November 11, 2009

Immigrants in Uniform

By John Ballard

Let's hope the teabaggers can peek out from behind their American Flags today long enough to check out this report regarding immigrants in the armed forces.

Senators Robert Menendez (D-NJ) Mary Landrieu (D-LA), Daniel Inouye (D-HI), Richard Durbin (D-IL), Kristin Gillibrand (D-NY), and Russ Feingold (D-WI) have introduced the Military Families Act (S. 2757). The Military Families bill would allow immediate family members of active military service members to become lawful permanent residents even when the sponsoring solider has lost his or her life in service. Also included in the bill are the sons and daughters of Filipino World War II veterans whose immigration status has been long deferred due to numerical limitations on immigrant visas.

"The introduction of the Military Families Act, is a reminder that our immigration system is badly broken, needlessly separating families, and even harming immigrants that are fighting and dying for our country. The Senate has delivered a well-deserved tribute to our immigrant soldiers and their families. Those who serve our nation - and their families who also make great sacrifices - deserve the full range of what our nation has to offer, including a path towards U.S. Citizenship," said Mary Giovagnoli, Director of the Immigration Policy Center.

An IPC paper released yesterday, Essential to the Fight: Immigrants in the Military, Eight Years After 9/11, highlights the critical role immigrants are playing in today's military. The report notes that "without the contributions of immigrants, the military could not meet its recruiting goals and could not fill its need for foreign-language translators, interpreters and cultural experts."

  • As of June 30, 2009, there were 114,601 foreign-born individuals serving in the armed forces, representing 7.91 percent of the 1.4 million military personnel on active duty.
  •  In Fiscal Year (FY) 2009 alone, 10,505 members of the military were naturalized. Naturalizations of immigrants in the military are at their highest during times of war."

To view the report in it entirety see:

Essential to the Fight: Immigrants in the Military, Eight Years After 9/11 (IPC Special Report, November, 9, 2009 -- 11 pages pdf)

Burial At Sea

By John Ballard

This is something for Veteran's Day I came across several years ago. I posted it at my old blog with regularity since most readers don't read archives and items like this are unforgettable. The original link is still active but the formatting has become messy. 

Continue reading "Burial At Sea" »

Drop of Water

By John Ballard thanks to Abbas.
BREAK TIME

Regulatory Reform Bills In Progress

By John Ballard

I use the term in progress advisedly. In Washington terms like "progress" or "in progress" don't mean the same as when used in everyday conversation.

Pat Garofalo at the The Wonk Room compares the two versions of financial services regulatory reform being crafted in the House and Senate. The Senate Banking Committee, Chaired by Chris Dodd, and the House's Financial Services Committee, headed by Congressman Barney Frank, are lined up side by side comparing five areas of interest.

  • Establishing a federal level Consumer Financial Protection Agency
  • Consolidation of the hodge-podge of regulatory offices now in place 
  • "Resolution Authority" (my favorite) which is Washington-speak for euthanizing big institutions
  • "Systemic Risk" assessment advisory groups (Washington-speak for "death panels")
  • "Breaking up risky firms" (self-explanatory)

It's hard to tell whether this drama is real or kabuki but in the aftermath of last year's meltdown and evidence of ongoing bubbles, it's a little of each. If nothing else, the banking industry's naked willingness to treat even their best customers with the same indifference as a wild animal eating newborns, there is ample reason for federal oversight. 

I heard about what is being tagged "Resolution Authority"  several months back.
I love the language, which is the same for both House and Senate summaries.

...Institutions must draw up a “living will,” to be used in the event they must be unwound.

This item, of course, is a political cop out. It's a smooth tactic calculated to make something happen without anyone's taking the blame.

I can predict with certainty that any such living will will insure comfort and security for the very people making it necessary at the expense of subordinates with no policy input authority.
It doesn't take much imagination to construct a situation where principals could deliberately trigger such an outcome.
Rewards like that don't even require a conspiracy.

I find it encouraging that both houses of Congress are at least going through the motions of doing something. Let's hope the results will be forthcoming in time to head of the next global crisis.Both bills are in agreement about that last item.

Gives federal regulators the authority to break up systemically risky firms on a case-by-case basis.

All we need now is gonads for the go-ahead.

Health Care Snapshot

By John Ballard

Posted without comment. 

Today my little brother Bill would have turned 51.

Which means he's been dead almost 9 years. Can't quite understand that.

He was waiting for health insurance to kick in at his new job: We'd watched how medical costs had starved our family when we were kids. So instead of being saddled with a "pre-existing condition", he lay down alone on that green-and-white striped couch and watched TV as a heart attack rolled on into cardiac tamponade and he bled out into his chest.

Universal health care for every human being, no questions asked, without profit linked to medical choices. Now. Get rid of any leader who caves, no matter what other distractions they toss up. The alternative is ongoing pointless death.

November 09, 2009

Where Health Care Reform Stands Now: Who’s Selling Out Whom For What

By John Ballard

"Without objection..." (as they say in Congress) I'm stealing Ian Welsh's headline.
He gets today's extra points for squeezing the most content into the smallest space with this latest step in health care reform's laborious, turgid, messy, bruised and stained trudge through Washington politics, hopefully on the way to the president's desk.

Guaranteed Issue: The best thing about the bill is unquestionably the fact that insurers have to issue policies to anyone who can pay. No one can be denied coverage, no matter what pre-existing conditions they have. This is a big deal....

Individual Mandates and cost sharing: An individual mandate force people to buy insurance whether they want to or not. Insurance works better when everyone is covered and in the same risk pool. It also shares costs throughout the population....

People who don’t have insurance right now are primarily younger people or those who feel they can’t afford it. What individual mandates will do, then, is subsidize older people’s insurance costs and the price of guaranteed issue, which is very costly since it forces insurers to cover people who are very likely to get sick. [And those who can least afford it are unfortunately the ones burdened with bearing the price.]

No Robust Public Option: A robust public option is one that is large enough and with enough pricing power to force down costs, and one which is available to everyone...

Reduces Practical Access to Abortion: The Stupak amendment, passed Saturday evening, makes it illegal for any plan offered on the exchanges to finance abortions. Any woman who wants abortion access, after being forced to buy insurance that doesn’t include it, will have to buy it elsewhere...

The Bottom Line: Who’s Getting What, and Who’s Paying

This bill does not contain a robust public option which will contain costs. It will give guaranteed issue and force cost sharing through an individual mandate. Older people will disproportionately benefit, and the people who will disproportionately pay are younger poorer people, and especially younger women, the poorer ones of whom will lose practical access to abortions.
[...]
This health care “reform”, if passed in this form or worse, which it will be if it is passed at all, will blow apart eventually, because it will not contain costs or ‘bend the cost curve” and the US economy simply cannot indefinitely afford health care costs wich rise faster than inflation or wages. But for as long as it lasts, it will help some people at the cost of other, generally younger and poorer people.

More remarks and links at the source.

His final comments, with which I agree...

If progressives really meant that a robust public option was their minimum requirement, when Medicare +5 failed they would have gone into opposition. They didn’t, therefore it wasn’t their minimum requirement. It remains to be seen if enough progressives really will vote against a final bill which still contains the Stupak amendment. Given progressives failure to live up to their threats to pull support if no robust public option was in the bill, I am forced to suspect that if Stupak is in the final bill, the final bill will pass.

The last couple weeks have been very revealing as to what various people, including politicians, progressive bloggers and activists, are really willing to fight for, and what their bottom line really is.

I would suggest that if progressives ever want their threats to be taken seriously by anyone again they go into opposition against this bill until such a time as it both has a robust public option and the Stupak amendment is out. Failure to do so will show that their threats were always hollow, that they are willing to sell out child-bearing age women, and that they prioritize the interests of older people over younger and poorer people.

In negotiation against a good negotiator, you get the minimum you are willing to settle for. Progressives have shown that their minimum is not a robust public option. It may not even be practical abortion access. They will not get a robust public option if they will not oppose the bill over it, and if they won’t oppose the final bill over the Stupak amendment, that too will most likely remain.

This is neither the time nor the place for the abortion debate.
The right to abortion, last I checked, is a legal right at the federal level. State restrictions are a mixed bag, but single-issue anti-abortion forces wish to federalize their agenda.

If that discussion is to have room for negotiation the abortion issue must be saved for arguing over the Freedom of Choice Act.

The Stupak amendment is a legislative land mine set to blow up during that debate.

November 07, 2009

Home-grown Terror -- CNN report, Andrew Kehoe and Others

By John Ballard

Speaking of denial, the tragedy at Ft. Hood (strategically scheduled exactly between Election Day and Veteran Day)  prompts little in the way of soul-searching as many patriotic Americans close ranks for a stoning.

As a population we are quick to be in denial about the violent extremism which was the subject of Mark Lynch's probing questions. We need not look outside the country to find violence and terrorism of American origin. 

CNN should be commended for quick reporting on a timely topic just hours after the event. I caught the story while on assignment and expected them to run with it. But for some reason this excellent piece of reportage has evaporated, likely because some pusillanimous, PC-crippled editorial self-censorship elected not to run it again. (I'm not an avid TV watcher, so I may have missed it. But I have already seen half a dozen repeats of talking heads with less to say.)

Fortunately someone captured it and uploaded it to You Tube. Unless it gets pulled, here it is.

==>Also, the Wall Street Journal has an on-line interactive map of the US showing fifteen locations over the last two decades accounting for the deaths of more than a hundred people in more than a dozen mass shooting incidents.

Go to the link and take a look.

Following the Virginia Tech killings I became aware of Andrew Kehoe and the Bath School disaster which still holds the record for the greatest number of students killed in one event.
The date was May 18, 1927.
The place was Bath Township, Michigan. 

Kehoe was born in Tecumseh, Michigan into a family of 13 children. His mother died when he was five, and his father remarried; reportedly, Kehoe often fought with his stepmother. When Kehoe was 14, the family's stove exploded as she was attempting to light it. The oil fueling the stove soaked her, and she caught on fire. He watched his stepmother burn for a few moments before dumping a bucket of water on her. She later died from the injuries.

Kehoe was regarded by his neighbors as a highly intelligent man who grew impatient and angry with those who disagreed with him. Neighbors recalled that Kehoe was always neat, dressed meticulously, and was known to change his shirt at midday or whenever it became even slightly dirty. Neighbors also recounted how Kehoe was cruel to his farm animals, having once beaten a horse to death.

This is a story worthy of a movie, but no one would buy a ticket. This is lifted from Wikipedia.

On the morning of May 18, Kehoe first killed his wife and then set his farm buildings on fire. As fire fighters arrived at the farm, an explosion devastated the north wing of the school building, killing many of the people inside. Kehoe used a detonator to ignite dynamite and hundreds of pounds of pyrotol which he had secretly planted inside the school over the course of many months. As rescuers started gathering at the school, Kehoe drove up, stopped, and detonated a bomb inside his shrapnel-filled vehicle, killing himself and the school superintendent, and killing and injuring several others. During the rescue efforts, searchers discovered an additional 500 pounds (230 kg) of unexploded dynamite and pyrotol planted throughout the basement of the school's south wing.

There is no clear indication as to when Kehoe conceived and planned the steps leading to the ultimate events. A subsequent investigation concluded that, based upon the activity at the school and the purchases of explosives, his plan had probably been under way for at least a year.

In early 1926, the board asked Kehoe to perform maintenance inside the school building. Regarded by most as a talented handyman, he was known to be familiar with electrical equipment. As a board member appointed to conduct repairs, he had free access to the building and his presence was never questioned.

There were a few warning signs prior to the events. Kehoe passed out employee paychecks the prior week and told bus driver Warden Keyes, "My boy, you want to take good care of that check as it is probably the last check you will ever get." Teacher Bernice Sterling telephoned Kehoe two days before the blast and asked to use his grove for a class picnic. Kehoe told her that if she "wanted a picnic she would better have it at once."

Prior to May 18, Kehoe had loaded the back seat of his car with metal debris. He threw in old tools, nails, pieces of rusted farm machinery, digging shovels, and anything else capable of producing shrapnel during an explosion. After the back seat was filled, Kehoe placed a large cache of dynamite behind the front seat and a loaded rifle on the passenger's seat.

In the same way that local officials sometimes wait for a few traffic fatalities before they get around to installing better traffic signals at dangerous intersections, we as a country often wait until the bodies pile up before investigating the causes.

Major Hasan happens to have been a Muslim, but he was also an American military officer. It would be careless and foolish to examine one of those identities for the roots of his behavior and remain in denial about the other.

Here are more links connecting a few more dots.

Continue reading "Home-grown Terror -- CNN report, Andrew Kehoe and Others" »

Fishing in the Nile Denial -- Two Bites in One Day

Denial is not a river in Egypt

By John Ballard

Denial is reaching pandemic proportions.
In the short space of a day I came across two more examples.

►►►Via NPR this morning, a new book by Michael Specter: "Denialism."

Nearly 20 percent of the families in Vashon Island, Wash., aren't getting their children vaccinated against childhood diseases. At the Ocean Charter School near Marina del Rey, Calif., 40 percent of the 2008 kindergarten class received vaccination exemptions. Author Michael Specter says the parents in these upscale enclaves are prime examples of what he calls "denialism."

That's also the title of his new book, . "We can all believe irrational things," the author of Denialism tells NPR's Scott Simon. "The problem is that I think an increasing number of Americans are acting on those beliefs instead of acting on facts that are readily present."

But the Vashon Island and Marina del Rey communities aren't places where religious or cultural traditions argue against vaccinations —- like the Amish or Jehovah's Witnesses.

Instead, they believe vaccinations are harmful to their children, citing stories they've heard about mistakes by doctors or pharmaceutical fraud.

But, Specter says, when parents make that decision, they focus on the one-in-10-million chance that a vaccine could kill a child and ignore the one-in-1,000 chance that a disease will do so. "These people retreat into denialism," he says. "It's like denial, but writ large, [because] this has consequences."

Those consequences don't just affect the children who go unvaccinated, but everyone they interact with as well, Specter adds. He points out that diseases like measles, which had almost been eradicated in North America, are now coming back.

►►►And via George Monbiot of The Guardian, a few terse words about Clive James.

There is no point in denying it: we're losing. Climate change denial is spreading like a contagious disease. It exists in a sphere that cannot be reached by evidence or reasoned argument; any attempt to draw attention to scientific findings is greeted with furious invective. This sphere is expanding with astonishing speed.

A survey last month by the Pew Research Centre suggests that the proportion of Americans who believe there is solid evidence that the world has been warming over the last few decades has fallen from 71% to 57% in just 18 months. Another survey, conducted in January by Rasmussen Reports, suggests that, due to a sharp rise since 2006, US voters who believe global warming has natural causes (44%) outnumber those who believe it is the result of human action (41%).

A study by the website Desmogblog shows that the number of internet pages proposing that man-made global warming is a hoax or a lie more than doubled last year. The Science Museum's Prove it! exhibition asks online readers to endorse or reject a statement that they've seen the evidence and want governments to take action. As of yesterday afternoon, 1,006 people had endorsed it and 6,110 had rejected it. On Amazon.co.uk, books championing climate change denial are currently ranked at 1, 2, 4, 5, 7 and 8 in the global warming category. Never mind that they've been torn to shreds by scientists and reviewers, they are beating the scientific books by miles. What is going on?

The writer provides the following explanation.

Had he bothered to take a look at the quality of the evidence on either side of this media debate, and the nature of the opposing armies – climate scientists on one side, rightwing bloggers on the other – he too might have realised that the science is in. In, at any rate, to the extent that science can ever be, which is to say that the evidence for man-made global warming is as strong as the evidence for Darwinian evolution, or for the link between smoking and lung cancer. I am constantly struck by the way in which people like James, who proclaim themselves sceptics, will believe any old claptrap that suits their views. Their position was perfectly summarised by a supporter of Ian Plimer (author of a marvellous concatenation of gibberish called Heaven and Earth), commenting on a recent article in the Spectator: "Whether Plimer is a charlatan or not, he speaks for many of us." These people aren't sceptics; they're suckers.

Such beliefs seem to be strongly influenced by age. The Pew report found that people over 65 are much more likely than the rest of the population to deny that there is solid evidence that the earth is warming, that it's caused by humans, or that it's a serious problem. This chimes with my own experience. Almost all my fiercest arguments over climate change, both in print and in person, have been with people in their 60s or 70s. Why might this be?

There are some obvious answers: they won't be around to see the results; they were brought up in a period of technological optimism; they feel entitled, having worked all their lives, to fly or cruise to wherever they wish. But there might also be a less intuitive reason, which shines a light into a fascinating corner of human psychology.

In 1973 the cultural anthropologist Ernest Becker proposed that the fear of death drives us to protect ourselves with "vital lies" or "the armour of character". We defend ourselves from the ultimate terror by engaging in immortality projects, which boost our self-esteem and grant us meaning that extends beyond death. More than 300 studies conducted in 15 countries appear to confirm Becker's thesis. When people are confronted with images or words or questions that remind them of death they respond by shoring up their worldview, rejecting people and ideas that threaten it, and increasing their striving for self-esteem.

I know you feel all better having had this puzzle explained. There's more at the links if you have further questions.
Now if you will excuse me, I have a couple of appointments.
I need to double check my final directives, make sure the lawyer who drew up my will still has a copy in his possession and let my family know once more about my funeral wishes.

November 06, 2009

Intermountain Healthcare -- Proof That U.S. Hospitals Can Improve

By John Ballard

I haven't read it yet but this is a snip from my next reading assignment. I'm posting as I wait for the printer to finish eleven pages.
H/T Maggie Mahar's blog. Looks like pretty good content.

Followup later: It's an excellent article. Recommended reading. Notes and comments after this snip...

VII. ONE DAY, WHILE I was standing in Intermountain’s cardiology intensive-care unit, which, unlike those in many other hospitals, is next to the cardiac-surgery wing, it occurred to me that Intermountain really was not so unusual. It is unusual for a health care organization. But its story is fairly typical in the rest of the economy.

The executives at a company realize that their industry has built up all kinds of bad practices over the years. Those practices damage the quality of their product and waste money. The executives do a rigorous analysis of their operations, relying on solid information rather than conventional wisdom. And then they persuade their colleagues to make changes. Much of the lingo of management theory — “quality,” “lean,” “Six Sigma” — is simply a dressed-up way of describing this approach.

James peppers his classes with anecdotes about W. Edwards Deming, arguably the original quality guru, and it is easy to see why Deming would be attractive to James. Deming grew up on a farm in Iowa in the early 20th century and majored in electrical engineering at the University of Wyoming. During World War II, he was part of a committee that helped the government make wartime production more efficient. After the war, his statistical methods caught on in Japan, and the Japanese credit him with helping to make their postwar boom possible. The so-called Toyota way stems from Deming’s work. Eventually, the same ideas caught on at General Electric, Intel, Wal-Mart and elsewhere in this country.

But there is a fundamental difference between Toyota and Intermountain. As Toyota built better cars than its competition for less money, it won new customers. Some rivals matched its successes (as Honda did); some lost market share (as Detroit did). No such dynamic exists in health care. William Lewis, a former director of the McKinsey Global Institute who studies productivity, says that the economic benefits from the various quality movements have been quite large but that they are also largely in the past. Most industries have incorporated Deming’s big ideas and are now making only incremental progress. “However, there is one big exception,” Lewis adds. “You guessed it: health care.”

Why? In part, it is the faith that patients have in their doctors. When people are buying a car, they often consult Consumer Reports or Road & Track. When they are choosing a place to have surgery, they ask their doctor to recommend a surgeon and go to the hospital where that surgeon works. Hospitals that provide less than top-quality care are rarely punished in the way that General Motors and Ford have been.

Even more important than how we choose our health care, though, is how we pay for it. One of Deming’s principles is that improving quality also tends to reduce costs. That is not always the case in health care; expensive treatments — implantable cardiac defibrillators, for instance — can bring enormous benefits. But Deming’s principle holds more often than you might think. When in doubt about the best procedure, doctors tend to do more — more tests, more procedures, more surgery. So if a hospital does a rigorous analysis of what actually works, it is likely to discover a fair amount of waste.

But in our current health care system, there is no virtuous cycle of innovation, success and expansion. When Intermountain standardized lung care for premature babies, it not only cut the number who went on a ventilator by more than 75 percent; it also reduced costs by hundreds of thousands of dollars a year. Perversely, Intermountain’s revenues were reduced by even more. Altogether, Intermountain lost $329,000. Thanks to the fee-for-service system, the hospital had been making money off substandard care. And by improving care — by reducing the number of babies on ventilators — it lost money. As James tartly said, “We got screwed pretty badly on that.” The story is not all that unusual at Intermountain, either. That is why a hospital cannot do as Toyota did and squeeze its rivals by offering better, less-expensive care.

For all of its focus on efficiency, Intermountain, too, can be tempted by the dark side of the fee-for-service system. In one committee meeting, I listened to a debate about how much the hospital should charge patients for a certain medical device. Intermountain previously had negotiated a price reduction from the manufacturer that saved thousands of dollars on each device. But the hospital was still charging patients the old price, and the insurers, including Medicare, were still paying. That was what their reimbursement charts said they would pay.

A few people in the meeting were clearly bothered by this. They asked the finance executive, participating by speakerphone, if anything could be done. One committee member argued that Intermountain (which is nonprofit) should not overcharge for a treatment, even if it helped the hospital cover its overall expenses. The finance executive replied, apologetically, that changing the reimbursement rate would cost Intermountain millions of dollars and that there did not seem to be any way to make up for the loss. The meeting then moved on to another topic.

The excerpt above was grabbed at random to start a post, but it turns out to be a snapshot of the whole piece. The writer set out to advance the case for"evidence-based medicine" whereby better outcomes would result with closer collaboration from a team of physicians following better-understood "protocols" or "best practices." It seems straightforward, but on closer examination the practice of medicine really is just that, a practice. No one comes right out and says so in this article, but the reader is left with the impression that medical treatments can have improved outcomes at lower costs, but there is no Holy Grail which will supply all the right answers. In the end, for some cases an educated intuitive guess will often trump science and protocols.

Continue reading "Intermountain Healthcare -- Proof That U.S. Hospitals Can Improve " »

The Aardvark's Ten Questions About Combating Violent Extremism

By John Ballard

Mark Lynch poses more questions than answers about how best to confront extremism. His list needs to be widely discussed by both laymen and policy makers. This timely list was published just in time for the tragedy at Ft. Hood to trigger another round of public consideration of the subject. As we hear an avalanche of opinions from sources great and small it might be helpful to consider these questions playing in the background.

The title does not indicate so, but this post eventually addresses yesterday's events at Ft. Hood. Interested readers continue after the break.

Continue reading "The Aardvark's Ten Questions About Combating Violent Extremism" »

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"Whoever can speak, speaking now to the whole nation, becomes a power, a branch of government, with inalienable weight in law-making, in all acts of authority. It matters not what rank he has, what revenues or garnitures. The requisite thing is, that he have a tongue which others will listen to; this and nothing more is requisite. The nation is governed by all that has tongue in the nation: Democracy is virtually there."
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~Thomas Carlyle, On Heroes and Hero Worship, 1841