Politics: Onward from New Hampshire

[Secret_Agent_Man]

Originally posted by Tyrone_Slothrop
Not quite. I'll quote from Time magazine, so you can understand:

• Other senior officials from both the Clinton and Bush administrations, however, say that Clarke had a set of proposals to "roll back" al-Qaeda. In fact, the heading on Slide 14 of the Powerpoint presentation reads, "Response to al Qaeda: Roll back." Clarke's proposals called for the "breakup" of al-Qaeda cells and the arrest of their personnel. The financial support for its terrorist activities would be systematically attacked, its assets frozen, its funding from fake charities stopped. Nations where al-Qaeda was causing trouble-Uzbekistan, the Philippines, Yemen-would be given aid to fight the terrorists. Most important, Clarke wanted to see a dramatic increase in covert action in Afghanistan to "eliminate the sanctuary" where al-Qaeda had its terrorist training camps and bin Laden was being protected by the radical Islamic Taliban regime. The Taliban had come to power in 1996, bringing a sort of order to a nation that had been riven by bloody feuds between ethnic warlords since the Soviets had pulled out. Clarke supported a substantial increase in American support for the Northern Alliance, the last remaining resistance to the Taliban. That way, terrorists graduating from the training camps would have been forced to stay in Afghanistan, fighting (and dying) for the Taliban on the front lines. At the same time, the U.S. military would start planning for air strikes on the camps and for the introduction of special-operations forces into Afghanistan. The plan was estimated to cost "several hundreds of millions of dollars." In the words of a senior Bush Administration official, the proposals amounted to "everything we've done since 9/11."

So, maybe Clarke did his job pretty well, Hank, and you could try hard to disagree with him without smearing him. Armitage and Powell said no ill of him in the section I've heard (Armitage even said something nice).

S_A_M

[Secret_Agent_Man]

Originally posted by bilmore
Mumia could have been a brilliant writer had the state just left him alone.

Yep, but he shot a cop. We kind of had to prosecute that.

Clinton did what he did -- but the GOP sure as hell didn't have to impeach him.

S_A_M

[Say_hello_for_me]

Briefing dot com note this morning reported that AP is reporting that Israel's cabinet decided to wipe out Hamas's entire leadership after last week's Ashdod bombing. While they didn't state why it is so important for Israel to send a message, I'll again note that there have been reports that the bombers appeared to have tried to access a chemical storage area with dangerous chemicals.

My guess is they do go after Rantisi and anyone else who decides to become the public face of Hamas, and soon.

Hello

[Tyrone Slothrop]

Originally posted by bilmore
I admire the way you phrase things so as to make 9/11 implicitly a part of "the four-year failure".

I think you are reading something into my post that I did not mean to put there. Would not be the first time.

I LIKE the fact that we've started to clean out Iraq.

I know. But at least you don't pretend that it has anything to do with terrorism.

And, yes, we'll rue the day the failed Bush protect-us-against-terrorism fiasco allowed all of the subsequent-to-9/11 attacks here. So many lives lost . . .

Bite your tongue.

[Replaced_Texan]

Originally posted by Tyrone_Slothrop
The whole health-care system is like a massive catalog of the different sorts of market failure. And then the government's involvement distorts the market (and others -- e.g., through the tax benefits for employers to provide health insurance).

One of the biggest problems with our health care system is that we do not pay as much attention to preventive medicine as we should. A study came out last week that suggested that bypass surgeries and stents are relatively ineffective in preventing further heart problems, though our system insists on treating the acute problems instead of focusing on the larger issue of public health. Diet, exercise and lifestyle changes much earlier in a person's life are much more effective.

The managed care models proposed in the 60s and 70s contemplated that an individual would be in a managed care plan for decades, and that the plan would have incentives to prevent expensive-to-treat health care problems before they manifested through educational programs, screening, and simple, inexpensive preventive care. Of course, the model got muddled, and the HMOs that came out of the model were inefficient and more importantly, easier to leave.

We look at health care very acutely in this country, and we focus more on treating disease as it presents itself instead of doing what we can to prevent it in the first place. We focus much more on the individual than on the community as a whole, which is much more expensive to deal with.

Additionally, we’re a population that insists on getting the state of the art everything. Insurance masks the real costs, and the consumers are blissfully unaware of how much they’re costing. My personal health care costs annually are minimal, since I have no dependants and my employer covers all of my health insurance. I pay for a few over the counter drugs, maybe a $25 co-pay once a year or so, my gym memberships, and a few prescription drugs. I glance at my pay stub every few months and estimate that my employer pays probably two or three thousand dollars a year for my coverage, but it doesn’t really impact me very much. Being a public health advocate, I don’t take advantage of the system, and I don’t pursue what I think are unnecessary services that might nonetheless be paid for under my plan. Not everyone is like me. My grandmother, for example, LOVES to go to her physician for every minor ache and pain. She’ll doctor shop until she’ll find someone to attend to her hypochondria. I can’t tell you how many ultimately unnecessary endoscopies she’s had that were fully paid for by Medicare and her co-insurance. She’s a beautiful candidate for an HMO, but she opted out after a year in a Medicare CHOICE+ plan because she didn’t like how limited she was in her health care choices. Finding the balance, where health care that is necessary is available without too much concern for cost, is probably our greatest challenge.

Also, EMTALA, while great for ensuring that most emergencies are taken care of, means that we have a very inefficient primary care system that’s run out of emergency rooms instead of health clinics. People without health insurance know that if they show up to the ERs, they have to be evaluated and stabilized before they are transferred or discharged. The problem is that often they wait until whatever disease or condition has escalated to the point that it really is an emergency. There are few in-between places for these people to go to for preventive, primary care. Some of counties run community health clinics, and those are great, but they’re not very well funded, and usually are understaffed and overcrowded. We need a safety net outside of the ERs for primary care for people without health insurance, especially since the managed care companies and other payors have done a very good job of whittling away the margins that the hospitals were using to fund un-reimbursed care. ER treatment is extraordinarily expensive, and using the resources that are wasted in the ERs to develop more community health clinics would be much more effective.

I think CMS actually is fairly well run, though each fiscal intermediary is a little different, so it depends on where you’re located as to how good your experience with CMS is. CMS is the best payor out there for processing claims, though it often has the lowest reimbursement rate. I’m very hopeful that once the software glitches in the HIPAA transactions and code sets get sorted out, the other payors will be on par with CMS in terms of turn around time for payments and that the administrative costs of health care will diminish considerably. I’ve read a few ROI studies on the transactions and code sets, and I do really think that despite the nightmare of getting them implemented, that they will help considerably in reducing some of the administrative costs of healthcare. I wouldn’t be surprised if in the next two or three years the staffing at CMS, the intermediaries and the health plans will end up being cut.

Ultimately, I think that we’re heading for means testing on Medicare and that the new prescription drug benefit will have to be amended to reflect income of the recipient. Unfortunately, baby boomers are aging and they will want the most possible benefits. Finding a way of cutting Medicare with that voting bloc sitting there will be difficult, though I think it would be a lot easier, especially given the recent revelations about the withheld cost estimates, to roll back the prescription drug benefit.

[bilmore]

Originally posted by Tyrone_Slothrop
I know. But at least you don't pretend that it has anything to do with terrorism.

We are never going to agree on this, so simply accept it as part of MY motivation. It has everything to do with looking at root causes and environmental fostering of terrorism. You disagree.

[Replaced_Texan]

Originally posted by Not Me
That is the kind of bullsh-- that happens when the state owns the hospitals and doctors are paid by the state. A for-profit hospital gives the doctors food for free. All they can eat!

Really? If I were a hosptial in the US, I'd be concerned about Stark and anti-kickback laws if I were to give anything to a physician for free.

[Tyrone Slothrop]

Originally posted by bilmore
We are never going to agree on this, so simply accept it as part of MY motivation. It has everything to do with looking at root causes and environmental fostering of terrorism. You disagree.

I'm sorry -- I understand the "drain the swamp" view, and am not wholly unsympathetic to it, but I think we both see the difference between attacking terrorism by attacking terrorists and those who harbor them, and attacking terrorism by attacking a corrupt, despotic regime that doesn't threaten us in order to lay the foundation for conditions in the Middle East that are less likely to foster terrorism. My objections to the latter are (1) the opportunity cost -- we could have been fighting threats to us more directly with those resources -- and (2) will it work -- a question on which we differ and on which the jury is still out.

[Replaced_Texan]

Originally posted by bilmore
Kerry , surprisingly, (to us and Chavez) comes out against him on the referendum question (from Kerry's web site):

"Kerry Statement on Venezuela
Throughout his time in office, President Chavez has repeatedly undermined democratic institutions by using extra-legal means, including politically motivated incarcerations, to consolidate power. In fact, his close relationship with Fidel Castro has raised serious questions about his commitment to leading a truly democratic government. "

Apparently, the Venezuelans are in shock over this, as Chavez has been touting Kerry as his bud.

I had dinner with a friend last night who (illegally) went to Cuba last October. He said that there were more Chavez posters in Havana than Castro posters. I'm hopeful that the referrendum can move forward. They have until August to get the signatures, right? My understanding is that they had several million, but a court struck most of them down as "invalid" for obscure reasons.

[The Larry Davis Experience]

Originally posted by Secret_Agent_Man
Armitage and Powell said no ill of him in the section I've heard (Armitage even said something nice).

Yeah, but Armitage also said that the key factor in the Spanish elections was Aznar's handling of the Madrid investigation. Clearly the man has an agenda.

Speaking of agendas, does anyone think that that Zelikow guy should stay as executive director of the 9/11 commission? It seems obvious to me that someone who participated in pre-9/11 admin briefings should not be involved even tangentially in that commission's work. But since this hasn't really come up until now I'm guessing that as usual there's some argument to the contrary that I'm not seeing...

[Hank Chinaski]

Originally posted by Tyrone_Slothrop
Not quite. I'll quote from Time magazine, so you can understand:

• Other senior officials from both the Clinton and Bush administrations, however, say that Clarke had a set of proposals to "roll back" al-Qaeda. In fact, the heading on Slide 14 of the Powerpoint presentation reads, "Response to al Qaeda: Roll back." Clarke's proposals called for the "breakup" of al-Qaeda cells and the arrest of their personnel. The financial support for its terrorist activities would be systematically attacked, its assets frozen, its funding from fake charities stopped. Nations where al-Qaeda was causing trouble-Uzbekistan, the Philippines, Yemen-would be given aid to fight the terrorists. Most important, Clarke wanted to see a dramatic increase in covert action in Afghanistan to "eliminate the sanctuary" where al-Qaeda had its terrorist training camps and bin Laden was being protected by the radical Islamic Taliban regime. The Taliban had come to power in 1996, bringing a sort of order to a nation that had been riven by bloody feuds between ethnic warlords since the Soviets had pulled out. Clarke supported a substantial increase in American support for the Northern Alliance, the last remaining resistance to the Taliban. That way, terrorists graduating from the training camps would have been forced to stay in Afghanistan, fighting (and dying) for the Taliban on the front lines. At the same time, the U.S. military would start planning for air strikes on the camps and for the introduction of special-operations forces into Afghanistan. The plan was estimated to cost "several hundreds of millions of dollars." In the words of a senior Bush Administration official, the proposals amounted to "everything we've done since 9/11."

Exactly. Like Rice said "things that would take a few years to have any effect, and things that they've done."

[Hank Chinaski]

Originally posted by Tyrone_Slothrop
I know. But at least you don't pretend that it has anything to do with terrorism.

Clarke wanted to dry up terrorist $$. Iraq was about the biggest state contributor. You do agree with this, don't you?

[Tyrone Slothrop]

Originally posted by Hank Chinaski
Clarke wanted to dry up terrorist $$. Iraq was about the biggest state contributor. You do agree with this, don't you?

Cite, please. And Iraq may have been supporting Palestinians terrorizing Israelis, but it wasn't supporting Al Qaeda. Iraq is the sort of regime Al Qaeda wanted to overthrow. From a fundamentalists perspective, how different were Hussein and the Shah?

Clarke wanted to do a lot of stuff, but the point is the Administration blew him off until after 9/11. Does this mean 9/11 could have been prevented? We'll never know, but I bet it wouldn't have made a difference. It's just very tough to prevent other attacks like that. For the same reason, I'm unimpressed by bilmore's proud claim on behalf of the President that he has prevented terrorist attacks since 9/11. Talk about wanting to have your cake and eat it too.

[Not Me]

Originally posted by Replaced_Texan
One of the biggest problems with our health care system is that we do not pay as much attention to preventive medicine as we should. A study came out last week that suggested that bypass surgeries and stents are relatively ineffective in preventing further heart problems, though our system insists on treating the acute problems instead of focusing on the larger issue of public health. Diet, exercise and lifestyle changes much earlier in a person's life are much more effective.

That study, although widely reported in the lay press, is not by any means widely endorsed. There are myriad studies that show that stents and bypass are effective for preventing future problems and moreover, stents and bypass operations are done to treat debilitating angina and acute ischemia/infarction. So those procedures are necessary for the person to live and function now, not just to prevent future heart problems - they are done to treat today's heart problems.

And the diet/exercise thing is not a problem with our healthcare system. It is a problem with people.

Originally posted by Replaced_Texan
The managed care models proposed in the 60s and 70s contemplated that an individual would be in a managed care plan for decades, and that the plan would have incentives to prevent expensive-to-treat health care problems before they manifested through educational programs, screening, and simple, inexpensive preventive care. Of course, the model got muddled, and the HMOs that came out of the model were inefficient and more importantly, easier to leave.

The reason HMOs don't work is because there really aren't any simple inexpensive preventive measures that do much except eating a low fat, high fiber well balanced diet high in fruit and vegetable consumption without overconsuming calories, regular exercise, no smoking, only drinking in moderation, and getting plenty of rest and drinking plenty of water and taking a multivitamin.

None of those things can be done by a doctor. They all have to be done by the patient themselves. The HMO doctor can tell you about this and maybe even refer you to a dietician if you are a moron and cannot figure out what is low fat/high fiber foods or how many calories is overconsuming (hint - having to unbutton your pants is a good sign you are overconsuming).

Originally posted by Replaced_Texan
My grandmother, for example, LOVES to go to her physician for every minor ache and pain. She’ll doctor shop until she’ll find someone to attend to her hypochondria. I can’t tell you how many ultimately unnecessary endoscopies she’s had that were fully paid for by Medicare and her co-insurance. She’s a beautiful candidate for an HMO, but she opted out after a year in a Medicare CHOICE+ plan because she didn’t like how limited she was in her health care choices. Finding the balance, where health care that is necessary is available without too much concern for cost, is probably our greatest challenge.

This has been well studied and was the basis for instituting MSAs. If the patient does not shoulder any of the burden for their healthcare costs or only a minimal burden, they will overconsume discretionary healthcare.

This has been well studied and many workable solutions have been proposed. Read the economics of healthcare literature (it is abundant) and you will see all the good ideas out there. Unfortunately, they don't get implemented. MSAs are a really good idea. The non-discretionary care or the proven preventive care is provided at little to no cost and the consumer pays for the discretionary care up to a certain amount a year.

Originally posted by Replaced_Texan
Ultimately, I think that we’re heading for means testing on Medicare and that the new prescription drug benefit will have to be amended to reflect income of the recipient.

Means testing is the way to go.

[Tyrone Slothrop]

Originally posted by Hank Chinaski
Exactly. Like Rice said "things that would take a few years to have any effect, and things that they've done."

Oh, and he got his meeting:

• Clarke finally got his meeting about al-Qaeda in April, three months after his urgent request. But it wasn't with the president or cabinet. It was with the second in command in each relevant department.
  
  For the Pentagon, it was Paul Wolfowitz.
  
  Clarke relates, "I began saying, 'We have to deal with [Osama] bin Laden; we have to deal with al-Qaeda.' Paul Wolfowitz, the deputy secretary of defense, said, 'No, no, no. We don't have to deal with al-Qaeda. Why are we talking about that little guy? We have to talk about Iraqi terrorism against the United States.'"

(link to Yglesias article quoting CBS)