The power of words

In the aftermath of last night’s Democratic presidential debate, the consensus seems to be that Hillary’s “change you can Xerox” line was an embarassing, disingenuous clunker and that her closing comments were a genuine moment that effectively showed her soft side.

Slate’s John Dickerson seems to capture the CW. He calls the Xerox line “a bad moment,” an unclever remark “cooked up by committee.” He called her closing remarks “her best of the night” because they “showed her heart and a little humanity.” I beg to differ.

Here is what she said (video), in response to the question of how she had been tested in a moment of crisis:

CLINTON: Well, I think everybody here knows I’ve lived through some crises and some challenging moments in my life. And…

(APPLAUSE)

And I am grateful for the support and the prayers of countless Americans.

But people often ask me, “How do you do it?” You know, “How do you keep going?” And I just have to shake my head in wonderment, because with all of the challenges that I’ve had, they are nothing compared to what I see happening in the lives of Americans every single day.

You know, a few months ago, I was honored to be asked, along with Senator McCain, as the only two elected officials, to speak at the opening at the Intrepid Center at Brooke Medical Center in San Antonio, a center designed to take care of and provide rehabilitation for our brave young men and women who have been injured in war.

And I remember sitting up there and watching them come in. Those who could walk were walking. Those who had lost limbs were trying with great courage to get themselves in without the help of others. Some were in wheelchairs and some were on gurneys. And the speaker representing these wounded warriors had had most of his face disfigured by the results of fire from a roadside bomb.

You know, the hits I’ve taken in life are nothing compared to what goes on every single day in the lives of people across our country.

And I resolved at a very young age that I’d been blessed and that I was called by my faith and by my upbringing to do what I could to give others the same opportunities and blessings that I took for granted.

That’s what gets me up in the morning. That’s what motivates me in this campaign.

(APPLAUSE)

And, you know, no matter what happens in this contest — and I am honored, I am honored to be here with Barack Obama. I am absolutely honored.

(APPLAUSE)

Whatever happens, we’re going to be fine. You know, we have strong support from our families and our friends. I just hope that we’ll be able to say the same thing about the American people, and that’s what this election should be about.

First, she for the umpteenth time perversely and unsubtly alludes to and somehow tries to take credit for the fact she chose to stay married to a lying, philandering scumbag for decades in order to advance her political ideas. It’s mind-boggling.

Second, she segues ever-so-crudely into the prefabricated, prescripted heart-tugging anecdote in a transparent effort to demonstrate to voters she is not just an adding machine wearing a blonde wig and an ugly outfit. The moderator could have asked Hillary to explain the quadratic equation and she would have uncorked this manipulative nonsense. I imagine advisers Mark Penn and Howard Wolfson unzipping the back of Hillary’s blouse during one of the commercial breaks and pulling down a flap in the middle of her back to reveal a bunch of circuitry, a la Vicky in “Small Wonder“:

Penn: Where’s the “emote” button on this damn contraption?

Wolfson:
Ugh. The male version of this robot was great at emoting. Had trouble controlling the mating function, though.

So it was a prefab, partly borrowed “genuine moment.” So what? In a way, that makes it worse when you parse what she actually said because you realize she spent all day practicing this claptrap and didn’t realize how horrible it was.

She says the par-for-the-course political attacks she’s received thanks to her vaunted 35 years of experience are nothing compared to the struggles of other Americans, especially soldiers who have been crippled in battle. But to whom, exactly, would it even occur to make this comparison? In what galaxy is Hillary a sympathetic or pitiable figure?

Let’s see. She is one of the richest people in the richest country in world history. Win or lose this campaign, she is virtually assured of two or three more decades as one of the 100 most powerful people in the world’s most powerful deliberative body — her incumbency to be perfunctorily interrupted every six years by a campaign against an underfunded, overmatched opponent. Yes, of course, she is “going to be fine.” More than fine. Who would suggest otherwise, except in a bogus attempt to “connect”?

Even Hillary’s vain (in both senses of the word) attempt to acknowledge her incredible good fortune is undercut by her self-serving evocation of wounded soldiers. The ugly truth that sits astride Hillary’s talk of faces disfigured by roadside bombs is that it was her vote, and her vocal support, that helped send those soldiers to the war where they were wounded. She has never even had the simple decency to apologize for the war she realized too late was not just wrong but tragically so, because to do so might weaken her politically.

And now, now, now, now — she has the audacity to use the victims of the war she helped to start as mere decoration for a concocted vignette in a vile effort to aid her own, fast-fading hopes for the presidency!

What kind of a disgusting human being thinks this way, believing not only that this is something short of an admission of callous indifference to her own role in perpetuating human suffering but that it somehow speaks well of her? How upside down is our thinking that people watch such garbage and hail it as demonstrating “humanity”?

Forget it, Jake. It’s campaign season.

(Also posted to Sinners in the Hands of Angry Blog.)

Reporting on health care report cards

The lede:

Twenty-one states have mandated hospital infection reporting in the last four years, and 221 health care quality report cards are listed on a Health and Human Services Web site.

Last month alone saw new quality reports released in New Jersey, Minnesota and the Seattle area.

The premise behind this wave of public reporting is that transparency will spur doctors and hospitals to improve quality and safety while giving patients valuable data to help them decide where to seek care. The concept has widespread
acceptance, yet it is also largely untested and unproven.

Since 1986, 45 studies have examined the impact of public reports on quality and safety. But while such reports appear to stimulate quality activity in hospitals, there is little evidence to show they improve the effectiveness, safety or patient-centeredness of care. They also can have unintended consequences, such as discouraging doctors from treating sicker patients.

The whole shebang.

What health care works?

The lede:

Buried in clinical guidelines and buffeted by the latest published research findings, what’s a physician to do when faced with a patient and a 15-minute treatment window? Begin to sort through the conflicting guidelines or analyze the latest research studies?

A Jan. 24 Institute of Medicine report suggests a way to bring order from the chaos that surrounds conflicting clinical guidelines and questions about how to choose the best available diagnostic, treatment or preventive service — but Congress would have to create a federal program to make it happen.

The whole shebang.

The audacity of ego

Mitt Romney has, so far, reportedly spent $35 million on his failing campaign for the Republican presidential nomination. Just think about it for a moment — $35 million. Inhale deeply, put your pinky finger up to your mouth a la Dr. Evil and say with me: Thirty-five meeeellion dollars!

What else could Romney have done with that money? He could, of course, have plowed it back into his entrepreneurial efforts and made lots of people lots more money — returns four times better than the S&P 500 if the Bain & Co. promotional materials are to be believed.

But apparently he wants to “help” people, not just make them money. Well, with $35 million he could have helped send more than 3,000 low-income children to private school from kindergarten through the 8th grade. The number would actually be higher because the money could be invested and the pot could grow even larger while the kids worked their way through school.

Or, he could have expressed his deep love for the faith of his fathers by giving the dough to the LDS welfare services operation, which assists the victims of disaster all over the globe. Sticking with education, he could have handed the money over to his alma mater, Brigham Young University, on the condition that it go to pay full freight for Mormons from low-income families.

Or, he could have used it to help the National Multiple Sclerosis Society — “the single largest private sponsor of MS research in the world” — fund efforts to find a cure for the disease that his wife Ann has so courageously battled.

Or … whatever. I’m not normally in the habit of telling obscenely rich people how to spend their money, but the truth is that nearly any use of the money would have made more sense, and been more laudable, than the purpose to which it has gone. Not only has Romney wasted $35 million (so far) on a broken political sector that cannot be “transformed” by a single man — yes, even the president — but he has done it in service of ideas that make “garden variety” seem exotic by comparison.

(New Jersey’s Jon Corzine is even guiltier of this offense, spending more than $100 million of his fortune to win a Senate seat and then the governorship. Wow, a liberal Democrat governing New Jersey? There hadn’t been one of those since … the guy who immediately preceded him!)

One could argue that a rich man pouring money into a political candidacy in service of an idea that otherwise won’t get a fair hearing — Steve Forbes pushing a flat tax, Ross Perot stressing fiscal discipline — is doing something to, in an inchoate fashion, nudge the national debate in a different direction. I’m not sure political campaigns are the best way of promoting out-of-the-box ideas, but at least a plausible case could be made.

But the hallmark of Romney’s campaign has been his painfully awkward lurches to grab hold of the most widely shared and worst ideas the Republican Party has to offer — everything from doubling the size of our illegal detention camp in Guantanamo Bay to impeding promising scientific research to building a wall in a vain effort to stop peaceful people from crossing an imaginary line to enjoy the fruits of their labor.

Thirty-five million dollars. What an enormous waste of scarce resources, and done in the name of helping people. That amount could supply 2,500 pumps to bring clean drinking water to African children, one of whom dies every 15 seconds from a water-related disease. Instead, Romney spent $35 million to buy TV ads to tell voters why he has recently come to support the National Review’s line on the issues.

No, it is worse than that. Because the truth is that the differences between Romney and McCain are not significant. Both support a war without end in Iraq. Both (now) support building a wall on our border without doing anything to make legal the freely exchanged labor of people without the proper government permission slips. He has steadfastly refused to criticize the spectacularly terrible Dubya & Co. except in superficial, technocratic terms. So, what excuse does Romney have left to explain why he wasted $35 million on politics when it could have been put to manifestly nobler ends?

The answer: ego. Mitt Romney is apparently the kind of man who looks at the $3 trillion federal budget and says, “The only thing wrong with this mess is that someone else is in charge of it.”

The notion that what the country needs is the same old government-centric approach to solving problems but someone just a little bit smarter to implement it is profoundly and tragically misguided, but Romney’s delusions of grandeur are especially laughable given his mediocre record in political office.

After all, the signature achievement of his governorship in Massachusetts is that he helped give a tax, spend (and spend again!), mandate and regulate approach to health care a Republican imprimatur.

Whether Romney’s decision to waste $35 million (so far) on politics is driven more by a disturbing distrust of civil society, a naive faith in the power of government, or a truly alarming and totally unjustified messianism is unclear. I do know this much: He could have bought a lot of magic underwear and hair gel with that money. It would have been money much better spent.

(Also posted to Sinners in the Hands of Angry Blog.)

You’ll need a license to rep

The lede:

The Washington, D.C., city council last month became the first legislative body in the nation to approve the licensing of drug reps. At press time, the bill was awaiting the signature of Mayor Adrian M. Fenty, who supports the legislation.

The measure, dubbed SafeRx, would require detailers to pay a licensure fee, adhere to an ethics code, receive continuing education and refrain from misleading doctors about drugs. Sales reps could be fined up to $10,000 for operating without a license.

The whole shebang.

Google’s new motto

Apparently, it’s “Don’t be evil afraid to use the threat of government prosecution to intimidate the competition.” I guess it replaces their most recent slogan, “Don’t be evil showing Chinese users how their government is censoring the Internet.”

After Microsoft announced its $41 billion offer for Yahoo! in a bid to remain relevant online, Google was quick to send its top lawyer to the blogosphere to man the barricades. And so we get this entreaty for politicians across the globe to please stop Microsoft from grabbing a truly frightening 30 percent share of the search market. Unfortunately, some Congress critters are only too happy to oblige.

Here is Google, which every day is pointing the way toward a Web-based form of computing that could render the operating system obsolete, engaging the same tired Microsoft scaremongering that was demolished 10 years ago.

The Cato Institute’s David Boaz recently lamented Google’s opening a lobby shop in D.C., complaining of “how the government lured Google into the political sector of the economy.” Looks to me like they’re taking to politics like a fish takes to water.

(Also posted to Sinners in the Hands of an Angry Blog.)

RedEye: A worthwhile alternative

There are some who say, and I quote here, that “RedEye sucks.” Indeed, a Google search for that phrase yields my long-ago post as the No. 1 hit. Cool!

That said, I am glad that I’ve a RedEye newspaper box within a block of home. Why? Without RedEye, I’d have to pay 50 cents for a paper to scoop up the dog’s poop on those rare occasions when I forget to bring along a plastic bag.

Thank you, RedEye!

Protecting patients or impeding improvement?

The lede:

More than 100 Michigan intensive-care units cut their average catheter-related bloodstream infection rate 66% by implementing a simple checklist of proven infection-control practices such as hand washing and removing unnecessary catheters.

But the Dept. of Health and Human Services’ Office for Human Research Protections last fall ordered the hospitals to suspend collecting data documenting the research project’s success because researchers did not properly comply with federal regulations aimed at safeguarding patients.

Now each participating hospital must seek institutional review board approval for the project, which was organized by the Johns Hopkins University School of Medicine in Baltimore and whose results were published in the Dec. 28, 2006, New England Journal of Medicine.

The study already has been cited more than 20 times in other medical journals, with experts in one patient safety publication dubbing it an “instant classic.” The safety effort reduced the median infection rate to zero per 1,000 catheter days, compared with national rates as high as 5.2 per 1,000 catheter days.

The whole shebang.

Ethics committees play waiting game

The lede:

Since their rise more than three decades ago, hospital ethics committees have sought to help physicians, patients and their families resolve ethical disagreements and navigate the treacherous terrain that so often accompanies medical care at the end of life.

The role of these committees was cemented in 1992 when the Joint Commission mandated that health care organizations come up with some way of addressing ethical concerns. Ninety-five percent of general hospitals surveyed in 1999 and 2000 offered ethics consultation or were starting up a consult service.

Yet at the median, these services handled only three cases in the previous year, according to the survey of more than 500 general hospitals whose results were published in February 2007 in The American Journal of Bioethics.

The use of ethics consultation services varies widely from hospital to hospital, but physician experts and ethicists agree that they frequently are underused. That leads, they say, to increased medical costs and ugly disputes among physicians, patients and families.

Physicians’ reluctance to seek aid when dilemmas arise is partly grounded in the notion that a call for help is equivalent to hauling in the “ethics police.” But the problem, experts say, goes far deeper.

The whole shebang.

Prescribing placebos

The lede:

Nearly half of physicians use placebos in clinical care, and only 4% tell their patients the truth about it, according to a survey of Chicago academic physicians that was published this month in the Journal of General Internal Medicine.

Only 8% of the 231 physicians surveyed used placebos more than 10 times during the last year, but experts were alarmed by doctors’ self-reported, less-than-straightforward conversations with patients about placebos.

The study is troubling because deceptive use of placebos is “inconsistent with what we now understand as the rights of patients to decide on treatment in a knowledgeable way and the duties of physicians to disclose to patients the treatments that they are providing,” said Paul S. Appelbaum, MD, director of the
division of psychiatry, law and ethics in the psychiatry department of Columbia University College of Surgeons.

The whole shebang.

The economics of organ vending

The lede:

Nearly 100,000 Americans are waiting for an organ transplant. Every day, the wait for 17 of those people ends in death.

It is a wait that could be drastically shortened or even eliminated if a market for live and cadaveric organs were allowed to operate, according to a paper co-authored by Nobel Prize-winning economist Gary S. Becker, PhD, and published last year in the Journal of Economic Perspectives.

The study comes on the heels of what observers say is slow but steady progress in breaking down opposition to testing the idea of financial incentives in an effort to combat an organ shortage growing by 5% each year. But resistance among many in the transplant community is still fierce, as other efforts such as paired donation exchanges begin to take off.

The whole shebang.

Refusing to serve

The lede:

A recent American College of Obstetricians and Gynecologists’ position statement outlining the limits of conscientious refusal in reproductive medicine is drawing fire from physicians who oppose abortion.

The ACOG Committee on Ethics opinion says doctors whose personal beliefs may require them to “deviate from standard practices” such as providing abortion, sterilization or contraceptives should:

  • Give patients prior notice of their moral commitments and provide accurate and unbiased information about reproductive services.
  • Refer patients in a timely manner to another doctor who can provide the requested service.
  • Provide medically indicated services in an emergency when referral is impossible or might affect a patient’s physical or emotional health.
  • Practice close to physicians who will provide legal services or ensure that referral processes are in place so that patient access is not impeded.

The opinion, published in November 2007, comes in response to heated debate over some pharmacists’ refusal to fill patient prescriptions for Plan B, known as the morning-after pill. The Food and Drug Administration in September 2006 approved Plan B for over-the-counter status, but the debate over the right to refuse certain procedures or medication has not disappeared.

The whole shebang.

Rooting interests

The only way for a libertarian who is also a political junkie to get through a presidential campaign is to develop some kind of rooting interest. This usually involves rooting against the most odious person in the race.

The libertarian side of me is constantly making mental calculations about the leading presidential contenders and how their election might affect the perennial struggle between individual liberty and government power. Picking between the Democrat and the Republican on this basis is sort of like trying to choose between a turtle and a snail about who will add the most to your track team. Both will be terribly lousy, so it’s just a matter of degree.

With only minimal policy differences to differentiate the contenders, my political junkie side, the human side, develops very superficial opinions about who I simply won’t be able to stomach watching on my TV for at least the next four years.

Since becoming a libertarian in 1994, these interests have usually coincided. It was easy to root for Dole against Clinton in 1996, as Dole had both the policy and personality advantages going for him.

You’ll recall that Dole, while always a moderate, was proposing major tax reform and was set to work with a GOP Congress which at that point had not completely sold out its limited-government ideals. In fact, they’d just shut down the government in a bruising budget battle with Clinton. Dole’s wicked sense of humor, curmudgeonly personality and constant references to himself in the third person made him easy to like on a personal level.

He certainly was not as smarmy, self-satisfied, duplicitous and odious as Bill Clinton, who was fresh from likening those who blew up the Oklahoma City federal building to Republicans who favored slowing the growth of spending on Medicare. He also had passed an entirely symbolic semiautomatic gun ban, raised taxes, and attempted to have the government “manage competition” in the health insurance industry. By election time, he was running on supporting school uniforms.

In 2000, it was a very tough call. Bush was clearly running away from the ideas of free markets and smaller government, while Gore was running on obnoxious “people vs. the powerful” theme. He was a liberal technocrat’s wet dream, and on the personal level I still held against him his despicable 1996 Democratic convention speech where he used his sister’s lung-cancer death to score political points. His obnoxious debate performances only confirmed how insufferable he would be to have as president for four years.

Bush, with his frequent malapropisms, would make excellent fodder for the late-night comics, I thought. So I gave him the very, very slight edge.

By 2004, Bush had already established himself as one of the worst presidents in U.S. history for self-evident reasons. His awfulness on policy filled me with so much rage that I could hardly generate a chuckle at his occasionally stupid and embarrassing remarks.

Kerry was no prize on personality, and you’ll recall that on the war he argued not that it should be ended but that he could fight it better. I suspected, though, that he would be much more likely to pull out were he elected. And indeed, he’s since come to favor withdrawing from Iraq. More than anything, I hoped a Kerry victory would be seen as a rebuke of the idea of pre-emptive war. In the time since, the course of the war itself has become such a rebuke.

And how about now? Normally, I’d be rooting for a Republican under the assumption that the Democrats will retain Congress and it’s best to aim for divided government and gridlock. But it seems likely the GOP nominee will remain committed to a forever war in Iraq and that the Democrats won’t be able to get a veto-proof majority to stop it. And the war is sort of a binary issue, and one the president will determine. So that means I’ve to root for a Democrat.

Also, I think George Will is right to note that it is almost certain that a Democrat will win the presidency this year:

Today, all the usual indicators are dismal for Republicans. If that broad assertion seems counterintuitive, produce a counterexample. The adverse indicators include: shifts in voters’ identifications with the two parties (Democrats now 50 percent, Republicans 36 percent); the tendency of independents (they favored Democratic candidates by 18 points in 2006); the fact that Democrats hold a majority of congressional seats in states with 303 electoral votes; the Democrats’ strength and the Republicans’ relative weakness in fundraising; the percentage of Americans who think the country is on the “wrong track”; the Republicans’ enthusiasm deficit relative to Democrats’ embrace of Hillary Clinton and Barack Obama, one of whom will be nominated.

So which one should I root for? Which one should libertarians root for?

First, the policy argument. Barack Obama was right on the war, and I believe he is more likely to follow through with his promise to end it. While Obama’s far from a noninterventionist, he is not the hawk that Hillary’s proven herself to be over time (remember the Kosovo war she got Bill to start as a price for standing by him after the Lewinsky fiasco?).

Both Hillary and Obama are terribly liberal, and both want to dramatically increase government control of health care. But I think that tactically, Hillary may be far preferable on policy. Obama — a magnetic, likeable and fresh face — could very will win a sweeping victory that goes all the way down the ticket, giving Democrats a much larger margin in Congress.

The Republicans are clearly flummoxed about how they could attack him. Their only hope would be a major foreign-policy crisis that they could use to highlight his allegedly slim resume (which is relative, I say; he has more foreign-policy experience than most governors or mayors).

Hillary, on the other hand, is deeply hated by Republicans and not much liked by independents. The trends would still carry her to victory, but it would be a much smaller victory. And once in office, I believe it would be much harder for her to marshal support for the many, many, many grandiose schemes she has in mind. Her mandate will be minimal, compared to the 55% or even better popular vote I think Obama could easily win.

Then again, I cannot stand the woman. Her voice irritates me. Her disdainful attitude toward those who disagree with her is disgusting. She literally cries, “Woe is me.” She shares all of her husband’s flaws and none of his charm. Once she is endowed with the terrible and expansive powers of the modern presidency (for which she’s expressed an alarming fondness), I’m quite sure my hatred for her will grow even stronger.

But, given the likely and frightening alternative of a popular, effective liberal president such as Obama, I guess this grinch may be rooting for Hillary after all.

(Also posted to Sinners in the Hands of Angry Blog.)