Thursday, December 30, 2010

An unhelpful distraction from an important national discussion

Today the Naples Daily News ran a commentary on its Editorial Opinion page titled “Death panels? Palin’s warnings coming true,” and yesterday it ran one titled “Politically-motivated end runs ignore our Constitution.” As I predicted in a post on my health care blog on Sunday, the death panel discussions are back.

A reader suggested I forward Sunday’s post to the Naples Daily News for publication, and after reading these two pieces, I decided to do just that. I did some more research, tweaked and edited. Below is what I submitted earlier today. Hopefully it will be printed.
An unhelpful distraction from an important national discussion
On Sunday, the New York Times reported that starting January 1, “the government will pay doctors who advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.”

Since then, much has been written about this, and today the Naples Daily News printed an opinion piece by Cal Thomas, a conservative columnist and FOX News regular, titled “Death panels? Palin’s warnings coming true.”

Needless to say, there’s another interpretation. But first, the facts.

One of the new Medicare benefits under the Affordable Care Act is coverage for an annual wellness visit beginning in 2011.

According to the regulation, “the annual wellness visit will include the establishment of, or update to, the individual’s medical/family history, measurement of his/her height, weight, body-mass index or waist circumference, and blood pressure, with the goal of health promotion and disease detection and encouraging patients to obtain the screening and preventive services that may already be covered and paid for under Medicare Part B.”

The annual wellness visit can – “upon agreement with the individual” - also include “voluntary advance care planning,” which is defined in the regulation as “verbal or written information regarding an individual’s ability to prepare an advance directive in the case where an injury or illness causes the individual to be unable to make health care decisions, and whether or not the physician is willing to follow the individual’s wishes as expressed in an advance directive.”

An advance directive is a general term that describes two kinds of legal documents, living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should he or she be unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently; in Florida they are regulated by the Florida Agency for Health Care Administration.

This is the context within which the “death panel” fear-mongering is being revisited.

Unless we as a nation begin to tackle health care spending in the final weeks and months of life, we won’t really be able to control health care costs. Statistics abound, but here are just a few from a recent PBS Frontline special “Facing Death:” 

  • Nearly 70 percent of Americans die in a hospital, nursing home or long-term-care facility, yet 7 out of 10 Americans say they would prefer to die at home.
  • More than 80 percent of patients with chronic diseases say they want to avoid hospitalization and intensive care when they are dying.
  • Almost a third of Americans see 10 or more physicians in the last six months of their life.
  • Patients with chronic illness in their last two years of life account for about 32 percent of total Medicare spending.
  • Medicare pays for one-third of the cost of treating cancer in the final year, and 78 percent of that spending occurs in the last month.
  • One large-scale study of cancer patients found that costs were about a third less for patients who had end-of-life discussions than for those who didn't.
Personally, if I’m miserable and in pain, with no realistic chance of a cure, I can think of nothing worse than having my life prolonged by a lot of costly and ultimately useless procedures in a hospital or nursing home. It’s good to know that I can make plans before that happens so I’m cared for according to my wishes. That’s why I’m going to have a discussion about end-of-life care with my internist and prepare an advance directive, even though I’m not yet covered by Medicare.

And given the many competing needs for government funding, I think we as a nation need to begin the discussion of just how much end-of-life care should be paid for with our limited tax dollars. Allowing Medicare to pay doctors to advise patients – with their consent - about their options for end-of-life care is a reasonable, necessary, and important first step toward addressing this difficult issue.

Bandying about the phrase “death panels” is an unhelpful distraction from an important national discussion.

We have to get out ahead of this issue. Please consider sending a letter to the editor of your own local newspaper. Help offset the cries about death panels!

Friday, December 17, 2010

Obama and the tax deal – triangulating or governing?

A friend and I got into a heated discussion the other day about whether Obama had fought hard enough for the Democratic agenda in the tax deal he negotiated with the Republicans. My friend, really angry, said he hadn't. He also said he thought Obama should have fought harder for a single-payer health care plan.

Our discussion was a microcosm of the debate raging among Democrats throughout the country. The liberal-left side of the debate says Obama has no principles and isn’t willing (or tough enough) to fight for anything. I’m on the other side. Compromise – important even after winning the White House and Congress in 2008 because of the broad range of views among Democrats - became critical when Democrats lost their filibuster-proof majority in the Senate last January. And it will be even more so going forward, given Democrats’ weakened position in both houses since November.

I view Obama’s tax compromise as a good and pragmatic way to put what happens to the expiring tax cuts behind us in the hope of getting the New START treaty, repeal of Don’t Ask Don’t Tell, and maybe even the DREAM Act passed in the lame-duck session.

Matt Bai framed the debate in the context of triangulation vs. governing in his insightful piece in today’s New York Times titled “Is ‘Triangulation’ Just Another Word for the Politics of the Possible?” when he asked, “Is President Obama himself a triangulator? Has he become the kind of compromiser he once disdained? Perhaps the better question might be: So what if he has?”
“Again and again, we have Democratic presidents who say, ‘Don’t make the perfect the enemy of the better,’ and ‘This is the best I can do,’ ” says Robert Reich, the liberal economist and former labor secretary under Mr. Clinton. “And over and over we have Republican presidents who say, ‘I am going to hold out for my principles.’”

In this more expansive sense of the epithet, one can reasonably tag Mr. Obama as a triangulator. In striking his tax deal — which extended cuts for the highest income levels and reinstated the estate tax at a much lower rate than sought by liberals, while also extending unemployment benefits and establishing a new payroll tax holiday — Mr. Obama effectively said that the perfect could not be the enemy of the better, and that this was the best he could do.

The problem with this definition of triangulation, though, is that it comes awfully close to an indictment of governing, generally. Some political compromises, of course, are craven or even disastrous; there’s a reason that the words “appeasement” and “Yalta” remain part of the lexicon. But to disdain pragmatic compromise is to become unyielding and self-satisfied in the service of theory, rather than creative in the service of your agenda. ...

Perhaps Mr. Obama could have won a more progressive resolution to the tax-cut debate had he and Congressional Democrats taken up the issue earlier this year, when the deadline wasn’t so close and when the president could have mounted a sustained public campaign. But as it stands, the deal Mr. Obama got, while no one’s idea of perfect, will pump hundreds of billions of dollars in consumer and business tax breaks into a languishing economy, while also aiding the unemployed and easing the tax burden on a strained middle class.

On the other hand, had Mr. Obama held the line on principle and allowed all the cuts to expire, as some Democrats would have preferred, the public debate in January would most likely have come down to which of the two parties was responsible for letting middle-class taxes rise during a recession. It’s an argument that Democrats, historically vulnerable on taxes and already fending off charges of expanding government, would probably have lost.

Such compromises, ideal or not, are the building blocks of responsible governance. If that makes Mr. Obama some kind of triangulator, then it could also make him a successful president.

My friend Greg Hudson also thinks the tax compromise was the right thing to do, noting the various stimulus measures Obama got in return. In his excellent post today titled “Obama-GOP Tax Deal Okay for Now--But Just for Now” Greg writes:
... now is not the time to advance a position on principle that runs the risk of stoking unnecessarily class antagonisms by unwisely setting up "taxing the rich" as a deal killer. Especially when the definition of rich does not resonate with a lot of professionals and small businessmen. Surely the Dems have got to be more practical than that--especially if they have any hope of bi-partisan work accomplishing anything for the country in the next congress.

No, too many Dems either failed to see the deal in the right light or, more likely, were too full of themselves, self-righteous or spiteful to deign to compromise with the Republicans. In the right light, this whole legislative package should be seen primarily as a kind of "stimulus" package--if not to add federal stimulus, at least not to take it away. That, I believe, was Obama's objective, and it appears he got the right deal done--despite many Democrats, including the abstaining lame-duck Speaker Pelosi. In the end, she just is who she is: a reliable, estimable social advocate and champion of the Democratic left wing, but not an effective leader in the difficult, often unsatisfying work of managing incremental legislative progress in a negotiated bi-partisan process.

Between now and 2012, Democrats are going to have to learn to appreciate the need for compromise and – as Greg says - the art of "managing incremental legislative progress in a negotiated bi-partisan process."

Call it triangulation if you will, but unless they do, Obama is sure to lose the next election.

Friday, December 10, 2010

Pay attention, we must...

As you may have noticed, I’ve not done much blogging since the election on November 2nd. I am still depressed about the loss of Democratic seats in Congress and the election of Rick Scott as governor here in Florida. I’ve been trying to focus only on the positive – or at least not to dwell on the negative – but it’s been hard.

Nevertheless, it’s important that we continue to pay attention to what’s happening politically and that we not tune out. We’ve got an election to win in 2012!!

So in the interest of sharing with you some of the developments I have on my radar screen, here are some quick sound-bites courtesy of today’s ProgressFlorida Daily Clips, a fabulous daily email that aggregates news from around the state. To read more about any of the items, simply click the hyperlink.

At St. Petersburg rally, Gov.-elect Rick Scott hints at school vouchers for all
By Ron Matus, St. Petersburg Times
Florida Gov.-elect Rick Scott told a cheering crowd of 900 voucher students today that he wants to continue expanding the program that allows them to attend private school at public expense and suggested the option should be available to all students.

Merit pay: 2 plans on state lawmakers' radar
By Leslie Postal, Orlando Sentinel
Florida is expected to adopt a merit-pay law next year that would tie teacher compensation to student performance on tests.

Lawmakers ready to cut public employee retirement, health care
By John Kennedy, News Service of Florida
With a $3 billion budget shortfall looming, Florida’s pension fund and employee health benefits are shaping up as piƱatas that state lawmakers will whack next spring – hoping they will yield millions of dollars in cost savings.

Florida State Senate Unleashes Dog Of War
By Daniel Tilson, The Examiner
Senator Mike Bennett (R-Bradenton) is a leading figure in the new self-proclaimed “hard right-wing conservative” Florida State Legislature.

State frets over pension debts of St. Petersburg and other cities
By Mary Ellen Klas, St. Petersburg Times/Miami Herald Tallahassee Bureau
With a $1.1 billion deficit looming in the state's employee health and pension accounts, lawmakers are poised to blow up the benefit programs and impose tough new limits on local governments, the chairman of the Senate committee said on Thursday.

The other path to an exemption from health care reform
By Travis Pillow, Florida Independent
A proposed constitutional amendment seeking to exempt Floridians from federal health insurance mandates became the first measure to pass a Senate committee Wednesday, and will likely be among the first bills to pass during this spring’s session.

Texas anti-abortion group targets Planned Parenthood, African-Americans in North Florida ad campaign
By Virginia Chamlee, Florida Independent
Heroic Media, the Austin, Texas-based anti-abortion group that counts Sarah Palin among its endorsers, has been branching out from its Texas roots to create a presence in Florida.

Departure of Crist leaves uncertain future for clemency board
By Gary Fineout, Florida Tribune
Gov. Charlie Crist and members of the Florida Cabinet held their last-ever clemency board meeting on Thursday, holding a marathon session that lasted seven hours.

Redistricting timeline stretches final deadline to June 2012
By Mary Ellen Klas, St. Petersburg Times
The Senate's redistricting guru, John Guthrie, told the Senate Reapportionment Committee on Thursday that the timeline for finishing its work will be compressed and difficult, based on the tentative schedule before them.

Sunday, December 5, 2010

Are your spending decisions helping Democrats or Republicans?

In the 2007-2008 election period, Netflix made $616,357 in political contributions. None went to Republican candidates. Barack Obama received the largest amount ($19,485).

Costco Wholesale gave $306,033, with 92 percent going to Democrats - $32,240 to Obama and $9,700 to Clinton.

Amazon.com contributed $279,269. Seventy-nine percent went to Democrats, with Barack Obama receiving the most ($104,382).

I’m happy to see that the companies I spend money with supported my party and my candidate with their political contributions in the 2008 election.

That is the kind of interesting information you can find with “Influence Explorer” (http://influenceexplorer.com) by The Sunlight Foundation, a nonpartisan nonprofit group focused on creating more government transparency online. It mines and compiles campaign contribution data from OpenSecrets.org and FollowTheMoney.org, and makes it easily searchable with this free online tool.

I learned about “Influence Explorer” in a recent article in the New York Times titled “The Political Impact of Your Consumer Spending” and couldn’t wait to try it.

You might find it fun to check it out, too.