Apples and Monkey Wrenches

Yesterday I vented on the latest attack on women's reproductive health. Today, the editorial board of the Los Angeles Times offered an editorial on the subject which is confusing, tepid, and contains one of the real clangers in the debate.

It begins by implying that the argument over mammography (a diagnostic test) is just like the argument over hormone replacement therapy for menopausal women (a treatment):

Hormone therapy after menopause was standard practice after a 1991 study found that it reduced the risk of cardiovascular disease -- until a study 11 years later found the opposite. Since then, the treatment has been linked to other health problems -- and found to have some advantages as well. Some doctors highly recommend hormones; others warn their patients away from them.

"Reasonable people may differ" seems to be the message.

Bull!

HRT was cut back after several studies showed that the therapy had significant, often deadly side effects for many women. I don't believe I have seen any studies which show that mammography (again, a diagnostic test) has caused any strokes or blood clots or any other life-threatening conditions. What studies have shown is that the test has had a significant impact in the fight to reduce breast cancer in the country.

The "center-left" board, perhaps aware of those latter studies and certainly aware of the potential consequences if the government panel's recommendations on the use of mammography are followed, then finally admits that until a better diagnostic test is devised, current mammography guidelines should remain in place. The board even acknowledges the real problem facing women:

Just about everyone knows a hard-to-ignore anecdote about a life saved by mammography. And many fortysomething women would gladly undergo the discomfort of mammograms, plus any anxiety or unnecessary biopsies, to be among those saved by early detection. But if the panel's findings lead insurance companies to eventually restrict coverage, these women might not be able to afford the health screenings they and their doctors believe are worthwhile. [Emphasis added]

OK, so the editorial board finally got there, but not until after making this rather appalling pronouncement:

As much as we would like to believe that every life is worth endless amounts of money, there are limits on resources for healthcare. It makes sense to locate those resources where they do the most good.

And that apparently is not women's health.

When Is It Going To Be Their Turn?

November has not been a good month for American women. The American Council of Bishops (Roman Catholic) got involved in health care reform by insisting that no government money, including the subsidies paid for health insurance for those who could not otherwise afford it, could be spent on abortion. They found a sponsor in Congressman Bart Stupak, and his amendment passed. The Senate bill also contains similar language, although it is reportedly not as restrictive as the Stupak amendment.

Although abortion is a legal medical procedure, the House (including Speaker Nancy Pelosi)felt that rather than push back against the anti-abortion forces they'd go along with them just so they could pass a health care reform bill. The excuse, once again, was "Don't let the perfect be the enemy of the good." Well, that bill is NOT good, especially for women. It is, in fact, deadly.

But wait, there's more.

Now a government study suggests that annual mammograms for women under 50 are unnecessary. Nice, eh? I guess the panel has decided that women under 50 don't get breast cancer, or at least shouldn't. Joan Vennochi of the Boston Globe takes on that issue in her latest column and points to the direct consequences of both the Stupak amendment and the government study for women.

Now, a government panel is telling women in their 40s that they don’t need routine mammograms. According to the US Preventive Services Task Force, the benefits of screening are supposedly outweighed by the potential for unnecessary tests and procedures and the anxiety they might cause.

You want anxious women? Take away health insurance coverage for routine mammograms.

Yes, these are simply guidelines; they are not yet part of any legislative proposal. The panel said it did not consider costs in the analysis.

On their face, they don’t stop any woman who wants a mammogram from getting one at any age.

But the panel’s guidelines can help health insurance companies position themselves down the road for this high anxiety-inducing outcome - the denial of coverage for routine mammograms for women between the ages of 40 and 49.

That, in turn, creates a two-tier health care system: Those who can afford to pay for screening on their own, and those who can’t. Those who can’t afford it are left to ponder the somber words of Dr. Daniel Kopans, a radiologist at the Massachusetts General Hospital Cancer Center.

Kopans told The Globe that the panel’s recommendations “will condemn women ages 40 to 49 to unnecessary deaths from breast cancer.’’ Maybe Sarah Palin’s “death panel’’ warning isn’t hyperbole after all. [Emphasis added]

Of course, all of this could have been avoided with a single-payer health system, but that was taken off the table even before the table was bought by the insurance companies and medical providers. Instead, we get a half vast program that maximizes profits for insurance and pharmaceutical companies and minimizes coverage for millions, over half of of whom are women.

Ms. Vennochi notes the dreadfully unfair results:

...somehow, health care costs will be reduced. But, at whose expense will those reductions come?

As women are finding out, every aspect of health care reform won’t be win-win for everyone. Cost control is a necessary part of the reform equation. But no one has yet cut treatment for erectile dysfunction. Why are women the first losers out of the reform box?

Why indeed?

Things That Make You Go Wow!

I spent the 45 minute train ride I had to make yesterday to Anaheim by reading the paper version of the Los Angeles Times, and I'm glad I did. I found this article in the business section and it reminded me that we still have plenty of innovators and risk takers in this country who, with a little financial help, can make a big difference in the economy and in the green revolution we so desperately need.

The potential for profit is blowing in the wind, and Green Wave Energy Corp. plans to catch it.

Among its secret weapons: an 11-foot-tall, blazingly white, nearly indestructible prototype generator that produces as much as 11 kilowatts of electricity using gusts of wind.

The fiberglass contraption could make homespun, do-it-yourself wind power a reality, Chief Executive Mark Holmes said. A model version recently stood amid yachts in a Newport Beach shipyard before being disassembled for updates, but Holmes envisions it moving soon into the backyards and rooftops of homes and businesses. ...

Unlike most windmills' propeller-shaped turbines, the Green Wave products operate on a vertical axis, merry-go-round style.

More than 20 U.S. companies build or are developing vertical-axis turbines. Around 200 urban or rooftop units were sold in 2008, double the 2007 number.

Sales of small wind turbines soared last year to $77 million and 10,500 units capable of generating 17.3 megawatts of electricity, marking a 78% increase in capacity sold from 2007, according to the American Wind Energy Assn. {Emphasis added]

The benefit of a vertical axis rather than that used by the propeller-shaped contraptions is that it is can catch the wind from more than one direction, which takes much of the geographical restrictions out of the picture. Wind gusts from any direction will spin the "merry-go-round" and generate electricity. The principle isn't exactly earthshaking, but its application just might be, if only on a small scale at this point.

Like most start-up companies, Green Wave Energy has had to learn the financial ropes by trial and error, but here too the company has shown resourcefulness:

Holmes has invested $100,000 of his own money since Green Wave launched in October 2008 with a vast underestimation of the resources, time and effort needed to operate.

Development costs have been about $1.7 million, about four times higher than the team had expected.

The crew quickly learned the value of resourcefulness.

Friends, family and other investors, who have pitched in $110,000, have given Green Wave access to $1.5 million in facilities, supplies, vehicles, equipment and services, Holmes said.

The company has no official employees. Instead, all partners who provide services, equipment and working space are considered shareholders and officers. Most Green Wave workers have day jobs, such as the man who engineers corneas for eye replacement surgeries when he isn't designing turbine parts.

Using shareholders' properties -- the shipyard, a 10-acre manufacturing facility in Perris, two others in Santa Ana and Costa Mesa, and a garage in Orange -- saves thousands of dollars in rent a year. Instead of using an expensive wind tunnel to test the strength of the turbines, team members hitch a 4-foot prototype to a truck bed and go for a 55-mph spin.

The really hard part, however, is getting through the dark thicket of governmental rules and regulations, which in California can be daunting, ironically because of environmental concerns. Still, Holmes himself has taken on the job of getting educated in that area as well. It may take several years before the company can ease into a more traditional manufacture and sales mode, but in the mean time, it's still in business:

Meanwhile, in the desert near Victorville, Green Wave is participating in a joint venture to construct and operate a 5-acre park filled with 70 wind turbines. The first 40-foot-tall, $350,000 colossus could be turning its 50-pound blades by February, Holmes said.

A venture capital firm has initially promised 90% of the $26.5 million to develop the park, which could be finished in two years. Green Wave and other partners will raise the rest.

The turbines could each bring in $160,000 a year if the park works out a power-purchase deal with a California utility, Holmes estimated.

That's a pretty decent start for a start-up. It's also a pretty good example of what can happen when good people find a good idea and get down to the business of making it work for the benefit of us all.

I am encouraged.

Fred Hiatt Takes A Day Off

There's quite an eyebrow-raiser on the editorial page of the Washington Post today. An editorial actually takes the Republicans to task for hypocrisy and focuses on Sen. Jeff Sessions of Alabama for his ludicrous and dishonest charges when it comes to a nominee for the federal appeals court. Pretty amazing stuff.

DURING THE BUSH administration, Republicans decried Democratic attempts to filibuster judicial nominees. Some went so far as to label such filibuster attempts unconstitutional and threatened to exercise the "nuclear option" to ban the procedural tool in nomination matters.

Yet now Republicans are threatening to filibuster in an attempt to thwart confirmation of President Obama's first judicial nominee, Indiana federal Judge David F. Hamilton. The Senate is scheduled to vote on cloture Tuesday on Judge Hamilton's nomination to the U.S. Court of Appeals for the 7th Circuit. The prospect of a filibuster is made all the more ridiculous because Judge Hamilton has been rated "well-qualified" by the American Bar Association, enjoys the support of both home state senators, including Republican Richard G. Lugar, and even wins praise from the conservative Federalist Society of Indiana.

Sen. Jeff Sessions of Alabama, ranking Republican on the Judiciary Committee, has distorted Judge Hamilton's record on the trial court in an effort to rally the GOP caucus. ...

Now, I doubt the Washington Post would have been so generous had President Obama nominated someone not approved of by the Federalist Society (which is a tell of sorts on both the nominee and the man doing the nominating), but the fact that Sen. Sessions would take on even this kind of appointment makes it clear that Republicans have no compunctions about continuing their "Just Say No" crusade. And here's the amazing part: WaPo called them on it.

Now might be a good time for President Obama to start sending in dozens of nominations for the federal bench (which desperately needs those positions filled). Who knows, Harry Reid might take a day off and whoever is second-in-charge might get a few of those nominees to the floor of the Senate for a vote.

Unsurprising News

We've watched as the credit card companies and banks have upped fees and interest rates quickly before the law limiting both becomes operative in February, 2010, so we shouldn't be surprised that the marketing geniuses at pharmaceuticals are doing the same before any health care reform bill takes effect. Still, the rather dramatic increases, as reported by the NY Times, are rather shocking.

Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992. [Emphasis added]

The White House claimed a victory when PHARMA and its members agreed to the cost reduction and the Senate dutifully wrote that promise into several of its versions of the reform bill, but once again, the public will pay for the hollowness of the promise:

...the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year — $80 billion over 10 years — from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal. [Emphasis added]

The drug companies have trotted out their perennial excuse for the price hikes: more money is needed for research into newer and even better drugs, especially since the patents on current drugs run out. Oddly enough, I have yet to see a news article which puts forth the annual budget for any given pharmaceutical company's research as compared to the budget for marketing (advertising and the free rides given to doctors and hospitals for prescribing the drugs). That would be useful information at a time like this, yes?

I knew there had to be a reason for PHARMA to make such a grandiose gesture at the White House: its representatives knew it was actually going to be a windfall of enormous proportions. But, hey! It's the marketplace at work.

Sunday Poetry: Lawrence Ferlinghetti

Speak Out

And a vast paranoia sweeps across the land
And America turns the attack on its Twin Towers
Into the beginning of the Third World War
The war with the Third World

And the terrorists in Washington
Are drafting all the young men

And no one speaks

And they are rousting out
All the ones with turbans
And they are flushing out
All the strange immigrants

And they are shipping all the young men
To the killing fields again

And no one speaks

And when they come to round up
All the great writers and poets and painters
The National Endowment of the Arts of Complacency
Will not speak

While all the young men
Will be killing all the young men
In the killing fields again

So now is the time for you to speak
All you lovers of liberty
All you lovers of the pursuit of happiness
All you lovers and sleepers
Deep in your private dreams

Now is the time for you to speak
O silent majority
Before they come for you


-- Lawrence Ferlinghetti

To Count Or Not To Count

Comes the dawning: if Senators Vitter and Bennett have their way and the census excludes noncitizens from the decennial count, a number of states will lose seats in the House of Representatives. California could lose five. New York could lose two. In addition, and just as important, federal aid based on population would also drop, something the already battered California budget could not bear.

Private groups who have been paying attention have gotten the message and two disparate tactics are being contemplated, according to the Sacramento Bee:

Steve Gándola, president and chief executive officer of the Sacramento Hispanic Chamber of Commerce, wants to count all Latinos in the 2010 census, including millions of noncitizens. ...

And the Rev. Miguel Rivera, who heads the National Coalition of Latino Clergy and Christian Leaders, wants illegal Latino immigrants to boycott the U.S. census as a way to show their displeasure with Congress' refusal to overhaul national immigration laws. His motto: "No legalization, no enumeration."

Rev. Rivera is fully aware of the implications of the proposed action, but he counters the argument of loss of federal monies by pointing out that very little of those monies are directed to the barrios in a way that would make a difference. The only thing worse than the streets in those areas are the schools, he contends, and he may very well be right. He wants immigration reform and he sees this action as a way to get Democrats in Congress to start paying attention to the problem.

Still, such an action has the effect of shutting out immigrants, legal or illegal, and of silencing them, which is the obvious intent of Vitter and Bennett. Hopefully, the comments of DHS Secretary Janet Napolitano last week calling for immigration reform which included a pathway to citizenship for those who are here without permission (see my post here) will change Rev. Rivera's mind and those of his organization.

A better way to put pressure on Congress is to show the clout that immigrants have in this country, documented or not. The chart that is included in the Bee article shows what happens if noncitizens and illegal immigrants get excluded from the count. The California and New York delegations should have copies placed on their desks. One California congressman has already seen the problem:

In the House, California Democratic Rep. Joe Baca of Rialto responded by introducing the Every Person Counts Act, which would not allow anyone to be excluded from the census based on their immigration or citizenship status. Baca said the Vitter-Bennett amendment clearly violated "the spirit of the Constitution."

Indeed it did: the Constitution says nothing about counting "citizens," it refers only to "persons." That has been interpreted to mean all people get counted, even immigrants.

Citizenship has never been a requirement, dating back to the first census in 1790, when each slave was counted as three-fifths of a person, said Clara Rodriguez, a sociology professor and census expert at Fordham University in New York.

"Slaves were not citizens," she said. "They did not become citizens until after the Civil War."

In the days of the Homestead Act, she said, there was no concern about the status of people who settled in Oklahoma and elsewhere because the nation was being flooded with immigrants: "I don't think that anybody was asking whether they were citizens," she said.

The Vitter-Bennett amendment was defeated in the Senate by cutting off debate, but I doubt those two gentlemen have admitted defeat. I anticipate another attempt as the Census draws nearer. That kind of mean spiritedness isn't easy to choke off, but passage of Rep. Baca's bill would be a good start.

Then maybe Sen. Vitter will go change his diaper and focus his attention elsewhere.

Sunday Funnies

(Cartoon by Jim Morin / Miami Herald (November 12, 2009) and featured at McClathcy DC. Click on image to enlarge.)

Bonus Critter Blogging: Hawksbill Turtle

(Photograph by Nick Caloyianis and published at National Geographic.)

I Give It A 7: Catchy, But You Can't Dance To It

There was an interesting take on Attorney General Eric Holder's announcement that those charged with the 9/11 conspiracy currently held at Guantanamo Bay would be tried in a civilian court in New York City by Geoffrey Robertson in the "Comment Is Free" section of the U.K's Guardian. While Mr. Robertson finds much to cheer about in the administration's decision, he also expresses his disappointment in one key part of the decision.

The US attorney general, Eric Holder, deserves two cheers for his brave decision to bring the alleged 9/11 conspirators to an open trial in New York rather than to put them through a discredited military commission process. But his demand for the death penalty will be counterproductive: the obscene ritual of lethal injection will bestow on convicted defendants the martyrs crown they so desperately crave.

This is a trial that must be seen to be fair – not only by the American media (which to judge from the questions at Holder's press conference has already made up its mind that the defendants are guilty) but throughout the world. Much will depend on the choice of judge, who must be conspicuously independent and of sufficient steel to reject evidence obtained by torture – there is no doubt that Khalid Sheikh Mohammed has been waterboarded. ...

The death penalty decision will ultimately be for the jury, and it can only be hoped that they will refuse to contemplate the spectacle of convicted defendants, spot-lit and stretched on a hospital trolley, in some auditorium which must by law be large enough to accommodate relatives of their victims. Does Holder plan to requisition a baseball stadium?

It would be a martyrdom beyond the wildest dreams of the most fanatical Islamic terrorist. There is one reassuring precedent – the jury trial in Virginia of Zacarias Moussaoui, who was alleged to be the "20th hijacker". The jury rejected the prosecution's overblown demand for his death, although the judge had unfairly allowed them to hear tapes of the last moments of Flight UA93 in order to inflame their prejudices. [Emphasis added]

Snark about stadia aside, Mr. Robertson does raise a valid pragmatic point. At this point, the death penalty is not a punishment in the eyes of these Islamic fundamentalists. It is a reward. Whether guilty or not, they will be revered as martyrs. But Mr. Robertson also looks to the barbarism of the death penalty to which this country clings so desperately. If Mr. Holder is going to try the defendants in this country, he really didn't have much choice in the matter of the punishment being sought.

There was, however, another option (which Mr. Robertson pointed out), one which might anger the right wing, but which would signal the intent of this administration to return the US to the world community, and herein lies the most interesting part of the essay:

There is, of course, a better solution. The 9/11 atrocity was, in international law, a crime against humanity and there is no doubt that the UN could have provided three international judges and the kind of trials currently being visited upon Charles Taylor and Radovan Karadzic. That would end not with one word from the foreman of the jury ("Guilty"), which will hardly convince doubters, but with a closely and carefully reasoned judgment setting out the case for guilt beyond reasonable doubt. But international courts cannot impose the death penalty and American attachment to this punishment is still unassailable.

I have long argued that the attacks on 9/11 were criminal acts and should have been handled as such, just as the first attack on the World Trade Center was, rather than as a matter of high-level national security and all the secrecy and suspension of basic civil rights that entails. I am now willing to admit that there might be an even better way of handling those crimes, the way Geoffrey Robertson suggests.

Unfortunately, this country, which still willfully insists on remaining in the grips of the simplistic views on revenge and retribution of spoiled children, might have squealed like those same children refused an extra serving of dessert. That's where leadership, real leadership comes in. President Obama could have taken the extra step and referred the matter to the UN, preparing the country with a speech that spelled out with great specificity on how those attacks were clearly a crime against humanity for which the entire world needed to bear witness and to bring judgment. That just might have defused the yammering of the far right and would have nudged the rest of the country towards some semblance of adulthood, especially as it pertains to the death penalty. If we expect to be seen as civilized, then we must take on the trappings of civilization, including the one which sees the death penalty as an excuse for perpetrating the violence we suffered.

That, of course, didn't happen. Still, President Obama did take a step towards adulthood, albeit a baby step, by moving this high profile case to a civilian court which will hopefully accord these defendants all the rights that other defendants charged with a crime in this country have: the right to knowing precisely what the charges against them are, a vigorous defense, the right to full disclosure of all evidence against them and all evidence which might exonerate them, and the right to a jury. And for that I am grateful.

Good News/Bad News

A real effort at immigration reform has been simmering on the back burner while the Obama administration addressed more pressing needs: the economy and health care reform. Now Janet Napolitano, Homeland Security Secretary, believes it's time to move the issue to the front, preferably next year. She cites some pretty good reasons for that.

From the Los Angeles Times:

The government has beefed up border security and workplace immigration enforcement, and now should begin the work of overhauling immigration laws, Homeland Security Secretary Janet Napolitano said Friday.

"The hope is that when we get into the first part of 2010, that we will see legislation begin to move," Napolitano said. The legislation should not only give law enforcement officials more tools to fight illegal immigration but create a "tough pathway" for undocumented workers to gain legal status, she said. ...

She said the "tough pathway" to legal status would require illegal immigrants to register, pay a fine, pass a criminal background check, pay all taxes and learn English.

Critics responded that immigration reform was code for a blanket amnesty, and that the strides Napolitano cited in enforcement were overstated.

While I agree that enforcement efforts haven't been totally effective -- traditional border crossings at the Mexican-US border have been better policed, but many would-be immigrants are chancing the far more dangerous routes through the desert --there certainly has been a decrease in the flow. The Obama administration has also shifted the target from the undocumented worker to the companies that employ them, handing out fines to employers who were particularly sloppy in complying with the laws currently on the books, but there are still plenty of businesses looking the other way when bogus social security and green cards are presented.

That said, I think Secretary Napolitano, who knows about the subject of immigration from her days as governor of Arizona, has suggested an interesting and a positive way of dealing with the estimated 12 million undocumented immigrants already here. If the "illegal" has been here for years, worked hard, paid taxes, and not engaged in criminal behavior, why not give them a way to change their status?

The path Ms. Napolitano has suggested is certainly not an easy one for those who wish to stay, and her plan can hardly be equated with "blanket amnesty." Critics such as Tom Tancredo and Lou Dobbs who don't want any brown people from Mexico, Central, and South America soiling our nation know this is the case, but would rather appeal to the baser instincts of the electorate.

The argument that those here without an invitation have already broken the law is a specious one. People who have fudged on their income tax returns when it comes to deductions have also broken the law, several in fact since the returns are signed under penalty of perjury. I don't see any mass round-ups of citizen-felons. Only those who engage in really egregious fraud get nailed for tax evasion.

The argument that this is the wrong time to explore such reform, either because the economy is still ailing and unemployment is high or the midterm elections are so close, is also wrong-headed. True immigration reform is long overdue. The fact that the Secretary of Homeland Security was allowed to make such an announcement is strong evidence that President Obama fully intends to push for good legislation on the issue and to do so in 2010.

Members of Congress standing for re-election in the midterms need not fear dealing with the issue, as at least one leader for immigration reform has noted:

Ben Johnson, executive director of the American Immigration Council, said, "Candidates who stand up for rational, comprehensive solutions to this complex problem don't lose races."

I think he's right.

I also think that President Obama is going to have to do a much better job in openly pushing for such a "rational, comprehensive solution" than he has for health care reform. Whether he's going to do so is still a large unknown.