1.  American voters are a lot like court juries. They have an uncanny ability to cut through hype, glitz and spin to get at fundamental issues. Last night the American jury cut through stellar amounts of partisan bullshit to re-affirm that a spectacularly weak candidate cannot be made acceptable by partisan psych-ops media anointing.  In the end, Romney was identified as what he was, a consolation prize that rose from the worst slate of presidential candidates in history.

2.  Last night also vividly demonstrated that a nonstop blitz of the most conceptually awful, insulting and mostly untrue political attack ads financed by groups no one ever heard of like the “Committee to form silk purses from sow’s ears.com” probably do the opposite of their intent. Everyone I know including myself pushed the “mute” button at first sight of any of them. Billions of dollars from special rich interests bent on psych-op coercion served only to make TV stations rich. Ignored by audiences.   A saga of greed, corruption and failure that makes Nixon look like an amateur and Charlie Manson a punk.

3.  The propensity for sour grapes amongst Republican losers is legendary, and nowhere more visible than the following pathetic wound-lick:

http://spectator.org/archives/2012/11/07/a-painful-night

Brought to you by none other than far right wing pundit Ben Stein, writer and producer of the impeccably stupid and totally inaccurate film “Expelled: No Intelligence Needed”, a cinematic pile of shit that generated the lowest rating ever from critics, including Roger Ebert who opined: “This film is cheerfully ignorant, manipulative, slanted, cherry-picks quotations, draws unwarranted conclusions, makes outrageous juxtapositions, segues between quotes that are not about the same thing, tells bald-faced lies, etc.”

4.  The endless series of polls through the months meant nothing in the end and are now under suspicion for partisan manipulation. All the highly biased predictions from Republican pundits and soothsayers meant nothing. Krauthammer is hiding out in a New Orleans bar drinking heavily. The ridiculous and contemptible pseudo-film “2012: Obama’s America” that Republicans touted as a chronicle of the end of the world that voters were packing theaters around the country was in reality a millisecond long blip on the screen.

5.  Important:  last night proved that a political agenda cannot fly with American voters if there is a thinly veiled hidden agenda of unacceptability behind it. Romney and Ryan espoused a primary agenda of fiscal responsibility but it was also pointed out that their hidden agenda, especially as it pertains to Ryan, was a Santorum-like social repression that if ever enacted would foment rioting in the streets. If the GOP ever expects to win another Presidential election, it’s time for them to undergo some reality therapy, viz:

a)  The GOP needs to get back to it’s roots of fiscal responsibility without being dragged down by unacceptable social platforms that either no one cares about or will bring out vociferous non-partisan opposition that will drag them down.

b)  They need to evaluate the circumstances that, metaphorically speaking, brought the Star Wars Cantina barflies into a National election as serious candidates. The thought of Michelle Bachmann actually at some point having a Republican wave of support is something that really need to think about.  Newt Gingrich is so aggressively evil that he glows at night.  He played in a league where Romney will never be anything but a bat boy.

c)  They need to consider what the Tea Party has done to disrupt their credibility. That Sarah Palin still gets a spot on Fox News is something they need to think about at great length. She has all the credibility of Tiny Tim leading the Boston Philharmonic. Tabloids should beat her like a red headed step child every time she appears.  The National Enquirer should publish nude pictures of her sans airbrush

d)  They need to think critically about the terrible, frightening specter of Rick Santorum and the far Christian right and what they’re capable of doing to destroy any GOP credibility with moderate voters next time around. Historians will remember him as a rat who kept scrambling to get back on the sinking ship.

“Politics is like the stock market: It’s a bad business for people who can’t afford to lose” (Nixon, 1968).

Some will march on a road of bones, others will be nailed up on telephone poles.  That’s the way it works.

I’ve been watching this back and forth now on Events for a long time and like K. Mattox says, it really never changes. A bunch of people with iron-clad opinions that never change if for no other reason than they only believe evidence that sees it their way   And, of course, I’m guilty of that as well.

But cut to the chase, I think the Presidential race is largely inconsequential. The dire straits the country has entered is largely a result of bad decisions made by a very large number of incompetent decision makers over a very long period of time. And there remains the possibility that no matter who was making any of these decisions, the evolutionary process would not have altered much or for long. The Presidential race gets a lot of visibility, but I’m not convinced any of them can do much more than make promises they have no power to keep. And the various factions are now simply committed to getting absolutely nothing done unless it’s with their interest group. Stalemate is now the order of the day, and Romney can’t avoid it anymore than Obama did.

Many of the problems we now face probably can’t be fixed by anyone. Call it whatever you want, the weather is dramatically changing and in that process, our food and water supply will change (for the worse) with it. The US economy is largely service oriented, with fewer interesting in purchasing those services. Half the world is at the throat of the other half and most of them have nuclear weapons now. We are already deeply in debt to factions that have no problem using that debt to our detriment.  The global economy is in serious trouble and there is no realistic cure for it.

I think people dwell on a Presidential candidate to fix all that because of the media visibility, but the reality is that they are all slightly more manipulative observers than the rest of us. Obama is a altruistic ideologue trying to create a safe haven for most of the country at premium prices.  Romney is a rich white guy trying to get back to his glory days of saving the Olympics. They both like flying around in Air Force One and waving at the crowds.  But in the end, I suspect none of them will alter the inevitable path we’re on. Our bed was made through a long period of time and like it or not, we’re going to sleep in it.

I continue to wonder if becoming an expatriate is not a viable option at my stage in the game. I have enough money in my retirement accounts to live quite comfortably without Social Security.  If I went on the cheap, I could make it till age 90. If I continued to blow money on stuff I like as long as I’m spry and healthy enough to enjoy any of it, I could probably make it to 80 and beyond. When it’s all gone, I could see myself with a room on a Personal Care Home with photos of the glory days on the wall, a cable TV and a laptop. As long as I could keep up with the world, I’d be OK with that. If I couldn’t do any of that, I’d make sure I had a deal with someone to take care of that situation.

I continue to wonder if the most enjoyable course is to move out of the country, not in a fit of pique because of the rule of a political candidate but simply because I don’t have much faith in where the country’s going no matter who’s in charge.  Re-locating to a burned out country out of the way of political upheaval seems like an interesting deal. A small area of a burned out country that no one in any power base cares about and is likely to maintain no matter what happens in the global situation.

I was in the South of Spain motorcycle riding a few years ago. The guy that owned the small motorcycle rental was a German expat, formerly an engineer of some kind.  He moved to a beautiful small town right on the Southern coast of Spain and set up shop. Potential renters flew into Malaga, he drove over and picked them up for an hour’s ride through the countryside.  I took a few days and rode all over the area. It was phenomenal and no one paid any attention to what was going on over the rest of the world. In this small town, satellite cable was available and an International airport (4th busiest in Spain) was an hour away. He was happy as a clam and spent a lot of time lying around the beach ogling pneumatic babes.

When I was in Morocco, the guy that owned the tour I went on (specialized for one or two individuals with specific interests) was a former professor at a Kansas university that did actually leave in disgust over the political situation a few years ago (conservative Republican afraid of Obama).  He had a nice deal there and was busy enough to make a living.  He said Morocco was a very nice, safe, comfortable place to be for expats. Totally apolitical. When I was there,  met three physicians actively planning to relate permanently to Jerusalem. I see more activity toward expatriation than ever before.

More people just don’t want to live in the maelstrom anymore. They just don’t care. The more political attack ads I see (and actively avoid seeing-) now about every twenty minutes on TV, the more resolved I am to get away from all of it. I could see myself purchasing a small out of the way bungalow somewhere in Scotland or England, near enough access to London and airports if needed, Cable TV, Satellite Internet, bikes and a car parked out front. I could find a LOT to do with the time I have left. When that time’s up, none of it matters anymore.

The discussion the Affordable Health Care Act of 2008 (hereafter called the ACA) is no longer political. It’s the law now and the overturn movement has about the same likelihood of success as the O.J. Simpson appeals. I’ll also assume for the purposes of this missive that Romney won’t be elected in 2012.  If by some stretch he is, then it will be a different conversation we can have then.

In order to understand the impact of the ACA, you have to understand two other concepts;

1.  The creation of Medicare/Medicaid in 1965 via Lyndon Johnson.

2.  The evolution of the Medical-Industrial Complex in the USA and where it’s headed.

In 1965, although we didn’t appreciate the impact it would have at the time, those in my age group watched the President use his bully pulpit to establish health care indemnification for the “elderly” (over 65) and the “poor” (below an established poverty line). I recall my father the general surgeon howling in anguish at the thought of “Government Medicine”. He and the rest of them thought this was the first step on the road to inevitable perdition, but the reality was that it made my father’s generation of physicians rich and created the American Medical-Industrial Complex.

It created the Complex by altering the supply and demand curve of health care financing into a situation where consumers of medical services bore no responsibility for the cost thereof. Cost of services was borne by third parties who had no idea if the services were needed or necessary.  Providers could create demand for services and then create supply to meet it, all financed by third parties who paid for it on the basis of correct paperwork. Today, the government in the public sector, including such programs as “Medicare, Medicaid and the Veterans Health Administration, provides 60-65% of health “insurance” (such as it is).

American health care is the most expensive in the world. The Congressional Budget Office reported that “about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in (expensive) technology”. In 2009, the United States federal, state and local governments, corporations and individuals, together spent $2.5 trillion, $8,047 per person, on health care. This amount represented 17.3% of the GDP, up from 16.2% in 2008. The Health and Human Services Department expects that the health share of GDP will continue its historical upward trend, reaching 19.5% of GDP by 2017. Growth in spending is projected to average 6.7% annually over the period 2007 through 2017. But the United States ranks poorly in, among other things, preventable mortality, below Canada, Ireland and Portugal.

The reality is that a government throttling a public that views health care as a right is political anathema.  Their only option is to let the public have their fill and cut back at the level of providers.  But all such attempts to control this spiral have failed. In the past, the government tried to control demand by limiting supply. Managed Care during the Clinton years generated little other than public anger.  Rationing by provider inconvenience (endless convoluted paperwork) generated only the creation of expert professional paperwork managers. The current ploy of refusing to pay for “events that shouldn’t happen” (urinary tract infections, pneumonia) will be met by creatively re-defining these disorders.

Hospitals routinely accept a relatively small percentage of reimbursement from negotiations with insurance companies. UPMC bills US$1480 for a bedside percutaneous tracheostomy and Medicare reimburses US$480.  However, if the patient has no insurance, they are billed full freight (US$1480) and the facility is quick to turn the debt over to a collection agency.  Accordingly, an unexpected medical emergency has the potential for ruining a family’s finances permanently.  A 2007 study found that 62.1% of all personal bankruptcies involved high medical expenses.

This issue cries out for justice, and the rest of us will be involved in it.

In the new millennium, an escalating cost spiral feeding unlimited and unrestrained demand with the government and other indemnifiers cutting expenses at the provision level has the REAL potential to collapse the entire system. SOMETHING has to be done to address it. Standing around hoping it spontaneously improves is NOT an answer.

Into this overheated death spiral now comes the Affordable Health Care Act of 2008 (ACA), a political attempt to accomplish at least three previously unrequited goals:

1,  Increasing affordable health care for more American Citizens currently unprotected and at risk for financial disaster if they get sick.

2.  Making health care indemnification portable, once you get it you can keep it.

3.  Forcing insurance companies to stop “cherry picking” clients least likely to make claims, refusing to pay for services after they’ve been rendered and increasing their premiums ad lib while at the same time decreasing their covered services.

This is a bold move and it remains to be seen whether it will survive intact for a number of reasons:

1.  It has become less of a proprietary social issue and more of a political football. Political opponents use it as a wedge to lessen the influence of the particular political party.  Any utility it may have for the general public is lost in the fight.

2.  All insurance companies provide more or less cost effective service by managing risk.  Clients with a history of drunk driving and lots of speeding tickets pay more for insurance, or are uninsurable. This is a fact of life.

The ACA purports to provide “new” indemnification for an estimated thirty one million patients not currently insured without addressing their previous risk. However, in our current social ecosystem, high-risk patients with alcohol related cirrhosis or smoking related COPD demand and get the same service as less risky patients at the same rates. This situation is unsustainable for any insurance company.

There is only one way to make “insurance” for all comers regardless of risk happen in an ecosystem where all the players MUST be treated on demand. That’s to spread the liability out through the entire population net. Unless we’re prepared to deny service to those that refuse to pay (we’re not), everyone MUST participate, whether they want to or not. The fewer participants, the less likely the indemnification will stay viable.  If we allow recalcitrant to refuse to pay for any reason, they will eventually show up and demand treatment on the backs of those that did.

So we’re all going to have to pony up, like it or not. The alternative is a government and private insurance system that’s unsustainable, especially following the global financial crash of 2007. It isn’t “if” it will crash, it’s “when” and it will be soon at the rate they are increasing rates and denying service.

As a practical matter, it doesn’t matter if it’s technically a tax or if it’s a tax by some other politically friendly name. It’s the price to pay for getting “most” Americans affordable health care coverage, deterring financial collapse for fault-less serendipity. The rest of the global medical village does it and we will too, or we will quickly price ourselves out of any ability to do so for any of us.

Don’t care about your fellow citizens’ potential for financial collapse if they get sick?  Refuse to pay increased taxes for people you care nothing about?  That’s a separate issue and a separate argument. It remains to be seen whether you will be allowed to do that in our society.  Don’t have to pay auto insurance if you don’t want to drive a car?  Good. Ride a bicycle ten miles one way to work and watch your wife push a cart to the grocery store for a while and see how that works for you.  Concerned that the sky is falling and any addition to the National Debt will collapse society?  To that I say, how many guaranteed current disasters are you willing to ignore for a future that may or may not occur?

The IDENTICAL arguments currently being used against the ACA were used in 1965 against Medicare/Medicaid, which turned out to be a great benefit to Americans and now an authentic sacred cow. The ACA isn’t perfect by a long shot, and there is no guarantee it will solve most of our current problems, but it’s a start solving some of them. In time, both consumers and providers will get used to the ACA, just like they did Medicare/Medicaid. It’s a proactive move to try to do something positive.  Not relying on our current system, the continued escalation of which is increasingly ineffective and inadequate, accomplishing nothing but endless spending into a black hole.

The risks and values of the ACA cannot be evaluated in an isolated snapshot. It’s basically a comparison issue. It’s value must be looked at compared to something. The alternative is doing nothing but allowing our current situation’s death spiral to tighten. The ACA is a risk, but it’s a reasonable calculated risk. We have to take that risk and make the best of it because the alternative is an inevitable, guaranteed disaster.

Further discussion in a multi-national forum will be out probably this September (see enclosed book cover).

From Med-Events:  “The demise of the public sector union is an essential ingredient in rebuilding a leaner USA which can continue to grow and prosper”.

—————————————–

“Building a leaner USA” is an extremely problematical issue loaded with bombs and traps. The theory is that cutting back on government expenditures would lead to a better cost/benefit.  In fact the real chances of this happening EVER is vanishingly small, regardless of Republican rhetoric, for the following reasons:

1. In order to achieve the desired lean-ness, government programs must be cut.  Some say to the bone. At least 80% of the expenditures of government are entitlements:  Medicare, Medicaid, Social Security and other benefits accumulated by voters who have paid premiums for them though their working career.  The voting public seems to agree with cutting back to a lean USA……..until they, themselves, feel the pain. Cut Medicare for oldsters eating cat food to afford their hypertension medications?  Cutting Social Security benefits for oldsters that paid into it their entire working careers?  I don’t think so. When voters feel the pain of proposed (Republican) cuts, they will do what they did in 2010.  Any congress person that actually gets identified as being part of a painful cut will be a one term, or part of one term sacrificial lamb.

2.  Even if the congress (or the President) had the balls to make these cuts, which they don’t, NO ONE can (or will) agree on how to accomplish it. Simpson & Bowles came up with the most fair and equitable system of spreading the pain yet and they all said it “needed more study”.  That means they support all measures to lean out the USA until it comes time to actually go on record as voting for one.  See # 1 above.

3.  Former gov. Romney has not to date actually uttered a formal plan for the economy other than broad generalizations he doesn’t have to personally defend to voters. His plea is “Elect me and I’ll stop everything Obama is doing”.  The same Obama that is at least holding some degree of defense on an economy that was headed into the ground at the speed of sound in October of 2008.

Exactly what would Gov.Romney do different than Mr. Obama?

a)  Cut “government spending”?  Cut exactly what?  Medicare?  Social Security?  Government Pensions? Government employment?  Does he expect that all those directly affected by such cuts would smile broadly and say: “I’m proud to tighten my belt for the good of the country?  Not likely. As Gil will tell you, every innocent bystander that got hit over the head by a cop at the 1968 Democratic Convention in Chicago became an instant radical protester. This is precisely why Gov. Romney is being very vague as to exactly how he plans to cut costs. He’s hoping the disaffected 8+ percent of unemployed will sweep him into office?

b)  Abridge the reproductive rights of women? Those so abridged will collectively squeal like pigs in hot oil and the media will broadly cover all of it. And of course none of the Santorum-like plans will stop one single abortion from taking place. It will simply establish a freely moveable cottage industry.

c)  Make Government more transparent and visible to the voters? I seem to recall promises like that in 2008, few of which came true. Few will come true for Gov. Romney either in the unlikely circumstance he’s elected. Obama thought he could bring a new paradigm to the Presidency on the basis of his organizational ability and personal magnetism.  He didn’t change it, it changed him as it would Romney. Romney’s experience and expertise is in a business realm where he can make decisions that affect others that are hamstrung to do anything about them.  The government isn’t Bain. It doesn’t work that way in Politics, and it definitely won’t work that way for Gov. Romney.

Gov. Romney is a weak sister consolation prize that shuffled out of the worst slate of would-be candidates in history (Sarah Palin in a class by herself). Republicans speed-dated through some of the most incredibly offensive candidates ever trying to find anything better than the inevitable Romney and finally gave up. Those that now smile broadly and extol Gov. Romney as the savior of the country do so not-so-convincingly through gritted teeth.

The stark reality is that no one can fix the problem in the economy because no one is willing to sink with the painful cure. Obama puts it off by priming the pump. Romney would hasten it by cutting off flow to the pump. No one in congress wants to go on record with supporting the cure and then facing the pain.  There is only one way the economy will be fixed and that’s when it crashes and burns and we’re forced to start over from what remains. That day will come regardless of who wins the Presidential race in 2012.

Answers to some comments:

Comment:  You may be partially correct in this claim but there is enough

waste in the federal government that some reductions could occur that

would help reduce the deficits and out of control spending.

Since most of the “waste” is spent on entitlements, and assuming that entitlements are inviolate (they are), then reducing any other wastage does not amount to any meaningful savings. Like your argument that taxing the super rich won’t actually bring enough money in to matter. Give me some idea who is willing to come out for reducing Social Security?

The future medicare spending could be reduced by setting

an age limit and shifting to a less costly program.

And that’s exactly what’s in the future. The only problem is getting it done without a trail back to who is guilty of making those changes. that issue has not been resolved, so those changes won’t happen anytime soon if ever.

I expect my President to lead. Obama is not a leader. He is a spender,

a radical socialist, and a finger pointer to others but provides no

leadership unless it is for one of his socialist programs.

Watch out now, there is no convincing evidence he is a radical anything. He is spending to prime the pump to keep things going. Not the same as idle spending just to spend. And a socialist program like that in Sweden is definitely not in force in this country.

One of his bigger failures is his inability to submit a

reasonable budget that even his own party can support.

Then I must ask exactly who would be capable of submitting a budget that would pass this congress, each and every one of whom is only interested in doing whatever it takes to insure he or she is not blamed for anything.

Romney is no different that Obama in this respect.

Every program that Obama wants only increases

spending but really doesn’t solve any problem. Obama

Care will bankrupt this nation.

Well, that’s arguable. Look at an analogy. “Life Support” in an ICU. We keep sick patients on ventilators and other modalities while a healing process occurs, then take them off the support when the healing occurs. Were it not for the machines, the patient would die before healing is accomplished. Obama is keeping the support for business open so it can function until better times takes over support. If ever. The Republicans want to discontinue the life support and hope the healing process occurs without it. I say unlikely.

Change the system to promote primary care in the non-hospital

setting, eliminate the EMTALA Laws, and enact TORT

Reform and I will support some better version of the Affordable Care Act.

None of most of the above will happen in our lifetime, if ever.  Exactly who will eliminate EMTALA?  It’s a technocracy now. No one can identify who is making the rules so they can’t be found to change them. Lawyers make the laws. Tort reform will never happen in our lifetime and beyond as long as there is a demand for tort actions by the public, there will be lawyers to fulfill that demand.  The Affordable Care Act of 2008 is a better deal than a huge portion of the population risking a lifetime of financial ruin and progressive loss of health insurance due to unrestrained cost.

Medical Care including reproductive rights are a private matter

between a patient and their doctor. Get the Democrats to support

this and I will support the democrats that comes out for this.

The above does NOT sound like Santorum who proudly proclaims he’s the only real conservative. I will support the Republican version of this when they tell Santorum he’s out of line and to buzz off.

GWB made some mistakes. However, He was responsible for

making this country safer from terrorist acts.

Iraq, a country with a two bit tin horn dictator that had no interests in the USA and ignoring Saudi Arabia, home of every one of the 911 terrorists?  By attacking Iraq KNOWING there were no Weapons of Mass Destruction.

Obama has had 3.5 years to work on some problems.

He has been a miserable failure.

Well, everyone knew this issue was not going to be resolved in four years, or ten years or ever. We’re all guilty of inappropriate optimism. No power on earth could have resolved this issue in 3.5 years. Certainly not McCain.  Romney has the same inappropriate optimism.

Let’s argue just for grins that Romney is elected in 2012. Here’s exactly what will happen.  He will be in office for about two weeks and he’ll loudly exclaim that the economic situation is infinitely worse than he or anyone else could have known (because of the incompetence of the previous President).  So it’s unfortunately going to take a little longer to fix so he calls on the Democrats to work with the GOP to get things done effectively. The Democrats sneer that Romney is an idiot and he can’t fix the situation because he’s incompetent and he won’t be able to fix anything anyway because they (Dems) will throw the full force of their influence to insure he doesn’t. Then in 2016, each party will start the cycle again.  Does that sound familiar.

I noticed the hoary, smirking caricature of Sarah Palin at the Conservatives Convention in DC exhorting patrons to vote for the most radically conservative candidate possible without actually endorsing one.

If you want to understand how truly frightening this ruthlessly ambitious, self serving, opportunistic would-be politician is and what a terrible danger to the country or the world if, however unlikely, she were to ascend to any position of authority other than a highly overpaid Fox pundit, you need to read two works:

1.  “Game Change” (2008) (you should read this anyway as it is a very clear and well referenced portrait of the ’08 election by respected journalists not affiliated with any radical groups). It is REALLY a must read for all, including right wing-nuts and wild-eyed liberals. There’s something for all.

http://en.wikipedia.org/wiki/Game_Change

Of particular interest is a chapter on Palin written by the woman charged with getting her ready for prime time politics, documenting all the hysteria, paranoia and instability they all lived with, and few willing to recall in print.

As they were about to set off to meet Couric, Palin announced ‘I hate this makeup’ –
smearing it off her face, messing up her hair, complaining she looked fat”.  Palin
went on to give answers to Couric that were so incoherent the interview permanently
damaged her.  Palin went into a tailspin. She stopped eating or sleeping and drank
only a half a can of diet soda a day. “When her aides tried to quiz her she would routinely
shut down – chin on her chest, arms folded, eyes cast to the floor, speechless and motionless,
lost in what those around her described as a kind of catatonic stupor”.

Still being paid tons of money for the fruits of this activity.

Also said to be a film coming out on the 2008 election theme starring Julianne Moore as a pretty convincing Palin. there is already rumor that Palin is not happy about the portrayal, not that she would be happy with any realistic portrayal of her.

http://www.politico.com/blogs/click/2012/01/sarah-palin-skewered-in-game-change-112991.html

2.  “The Rogue” by Joe McGinniss. A volume full of bias critical of both the Palins, which was most interesting for it’s depiction of the Palin paranoia and the open ended acceptance of numerous distortions and non-truths related to Fox News and especially Glenn Beck about the would-be spying activities of McGinness. The Palins told Fox and Beck that McGinness peered into her daughters window at night and produced a photo of him with binoculars viewing birds in a tree from the opposite end of the porch facing the opposite direction. Fox immediately labeled him a dangerous stalker and Beck suggested thinly veiled threats on his life might be in order. Locals came around offering him weaponry and told him his best course was to stay out of sight.

So like Ken says, if only 25% of the material in “The Rogue” is true, the Palins are contemptible individuals, equally or more-so matched by Fox News and especially the impeccably evil Glenn Beck, a scoundrel so odious the was thrown off even the most conservative wing-nut TV shows and hasn’t been seen since.

http://www.nytimes.com/2011/09/15/books/joe-mcginnisss-the-rogue-on-sarah-palin-review.html

I spent about two hours this morning talking to one of the young doctors that did his fellowship here a few years ago, did phenomenally well and now is climbing quickly climbing up the vines toward a stellar career here at UPMC. I respect him a lot and I am proud to have been a part of his professional nurturing. He spends most of his time at one of the other UPMC hospitals and drops by to see me now and then when he’s around.

Like most doctors, he’s a voting Republican. I think he is clearly more on the moderate end of the spectrum, which I suspect a greater percentage of advertised Republicans are. He claims to be a “conservative”, but he differs radically from most of what I’m hearing other (said to be) conservatives are saying on “Events”.

At any rate, we had a long conversation about a lot of things and I think his opinions are very interesting and worth relating to you. Here are some of his expressed opinions as best I can interpret them.

1.  Being “conservative” doesn’t necessarily mean being a nut.

There are some politicians out there that use the “conservative” angle as a platform to extol their social theories that are not necessarily what a lot of other “conservative” voters believe.  In fact, many conservatives think of Sarah Palin as a self promoting opportunist who happens to stand on a conservative platform because it tends to gather a bigger crowd. Rick Santorum is a radical evangelical purist who calls himself a conservative because it resonates to a smaller but more vocal crowd.  Newt Gingrich is a cold blooded politician that has been working the system for many years and has figured out how to use conservative angles for his own financial and political benefit.

But in fact, a conservative is just a reasonable person who is concerned about reasonable things. Fiscal responsibility. Treating people as you would like to be treated. Some degree of personal autonomy in a world full of regimented political mandates. Things most reasonable folks subscribe to (Gasp….even some Democrats). The problem is that those principles have been hijacked by self-serving, self-promoting persons using them as a base for their own social restructuring programs in the name of all conservatives. The current sitting President is not Satan incarnate. He is a person whose policies are perceived as contra-productive to the GOP ideal, and therefore they oppose his policies, not the man.

The reality is that the majority of Republicans don’t subscribe to the Sarah Palin brand which is why after all the hoopla, she is sitting in a cabin in Alaska instead of being intimately involved in Republican issues.  If she thought she’s get more mileage from the American Nazi Party, she’d be wearing jack boots tomorrow on Fox. It is also why Santorum is getting about 10% of the vote anywhere but in States infested with evangelicals. And “most” responsible Republicans are appalled and embarrassed by Newt Gingrich and this will be a self correcting issue in time.  In the end, the GOP will do the best they can with what they have to work with, just like everyone else. Time smooths all wrinkles.

2.  Some of his VERY interesting observations about the Affordable Health Care Act of 2008 (AHCA/2008).

He thinks the AHCA/2008 is unconstitutional because it allows the Federal Government to MANDATE what amounts to a tax by some other name without calling it a tax. There is no precedent for the Government doing that. It is extra-constitutional for the States to do exactly that (Mass), but not the Federales. The most effective way to afford health care for all citizens is simply to create a tax to support it (just like Medicare/Medicaid). The reason that was not done is as soon as any voter hears or sees the word “tax”, they immediately vote against it as a knee jerk. Residents of affluent townships routinely vote against school tax increases that benefit their own children.

So the theory of the AHCA/2008 is technically correct as far as it goes. It definitely does good things for the population. Contrary to some highly biased sources, there is no language in it creating “death panels” and no specific restrictions as to who will be treated. However, there is a 600 lb gorilla sitting in the room. The fact that under current regulations COBRA and EMTALA, everyone presenting for medical care has to be seen and treated to their satisfaction regardless of their ability to pay. So that means there is no incentive for younger, lower risk patients to purchase indemnification and virtually no practical way to make them if they refuse. You can’t get much blood out of turnips. And if they don’t, then the point of spreading the risk to lower the cost is lost.

So, unless the law mandates that anyone that didn’t purchase the plan will be REFUSED medical care if they get sick, the plan can’t work in practice even though it’s technically right minded. And the voters will never sit still for any refusal of service no matter how it’s applied.  So, if the AHCA/2008 is trashed by the SCOTUS in March, we then go back to a system that is very rapidly and reliably going broke. Even if it’s implemented on time in 2013, it’s probably already too late to save our current Medicare/Medicaid system, and the private insurers are already in the process of pricing themselves out of the market.

The reality is that there is only one way to provide health indemnification for all comers in the USA, and that’s where it’s applied in virtually every other country- a straight up National Health Care Service just like the UK does it, with an option for the well-off to purchase more if they can. This from the mouth of a Republican(who knows the system). Traditionally, private indemnification has been a GOP hallmark, but it suffers from a double whammy: 1)  They cannot keep up with the never-ending escalation in cost, and 2) the coming laws disallowing them from cherry picking only low risk patients will finish them, just like it would finish a car insurance agency that was forced to charge drunk drivers the same as safe drivers.

The voters (and the GOP) want it both ways. They want cheap, efficient health care without Government input and they also want unlimited benefits. The Government can’t afford that and neither can the private insurance companies. We will continue on that course until the system we have now collapses, and it will…..in my lifetime. When it collapses, there will be only one way to re-build it. That will be with restrictions as to how much money is spent on non-viable resources, and it will be tied to a GNP. There will be no dialysis after age X, no unlimited ICU stays awaiting the pie-in-the-sky-bye-and-bye-long-shot-cure, no instant MRI for trivial complaints, extremely limited transplantation, no unrestricted ED admission for convenience complaints, and on and on and on. It will be that or it will be nothing. Pay or die.

I have three card carrying Republican friends that I physically see and discuss politics with.  Interestingly, none of these people support Gingrich (or Santorum) and as of today, the day after the South Carolina primary, I’m hearing some pretty tight mouthed grumping.  All three support Ron Paul but all know Paul has no chance of being nominated and so are also willing to vote for Romney rather than take a chance on Obama winning again. All have said recently that, holding their noses, they are on board with Romney because he is the only candidate that has a shot at winning in 2012. The others candidates are more or less in tune with their conservative principles, but all are un-electable. My riding buddy has taught me a lot about Republicans.  They all thought this was a done deal and considered that the others were place markers merely stating a lot of conservative principles all of them bought into but seriously doubted would ever fly in a National election.

Now the Republicans are facing a clear dilemma. They had a shot at the 2012 election from a candidate they weren’t thrilled with but was infinitely better than their mortal enemy Obama. It was just a matter of waiting it out. Then suddenly things changed. Because the State of South Carolina, a radically conservative State, bought into a spirited debate performance by an otherwise unacceptable candidate, they decided to rebel against the self fulfilling prophesy. Almost exactly what happened to Hillary in 2007. Hillary was the heir apparent, there was no way she could lose, it was her karma. She hadn’t really even worked at it. then came a debate performance by someone no one had heard of.

Now, it’s remotely possible that a candidate with an wholly unacceptable past history and even a high unacceptability rating within much of his own party could get the nomination if remaining ultra-conservatives unexpectedly get on board with the revolt.  If Gingrich actually gets the numbers and nails the nomination, that will put him up against an infinitely more powerful enemy that didn’t exist before. Any deficit ascribed to Obama would be put into the perspective of his opponent.

All Republicans fear and loathe the media and Gingrich will go out of his way to fight a war of attrition with them, ultimately to be sucked dry like David Bowie in “The Hunger”.  It’s a battle he will not win and in the end will destroy him.  Those things are downplayed by conservative Republicans because they consider them lesser evils of available issues, but you can be sure that in a general election, they will be considered differently by a more pleuralistic population of voters.

There might have been some more moderate Democrats roll over for Romney out of frustration with Obama’s perceived weak management style. That will never happen with Gingrich. EVERY Democrat will go way out of their way to vote AGAINST Gingrich. Many independents that might have swung toward Romney as a more moderate alternative to Obama will definitely not do so. Many moderate Republicans will vote for Ron Paul out of frustration, essentially voting for Obama by default. unelectable candidates Paul and Santorum will go all the way to the convention out of pure hubris, fighting all the way, and will do everything they can to disrupt the entire process and the GOP will become the part of discord, while Obama smiles from afar. The Republicans will fall on their collective swords on principle and lose infinitely more than they gain.

Now responsible Republicans have gotten what they asked for and they’re going to have to figure out how to fix it.  Gingrich simply cannot win a general election where his spectacularly evil past history on every level will be worked mercilessly by all his enemies including Republicans and Democrats, and his angry unpredictability will be on constant exhibit.  He will spend most of his time denying and explaining, not very convincingly. There aren’t enough truly strident conservative Republicans to put him into the white House and it will be McCain revisited.

• 
  

  ————————————————-
  From Politico.com:  The Iowa caucuses delivered a virtual tie for first place between Mitt Romney and Rick Santorum, with Romney ahead by just eight votes, Iowa GOP chairman Matt Strawn announced early Wednesday. Each carried 25 percent of the vote, with Ron Paul in third at 21.5 percent. Newt Gingrich was in fourth, with 13 percent, Rick Perry in fifth, at 10 percent, Michele Bachmann at 5 percent and Jon Huntsman at 0.6 percent.

  It’s a dead heat tie with much bigger implications.

  It means among other things that there are actually people out there that went out of their way to support a seriously damaged candidate with an extensive record of gaffes, weird behavior and failure as a public servant in Pennsylvania that got him dumped after one term by the largest majority in voting history.  SPECIFICALLY to avoid supporting the only candidate that has any meaningful chance of competing with Obama.  Each and every one of the current candidates still (for a while) in the race is spending more time dumping on the only viable choice than pushing a Presidential agenda. That means that the dissension within the Republican party is such that they are severely damaged before they even go up against the Obama machine, a formidable opponent.

  Lets argue just for grins that the radical right wing of the GOP really is in charge now and they can maneuver to pick a candidate. Lets argue further than that faction has decided after munching on each of the others for a while that Santorum is the best choice to carry their banner. If that were to happen, the GOP would go down in flames like Pierre the French fighter pilot almost immediately.  There’s a reason why Santorum only earned a < 10% share outside the Tea Party enclave of Iowa. He’s not an arrogant, mean spirited asshole like Gingrich, not a brain damaged serial platitude spinner like Bachmann and he’s not a kindly grandfatherly relic of Ayn Rand like Paul. He’s a sober, well meaning person with a history of failure that has no business being allowed to do it all again on a higher level. Not only do 90% of mainstream GOP voters not support him, if he were to be actually selected to run against Obama, every Democrat of any stripe would come from as far away as Venus to specifically vote AGAINST him. It’s Clark’s Law.  The reason Romney has a shot at it is not just because he will appeal to the majority of non-Tea Party mainstream Republican voters in the end, but also because he has the only chance to draw in disaffected Democrats who will NEVER vote for a strongly conservative candidate.

  Accordingly, since I’m doing pretty well in my predictions (I predicted Paul, Romney and Santorum as 1,2,3 in Iowa) 😉 I’ll now push my luck again.

  *  Santorum has gleefully gotten the erroneous message that he can win and will lunge forward with renewed vigor to be beaten by Huntsman (0.6 share in Iowa) in New Hampshire and end up on the bottom (again).  He will then go on to South Carolina and end up 4th or 5th and will then issue forth the “it’s been a great day for conservatives” speech and tearfully drop out.

  *  Sadly, Bachmann drop out and all the late night comics will be forced into retirement. She’ll tearfully issue the “it’s been a great day for conservatives” speech and quietly fade back to converting gays to the path of righteousness.

  *  Paul will continue to be the kindly grandfather with a copy of Atlas Shrugged under his arm and will continue to run every four years until he dies quietly in bed at age 104, then he’ll be cryopreserved by Mike Darwin and run again in the year 3424.

  *  The Grinch will do everything in his power to create as much disaffection within the party for the obvious choice until someone in the power base gives him the “Hillary Call” and tells him to die more quietly. He’s too mean to die however and will eventually be pickled and rolled in and out of conventions in-state like Jeremy Bentham.

  *  Huntsman will have a fair showing in New Hampshire then vanish. He will write a book wondering what it was all about that will sell three copies.

  *  Perry is the one of the clown acts that has correctly observed this is over and has quietly moved out with as much dignity as is possible to muster under the circumstances.

  *  Romney will win New Hampshire big and go on to win South Carolina which will rubber stamp New Hampshire and then this drab, dreary, dreadful, draconian drama will drag to a merciful end. When selected as  the however reluctant GOP candidate, he will continue to reverse virtually every position he’s ever held to appease the Tea Party which will use his photo for target practice on firing ranges.

  That said, it probably doesn’t matter in the grand scheme because the GOP is in the process of tearing itself apart and as long as the economy remains even reasonably stable, it’s highly unlikely voters will dump an incumbent.

The continuing “sky is falling” objections to Obama continue to fade in credibility. And the voters don’t give a shit about the contrived and hateful blogs even if they understood them, which most don’t. The Republicans have been working the theory that if Obama was allowed to continue, they country would be destroyed for about three years now and there is no sign any of it is happening. So as the next election approaches, one would wonder how the voters view that prediction.

In fact, the sky has not fallen and shows no sign of falling. The worst that can be said is that Obama diverted a virtually certain plunge into worldwide depression under Bush to a relatively manageable recession. A recession certain to take another nose dive if Republicans are successful in cutting funds for virtually everything (except the welfare of big business), guaranteeing that every cent of those cuts will directly harm individuals currently hanging by a thread.

Obama may not have been the most stellar choice in 2008, but it must be remembered that the alternative was infinitely worse. McCain- an old man with old ideas. Erratic and unstable behavior. ZERO appearances for ANY environmental votes in the Senate, 95% record of voting with Bush. The continuance of Bush’s tax breaks for the rich, despite voting against them in the past. The vote for torture, despite speaking against it before the vote, his miserable record of support for Veterans’ affairs, the fact that Iraq soldiers gave Obama SIX times the money they give to McCain, and of course the ultimate deal breaker……..Sarah Palin.

McCain figured he would pull in some of the disaffected female vote after Hillary got trashed, but wasn’t smart enough to understand that every one of those females would loathe Palin and the white horse she rode in on. He didn’t bother to vet Palin, who turned out to be a categorical liar, ruthless manipulator and shameless self-promoter with a fifth grade knowledge base.

Clark’s Law held true after a huge majority elected Obama.  The further to one end of the political spectrum a President is, the further to the other end of the spectrum the opposition is willing to go to get rid of him. This explains why anyone completely sober would vote for Christine O’Donnell or Sharron Angle. Reagan was right. A true believer will vote for ANY Republican with even a small chance of winning even if it’s Charlie Manson, the welfare of the country be damned.

The reality is that Obama is not a stellar player but he isn’t the Antichrist either. He’s doing a reasonable job under the circumstances despite a bevy of Republicans that will do ANYTHING to stop his fairly reasonable programs, even at the country’s peril.  Predictions of his demise must be viewed in terms of what else is out there.

Look at the odious Republican slate, generating more fodder from late night comedians than any political group in history.

• Bachmann- I think convincing evidence of brain damage. Duhhhh……extensive history of more malapropisms and non-sequiturs than any politician in history. Has done nothing in her career but complain, not even eloquently.

• Newt (The Grinch) Gingrich. Spectacular evil past history, thrown out of Washington on his ear over 20 years ago for virtually every gaffe possible. Makes Bush look like an amateur and Nixon a punk.

• Santorum- a history of weirdness and strange behavior bordering on sociopathy. Thrown out of Pennsylvania politics by a huge majority for cause.

• Cain- Continues to deny escalating evidence of behavior that even conservative Republicans find abhorrent. 9-9-9 is really 6-6-6 tattooed somewhere him.

• Perry- HAAAAAAAAA, the new millennium clown act. Now parodying himself on late night comedy shows. Dug his own hole now laughing all the way into it.

• Huntsman- The only guy with a half a grain of sense on the slate. Has a zero credibility rating. Letterman won’t even make fun of him. Leno doesn’t know who he is.

• Paul- Has been hyping the same tired libertarian bullshit that doesn’t work in real life for years, has run for President for years and flops every time. Looks bored. I would be.

• Romney- about as colorless as any potential candidate in history, flip-flops on every issue, was beat out by the likes of McCain in 2008.

Of all these insipid players, the only one with a hint of a chance of getting the nod from rank and file Republicans is, obviously, Romney. The rest are all Dead men walking, continuing to be in it for grins and free drinks.  Bachmann is too stupid to know she’s a laughing stock. A further reality is that Romney has no meaningful chance to win for the following reasons:

*  Obama incumbent edge. Voters rarely change horses in the middle of the stream in times of crisis.

*  Republican predictions of the sky falling isn’t happening. They’ll look stupid next summer.*

*  Republicans are increasingly seen as holding up recovery for no other reason than to get Obama out in 20012 by obstructing everything he wants to do, making him seem ineffective.

*  Here’s the big one- the Tea Party and the wacko religious right. They can’t actually do anything constructive but they can lose elections, which they will do in 2012 by fractionating their support (or better yet, forming a third party).  Instead of every single Republican biting the bullet and getting behind one candidate, they will all spread out and dilute the thrust. Democrats may complain about Obama but in the end they will ALL vote for him because the threat of a Republican in the White House is far scarier.

Best selling author Joe McGinnis was on one of the cable book review 
channels yesterday and it was a most interesting interview.

http://www.joemcginniss.net/the-rogue

McGinniss’s real crowning achievement was back in the 80s with “Fatal Vision”; a true masterpiece shat showed what he’s capable of in terms of investigative journalism. But he also showed he wasn’t entirely trustworthy. He started out to write a sympathetic missive about (Dr) Jeff McDonald, who had already been more or less acquitted in the deaths of his wife and daughters in 1970, then was brought to trial again in 1979 for murder based on new evidence. Not that any of it matters but I happened to know personally some of the forensic doctors (and one police officer) deeply involved in the case, including the pathologist that did the autopsy on one of the alleged principals, Helena Stoeckley. But that’s another story.

McDonald is almost exactly my age, born in Oct 1943 and his next parole hearing is in 2020. He will more than likely die in prison. He has never admitted guilt and some psychiatrists think he has convinced himself of his innocence and actually believes the story he gave in 1970, which has been thoroughly discredited at every level. The case remains a prime example of the fact that no matter what the factual evidence of guilt is, someone somewhere will use the media to discount all of it and continue to claim a conspiracy to railroad an innocent. The only difference between McDonald in 1979 and Simpson and Casey Anthony in the new millennium is it’s now almost impossible to find anyone guilty of anything once the media circus fires up.
Interestingly, McGinniss sat through the O.J. Simpson trial intending to write a book about it, but after Simpson was found innocent, he returned the million-dollar advance and refused to write the book, claiming the trial was a “farce”.

McGinniss, like virtually everyone else that looked into this case became quickly convinced that McDonald “couldn’t have not done it”. But he didn’t inform McDonald of his change of heart and continued to be privy to inside information within the defense team. Following the conviction, McDonald published “Fatal Vision” and was immediately sued by McDonald, and had to pay an undisclosed sum (McDonald didn’t get any of it). Janet Malcolm then trashed him in a New York Times editorial for professional irresponsibility. That said, Fatal Vision is a masterpiece must-read, as it very effectively nailed the last spike into McDonald’s defense casket.

McGinniss became interested in the media circus surrounding the Palins as it became apparent that the hype surrounding them didn’t seem to be justified by the real history of their actual accomplishments. So he rented a house right next door to the Palins and set about collecting information about them. McGinniss says there was never an invasion of privacy issue and there seems no evidence of this. He just sat on his porch and tapped into a laptop the aura of folks in Wasilla who chose to be interviewed by him, not very many after the Palins put out the word that political or otherwise retribution would be in order. 

Then begins the tale.

McGinniss usually refers to them as “the Palins” since the husband is deeply involved in everything Sarah does, even as governor. Interviews reveal their propensity to levy retribution on anyone that displeased them, on any level, for extended periods of time. The two-year program of retribution toward the ex-husband of her sister following a bitter divorce, confirmed as an ethics violation by a pluralistic investigation board. It appears many are afraid of her and usually with good reason.

He also points out that she is in fact a real religious right wing advocate as well, and if put in any position of authority would not hesitate to start inserting religions principles she personally advocates into the law wherever possible. He has made numerous speeches in which she has said “the Lord” had guided her and should guide the country as well. All things considered, he paints her as a very scary and expert manipulator of the media and of the public whose program if ever elected would be very different than her rhetoric during a campaign. 

Once the tabloid media got hold of this, as always, a decision was made as to the best way to present it that sold the most access to their sponsors. It was decided to sell it as a personally biased diatribe of a political candidate for the personal aggrandizement of an author who had a history of doing it before. Then, as usual, the march of pundits discrediting McGinniss, none of whom had read the book.

Quoting from his blog: “I was slightly annoyed that the cowardly lion Keith Olbermann, after bashing my book and me on the Bill Maher show–even while admitting that he hadn’t read it–canceled my scheduled appearance with him last week, apparently afraid to confront me face to face”.

So the bottom line is it’s difficult to know how much if any of “The Rogue” is completely truthful or expertly bent to serve the ends of a biased author who can make any fact more or less sympathetic to his cause. One thing is certain-apologists for Palin will never believe a word of it and opponents will take all of it as gospel. The end result is the proverbial dilemma of the irresistible force meeting the immovable object. Most or all of it will continue under the broad rubric of “entertainment” as the real chances of Sarah Palin becoming President approach zero. The book is probably worth a look anyway.

A more sympathetic editorial can be found at:

http://www.nytimes.com/2011/09/18/sunday-review/the-political-provocateur.html?_r=1&pagewanted=all