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Is the future of American health care in Oregon?

Ezra Klein — Mon, 20 May 2013 06:20:25 PDT

“The governor has a notion that you can move away from medical billing and towards a more flexible approach to health-care spending that makes more sense for the community,” John McConnell, a health economist at Oregon Health and Science University, is telling me. Then he stops. “You’ve heard the air conditioner story, right?”

Oregon Gov. John Kitzhaber has a plan to save Medicaid. (Robbie McClaran)

As it turns out, I have heard the air-conditioner story. Oregon Gov. John Kitzhaber (D) loves to tell the air-conditioner story. He loves to tell it so much, in fact, that it has become something of a running joke in Oregon health-policy circles. At this point, even Kitzhaber is in on it. Before he repeats it to me, he says, “I probably shouldn’t bore you with my air conditioner story.”

Here’s the air conditioner story: There’s a 90-year-old woman with well-managed congestive heart failure who lives in an apartment without air conditioning. That’s actually the whole story.

Kitzhaber, a former emergency room physician, sees this as the perfect example of what’s wrong with our health-care system. “A hot day could send the temperature in her apartment high enough that it strains her cardiovascular system and kicks her into full-blown congestive heart failure,” he said. “Under the current system, Medicare will pay for the ambulance and $50,000 to stabilize her. It will not pay for a $200 window air conditioner, which is all she needs to stay in her home and out of the hospital. The difference to the health-care system is $49,800. And we could save that $49,800 without reducing her benefits or her quality of life.”

Oregon’s Two Experiments

The past few years have seen two remarkable health-care experiments in the Beaver State. One is the Oregon Health Insurance Experiment, the first randomized, controlled trial comparing Medicaid — or any kind of health insurance — with being uninsured. The other is Kitzhaber’s effort to rebuild the state’s Medicaid program around community health rather than individual fee-for-service treatments. The health-insurance experiment has gotten all the attention. But it’s the Medicaid reforms that really matter.

The Oregon health insurance experiment didn’t begin as an experiment. It began as a budget cut. From 2002 to 2008, Oregon threw 93,000 people out of its Medicaid program. In 2008, the state found it had enough money to add 10,000 of them back. The only fair thing to do, state officials figured, was draw straws. So 90,000 of the poorest residents of the richest country the world has ever known entered a lottery to win health insurance.

The 10,000 Oregonians who got Medicaid weren’t the lottery’s only winners, though. Early on, a group of eminent health economists realized the lottery offered a chance to conduct a study no one in their discipline had ever managed but everyone had always wanted: a randomized, controlled experiment comparing those who received Medicaid with those who remained uninsured. This would enable researchers to isolate the effects that insurance — at least as delivered by Oregon’s Medicaid program — had on the uninsured.

“It’s hard to overstate how excited we were,” said Amy Finkelstein of the Massachusetts Institute of Technology. “We thought it was a once-in-a-lifetime opportunity to bring the gold standard of experimental design to this question.”

Two weeks ago, the group reported the data from the first two years of the study. They found that Medicaid coverage increased the amount of health care people used, offered almost total protection against catastrophic health expenses and reduced depression by 30 percent, but it didn’t show a statistically significant effect on blood pressure, cholesterol or blood sugar.

Statistical Questions

The study has come under fire from health researchers who think the sample of sick people was too small to show statistically significant improvements in those measures. “What I don’t get is if you look at the table in their study and look at baseline blood pressure it was like 119 over 76,” said Aaron Carroll, associate director of Children’s Health Services Research at Indiana University’s School of Medicine. “That was normal. You wouldn’t expect it to go down by nine. It would be a bad thing for normal blood pressure to drop that much. All we should care about is blood pressure in the small subset that had high blood pressure. But they don’t present that.”

It’s a critique that Katherine Baicker, a Harvard health economist who was one of the principle authors of the study, partially accepts. “Our power to detect changes in health was limited by the relatively small numbers of patients with these conditions,” she said. “Indeed, the only condition in which we detected improvements was depression, which was by far the most prevalent of the four conditions examined.” She also noted that the diabetes results were consistent with the improvements one would expect from the clinical literature but the number of people with diabetes was too small to establish significance.

However, she said the sample size was large enough to rule out large improvements in blood pressure and cholesterol, at least over the first two years.

All this might make for an interesting academic panel on Medicaid. But the results were quickly conscripted into the war over President k Obama’s health-care reforms. “Today, the nation’s top health economists released a study that throws a huge ‘STOP’ sign in front of ObamaCare’s Medicaid expansion,” wrote Michael Cannon, director of health policy studies at the libertarian Cato Institute. Perhaps the law’s supporters oversold what is really just “a $1 trillion program to treat mild depression,” wrote the Daily Beast’s Megan McArdle.

I would be more favorably inclined toward such commentary if the authors followed their analysis to its logical conclusion and turned in their own health-insurance cards. “My daughter needs private coverage,” says Ezekiel Emanuel, an oncologist and chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania who worked on the Affordable Care Act. “Do I say to her the health-care system in the U.S. won’t necessarily do a great job managing your blood pressure so don’t get health insurance? No way in hell! And if that wouldn’t be my response for my daughter it shouldn’t be my response for poor people.”

The study’s bottom line is that Medicaid worked. It performed the core functions of health insurance. It got people access to health care and protected them from catastrophic expenses. “We can reject the ‘Medicaid does nothing’ hypothesis,” Finkelstein said. “Medicaid had impact. It increases their use of preventive care. It increases their outpatient visits. It increases their health-care utilization.

What the study called into question is the next step in the health chain: How much healthier, really, does the care we’re buying make us? And I use the term “us” advisedly. “Medicaid is a financing tool,” Kitzhaber said. “Once people get on Medicaid they are bought into the same hyperinflationary, inefficient, backloaded medical system as everyone else.” That’s the system Kitzhaber wants to change.

Oregon’s gamble

In 2012, Kitzhaber struck an audacious deal with the Obama administration. If the federal government would give Oregon $1.9 billion to remake its Medicaid program, Oregon would put Medicaid on a tight budget, guaranteeing $11 billion in savings over the next decade. If the savings don’t materialize, the funds dry up and Oregon is left with a huge budget hole.

“The fundamental problem with our health-care system is the growing discrepancy between the cost of care, the resources available to pay for it and the tenuous connection between that expenditure and actual health,” Kitzhaber said. “What we’re doing is instead of putting our budget into the ER and paying for congestive heart failure after congestive heart failure, we’re putting it into care coordination and community health workers. We’re investing in health. It’s just a paradigm shift.”

At the core of this shift are Oregon’s 15 “coordinated care organizations.” What makes them different from accountable care organizations or managed care is that they’re responsible for more than the health of their members, which now include 94 percent of the state’s Medicaid population. They’re also responsible for the health of the communities they’re in. They have to run regular community health assessments, and the results influence their pay.

This is a potentially transformational notion, based on a belief that the health-care system doesn’t decide or drive health, even that individuals don’t particularly drive their own health. If you live in a community where the streets are dangerous and the health of your neighbors is poor, you’re probably going to be unhealthy — and there’s little or nothing your local hospital can do about it.

Privately, many who are enthusiastic about Oregon’s effort to reimagine its health-care system admit that it’s not exactly clear how CCO’s will begin transforming whole communities.

The biggest change relates to the air conditioning story. Kitzhaber has given the CCOs radical flexibility in what they can purchase with Medicaid dollars. They can buy an air conditioner for a 90-year-old woman in a hot apartment. They can also try to improve outcomes by investing in “upstream” preventive care; one CCO is paying pregnant women to stop smoking. They’re also integrating with other public services.

“Six months ago,” said Oregon Health and Science University’s McConnell, “if you were a Medicaid patient who came to ER 20 times you’d get treated on your 21st time and go home. Now you come in and there’s a social worker with a list of names and they work with you when you leave to connect you with outpatient care and other resources.”

All that might be an improvement, but it’s a long way from a revolution. “I’m obsessed with what they’re doing in Oregon,” says Jeffrey Brenner, head of the Camden Coalition of Healthcare Providers, one of the country’s most innovative community-health efforts. (Do you remember that Atul Gawande article in the New Yorker about the doctor pioneering “hot spotting” in health? That was Brenner.) “But the problem you can run into with this population health stuff is people don’t know how to connect it to a change strategy that’s incremental. They get paralyzed by the vision and they don’t know where to start. You need small victories.”

Obamacare gives almost every American health insurance. That’s a necessary but not sufficient condition for making them healthier. Oregon’s experiment may or may not work, but it’s the right next step. “Medicaid can be improved,” Carroll said. “But we need to differentiate between the way we deliver care and the way we design insurance. Giving people insurance just gives them the access to the care itself. Denying them Medicaid deprives them of simply accessing the system. But if we want to improve quality, we have to change how we deliver care.”

In Oregon, at least they’re trying.

Further reading:

- The Oregon health insurance experiment.

- What the Oregon health insurance experiment really found.

- Can Oregon save American health care?

- Atul Gawande, “The Hot Spotters“.

David Schweikert: Say whatever else you want about the man, he can sure follow instructions

cpmaz — Sun, 19 May 2013 21:10:40 PDT

While I no longer live in his district (thank you Arizona Independent Redistricting Commission), apparently I'm still on the email list compiled by Congressman David Schweikert (R-AZCD6). I expect that to change shortly after this post is seen by ~~the Congressman~~ ~~his senior staff~~ ~~a junior member of his staff~~ OK, some lowly intern reading this stuff for college credit and chance to make contacts for a future political career.

On Friday, news broke that the Heritage Foundation, an influential Republican "think tank", sent a letter to Republican members of Congress advising them not to bother with trying to "govern" (no proposing or passing responsible legislation) and instead focus their efforts on "getting" President Obama by focusing on scandals, real (IRS scandal and AP phone records, maybe), spun from almost nothing (Benghazi), and completely made up (umbrella-gate).

Note to the Heritage Foundation: Not to belabor the obvious, but "getting" the President has been the Republican plan since he was inaugurated in 2009. Advising the Rs in Congress to do what they have been doing all along probably isn't going to enhance your credibility.

Anyway, on to the story...

From theGrio, written by Joy-Ann Reid -

In a letter to members of Congress, which was obtained by NBC News, Heritage Action for America, the lobbying arm of the Heritage Foundation (which recently found itself in hot water over the racial IQ theories of the co-author of their widely panned immigration reform study, Jason Richwine, who resigned from the think tank last Friday), urged Republicans on Capitol Hill not to govern, and instead, to focus on the would-be “scandals” plaguing the Obama administration.

The letter, which is addressed to House Speaker John Boehner and House Majority Leader Eric Cantor, trumpets the negative media buzz surrounding the White House, saying that, “for the first time, the activities of the Obama administration are receiving a sustained public vetting. Americans’ outrage over Benghazi is amplified by the Internal Revenue Service’s intimidation of conservative grassroots organizations and a cascade of negative headlines. There is the real sense the Obama administration has been less than forthright with the American people, the press and lawmakers.”

In light of the white hot media spotlight on the administration, and to deflect attention from the many policy areas where Republicans don’t quite get along, the letter urges: “it is incumbent upon the House of Representatives to conduct oversight hearings on those actions, but it would be imprudent to do anything that shifts the focus from the Obama administration to the ideological differences within the House Republican Conference.”

This diary from DailyKos has the text of the full letter.

It didn't take long for "Foreclosure Dave" Schweikert to "snap-to" upon receiving the letter.

His latest "newsletter", from my email inbox today, from the email address david.schweikert@congressnewsletter.net -

Schweikert hit all of the high points in the current litany of Republican talking points, even throwing in a demonization of health care reform for good measure.

When dogs perform tricks at their masters' commands, they generally receive treats of some kind; I don't know what members of Congress get when the perform on cue, but I'm guessing there are dollar signs attached.

Oh, and before the Congressman's staff removes me from their email list, I hope they take a refresher course on the use of the possessive in the English language -

Normally, I'm not a grammar Nazi (as a blogger, I've published too many typos to be a hypocritical hardass about it), but this was (presumably) written by the staff of a sitting member of Congress. They're supposed to be better than this.

The way that they wrote the last sentence signifies the existence of multiple "White Houses" in the US. While there are many "white houses" (houses painted white), there's only one "White House" (the seat of the President of the United States, located at 1600 Pennsylvania Avenue in Washington, D.C.)

Tighten it up, folks.

Would You Be Embarrassed to Have Trent Franks as Your Congressman?

Matthew Hendley — Sun, 19 May 2013 22:43:19 PDT

Is Republican Congresxsman Trent Franks addressing the issues most important to this country?Of the eight bills he's proposed this session, three are abortion-related, one prevents the Tohono O'...

Continue reading "Would You Be Embarrassed to Have Trent Franks as Your Congressman?" >

New Arizona law establishes 'benefit corporations'

(author unknown) — Mon, 20 May 2013 05:51:59 PDT

Arizona has created a new class of corporation that focuses on more than just the bottom line. The Arizona Daily Star reports the state legislature passed a law establishing for-profit "benefit corporations," or companies that must have the purpose of creating a "general public benefit." The governor signed it into law late last month and it goes into effect in 2015. Read more at the link below.

Pain Capable Unborn Protection Act proposed nationwide

ADI News Services — Mon, 20 May 2013 02:15:37 PDT

Arizona’s congressman Trent Franks announced last week that he would soon be amending his bill, the D.C. Pain Capable Unborn Protection Act, to apply nationwide. Franks wants to “prevent more cases like that of Kermit Gosnell.” The initial legislation would have outlawed abortions in the District of Columbia after 20 weeks (or 22 weeks in the “LMP” system), when studies have indicated babies have developed the ability to feel pain. As Chair of the House Judiciary’s Subcommittee on the Constitution and Civil Justice, Franks will hold a hearing on the legislation next Thursday, May 23, 2013, at 10 AM. “I know when the subject is related in any way to abortion, the doors of reason and human compassion in our minds and hearts often close, and the humanity of the unborn can no longer be seen. But I pray we can at least come together to agree that we can and should draw the line at the point that these innocent babies can feel the excruciating pain of these brutal procedures,” said Franks in a statement released Friday. “The case of Kermit Gosnell shocked the sensibilities of millions of Americans. However, the crushing fact is that abortions on babies just [...]

David Fitzsimmons: Hillary Alert

(author unknown) — Mon, 20 May 2013 07:00:28 PDT

David Fitzsimmons: Hillary Alert

AZ Illustrated Politics: Medicaid Expansion, Election Bills, Rosemont Mine & More

Jim Nintzel — Sun, 19 May 2013 16:16:00 PDT

On this week's AZ Illustrated Politics: Host Jim Nintzel, Tucson Hispanic Chamber of Commerce President Lea Marquez-Peterson, former Pima County Democratic Party chairman Jeff Rogers and Tucson Tea Party founder Trent Humphies talk about the chances that Gov. Jan Brewer's Medicaid expansion can get through the Arizona House of Representatives; the pros and cons of election overhaul bills that are still alive at the Legislature; the IRS scrutiny of Tea Party groups; the question of whether the proposed Rosemont mine should get CAP water; the uproar over a proposal to lease El Rio golf course to Grand Canyon University; and more!

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AZ Illustrated Politics: Medicaid Expansion, Election Bills, Rosemont Mine & More

(author unknown) — Sun, 19 May 2013 17:08:09 PDT

Arizona UPRISING -- Change happens... or does it?

Steve Muratore — Sun, 19 May 2013 22:03:21 PDT

Newton's First Law of Motion states:

Every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it.

This is also known as the Law of Inertia.

Inertia is not limited to the realm of physics. There is cognitive inertia.

Cognitive inertia refers the tendency for beliefs or sets of beliefs to endure once formed. In particular, cognitive inertia describes the human inclination to rely on familiar assumptions and exhibit a reluctance and/or inability to revise those assumptions, even when the evidence supporting them no longer exists or when other evidence would question their accuracy. The term is employed in the managerial and organizational sciences to describe the commonly observed phenomenon whereby managers fail to update and revise their understanding of a situation when that situation changes, a phenomenon that acts as a psychological barrier to organizational change.

Then there is social inertia or cultural inertia, where cognitive inertia takes over small or large groups or societies.

The common thread is resistance to change.

Cultural inertia is the reason it took until Lincoln's presidency before slavery -- in spite of the Founding Fathers declaring decades earlier that "We hold these truths to be self-evident, that all men are created equal..." -- to abolish the unquestionably evil practice of slavery.

Cultural inertia is the reason it took until August 1920 -- with ratification of the 19th Amendment to the US Constitution -- before women were granted the right to vote throughout the United States.

The United States, by the way, was NOT the first nation to recognize that right. Note that the (Progressive) State of Arizona did so with the passage of a ballot measure on November 5, 1912. That was the first general election after Arizona obtained statehood.

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Let's cut to the chase. Change happens.

Does it matter how or why change happens? Or doesn't happen?

Why do I bring this up now? Pointedly stated, we are at the most important moment in human history: NOW.

How quaint, right? Can we change the past? Notwithstanding those who would rewrite history, what happened, happened. Can we predict the future? Can we change the future?

I'm thinking that there are people who have the ability to predict, or at least envision what is likely to take place in the future based on a current course of action or set of events. There are also people who can present a vision of what a person or group may want to make happen in the future, and based on collective intelligence or resourcefulness, the group may be able to take steps at a given moment (a certain "now") to increase the likelihood their vision of the future will actually take place.

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As a society, there are some pretty fierce and seemingly insurmountable crises on the horizon.

First and foremost, we MUST Move to Amend the US Constitution to overturn or nullify the Citizens United ruling. US citizens have demanded amendments before and when the cultural inertia was overcome, change happened.

For several decades, scientists and engineers have seen climate change and other consequences of industrialization approaching.

Because of this understanding, rapid development of new technologies available to meet and overcome related challenges and crises have also been in the works for decades. When we overcome the cultural inertia, food production, manufacturing and transportation technology as well as energy usage practices will change.

Remember, overcoming inertia is only accomplished by application of an external force.

Source: benandjerrysfoundation.org via STLAreaFoodbank on Pinterest

WE are the leaders we've been waiting for. -- Bob Edgar

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Technological change in society can also be often incredibly disruptive. Such is the case before us with the Navajo Generating Station in Northern Arizona. The need for crucial, long ranging decisions about NGS was thrust upon our state when out-of-state utilities holding substantial ownership percentages in NGS announced intent to divest.

The decisions announced by Los Angeles Department of Water and Power (LADWP) and Nevada Energy are out of the hands of Arizonans. Other related decisions can and should be influenced by the people of Arizona and what is in OUR best interests. Which brings us to Arizona's political environment and makes election campaigns for statewide offices in 2014 most urgent NOW.

Several people are already considering or planning to compete for the two expected open seats on the Arizona Corporation Commission. But only one candidate thus far has impressed me as having the vision and determination to lead Arizona through the challenges we face. People like Glenn Hamer and Steve Macias already recognize that situation also. They wrote:

In her recent “My Turn,” [which was also published by the Arizona Eagletarian as a guest blog post] Nancy LaPlaca touted Los Angeles and Nevada for their plans to abandon coal-fueled electricity (“Coal is poor investment in state’s energy future,” May 6).

She encouraged Arizona to follow suit with little to no regard for the economic implications of her suggestion, which would undoubtedly result in higher energy and water rates for the state.

LaPlaca has already provided data to show how wrong Hamer and Macias are. I plan to publish some of that information over the next few days. But when I started writing this evening, it became apparent that the most urgent thing to convey was how Hamer and Macias represent inertia or resistance to change. A resistance, by the way, that is undoubtedly futile.

If the two of them were genuinely advocates for Arizona businesses, rather than commit themselves to remaining in a state of cognitive inertia, perhaps the organizations they work for would be better served if the two would set forth an entrepreneurial vision recognizing the business opportunities this situation represents.

For a little chuckle, view this clip. But please, don't take it too seriously. We are not the United Nations, after all. Wink, wink.

Above all, do not forget that Arizona was built upon a very progressive foundation.

Big-thinking Cato Institute: 400ppm haz got what plants crave

rss@dailykos.com (Hunter) — Sun, 19 May 2013 18:45:09 PDT

Whatever keeps the checks coming, I guess

I continue to be impressed at just how devoid of sentient thought you can be and still land a gig at a "think tank." In this case, the Koch-founded, hypothetically libertarian Cato Institute:

The atmospheric concentration of carbon dioxide (CO2) has recently reached a “milestone” of 400 parts per million (ppm). In some circles, this announcement has been met with consternation and gnashing of teeth. The proper reaction is celebration.

Hooray! The announcement that our planet's atmosphere has now been bent to something not previously seen in all of human existence should be heralded, you see, because it means we're getting really, really awesome at using fossil fuels. It's like when your house catches on fire and you beam in pride at all the smoke because hey—that just means you had a lot of expensive crap in there. Celebrate your success, fella. Soak it in.

It's not just the planet is getting warmer and that that's an awesome thing because woo, free heat; the even more awesomer thing is that fossil fuel pollution HAS GOT WHAT PLANTS CRAVE!

There are two primary externalities that result from our emissions of carbon dioxide into the atmosphere—1) an enhancement of the greenhouse effect, which results in an alteration of the energy flow in the earth’s climate and a general tendency to warm the global average surface temperature, and 2) an enhancement of the rate of photosynthesis in plants and a general tendency to result in more efficient growth and an overall healthier condition of vegetation (including crops). There’s incontrovertible evidence that the planet is both warmer and greener than it was 100 years ago.

Point (1) is a rather sterilized way of saying that millions upon millions of people are about to see their homes go away, but point (2) is super-better. Dumping all those greenhouse gases into the air is practically like turning the whole planet into, well, a greenhouse—just think of how great all our crops are going to grow now! I mean sure, maybe they won't grow anywhere we're currently planting them, but where they do grow, look out. We're talking serious, serious photosynthesis, baby. Shale oil HAS GOT WHAT PLANTS CRAVE! The Koch brothers, who help produce the stuff and who coincidentally are the driving force behind the Cato Institute, are practically gods among men for their work in making our future planet so lush and green!

This is so awesome, in fact, that we can barely stand it. Did you know that hitting the 400ppm threshold, a milestone marking the beginnings of serious climate change that could "result in an alternation of the energy flow in the goddamn earth's climate itself," changing weather patterns in unpredictable and possibly nation-shattering ways, means that we are no longer so beholden to that stupid weather? Of course you don't—but that's because you don't realize changing the atmosphere of the planet HAS GOT WHAT PLANTS CRAVE!

400ppm of carbon dioxide in the atmosphere should remind us of our continuing success at expanding the global supply of energy to meet a growing demand. That success which ultimately leads to an improvement of the global standard of living and a reduction in vulnerability to the vagaries of weather and climate.
400pm is cause for celebration. “A world lit only by fire” is not.

Wooo! Now that we have accepted climate change is happening, we also realize that it is awesome! We have the ability to affect the atmosphere of the entire planet, and that means we have been doing awesome! Party time! All you people in coastal cities, the Koch brothers are gonna spring for free inner tubes for the lot of you (not really) so you can enjoy your new backyard pools, complements of Mother Nature and our Most Awesome and Well-Heeled Energy overlords! Release the nukes, the radiation will make our newly awesome super-green mega-crops f--king glow! BIGGER BOOM GOT WHAT PLANTS CRAVE!

Cough—excuse me. Anyway, the very serious Cato Institute, often hailed as the very pinnacle (snicker) of libertarian/conservative "thinking" (snicker), was recently the subject of an intense power struggle between the staunchly Republican Koch brothers and the more traditionally libertarian members of Cato's board. The essential battle was over Cato's continued independence or whether they would evolve, as the Koch faction desired, into a more reliably conservative, Republican, corporatist and nakedly partisan outfit. There was a lawsuit and everything.

I'd tell you which side won, but really, does it matter?

Addressing Seditious Rhetoric…

jaango — Sun, 19 May 2013 11:00:49 PDT

Despite my frustration with today’s toxic politics, the Republicans continue to use various forms of “seditious rhetoric” and which must always be challenged, otherwise our standing as military veterans, does not becomes us, and therefore, our lack of “standing tall” for the Constitution makes us a hapless non-entity for espousing our ‘brand’ of politics. Thusly, we must ask ourselves the proverbial question relative to our being staunch Democrats and members in good standing within the Democratic Coalition, knowing that on some issues we will “win” while on other issues we will “lose.”

And this proverbial question is the following: “Are we ‘constitutional’ Progressives with a firm grasp of the Unassailable Facts?”

I believe so since we continue to espouse our continuing support for both the New Deal and the Great Society, and that’s just for starters. However, today’s conservatives espouse their seditious rhetoric, and like-minded Progressives very seldom challenge these seditious comments. And in today’s latest installment among conservatives here in Arizona, Republicans in support of an expanded Medicaid program, are being called “traitors” by those Republicans in opposition to an expanded Medicaid. Subsequently, or in contrast, the Republicans in support of an expanded Medicaid, have taken their velvet gloves off and are now calling the Republicans in opposition to an expanded Medicaid, “traitors” too.

And in yesterday’s book salon here at the Firedoglake.com and where Dina Hampton’s book and titled, “Little Red: Three Passionate Lives Through the Sixties and Beyond,” was discussed in great detail and with over 100 comments. To wit, the “anchor” of these three separate and distinct persons, the Communist Party champion of Black Power, Angela Davis, the New Left advocate in Tom Hurwitz, and the neo-conservative for ‘no boundaries’ on Empire in the person of Elliot Abrams, was the subject under discussion.

As such, all three attended the same school called the Little Red School House and the Elizabeth Irwin High School, and collectively known as the Little Red. Subsequently, a divergence in a political life, that in all likelihood, won’t make the footnote section of any publication authored by historians of the future. And for those among us and who lived through this era, we well understand that none managed to corral any votes as either Elected or Appointed Officials. And therein, is the difference, when we write our ‘history’ and with our ‘starting point’ being the history that is accurately representative of and reflective of the Sonoran Desert.

And my being grey of beard, long in the tooth, and an obvious Contrarian, I never got to pose this proverbial question, and find if or not, would these three persons now see themselves as “constitutional” Progressives?

But more on point, several days ago, the new President of the National Rifle Association, not only called President Obama a “fake president” but went on to suggest that the Civil War was an example of an armed citizenry, and thusly, training all able bodied Americans in the use of a prodigious amount of military weaponry, each trainee will have developed the skill set to repulse ‘tyranny,’ of any sort. Subsequently, any disagreeing with James Porter is equivalent to ‘bordering’ on Treason.

And yet, today, I have found only one person, via the Internet, that has taken the time to challenge Porter, and perhaps, permit me to lead you to Ed Kilgore of the Washington Monthly Magazine, and from several days ago when he said the following:

Am I perhaps being unfair to these people in suggesting that they are behaving like America-haters and are flirting with treason? I don’t thinks so. Porter and those like him could dispel this sort of suspicion instantly, any time they wanted, by just saying, Let’s be clear: the kind of ‘tyranny’ we are arming ourselves to forestall is something entirely different from anything Americans have experienced since we won our independence—a regime engaged in the active suppression of any sort of dissent, and the closure of any peaceful means for the redress of grievances. We’re not talking about the current administration, or either major political party, as presently representing a threat of tyranny.

I’m not holding my breath for any statements like that to emerge from the NRA, or indeed, from the contemporary conservative movement. It’s ironic that people who almost certainly think of themselves as patriots—perhaps as super-patriots—are deliberately courting the impression that loyalty to their country is strictly contingent on the maintenance of law and policies they favor, to be achieved if not by ballots then but bullets. Republican politicians should be repudiating such people instead of celebrating them, accepting their money and support, and even adopting their seditious rhetoric.

In closing, historians in the future will be utilizing the nomenclature for the “constitutional” Progressive and albeit, the “liberal” label will become an outdated acronym and non-comparable to the ever-increasing “Demographics is Destiny” mindset, and especially for those of us and who ascribe to being categorized with the Nixon’s “racial and ethnics” and furthermore, where we are overwhelmingly Progressive in our politics.

Jaango

Originally posted on the web site of the Chicano Veterans Organization.

Photo by Fibonacci Blue under Creative Commons license

Heritage Foundation To GOP: Attack Obama, Don't Govern

karoli — Sat, 18 May 2013 19:00:00 PDT

Jim DeMint's Heritage Foundation is busy at work figuring out how to make sure Republicans are completely marginalized in 2014. As their faux scandals fall apart as rapidly as they're concocted, DeMint's minions are instructing Eric Cantor and John Boehner to please, please just keep attacking the president and forget about governing altogether.

Joy Reid at The Grio:

In a letter to members of Congress, which was obtained by NBC News, Heritage Action for America, the lobbying arm of the Heritage Foundation (which recently found itself in hot water over the racial IQ theories of the co-author of their widely panned immigration reform study, Jason Richwine, who resigned from the think tank last Friday), urged Republicans on Capitol Hill not to govern, and instead, to focus on the would-be “scandals” plaguing the Obama administration.

The letter, which is addressed to House Speaker John Boehner and House Majority Leader Eric Cantor, trumpets the negative media buzz surrounding the White House, saying that, “for the first time, the activities of the Obama administration are receiving a sustained public vetting. Americans’ outrage over Benghazi is amplified by the Internal Revenue Service’s intimidation of conservative grassroots organizations and a cascade of negative headlines. There is the real sense the Obama administration has been less than forthright with the American people, the press and lawmakers.”

In light of the white hot media spotlight on the administration, and to deflect attention from the many policy areas where Republicans don’t quite get along, the letter urges: “it is incumbent upon the House of Representatives to conduct oversight hearings on those actions, but it would be imprudent to do anything that shifts the focus from the Obama administration to the ideological differences within the House Republican Conference.”

“To that end, we urge you to avoid bringing any legislation to the House Floor that could expose or highlight major schisms within the conference. Legislation such as the Internet sales tax or the FARRM Act which contains nearly $800 billion in food stamp spending, would give the press a reason to shift their attention away from the failures of the Obama administration to write another ‘circular firing squad’ article.”

Shorter Heritage Foundation: We know we've got all sorts of internal problems, so for the sake of the cause, please just keep flogging dead horses and whatever you do, please do NOT actually govern.

Did he really have to give these instructions? It seems as though they've been falling into lockstep on the scandalmongering piece quite well without any help from the KochHeads.

Maddow: Fair Game to Disclose Names of Republicans Who Lied to ABC News

Heather — Sun, 19 May 2013 07:00:00 PDT

Click here to view this media

After taking her viewers through the whole, long, ugly mess with ABC's big "scoop" on the Benghazi emails and the how the story pretty much fizzled out by the end of the week with the discovery that Republicans were responsible for doctoring the supposed quotes from the emails that they published, Rachel Maddow gave her two cents on ABC still protecting the sources who lied to them.

MADDOW: And now, part of the scandal here is a press scandal. You know what? When you get used like this and you end up publishing false information, false quotes, you have to correct it. But the bigger scandal here is not a process matter, not a press matter. There's a very stark fact that somebody in Congress right now, or somebody working for somebody in Congress right now, a staffer, concocted a big lie to try to make the White House look very desperately bad on this Benghazi scandal that they otherwise have not been able to get traction on.

Who told the lie? And a note to my journalist pals who got involved in this scandal. If your source lied to you, they are not actually a source. They are a con artist and you are their victim. It means you don't have to protect them any more. They're not a source.

When you get lied to, when you are a tool of somebody else's deception, when you get lied to, the person lying to you is no longer a source, they are news. Their lie to you is itself news and you can report that news. Republican Congressional offices shopped a false dossier as if it was a White House email. That is a story. The office and the staffers and the members of Congress maybe who did that... that is news. And if you know who it is, you can say so.

Boy do I wish they'd take her advice, but again, I'm not holding my breath.

Anonymous launches Operation Guantanamo

Diane Sweet — Sun, 19 May 2013 10:00:06 PDT

On Friday, May 17, the international hacktivist collective known as Anonymous, joined by Code Pink and other political action groups from the U.S. and the U.K., launched Operation Guantanamo to mark the 100th day of a hunger strike within the Guantanamo Bay prison camp.

The three day campaign of global action is intended to raise awareness of the human rights violations currently going on at Guantanamo Bay prison camp via social media and on the ground protests. Alleged violations at Guantanamo include the indefinite detention of prisoners, many of whom have been cleared for release years ago.

The following is an excerpt from a press release issued by Anonymous regarding Operation Guantanamo (#OpGTMO):

"With no hope for justice, over 100 men who have been held and tortured for years have gone on a hunger strike. On May 18th, it will have been 100 days since they have eaten voluntarily. Prisoners have died suddenly, violently, and suspiciously. All inmates in Guantanamo Bay have been locked in solitary confinement. Some are being force fed, an international crime. These men face the prospect of a terrible death in prison despite many of them having been cleared for release years ago.

Guantanamo Bay must be closed at once, and the prisoners should be either returned to their home countries or given a fair trial in a federal court. Guantanamo Bay is an ongoing war crime. Anonymous will no longer tolerate this atrocity.

On May 17 to May 19, to coincide with the 100th day of the hunger strike, we urge everyone to join global actions on the ground and hacktivist protests as well as twitterstorms, email bombs, and fax bombs, in 3 days of nonstop action.

Phone Bomb the representatives:

Call the White House and insist that President Obama fulfill his promise to close Guantanamo: 202-456-1111, 202-456-1414

Call the U.S. Southern Command to decry the conditions at Guantanamo: 305-437-1213

Call the Department of Defense, voice your concerns about the treatment of hunger strikers: 703-571-3343

Call your senators and representatives and urge them to support the closure of Guantanamo: http://congresslookup.com/

Sign the petition:

https://www.change.org/CloseGTMO

For updates:

Twitter : @opGTMO

Hashtag: #opGTMO"

McComish draws First Blood

azconservative — Sat, 18 May 2013 12:16:41 PDT

From the AZ Republican Party resolutions:
“Stand your ground. Don’t fire unless fired upon, but if they mean to have a war, let it begin here.”
John Parker, Battle of Lexington, 1775.

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In a stunning late night move Republican Senators John McComish, Adam Driggs, Rich Crandall, Steve Pierce, Bob Worsley and last minute surprise Michele Reagan turned on the Republican caucus passing a pork-heavy-spend-expand-grow budget. Make no mistake – they drew first blood.

Senator John McComish voted 18 times with the Democrats.

There was nothing bi-partisan about the budget, nothing bi-partisan about the amendments and absolutely nothing bi-partisan about the Medicaid Expansion – simply the 6 Brewercrats gave the Democrats everything they asked for. An observer in the gallery observed the Democrats were “drunk with glee.”

The afternoon began with President Biggs proposing a budget that offered the Governor many of her spending increases including education but not including the Medicaid Expansion.

So John McComish put it on their for her releasing a frenzy of million dollar spending.

The AZ Capitol Times reported they “included $9 million for Child Protective Services, $875,000 for Navajo Technical College and funding for the Arizona State Parks Board and Arizona Arts Commission.” Senator Rich Crandall justifies making the cake and then fork-feeding it to the Democrats as a “challenge to get the 16 votes …. Biggs warned his colleagues that adding at least $57 million in spending over three years could blow up the entire spending package.”

So – you following this? The Democrats would only agree to pass the Medicaid Expansion budget if it also funded Adult Education, Arts, and the stupid State Parks Board! Not one compromise was extended to a Republican. President Biggs offered 11 amendments trying to keep the Expansion constitutional and in control of the legislator. All were voted down by the democrats and a mixture of the same 5 Senators. Senator Kelli Ward, the only elected physician, offered 7 amendments with justifications based on real life consequences - all defeated. The oh-so-delighted to discover the liberal out of control spending mindset was back in charge at the Arizona senate twittering press ramped up the personal insult slings at Ward.

If the Medicaid Expansion circuit breaker kicks in and the Federal Government stops paying Medicaid Expansion these additional programs and all this spending will not stop. This scenario is setting Arizona up for mountainous debt worse than 4 years ago. Do we want to live through all these cuts again?

Six Republican Senators turned on their own over and over and over again.
They turned on the precinct committeemen in Arizona.
They turned on those who walked and called and gave them money.
They turned on the 11 republicans in the room with them.
Then they went up to the Governor’s office for a pizza party before they dealt the final blow.
All while the Democrats celebrate the new plus four majority in the Arizona Senate.

What is next? It now goes to the House. – we can and must stop it there. Speaker Tobin is leading this battle and trying everything in his power to stop Obrewercare. For a complete list of contact information, email updates and call to actions go to: www.fragaz.org

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Arizona Republican Legislative District 10 Conclusion:

While we applaud Governor Brewer’s decision to oppose the Obamacare Exchanges, we oppose her support for the Obamacare Medicaid expansion. We must stop State implementation of both. We urge Governor Brewer, and all Republican legislators, to hold the line against enabling the socialist takeover of our health care system and insurance industry by rejecting the Medicaid expansion. Do not sell out our Republican principles and our birthright of Liberty for a bowl of lentils and the promise of 3 years funding that will benefit a few special interests at the cost of our State sovereignty and our core Republican values. We will adamantly oppose all those who compromise our core values for short term political expediency. Governor Brewer is correct that “elections have consequences”. She is wrong in believing that it means that Republicans must roll over and forsake our core values whenever Republicans lose a national race. This is our line in the sand.

Waitaminute. Isn't the IRS Supposed to Watch Out for Tax Cheats?

David Neiwert — Sat, 18 May 2013 12:30:00 PDT

As if it weren't already clear that the so-called "IRS scandal" is nothing of the sort, now it's becoming even clearer that it's a just another bit of that down-the-rabbit-hole-up-is-downism in which conservatives have come to specialize in recent years.

The Institute for Research and Education in Human Rights -- which, among other things, monitors the far-right extremists who have been filling the ranks of the Tea Party -- has an excellent takedown of the IRS nonsense:

The Tea Party and the IRS “Scandal”:
The Actual Facts of the Case

While it is well-known that the so-called IRS scandal has been used by Tea Partiers to bash the IRS, less well known are the actual facts of the case.

Some of the flagged groups did have their tax-exempt status delayed or did face some additional scrutiny, but not a single group has been denied tax-exempt status.

A May 14 draft report by the Treasury Inspector General for Tax Administration found that none of the 296 questionable applicants had been denied, “For the 296 potential political cases we reviewed, as of December 17, 2012, 108 applications had been approved, 28 were withdrawn by the applicant, none had been denied, and 160 cases were open from 206 to 1,138 calendar days (some crossing two election cycles).” (p. 14)

In fact, the only known 501(c)(4) applicant to recently have its status denied happens to be a progressive group: the Maine chapter of Emerge America, which trains Democratic women to run for office. Although the group did no electoral work, and didn’t participate in independent expenditure campaign activity either, its partisan nature disqualified it from being categorized as working for the “common good.”

The Inspector General’s report found that in the “majority of cases, we agreed that the applications submitted included indications of significant political campaign intervention.” (p. 10). In fact, only 91 of the 296, roughly 31%, of the applications reviewed for the report did not have “indications of significant political campaign intervention.” In other words, more than two thirds of those flagged for processing by a team of specialists had those indications.

That sort of political campaign intervention would normally disqualify a group from 501(c)(4) status, but the deluge of Tea Party applications combined with the politicization of the process has allowed them to slip through. A closer look by IREHR at the activities of some of the Tea Party groups that are currently under review or have received non-profit status from the IRS, reveals a difficult and dangerous situation.

Be sure to read the whole thing.

As the report concludes:

Rather than the so-called scandal cooked up by Tea Party groups, the real criticism of the IRS may be that it has let so many of these groups get away with what are apparently egregious violations.

That's what all the yelling's about. It's to keep people from seeing the plain truth: Many of these people really are tax cheats trying to game the system for partisan advantage.

Reagan, O’Connor: Liberal elites masquerade as Republicans

seeingredaz — Sat, 18 May 2013 14:19:40 PDT

Last Monday night the Arizona Project featured Republican state Sen. Michele Reagan (LD-23) as its guest. The group even had her appearance in a live streaming video for all to see. Amazingly, the woman who voted with the Democrats for the costly and unsustainable expansion of Medicaid — a key element of ObamaCare — told the group she was adamantly opposed to the scheme, though she supported it days later.

Arizona Conservative Coalition runs a weekly updated ranking of legislators during the session. Expect the chronically low-rated Michele Reagan to drop even further after this deception.

Last Tuesday evening Legislative District 28 held its monthly meeting. District chairman Scott O’Connor took the opportunity to admit to the Republican elected Precinct Committeemen he leads that he is a RINO and a minority on the EGC — the Executive Guidance Committee of the Maricopa County Republican Committee.

These two incidents beg the question: How did Arizona Republicans get skunked and what are we going to do about it?

It's a scandal

About Rogue Columnist — Sat, 18 May 2013 15:13:10 PDT

It's a scandal. It's an outrage.
On our manhood it's a blot!
Where is the leader who will save us
And be the first man to be shot?
— Rodgers and Hammerstein

The "scandals" of the past week — Benghazi and the IRS — have two purposes: To destroy Hillary Clinton, the presumptive/feared Democratic nominee in 2016 and "to break him," as the secesh former South Carolina Sen. Jim DeMint said of President Obama on another issue. Whether the tempests can rise out of their right-wing teapot remains to be seen. Ruining Hillary and seeking to impeach Mr. Obama will be the Republican enterprise for the next three-and-a-half years. It's a tired playbook, but it keeps working for the right.

Little of what the right claims about Benghazi is correct. And, as Rogue's Front Page Editor tells me (and he's a man who knows about such things), the truth will never be known because the CIA will never come clean about its part in the mess. It is interesting that we've been spending more on the military than during the Cold War and yet we couldn't get help to the consulate/CIA safe house during the attack. I know there's a Marine FAST unit (Fleet Antiterrorism Security Team) based right across the Med in Rota, Spain. FAST is specifically designed for these crises. Why has the press never raised the question about why it was not mobilized? The narrative has it that the nearest help was in the Balkans. But I don't blame Hillary for this tragedy. John Boehner's House ensured that funds for State Department security was cut back.

As for the IRS "scandal," this is a direct outgrowth of Citizens United and the huge influx of corporate and plutocrat money into the electoral process. Why the 501(c)4 tax break for these powerful and shadowy organizations was ever created is scandalous, not that they were given some scrutiny by the IRS. The Tea Party was always doing the work of its hidden puppet-masters, no matter what the old white people dressed up in colonial garb and ignorant of American history thought.

The Obama administration's filching source material from the Associated Press is shameful and dangerous, but only the latest sign of our slide under President George W. Bush and Mr. Obama, abetted by Congress, to shred the Constitution in the name of Das Homeland Security. To paraphrase Churchill, we have given up our liberties to obtain safety and now we shall have neither. This is a scandal but don't look for Darrell Issa to become a profile in courage. The "lamestream media," as Sarah Palin, perhaps the future governor of Arizona, calls it necessarily has a "left-wing bias" because the facts do, too. Which doesn't keep the media from scandalous malpractice in its attempts for "balance" and false equivalency — "both sides do it"; the "left" is as loud, well-funded and extreme as the right, etc. The center of our discourse has moved so far to the right over the past 20 years that Dwight Eisenhower would be considered in the same camp as Noam Chomsky.

Let's not burn books, as the right would seek (or just making reading into a hoity toity smarty pants liberal thing as opposed to authentic real 'Mericans). Let's be more careful about words and phrases. "Great Recession," for example. I'm so sorry I ever hopped on that train. For one thing, it trivializes the Great Depression. More important, it is imprecise about the nature of what actually happened, and how it will happen again, probably worse, and we'll be out of "Greats." I prefer the Panic of 2008. In financialized Randian quiet coup America, better to return to 19th century language when referring to the consequences of robber barons run amok. Coming up: The Panic of 2015. The same is true of "gridlock." As if our political status is an accident and people just need to get along. It implies paralysis. We are indeed polarized, perhaps more so than anytime since 1860. But the Republicans are not paralyzed. From taking hostages over the budget and holding up even minor presidential nominees to preparing for the next impeachment, they are playing a dynamic role. It's toxic, to be sure. Nominees were once routinely approved. The debt ceiling was increased as a matter of course. Without compromise, American democracy can't function in a healthy way. But paralyzed? No. The Republicans, the representatives of the New Confederacy, are getting exactly what they want. It's a scandal.

It's a scandal that we have passed the ominous 400 ppm level of carbon dioxide and the United States is doing nothing to slow, much less reverse, the rate of climate change. No, we are drilling, baby...to ensure (as they say on Battlestar Galactica) that the planet is fracked. And Serious People have the brass to lecture us on austerity so we don't leave a debt burden to future generations. Instead, we will leave them a planet our of a science fiction nightmare. Hey, science is fiction, because it has a left-wing bias and Creationism must be taught.

It's a scandal that endless war and empire are the policies that have propulsive force in America. Republican, Democrat, endless war. Another is ongoing financialization, setting up the next bust with bubbles and gambling and the playerz get away with it. People sigh. Oh, well, business as usual. USA USA! The terrorists hate us because of our values.

It's a scandal that historic inequality, loss of economic mobility, wage stagnation, the hollowing out of American industry (sorry, no manufacturing renaissance), shocking levels of unemployment, 1970s infrastructure and poverty are not being addressed. If you were just willing to put in an honest day's work, you'd get ahead, you welfare queen loser. We've got to tighten our belts, as long as it means federal spending on such things as schools, research, Amtrak and transit, not going after the trillion-dollar tax dodgers.

The real scandals listed above involve classic corruption, deceit, damage to the public good, destruction of fair play and scummy bag men/women, even if they dine at the most exclusive restaurants in D.C. The Koch brothers, Big Oil, Big Coal, Jamie Dimon, Lloyd Blankfein "doing God's work," Tim Geithner, tech billionaires lending their hubris and money to the charter schools racket while offshoring work and pushing for more H-1B visas, the revolving door between Wall Street and the lapdog regulators, the Military Industrial Complex, the usual suspects.

But on these there will be no hearings, no cries for accountability. The people who should be broken will keep doing the breaking, of America's future. And the residents of Moronistan will sleepwalk into the next crisis, then cry, "How could we have known?"

Jan Brewer: Ignorant, Irrational, Prevaricating, Self-Serving Bigot

Stephen Lemons — Sun, 19 May 2013 18:11:06 PDT

They don't call her "GED Jan" for nothin'. Following U.S. District Court Judge David Campbell's ruling this week in Arizona Dream Act Coalition v. Jan Brewer, Brewer was quick to gloat and mi...

Continue reading "Jan Brewer: Ignorant, Irrational, Prevaricating, Self-Serving Bigot" >

J.C. Scott: Az Senate budget includes Medicaid expansion

John C. Scott Show — Sun, 19 May 2013 11:03:41 PDT

Interviews with Rep. Bruce Wheeler D-LD28, Sen. Linda Lopez D-LD2, Sen. Steve Farley D-LD9, Ben Buehler-Garcia Ward 3 Tucson City Council Candidate, Reporter Ben Giles Arizona Capitol Times, Jesse Lugo Civic Leader, Middle East Expert Prof. Stephen Zunes