Within Normal Limits

Keep Your Powder Dry

2011-05-16T22:50:00.000-05:00

Knowing the great degree of influence my posts have on my faithful readers, I want to take this opportunity to alert you to an upcoming post discussion about the merits of some potential 2012 GOP Presidential contenders. Actually I plan to go so far as to lay out my endorsement for the 2012 Republican nominee for President. I made the decision to donate money to his campaign just this weekend, and bumper stickers are ordered. I therefore know you'll all want to "keep your powder dry" until I have time to publish my post in the next couple of days.

It's possible that my reasoning will surprise you, though I'm confident you'll give due consideration to my points and to the man I plan to endorse.

Presidential primary time is fun for political junkies like me. So, people, study your candidates and their positions and be prepared to join me later in the week for my 2012 GOP Presidential Nomination field analysis.

Blessings, and I'll be back soon.

Warrior Obama, Master of Sonorous Small Words and Smaller Deeds

2011-03-23T00:45:00.004-05:00

Do we really find ourselves flying military sorties over Libya, in the absence of any congressional vote to approve such an action? Do we find ourselves flying these sorties with no properly constituted lines of authority? And do we find our great military sent to, among other worthy goals, "stop the killing"?

Why at every turn am I flashing back to memories of Michael Dukakis riding in a tank with a goofy helmet, or of other memories of President Carter being attacked by a crazed rabbit near his ancestral home in Georgia? I even recall in an unusual fit of honesty The Rev. Dr. Jesse Jackson commenting, during BHO's procession to his November 2008 coronation, on the Peace Prize recipient's apparent lack of two spherical anatomical organs generally thought to be critical for purposes of intimacy and procreation. The reason for these flashback memories? Simply put, the emperor has no clothes, and more and more Democrats are joining Republicans and conservatives in coming to this realization, which is why I expect polls to reflect a fairly sour American public, bipartisanly so, in the coming months.

The liberals' quarter-war policy is clear, once you understand certain touchstones for Democrat liberal policy makers. George W. Bush was and remains the focus of evil in the modern world, so no strategy out of the Peace Prize recipient's administration can even remotely resemble a Bush coalition. Moreover, a multitude of partners is critical, and deferring operational command to one of these lesser powers is desirable. Bonus points are awarded for prolonged dickering about the chain of command. Next, the policy must hamstring its own forces by denying them their most lethal weapons and by putting forth rules of engagement that are complex and difficult to understand. These ROEs will ensure no decision is made without opportunity for second and third guessing, with plenty of input by Department of Justice lawyers. Further, a freewheeling loud public debate ought to take place regarding where any captured "suspects" may be held pending their civil trials. It goes without saying that full access to lawyers and the press will be enjoyed by the detainee "suspects."

Unfortunately for the Ivy League frat boys running this show, and more unfortunately for the people of America, and most unfortunately for those brave men and women who may be called upon to give the ultimate sacrifice as they serve as the tip of our spear, this quarter-war that the Peace Prize recipient has gotten us into will not end well for America. This is so for innumerable reasons, but the first and foremost is that no one has yet to define our mission. Why are we there? What does victory look like? Are the rebels really our friends? Can we identify our friends in the region? I'm skeptical about that last question in particular.

For now, regular Americans are just lying low, watching in disbelief as the inmates run the asylum and hoping there'll be something left to salvage after the 2012 presidential elections. We've got to get this train that is America turned around, my friends. The future of our children and grandchildren depends on it.

Look for a post in the next week or so about Israel. The issues facing that small nation so favored by God are of great interest to me, and what's more amazing is that Holy Scripture can guide us as we seek to learn about these issues confronting The Holy Land today.

Let's "Opt Out" To Victory

2011-03-01T10:14:00.000-06:00

The travesty of ObamaCare has so discouraged me that I can't often post about it. I'm proud of the House Republicans and wholeheartedly support their legislative efforts to kill the law with death by a thousand cuts. At the end of the day, however, most of us believe it will take a new President to repeal this Orwellian monstrosity by ripping out its roots and casting it into the lake of fire, so that efforts at meaningful reform that empowers patients and their doctors can take shape.

It was in this context that I've been reflecting on how a catchy turn of phrase can make a profound impact on an idea's success in the marketplace of ideas. Examples abound, such as "affirmative action" instead of "race-based preferences," or "investment in our children," instead of "pouring good money after bad down a rat hole of overpaid, incompetent, unmotivated teachers." "Reform" is another useful noun that can mean anything, as in "tax reform" that lowers marginal rates and eliminates the double taxation of the death tax, versus "tax reform" that raises marginal rates, punishes entrepreneurs and investors, and generally incentivizes people to hide money under their mattress. The same word, but two completely opposing meanings.

I suggest we who oppose ObamaCare down here in the trenches begin to call for allowing individual states to "opt out" of ObamaCare. The term "opt out" is catchy and conveys clearly our goal, but with a positive connotation that suggests "freedom" and "choice" to citizens. It lends itself to a number of slogans, such as "Just opt out!" or "Opt Out Now," and it can even be used as a stand alone motto.

The value of a catchy phrase, composed of two or three three letter words, that clearly communicates our values and goals cannot be overestimated. Opting out is consistent with America's historic federalist principles, and ought to appeal to moderates and fence-sitters and others who might oppose outright federal appeal.

I envision a coordinated grass roots effort among roughly the same red and purple states which are participating in legal challenges to ObamaCare, which is more than half of the Union. Existing conservative infrastructure would promote the idea publicly and pressure the individual states to pass "opt out" laws. In turn this would generate further federal pressure against ObamaCare, and in fact the Opt Out movement might be viewed by President Obama as a face-saving compromise as he positions himself for his 2012 re-election race. I dare even hope that federal legislation allowing for an Opt Out option might be perceived as reasonable enough to pass the Senate and avoid an Obama veto.

Granted, Opt Out does not by itself nullify all the damage done by ObamaCare, but it is an achievable goal in 2011 or 2012, and as policy would boost a number of favorable precedents, not least the broadening of the concept of federalism and state sovereignty. Granted as well, Opt Out requires action at both federal level and in each state, but in accomplishing each legislative victory another nail is driven into the heart of the concept of centralized health care rationing. No one said this would be easy, but with hard work I'm convinced we can achieve victory.

By all means let's press on toward the goal of repeal, but let's open another battle front against the forces of statism and stagnation with a new grassroots movement to Opt Out! Far from diluting our efforts, Opt Out will strengthen our cause by adding new volunteers, persuading more voters, and encouraging those of us in the trenches with achievable victories in the short-term. Conservative leaders, tea party activists, Republican officials, are you listening? We the people are crying out for leadership on this issue.

Not This Time . . .

2011-01-08T14:13:00.005-06:00

I've just read the news of the terrible tragedy in Arizona today. Congresswoman Giffords was wounded, and a federal judge killed, by a lone shooter who is now in custody. The congresswoman is now the second House member to be shot in the line of duty in my lifetime, as far as I know, the other being Congressman Leo Ryan who was killed by members of the Jim Jones cult in Guyana in 1978. What a tragedy! I'm reminded of the sacrifices so many of our nation's founders faced so that Americans have the freedom to govern ourselves, and at the same time how fragile and unique and precious are the values and liberties Americans share. That this event shocks us is a sign of the inherent moral fiber that makes America a great nation.

Americans should not and will not allow events like this to deter us from involvement in politics and self-government. I already see in news reports the linkage between the shooting and Congresswoman Giffords' support of Obamacare, and I'm reminded how President Clinton and the Democrats used another tragedy in 1995 to demonize conservatives and to try to deter and discourage us from taking part in partisan politics. At the time, just after the 1994 Republican takeover of Congress, President Clinton linked the Oklahoma City federal building bombing to Rush Limbaugh and the "haters" encouraged by talk radio. Republicans and conservative activists, shocked by the bombing and on the defensive from Clinton's attacks, allowed themselves to be painted as sympathizers and encouragers of terrorists, and the righteous activism faded away. I fully expect a similar effort in the coming days from some quarters of the Democratic partisan attack machine.

Well, it won't work. Not this time. No one knows details yet, but only the shooter (and anyone who might have assisted him) is responsible for this crime. Americans cannot allow terrorism to bar us from doing those things that make us Americans, and that includes standing up for those values and ideas we believe in as part of the political process.

Let me emphasize again that no one who participates in American political give and take need feel guilt about the shooting of Congresswoman Giffords and the other victims today in Arizona. We should feel shock, sadness, and anger, and empathy for her and for her family and the other victims, but also resolve and fortitude to not let this tragedy be used by those who would advance their own agendas with the blood from their wounds and the tears of their families and the mourning of a nation.

For every left-wing partisan who tars conservatives with the taint of the Giffords shooter, I would counter with this: Democrats passed Obamacare in the face of massive public resistance, with almost no Republican votes, taking advantage of every parliamentary trick in the book, essentially making a mockery of the will of the people. This is in contrast to every other example of major social legislation in the last hundred years which were all passed on a bipartisan basis. Was it foreseeable that someone who was already mentally unbalanced might take their frustrations too far? I would say, yes, and I would say so no matter what motive is ultimately shown in the case of the Giffords shooter.

No, the blame belongs to the shooter and the shooter alone (and any possible conspirators), but if the Democrats want to use this horrendous event for their political advantage, they stand on very shaky ground. I don't believe the American public will let them, not this time. Let us today pray for Congresswoman Giffords and her family and the rest of the victims, mourn those who lost their lives, and resolve to honor them with our involvement in the political process and our refusal to let anyone trade on their sacrifice.

Health Care: Who Should Pay?

2010-11-28T21:15:00.003-06:00

This is an updated and refreshed version of a post I originally published a few years ago (April 22, 2007). Given the issues it addresses and the current debate over whether and how to repeal Obamacare, I thought it would be helpful to re-publish it. My intent is to promote a solution to the current flawed health care payment system that is consistent with human nature and a conservative political philosophy. Enjoy, or abhor, as your beliefs require:

Our society has come to accept the notion of health care as a "right," and that it should be available for everyone regardless of their ability to pay. This principle collides, however, with the inconvenient truth that someone must pay. As a provider, I wouldn't be in business very long if I did not pay my staff and my office rent and all the other expenses associated with a medical practice. Even in a Utopian single payer system, one can't magically legislate away cost, no matter how much one denies or ignores. The tension evident in today's system results from the fact that the users of a given service, poor or not, are largely removed from directly paying for that service. This divergence drives up the costs of care and the demand for services.

In America the linkage between a health care service and its cost is now completely absent for most people, and the result is greater demand at greater cost. The American people are only dimly aware that at every doctor visit, sitting invisibly in the room, listening, watching, taking notes, sits a third person, someone the patient and the doctor don't even know. This invisible third person is the payor, and that's the unspoken penalty of de-linking the consumer from the cost of his choice. The person who pays the bills winds up running the show. I could give a multitude of examples of the huge and intrusive role of government and insurance company third party payors, but I'll try to illustrate my point with the following: for every service or good one can think of, the market creates a balance between supply and demand, and cost (or price, more properly) is the expression of that balance. Assuming you're not on food stamps, who pays for your groceries? You do, of course, as you do your phone bill and your car payment and whatever else you buy. Now, again assuming you are part of America's great middle class, how did you choose which car you drive? The answer is that you bought the car you wanted, that fit your needs, and that you could afford. No one expects to pay their employer or the government a monthly premium, and to be given a choice of three different cars to pick from every March. And if my illustration were true, I'll assure you that not only would your car choice be limited, it would be more expensive, as well. Competition is a potent motivator and price cutter, and innovation is its fruit.

I'm a board-certified internal medicine specialist, and I deliver what I believe to be excellent care for my patients. Yet, last year I was only a participant in three of the four available Blue Cross plans in the area. Why was I not part of the fourth? It had nothing to do with my qualifications, but was because I was unwilling to provide my services at the price Blue Cross offered for that particular plan. Meanwhile, I provided exactly the same services for Blue Cross patients in the other three plans, for a fee that I found acceptable. Blue Cross, and employers, you see, are driven by different motivations than patients themselves might be. Why should the employer or the insuror determine whether a patient can see me? It sounds like care is being rationed, and it is, by the employer who chooses to provide the less expensive plan for his employees. Why in the world do we accept this ridiculous system? Even more amazingly, why did the recently deposed Congress choose to make employer-based insurance the foundational basis for its "reform" plan? I submit that the cost, quality, and choice available to patients would be greatly improved if the patients were more directly responsible for the cost of their care.

The so-called "health care reform" pushed and passed by President Obama and congressional Democrats went in exactly the wrong direction. Instead of true reform, this legislation built upon the worst aspects of the existing health care system by further removing consumers from the consequences of their choices and essentially starving by regulation the promising growth in high-deductible health plans, health savings accounts, and Medicare Advantage plans, each of which put the patient in more control of spending his own health care dollars. Americans have been given a chance for a do-over of this egregious legislative mistake by virtue of an angry and motivated electorate, and it's my prayer that we're wise enough to take advantage of our second chance. Let me emphasize here the crucial point of semantics that we're advocating reform of the broken health care payment system. It is empirically true that health care in America, at the point of the clinical encounter, is generally superb, though such quality won't long survive a fundamentally broken payment system.

Unless we radically change the direction of our current reform efforts, patients will in the future have vast restrictions placed on their choice of doctors, hospitals, treatments, and medicines. How many dollars won't be spent developing new medicines and treatments, because the money and brain power are diverted to less productive pursuits? The bureaucracy even now often chooses which medicine to pay for, and which physicians to contract with, and those choices are driven by interests that are often at odds with the patients' best interests. Physicians, for their part, have little incentive to openly publish their fees or compete for patients based on convenience issues such as flexible appointment availability or timely message return. Employers, saddled with the job of picking insurance options for their employees in this inefficient system, are left with a responsibility and cost they'd rather not have, but which has developed, not out of any affirmative policy decision, but because of a World War II era tax loophole for Kaiser shipyard workers. It's past time to declare that the emperor has no clothes, that the current health care payment system is built on a foundation of sand, and that American exceptionalism demands an exceptional health care system!

One of the least appreciated but most terrible results of our current "accidental" system is the erosion of the doctor-patient relationship. In its ideal form this is one of the most precious and protected of human relationships, one that for the patient lends itself to a feeling of trust, security, and hope, and for the physician yields an incredible sense of duty, responsibility, and obligation to his patient. I've had the privilege to have this relationship with some of my patients, but it is no longer the norm. Do you as patients think you've lost anything with the loss of this type of relationship? Do you even recognize that it's gone? Do you get a glimpse of the magnitude of the lost job satisfaction of physicians whose practices have bridged this transition?

The surest path to a successful solution will be one in which the individual patient maintains maximal control over his own health care decisions, and that recognizes that it is the payor who has the control. I've chosen to be a physician for the freedom and blessings that are its fruit, both for me and for my patients. On a broader scale, I hope Americans will continue to have a rich array of health care options in future years. It's not a given that we will.

In Praise of the Endomorphs

2010-11-23T23:54:00.006-06:00

Political junkies always look toward the next election cycle more quickly than sane people, and conservatives are waxing optimistic this month as we savor the "shellacking" of the President's party in the late congressional elections. Meanwhile, we watch in awe as his presidential poll numbers slide inexorably into Carter territory. The election debacle was compounded by the very public diplomatic failures of the President's Asian trip this month and his administration's ham-handed handling of their message on (not?) extending the Bush tax cuts during the lame duck congressional session. Such failures tend to build on one another, and, if unchecked by President Obama's willing but demoralized media apologists, can ultimately lead to irreversible public perceptions of incompetence. It's but a short hop from there to a primary challenge, which no elected incumbent President in the 20th Century has overcome to win re-election.

As gratifying as it would be to see some left wing kook challenge the left wing kook-in-chief who currently occupies the White House, my more immediate interest is in surveying the Republican field of prospective presidential candidates. The potential GOP nominees are an interesting and ideologically diverse group who pretty much cover the spectrum of conservative ideology, from Hamiltonian to Jeffersonian, libertarian to traditional law and order. Most exciting, there's no clear front-runner and no past runner-up waiting in the wings for his traditional turn. In theory at least, the GOP nomination is anyone's for the taking.

My two personal favorites for the GOP nomination at this point are Chris Christie and Haley Barbour, with Jeb Bush a close third. Each man has unique qualities which would serve him well as President. Tea partiers and indeed many other Americans have admired New Jersey Governor Christie's brash refusal to be bullied by his state's teachers' union, and they respect his tough budget cutting decisions in the face of great weeping and gnashing of teeth by those who gorge themselves at the public trough. Mississippi Governor Haley Barbour was a Republican in Mississippi when all the Republicans in Mississippi could meet in a phone booth in Southaven with room to sit down, and there's a widespread belief amongst the GOP cognoscenti that his Republican Governors' Association fundraising arm saved Republican bacon this election cycle from Michael Steele's incompetence. Finally, I'd be remiss if I didn't include Jeb Bush in a list of conservative presidential prospects whom I admire. The Bush brand is further rehabilitated with each passing day of the Obama administration, and Jeb has always been the more conservative and more articulate of the Bush brothers. If he wants to run he's an instant contender.

On a personal and admittedly shallower note, it's nice to see these accomplished and talented achievers, who clearly enjoy pizza or a burger as much and as often as I do, emerge as unapologetic defenders of a conservative worldview. Some might doubt whether husky guys such as Christie, Barbour, and even Bush can connect with image-obsessed voters in a media age, but I suspect their images will serve them well when they are compared with an arrogant skinny-legged professorial incumbent who wears pressed blue jeans and throws like a girl and tends to talk down to anyone who disagrees with him.

For us political junkies, 2010 is history and it's on to 2012! In the meantime, I wish a Happy Thanksgiving to every one.

Reflections on the Vote

2010-11-11T00:25:00.009-06:00

With a week's perspective I feel reasonably comfortable in drawing some worthwhile conclusions from the recent elections. Ever the optimist, I generally tend to predict that conservatives will perform better than they actually do, simply because the basic philosophies underpinning the two competing American political parties seem so cut and dried to me, and I have trouble understanding why some voters would choose a course of action harmful to themselves and our nation. Even so, I never would have foreseen such a fall as I have seen in President Obama's standing in the space of two short years. I hope Democrats really do believe the problem is one of communication and "messaging." If so, then 2010 will serve only as a prelude to an even more cataclysmic result for Democrats in 2012.

The spontaneous rise of the tea party movement over the past eighteen months is probably the most consequential domestic political development in my lifetime. The miraculous milieu which led to liberty's rebirth in American politics was kindled by the disillusionment of voters with the extreme leftist policies pursued by the Obama administration, which contrasted so clearly with the unifying post-partisan theme of his presidential campaign. The Internet Age served to midwife and nurture the birth and early development of the movement. Without the diffusion of news sources from the mainstream media, without the internet, without Facebook and other social media, without the interconnectedness now enjoyed by regular Americans, the tea parties would never have translated silent frustration into coordinated political action. Finally, without the wisdom of leaders in the GOP and the tea party movement, the voters' anger could easily have been channeled into unproductive third party candidate efforts. Instead, tea party activists largely worked within the Republican party framework and were able to essentially revolutionize and reinvigorate the GOP. Whether the tea party movement develops into a permanent organized voting bloc, or instead fades as it is subsumed into the larger conservative movement, it has already accomplished much and found a generally receptive home within the Republican party.

Nationally the GOP's 60+ gain in the House of Representatives marks a second chance for the party of Mark Foley and Duke Cunningham and Bob Ney. The final two years of President Obama's term will not see further leftward lurches that encroach on American liberty, and I'm optimistic that Republican House committee chairmen will be able to effectively use their subpoena power and control of the congressional agenda to hold the Obama bureaucrats accountable, to limit the reach of their regulatory tentacles, and to frame clearly for voters the issues that we face. Unfortunately the most egregious work of Obama's presidency, the Orwellianly-named Patient Protection and Affordable Care Act, remains the law of the land. It will take bold leadership and a persistent focus to limit the implementation of this travesty over the next two years, and I'm not bowled over with excitement given the actions of the last Republican majority. Surely, however, Republicans have learned lessons from the 1995 government shutdown that was blamed on them, and with the refreshing enthusiasm of the new tea party-backed members I do have some hope. True health care reform that empowers patients and expands their choices will have to wait for a different President, I'm afraid.

In my wildest dreams I never imagined that Tennessee's congressional delegation could flip from a 5 to 4 Democratic majority to 7 to 2 in favor of Republicans. In addition, Stephen Fincher's victory in my own Eighth Congressional District marks the first time ever that Republicans have held this Northwest Tennessee seat, and I'm so proud to have a man of his caliber representing me. I would have been delighted with victory by any reasonably conservative candidate, but with Stephen we are blessed with someone who is ideologically centered and who also has a background that fits well in the district and who is a man of unquestionable integrity. I suspect that God has plans for Stephen that go beyond representing Tennessee's eighth district in Congress, but I'm thankful to have him there for now.

As for the Republican gains in Tennessee's General Assembly, no one predicted a gain of 14 House seats, nor the picking off of Democrat state senator Doug Jackson of Dickson. What a clear and emphatic expression of Tennessee voters' revulsion with the policies of the national Democratic party! These gains ought to cement GOP control of the General Assembly for the foreseeable future, in part because of the Republicans' ability to undo decades of Democratic gerrymandering in the next legislative session. I believe the major benefit of Republican control of the General Assembly won't be seen in headline-making initiatives, but in thousands upon thousands of smaller victories that will ultimately serve to make Tennesseeans more free, more prosperous, and more secure. It will be up to an informed electorate, including tea party voters, to make sure that Republican state legislators maintain their focus and don't get too comfortable with the power we've entrusted to them.

All in all, it's been a very satisfying week, and one that I did not foresee two years ago. I'm reminded of the truth that a year is an eternity in politics, and of the even more profound truth that God is in control. I should learn to trust Him more.

Obama's Catastrophic Error

2010-08-14T15:37:00.007-05:00

President Obama's endorsement yesterday of the construction of the Ground Zero Jihad Mosque in New York, coupled with his attempts at a quick backtrack now less than twenty four hours later, represents a critical turning point in how Americans will view the Obama presidency. Most Americans are too busy living their lives and working to earn money to pay their enormous tax burden to pay too much attention to what goes on in Washington, but the President's remarks at the White House Ramadan ceremony Friday night will be viewed by many Americans as just a little too friendly toward the faith of those who hate America. Even more Americans will recognize the plain poor judgment and lack of perspective the President's remarks reveal. Finally, Obama's attempts to backtrack today guarantee that the story will be magnified exponentially in the American consciousness, and also highlight the President's political cowardice in not standing up for his true beliefs.

It is absolutely true that Muslim citizens share the same freedoms of religion and association as Americans of other faiths. However, as most of us learned in civics class, or at least through the living of life, just because one has the freedom to do certain things, not all things should be done. Jihad apologists bandy the argument of American exceptionalism only now, claiming that because we are Americans we should allow the sacrilege of the building of the mosque, while on any other issue those same liberal elites reject any whiff of that very same exceptionalism. Well I call foul! It is not un-American to oppose the Ground Zero Mosque, no more so than it is to oppose the building of a Nazi Heritage Center at Auschwitz, or a Japanese Imperial Center at Pearl Harbor. Civilized people act civilly.

To be sure, I'm not in favor of the "torts gone wild" mindset of today in which people claim harm for every perceived slight, but the circumstances here are clearly unique. The attacks of 9/11 were one of the seminal events of my life and yours, properly awakening Americans to the Islamic jihad being waged against them. Moreover, I do not accept the premise that the Ground Zero Mosque is being promoted by moderate Islamic interests, and this becomes clear with just a little research into the background of the project's front man, Feisal Abdul Rauf. And this is no mere storefront meeting place, but a planned sixteen story tower. For what possible purpose can such a megalith serve in this location? I'm afraid we know all too well. All of us except President "the Cambridge police acted stupidly" Obama and his ilk. Why am I reminded of the oh so earnest nuclear freeze movements of the 1980s, which we learned in the 1990s were funded and directed by the Communists?

America, bless her quasi-isolationist heart, tends to, not forget, but to move on about her business of living life and creating prosperity, such that we sometimes lose our collective focus on some important things. We don't want to be at war. We don't want to argue about religion. We don't want to conquer any territory. We just want people to be left alone to live in freedom. In our war weariness and our desire to move on America elected Barack Obama to the Presidency. The consequences of that choice are becoming clearer to many Americans, and they don't like what they see.

Economic Heresy and Foreign Policy Ostrich-ism

2010-07-03T12:53:00.008-05:00

Everywhere the headlines seem to paint the same picture---a bleak jobs outlook, tepid economic growth, a declining stock market. Dare I say it, it's almost as if America is suffering from an economic "malaise." The ruling liberal elites and the chattering class of the press seem perplexed and bewildered that President Obama's vaunted stimulus package, not to mention his very presence in office, hasn't led to universal prosperity. Of course, there is one subset of the economy that's doing well, the public employee sector, beneficiaries of the Democrats' statist leanings. We'll accept the exception, noting our skepticism that public sector employment drives economic expansion.

Across our great nation one can sense the almost palpable anxiety of the people. Where are the jobs? How can I continue to provide for my family? As a physician I see a cross section of people in my practice, and anecdotally I can confirm the hurting is real and widespread. Our national sense of confidence has fallen so far that no one now even asks the quintessential American question, "Will my children be better off than I've been?'' Sadly, I think the expectation is that that's just not possible.

Contrary to the Democrats' expectations, the passage of Obamacare hasn't lessened economic anxieties. Instead, most people rightly understand that it transfers control from individuals to a bureaucracy, at an untold cost saddled onto our children and grandchildren.

Is there then no solution? Are our leaders correct? Obviously not. It's time to proclaim that the emperor has no clothes. President Obama and his socialist allies have no clue how to create jobs or grow the economy, themselves having never respected market economics and the creation of wealth. If the stakes weren't so high, it would be almost pitiful to see their bumbling incompetence revealed for all to see. Unfortunately, their worldview is so fatally flawed and intransigent that I fear there's no chance they will change their economic policy.

Here's a truth worth shouting from the rooftops. The single biggest hindrance holding back economic growth is the upcoming expiration of the Bush tax cuts, less than six months from now. Not only are employers staring down the oncoming freight train of the largest tax increase in history, incredibly that's just the devil they know. The devil they don't know is the degree of extra taxes that will be required to fund Obamacare and the various bailouts and other statist policies pursued by this Administration.

Employers generally aren't amenable to committing economic suicide, and I think the prevailing sentiment among entrepreneurs is one of hunkering down and simply trying to survive the times in hopes of a more friendly policy environment in the future. Incredibly, I hear no one in any position of authority even recognizing that there might be merit in maybe lessening the impact of the coming tax hikes.

It's discouraging. So many of our nation's policies are misguided, and we fear that we're continuing to head in the wrong direction. I've not even touched on foreign policy, or the fact that our leaders refuse to even recognize that our enemy is Islamic radicalism. Or that President Obama, who bows to kings and emperors, is probably viewed by real and potential foreign adversaries as a boob and an incompetent at best.

Over thirty years ago President Carter in one term managed to preside over a profusion of foreign policy disasters, among them the loss of Iran to Islamic radicalism, a high-profile and demoralizing hostage crisis in Iran punctuated by a disastrous attempted rescue debacle, the loss of Rhodesia to a thuggish dictator, and the encouragement of an aggressive expansionist Soviet foreign policy that required a man like Ronald Reagan to overcome. It's my fear that the fruit of a single Obama term will make the Carter foreign policy seem successful. With regard to Obama's economic policy, comparing the current situation to Carter's seems unfair to Jimmy Carter.

November can't come soon enough.

Rich (-adj, ridiculous or absurd)

2010-06-26T12:07:00.009-05:00

Today's Jackson Sun contains an intriguing article quoting retiring Congressman John Tanner's criticism of 8th District GOP candidate Stephen Fincher's recent tour of the Milan Army Ammunition Arsenal. Why intriguing? Not only has the outgoing congressman been virtually invisible to the media since he announced his intention not to seek re-election, but it's unusual for a retiring incumbent to insert himself into the opposing party's primary. As so often is the case in politics there's more here than meets the eye.

You see, Fincher's opponent in the GOP primary is an avowed friend of and political contributor to John Tanner. Tanner's criticism of Fincher is clearly calculated to help his friend Ron Kirkland in the primary election. The GOP nominee will face Democrat Roy Herron in November's general election. It's hard for me to believe Tanner's criticism isn't coordinated with an assist from the Kirkland camp.

My own sense is that Republican primary voters will see Tanner's comments as a badge of honor for Fincher. It often seems that we live in an Orwellian political world where truth is subjugate to "spin." Kirkland's effort to portray Fincher as somehow a tool of Washington insiders is a perfect example of such nonsense.

I know both Fincher and Kirkland. I've served on the board of directors of The Jackson Clinic with Kirkland, and he's the insider. Kirkland is the friend of congressmen and the Washington elitists. He's the supporter of and believer in the get-along back-scratching culture of power where there's not a dime's difference in Republicans and Democrats. Surely the GOP won't let Kirkland get away with smearing a farmer who's spent his life raising his family, spreading the gospel, and feeding America and the rest of the world.

It's always wise to remember the adage, when hearing criticism, consider the source. Considering who's criticizing Fincher, I'll stand with him.

Huck's Main Street Steamroller

2008-01-03T21:05:00.001-06:00

I'm posting tonight as the final tallies are being made of Iowa's caucus votes. With Mike Huckabee's strong victory, the mainstream conservatives who make up the backbone of the Republican party have spoken loudly and clearly. The elitist "thought-leaders" of the GOP have been humbled by a man whose very campaign is anathema to establishment Republicans. The margin of Huckabee's victory over Romney tonight surprised even me, and I've been hoping for a Huckabee win for months. I will say that Huck's margin would have been even greater but for his recent unwarranted attack on the Bush foreign policy, but that error will likely be forgotten in the avalanche of favorable press from tonight's big victory. Even now, the television talking heads do not appreciate the strength of the Main Street Steamroller, but I believe Huckabee can win the GOP nomination and the Presidency.

How can Mitt Romney overcome the hard truth that three out of four Iowa GOP caucus voters, after intense media exposure to Romney, chose someone else? I don't think Romney can overcome tonight's result. McCain will clean Romney's clock in New Hampshire five days from now, but I do not believe Republicans will nominate McCain for President. McCain has alienated too many GOP faithful with his apostasies on immigration, tax cuts, and First Amendment free speech restrictions. I also do not believe Thompson's 3rd place tie with McCain tonight is enough to keep his candidacy alive. Huckabee will blow him and everyone else away in South Carolina, forcing Thompson's withdrawal and leaving Giuliani as the sole alternative to Huckabee.

I am surprised by the results on the Democratic side. I would not have thought, prior to today, that Hillary could possibly finish worse than second in Iowa, but it looks like she may finish behind Edwards. I do not believe Edwards did well enough tonight to survive. He needed a victory or at least a close second to make a legitimate case for viability. I'm happy with this result, because I feared Edwards as the strongest general election threat for the Democrats. Obama's strength amazes me, and I wonder how Hillary will frame the debate in New Hampshire over the next five days. I suspect lots of muck and mud will be thrown at Obama in New Hampshire, and if Hillary loses that primary, look out! At that point, Democrats would be in full self-destruct mode.

I look forward to the next five days. We live in interesting times.

Huck's Mistake Involves Integrity

2007-12-22T01:18:00.001-06:00

"George W. Bush has resolutely led our nation on a new course, a course not sought by America on September 11, 2001, but a course that rightly affirmed the value of honor and liberty and life. I thank God for his wise leadership and his calming and steadfast policies, policies that in some ways with hindsight could have admittedly been improved, but policies all too quickly attacked, and now being vilified despite the best news from Iraq in over a year." These are the sentences that should headline any foreign policy apologetic by any mainstream conservative seeking the Presidency.

Unfortunately, Governor Huckabee has sunk disappointingly to the level of others who've forgotten the GOPs Eleventh Commandment. Not only has the lightly regarded pseudo-Commandment been breached, far more Huckadamage has been done with his patently fact-challenged attack on the Bush Administration's "arrogant bunker mentality." I say patently false because of those pesky things, facts, that get in the way of a good poll-tested focus group opinion. Never mind the support of England, Poland, Australia, and numerous other countries. Military personnel of these countries are fighting and dying, not because they're stupid, but because their nations' leaders see the same Islamofascist threat that Bush sees.

I don't think a man of integrity ought to be so driven for personal gain that he impugns his own President in time of war and energizes those opponents of our nation's success, both foreign and domestic. I especially believe this when the President has plainly stated his case for his actions, and when after hard times his plans seem to be beginning to work.

Huckabee's poll numbers took a noticeable dip a couple of days ago, a timing coincident with his "arrogant bunker mentality" quote. That Huckabee would write such a screed gives one pause to reconsider other claims of ethical lapse against him. My point is not that the other accusations have merit, nor would they have any traction absent "arrogant bunker mentality," but it is that this whole blunder was completely and totally avoidable, and is even now fixable with a simple apology. I pray that an infection of good sense will gently waft throughout Huckabee headquarters, and that said apology will be forthcoming.

Huckabee's Mistake

2007-12-15T13:30:00.000-06:00

Here's a quick post on a wonderful snuggly rainy Saturday. Family games in front of the fire and Miracle On 34th Street are on tap for later. I wanted to post today because I'm concerned about the first real mistake I've seen the Huckabee campaign make.

Mike Huckabee's decision to write an article for a respected (ie mainstream elites) foreign policy magazine was probably necessary, but he's made a pretty severe tactical error by his forceful criticism of the Bush Administration's so-called arrogant "bunker mentality." What, pray tell, would Huckabee have had George Bush do in a post-9/11 environment when the consensus of the intelligence community pointed toward Irag's possession of weapons of mass destruction? Remember that the leadership of France and Germany based their foreign policy on opposition to America's interests. Remember the noxious corruption of the UN, evidenced in the Oil For Food scandal. Remember that, conversely, many nations, including England, Australia, Poland, and others have been staunch allies of Bush Administration policies. Remember also that, pre-9/11, candidate George Bush campaigned on a platform of "humility" in American foreign policy. The recognition of the civilized world's mortal danger from Islamic terrorists forced the change in Bush's foreign policy approach, and thank God for George Bush's willingness to face the threat. I certainly don't agree with everything the President has done, but it's helpful to no one at this point for Republican Presidential candidates to use such incendiary rhetoric.

Not only am I disappointed in Huckabee for making these statements, but it raises legitimate questions about his willingness to stand up to the liberal elites' conventional wisdom on any number of other issues. I've been a huge Huckabee supporter, in part because of his willingness to stand up for social and cultural truths unpopular on the East and West Coasts. Huckabee allayed my initial concerns about his commitment to limited government and personal liberty with his Second Amendment support and his advocacy of the FAIR Tax. If his purpose in writing this article was for short-term media approbation, his character is not as strong as I'd thought. If he actually believes such silly claptrap, his judgment and philosophy are suspect. I admit I haven't read Huckabee's article, but only seen excerpts from it, but even if the reporting on the article is incorrect, Huckabee should have had the good sense to see how the article would be portrayed.

None of the exogenous attacks on Huckabee that I've seen could harm him significantly, in my opinion. Unfortunately, this unnecessary and self-inflicted blunder has the potential to stall the enthusiasm of his supporters and his appeal to those voters for whom national security is the paramount issue. Even if Huckabee survives the Romney and Thompson attacks in Iowa and New Hampshire, this article supplies Rudy Giuliani with plenty of ammunition to use against Huckabee later in the nominating process. What a big mistake! I hope Mike Huckabee has the good sense to back away from these comments, and the quicker the better.

Quick Political Round-Up

2007-12-11T20:29:00.000-06:00

I'm writing tonight after a several week period of being too busy for my own good, and too busy to post. Tonight's subject is political prognostication. I'm gratified to see, in the GOP race for the Presidential nomination, that my favored candidate, Mike Huckabee, is surging. Huckabee has succeeded in courting the mainstream media, who do not understand that a big-time pastor has the same skill set as a major corporate CEO. I now believe Huckabee will win Iowa, and he is approaching an even money shot at winning the nomination. I do not believe any of the attacks on Huckabee I've seen so far will stick, and the attacks may actually serve to legitimize him.

I still think Giuliani is the national front-runner. Romney will probably be crippled after New Hampshire, and finished after South Carolina. Here's why Romney will fade: John McCain will exceed expectations in New Hampshire, probably finishing a close second to Romney. A narrow and fading victory by Romney in New Hampshire will further shred an image that will be in tatters after Iowa. I don't think McCain has enough mainstream Republican support to capitalize on what I expect to be his New Hampshire success. Huckabee will dominate South Carolina, forcing Thompson's withdrawal. This will set up the February 5 battle which will probably decide the nomination, with the advantage to Giuliani over Huckabee on the basis of money and organization. This scenario should not be surprising, as I've for months predicted the GOP fight would wind up being between EITHER Huckabee or Thompson and Giuliani or Romney. Thompson's fizzle is the direct result of Huckabee's fire, though I had expected a better campaign performance than Thompson has thus far shown. It's all thrilling to watch for a political junkie like me. We'll see how my predictions turn out, but right now Huckabee is riding his wave, and I'm right there with him.

On the Democratic side, it's fun to watch Hillary squirm. Can you imagine the staff meetings with Hillary over the past two weeks as her internal polling has tanked? I have written before of Hillary's political tin ear, which I've hoped would doom her general election prospects. Until recently, I've never thought, though, that she could lose the Democratic nomination. Her organization looked too strong and her competition too weak. I've had to rethink this over the past two weeks, but I still cannot credibly imagine the Democrats handing their nomination to a candidate as weak as Obama or Edwards. If Hillary does indeed lose Iowa, and five days later does not win strong in New Hampshire, look for crisis-management mode among the Democrat muckety-mucks. It will likely manifest itself in the form of a major Draft Al Gore movement. All bets would be off at that point, with a major dogfight between Gore and the Clintons. In any case, I believe that scenario unlikely, and I still think Hillary is likely to win the Democratic nomination. Never underestimate the Clintons. They are capable of anything.

Thankful Thoughts

2007-09-01T13:58:00.000-05:00

I'm posting today from beautiful Perdido Key in Orange Beach, Alabama. We arrived last night and have had a glorious morning playing on the beach. The weather is great, and the beach is perfect--with just enough other beachgoers for our children to make friends and have playmates, but by no means crowded. I've already had the chance to eat some gumbo and shrimp, so life is good.

It's an emotional trip for me. It's my first visit here in three years, since we evacuated this very place on the day Hurricane Ivan hit. Our two bedroom Gulf-front condo (which we co-own with another couple and the bank) took a pounding, and the restoration has been slow, difficult, expensive, maddening, and depressing. When I was here last, my children were babies, I was a partner and board member of one of the largest multi-specialty physician practices in the Southeast, I was busy in church teaching Sunday school every week and serving on the pastor search committee,and I was not yet forty years old. Today, I'm an exhaused almost-43 year old who has weathered a tumultuous year building my own solo internal medicine practice, a venture which has been both consuming and liberating, both frightening and comforting, and stressful yet strengthening.

This brings me to the title of this post--thankfulness. I am most thankful to my wonderful wife, who has stood by me while I have upended her life, and who has been instrumental in building what is now clearly a successful solo medical practice. Thanks to her unconditional love and her willingness to allow me to take risks, we have built what I believe is a unique medical practice, one that is making a difference in people's lives, and one that is positioned to withstand the turbulent times ahead for primary care medicine. Not only has Mary Kaye stood by me, steadfast, but she has home-schooled our children with measurable success, and along the way she's managed to complete re-licensure as a physical therapist to boot, providing much-needed financial support for our family during my practice start-up. Not one woman in a million could have accomplished what she's done, and I'm so proud of her I could burst. Oh yes, that's not to mention that I've also relied on her to take the lead in all the dealings required for restoration of our condo. In all things, in every aspect of my life, she has made better anything I've been part of. I love you, Mary Kaye.

I'm also thankful to God, who has blessed me with Mary Kaye and three wonderful, intelligent, rambunctious, and unique children. They are a joy. Granted, they are expensive, tiring, and exasperating, but they are mainly a joy. I revel in them even as I take seriously my responsibility to raise them. God has also blessed my practice, and I see His hand evident whenever I take the time to look. A close friend who has been a pastor has remarked to me how energizing it is to minister to people, even in the face of an exhausting schedule, and I see that also in my work--I feel a God-given sense of satisfaction and fulfillment when I help people through my medical practice. I almost feel that to talk about that God-given motivation may somehow cheapen it or open it to ridicule, so I won't dwell on it, but it's there, and it's real, and I'm thankful to God for His blessing in bestowing it.

The kids are studying the founding of America in their history lessons, and their study has opened my eyes anew to God's blessings on our nation. We all ought to be thankful to be Americans. I will often rant and criticize about political issues, but I must remember to be more thankful for our system of government. I do believe God had a special and unique plan in the founding of our nation, though I shudder in fear at how far we've strayed from His principles.

I'll close for now, with plans to post again during our vacation. Beach and nap and seafood are calling, and I'm thankful for them, as well...

Progress Report

2007-08-04T14:25:00.000-05:00

Today's post will not be my typical laser-focused gem of nuanced and knowledgeable insight. I am fighting off a cold and Mary Kaye is off to a scrapbooking convention, so today is a lazy day home with the kids. It is an opportunity to post on several topics I've touched on in the past, however.

Plans are apace for the Open House my office is having August 23. The Open House is being held to celebrate the completion of our first year of practice. We never held a Grand Opening because we were too busy from the start, but I wanted to celebrate what I believe is a successful start for our efforts at delivering primary health care in a different and better patient-centered model. We also wanted folks to see our expanded office space, which we just finished remodelling a couple of weeks ago. We have almost doubled our office's square footage, and have doubled the number of patient exam rooms. Another reason for the Open House is to introduce Tina McCall, our new nurse practitioner, to my patients. Tina's presence will help us tremendously as we strive to be conveniently available to patients, and we want to give folks a chance to meet her, as well as to publicize that work-in appointments, especially on Fridays, will be more available. Finally, we wanted to use the Open House in a low key manner to introduce the new Premier Wellness option that we are now offering. As I've noted before, Premier Wellness is an optional retainer-based program in which patients pay an annual or monthly fee in return for a wide-ranging annual Wellness Review, as well as guarantees of quicker work-ins and generally enhanced levels of office time spent discussing health issues.

I have developed the Premier Wellness program in an effort to insulate myself and my patients from what I fear are impending devastating public policies regarding reimbursement for health care services. My fear is that, as third party/government payors exert more and more influence on health care policy, the traditional and precious relationship between doctor and patient will be irreparably harmed. Only a socialist would argue that the individual's best interest is always concordant with society's, or the government's. Unless the patient is paying for the service, someone else is calling the tune. The practical result, I fear, is that without Premier Wellness or something similar, all primary care doctors will be forced into becoming "office visit mills" with limited time and little satisfaction for both patient and doctor. If I can develop a model in which patients feel valued and empowered and really "cared" for, a model in which the patients themselves decide the value of the services and whether to pay for them, then I will have protected some modicum of the traditional relationship between doctors and patients. I will have also salvaged that ideal which should motivate physicians--the concept of servanthood.

Too often, conservatives cede the moral high ground to liberals who preach generosity and unity, but the truth is that none of the ideals I've spoken of above can occur unless the staff is paid, the rent is paid, and the monthly bills are paid. I love the old joke about liberals, that they're so generous they'll give you the shirt off someone else's back. I'm here in the trenches, trying to care for folks, but I'm also saying that providing the care people want costs money, and that's a truth that needs to be faced. My Wellness option isn't for everyone, but neither is any other single option. The thrust of my position, however, is that patients need to control the system, and that will not happen unless they are also paying the bills.

With regard to Premier Wellness, I'm excited that the response to my initial offering has exceeded my expectations. I have already seen one patient this week as a Wellness patient, and I believe that this patient felt , dare I say it, pampered and well cared for. I was able to take the time to speak with a specialist about one of this patient's health problems, and arrangements were made for an expeditious office visit with the specialist. This was all able to be accomplished because I was able to allocate extra time with this patient. Time--that is the most important asset I have to offer patients, and the commodity that patients are being deprived of in today's system.

I am also trying to find other ways to add value to the product I offer Wellness patients. I have arranged a substantial discount for membership at a local water-based therapy center, and I hope to arrange access to an entity that offers gym and exercise equipment. I would also like to have my Wellness patients meet annually with a dietitian for nutritional counselling, and I'm going to try to add that benefit at no extra cost to the patient. Offering these and other benefits will help these patients achieve their goal of good health and access to personalized care that is convenient for them. I am proud to be part of the process.

I'll close with a word about Presidential politics. It goes without saying that all the Democratic proposals regarding health care are horrible. Among the Republicans, there is a glimmer of sense. Giuliani, whom I've slammed for his pro-abortion stance, has made headlines recently with an outline which seems to try to apply market principles to health care spending by making individual health care premiums tax deductible. This proposal is good in that it weakens the artificial and harmful linkage between employment and health insurance. Mike Huckabee, who I believe is the most engaging and credible conservative in the race, has a good strong tax policy proposal called the FAIR tax. I need to learn more about his health care spending proposals. Huckabee needs to do well in an upcoming Iowa straw poll next week. I hope he does.

Patient Driven Health Care

2007-07-28T23:59:00.000-05:00

It seems that a perfect storm of events has occurred over the last several weeks which has brought the discussion of health care delivery in the United States to the fore. The federally funded but state administered Medicaid plans, for example, are woefully underfunded and lacking in sufficient primary care and specialty care, and patients' frustration with a system which does not serve their interests has reached a critical mass. I've seen several recent newspaper articles on the subject, and just about all the Presidential candidates have their own ideas (mostly bad) about how to fix things.

But wait, you say, Medicaid is just a welfare program for the poor and chronically ill. You have Medicare, the federal government run program available (mandatory, actually) for those over 65. Didn't that program add a nice new drug benefit last year? It's saving me a bundle on my meds. What you soon-to-be Medicare patients don't realize is that when you turn 65, your doctor automatically gets paid about 30% on average less money for the exact same office visit with you, compared to when you didn't have Medicare. And it's illegal for you or your doctor to negotiate any fee higher than "Medicare allowable." How many doctors with full practices will be anxious to add new Medicare patients into their slots, which could be filled with non-Medicare patients paying 30% more for the exact same work? The answer is, Not Many, and therein lies a huge problem most people nearing 65 aren't even aware of. But it's real, and it's coming.

Unfortunately, another truth is that Medicaid, the federally paid but state managed health care system for the poor, pays so poorly that growing numbers of primary care and specialty doctors are refusing to lend their legitimacy to this fiasco by participating. Meanwhile Medicare payments to primary care doctors are down 9% in 10 years in inflation-adjusted dollars, and draconian cuts in payments to providers are on the way. Limitations in choice of, and even access to, providers are looming on the horizon.

Well, perhaps I'm guilty of overdramatizing a problem. Let's look at where all the new medical school graduates are going to finalize their training and choose their specialties. And over the past ten years, we've seen a stunning and unique drop in the students choosing general internal medicine, a drop of nearly 50 percentage points in ten years. These graduates are voting with their choice of specialty, and they are voting to choose more money over less, less work over more, respected work over ridiculed work, daytime work over night time.

The picture that I've drawn is one of a broken system, specifically a broken payor system. The health care you're given is still generally top notch, but that may not be for long. Clever, capable, driven young men and women will find other and easier routes to glory and service, without the debt, and where their services are appreciated. You appreciate your primary care doctor, you say? Well, unfortunately, the third party payor who pays your bills generally doesn't.

I'll give one actual example for your consideration. I recently bought a machine that allows me to assess for the presence of peripheral arterial disease. Having the machine helps me provide better care to my patients, most of whom have multiple risk factors for arterial disease. Incredibly, I get reimbursed more from Medicare for performing the test than I do for the office visit in which I use those test results to formulate a treatment plan! Not only do I get paid more for doing the test, but, even more ridiculously, it takes 5 or 10 minutes to read and interpret the test, while an office visit is 15 to 20 minutes on a good day. I'd be better off to stop caring for patients and just do ABI testing full time. Stories like this will be repeated and repeated until we finally realize that, in order to restore some balance to the health care market, patients must be put back in charge of their own health care spending.

The solution? I suspect there may be many solutions, but one solution for my small medical practice is to attempt to remove myself from being in bondage to the third party payors. I will attempt to offer to patients a guarantee of such a pleasurable and low-stress office visit environment, care that is focused on meeting the patients' needs, with bonus perks for Wellness-related services, that these patients will be willing to pay me an annual retainer just to get to be part of the practice--to have access to the annual Wellness review, the guaranteed work-in times, the "no-waiting" policy, the quarterly newsletter, the portable medical records on CD-ROM, the dietitian consultation, the massage, the discounted Aquatherapies and gym membership, and my personal cell phone number.

Having a cohort of patients who are focused on Wellness and who identify me as their doctor--that will make me no longer a slave to the third party payors, but will instead restore me to the traditional physician's role of being a servant of the patient. Instead of the government or Medicare or insurance companies determining what my services are worth, it will be the patients--the consumers of my services--who decide what they are worth. Nationally this concept is referred to as "patient-driven health care," and it results in excellent patient satisfaction survey numbers.

I believe in this concept so much, and I am so fearful of the status quo in medicine, that I am implementing a patient-driven, retainer-based protocol in my own practice. The response has been very encouraging, and I no longer have any real doubt as to its success. These patients have every right to expect from me top-notch medical care, efficiently delivered, in a manner that fits their schedule, not my own, and I am motivated to deliver for them and to be accountable to them for the results.

I'll let you know how it works out.

"Evidence-Based" Medicine?

2007-06-06T19:04:00.000-05:00

My sister, who is an RN and studying to become a nurse practitioner, recently was required to interview a physician regarding what is known as "evidence-based" medicine. She asked me for perspective.

Here is the question:

The Interview Objective:
To determine individual perspective regarding the significance of research in generating an evidence-based practice for nursing.

Here is my response to her:

Evidence-based medicine is the substitute created by third party payors to replace the traditional boundaries of accepted clinical practice defined by the physician-patient relationship. While the research itself might be useful, the underlying impetus for the research is harmful to the practice of medicine. There will always be outliers among providers, who in a traditional model would likely be marginalized by other providers and by the community itself. With the rise of insurance and government payors and the concomitant weakening of the unique provider-patient relationship dynamic, traditional means to identify substandard providers have been weakened. In general, the American system of health care delivery is excellent, but the brokenness of the reimbursement system will inevitably lead, I believe, to a decline in the quality of care.

Insurance companies are driven not by altruistic motives, but by profit margins, and government by political considerations. While insurors today claim that it's good business to promote wellness and provide thoughtful care, the facts belie their claim. Anecdotal evidence abounds to confirm what is suggested by common sense---that insurance companies prefer to delay and challenge legitimate payments as much as possible. Employers, the traditional conduit for health insurance benefits for the last 40 years, pay insurance companies prospectively on a monthly basis for their employees' health benefits. Meanwhile, in my hypothetical, the insurance company withholds payment for a legitimate service routinely for three to four months. The interest rate "float" generated by this cash flow manipulation must generate millions upon millions of dollars for these companies!

But I digress. The question relates to the significance of the research in generating a particular model of practice. Again, most research is inherently helpful in contributing to the body of knowledge of medicine. Such research has, in my thirteen years of private practice, led to striking improvements in patient care, especially in cardiovascular disease. Examples include the improvement in mortality and morbidity from tighter blood pressure control in hypertensive patients or glycemic control in diabetics. We are currently in the midst of a dramatic increase in the use of statin drugs due to overwhelming evidence of their benefit. All of these treatment trends are beneficial to patients.

Unfortunately, clinical patient encounters resist the precision inherent in the scientific method. This makes quantitative assessment of patient care very difficult, and current methodology is very primitive. It's my belief that an excellent clinician might have, on the basis of a number of unmeasurable variables, poor results in such analyses. Patients don't come to the doctor with Problem X, Y, or Z. They come in as themselves, indivisible, and the art of the clinical encounter is in managing that session to the benefit of the patient. Treatment based on evidence is desirable but incomplete unless it is modified to a patient's particular circumstance. I recently put a patient on an angiotensin-receptor blocker for his newly-diagnosed hypertension, and his insuror resisted paying for the medicine. Evidence-based guidelines would suggest that I use a different and less expensive drug. But I know that this patient is resistant in coming to the doctor in the first place, would be non-compliant with any medicine with even mild side effects or an inconvenient dosing schedule, and his sister and mother developed a cough when placed on ACE inhibitors. His insurance company and the evidence-based reviewers don't care about these things. This is a trivial example but the first to come to mind, and it illustrates in a small way the factors which are encompassed in an encounter.

A provider who bases her practice on evidence-based medicine is an automaton who would miss critical nuances. On the other hand, a provider who incorporates evidence-based practices into a framework of basic science education, clinical experience and compassion will provide superior care. Payors and regulators, however, will not necessarily be impressed. This is one of the major sources of tension in American medicine today. At their core, evidence-based clinical guidelines are a tool for clinicians, but are not an end unto themselves.

End of my response.

I will soon post more on what I believe is a fundamental problem with America's health care reimbursement system. Notice that I intentionally specified "reimbursement." It may be self-serving, but my perspective is my perspective, and I think America's health care system is excellent. However, as I noted above, the health care system is imperiled by a broken payment system.

A note about last night's Republican Presidential Debate. Mike Huckabee again distinguished himself among a host of men who will say anything to be elected President. When I heard his response to a question about evolution, I wanted to (and did) stand up and applaud. Many folks have not taken the time to become familiar with Huckabee, but I urge you to take a look. He is an impressive guy. He has given I think objectively the best performance through all three GOP debates.

Immigration Amalgamation

2007-05-20T12:38:00.000-05:00

My plan had been to wait until I'd read the recent bipartisan Senate compromise bill on immigration, until I realized the Senate apparently plans to vote this week before Senators have even read the bill. In fact, even today the final version is not yet drafted, so no one really knows what's in it. If a Senator can vote for something he knows nothing about, then I can certainly opine, as well. Since facts are in short supply regarding this bill, it is useful to look at who the supporters are, and compare them to the opponents, always looking toward the motivation of each side.

Amongst the supporters: the Bush Administration, most Democrats, the U.S. Chamber of Commerce, and some Republicans such as Lindsey Graham of South Carolina. The motivation of the Bush Administration is easy to deduce. Bush has always been a little leftward on immigration, I think because he views it as a demographic plus long-term for the GOP, and also because he really believes his rhetoric. Besides his judicial legacy, with the permanency of his tax cuts in doubt and with the failure of his Social Security reform, immigration reform would be viewed by opinion-makers as one of Bush's major accomplishments. President Bush is human and therefore not immune to such fluff, especially at a time when he is steadfast in the face of ferocious opposition to his foreign policy objectives.

With regard to most Democrats, again, their support is predictable. Most national Democrats will reflexively support any measure that results in increased numbers of low-income government dependent voters, as this bill will. Only the most left-wing radical Democrats would oppose this bill, and then on the grounds that it doesn't let in enough immigrants. Increased immigration fits well into their philosophy of "sharing" and redistributing wealth, and more immigrants means bigger budgets for entitlements such as Medicaid, Social Security, and children's services. Bigger budgets mean bigger taxes and bigger bureaucracy and bigger government--these are Democratic fundamentals.

I think the Chamber of Commerce, along with some other business interests, views this bill as a way to ensure a ready supply of lower-wage workers, especially in service sectors. I'm not in disagreement with much of their reasoning, but, on the other hand, these are the same guys advocating increasing ties with Communist China and who are building factories and business partnerships with the Chinese. Their aim is economic gain, but I can't shake the feeling that in dealing with folks like the Chinese, we are dealing with potential enemies. I fear that 50 years from now our children and grandchildren will face a Chinese threat that we helped fund. Forgive my roundabout process, but my point is that I'm not convinced the Chamber of Commerce has our national interest at heart--they have big business interests at heart, and those two interests are not always concordant.

Finally, there are the Republican supporters of the bill. A few, I think, are motivated by principle, but others are simply interested in favorable publicity or are appeasers always willing to compromise to "make a deal." Lindsey Graham of South Carolina, one of the Republican negotiators, has never met a camera he didn't like, and he is way too quick to sponsor compromises that sell out principles. John McCain typifies this group well. These, then, are the players in support of the immigration bill.

What about the opposition? Amongst the GOP Presidential candidates, most except McCain have come out against this compromise. This tells me that these guys have read the pulse of GOP primary voters and detected real concern. I was particularly interested to see Fred Thompson quickly come out in opposition with a well-reasoned article which can be found on the RealClearPolitics website. Countering the Chamber of Commerce support for the compromise is the National Federation of Independent Business. The NFIB might have been expected to represent the same interests as the Chamber of Commerce, but they have instead come out against the bill because of its punitive measures against small businesses and because of the regulatory burden it places on them.

On balance, just looking at the compromise's supporters and opponents, I'm pretty comfortable in opposing this bill. It seems to me that the merits of a guest-worker program ought to be subjugated to the imperative of securing our national border. Why can't the government come to the American people and say, " We've reduced illegal entry into this country by 80% over the last two years, and every illegal immigrant who commits a felony is being deported. Now that we've secured our borders and established the rule of law, here is our proposal for a guest worker program." This seems eminently more reasonable to me.

I hope conservatives can muster the groundswell necessary to stop this compromise. I'm optimistic that if we can, then perhaps progress can be made in enforcing our current immigration laws. If that happens, then I'm all for hashing out an agreement that allows for reasonable immigration. Right now, though, we're too busy getting the cart before we have a horse. And this is one ugly cart.

Debating the Debate

2007-05-17T20:32:00.000-05:00

This week's GOP debate in South Carolina was another opportunity for the top tier guys (McCain, Romney, Giuliani) to distinguish themselves from one another, as well as an opportunity for the lesser-known candidates to kindle an identity for themselves in the public eye. Unlike the earlier GOP debate, I did not watch this one in its entirety, but I've reviewed partial transcripts and viewed snippets and digested some snap post-debate commentary, and, having done so, I feel reasonably confident in offering this analysis. By the way, the news of the day today has to do with the Senate's backroom bipartisan deal on immigration reform, and I'll certainly post on that once I know more details of the agreement. At first blush, I'm at best greatly conflicted, and I need to reflect for a few days on how this agreement purports to solve such a base failure as our government's failure to adequately secure our nation's borders. But I digress...

With regard to the GOP debate, Mitt Romney was clearly the biggest loser of the night, I think in part because he had done so very well in the previous MSNBC debate. This week Romney was not so sharp, seemed to struggle with some answers, and consequently suffered the letdown of unmet expectations. My impression of Romney from the first debate was that he looked Presidential and in command of the issues. That was not my impression this week.

The conventional wisdom is that Rudy Giuliani helped himself the most among the Big Three with his authoritative focus on national security and his seemingly spontaneous umbrage with Libertarian Ron Paul's blaming of 9/11 in part on American foreign policy. Nevertheless, I do not believe Giuliani can win the GOP nomination with his strategy of embracing his pro-choice views on abortion. I once thought he could possibly finesse the issue with his assurances about appointing strict constructionist judges, but I believe he has needlessly alienated too many social conservatives with what I perceive is a flippancy ("It'd be OK..." to reverse Roe) toward one of the foundational issues of our day. He once had the reserve of good will to handle this issue, but I believe his opportunity is lost.

The debates do not help John McCain. His answers remind me of Al Gore's--the canned responses of an insider. I'm convinced John McCain is pursuing a pipe dream but doesn't know it. He has banked on the tradition of Republicans to nominate "the next in line" (think Bob Dole, George H.W. Bush, even Ronald Reagan in 1980), but he underestimates his negatives. Conservatives remember his campaign finance reform which limits our free speech rights, his opposition to the Bush tax cuts, his coddling of the liberal media in 2000 in part by attacking religious conservatives, and his hamstringing of America's efforts to interrogate terrorists with his publicity-seeking opposition to "torture." McCain is learning the same lesson many other Republicans have learned the hard way--he was once a media darling by virtue of attacking conservatives, but now that the mainstream media has deserted him, he finds himself alienated from those conservatives. His base is now largely comprised of establishment inside-the-Beltway types who have no firm ideology. Support from such folks might normally be enough for a Republican to win the GOP nomination, but I suspect not for McCain, because I think he's made too many conservatives mad.

I've posted before of my support for Mike Huckabee, and I think his polished performances in both GOP debates may be enough to push him up from the mass of lower-tier candidates into his own lone position as a second tier alternative. He clearly had the line of the night with his John Edwards beauty shop one-liner, and his deft handling of questions and fresh yet polished candor is very appealing. National pundits don't appreciate what many of us know--Huckabee's background as a pastor of a large Baptist church is serving him very well right now. Huckabee has also quelled my concern that he might not be committed enough to limited government and lower taxes. He has a proposal for a consumption tax called the "Fair Tax" to replace income and corporate taxes, and his support for this indicates to me that he understands the economic imperative of a limited tax burden. Political consultant Dick Morris has called Huckabee's delivery a combination of Reagan's and Clinton's styles, and after a bit of a shudder at his linkage of these two icons, I can see Morris's point. Huckabee is Reaganesque in his ideology and optimism and his media savvy delivery, but he also emotes and engages the crowd like Clinton can.

We're about two months away from the campaign's second quarter fund-raising reporting, and Huckabee will have to have shown some movement by then if he is to have a chance. I suspect he will. I also predict McCain will muddle along while most media attention is devoted to Giuliani and perhaps a summertime Fred Thompson entry into the race. This is all very interesting to political junkies like me, but it's also critically important for our country as these candidates lay the groundwork for our nation's alternative to the Democratic vision of defeat, retreat, division, and economic and moral decay.

Who Will Write Our History?

2007-05-13T00:17:00.002-05:00

My children and I traveled to Shiloh National Military Park this weekend for a family getaway and history lesson. It was a wonderful and fun trip for the kids and for me, as I remembered similar trips to Shiloh when I was their age. In a time when so many of the defining elements which shape our culture are not being passed to the next generation, it was a joy for me to be able to build memories with them.

As we wandered the beautiful and meticulously kept grounds of the cemetery, John Henry and Lydia were full of questions. Among them were questions about who was buried there, and which side were the "good guys" fighting on? It is hard to explain to seven year olds the concept of a civil war, with brother fighting against brother. Nor did they ever grasp that everyone buried in the cemetery in individual graves fought for the Union, while the Confederate soldiers were buried by the thousands in huge burial trenches. Indeed, according to family lore, my own great great grandfather is buried in one of those trenches, having himself left behind a seven year old daughter who would grow up to become my great grandmother.

The epiphany hit me while we were wandering in the cemetery. History is written by the victors, so it has always been, and so will it always be. We who live generations later can have little real understanding of the milieu which led these ancestors of ours to make the choices they made. We can study and read and educate ourselves, but the truth remains that in a major conflict such as The War Between the States, where basic philosophies are at odds, the victor conquers more than people or land. He vanquishes the losers' ability to frame the debate. I hasten to add that I do not speak of racial matters here, for there can be no reasoned debate on race in today's America.

I speak, instead, of victory in a society's battle of ideas: The South's belief, for example, that their government was the true inheritor of the principles of the Founding Fathers. That the individual states did have a sovereignty that superseded that of the Union. That many who fought for the South fought not for slavery but to defend their homes from what they viewed as armed invaders. Yet none of these truths, as Southerners saw them, has survived to the national identity of today, because the South lost the war. The United States after the Civil War was a very different country from the looser organization of states that existed before the war, and the Southern cultural perspective is now relegated to a quaint footnote, or worse.

My point is not to comment on the consequence of the Civil War on today's America, but rather is to recognize that our society's views are a product of those battles of ideas that have preceded us. Further, we as a people are engaged today in a multitude of battles whose outcome will determine what kind of world our children and our children's children will live in. The victor will tell the story. If you are apathetic about these battles, you shouldn't be. The stakes are high.

We face, among numerous other challenges, an implacable Islamic terrorist foe who believes that women are second class citizens, who denies freedom of speech and religion, and who does not share the traditional Judeo-Christian view of the worth of the individual. If we as a society do not steel ourselves to recognize and fight this enemy, it is hardly an exaggeration to believe that our progeny might grow up under sharia law, with no understanding or appreciation for the freedoms we now take for granted. It does not matter whether we acknowledge the threat we face---the threat is before us and threatens our very existence. We ignore it at our children's peril.

Scripture tells us in the Book of Judges that the Hebrew people did such a poor job of teaching their children that, " ... a generation grew up which knew neither the Lord nor the things He had done for Israel." (Judges 2:10) It is incredible that after all God had done for the Hebrews--delivering them from Pharoah and slavery, parting the Red Sea, delivering The Ten Commandments, parting the Jordan River, and delivering Jericho--that God's people did not teach their children about Him. Let us not make the mistake that those Hebrews made. Let us recognize and engage our foes, and teach our children to appreciate and defend the blessings of Western civilization, so that they can carry those blessings forward for themselves and our children's children.

America's Reputation

2007-04-29T18:11:00.000-05:00

I read a recent quote from John McCain that one of his first tasks, should he be elected President, would be to "restore" America's reputation in the world. Implicit in his statement is the criticism that George W. Bush has harmed America's stature in the world, and that it is a priority that other nations "like" us. I've been fuming ever since I read the quote, but it fits well with other McCain policy positions over the past couple of years. It was McCain who forced President Bush to tie the hands of American military investigators by publicizing which techniques are acceptable for interrogation of military prisoners. I remember then that McCain said we needed to "show the world" that we are different.

I beg to differ. The worldview of those who hate America will not be changed one iota no matter what we do, and the empirical evidence of the superiority of the American way is manifestly obvious to anyone who cares to see. I do not understand this need of American appeasers to be liked. It certainly should not be a matter of national priority. We must however, be respected, and the resolve of our national will should be unquestioned. The lesson Osama bin Laden learned from the American response to Somalia, to the U.S.S. Cole and West African embassy bombings, and other attacks on American interests over the years, was that America would cut its losses and sell out its allies when pushed to the brink. We were viewed as impotent and weak and unwilling to stay a difficult course. Say what you will, and notwithstanding his mistakes, God bless George W. Bush for proving Osama wrong and for showing the world that our resolve is strong, at least for the last six years.

The goodness of America is seen in the millions who want to come here to start new lives, and in the strength and resiliency of our economy. The foreigners who hate America are motivated by interests which are contrary to American interests, and examples include Russia, China, North Korea, and of course the Islamist states. Left-wing European elites oppose America partly from jealousy and partly to further their own economic interests in competition with America's. Can anyone be so gullible as to be deceived by these people? Unfortunately, yes. That the Democrats and some Republicans running for President do not see this obvious truth reflects, I think, an insular mindset that often develops among those who are too comfortable with power and its trappings.

I myself am not fully comfortable with the degree of the Bush policy of intervention and engagement in the world, and I do see problems related, for instance, to American national security from unbridled free trade policy, but the arguments of the Left against such policies are breathtakingly shallow and hypocritical, and I am almost ashamed for the people making them. However, it is in the context of today's Republican party that real ideas are being debated with intellectual rigor, vigor, and respect. Such debates over immigration, trade policy, and education reform are driven intellectually from the Right, and whatever policy coalesces from these debates will be stronger and better because it will have been borne from this crucible of moral and intellectual discourse.

I've written above of my unhappiness with John McCain's policies (while I honor his unquestionably heroic service to our country), and I have grave concerns at this point about each of the top tier GOP Presidential candidates. I've also written about Mike Huckabee, and I really believe that if he could just get a little more exposure, others would find him as appealing as I do. Huckabee did win a recent straw poll among GOP activists in Spartanburg, South Carolina, and I'm hopeful that this portends a move up for him in South Carolina, which is a critical early primary state.

America is the greatest nation the world has ever known, albeit with flaws, but unquestionably great. I am sorry that some who have inherited bountifully from her greatness are so quick to carry water for her enemies, and I pray that come November 2008 we have at least one choice for President who can stand tall for America's interests.

Health Care--Who Controls Your Choices?

2007-04-22T16:54:00.000-05:00

Who makes your health care choices--you, your doctor, your insurance plan, or your government? Who should make such choices, and who should pay for the delivery of the chosen services? In truth, each of the four entities I mentioned above plays some role in the delivery of health care in America. Today marks my first effort at discussing the state of health care delivery in the United States, and it's my opinion that the critical question is the one I asked at the beginning of this paragraph. Who should be paying for the array of wonderful and advanced treatments available to us?

Our society has come to accept the notion of health care as a "right," and that it should be available, at least at a basic level, for everyone regardless of their ability to pay. This principle collides, however, with the inconvenient truth that someone must pay. As a provider, I wouldn't be in business very long if I did not pay my staff and my office rent and insurance and all the other expenses associated with a medical practice, not to mention that I would like to provide for my family. The tension evident in today's system results from the fact that the users of a given service, poor or not, are largely removed from directly paying for that service. This divergence drives up the costs of care and the demand for services.

For the vast middle class in America, the linkage between a health care service and its cost is lost, and the result is greater demand at greater cost, and ultimately more limited choices. The schism that I'm talking about has come about because of the huge and intrusive role of third-party payors--insurance companies and government--that has developed over the years. I can give a multitude of examples, but I'll be brief to try to illustrate my points. For every service or good you can think of, there is a balance between supply and demand, and cost is the expression of that balance. Assuming you're not on food stamps, who pays for your groceries? You do, of course, as you do your phone bill and your car payment and whatever else you buy. Now, again assuming you are part of America's great middle class, how did you choose which car you drive? The answer is that you bought the car you wanted, that fit your needs, and that you could afford. No one expects to pay their employer or the government a monthly premium, and to be given a choice of three different cars to pick from every March. And if my absurd illustration were true, I'll assure you that not only would your car choice be limited, it would be more expensive, as well. Competition is a potent motivator, and innovation is its result.

Apart from emergency care, my illustration above is as equally applicable to health care services as it is to car purchases or haircuts or groceries. Unless our current system changes, patients will in the future have vastly greater restrictions placed on them with regard to choice of doctors, hospitals, treatments, and medicines. We are already seeing examples in physician provider panels, and in medicine formularies that pay for only one drug, if any, in a given class. The bureaucracy chooses which medicine to pay for, and which physicians to contract with, and those choices are driven by interests that are often at odds with the patient's best interests. Physicians, for their part, have little incentive to openly publish their fees or compete for patients based on convenience issues such as flexible appointment availability or timely message return. Employers, saddled with the job of picking insurance options for their employees, are left with a responsibility and cost they'd rather not have, but which has developed because of a longstanding tax loophole which favors employer-provided health insurance. Human nature can't be legislated, and those who pay the bills will always control the process. My fear is that the precious doctor-patient relationship is at risk from these outside forces.

One ridiculous and disingenuous proposal before Congress now is to have the federal government "negotiate" drug prices with pharmaceutical companies. This means price controls, and I can't think of a more effective way to dry up the basic research that leads to breakthrough treatments, which now routinely cost one billion dollars or more to bring a single drug to market. Certainly it's not fair that we are the only major Western nation without price controls, and the result is that we wind up subsidizing new drug development for these socialized countries. But the solution is not to do wrong just because everyone else is. I am armed today with a potent arsenal of drugs which are effective treatments for hypertension, diabetes, and heart disease, and many of these drugs did not exist 13 years ago when I entered private practice. Lives are being saved today because of the existence of these medicines. Instead of beating up on Big Pharma, lots of folks need to give them a word of thanks, and we should let our congressmen know how we feel, as well.

Nobody wants to hear doctors poor-mouth about money, but the truth is that primary care physician incomes are down about 9% in inflation-adjusted dollars over the last 10 years, and Medicare reimbursements are on track to be reduced even more drastically in years to come. Let's say you're a doctor with a full practice, and Medicare reimburses you only about 60% of what a private insurance plan would for the same service. How anxious would you be to fill all your slots with Medicare patients? Not very, and therein lies a substantial looming problem for everyone nearing the age of 65. Reimbursement is better with private insurance than with Medicare, but the same issues are in play, just delayed a little bit.

I'm a board-certified internal medicine specialist, and I deliver what I believe to be excellent care for my patients. Yet, I'm only a participant in three of the four available Blue Cross plans in the area, for example. Why am I not part of the fourth? It has nothing to do with my qualifications, but is because I was unwilling to provide my services at the price Blue Cross offered for that particular insurance plan. Meanwhile, I provide exactly the same services for Blue Cross patients in the other three plans, for a fee that I find acceptable. Blue Cross, and employers, you see, are driven by different motivations than patients themselves might be. Why should the employer or the insuror determine whether a patient can see me? I submit that the cost, quality, and choice available to patients would be greatly improved if the patients were more directly responsible for the cost of their care.

How might this be accomplished? One solution is being implemented now in the form of high-deductible health insurance plans coupled with health savings accounts. These programs are relatively new but are already transforming the health care delivery dynamic. The problem is that these plans are not nearly available enough to make a dent in the overall system. If these plans were more widely used, patients would likely become much more savvy consumers of health care dollars, and doctors would ultimately be forced to compete for patients much more directly in terms of transparency of cost, availability and convenience of services, and patient satisfaction indices. In my own new solo practice, I'm trying to implement some of these protocols, but in many ways I'm swimming upstream with my efforts. In any case, it's not just my solution, or anyone else's solution, but a multitude of solutions that will fit the needs of a diverse America. This is the vision I have for health care in America, with the patients and their doctors driving innovation.

Sure, patients may not immediately see the problems with third-party payors as I see them, and indeed these problems have developed gradually over the last 50 years. Nevertheless, the predicament is real and worsening, and I pray for wise leadership to bring us to sustainable long-term solutions. The surest path to success will be one in which the individual patient maintains maximal control over his own health care decisions, and that recognizes that it is the payor who has the control. I've chosen to be a solo practitioner for the freedom and flexibility that are its fruit, both for me and for my patients. I believe that people will value what I have to offer. On a broader scale, I hope Americans will continue to have a rich array of health care options in future years. It's not a given that we will.

A Crucial Victory, By A Hair

2007-04-18T23:18:00.000-05:00

Today's Supreme Court decision backing limits on partial birth abortion represents the first fruits of the Bush judicial realignment, and marks a watershed moment in the battle for recognition of the rights of the unborn. With a vote of 5 to 4, the decision also illustrates the tenuous and precarious character of the hard-won battles over conservative judicial nominees. Make no mistake, the liberal Left recognizes the stakes, and today's result reinforces their strategy of delay, delay, and delay, in hopes that President Bush will tire of the fight, and that he will be replaced by a Democrat. No issue personifies the distinction between the two national parties more than that of abortion, and the evidence of that can be seen in the responses of the candidates of the two parties for the Presidential nomination. To a man, the Republican candidates were supportive of the decision, even Giuliani, who is no friend of the pro-life movement. Conversely, every Democratic contender was critical of the decision. The amalgamation of interest groups that is the national Democratic party has no unifying philosophy, apart from Bush hatred, unless it is the absolute right of a woman to abort her baby, down to the very last birth contraction, or even beyond. That today's victory has been so long in coming speaks to the success of the abortion industry's tactics, yet even so our focus today should be one of exultation in the sweet aroma of long-awaited judicial victory.

The ruling marks the first restriction on abortion that has passed constitutional muster since Roe (apart from those with exceptions for "health of the mother," which are deceptive smokescreens emasculating the intent of the restrictions). Today's decision has no such exception, and is therefore landmark in its scope. It seems likely to me that future Roberts Court decisions on abortion will focus on building a constitutional bulwark of judgments that gives legitimacy to abortion restrictions, and I think it is unlikely that the votes will exist on the Supreme Court in the foreseeable future to flatly overturn the travesty that is Roe v. Wade. Given the politics and the personalities of the players involved, I suspect Chief Justice Roberts has wisely opted to aim for base hits, to use a baseball metaphor, rather than shooting for the fence with a home run overturning Roe. I believe Roberts has chosen the wiser course, and one that will most likely yield long term success for the pro-life movement.

While we must always remember that our ultimate purpose is to honor and protect the lives of unborn babies, today's ruling also has a secondary and very interesting side benefit. Occurring as it has in the hotbed of Presidential primary politicking, the decision has focused attention on the nuances of the various Republican candidates' abortion rights stances. The decision does not have the same tactical implications for Democratic candidates since their positions are all in lockstep with Planned Parenthood and NARAL. For the Republicans, however, obfuscation and deflection will be more difficult as a result of the new legal landscape, and greater clarity in their positions will be required. This is certainly to our benefit as voters.

I await with interest how all today's events shake out with Republican primary voters. I've previously posted my opinion that none of the top tier GOP candidates have completely sound pro-life credentials, and I hope one result of the renewed focus on abortion will be to cement the pro-life platform of whoever is the Republican nominee. While I can respect Giuliani for at least his consistency regarding his position on abortion rights, I'm convinced both McCain and Romney will perform whatever contortions are necessary to win the Presidency, and that the pro-life worldview is not foundational for them. Meanwhile, I'm amazed at the descriptions I've read of Fred Thompson's pro-life record. I do understand the attractiveness of, and could even support, a Fred Thompson candidacy, but he is most assuredly not a bedrock pro-life partisan.

Fred is, however, a states' rights federalist, and it is on that basis that I could support him. I believe he would indeed appoint strict judicial constructionists to the federal bench, and the end result for pro-lifers would be the same, since Roe is itself such a perversion of constitutional law. I believe Fred would justify his position, not on principles of Divinely-authored respect for life, but instead on the improper usurpation by the courts of an issue more properly decided in the political arena. Either argument is intellectually sound and achieves the same goal.

Notwithstanding all of the above, President Bush has been correct in saying that the larger task for pro-lifers is to engage with mainstream America to promote a "culture of life." Without success in that arena we will never achieve the political victory that we are seeking. Let us busy ourselves about that task as we savor today's nugget of triumph.

A Day of Tragedy

2007-04-17T23:54:00.000-05:00

What a tragic and sobering drama yesterday at Virginia Tech. My family and I are away on vacation this week, so I didn't learn of the shootings until late yesterday afternoon. Since then, I've purposefully not watched television accounts, partly because it feels somehow unseemly or gawkish, and partly to protect my children from this horrible example of man's vile potential. For similar reasons, I've also curbed my natural inclination to follow the trial of Mary Winkler, going on now in my hometown. The picture of their nine year old daughter testifying yesterday is heartrending and pitiful.

With regard to the Viginia Tech nightmare, one wonders how someone who was apparently recognized as potentially dangerous could have the opportunity to wreak harm of such magnitude. No, I don't know the details, and it's premature to draw conclusions, but major warning signs were evident. I'm curious as to what degree university officials were aware of the shooter's problems. It may be that they did everything right, and I know from my own experience that it is hard to quantify a disturbed person's risk of harming self or others, but I suspect we'll ultimately see evidence of administrative bureaucratic inaction and inertia.

Undoubtedly and unfortunately, opportunists with an agenda will attempt to capitalize on the national sense of outrage over the campus shootings to advance their efforts at gun control. How easy and naive are their proposals, how innocuous and reasonable do they sound, and how I wish life were indeed as simple as these misguided folks believe. Regrettably, the truth is that violent criminals and sociopaths will find ways to do violently criminal and sociopathic acts, and on April 16, 2007, Virginia Tech had too few guns on campus, not too many.

As horrendous as the campus murders are, it is the magnitude of the violence and the youth of the victims and the backdrop of a campus setting that transfixes the nation. The motive is sadly all too familiar. The Winkler tragedy, on the other hand, is so mesmerizing precisely because the motive is so mysterious. The Winklers could have easily been neighbors or friends of ours, and my nagging fear is that they could've been US. What went so terribly wrong in that marriage? Disturbingly, we'll never know. We grieve for Matthew and the children and the other relatives, and even for Mary, but for me personally, there is more. What led this family, so like my own in background and belief, to such an end? Are there other wives as desperate as Mary amongst our friends? Are there lessons for Mary Kaye and me to apply to our own lives? I have no answers, beyond the reinforcement that sin is real, that Satan is on the prowl, and that my marriage and my family are fragile and precious and to be treasured and protected.