Monday, November 28, 2011

Throw Them All Out--Read It with a Pair of Sunglasses!

Last week, I read Peter Schweizer's insightful book, Throw Them All Out. I found it to be very well researched and well written. It is a fascinatingly frustrating read, in a righteous indignation kind of way. The book is a reminder that we need to evaluate politics vertically (top to bottom) a lot more often rather than just approaching politics on the horizontal spectrum of left to right ideology. Schweizer further reveals that those at the top of the political food chain are politicians themselves and their cronies, and we everyday Americans are subject to the rules these individual craft for everyone but themselves.  Unlike intellectually dishonest researchers who often "forget" that correlation does not equal causation, Schweizer lays out the facts--the legislation, stock trades, associations, and timing-- of the unethical behavior of Congress, the White House, and their cronies and allows the reader to make the judgement for himself or herself. He's the prosecutor; the reader is the juror.

Throw Them All Out is comprised of three parts--discussion of Congressional transgressions, the gains made by politicians' cronies, and how Schweizer's feels these problems can best be addressed.   Much of the Congressional behavior Schweizer discusses was highlighted in the recent 60 Minutes segment. Schweizer goes into detail on Congresswoman Pelosi's insider trading on Bank of America IPOs and how earmarks for light rail projects would raise the value of nearby property that she owned. Isn't it interesting that if you had the letters P-E-L-O-S-I, you could spell both "IPO" and "lies" on a Scrabble board? Schweizer hits at both parties--from former Republican Congressman Dennis Hastert and Democrat Heath Shuler on their land deals and the benefit they received from legislation. Schweizer also presents an excellent expose on how Congress trades health insurance and drug company stock based upon early knowledge of whether or not healthcare legislation is posed to pass. Isn't it any wonder how Congress is more concerned with Americans health insurance and drug coverage specifically than they are with Americans health?

Schweizer continues in part two focusing in large part on two of Obama's wealthiest cronies-- George Soros and Warren Buffett. Schweizer highlighted the trend of hedge fund managers' growing closeness with the political arena. Such associations likely contributed to Soros' excellent stock picks that somehow seemed to be many of the same companies who received government grants. Buffett's modus operandi seems to be feigning populist outrage only to greatly gain from legislation like the TARP bailout. Schweizer also highlights how 80% of green energy loans went to companies associated with President Obama's top donors.  In reality, of course, with companies like Solyndra receiving hundreds of millions of dollars, all of this crony capitalism amounts to taxpayer dollars swirling the water efficient "green" toilet?

Schweizer closes the book with a few chapters that seem like a cross between the Federalist Papers and Thomas Sowell's Intellectuals and Society. He mixes both the thoughts and visions from the Founders on ethical government with the anti-Elite message Sowell pounded home in his book. He closes the book by offering some reforms to help solve this massive political problem. These reforms fall right in line with the reforms Governor Palin offered in her recent Wall Street Journal op-ed:
What are the solutions? We need reform that provides real transparency. Congress should be subject to the Freedom of Information Act like everyone else. We need more detailed financial disclosure reports, and members should submit reports much more often than once a year. All stock transactions above $5,000 should be disclosed within five days. 
We need equality under the law. From now on, laws that apply to the private sector must apply to Congress, including whistleblower, conflict-of-interest and insider-trading laws. Trading on nonpublic government information should be illegal both for those who pass on the information and those who trade on it. (This should close the loophole of the blind trusts that aren’t really blind because they’re managed by family members or friends.) 
No more sweetheart land deals with campaign contributors. No gifts of IPO shares. No trading of stocks related to committee assignments. No earmarks where the congressman receives a direct benefit. No accepting campaign contributions while Congress is in session. No lobbyists as family members, and no transitioning into a lobbying career after leaving office. No more revolving door, ever.
Recently, Governor Palin suggested that all presidential candidates read Schweizer's book. It would do us all well to read it also. It provides us with a glimpse into the swamp of Washington inhabited by both parties and offers proposals to drain that swamp.At less than 200 pages complete with references and tables, Schweizer's book is not heavy on opinions or words. It is a concise, yet thorough investigation of the political class. Former Supreme Court Justice Louis Brandeis once said that sunlight is the best disinfectant. You might want to read Schweizer's book with a pair of sunglasses.

Crossposted here and here.

Wednesday, November 23, 2011

Thanksgiving--God's Grace, the 1%,the Blessings of America, and the History

As we celebrate Thanksgiving this year , there is much to be thankful for, among the most important of these is God's grace and His love. Without it, I know I would be nothing. The Bible talks about thankfulness throughout its page from the Israelites in the Old Testament to the Psalms of David to the days of the early church following Christ's resurrection. One of the more well known Scriptures about thanksgiving comes from Psalm 100, written by David:
Shout for joy to the LORD, all the earth. Worship the LORD with gladness; come before him with joyful songs. Know that the LORD is God. It is he who made us, and we are his; we are his people, the sheep of his pasture. Enter his gates with thanksgiving and his courts with praise; give thanks to him and praise his name. For the LORD is good and his love endures forever; his faithfulness continues through all generations.
In additions to those blessings from God that are more spiritual in nature, there are the material blessings and the freedoms that we have in America to be thankful for. While there are some who are protesting against the 1% of America, in America a good many of us are really amongst the 1% of the world when it comes to income:
As author Matt Ridley put it, "Today, of Americans officially designated as 'poor,' 99 percent have electricity, running water, flush toilets, and a refrigerator; 95 percent have a television, 88 percent a telephone, 71 percent a car and 70 percent air conditioning. Cornelius Vanderbilt had none of these." Nor does much of the world. Food for thought.

We have been so blessed in America with our physical blessings. While there is high unemployment and homelessness in America, we are generally all well nourished,  have sufficient shelter, and have clothing.(As a side note, if you are looking to help the true 1%, I recommend supporting Christian Relief Fund. 92% of their donations go directly toward helping the truly in need in the world). Those physical provisions are in addition to the luxuries of our technology created by innovators throughout the world and throughout history. Beyond those things though, we live in  a free society. We may not be able to tangibly touch freedom or liberty, but  their blessings are manifested in every aspect of our lives. David Boaz of the Cato Institute shares a nice list of things that we have to be thankful for as Americans:
Rule of law. Perhaps the greatest achievement in history is the subordination of power to law. That is, in modern America we have created structures that limit and control the arbitrary power of government. No longer can one man — a king, a priest, a communist party boss — take another person’s life or property at the ruler’s whim. Citizens can go about their business, generally confident that they won’t be dragged off the streets to disappear forever, and confident that their hard-earned property won’t be confiscated without warning. We may take the rule of law for granted, but immigrants from China, Haiti, Syria, and other parts of the world know how rare it is. 
Equality for women. Throughout much of history women were the property of their fathers or their husbands. They were often barred from owning property, testifying in court, signing contracts, or participating in government. Equality for women took longer than equality for men, but today in America and other civilized parts of the world women have the same legal rights as men. 
Self-government. The Declaration of Independence proclaims that “governments are instituted” to secure the rights of “life, liberty, and the pursuit of happiness,” and that those governments “derive their just powers from the consent of the governed.” Early governments were often formed in the conquest of one people by another, and the right of the rulers to rule was attributed to God’s will and passed along from father to son. In a few places — Athens, Rome, medieval Germany — there were fitful attempts to create a democratic government. Now, after America’s example, we take it for granted in civilized countries that governments stand or fall on popular consent. 
Freedom of speech. In a world of Michael Moore, Ann Coulter, and cable pornography, it’s hard to imagine just how new and how rare free speech is. Lots of people died for the right to say what they believed. In China and Africa and the Arab world, they still do. Fortunately, we’ve realized that while free speech may irritate each of us at some point, we’re all better off for it.
You can read his whole post here.

Why do we celebrate Thanksgiving here in America? There is indeed the stories of the pilgrims celebrating with the native Americans early in our Colonial history. There are the proclamations of Thanksgiving from Presidents Washington throughout our history,  but Thanksgiving wasn't an official holiday until President Lincoln officially declared such a day in 1863 in the midst of one of the darker times of our history. What proved to be the impetus for this declaration? A letter from a women named Sarah Hale encouraging him to declare a national holiday. As the Independent Women's Forum shares:
Lincoln was thankful - thankful that the Union had held together after the Civil War. During his time in office, he had received many letters from the editor of Godey's Lady's Book, a woman named Sarah Josepha Hale, encouraging him to adopt a national holiday to thank God. 
But Lincoln was not the first president to receive such letters from Hale. She'd written to four other presidents before him: Zachary Taylor, Millard Fillmore, Franklin Pierce and James Buchanan. 
According to Davidson historian Anne Blue Wills, Sarah Hale's vision for the national holiday included more than a remembrance of American roots: 
*Americans would travel to their homeland, to be with their families. Hale lived in a time when Americans were increasingly living in places not their birthplace. She wanted Americans to experience the rural countryside and to see God's bountiful blessings as well as taste them. 
*Americans would feast - and not just a little. The near gluttony of today's holiday was a part of Hale's vision. The first dinners shared by the pilgrims were not likely to be very bountiful. The pilgrims actually had a rough time getting enough food! But Hale wanted Americans to feast on big birds - turkeys or chickens. 
*Americans would experience the joys of being at home. As editor of a ladies' magazine, Hale put great emphasis on the decorating and homemaking that were necessary to make Thanksgiving a cozy holiday. She believed in the home as the woman's sphere, where women could display their excellent cooking and decorating skills.
Read the whole post here.

From the spiritual blessings given by God to the blessings of friends and family to the blessings of being an American, there is so much to be thankful for. As President Coolidge, a descendent of those Pilgrims who celebrated the first "Thanksgiving"in America, once said in one of his presidential proclamations of thanksgiving as a challenge and a reminder:
An abundant prosperity has overspread the land. We shall do well to accept all these favors and bounties with a becoming humility, and dedicate them to the service of the righteous cause of the Giver of all good and perfect gifts. As the nation has prospered let all the people show that they are worthy to prosper by rededicating America to the service of God and man.

Monday, November 21, 2011

What the health is wrong with "personal responsibility"?

Discussion of the individual mandate for health insurance has been swirling for quite a long time from debates over healthcare reform at state and federal levels or a point of political criticism by fellow candidates in the upcoming presidential primaries. It's not only that liberals approve of it, such as in the passage of Obamacare or in in candidate Hillary Clinton's plans. Republicans and conservative groups have expressed support for an individual mandate to some degree as well. Governor Romney wrote the book on an individual mandate when he passed a healthcare reform plan as Governor of Massachusetts, despite the fact that he defends his plan using the "federalism" argument. The 10th amendment may give Constitutional support to what states do, but it doesn't make those things a good idea. Yesterday, Mitt Romney continued to defend his plan, but this time re-iterated its merits on the basis of personal responsibility (as he has done previously). Sensing that Speaker Gingrich is his current competition, Romney noted that Gingrich also had supported the concept of health insurance mandates on the basis of "personal responsibility", noting too that the Heritage Foundation had supported the concept of insurance mandates.

What might make supposedly "conservative" politicians want to have government mandate that individuals purchase a certain product such as health insurance, even under the guise of "personal responsibility"? Doesn't that conflict with the idea of personal liberty that conservatives espouse? Peter Schweizer just published a book, Throw Them All Out, where he spent a whole chapter discussing the relationship between Congressional stock trades and legislation. He discussed how Congressmen purchased stocks in drug companies just before the Medicare Part D legislation was passed in 2003, knowing that the stock prices would rise after the bill was signed into law and they would reap the profits. During Obamacare deliberations, Congressmen purchased stock in health insurance companies once they new the "public option" would be nixed, and insurance stock prices would go up. While neither of these situations focused on a personal mandate, they do suggest that politicians are willing to add layers of bureaucracy and create new government programs for their personal benefit. Speaker Gingrich has expressed support for a personal mandate on multiple occasions, as early as 1993 and as recently as this past May. Why? While Gingrich is indeed opposed to Obamacare and has expressed disapproval of its mandate, he also consulted for drug companies and health insurance companies as part of  his healthcare think tank, which supported insurance mandates, to the tune of millions of dollars. Governor Perry also supported a health care mandate of sorts with his (thankfully overturned) Gardasil mandate, which was essentially political payback for Merck's donations to his campaign and to the RGA. Politicians, even self-proclaimed conservatives, will often advocate for greater government control over healthcare if it helps their pocketbook or their political career.

The idea that personal responsibility lies in the purchase of health insurance, even by the Heritage Foundation, is misplaced. Individuals should be responsible for their own health, not mandated to purchase a product. Government can do little to control or mandate health, but they can do a heck of a lot to mandate health insurance purchase,  create greater bureaucracy, and implement larger regulations. However, people are truly responsible for their own health. The most free market, patient centered healthcare ideas center around the fact that the individual is empowered to make his or her own decisions when it comes to health. This is why things like health savings accounts are well supported by conservatives, as they enable individuals to choose how their money is being spent for a portion of their health care needs.

Beyond this, though, is the needed focus on personal responsibility in health choices in eating and exercise, not because of mandated school lunch programs to help curb childhood obesity proposed by fearmongering liberals, but for the sake of one's own health. While cancers and chronic diseases are often linked to genetics and other factors outside one's control, 40% of cancers and 80% of chronic diseases are preventable.  Choices in exercise, smoking, and nutrition will go along way to help keep an individual healthly. This is not to say that people should not purchase health insurance or accept health coverage from their employer, but simply that it not be the subject of the mandates, nor couched in "personal responsibility" language.  Many laughably defend the health insurance mandate by referencing car insurance mandates (never mind that you're not mandated to own a car).However, if we were to take even that irrational argument further, then health insurance should only cover when you get in an accident, not when you go in for a routine physical, which is akin to an oil change and is not covered by car insurance.People with health insurance are generally healthy, but health insurance does not make one healthy. Making healthy personal choices (without government intervention) is the truest form of personal responsibility, but it sure is a lot harder for politicians to make money off of our own personally responsible choices.

Saturday, November 19, 2011

Compromise, Capitulation, and Congress

G.K. Chesterton once said,"[c]ompromise used to mean that half a loaf was better than no bread. Among modern statesmen it really seems to mean that half a loaf; is better than a whole loaf." That line could easily apply to today's GOP controlled Congress. From budget deals where GOP leadership claimed to cut $38. 5 billion  when the actual cut was a mere $353 million to caving on a raise in the debt ceiling and the creation of a "Supercommittee" to deal with spending and budgeting,  the Republicans in Congress have made a habit out of choosing capitulation over principles and legitimate compromise.

Today, an overwhelming majority of House Republicans voted for a "half loaf" balance budget amendment which did not cap spending and too small of a majority of votes to propose tax increases or to override the balanced budget requirements. Some argue that this would be a start towards fiscal prudence, but should such "compromise" be attempted on a constitutional amendment, especially when a better "full loaf" amendment had been proposed by the Senate? To be sure, deficit reduction is an imperative, but if the deficit reduction and spending reduction aren't concurrent, how is supposed to help our economy in both the short and long term? It's a "half loaf" idea when a "full loaf" proposal is on the table.

An example of a solid "half loaf" compromise of sorts, can be seen in the public sector union reforms of Governor Scott Walker of Wisconsin. Governor Walker signed into law a bill that reformed collective bargaining rights of teachers that allowed them to still bargain for pay raises, but not changes to benefits. It also only sought to reform the benefits and bargaining of teachers.  Juxtapose this with the reforms of Ohio Issue 2 which included changes to  all public employee benefits and collective bargain criteria, including that of first responders.To be sure, government employees should have to contribute to their benefits, but the sweeping changes of such a referendum makes it hard to achieve incremental progress that would be necessary for such reforms to be made in a purplish state like Ohio.

Given the choice between principles and capitulation, many in Congress and state governments blur the lines between compromise and capitulation. Principles must be married with pragmatic compromise, but never with capitulation.

Wednesday, November 16, 2011

What if Political "Journalism" Was Held to the Same Standard as Scientific Research?

As I have realized the necessity of being politically and culturally aware in recent years, it has become increasingly clear that the media, in general, hold themselves to a different occupational and ethical standard than the rest of us. Yes, I know this is no breaking news; it's been this way for years. However, I've begun looking at things in the context of my job as a healthcare researcher. The essence of journalism and scientific research of any kind are very similar broadly speaking. You pose a question. You determine your methods of data collection and collect your data, then you report your results. Pretty simple, huh? For the most part, journalism, as we know it today, does not do this. However, what if journalism was held to that same standard--both in process and writing?

When a scientific researcher poses a research question, there generally is a null hypothesis and an alternative hypothesis for their question. For example, if a researcher wanted to compare two treatments for the flu, their null hypothesis is that there is no difference between the two treatments. The alternative hypothesis may be that treatment A is more effective than treatment B based upon what the researcher anticipates. However, when a researcher begin their experiment and does their analysis, they do so using the null hypothesis as their statistical standard and draw their conclusions based on the actual results. When journalists do their investigation, they often begin their equivalent to the alternative hypothesis, making their bias the leading factor in all facets of their journalistic process--their data collection technique, the analysis of those data, and the presentation of their results. Ultimately then, their research proves their bias. For example, 60 Minutes has a segment on Sunday looking at insider trading in Washington. Their segment highlighted a handful of Congress members who engaged in insider trading, land deals and the like. However, the segment included four Republicans and only one Democrat. To be sure, Republicans need to be held accountable for their unethical behavior and I most certainly don't want to let them off the hook, but why did CBS choose this unbalanced ratio of examples? Likely it is because this type of behavior among Republicans fit their "alternative hypothesis" based upon their bias. If researchers engaged in this kind of behavior, their research would be considered lacking integrity and would not be published. When "journalists" do it, it's commonplace.

When a researcher sets out to publish their results, the first part of their manuscript is their background/significance section where they describe why the research is significant and share other relevant information. Upon doing this, the researcher is required to cite their sources--whether it be a cancer prevalence statistic or the results of a previously performed study. The need for citing sources appears to be unnecessary for some journalists. Often, they "cite" anonymous sources only (see pretty much any article about the McCain/Palin campaign in October of 2008), where no sources in a story hundreds or thousands of words long is a proper noun. Heck, sometimes the only source they seem to have is a strawman, which seems to feed and perpetuate their bias. 

If a researcher's project gets funded--be at from a non-profit, the government, industry, or their own institution--they are required to note their funding source, and they are also required to report any conflicts of interests that may exist. I remember doing the literature review for my master's thesis which was on caffeine consumption and depression when I ran across an article on the effects of drinking soda where the researchers concluded that soda was a reasonably benign beverage. However, I noticed that the study was funded by Coca-cola. This isn't to say the data and results were biased necessarily to indicate the effects of soda were neutral or benign. The study had been peer-reviewed. However, at least those reading the piece were aware of where the funding came from and that possibly the results could be skewed toward the liking of those funding the research.  If a researcher is a consultant for a drug company, that is known as well. However, in journalism such informational tidbits are not readily known to the average American. The average American may not know that George Stephanapolos once was President Clinton's press secretary, yet he is working as a "journalist", not a commentator. It is not readily known that, although they are managed independently, there are funding ties between federally subsidized GE and MSNBC. If a researcher leaves out their citations, funding source, or conflicts of interest, they don't get published,  yet for "journalists" is just another day at the office.

Striking the balance between idealism and realism while attempting to not become overly cynical is hard when it comes to today's journalism. However, what is required of scientific researchers as a matter of solid research principles, integrity, and ethics, is tossed by the wayside by many journalists. I don't want to lump everyone in that category; there are a rare few who understand the core of real investigative journalism. Scientific research is not without its own faults and failings itself--both in method and ethics. It mush be said though that it would go along way for the reputation of political journalism if they held themselves to the same standards as research scientists do as a matter of both principle and career success.

Tuesday, November 15, 2011

Drain the Swamp

Outside of Chicago, most of Illinois is generally seen as farmland with small to medium sized cities and small towns dotting the landscape. However, although central Illinois is well known for having some of the richest soil in the world, southern Illinois was not always fertile farmland. In fact, many of the early settlers died from malaria due to the mosquito infestation of the swampland that covered nearly a fourth of the state.  In the 1800s, settlers to Illinois began to install underground tile drains and ditches to drain the swampland. This allowed them to use the land to begin farming to provide for their families, as the once swampy land was now suitable to be settled.

What does this have to with politics? Everything. When Nancy Pelosi took over as Speaker of the House in 2007, she promised to “drain the swamp” and lead the “most honest and open Congress in history”:

 One can only think of Governor Palin's words at her speech in Indianola, Iowa in September when she called out the crony capitalism of the permanent political class:
Yeah, the permanent political class – they’re doing just fine. Ever notice how so many of them arrive in Washington, D.C. of modest means and then miraculously throughout the years they end up becoming very, very wealthy? Well, it’s because they derive power and their wealth from their access to our money – to taxpayer dollars.  They use it to bail out their friends on Wall Street and their corporate cronies, and to reward campaign contributors, and to buy votes via earmarks. There is so much waste. And there is a name for this: It’s called corporate crony capitalism. This is not the capitalism of free men and free markets, of innovation and hard work and ethics, of sacrifice and of risk. No, this is the capitalism of connections and government bailouts and handouts, of waste and influence peddling and corporate welfare. This is the crony capitalism that destroyed Europe’s economies. It’s the collusion of big government and big business and big finance to the detriment of all the rest – to the little guys. It’s a slap in the face to our small business owners – the true entrepreneurs, the job creators accounting for 70% of the jobs in America, it’s you who own these small businesses, you’re the economic engine, but you don’t grease the wheels of government power.
The last week or so has provided us more of peek into what Governor Palin has been mentioning over the past several months—that the crony capitalism of Solyndra is only the “tip of the iceberg”. The 60 Minutes segment that aired on Sunday highlighted the crony capitalism and unethical (but frustratingly not illegal) insider trading done by Congresswoman Pelosi and other member of Congress like Congressman Baucus, whom Andrew Breitbart is calling to resign.  Governor Palin’s adviser, Peter Schweizer has a book out today entitled Throw Them All Out where he writes in depth about the crony capitalism and unethical dealings of members of both parties. Tony Lee at Human Events has a good review of the book here.

Governor Palin has made fighting corruption and crony capitalism the foundation of her time in public service and the last year and a half as well. Whether it was calling out a fellow city council member nearly twenty years ago for trying to steer business to his company through regulation or highlighting the crony capitalism of the Obama administration and the permanent political class as a whole in recent months, Governor Palin has shined a bright light on the corruption and cronyism that is pervasive in government. With her decision not to seek the presidency at this time, many conservatives and clean government advocates feel a bit lost and rudderless. However, it should be noted that the settlers who arrived in Illinois did not start farming until the swamps were drained. The same could be true of the swamp of Washington D.C. Could this proverbial iceberg bring down the Titanic of crony capitalism? Could this swamp draining allow Governor Palin and/ or other reform minded corruption fighters to cultivate a harvest of clean government in the future?  Time will tell, but let us keep vigilant in the meantime. What has become the status quo in Washington, in our state capitals, and in our city halls should not be acceptable. We must hold our leaders to high standards and support those running for office who will be supportive of draining the swamp rather than infesting it.

 Crossposted here and here.

Thursday, November 10, 2011

May God Bless America's Finest

I have re-post below a brief post I wrote for Veterans' Day last year on our 9/12 Project website:

When we assumed the Soldier, we did not lay aside the Citizen; and we shall most sincerely rejoice with you in the happy hour when the establishment of American Liberty, upon the most firm and solid foundations shall enable us to return to our Private Stations in the bosom of a free, peacefully and happy Country.

-George Washington June 26, 1775

The origins of Veterans' Day reach back nearly 100 years, though today what its remembrance encapsulates extends back more than 230 years. World War I ended on June 28, 1919 when the Treaty of Versailles was signed. However, armistice was agreed upon between the United States and France on November 11, 1918. A year later, President Wilson signed a commemoration of "Armistice Day" stating:
To us in America, the reflections of Armistice Day will be filled with solemn pride in the heroism of those who died in the country’s service and with gratitude for the victory, both because of the thing from which it has freed us and because of the opportunity it has given America to show her sympathy with peace and justice in the councils of the nations…
An official recognition of Armistice Day was acknowledged by Congress on June 4, 1926. In 1938, it was designated a legal holiday, and in 1954, "Armistice Day" became known as "Veterans Day" to commemorate the veterans of all wars. President Eisenhower stated:
In order to insure proper and widespread observance of this anniversary, all veterans, all veterans' organizations, and the entire citizenry will wish to join hands in the common purpose. Toward this end, I am designating the Administrator of Veterans' Affairs as Chairman of a Veterans Day National Committee, which shall include such other persons as the Chairman may select, and which will coordinate at the national level necessary planning for the observance. I am also requesting the heads of all departments and agencies of the Executive branch of the Government to assist the National Committee in every way possible.
Efforts were made to commemorate Veterans' Day as part of a three day weekend. However, it now remains on November 11th regardless of what day of the week it falls on as a reminder of what day was essentially the end of World War I. Let us take today to remember those American men and women who have fought for our freedoms and defended our liberties across 4 centuries in wars ranging from the War for Independence to the Spanish American War to World War II to the current day action in Afghanistan. Thank you.

Crossposted here.
On an additional personal note, I'm very proud of the members of my family who have served our country. My Uncle Dean served in the Air Force. My cousin Nikki has served in Iraq as an army nurse. One of my grandpas served in Korea during the Korea War, while also spending decades in the Air Force both as a civilian and an officer working as a flight simulation instructor. My other grandpa, who passed away last month, enlisted in the Army Air Corps at the end of World War II. As a farmer, he was exempt from being drafted, as there was a need for farmers to feed the nation. However, my grandpa felt a desire to serve his country, so he enlisted towards end of the war serving for just over two years as a flight engineer for an officer. He got to travel all across America (below is a photo of his trip to Washington DC), but never was sent overseas, nor did he get to fulfill his dream of actually flying himself. There is most definitely good reason for these men and women to be known as the "greatest generation". They didn't feel entitled to received; they felt compelled to serve.

Thank you isn't enough for the millions of veterans who have served our country. We forever owe a debt of gratitude to the men and women who have fought for our liberties. May God bless  America's finest.

Monday, November 7, 2011

Death Panels--Turning Patients into Algorithms

Over two years ago, in the heated discussions leading up to the passage of Obamacare, Governor Palin rightfully categorized a key aspect of the legislation--the "death panel".  More and more evidence of such rationing continues to become evident day-by-day. In her initial post, Governor Palin rightfully highlighted President Obama's healthcare adviser, Ezekiel Emanuel and his advocacy of a "complete lives system" that would ration care to those who are capable of being productive in society (i.e. those who are disabled, have special needs, or who are elderly would be less likely to receive needed care). Controversial former Medicare commissioner nominee Donald Berwick willingly admitted that he considered rationing to be necessary component of healthcare. Congressional Democrats have even recognized that the Medicare Independent Payment Advisory Board is an effect a rationing board that essentially redistributes the health of Medicare recipients. The FDA has also skirted the thin line between being a regulatory agency and a rationing board when they took cost into consideration in their approval process for a breast cancer drug, rather than sticking to their role of evaluating safety and efficacy of drugs.

Eyebrows have been raised also with reports released in the past few years from the US Preventative Task Force suggesting changes to the normal breast cancer and prostate cancer screenings. Those who disagree with the task force's findings are critical of the fact that they do not include radiologists and oncologists as part of their group as this may indicate that the appropriate expertise is not being utilized. Supporters of the findings think that this is beneficial as it removes the potential of bias from those who may benefit professionally from the status quo or increased frequency in screening recommendations. Those on both sides of the issue are addressing the wrong problem.

Dr. Richard Ablin,the physician who developed PSA testing for prostate cancer, is now saying that routine testing is "a public health disaster". Yes, PSA screenings can detect cancer when it is treatable, but that also must be weighed against unnecessary treatment and surgery if the test results in a false positive. The psychological effect must also be taken into consideration for those who tested positive, but were actually negative. Sometimes very old patients are treated for cancer with treatment regimens that are very painful and uncomfortable in and of themselves, and some would have likely have died of natural causes prior to the cancer itself killing them. Similar issues can occur with breast cancer. There is a concern that too frequent of mammographies has the potential to cause cancer itself. There's also the psychological concern that arise with the worries of yearly examinations among other problems.

The true problem is the burgeoning influence of the government in these screenings and the shrinking influence of individual patients and physicians. The recommendations of such a government commissioned panel as the US Preventative Task Force has the potential to create a precedence for influencing what both private and public insurers cover and at what ages and frequencies they cover screenings such as mammograms. In the United Kingdom, their universal health care covers mammography for women aged 50-64 years of age every three years. Prior to the most recent US Preventative Task Force recommendations, women in the United States were recommended to receive mammograms on a yearly basis from age 40 and up, which is still what is generally adhered to. In the UK, breast cancer  mortality rate of 26.2 per 100,000 while it was 23.5 per 100,000 in the US for an 11% difference in mortality. Although not all factors can be effectively evaluated, earlier and more frequent screening likely played a role in making survival better for American women than UK women.

In addition to the potential for task force  recommendations to turn into government regulations, the influence of comparative effectiveness research provides a potential threat to the patient-physician relationship. When applied on the micro level, comparative effectiveness research is needed and welcomed. Patients and doctors alike want to ensure they are either receiving or administering the most effective treatment for their condition. No one wants unnecessary, ineffective procedures to be performed. However, when the results of such research is applied on the macro level through government regulations, it has the potential to turn patients into algorithms where a patient's demographics, symptoms, and disease are placed into an equation to spit out what is deemed the appropriate treatment.  This is the kind of healthcare system that has been implemented in England through the National Institute for Health and Clinical Excellence  (NICE) which has lead to increased rationing of care, increased wait times, and non-coverage of cancer treatments often basing decisions on a quality of life equation. To be sure, quality of life is important and often more favorable than an increased quantity of life of just a short time. However, the problem lies with who makes this determination. Does a government panel make this decision? Does the influence of government applied comparative effectiveness research play too large a role? Two of the key tenets of bioethics are autonomy and beneficience. When decisions are made by government panels and government implemented algorithms rather than by patients and their doctors, it flies in the face of both of these tenets.

Friday, November 4, 2011

Introducing Sarah "John Wooden" Palin

With Governor Palin's decision not to seek the GOP nomination, many want to pigeon hole Governor Palin into the role of "cheerleader", as if there was some false dichotomy between being a player in the game and being a cheerleader.  Perhaps it's my personal former point guard/semi anti-cheerleading bias, but I didn't see a cheerleader giving a speech to the Florida GOP--her first fundraising speech following her decision not to seek the nomination. I saw a coach. To be sure, Governor Palin helped raise more than $900,000 for the state GOP, more than the Democrats did in the entire third quarter.  However, cheerleaders cheer for the players; they don't offer ideas. Coaches offer ideas. Governor Palin offered an articulate discussion of  capitalism vs. crony capitalism and entitlement vs. empowerment. She discussed the relationship between energy independence and the economy. She praised the Tea Party for being among the first to express disgust against the bailout culture in Washington. Here are a few clips from this speech on Thursday:

Even prior to her decision not to run for president, Governor Palin was offering ideas and driving the debate ranging on everything from energy to quantitative easing. Most recently and prominently this was seen in her discussion of crony capitalism, corporate welfare and bailouts, which she focused on heavily in her Tea Party speech in Iowa in September. Two months later, Governor Palin's ideas are at the forefront of the economic discussion. Congressman Paul Ryan, whom many Tea Partiers and Establishment GOPers alike see as the economic golden boy, has made this a key point of his economic message (see the 2:00 mark and following):

Congressman Ryan took a lead from Governor Palin's speech two months ago and continues to articulate the message that Governor Palin has put forth. Some argue that in order for Governor Palin to have an impact, she must run for President, therefore her decision not to run removes her impact. The past month has proven that this is not the case. Ideally, Governor Palin would seek the role of player-coach and drive the debate while playing the game. Her prayerful decision led her a different direction for now. However, she continues to "coach" by presenting the ideas necessary to win the game. Whether it is crony capitalism or quantitative easing, perhaps Governor Palin is becoming the John Wooden (of whom she is very fond) of politics. Wooden's famous quote (often misattributed to President Reagan) of "It's an amazing what can be accomplished when no one cares who gets the credit" sounds a lot like "you don't need a title to make a difference", doesn't it?