Romney would engage in human trafficking if he thought it might benefit his campaign somehow.
• If Edwards wins South Carolina, Super Tuesday is going to be really interesting.
• Arthur told me at work that someone needs to start a national interest group for people who live solely off their physical or mental labor. Imagine giving low and middle income tax brackets a voice as powerful as the NRA or AARP.
  
• I watch too much Futurama, as evidenced by the fact that I ordered a Futurama poster online today.
  
• Do a search for David Frum on YouTube. Its kind of scary.