Monday, September 30, 2013

The GOP Suicide Caucus

"The members of the suicide caucus live in a different America from the one that most political commentators describe when talking about how the country is transforming. The average suicide-caucus district is seventy-five per cent white, while the average House district is sixty-three per cent white. Latinos make up an average of nine per cent of suicide-district residents, while the over-all average is seventeen per cent. The districts also have slightly lower levels of education (twenty-five per cent of the population in suicide districts have college degrees, while that number is twenty-nine per cent for the average district).

"The members themselves represent this lack of diversity. Seventy-six of the members who signed the Meadows letter are male. Seventy-nine of them are white."

Read the whole article in The New Yorker

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Sunday, September 29, 2013

HCR -- What's "Affordable" Really Mean?

Checking yesrerday's traffic I see several hits for an early August post, HCR -- Medical Tourism -- This time to Europe, which tells how much less medical care costs in the rest of the world, underscoring the point referencing a joint replacement in Belgium for much less than it would cost in the USA, including the costs of travel and accommodation -- hence the term "medical tourism." Except for a small subset of  people with extremely high-deductible insurance, most Americans have no idea what medical care actually costs. They may be able to tell you what is deducted from their pay if they have company group insurance but they won't know how much the company adds to that amount. If they are in the military or have Medicare the amounts they pay is nowhere close to the actual costs, since those government-funded arrangements are not burdened with advertising, sales commissions, profit-line expectations or executive compensation packages that are typically part of medical care in the private sector. And young, healthy people are not apt to know what healthcare costs, even if they have no insurance, because they are for the most part, in fact, young and healthy. And besides, even without  private insurance we are covered by other insurance we never think about -- auto insurance pays medical bills in the case of accidents, workers comp pays for work related illness or injury,  liability insurance picks up the tab if we get hurt on someone's property or as the result of an accident caused by food, faulty design, negligence, etc.
So that word "affordable" turns out to be something of a bait-and-switch term in the Patient Protection and Affordable Care Act. Yesterday's column by Elisabeth Rosenthal who wrote the column linked in the post above, spells out in plain language what affordable will mean when everybody has insurance. Some will be pleased and others will be surprised to discover how much they will be paying out.  With no sense of editorial irony the headline puts scare quotes around "Affordable Care" but omits them around "Rip-Off." In reality the law is a first step moving the costs from rip-off to just horrendously expensive, thanks mainly to the medical loss ratio provision that restricts what portion of premium revenue can go toward non-medical expenses. Eighty percent of premium dollars must now be applied to medical costs. 

Meantime, a large population of people who have no experience with insurance will encounter something like sticker shock as they discover the economic mine fields of co-pays and deductibles which vary widely in the insurance landscape. 

‘Affordable Care’ or a Rip-Off
“The perception of cost will vary a lot,” said Dan Mendelson, the chief executive of the consulting firm Avalere Health and a former associate director for health at the federal Office of Management and Budget. 
Mr. Mendelson predicted that the plans would be welcomed by people who had wanted to be insured but couldn’t obtain or afford insurance because of pre-existing conditions, for example, and for low-income earners who would qualify for heavy subsidies for premiums. “For some people it will be free, and that is a pretty good value,” he said. 
But the required outlays might seem like a lot of cash to healthy families who previously did without insurance. And they could be downright shocking to patients who last had insurance a decade ago, when health plans tended to require little if any patient payments. 
“More of the cost responsibility is being shifted to patients, and more to patients with serious chronic illness,” Mr. Mendelson said, noting that the silver plans, the second cheapest, are intended to cover only about 70 percent of a patient’s medical costs. “This is different from the concept of insurance we’ve been carrying around for a long time. So people who sign up for insurance thinking all will be covered are in for some surprises.”
Obamacare is a first step in bringing medical care costs into line with what the rest of the world might consider expensive but reasonable. They will always be expensive because in America we pay more for just about everything than elsewhere. We complain about it. But we still pay it. From packaging that costs more than the products being bought to capricious, irrational pricing schemes for everything from airline tickets to sporting events, from new clothes at the start of a season to the identical products on sale to make room for next season's inventory -- Americans seem not to care how much anything costs as long as they have a chance to charge it an make payments.  Where but in America do people pay more by the gallon for water than for gasoline, and complain about the costs of the gas?

Getting back to health care and insurance, the two big changes that are happening are
  1. Health insurance is about to become an actual insurance product instead of the illusion of care it has been for two or three generations, a tax-favored scheme to swell the profit lines of companies offering group insurance to their employees as well as the insurance companies that service those policies.  
  2. The first steps to uncoupling employment from the delivery of health care, which will have a couple of unpleasant consequences as beneficiaries for the first time must face the realities of what it costs to insure them and meet their real (or perceived) medical needs. Both of these changes will be bitter medicine for many.
Yes, it is bitter medicine we will have to swallow, and the president is wise not to allow political pressures to change his determination to give this new a chance to take effect. Those who argue for repeal or delay are no different from patients who stop taking a full course of antibiotics when they get to feeling better, or worse, are part of that extreme group which eschews antibiotics altogether, along with vaccinations and other science-based solutions to disease and injury. 

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Saturday, September 28, 2013

Morning Twitter Messages -- September 28

No time this morning to leave snips but here are lots of links. Some are interesting, others are both interesting and important.




Do take a moment to read this. It's not too long. 
"Gamal Abdel-Nasser taught us about belonging, and it is that sense of belonging that brought us back together again on 30 June [2013]," says 60-year-old labor union member Mohamed Abdel-Razek as the anniversary of the late leader's death approaches.

Nasser, who led the 23 July, 1952 revolution that toppled the British-backed monarchy in Egypt, passed away on 28 September, 1970. His funeral, which was attended by millions of mourners, is still considered one of the biggest funerals in history.




Gotta go now. 
More later, maybe. Thank goodness it's the weekend. 
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Thursday, September 26, 2013

HCR -- Job Lock is Coming to an End

It may or may not have been triggered by PPACA but a clear trend is accelerating for employers dropping dependent coverage, retaining it only for the employee. A brief search turns up these instructive links.

►NY Times, June, 2010 (over three years ago)
To the list of letters that produce a groan when they arrive in your mailbox — a jury duty summons, past-due tax bills — add this one: a “dependent audit.” 
A what?
A dependent audit comes from your employer, who wants proof that the people you’re carrying on the company health plan really are your dependents. If you can’t prove they are, the company will drop them. 
The goal is to ferret out children who are over age 18 and not in school, ex-spouses, sometimes even nieces or nephews — people, in short, who do not meet an employer’s definition of dependent. 
If your company does not already conduct these audits, chances are it eventually will. And while it may strike you as an annoyance, do not ignore this task. Otherwise, eligible dependents could lose their health coverage. 
From an employer’s perspective, audits make good business sense. Health care costs have been rising by 5 to 10 percent a year for over a decade, and employers want to contain those costs.
► UPS won't insure spouses of many employee
UPS will follow thousands of other companies this fall in ending health insurance coverage of employees' spouses if they can get coverage elsewhere.

Partly blaming the health law, United Parcel Service is set to remove thousands of spouses from its medical plan because they are eligible for coverage elsewhere. 
Many analysts downplay the Affordable Care Act's effect on companies such as UPS, noting that the move is part of a long-term trend of shrinking corporate medical benefits. But the shipping giant repeatedly cites the act to explain the decision, adding fuel to the debate over whether it erodes traditional employer coverage.
Rising medical costs, "combined with the costs associated with the Affordable Care Act, have made it increasingly difficult to continue providing the same level of health care benefits to our employees at an affordable cost," UPS said in a memo to employees.
► Companies cutting health insurance cost may mean dropping coverage for spouses
For two-income couples, it's been one of the little financial perks of marriage: Go on your husband's or wife's health insurance so you can avoid paying for two policies. 
But with employers looking to cut costs as key provisions of the Affordable Care Act begin to take hold, the benefit is heading for the endangered list. 
In one of the most far-reaching examples to date, UPS has told its workers that it is dropping coverage for about 15,000 of 33,000 spouses of non-union employees in the U.S. — if those spouses are able to obtain insurance from their own employers. Spouses who can't secure coverage through a job will still be insured through UPS, the company said.
►Wall Street Journal, last month
By denying coverage to spouses, employers not only save the annual premiums, but also the new fees that went into effect as part of the Affordable Care Act. This year, companies have to pay $1 or $2 “per life” covered on their plans, a sum that jumps to $65 in 2014. And health law guidelines proposed recently mandate coverage of employees’ dependent children (up to age 26), but husbands and wives are optional. “The question about whether it’s obligatory to cover the family of the employee is being thought through more than ever before,” says Helen Darling, president of the National Business Group on Health. See: When your boss doesn’t trust your doctor 
While surcharges for spousal coverage are more common, next year, 12% of employers plan to exclude spouses, up from 4% this year, according to a recent Towers Watson survey. These “spousal carve-outs,” or “working spouse provisions,” generally prohibit only people who could get coverage through their own job from enrolling in their spouse’s plan.
Before everyone starts climbing into Ted Cruz's bandwagon, they need to know that this trend has been going on since before the passage of Obamacare. The legislation may have accelerated the trend by creating alternatives, but the rising costs of health care in America has been a financial burden for employers for years. Sooner or later it was going to happen. In the same way that many employers will retain their old-fashioned pension plans in addition to a host of employee-paid retirement arrangements that followed the first IRA's in the Seventies, some employers will continue to provide subsidies for employees. But on the whole employer subsidized health care plans for entire families will not be the golden handcuffs they have been for two or three generations. Portable insurance spells the end of job lock. 
...gone forever on January 1 will be an obstacle unique to America in the developed world -- job lock. An untold number of Americans for all practical purposes are indentured servants in large corporations, locked into jobs they don't like but won't dare quit because of their employer-subsidized health coverage. 
By making the discriminatory practices of insurance firms unlawful, which will bring to an end their ability to cherry pick only the policyholders they want -- the young and healthy -- the Affordable Care Act will give American workers the key to that lock.
Like all medicine, this is hard for most people to swallow. Except for a small handful of people with high-deductible private plans, most Americans have no idea what the actual costs of health care are unless they experience some horrendously expensive, often life-threatening medical condition. And by then it's too late to think about costs. For a family facing life and death choices, financial ruin is a welcome alternative to death or losing a family member for financial reasons.

I came across an interesting example of an institution requiring people to protect themselves from financial catastrophes by obligatory health insurance -- Brigham Young University.  Check out this list of questions and answers regarding students at that school, ending with this one: 
(Click for larger image)*

*Health insurance is not optional for students at BYU and has not been
since 1989. They don't call it an "individual mandate" but that is what it
actually is -- obligatory insurance paid for by the insured.  BYU is a well-
run institution of the Mormon Church.  Do we know any famous Mormon
presidential candidates who were Mormon?  Were any of them associated
with universal health care plans, like the one in Massachusetts, maybe?
One of the ironies of our time is that Barack Obama, poster child for all things Liberal, turned out to be an agent of change in much the same way that Richard Nixon, the toughest of anti-Communist American politicians, was the very one who famously was able to open the door to China. The landmark legislation now called Obamacare -- a derisive term he was quick to claim, insuring no one would ever forget who gets credit for enabling universal health care to America -- is, as all policy experts agree, an essentially Conservative, Republican construct.

In a recent post at The Health Care Blog, Ewe Reinhardt (one of those policy experts -- look him up) said exactly that.
My early introduction to the texts coming from conservative thinking on health reform was the Heritage Plan of 1989, Viewed through the prism of the ACA of 2010, its language seems eerily familiar. One provision, for example, proposed a:
  • “[m]andate all households to obtain adequate insurance. Many states now require passengers in automobiles to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement” (p.5).
The Heritage Plan also called for income-related, refundable tax credits toward the purchase of private health insurance. Although it did not call for community rated premiums, it proposed means-tested public subsidies and toward high out-of-pocket expenses of individuals and families. It did not spell out the daunting administrative apparatus that would entail. But one can imagine the required new bureaucratic apparatus, replete with auditors to prevent fraud and abuse. Presumably, income-related subsidies would have involved the Internal Revenue Service (IRS) in some ways as well.
He underscored the point in the comment thread.
Most other nations have muddled through, one way or the other, and for sheer muddling the US wins the world cup prize. But even here the goal — at least the goal stated for public consumption — is that everyone who needs health care should have it, regardless of their own ability to pay for it, something the market just could not achieve. 
We can have endless debates over the exact mix of private and public activity in health care, and it will always be so. 
The irony is that Obamacare, copied for the most part from the play book of Republicans, should have been the platform for a bipartisan compromise. Sen. Baucus certainly tried. But, if you want to be honest about it, the Republican game was to prevent the President’s reelection, and they sacrificed their own health reform ideas for that futile pursuit. It was never about what might be helpful to the people, especially th millions of uninsured. 
What would Republicans do if, like a dog chasing a car that then stops, they should win the White House and the Congress? To get a clue, read S.1099, or the old Republican plans of the 1990s. they would legislate something like Obamacare, although perhaps smaller. And, to keep it elegant, they might just deficit finance it, as they did the MMA 03, a truly irresponsible act.
My conclusion is that we should thank Barack Obama for insuring that the end product now called Obamacare has self-funding mechanisms unlike the mindless, unfunded mandates crafted by Republicans, first by creating the budgetary nightmare which gave us that famous "doc fix" (requiring a perennial budgetary sleight of hand since the late Nineties) and The Medicare Modernization Act of 2003 which created the hated "donut hole" for seniors with Medicare "Part D" which bled out tax dollars to the drug industry with no recovery mechanism and nothing in return.

In addition to the like Dr. Reinhardt provided, here is another, also from American Enterprise Institute, describing in detail the need to separate health care from employment and examining a variety of mechanisms to bring it about. In some way this reads like a Liberal manifesto.
President George W. Bush's ambitious second-term agenda includes proposals to reform the tax system and, more specifically, to use it to make our increasingly costly health-care system more efficient. After explaining the decisive influence of tax policy in shaping the current system, with its preference for employer-based health insurance, this essay discusses the main options for altering the tax treatment of medical expenses and identifies three measures that could lead the way toward more comprehensive health-care reform.
[...]
Why did employer group coverage become the dominant form of health insurance coverage? There are two major reasons. First, a group of people working for a company provides a convenient and efficient risk pool for insurance. Insurance companies were willing to sell coverage for an employment group at a reasonable rate because they learned that, in most cases, the group could be expected to represent only an average level of medical risk. People go to work for companies for reasons other than health coverage, so insurers did not expect to attract a large proportion of high-cost workers. This was not the case with health insurance policies sold to individuals. Health insurance companies knew already (and still know) that people who expect to have higher-than-average medical costs are more likely to buy insurance coverage. To protect themselves against this adverse selection, companies selling individual insurance priced it at a higher level than equivalent coverage sold to an employer group.
[...]
Second, excluding employer-paid premiums and payroll taxes from taxable income accounts for the great majority of health-related tax preferences. The medical expense deduction (bottom) is relatively small compared to the effect of the exclusion. 
The tax subsidy is regressive, offering more benefits to those with higher incomes. John Sheils and Randall Haught of the Lewin Group estimate that those with family incomes over $50,000 got 71.5 percent of the value of the total 2004 federal tax expenditure of $188.5 billion. Those in families with income below $20,000 got only 3.4 percent.[4] This distribution also helps to explain the political popularity of the tax exclusion. The policy gives more to those who have higher incomes and who work for firms that offer health insurance--a powerful bloc of voters.
Unfortunately universal health care will remain a dream for millions of Americans who will for whatever reasons remain outside the system until they have a life-threatening emergency. The truly destitute will access whatever Medicaid provides in the states where they live, but for millions more living in states that have opted out of the Medicaid provisions of the new law (in accordance with that Supreme Court decision) the subsidies making insurance affordable through their state exchanges will not be available. 
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Wednesday, September 25, 2013

HCR -- There Is No "Mind Over Cancer" Cure

Jim Coyne is a card-carrying expert on cancer and clinical psychology at the University of Pennsylvania.
Life has taught me that beliefs trump facts when the two collide, so I don't pay a lot of attention to alternative medicine any more. But some readers may find this to be helpful.  This is not cynicism on my part but as Dr. Cloyne illustrates by many examples, the human capacity for blind hope in the face of impending realities may be good for the spirit but has little or nothing to do with the flesh. Or as the old saying goes, the spirit is willing but the flesh is weak. Here is a key snip from the end of his post.

►If the reader gets nothing more that exposure to the word and concept of churnalism (highlighted in the snip) this post will have served a good purpose.

Protecting consumers from misleading “mind over cancer” info from “peer-reviewed” journals
By James Coyne PhD
September 10, 2013
Cancer patients frequently turn to the Internet for information about the best treatments for their disease. They can readily find false claims that conventional cancer treatments do more harm than good and that they should harness the power of the mind if they want to live longer. There are testimonials about conventional treatments failing were unconventional treatments exceed. There is often the insistence of having the backing of science. That sells. 
Surfing the web, cancer patients may find a review in the open access Journal of Alternative Medicine Research that cites some of the same studies as the British Journal of Health Psychology article. It declares that the ‘creative novation behavior therapy’ of Ronald Grossarth-Maticek is the most effective psychotherapy for extending the lives of cancer patients. 
Never mind that Grossarth-Maticek’s claims were investigated by an international team of experts, including David Spiegel, who dismissed the claims for this therapy as exaggerated, implausible, or outright fraudulent. The claims persist in a seemingly scientific journal citing other studies in scientific journals. We cannot expect that cancer patients will see through this or do a thorough systematic review of the literature before accepting such dazzling claims. 
Other websites offer Laurence LeShan’s mobilization of the immune system with individual marathon therapy, workshops, and retreats with the promise “Our aim goes beyond “support”: it is to enhance and extend life.”
  • Working toward creating a richer, more fulfilling life appears to be far superior in survival time to that of traditional psychotherapies focusing on psychological problems and past causes. For people with cancer, this approach often increases their positive response to medical treatment by (theoretically) stimulating their self-healing abilities. 
Still other sites offers the Simonton Method, which involves patient visualizing their cancer and treatment destroying the cancer through the mobilization of the immune system. Some of the therapeutic exercises involve imagining Pac-Men gobbling up and destroying the cancer cells. Hopefully they have now been updated to contemporary video games.
A couple of years ago, Elizabeth Simonton sent me a series of emails pleading with me to participate in a project that would explore her father’s Simonton Method. She stated that she had
  • interviewed such people as, Barrie Cassileth, David Spiegel, Carl Simonton, Jim Gordon, David Bresler, Bernie Siegel and many more. I am extremely interested in your point of view on the matter, as you have publicly expressed that you are skeptical of these ideas, and I am looking to get opinions such as yours to explore all of the facts behind the work….Please let me know if you would consider doing this interview, without it I feel the film would be lacking any sort of balance. 
I refused to be interviewed. Let there be a lack of balance. Apparently, the film was never completed. But why couldn’t Ms Simonton apparently not identify other professionals to present the side she expected from me? 
I think it is vitally important, that as much as we can influence what appears on the internet or in journals, we stick to evidence-based conclusions that there is NO evidence of mind triumphing over cancer, at least in terms of physical health outcomes. If British Journal of Health Psychology and Psycho-Oncologyare going to create confusion with inadequately reviewed or unreviewed articles, then an authoritative body like the UK National Health Service should investigate the claims and issue a statement, just as the ACS has issued a statement. 
There is certainly a precedent for this. A few months ago, there were exaggerated claims about an inexpensive blood test that would be soon available to determine whether pregnant women were at risk of getting depressed after delivery. The claims arose in a scientific journal but then got churnalled by lazy journalists who accepted what the authors claimed without getting second or third opinions. The NHS issued a statement denying that any blood test was going to be available anytime soon. I think it is incumbent upon the NHS to protect cancer patients and their families from being misled by the failure of peer review. 
So, NHS, please issue a statement to reduce any confusion on the part of cancer patients, their families, and their providers: No evidence that support groups or psychotherapy improve survival. Commission a review of the evidence, if you must. If it is free of the bias shown in the British Journal of Health Psychology and Psycho-Oncology articles, I am sure what the review would conclude.
~~~~~~~~~~~~~~~
Churnalism is a form of journalism in which press releases, wire stories and other forms of pre-packaged material are used to create articles in newspapers and other news media in order to meet increasing pressures of time and cost without undertaking further research or checking. The neologism "churnalism" (churning + journalism) has been credited to BBC journalist Waseem Zakir who coined the term in 2008.

Churnalism has increased to the point that many stories found in the press are not original. The decline of original journalism has been associated with a corresponding rise in public relations.
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Tuesday, September 24, 2013

HCR -- Lower Costs via the Exchanges

Maggie Mahar has compiled two comprehensive summaries headlined "Reverse Sticker Shock" which included the latest data available for what insurance will cost through the state exchanges. Insurance companies will be able to issue health insurance policies appropriate to selected age categories in the same way they issue life insurance.

Why? Think about it. It costs less to insure a young person than an older one. So the longer you live the more expensive your medical care can be expected to become. Just as some people will live a long time and others will die sooner, some old people will enjoy good health until they die while others will incur more medical expenses.

That's why it's called "insurance."  The company is betting you're gonna stay well and you are betting you will get sick or hurt. The game is tilted to protect the insurance company. Why? Because they have the data. In fact it's no secret. Anyone can get the data. But knowing that X-number of people will die or get sick doesn't mean it is possible to know which individuals will die or get sick. As I said, that's why it's called "insurance." It's probably the only money you ever spend hoping never to get your money back.

Go to these two links for a multitude of links and details.

►Reverse “Sticker Shock”—Why are Insurance Rates in the State Marketplaces Lower Than Expected? — Part I - 
What is making health insurance more affordable? 
First, the majority of individuals shopping in the Exchanges will be eligible for government subsidies that will go a long way toward covering premiums.  
The second reason premiums are significantly lower than expected is that as I have explained on healthinsurance.org in the state marketplaces insurers are forced to compete on price.  
Third, in many cases, state regulators have been clamping down. In Portland Oregon, for example, regulators forced insurers to cut their proposed rates by an average of nearly 10%. Three of the 12 insurance companies in that market had to lower their rates by more than 20%

Finally, rates in many Exchanges are looking surprisingly affordable because many insurers are narrowing their networks to a group of hospitals and doctors who will offer higher-quality care for less. Meanwhile the fear-mongers argue that this means patients won’t receive the care they need.
In August the Kaiser Family Foundation (KFF) published an “Early Look at Premiums” in California, Colorado, Connecticut, DC, Indianapolis, Maryland, Maine, Montana, Nebraska, New Mexico, New York, Ohio, Oregon, Rhode Island, South Dakota, Virginia, Vermont and the state of Washington.

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Monday, September 23, 2013

Mostly Long Reads -- September 23

Some days Web links are like popcorn, coming fast and short, more than you can catch. Other days not so much. Today is one of those slow days, perfect for reading if you don't have too many interruptions. It's not yet noon and already I can recommend these:

►  The $200K lesson I learned from getting shot
How a health insurance check sent 6 hours before being shot saved my life. And what it means for you (and America)
By Brian Beutler, via Salon

This is not long and is exactly what the subtitle says, the story of how getting health insurance at the last minute (six hours, actually) before getting shot protected one invincible young man from sure bankruptcy. The medical bills amounted to two-hundred grand. 

At a time when opponents to Obamacare are suggesting the truly nutty idea that young people really don't need insurance, this is a timely message.That's not the exact message, of course, but since Obamacare provides a path for lower premiums for young people for better insurance than in the past... you know the rest. 

By Jason Zengerly via GQ

It may seem odd for an old Liberal like me to recommend reading anything about one of the most colorful super-Conservatives in Washington, but this guy's influential enough that everybody needs to pay attention. This article is something of a soft hit piece, including just enough edgy material to keep it from being nakedly mean. But describing Ted Cruz without including some of his more colorful qualities would be like describing Donald Trump without mentioning his famous hair. 
[...]  Cruz, 42, arrived in Washington in January as the ultimate conservative purist, a hero to both salt-of-the-earth Tea Partiers and clubby GOP think-tankers, and since then he has come to the reluctant but unavoidable conclusion that he is simply more intelligent, more principled, more right—in both senses of the word—than pretty much everyone else in our nation's capital. That alone isn't so outrageous for the Senate. "Every one of these guys thinks he's the smartest guy in the room," one senior Democratic aide told me. "But Cruz is utterly incapable of cloaking it in any kind of collegiality. He's just so brazen."
~~~~~~~~~~~~~~
Ted Cruz doesn't look much like a wacko bird. With his pomaded black hair and trim suits—the kind you might expect on a former partner at an international law firm, say, or the husband of a Goldman Sachs executive—the more appropriate avian metaphor would seem to be a peacock. He doesn't sound much like a wacko bird, either. Cruz is a dazzling orator, speaking not merely in precise sentences but complete paragraphs—no teleprompter, sometimes not even a podium—and name-dropping everyone from Reagan to Rawls (as in John, the late Harvard philosopher). 
But as Cruz and his supporters define it, "wacko bird" describes more of a state of mind. Or as Cruz put it on the Senate floor a few weeks before my visit, in the midst of yet another fight with McCain, this time over the rules for negotiating a budget: "It has been suggested that those of us who are fighting to defend liberty—fighting to turn around the out-of-control spending and out-of-control debt in this country, fighting to defend the Constitution, it has been suggested that we are wacko birds. Well, if that is the case, I will suggest to my friend from Arizona, there may be more wacko birds in the Senate than is suspected."
~~~~~~~~~~~~~~
Princeton turned out to be as alien to Cruz as Austin had been to his father some thirty years earlier: "I did not know anybody there; I didn't know anybody who had gone there." Like his father, he needed to earn tuition money. Unlike his father, he didn't do it by washing dishes. He got a job with the Princeton Review, teaching test-prep classes. 
The elite academic circles that Cruz was now traveling in began to rub off. As a law student at Harvard, he refused to study with anyone who hadn't been an undergrad at Harvard, Princeton, or Yale. Says Damon Watson, one of Cruz's law-school roommates: "He said he didn't want anybody from 'minor Ivies' like Penn or Brown."
Qassem Suleimani is the Iranian operative who has been reshaping the Middle East. Now he’s directing Assad’s war in Syria.
By Dexter Filkins via The New Yorker

If you don't know enough about Qassem Suliemani or if that is a name you don't remember, this ten-thousand word tour de force will bring you up to speed. This is a heavy slog for anyone with a shallow background in recent histories of the Middle East, but it has valuable glimpses into what some call the back channels of international diplomacy. This is highly recommended reading. 
Suleimani was born in Rabor, an impoverished mountain village in eastern Iran. When he was a boy, his father, like many other farmers, took out an agricultural loan from the government of the Shah. He owed nine hundred toman—about a hundred dollars at the time—and couldn’t pay it back. In a brief memoir, Suleimani wrote of leaving home with a young relative named Ahmad Suleimani, who was in a similar situation. “At night, we couldn’t fall asleep with the sadness of thinking that government agents were coming to arrest our fathers,” he wrote. Together, they travelled to Kerman, the nearest city, to try to clear their family’s debt. The place was unwelcoming. “We were only thirteen, and our bodies were so tiny, wherever we went, they wouldn’t hire us,” he wrote. “Until one day, when we were hired as laborers at a school construction site on Khajoo Street, which was where the city ended. They paid us two toman per day.” After eight months, they had saved enough money to bring home, but the winter snow was too deep. They were told to seek out a local driver named Pahlavan—“Champion”—who was a “strong man who could lift up a cow or a donkey with his teeth.” During the drive, whenever the car got stuck, “he would lift up the Jeep and put it aside!” In Suleimani’s telling, Pahlavan is an ardent detractor of the Shah. He says of the two boys, “This is the time for them to rest and play, not work as a laborer in a strange city. I spit on the life they have made for us!” They arrived home, Suleimani writes, “just as the lights were coming on in the village homes. When the news travelled in our village, there was pandemonium.” 
As a young man, Suleimani gave few signs of greater ambition. According to Ali Alfoneh, an Iran expert at the Foundation for Defense of Democracies, he had only a high-school education, and worked for Kerman’s municipal water department. But it was a revolutionary time, and the country’s gathering unrest was making itself felt. Away from work, Suleimani spent hours lifting weights in local gyms, which, like many in the Middle East, offered physical training and inspiration for the warrior spirit. During Ramadan, he attended sermons by a travelling preacher named Hojjat Kamyab—a protégé of Khamenei’s—and it was there that he became inspired by the possibility of Islamic revolution. 
In 1979, when Suleimani was twenty-two, the Shah fell to a popular uprising led by Ayatollah Ruhollah Khomeini in the name of Islam. Swept up in the fervor, Suleimani joined the Revolutionary Guard, a force established by Iran’s new clerical leadership to prevent the military from mounting a coup. Though he received little training—perhaps only a forty-five-day course—he advanced rapidly. As a young guardsman, Suleimani was dispatched to northwestern Iran, where he helped crush an uprising by ethnic Kurds. 
When the revolution was eighteen months old, Saddam Hussein sent the Iraqi Army sweeping across the border, hoping to take advantage of the internal chaos. Instead, the invasion solidified Khomeini’s leadership and unified the country in resistance, starting a brutal, entrenched war. Suleimani was sent to the front with a simple task, to supply water to the soldiers there, and he never left. “I entered the war on a fifteen-day mission, and ended up staying until the end,” he has said. A photograph from that time shows the young Suleimani dressed in green fatigues, with no insignia of rank, his black eyes focussed on a far horizon. “We were all young and wanted to serve the revolution,” he told an interviewer in 2005.
Suleimani earned a reputation for bravery and élan, especially as a result of reconnaissance missions he undertook behind Iraqi lines. He returned from several missions bearing a goat, which his soldiers slaughtered and grilled. “Even the Iraqis, our enemy, admired him for this,” a former Revolutionary Guard officer who defected to the United States told me. On Iraqi radio, Suleimani became known as “the goat thief.” In recognition of his effectiveness, Alfoneh said, he was put in charge of a brigade from Kerman, with men from the gyms where he lifted weights.
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In the chaotic days after the attacks of September 11th, Ryan Crocker, then a senior State Department official, flew discreetly to Geneva to meet a group of Iranian diplomats. “I’d fly out on a Friday and then back on Sunday, so nobody in the office knew where I’d been,” Crocker told me. “We’d stay up all night in those meetings.” It seemed clear to Crocker that the Iranians were answering to Suleimani, whom they referred to as “Haji Qassem,” and that they were eager to help the United States destroy their mutual enemy, the Taliban. Although the United States and Iran broke off diplomatic relations in 1980, after American diplomats in Tehran were taken hostage, Crocker wasn’t surprised to find that Suleimani was flexible. “You don’t live through eight years of brutal war without being pretty pragmatic,” he said. Sometimes Suleimani passed messages to Crocker, but he avoided putting anything in writing. “Haji Qassem’s way too smart for that,” Crocker said. “He’s not going to leave paper trails for the Americans.” 
Before the bombing began, Crocker sensed that the Iranians were growing impatient with the Bush Administration, thinking that it was taking too long to attack the Taliban. At a meeting in early October, 2001, the lead Iranian negotiator stood up and slammed a sheaf of papers on the table. “If you guys don’t stop building these fairy-tale governments in the sky, and actually start doing some shooting on the ground, none of this is ever going to happen!” he shouted. “When you’re ready to talk about serious fighting, you know where to find me.” He stomped out of the room. “It was a great moment,” Crocker said. 
The coöperation between the two countries lasted through the initial phase of the war. At one point, the lead negotiator handed Crocker a map detailing the disposition of Taliban forces. “Here’s our advice: hit them here first, and then hit them over here. And here’s the logic.” Stunned, Crocker asked, “Can I take notes?” The negotiator replied, “You can keep the map.” The flow of information went both ways. On one occasion, Crocker said, he gave his counterparts the location of an Al Qaeda facilitator living in the eastern city of Mashhad. The Iranians detained him and brought him to Afghanistan’s new leaders, who, Crocker believes, turned him over to the U.S. The negotiator told Crocker, “Haji Qassem is very pleased with our coöperation.” 
The good will didn’t last. In January, 2002, Crocker, who was by then the deputy chief of the American Embassy in Kabul, was awakened one night by aides, who told him that President George W. Bush, in his State of the Union Address, had named Iran as part of an “Axis of Evil.” Like many senior diplomats, Crocker was caught off guard. He saw the negotiator the next day at the U.N. compound in Kabul, and he was furious. “You completely damaged me,” Crocker recalled him saying. “Suleimani is in a tearing rage. He feels compromised.” The negotiator told Crocker that, at great political risk, Suleimani had been contemplating a complete reëvaluation of the United States, saying, “Maybe it’s time to rethink our relationship with the Americans.” The Axis of Evil speech brought the meetings to an end. Reformers inside the government, who had advocated a rapprochement with the United States, were put on the defensive. Recalling that time, Crocker shook his head. “We were just that close,” he said. “One word in one speech changed history.”

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ADDED LATER:
Terry Gross interviewed Dexter Filkins on Fresh Air Wednesday, October 25'
Excellent and engaging as usual and highly recommended. 
Meet The Iranian Commander Pulling Strings In Syria's War
September 25, 2013
This is about 45 minutes long. 
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Sunday, September 22, 2013

Morning Links -- September 22

Misguided indeed. It is a small mind that reacts to tough challenges by saying "There oughta be a law against it!"  The most famous illustration, of course, is America's experiment with prohibition which resulted in an alcohol production and distribution infrastructure that rivaled any legal corporate enterprise.  The current "war on drugs" is the same phenomenon writ large, but today's cartels (coupled with America's prison-industrial complex, security-industrial complex, fear-industrial complex and a host of ancillary spinoffs) makes the bootleggers of the prohibition era look like cottage industries. How blind we have become.

And the same dynamic is at work with the global sex industry which has almost as many permutations as the war on drugs. Lord, save us from those who would pass laws to save us from ourselves. Why can't they see that they are only a few orders of magnitude removed from the terrorist enterprises spawned by misguided extremists of another sort.

Campaigners protest against United Nations stance on prostitution
Former prostitutes and anti-sex trafficking groups criticise UN call to decriminalise pimping, brothel-keeping and buying sex
Former prostitutes and groups campaigning against sex trafficking will launch an international protest against UN reports that recommend the decriminalisation of pimping, brothel-keeping and the purchase of sex. 
As global leaders gather in New York for the UN general assembly, the protesters claim that decriminalisation of the sex trade will endanger women.
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Addendum -- If  Twitter doesn't intervene by suspending their accounts, al-Shabaab members are live-Tweeting the Kenya Mall assault.
Today, as the bloodshed has unfolded in Nairobi, @HSMPress has been tweeting along in an apparent bid to explain and justify the killers’ actions. The tweets may give some insight into the group’s thinking, but take them with salt: The group’s allegiance to facts is tenuous, and there is a strong chance that its attempts to justify the slaughter of unarmed civilians will make you seethe.






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Not particularly newsworthy, but this photo was too good to miss.
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 Private donations give edge to Islamists in Syria, officials say
By Joby Warrick, 
September 21
GAZIANTEP, Turkey — The stream of U.S. weapons heading to moderate rebel groups in Syria is being offset by a fresh torrent of cash for Islamist extremists, much of it from small networks of Arab donors who see the Syrian conflict as a step toward a broader Islamist uprising across the region, U.S. and Middle Eastern officials say. 
The private donors, who use Twitter and other social media to collect millions of dollars from sympathetic Muslims, are providing crucial backing for Islamist militias that appear to be gaining ground in northern and eastern Syria, even as fighting stalls elsewhere, the officials said. 
Dollars raised over the Internet are wired between private banking accounts and hand-delivered by courier, often in border towns like this city of 1.4 million, about 20 miles from the Syrian frontier, according to Middle Eastern intelligence officials who monitor the activity. Some fundraising pitches ask for specific pledges to cover the cost of a weapon, for example, or to finance an operation. For $2,400, a donor can pay for the travel, training and arming of a single non-Syrian fighter. 
“You can even get a video afterward showing what it was you paid for,” said one senior intelligence official based in the region. The official spoke on the condition of anonymity to discuss his country’s intelligence collection.
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Anatomy of Outrage: On the Obamacare Resistance
Zoë Carpenter
The Defund Obamacare movement represents irresponsible governing at its apex, but what’s insidious about the whole show is the way it distracts from the actual threat to healthcare reform: the efforts to cripple the law’s implementation, led by Republican-controlled state governments and a range of right-wing PACs. 
Sixteen states have imposed unnecessary restrictions on “navigators,” a workforce drawn from nonprofit and government agencies to educate consumers about their options and walk them through the new system. Twenty-one states have refused to expand Medicaid, which was intended to cover 17 million uninsured, low-income Americans. Officials in Missouri have been barred from doing anything to implement the law. A handful of other states are refusing to enforce its consumer protections, most critically the provision that bans insurers from rejecting applicants with preexisting conditions. 
At the center of the “Obamacare resistance” is a media campaign to discourage young people from signing up for the exchanges. In order for the economics to work, the costs of adding unhealthy people to the insurance pool must be offset by premiums paid by the healthy. With only six in ten people aware of the exchanges and some 2.7 million young enrollees needed next yearfor the program to work, the administration has committed millions to reach young adults and get them enrolled. Earlier this year conservatives harassed organizations partnering with Health and Human Services on public-awareness campaigns; now they’re targeting young Americans directly. 
Koch-funded Generation Opportunity launched a web series on Thursday as part of a six-figure campaign designed, in the words the nonprofit’s president Even Feinberg, “to communicate, ‘No, you’re actually not required to buy health insurance.’ You might have to pay a fine, but that’s going to be cheaper for you and better for you.” In one video, a leering Uncle Sam pops up between the legs of a young woman who has recently signed up for Obamacare and is reclining on the examining table, waiting for a pap smear. “Don’t let government play doctor,” the text reads, as Uncle Sam ratchets out the forceps, “Opt out of Obamacare.” Tinged with sexual violence, the ad is rich in irony, coming from the party that aggressively “plays doctor” to women across the country and isn’t exactly sure what rape is. 
Generation Opportunity will tour twenty college campuses this fall, dogging nonprofits like Enroll America that are signing up young Americans. A slew of other organizations are working in tandem, including FreedomWorks, which encourages college students to burn Obamacare “draft cards,” and YG Network, which ran an anti-Obamacare ad on Saturday Night Live. Just like the assault on women’s health providers, these attempts to convince young people that being uninsured is “better for you” are dangerous. Young adults are the people least likely to have insurance, and unexpected health emergencies can be financially crippling. Under Obamacare, subsidies will dramatically lower the cost of coverage, to as little as $5 a month for some 21-year-olds in California. Other provisions will give young people access to essential preventative services, with no copay—like the gynecological exam denigrated in the Generation Opportunity ad.
 Telling young people that being uninsured is "better for you" is worse than dangerous. It's morally reprehensible.

Speaking of morality, how about this new Pope?


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Saturday, September 21, 2013

Morning Reading -- September 21

This has been a good Facebook morning for me. Two provocative links that made me leave long comments, and now this. 
If Rami Khouri RTs  something I pay attention. 
Israeli forces manhandle EU diplomats, seize West Bank aid
Thomson Reuters Foundation, September 20
By Noah Browning
KHIRBET AL-MAKHUL, West Bank, Sept 20 (Reuters) - Israeli soldiers manhandled European diplomats on Friday and seized a truck full of tents and emergency aid they had been trying to deliver to Palestinians whose homes were demolished this week.
A Reuters reporter saw soldiers throw sound grenades at a group of diplomats, aid workers and locals in the occupied West Bank, and yank a French diplomat out of the truck before driving it away. 
"They dragged me out of the truck and forced me to the ground with no regard for my diplomatic immunity," French diplomat Marion Castaing said. 
"This is how international law is being respected here," she said, covered with dust.
Locals said Khirbet Al-Makhul was home to about 120 people. The army demolished their ramshackle houses, stables and a kindergarten on Monday after Israel's high court ruled that they did not have proper building permits. 
Despite losing their property, the inhabitants have refused to leave the land, where, they say, their families have lived for generations along with their flocks of sheep. 
The Israeli army said on Friday that security forces had tried to prevent tents from being erected in area, in accordance with the high court decision. 
"At the site, Palestinians and the foreign activists violently objected, throwing stones and striking law enforcement officers," a military spokeswoman said. 
"Reports that foreign diplomats abused their diplomatic privileges are currently being reviewed, and if required, complaints will be filed with the relevant authorities." 
The French diplomat jabbed a soldier in the face after picking herself up off the ground. Reuters reporters at the scene said they saw no stone throwing or foreign activists. 
"SHOCKING AND OUTRAGEOUS" 
Israeli soldiers stopped the International Committee of the Red Cross (ICRC) delivering emergency aid on Tuesday and on Wednesday ICRC staff managed to put up some tents but the army forced them to take the shelters down. 
Diplomats from France, Britain, Spain, Ireland, Australia and the European Union's political office, turned up on Friday with more supplies. As soon as they arrived, about a dozen Israeli army jeeps converged on them, and soldiers told them not to unload their truck. 
"It's shocking and outrageous. We will report these actions to our governments," said one EU diplomat, who declined to be named because he was not authorised to talk to the media. 
More at the link, including this comment which says it all:  I wonder if the latest group of Palestinians whose homes have been demolished are pleased to hear that London is "seriously concerned". I am sick of the UK government pussy-footing around with such "diplomatic" language that achieves absolutely nothing. If it worked we would not still be seeing scenes like these.

It should be noted that the West Bank is not part of Israel. It is occupied territory seized at the time of the Six Day War in 1967. The soldiers operating there are often called IOF (Israeli Occupation Forces), not IDF.


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How the US War in Afghanistan Fueled the Taliban InsurgencyGen. Stanley McChrystal himself put it best: “Because of civilian casualties, I think we have just about eroded our credibility here.”
This from The Nation by Bob Dreyfuss restates one of the oldest challenges of warfare. It's the old hearts and minds meme redux. Check it out.
This was my Facebook response....

It's somewhat off topic, but I'm fascinated by the intellectual acumen of two high profile military commanders lately, McChrystal and Petraeus. Both of these men have extraordinary intellects and insights into human behavior. They make most marketing and business leaders look provincial by comparison. Petraeus literally "wrote the book" on counterinsurgency and was brought to my attention, I think, by Tom Ricks, one of the critics of the Iraq war (and another member of the smart commanders club) who left me with the impression that had Petraeus been in charge of more operations, sooner, his grasp of "winning hearts and minds" may have averted a lot of mistakes.

But it seems all these very bright guys have bigger egos than normal which stain their otherwise pristine images. The problems of Petraeus have been in the spotlight far longer than we need to see, and McChrystal's story includes that tawdry coverup of the Pat Tillman scandal. Seems like I have read a hit piece or two on Ricks as well but I tend not to pay attention to stuff like that.

Just thinking out loud, I guess...

I'm waiting for the commanders of the Egyptian military to show their true colors as we wait to see if they really succeed in shepherding their country into some semblance of working representative government. (Now I have drifted way off topic.)

The Egyptian military command cadre has been largely a product of American education and advanced training. I will be watching Egypt for a clue to whether (or how soon) we might expect the US to morph into a more rigid form of military-controlled system. With the military-industrial complex that Ike warned about now several decades in the making we already have a soft form of benevolent tyranny. County and local para-military police corps are becoming more developed across the country. And the prevalence of firearms is endemic....

I try not to worry about these developments but when I stop and think about it this is what happens. McChrystal's arithmetic has yet to visit America in the form discussed above. But I wonder how much the same dynamic applies to the business of illegal drugs and the formation and strength of gangs. (See Chicago for the most famous and recent example.)

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This next unrelated topic makes for more weekend long reads for those who need to catch up. Learning about the dangers of antibiotic overuse and the dynamics of microbiomes is literally a life and death subject. 

Here is an infographic and three highly recommended links. 
Click to enlarge.
==>  If you hold the ctrl button as you click
most programs will open a new tab.
Drug-Resistant Superbugs Kill at Least 23,000 People in the U.S. Each Year

I always knew about how antibiotics killed "good bacteria" along with whatever was causing a problem but I had no idea what the magnitude of that was until this year. New Yorker published what was for me a life-changing article describing microbiomes (a new word for me as well) and how important they are to the ecosystems of humans as well as other animals, even plants, who thrive better when the microbiome in which they grow is optimal.

http://www.newyorker.com/.../10/22/121022fa_fact_specter

Another piece in Smithsonian makes another long read to go with it.

http://www.smithsonianmag.com/...

One of my sisters-in-law is a nurse. When I spoke with her about what I thought was an experimental procedure of fecal transplants -- using fecal matter from a family member to treat diseases of the gut in another person -- she told me that was already being done where she works. It's not what it sounds like, she said. The specimen appears to be a clear liquid and is introduced by a feeding tube.

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This would make a good infographic. 
A clear majority of the American conservative movement has degenerated into a fraudster-elevating, money-making, influence-peddling racket whose primary goal is little more than to give public expression to the hatred of liberalism (and, commonly, liberals), and get rich and famous at the expense of the public good while doing it. 
This is a terrible development, because conservatives frequently hold what is more-or-less the superior general political position. The supposed conservative movement taints such ideas and makes them unpalatable to minorities, the young, and the poor.

I think it will be the job of many thinkers of my generation to reclaim conservatism from the racket and construct a positive, tolerant vision of a twenty-first century conservatism.
He makes a good point, especially the part about  conservatives frequently hold what is more-or-less the superior general political position.  In my life some of the most respected authority figures have been the older people in my life -- parents, clergy, teachers -- and for the most part they are intuitively "conservative" not wanting to rock the boat too much, careful not to rush into changes without lots of introspection and with plenty of backup plans. A conservative temperament is the bedrock of social, political and community leaders and role models. We look to them for leadership, wise decision-making and the determination to follow through with plans made well in advance.  It takes a measure of blind determination to soldier through tough times. And that is not a liberal instinct. The Liberal is forever looking for a quicker, better, less sacrificial path through hard times. That need to push aside perceived obstacles instead of working with or around them is the stuff that makes revolutions.

Somehow during the decades of my life it seems Liberals have been the ones seeking safety, security and predictability and Conservatives have opted for a somewhat atavistic return to the laws of the jungle. Helped along by the nutty purism of laissez-faire capitalism and Randian Libertarianism, what passes for conservatism today has become a small-minded, somewhat paranoid reflection of childhood instead of adulthood, more attracted to playing games and getting lost in sophomoric discussions of arcane wrinkles than finding ways to make a bigger, stronger, more reliable garment in which to care for the swollen masses looking to leaders for protection in the present and security in the future.

I'm getting old. I'm not supposed to be more Liberal. It's time for me to get Conservative. But today's Conservatism scares the shit out of me.

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Why is the Federal Poverty Line So Far Off?
September 18, 2013
by John Light
Excellent overview. Excerpt here:
[...]
...in 1969, a review committee made up of representatives from many government agencies decided the thresholds would be indexed to the Consumer Price Index, not to changes in the cost of food or the share of a family’s income spent on food. Since that time, the method for calculating the poverty thresholds has changed little. 
The poverty measure today 
America, however, has changed quite a bit since 1969 — and has changed even more since the mid-1950s, when the USDA budget Orshansky used for her thresholds was designed.

“In some ways, the poverty measure such as it is today made a lot of sense in 1965, 1966, in the late ’60s. The problem is we haven’t really updated it in a meaningful way,” says Shawn Fremstad, a senior research associate at the Center for Economic Policy Research. “We’ve updated it for inflation, but that just means you’re measuring what it means to be poor today in what are essentially early 1960s terms.”

The share of a family’s income spent on food has changed dramatically — some recent studies place the share of a family’s income spent on food as low as six or seven percent of total household expenditures. That would mean Americans today are spending roughly 1/14th of their income on food, compared with the one-third figure used to calculate the poverty guidelines. 
“A lot has happened to society and to families needs,” says Arloc Sherman, a senior researcher with the Center for Budget and Policy Priorities. “Fewer people needed to drive to work — you could walk to work. People didn’t need to save the same for childcare, or for college. People could get away without having a telephone and still have a successful job search. It was just a very different world. 
“The rise in families with children where all parents are working for pay is driving up the importance of paid childcare. Spending a few thousand dollars on childcare is fairly typical now. Childcare costs have risen faster than inflation. Healthcare spending is a growing part of family budgets just like it’s a growing part of the national economy. 
“The fact that other basic needs have increased in cost more rapidly than food is one reason why the old poverty line is out-of-date and, in fact, is too low: It hasn’t kept up with our new necessities, it hasn’t kept up with new ideas of what our basic needs are.” 
And the line doesn’t just omit key expenses — because it looks at a family’s before-tax cash income, it also ignores important sources of non-cash income for poor people such as the Supplemental Nutrition Assistance Program (SNAP, or food stamps) and the Earned Income Tax Credit (EITC). If the poverty guidelines don’t incorporate income from benefits, it’s hard to measure if these benefits programs are doing their job and lifting people out of poverty.
“This is relevant right now because there are bills moving through Congress that would cut SNAP by tens of billions of dollars over the coming decade,” says Sherman. “And if you don’t know that SNAP is helping people, you’re more likely to say it doesn’t work.” 
A new measure?
Right now, many of those who study poverty are not overly hopeful that the U.S. will implement a new poverty measure in the near future. It’s a difficult topic, especially in today’s fraught political environment. Conservatives argue that the measures cover too many people, including many who are lifted out of poverty by government programs like the EITC. Liberals argue that the poverty measures don’t take expenses into account realistically. 
Those who work with the U.S. poverty line often look to the U.K.’s system of measurement as an alternative model the U.S. might follow. There, federal agencies use multiple measures of poverty to create policy. 
“It would be good for both the left and the right to say, ‘There is no single best way.’ And maybe we could adopt sort of a suite of measures along the U.K. line,” says Fremstad. “And some of those could be more conservative, more absolute, and some of them could be more relative, more liberal. And then we could argue about which ones are the best. But at least we’d have a few — three or four measures that were all good, that Census and the federal government put out and that narrowed the debate.” 
Even before her long career researching American poverty ended with her retirement in 1982, Orshansky was unsettled to see her poverty measure become outdated, but remain as federal policy. In 1969 — the year the poverty measure was adopted nationwide and tied to inflation — she expressed skepticism about its implementation. “The best you can say for the measure is that at a time when it seemed useful, it was there,” she wrote.
The paper linked above is densely academic. The first 21 pages are the introduction, contents and main body, followed by two Appendices, bibliography and endnotes running the entire project to fifty pages.
Interested readers can plow through it at their leisure, but the long and short of it is that there are many ways to view poverty, and the official metrics that have been in use for decades are as old-fashioned as vacuum tubes in radios.

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Thursday, September 19, 2013

Rant -- Tired Old Liberal Looks Back

Bernie Sanders posted this infographic last night that triggered a rant in me in the middle of the night. It too a while to get it all out, but I was able to go back to sleep when I finished. I still felt helpless and pissed off, but sleep finally came. This is what came out...

When Barack Obama was elected over five years ago I was excited because I thought the Reagan revolution was finally over. Ever since the election of Ronald Reagan I have watched social and economic developments with an aching hope that as a country we were learning lessons the hard way that would eventually make us stronger as a nation.

Boy was I wrong. I was wrong to imagine that as income inequality got worse surely enough people would notice that policy changes would correct the problem. I was wrong to imagine that the many ways that the compromises that Bill Clinton made with what during his two terms passed for a loyal opposition were perhaps incremental steps back to more rational economic and social policies. And worst of all I greatly underestimated the depth of hatred which would drive political opponents to torpedo just about any initiatives our current president attempts to make.

As Barack Obama's first term came to an end I could not imagine why anyone else would even want his job. It was clear during the election that the Republican opposition was driven more by a burning need to defeat the incumbent at any price, not overcoming his popularity or accomplishments by more appealing alternatives. Despite the popular mandate that swept him into a second term he has spent whatever political capital he had left on simply surviving. Whatever greater vision he may have in the way of economic or social progress is and will continue to be no more than that -- a vision, a hope, a possibility.

The Tea Party opposition triggered by the election of Barack Obama is the democratic equivalent of the extremists that have surfaced in the rest of the world, from the drug cartels of Asia and South America to the religious extremists of the Middle East. These opponents are in an early stage, but their power and willingness to grow and overcome anyone opposing them is as tough to defeat as clearing an infestation of weeds in a garden.

Statistics like this one from Senator Sanders office are the political equivalent of a lab report with results that over time become life-threatening. Like the patient with chronic high blood pressure, obesity or diabetes we are inviting ourselves to years of suffering and an early death if we fail to take corrective action.

One of my faithful commenters left this thoughtful response, which let me know I was not finished:
If you remember correctly, the tea party movement was was energized by the lack of action in Washington to contain the growth of government, increasing irresponsible government spending and action, the spiraling national debt and leanings towards tax increases as the solution. Tea Party protests began with TARP, Stimulus, Cap and Trade, and Obamacare. I'm certain that the overwhelming reaction towards Obama is due to his world view, which differs greatly from 50% of America. As a political being, there is no equal to Obama's ferociousness and ability to clear the field of any opposition by any means necessary. Like any driven individual, President Obama's level of frustration escalates, when his plans are thwarted.
He's correct about the president's drive and political ambition. If anything he understates both. There hasn't been a politician in my lifetime since Lyndon Johnson, with the possible exception of both Clintons, with Obama's political acumen. In light of what is being spun as a big failure in the Middle East, it seems foolish for me to add that his grasp and meaningful control of foreign affairs may be the best of any president since Truman, but that's the real basis for my assessment of his political skills. A few years from now we will know if I am correct. At this point all we know is that he triggered a string of events that avoided US intervention, threw sand in the faces of those who said he should, shifted the main problems to Russia, raised the awareness of chemical weapons and opened the way to negotiations with Iran -- while making his GOP opponents at home into caricatures.  (Not to mention how quiet Israel seems to have been during all this mess.)

My view of what's happening currently is set in a thirty year time frame. This was my reply: 
I wrote what you just read a few hours ago about 2AM after half a night's sleep. If you want to know what keeps me up at night, I guess that's part of the answer. We could discuss the particulars for pages, I'm sure, but Bernie Sanders' infographic has little or nothing to do with Barack Obama or his politics and everything to do with what is shaping our politics in Washington. This is not a new trend. It only showed up when the metric of 24 years ago is compared with now, but the baseline causes are rooted in a Conservative ascendancy of the last three decades which started with a backlash to the blistering defeat of Barry Goldwater in 1964.

I didn't get to be a Liberal all at once. It started in my teens. And like any other life-shaping condition the after-effects continue now in my final years. I hear all you say about spending and taxes, but when I look at the world outside America I know how very lucky we are and how selfish we tend to be any time someone suggests we should be sharing that good fortune and inviting as many people as possible to be a part of it.

One man's "irresponsible spending" is another man's investment. One man's "spiraling debt" is another man's HELOC. One man's "growth of government" is another man's increased security and protection. Somehow the gridlock in Washington must be broken. Historically the two-party system has been the mechanism of compromise. But an obdurate minority of the minority stands in the way. And that unwitting group (yes, the Tea Party) is bought and paid for as surely as corporate interests own the rest of Congress.

I hate seeing it, but as long as corporations are considered people and money is considered speech, whatever political leverage everyday people may have left will continue to erode. Lincoln said the Lord must have loved the common man since He made so many of them. And I suppose the attitude of the UNcommon man (and his corporate allies in other parts of industry, commerce and banking) will always be that those multitudes are there to be exploited.
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Here's a link complimentary with Senator Sanders' infographic.
The typical American family makes less than it did in 1989
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