This story typifies, at least to me, the problem we can expect in the health care field if government becomes even more involved than it is now:
Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.
The trend for years has been away from general practice and toward specialties. Part of that stems from the fact that specialists are paid more than generalists.
Most of us understand that most of our medical care will take place in our latter years with the obvious exception of certain genetic and chronic diseases which afflict a portion of the younger population. So Medicare, which kicks in at 65 whether you want it or not, is a major payer (and player) to family practice doctors who care for older Americans that make up the bulk of their practice.
With that being the case, we’re seeing fewer and fewer medical students option to become family practitioners, preferring the more lucrative pay specialists earn. The consequent result of low pay, huge patient loads and little recourse for changing that has seen family practice numbers in medical universities drop alarmingly. Why spend all that time and money learning a particular craft when the rewards aren’t as great as you want?
So here we have the market for family practitioners reacting to a distortion in the market created by the government refusing to pay at what the doctors feel is an adequate rate for the treatment of the majority of their patients. The market’s feedback mechanism sends the signal to the potential doctor to look at areas which would be more lucrative than family practice to receive adequate compensation. That area is specialization.
The reason I bring this particular example up is the competing proposals. One say, “hey, if you want more family practitioners, pay them more – that provide the incentive to become a generalist”. On the other hand, there’s a proposal to do that, but to accomplish that increase at the expense of specialists who take medicare.
How do you suppose specialists will react? Well if they do as two of mine have, they’ll simply say, “sorry, we don’t treat Medicare patients”.
And how do you suppose such a decision would effect the number of family practitioners. Well, that would depend on how much they’re willing to increase payments to them.
In the era of massive budget cuts and the promise by government to “decrease” the costs of health care, any increase in my estimation, would by minimal and not enough to change the tide concerning family practice. But taking that increase out of what is paid specialists certainly might be the tipping point for many of them to declare they’ll no longer treat Medicare patients.
Certainly our old friend the Law of Unintended Consequences again at work.
You know, when you’re in DC it seems such a calm and beautiful place, and yet, the cynical machinations of politicians continue unabated.
We now have Nancy Pelosi under fire for essentially sanctioning the “advanced interrogation techiniques” by not speaking up against them or opposing them when she was briefed about their use many years ago:
Nancy Pelosi didn’t cry foul when the Bush administration briefed her on “enhanced interrogation” of terror suspects in 2002, but her team was locked and loaded to counter hypocrisy charges when the “torture” memos were released last week.
Many Republicans obliged, led by former CIA chief Porter Goss, who is accusing Democrats like Pelosi of “amnesia” for demanding investigations in 2009 after failing to raise objections seven years ago when she first learned of the legal basis for the program.
She and her staff can be as “locked and loaded” as they wish, but the fact remains that she’s said nothing about the use of those techniques for 7 years – not a single, solitary word to anyone about opposing them on any grounds.
So the use of these techniques wasn’t something which was going on in a dark corner out of the view or knowledge of Congressional leadership. Democrats have tried to sell that as the “conventional wisdom” – a fascist and authoritarian president making decisions that violate human rights behind closed doors and without the knowledge of the enlightened Dems who would surely have stopped it if they had only known.
But they did know – and said nothing. In the realm of Washington politics that is the same as giving something sanction.
More importantly, Democrats would like for you to believe that these things took place due to an out-of-control executive branch. However, and as usual, this all took place because both Republicans and Democrats in Congress allowed it to take place. When you have the information necessary to stop something you supposedly oppose and do nothing, you become as complicit as anyone.
So as I said in the beginning, Pelosi’s staff as “locked and cocked” as they wish, and they can spin it until they puke, but the fact remains she can’t plead ignorance and she certainly can’t say she did or said anything in opposition, and that that speaks louder than anything her spin machine can gin up in her defense.
Whether or not you agree with the use of the techniques doesn’t change the fact that when it came to “put up or shut up” time where leadership and principle were called to the fore, Nancy Pelosi blew it and any criticism or spin she or her staff now puts forward has the horrific stench of hypocrisy emanating from it.
In this podcast, Michael, and Dale discuss the torture memos and their possible legal consequences, and the possible securities law violations that the treasury committed in administering the TARP program.
The direct link to the podcast can be found here.
The intro and outro music is Vena Cava by 50 Foot Wave, and is available for free download here.
As a reminder, if you are an iTunes user, don’t forget to subscribe to the QandO podcast, Observations, through iTunes. For those of you who don’t have iTunes, you can subscribe at Podcast Alley. And, of course, for you newsreader subscriber types, our podcast RSS Feed is here. For podcasts from 2005 to 2007, they can be accessed through the RSS Archive Feed.
Patterico WLS, posting at Petterico’s “Jury” blog points out that, despite all the calls for prosecuting “former Bush officials” over the torture memos and the actions taken under their aegis, he wonders, as an actual prosecutor, who would be charged with a crime, and what, exactly, the crime would be.
In mulling over the news of the past few days, I’m curious as to what the critics of the Bush Administration see as plausible criminal charges against the officials who were responsible for the drafting/authorizaiton [sic] of the “Torture” memos.
It would be one thing to actually prosecute the CIA officials involved in carrying out the interrogations…[b]ut they would likely have the time-honored defense of “advice of counsel” which works to negate the mens rea (”guilty mind) necessary to establish knowing criminal conduct. When the top law enforcement officials of the US government tell another component of the US government that the conduct they are proposing to carry out on behalf of the government is not prohibited by statute, it’s exceedingly difficult — if not impossible — to mount a successful prosecution against any government official who acted in accordance with the advice…
Prosecuting the officials who offered the advice is a different question. But what would be the charge? It can’t be “Torture” under the statute — they didn’t do anything. They simply responded in their official capacity to a question raised by another governmental entity… Why is the ANALYSIS of the specific technique described in the memos — concluding it would not fall within Sec. 2340 — wrong?
Fair questions indeed.
The officials who wrote the memos were acting as lawyers providing legal advice over the meaning of a statute. Perhaps that advice was wrong. But is providing an erroneous legal opinion a crime? If so, what, exactly, would the crime be? You would have to prove that the advice was completely and knowingly concocted from whole cloth and/or that the concocted legal advice was part of conspiracy to commit torture. In that case, you’d have to find evidence of specific collusion between the CIA and DOJ to knowingly concoct spurious justifications.
Absent such evidence, all you have is lawyers providing legal advice that the current administration doesn’t like. In that case, I don’t see what the prosecutable offense is.
Taking it further, the CIA officials who actually conducted the torture have a very good defense, namely, that the formal legal advice they received from the government’s top lawyers at the DOJ was that the specific techniques they used fell outside the meaning of §2340. In that case, they cannot have known they were committing a crime, but rather, they believed they were, on the advice of counsel, acting entirely within the law. So, unless there’s evidence that the interrogators went off half-cocked and began using non-approved techniques in the questioning, it’s difficult to see what the crime would be on the part of the interrogators themselves.
With the above in mind, it’s difficult to construct any other scenarios in which any of these of officials are prosecuted without it becoming, in effect, a criminal prosecution for partisan policy differences.
Whatever else that might be, it is not the Rule of Law as it is commonly understood.
USA Today says the public sees Obama’s first 100 days as a “strong opening”.
But when you get in the number of the USA TODAY/Gallup Poll, it’s not quite as strong an opening as you might expect:
Now, 56% say he has done an “excellent” or “good” job as president vs. 20% who rate him as “poor” or “terrible.” An additional 23% say he has done “just OK.”
His excellent/good rating on national security is 53%. On the economy, it is 48%.
“He is seen as someone who was handed a large array of challenges and is dealing with them in a sensible way,” adviser David Axelrod says.
Those are lower numbers than I expected. And certainly very interesting numbers on the most pressing interest of the day – the economy. Those numbers also signal to me that this is now considered the “Obama economy” now, whether deserved or not.
As for national security, I’m not sure what rates the number – he’s really not done anything concerning national security except do a little talking about the subject. And, despite claims to the contrary, SEALs taking out three rag-bag pirates who botched a highjacking was not a victory on the national security front.
While I appreciate the fact that we’re hearing a more positive spin from the Obama administration concerning the economy, the so-called “glimmers of hope” aren’t really anything but outliers.
Worse-than-expected news on unemployment and home sales Thursday dampened optimism that a broad economic recovery might be near.
Jobs losses aren’t expected to bottom out until the middle of 2010 and the housing market hasn’t bottomed out yet either:
Meanwhile, the National Association of Realtors said sales of existing homes fell 3 percent in March to a seasonally adjusted annual rate of 4.57 million units, with February revised down to 4.71 million units. Sales had been expected to fall to an annual rate of 4.7 million units, according to Thomson Reuters.
Per the analysis, the best reading of these economic indicators is that perhaps the “free fall” is coming to an end.
“The economic downturn remains intense, but it is no longer intensifying,” said Mark Zandi, chief economist at Moody’s Economy.com. “We are still falling, but we are no longer crashing.”
So, while we may have passed what some are terming the “crisis stage”, the economy is still contracting. I’m coming to believe that we may not see any real and meaningful “glimmers of hope” until mid 2010.
Patterico brings us some good news about Ted Rall:
I don’t normally gloat when someone loses their job, but for this tool, I’m willing to make an exception. Especially given that his “job” consists of comparing U.S. soldiers to suicide bombers; mocking widows of terror victims; profiting from Pat Tillman’s death; assuming the voice of Iraqi soldiers talking about killing American soldiers; making leftist political hay out of the Nick Berg beheading; lying about lefty blogger vitriol; and suing a guy for making him appear to be a “rude, petty, self-absorbed writer/cartoonist” (which is what he is).
I normally don’t celebrate anyone being laid off – but in Rall’s case I’ll make an exception.
Rall will reemerge, unfortunately, but for the time being, he hasn’t the well funded platform from which to spread his crap. I personally find that to be a net positive.
We’re known here at this blog for being adamant about denouncing plans which appease terrorists. It’s a absolute no-win situation for the appeaser. Pakistan is now in the middle of learning that hard lesson:
Pakistan’s strategy of trying to appease Taliban militants is showing signs of backfiring, as extremists move within 60 miles of the capital and threaten to spread their influence throughout the country.
Really? What a surprise. They caved to the Taliban demands and allowed them to impose Sharia law in the Swat valley in return for promises the Taliban would lay down their arms.
And, unsurprisingly, the Taliban have reneged on the promise. That, of course, has Hillary Clinton huffing and puffing at Pakistan:
Secretary of State Hillary Rodham Clinton warned Wednesday that Pakistan’s government is “basically abdicating to the Taliban” by agreeing to let them implement Islamic law in the Swat region last week. Instead of putting down their weapons, as the government had hoped, the insurgents have since moved fighters into the neighboring Buner region, local lawmaker Istiqbal Khan said.
Of course that’s precisely what appeasement buys with zealots. Absolutely nothing except an even weaker position for the appeasers.
Additionally, the Taliban have turned the Swat valley into a theocratic hell while the Pakistani government stands by and tut-tuts:
President Asif Ali Zardari has blamed the Taliban for a wave of assassinations in Swat in recent months, and he condemned a recent video that showed militants flogging a young woman they accused of having an improper relationship.
There is a glimmer of good news however. There seems to be a public backlash building among Pakistanis with even conservative members of the Pakistani parliament distancing themselves from the militants. However in the complicated world of Pakistani politics, that may end up meaning nothing in a real sense as the Taliban, who recognizes no authority and certainly no obligation to live up to any promises, relentlessly pushes to expand its hold on northern Pakistan.
Or so claims David Axelrod.
Apparently Fidel Castro didn’t get the memo:
…At the press conference, as well as in the final meetings of the Summit, Obama looked conceited.
It’s an interesting little diatribe from Casto, and most of it is the usual nonsense, but what it easily demonstrates is Axelrod is as clueless as I asserted a couple of days ago.
Castro saw through most of the Obama rhetoric and unlike a vast number of Americans, figured it out:
When the US President said, in answering to Jake [Tapper], that thousands of years had elapsed since 2004 until the present, he was superficial. Should we wait for so many years before his blockade is lifted? He did not invent it, but he embraced it just as much as the previous ten US presidents did.
That’s the Cuban version of “meet the old boss, same as the new boss …”.
And my favorite:
Leaders just pass through; peoples prevail. There would be no need to wait for thousands of years to pass by; only eight years will be enough so that a new US President — who will no doubt be less intelligent, promising and admired in the world than Barack Obama- riding on a better armored car, or on a more modern helicopter, or on a more sophisticated plane, occupies that inglorious position”
Yup – completely charmed and impressed by our new leader, no?
Castro picks up on and states what he saw – conceit and superficiality. My guess is he wasn’t the only Latin American leader who came away with that impression.