Dale and I once interviewed Ezra Klein about health care on our podcast. Klein held the VA system up as a shining example of good government health care. Of course that was before the shameful condition of Walter Reed had been discovered. Since then other problems (for instance, contaminated colonoscopy equipment in various locations) have been discovered.
A commenter once asked “if VA is good enough for our veterans, why isn’t it good enough for us.” My answer was “it isn’t good enough for our veterans, it is instead what they’re stuck with.”
Today brings another example of the problems this sort of medicine is bound to have. It is a bureaucratic nightmare, even at the relatively small size of VA.
For patients with prostate cancer, it is a common surgical procedure: a doctor implants dozens of radioactive seeds to attack the disease. But when Dr. Gary D. Kao treated one patient at the veterans’ hospital in Philadelphia, his aim was more than a little off.
Most of the seeds, 40 in all, landed in the patient’s healthy bladder, not the prostate.
It was a serious mistake, and under federal rules, regulators investigated. But Dr. Kao, with their consent, made his mistake all but disappear.
He simply rewrote his surgical plan to match the number of seeds in the prostate, investigators said.
The revision may have made Dr. Kao look better, but it did nothing for the patient, who had to undergo a second implant. It failed, too, resulting in an unintended dose to the rectum. Regulators knew nothing of this second mistake because no one reported it.
That as they say, was the tip of the iceberg. No one reported the problem because there was no peer review. And, this was one of many mistakes made by this doctor that apparently no one knew about:
Had the government responded more aggressively, it might have uncovered a rogue cancer unit at the hospital, one that operated with virtually no outside scrutiny and botched 92 of 116 cancer treatments over a span of more than six years — and then kept quiet about it, according to interviews with investigators, government officials and public records.
The team continued implants for a year even though the equipment that measured whether patients received the proper radiation dose was broken. The radiation safety committee at the Veterans Affairs hospital knew of this problem but took no action, records show.
Six years and no one had a clue. In fact, if you read the article in full, as you should, you’ll see that the discovery of this was essentially an accident.
This is government health care. This is what our vets are stuck with. This is not something we, as a society, should want any part of.
There have probably been moments where I’ve been more disgusted with my country’s leadership, but I’m having great difficulty bringing them to mind. Somehow, having repressive and murderous regimes over for lunch clouds my memory of indiscretions gone by:
The United States said Monday its invitations were still standing for Iranian diplomats to attend July 4 celebrations at US embassies despite the crackdown on opposition supporters.
President Barack Obama’s administration said earlier this month it would invite Iran to US embassy barbecues for the national holiday for the first time since the two nations severed relations following the 1979 Islamic revolution.
“There’s no thought to rescinding the invitations to Iranian diplomats,” State Department spokesman Ian Kelly told reporters.
“We have made a strategic decision to engage on a number of fronts with Iran,” Kelly said. “We tried many years of isolation, and we’re pursuing a different path now.”
The only thing I can think to say is, how dare you?
How dare the representatives of a country founded on freedom from tyranny and the principles of inalienable rights not give any thought — no thought whatsoever — to reexamining its invitation to theocratic sponsors of terrorism who violently deny their own people access to any say in how their lives are governed?
How dare the supposed leader of the free world not ponder, even for a moment, that perhaps treating thuggish dictators as legitimate state actors, on our nation’s birthday no less, might be sending the wrong signal?
How dare the supreme ambassadors of everything we hold dear as a country extend anything more than a single, firmly-flexed digit in the direction of a bully state that clearly has no business pretending to represent the interests of its citizens?
President Obama, how dare you slap your own countrymen in the face with such a rude and thoughtless gesture?
How dare you forgo “thought” on the matter; aren’t you supposed to be the intellectual president … y’know, The One who thinks about things?
I can only hope that our government hasn’t become so comfortable with its own power-grabbing that it fails to recognize blatant state repression when it’s invited over for hot dogs and fireworks.
It’s one thing to hold one’s tongue, or to speak in moderate tones when addressing momentous historical events as they unfold. It’s entirely another thing altogether to look tyranny in the face and smile as you invite it into your home. Even more significantly, our duly elected representative to the world is doing all this on the day to commemorate the culmination of the blood, sweat and tears our forefathers spent in casting off the yolk of dictatorial control so that we might have a nation of laws, and freedom to pursue our own individual happiness — freedoms that our “guests” routinely spit upon. President Obama should be ashamed.
[HT: Hot Air]
UPDATE: Bruce helpfully makes the point I was trying to get at above, but somehow failed to include in my rant:
And, for those who find “hot dogs on the 4th” still acceptable for members of a regime presently engaged in viciously and murderously silencing their own people, on has to assume you believe in rewarding bad behavior by pretending it hasn’t happened. That’s not “diplomacy”, that’s simply an abysmally poor choice that signals weakness.
Obviously we’ve coddled repressive regimes before, to our and their people’s detriment, but I’m not trying to suggest that we simply disengage from any discussions whatsoever. There are times and places for diplomatic discussion, even with tyrannical governments such as Iran’s. While that regime is busy slaughtering peaceful protesters and on a national holiday celebrating our hard-won freedoms is not such a time.
I guess this just wasn’t considered true until the boys at al Qaeda said it was true, huh?
If it were in a position to do so, Al Qaeda would use Pakistan’s nuclear weapons in its fight against the United States, a top leader of the group said in remarks aired Sunday.
Not only would it use Pakistan’s nuclear weapons, it would use Iran’s, North Korea’s, Russia’s or anyone else’s they could get their hands on.
And that says what? That we have every reason to consider it a national security priority to ensure a) they (AQ) don’t get their hands on such weapons and b) those nations most likely to develop them and hand them over to AQ don’t get the opportunity to do so.
Anyone – what would be an indicator that a regime might hand that sort of weapon over to AQ?
Answer? If the regime already actively supports terrorists and supplies them with weaponry .
I’ll leave it to you to figure out which country that is and why now is a perfect time to be taking a much stronger stand in support of dissenters there. If you’re still in the dark, read this interview, especially the last few paragraphs. If what the interviewee says is true, we’re talking sea change, folks.
Frankly, that’s precisely what’s going on with the developing situation in Iran. Our President is both inexperienced and naive, and in the world of foreign relations, that can be a fatal mix.
As I pointed out about Gitmo below, the president hadn’t done his homework when he announced his pre-election decision to close the prison there. And, as mentioned, his decision has been a fiasco.
Iran is the same sort of problem for him. He announced a policy of engagement as though nothing of the sort had ever been put forward before. And, in so announcing his policy, he apparently didn’t understand or chose to overlook the fact that two of the regimes about which he spoke (Iran and NoKo) had absolutely no real desire to engage him.
Part of the problem is Obama believes the hubris about his abilities. Unfortunately, the Iranian regime doesn’t and has no real reason or necessity to actually engage him. Professor Faoud Ajami takes Obama to task over his performance so far:
Mr. Obama may believe that his offer to Iran is a break with a hard-line American policy. But nothing could be further from the truth. In 1989, in his inaugural, George H.W. Bush extended an offer to Iran: “Good will begets good will,” he said. A decade later, in a typically Clintonian spirit of penance and contrition, Secretary of State Madeleine Albright came forth with a full apology for America’s role in the 1953 coup that ousted nationalist Prime Minister Mohammed Mossadegh.
Iran’s rulers scoffed. They had inherited a world, and they were in no need of opening it to outsiders. They were able to fly under the radar. Selective, targeted deeds of terror, and oil income, enabled them to hold their regime intact. There is a Persian pride and a Persian solitude, and the impact of three decades of zeal and indoctrination. The drama of Barack Obama’s election was not an affair of Iran.
Obama obviously thinks more of his abilities to persuade than are proven on the world stage. Again hubris. The magic “Cairo speech” which is assumed to have done in a week or so what wasn’t possible for decades in the region:
That ambivalence at the heart of the Obama diplomacy about freedom has not served American policy well in this crisis. We had tried to “cheat” — an opening to the regime with an obligatory wink to those who took to the streets appalled by their rulers’ cynicism and utter disregard for their people’s intelligence and common sense — and we were caught at it. Mr. Obama’s statement that “the difference between Ahmadinejad and Mousavi in terms of their actual policies may not be as great as had been advertised” put on cruel display the administration’s incoherence. For once, there was an acknowledgment by this young president of history’s burden: “Either way, we were going to be dealing with an Iranian regime that has historically been hostile to the United States, that has caused some problems in the neighborhood and is pursuing nuclear weapons.” No Wilsonianism on offer here.
Mr. Obama will have to acknowledge the “foreignness” of foreign lands. His breezy self-assurance has been put on notice. The Obama administration believed its own rhetoric that the pro-Western March 14 coalition in Lebanon had ridden Mr. Obama’s coattails to an electoral victory. (It had given every indication that it expected similar vindication in Iran.)
But the claim about Lebanon was hollow and reflected little understanding of the forces at play in Lebanon’s politics. That contest was settled by Lebanese rules, and by the push and pull of Saudi and Syrian and Iranian interests in Lebanon.
Mr. Obama’s June 4 speech in Cairo did not reshape the Islamic landscape. I was in Saudi Arabia when Mr. Obama traveled to Riyadh and Cairo. The earth did not move, life went on as usual. There were countless people puzzled by the presumption of the entire exercise, an outsider walking into sacred matters of their faith.
As someone said, it’s 3am and Obama is continuing to hit the snooze button. He needs to learn very quickly, and especially when it comes to foreign affairs, that you can’t vote “present” when you’re the President of the United States.
Michale Barone, observing the Obama presidency as it unfolds, has penned his own “Three Rules of Obama”.
First, Obama likes to execute long-range strategies but suffers from cognitive dissonance when new facts render them inappropriate.
Barone cites Obama’s long range strategy of conciliatory diplomacy with the likes of Iran and North Korea being “undercut by North Korea’s missile launches and demonstrations in Iran against the mullah regime’s apparent election fraud.”
His assumption that friendly words could melt the hearts of Kim Jong Il and Mahmoud Ahmadinejad have been refuted by events. He limits himself to expressing “deep concern” about the election in the almost surely vain hope of persuading the mullahs to abandon their drive for nuclear weapons, while he misses his chance to encourage the one result — regime change — that could protect us and our allies from Iranian attack.
Obama apologist continue to insist his policy of “restraint” is the right course. Events and history seem to argue otherwise. Bottom line: not very agile when his presumptions are shattered.
Second, he does not seem to care much about the details of policy.
The “closing” of Guantanamo is perhaps the perfect example. Obviously politically satisfying at the time it was announced, its execution has been an absolute fiasco. None of the underlying problems of closing the prison had apparently been researched or considered when the promise was made.
And that’s not the only example:
He subcontracted the stimulus package to congressional appropriators, the cap-and-trade legislation to Henry Waxman and Edward Markey, and his health care program to Max Baucus. The result is incoherent public policy: indefensible pork barrel projects, a carbon emissions bill that doesn’t limit carbon emissions from politically connected industries, and a health care program priced by the Congressional Budget Office at a fiscally unfeasible $1,600,000,000,000.
Obama sees himself as the grand vision guy and it is up to his minions to put his vision together. Of course, that sort of outsourcing is bound to come up against competing agendas. He doesn’t seem to take that into account, apparently doesn’t do the necessary work to assure his version of his agenda is the dominant one and the result is chaos. Bottom line: his legislative and executive inexperience is the worst enemy of his aggressive agenda.
Third, he does business Chicago-style.
“Transparency” and “openness” are now just a words as he and his administration begin to insist on more and more executive privilege. And there’s also the example of the IG mess, not to mention the stories of threats and intimidation toward auto company bond holders and banks.
From Chicago he brings the assumption that there will always be a bounteous private sector that can be plundered endlessly on behalf of political favorites.
Just ask the UAW (and other unions) and ACORN. And Barone uses precisely the right word here – plunder. All of his grand plans are based on plundering the rich and redistributing the spoils to favorites. A more destructive presidency is hard to imagine.
Hope and change.
Jim Lindgren at The Volokh Conspiracy says the White House is backing off of the promises Barack Obama made in his speech to the AMA.
You remember the promises:
If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.
Where I come from those sound like pretty straight-foward promises, wouldn’t you say? But Lindgren cites Mike Gonzales at the Heritage Foundation:
Less than 24 hours after Heritage Foundation President Ed Feulner questioned the veracity of President Obama’s persistent claim that, under his health care proposals, “if you like your insurance package you can keep it”, the White House has begun to walk the President’s claim back. Turns out he didn’t really mean it.
According to the Associated Press, “White House officials suggest the president’s rhetoric shouldn’t be taken literally: What Obama really means is that government isn’t about to barge in and force people to change insurance.” How’s that for change you can believe in?
Depending on how the public plan is designed in Congress, millions of Americans would lose their existing coverage. By opening the public plan to all employees and using Medicare rates, the Lewin Group, a nationally prominent econometrics firm, has said that the public plan could result in 119.1 million Americans being transitioned out of private coverage, including employer based coverage, into a public plan. With employers making the key decision, millions of Americans could lose their private coverage, regardless of their personal preferences in this matter.
So the public plan will see those who have health care plans they like (and doctors) at the mercy of a distorted market (distorted by government intrusion and artificial pricing) which will see employers dump coverage of the present health care plans in favor of the public plan. How such a plan “fixes” anything remains a mystery.
However, for the record Lingren reformulates the Obama “promises”:
When Obama said he “will keep this promise”:
If you like your doctor, you will be able to keep your doctor. Period.
he actually meant:
If you like your doctor, many of you will NOT be able to keep your doctor. Period.
And when Obama said he “will keep this promise”:
If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.
Obama really meant:
If you like your health care plan, many – perhaps most – of you will NOT be able to keep your health care plan. Period. Someone – perhaps your employer – may take it away. It all depends on how things work out.
Hope and change.
In this podcast, Bruce, Michael, and Dale discuss the Letterman/Palin controversy, and the situation in Iran.
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.
If ever there was a text book example of a false premise wrapped in an absurd ‘moral’ analogy, Glenn Smith at Firedoglake provides it:
The gravity of America’s health care crisis is the moral equivalent of the 19th Century’s bloody conflict over slavery. This is not hyperbole, though the truth of it is often lost in abstract talk of insurance company profits, treatment costs, and other cold, inhuman analyses.
Today’s health system condemns 50 million Americans to ill health and death while guaranteeing health care to the economic privileged. It cannot stand.
About 18,000 Americans die each year because they lack health insurance. That’s more than a third the number of lives lost in battle during each year of the four-year Civil War.
Heh … you have to love the attempt to wave off this hyperbole by simply declaring it isn’t hyperbole. But I would hope that it is evident to any rational thinker that the attempt here is to equate those who resist the intrusion of government into the realm of health to those who fought to retain the institution of slavery.
This is, instead, a plain old rant against capitalism and the free market cloaked in this absurd moral equivalence Smith invents. Seeing the liberal goal of government run health care being battered by real world realities, he’s decided he has to turbo-charge his argument for such change by defining down the horror of slavery in order to find a moral equivalence he can use as a bludgeon on the dissenters.
Don’t believe me? How about this:
Members of Congress without the moral clarity to recognize this equivalence will be condemned by history. Their spinelessness and lack of will when confronted with the power of the insurance industry is just as morally bankrupt as the American congressmen who bowed to Southern slave-owners.
The morally compromising efforts to pass health care reform that insurance companies might like is as insane as the compromises over slavery.
The health insurance industry earns its profits from the denial of coverage and benefits. It’s not so different from the Southern plantation owners who earned their profit from slave labor. The latter had their economic justifications for their immorality. So do the insurance companies.
Of course, this sort of nonsensical thinking muddles important concepts that underlie the inalienable rights of man. Slavery was a violation of man’s right to his own life. Health care insurance is nothing more than a tool that helps pay for a person’s health care. Health care is not “unavailable” to those who don’t have it. More importantly, health care is not a right.
Whereas slave owners physically denied slaves the freedom to pursue their lives, insurance companies do not stop anyone from pursuing their own health care.
But – they have to pay for it because it entails the use of the time, abilities and services of others. That is what people like Smith really object too. Read the nonsense in the paragraph above and that’s clear. And, as many extremists like to do (like those who claim, for instance, that those who don’t agree on AGW are akin to Holocaust deniers), he chooses the most inflammatory but false “moral” example he can choose to demonize his opposition, counting on the dearth of critical thinking these days to win their point.
Unfortunately, it is more successful than I’d like to admit, which is why it is important to refute it immediately when it crops up.
I believe the answer is “yes”. It has to do with the breaking of the aura of divine authority coming from the ruling mullahs and casting doubt, among the people, on the belief that the theocracy is divinely sanctioned.
Fareed Zakaria offers an excellent summary of the point:
CNN: Do you mean you think the regime will fall?
Zakaria: No, I don’t mean the Iranian regime will fall soon. It may — I certainly hope it will — but repressive regimes can stick around for a long time. I mean that this is the end of the ideology that lay at the basis of the Iranian regime.
The regime’s founder, Ayatollah Ruhollah Khomeini, laid out his special interpretation of political Islam in a series of lectures in 1970. In this interpretation of Shia Islam, Islamic jurists had divinely ordained powers to rule as guardians of the society, supreme arbiters not only on matters of morality but politics as well. When Khomeini established the Islamic Republic of Iran, this idea was at its heart. Last week, that ideology suffered a fatal wound.
CNN: How so?
Zakaria: When the supreme leader, Ayatollah Ali Khamenei, declared the election of Mahmoud Ahmadinejad a “divine assessment,” he was indicating it was divinely sanctioned. But no one bought it. He was forced to accept the need for an inquiry into the election. The Guardian Council, Iran’s supreme constitutional body, met with the candidates and promised to investigate and perhaps recount some votes. Khamenei has subsequently hardened his position but that is now irrelevant. Something very important has been laid bare in Iran today — legitimacy does not flow from divine authority but from popular support.
CNN: There have been protests in Iran before. What makes this different?
Zakaria: In the past the protests were always the street against the state, and the clerics all sided with the state. When the reformist president, Mohammed Khatami, was in power, he entertained the possibility of siding with the street, but eventually stuck with the establishment. The street and state are at odds again but this time the clerics are divided. Khatami has openly sided with the challenger, Mir Hossein Moussavi, as has the reformist Grand Ayatollah Montazeri. So has Ali Larijani, the speaker of the parliament and a man with strong family connections to the highest levels of the religious hierarchy. Behind the scenes, the former president, Akbar Hashemi Rafsanjani, now head of the Assembly of Experts, another important constitutional body, is waging a campaign against Ahmadinejad and even the supreme leader himself. If senior clerics dispute Khamenei’s divine assessment and argue that the Guardian Council is wrong, it is a death blow to the basic premise behind the Islamic Republic of Iran. It is as if a senior Soviet leader had said in 1980 that Karl Marx was not the right guide to economic policy.
Once the genie is out of the bottle in this sort of a situation it is pretty much impossible to get it back in. The split among the mullahs, who have, in the past, always sided with the regime, is a critical point. Someone comes out of this being declared “wrong” (whether they actually are or not). And the split will remain even of those declared “wrong” are replaced. As Zakaria points out, the very fact that some mullahs have acknowledged that there may be some credibility to the charges of vote fraud and are willing to investigate it is a huge blow to the legitimacy of “divine authority” (which originally supposed “approved” this election), the power of the mullahs and Ahmadinejhad.
I agree with Zakaria that it is indeed a mortal blow to the basic premise behind Iran’s government. How long it will take for that blow to finally kill the regime is, as of yet undetermined. But I think the assumption that it is merely a matter of time is basically correct.
Certainly the regime may muster the force necessary to put the protests down at this moment. But the powder keg will remain, just waiting for the proper detonator event to blow it sky high. I don’t think these protests are going to stop any time soon. And at some point, if the protesters keep the pressure on, the tide is going to begin to turn. The ability of the regime to muster the will and the thugs to do this over and over again is, at some point, going to fail.
It always does.
My question is, will whatever government eventually takes the helm there see the US as a supportive ally in their quest for freedom or a country that sat on the sideline, mouthing platitudes and trying to keep their options open with the oppressive regime now gone (on this particular question, Fareed Zakaria and I seem to disagree)?