BobbyG's Open Salon Blog

Public Optional

Mon, 24 Aug 2009 15:08:39 -0400

To use an aviation analogy, we have turned from the downwind vector and are now in mid-approach "base leg" on this policy reform flight prior to turning 90 degrees into the turbulent fall 2009 headwinds of final approach and (crash?) landing of "health care reform" legislation. I will add a few more observations, and recap central points and issues I've addressed in my prior three posts before moving on to another topic (drought and water policy).

"PUBLIC OPTIONAL"

I am really sick of hearing about the "public option" wrangle 24/7 in the media these days. I am increasingly skeptical of its inclusion of any final legislation that may or may not reach the President's desk, and likewise skeptical that it would comprise much of an improvement even should it pass the Congress (and, it looks increasingly to me like a slickly orchestrated "misdirection" strategy). Without a "public option" (our having taken Single Payer off the table a priori), it is difficult to see what "health care reform" would truly amount to. But, then, "public option" as currently proffered (e.g., H.R. 3200) merely looks like -- as I've said before -- [1] corporate welfare ("Play or Pay" forcing everyone to buy health insurance policies, under threat of tax penalty), and [2] outright "welfare" (means-tested government subsidy for health insurance "affordability").

The sarcastic title of this post simply alludes to the very real political fact that, to the extent that the priorities of key legislators align with true needs of the aggregate public (e.g., universal access, better clinical quality, and restraint on cost), they will work for such things, but, the overriding, never-ending imperative of most lawmakers seems to be simply that of re-election. And, for the Legislative Branch (in particular the House**), there's only one viable source of effective campaign funding -- special interest money. This is beyond debatable, and is not exactly news. You might be able to mount and sustain a viable Presidential campaign on broad-support grassroots small-increment donation money -- as Obama obviously did -- but this is simply not the case for Senators and Representatives. It has been recently reported that there are today six health care industry lobbyists in place for every member of Congress. The money is flowing generously, and the backroom special interest pleading is in high gear.

[**] It has long been noted that roughly 80% of a Representative's time is spent on campaign fundraising, given the short 2-year re-election cycle. In the House, staff do nearly all of the actual legislative detail work, with the elected official mostly just stopping in for "drive-by" votes.

So, your interests as a citizen are "optional." A couple of headlines today:

"OK, so, how much is AHIP Job?"

This one is blanketing the TV channels of late. AHIP (American's Health Insurance Plans) is the lobbying organization for the private health insurance industry. From their March 2009 "Board of Directors’ Statement on Setting a Goal to Achieve a More Affordable and Effective Health Care System" -

Health care reform has eluded our nation for nearly a century. But today, a broad consensus is emerging that comprehensive reform of the system – that covers all Americans and provides safer and more effective care – is possible if the growth in health care costs can be brought under control. Health care costs are rising at an unsustainable rate and adding a burden on families and small businesses, and hampering our competitiveness as a nation...

Can't argue with that: universal coverage improved quality, cost containment. Recall the opening words of my May 25th post, "The U.S. health care policy morass":

Some reform advocates have long argued that we can indeed [1] extend health care coverage to all citizens, with [2] significantly increased quality of care, while at the same time [3] significantly reducing the national (and individual) cost. A trifecta "Win-Win-Win."

Note the soothing v/o in the AHIP PSA above: "...If everyone's covered, we can make health care as affordable as possible (0:14)...and the words 'pre-existing condition' become a thing of the past (0:19)..."

Laudable, without a doubt (notwithstanding the red-flag weasel phrase "as affordable as possible").

Again, citing the AHIP Directors' Statement:

Health plans are doing their part by pioneering disease management and care coordination programs; promoting prevention, wellness and early intervention; and implementing innovative payment strategies that reward performance and outcomes. We are committed to working with the Administration, Congress and other stakeholders to advance strategies that promote effective, efficient, and high-value health care.

So, assuming this is not simply finely crafted rhetorical lorazepam PR spin, the AHIP membership in fact regard themselves as indispensably embedded, value-adding, necessary clinical adjuncts, rather than the bloodsucking, obscenely profitable (and otherwise ruinously expensive), paper-pushing, value-hampering, care-denying intermediary parasites their political adversaries claim them to be., e.g., liberal OpEd writer Chris Hedges:

The real debate, the only one that counts, is how much money our blood-sucking insurance, pharmaceutical and for-profit health services are going to be able to siphon off from new health care legislation. The proposed plans rattling around Congress all ensure that the profits for these corporations will increase and the misery for ordinary Americans will be compounded. The corporate state, enabled by both Democrats and Republicans, is yet again cannibalizing the Treasury...

...The Democrats are collaborating with lobbyists for the insurance industry, the pharmaceutical industry and for-profit health care providers to craft the current health care reform legislation. “Corporate and industry players are inside the tent this time,” says David Merritt, project director at Newt Gingrich’s Center for Health Transformation, “so there is a vacuum on the outside.” And these lobbyists have already killed a viable public option and made sure nothing in the bills will impede their growing profits and capacity for abuse.

A commentor on Salon.com notes:

A Broken Process

As I've said before; our political system is not capable of dealing with long term complex issues. Between entrenched special interests that fight to maintain the status quo, a legislative branch beholden to those interests, a political culture that only looks as far as the next election cycle, a fundamentally broken news media, an ignorant misinformed and unengaged electorate and a host of other problems it will be miracle if US makes to the half century mark as anything other than third rate power with most of its citizens living in abject poverty trying to get buy with crumbling infrastructure and a collapsing environment.

A skeptical commentor in my local paper observes:

Trust in government must be earned. The 'government' programs called Social Security and Medicare have been headed for insolvency for years. What have our representatives done about that? Nothing. We have needed real immigration reform and a sane immigration policy for years. What have our representatives done about that? Nothing. I could go on but you get the point. Health Care insurance needs reform and it will not be reformed without some government action. That said, it is possible for the present system to be reformed by legislation and not replaced by a full government program if our representatives took some tough action. But just like Social Security, Medicare and Immigration, either nothing gets done or what is done is overkill or ineffective or both. I feel both shame for my government and fear of my government and in my estimation I have good reason...our government has done such a poor job for so long on so many big issues I don't have much belief in them at this point.

An even more skeptical commentor writes to my other local paper:

It is important for all of us to realize that the health care legislation currently being hotly debated is not about insuring the uninsured, reducing health care costs, etc.

This legislation is all about power -- greatly expanded power for the Obama administration, for Speaker of the House Nancy Pelosi and for Senate Majority Leader Harry Reid.

The federal government and the unions already effectively control the American automobile industry. The government has recently gained great power over the financial institutions of the United States.

Renewable energy regulations give the government a lot of power over utilities. If the cap-and-trade legislation passes the Senate, the government will totally control the production of energy in this country.

If the proposed health care legislation passes, the federal government will control one-sixth of the U.S. economy. President Obama's appointed czars and other unelected bureaucrats will control the health care system in the United States, maybe not in the next year, but certainly within the next five years.

Make no mistake, this health care legislation is all about power.

That is why President Obama, even in the face of stiff opposition from some of his own Democrats, refuses to give up his demand for a government-run health care system to compete with the private sector.

It is precisely this frequently heated divergence of characterization that comprises the core of the health care policy reform issue soon to resolve itself one way or another, for better or worse.

"OK, so, what exactly is AHIP Job?"

From the March 2009 AHIP Directors' Report:

What Our Community Brings to the Table

Health plans offer strategies and tools to consistently improve quality and drive down the cost of care delivered to patients across all care settings:

Tools to Coordinate Care Across a Variety of Settings for Specific Patient Populations: Health plans have a wealth of administrative and clinical information which can be integrated to help clinicians have a comprehensive view of a patient’s clinical history. For instance, plans may evaluate this [sic] data to identify preventable medical errors, providing clinicians with this information to address gaps in care and help make efficient, informed patient-care decisions.

Incentives for an Interconnected Electronic Health Care System: A fully integrated, electronic health information exchange is essential to ensuring that high-value health care is delivered to the right patient, at the right time, and in the right setting.

Clinical Decision-Making Based on Best Evidence: Health plans encourage clinical practices that rely on best data and best evidence. A strong base of evidence can help evaluate whether the costs of services, devices, and drugs are commensurate with the value of care delivered.

Innovative Payment Models That Drive Real Delivery System Change: Health plans have experience with and are committed to innovative payment models that reward improved clinical outcomes and overall health status, and optimize the patient experience, such as an enhanced medical home, paying for episodes of illness, and shared risk models that promote comprehensive care management.

Benefit Design: Plans can implement benefit design strategies to encourage consumers to choose the safest, highest quality and most cost-effective drugs, devices, and procedures. These strategies include offering lower cost sharing for those procedures and technologies that are proven to be the safest, higher in value and lowest in cost.

Administrative Efficiencies: Health plans, in concert with providers and consumers, can drive down administrative costs and by doing so, improve efficiency and care delivery.

Mostly all high-mindedly Mom & Apple Pie laudable, no doubt. The foregoing, however, do beg a few questions. First, if the AHIP membership is equipped with and savvy with "strategies and tools to consistently improve quality and drive down the cost of care," then why the evolved crisis nearly everyone agrees is extant? Why the pressing, politically front-burner imperative for comprehensive reform? Why do we see chronically suboptimal, uneven outcomes quality, and cost escalation running three times the rate of inflation -- in particular when concomitant with the AHIP membership's enviable, ever-increasing profits?

Feeling the policy reform heat, are we?

[1] "Health plans have a wealth of administrative and clinical information which can be integrated to help clinicians have a comprehensive view of a patient’s clinical history." Really? I would take issue with this with respect to private, and most notably, employment-based coverage. "Plan-hopping" has become a commonplace, as bottom-line anxious employers increasingly shop the most affordable benefits plan du jour. As I noted in a prior post, during my last two-year job tenure, my employer switched plans THREE times. I had no say in the matter, and was not consulted in advance. Each time, my personal "administrative and clinical information" became the private HIPAA-firewalled "business intelligence data" of the new vendor. Seamless ongoing longitudinal "continuity" of my "patient history" may have a nice ring, but it is not the predominant reality -- except, I should note, for those covered under Medicare or the VA, i.e', the public entitlement de facto "single payer" programs.

[1.b] "...plans may evaluate this [sic] data to identify preventable medical errors, providing clinicians with this information to address gaps in care and help make efficient, informed patient-care decisions." Well, that is precisely the type of analytic data-mining work I did during my two tenures with the Medicare QIO. It is also the type of extensive outcomes research performed by the CMS Agency for Healthcare Research and Quality (AHRQ). A salient -- no, critical -- difference is that entitlement beneficiaries are not put at risk of coverage exclusion/"rescission" that is increasingly common within the for-profit actuarial insurance model.

[2] "A fully integrated, electronic health information exchange is essential to ensuring that high-value health care is delivered to the right patient, at the right time, and in the right setting." Yes, of course. Again, see my foregoing comments in response to [1]. These things go the acronym "RHIO" or "RHIE" ("Regional Health Information Organization/Exchange"). The Utah Health Information Network (UHIN) stands as a fairly mature example here. During my last QIO tenure, I sat on the Steering Committee for a southern Nevada RHIO startup attempt. I recall the fractiousness of the proceedings, given the disparate interests of the various for-profit and non-profit interests. We still don't have one in Nevada. I applaud these efforts, but they remain fraught with technical and policy difficulties [a], difficulties that would be significantly abated under a universal coverage "social insurance" paradigm (be it a "Single Payer" model or one more akin to a "Swiss Model").

[a] The private sector "EMR" (Electronic Medical Records) industry -- regarding which I am thoroughly evangelistic -- has been in high gear for a number of years and has matured greatly, but it has nothing to do directly with the health insurance industry, except to the enervating extent that the latter significantly complicates the work of the former. An integrated EMR is one wherein the front office (demographic & scheduling), mid office (the clinical/patient encounter and historical record), and back office (billing and admin) functions are synch'd (with automated CPT/ICD-9 encounter coding linked with the front and back office functions). The focus, though, ultimately remains that of reimbursement, i.e., the back office imperative of billing -- having to deal with the hundreds of 3rd party payers, each with their own proprietary submissions forms, policies, and procedures. This adds nothing substantive to improved actual health careeffectiveness. Single Payer would simplify this aspect of health information technology immeasurably, enabling software developers and their end-users to focus more on leveraging the EMRs for better care.

[3] "A strong base of evidence can help evaluate whether the costs of services, devices, and drugs are commensurate with the value of care delivered." Again, no argument with that ideal. However, again, it begs the question of efficiency and effectiveness, when health care data constitute in large measure the proprietary "business intelligence" of competing for-profit actuarial model enterprises. By contrast, the research initiatives of public entities such as AHRQ (a) suffer from no such potential profit-model conflicts-of-interest, and (b) are already focused on patient populations with the higher levels of utilization experience (increasingly so as the population ages)

[4] "...innovative payment models that reward improved clinical outcomes and overall health status..." It's called "P4P" (Pay for Performance), already long a front-burner priority within CMS. Nothing exactly "innovative" about it -- it's called "evidence-based medicine," i.e., "science," which results in "clinical practice guidelines" (which, it should be noted in fairness, is derisively referred to by numerous skeptical docs as "cookie-cutter medicine"). I find it the height of hypocrisy that this is touted as a virtue by the likes of AHIP while it is also attacked by reform opponents as looming, ominous "death panels" and "federal health/lifestyle police" if undertaken by the public sector.

[5 & 6], OK, what, precisely, have you been waiting for? AHIP claims that their membership "can" do these things. The private sector for-profit evidence to date seems to infer the opposite.

___

MENDACITY OF THE DAY

"And you know what public option is? It leads to single-payer, completely government-run health care system and no choice. And we want to preserve choice for our people."

- Senator Charles Grassley (R-IA), Des Moines Register, 09/25/09
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Main Entry: op·tion
Pronunciation: Ëˆäp-shÉ™n
Function: noun
Etymology: French, from Latin option-, optio free choice; akin to Latinoptare to choose
Date: 1593
1: an act of choosing
2a: the power or right to choose: freedom of choice

Not exactly the sharpest knife in the drawer, this man. Beyond the patent lexical contradiction, it's undergrad sophomoric Slippery Slope Fallacy 101.

First of all, we have had Medicare in place for 44 years now. And, guess what? This government entitlement beneficiary cohort also can and does avail itself ofprivate sector "Medi-Gap" insurance coverage. And, guess what? The Evil Government-run agency Medicare itself touts these policies on its website:

Medigap (Supplemental Insurance) Policies

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs...

More to come, stay tuned...

BTW, I am fully updating this post at bgladd.blogspot.com. The Open Salon editor is simply too feeble for lengthier posts.
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Obama wants to kill Grandma and Grandpa

Fri, 31 Jul 2009 12:07:18 -0400

FROM "BIRTHERS" TO "DEATHERS"

Sometimes you just have laugh, notwithstanding the lack of actual humor in the circumstance. I recently had my bit of Photoshop fun with this inane "Birther" thing (regarding people who continue to increasingly insanely claim that Barack Obama was not really born in Hawaii to an American citizen mother and, consequently, cannot be our legitimate President).

Click to enlarge. Now we get to put up with the equally idiotic "Deathers," people who claim that health care reform will result in forced euthanasia of the too-costly, expendable elderly, e.g., GOP House member Virginia Foxx of North Carolina:

and the unbelievably hokey Family Research Council's "After A Government Health Care Takeover":

LOL. In terms of "acting," next to them, Harry and Louise look like Oscar nominees.

BTW, Mrs. Foxx and FRC, my personal, actual "pro-life" bona fides are succinctly documented here.

___

OK, back to serious health policy reform discussion. It takes something less than rocket scientist acumen to ascertain that health care expenditures are to a significant degree correlated with age. As I noted in a previous post, my health care CQI mentor Dr. Brent James long ago pointed out that, on average, roughly 80% of a person's lifetime health care expenditure comes during the last six months of life. I would today call that A Binding Glimpse Of The Obvious. Consider the following graphic, from UCSC:

31 nations, rank-ordered, high to low (L-R) in terms of "average life expectancy" as a function of per capita cost expressed in currency-adjusted "International Dollars" (Note: I drew the black "trend line" through the chart in Photoshop. Eyeballed it -- not having access to the underlying data -- and I tried to visually ignore the U.S. "outlier"). What is noteworthy here? Well,

the life expectancy range, or "spread," is about 5% from the highest to the lowest (Japan to Portugal);
The United States ranks near the bottom, notwithstanding far and away the highest per capita cost (again, as we have discussed before, roughly 2x the otherwise average);
cost, while a salient contributory factor, is nowhere near determinative; e.g., Cuba's spending is nil relative to ours, all the while their having essentially the same average life expectancy. Moreover, Japan, ranked highest in life expectancy, appears to be around the average in terms of per capita expenditures. Myriad other elements are clearly at play. In general, one needs to be aware of the post-hoc, ergo propter hoc fallacy ("correlation=causation"). This very graphic refutes it -- i.e., given U.S. expenditures, Americans ought easily all survive into our 90's and beyond, given the money spent.

What can you rationally take away from the foregoing? [1] Older people cost more to care for (duh, hel-LO?); [2] Other nations do it far more efficiently and effectively overall -- and without having to resort to heartless, whiney "Kill Grandma" canards.

Spare me.

___

CANARDS UPDATE

"When the government gets involved in health care, things go rapidly downhill." - Standard GOP obstructionist talking point.

OK. Here's the relative distribution of private vs. public health care expenditures since 1997:

Roughly half of health care expenditures (45% vs 55%) have been publicly funded across this period. I was going to graph it, but it's pointless, the trend lines are flat. You can see that right there in the table. [Source: HHS (pdf), click the image to enlarge]

Below, for historical context. In 1960, 3/4 of NHE were "private." Medicare came to the sociopolitical landscape in 1965, and subsequently, as the population has aged, the relative proportions have indeed shifted inexorably in the direction of public funding.

The point? We have had Medicare for 44 years. It works (and is going to have to continue to do so, as its share of the patient population grows with the incipient huge eligibility wave of the Baby Boom generation). We have had a Veterans' Administration since 1930. It works. No, neither or them perfectly. But they effectively serve their intended functions. Which is that of serving their beneficiaries, rather than the portfolio accounts of for-profit stockholders.

A FEW PERSONAL OBSERVATIONS ON THESE "BURDENSOME ELDERLY"

I have quite a bit more than just a passing familiarity with health care costs. I have been studying many of the issues professionally since 1993 (see my prior posts), when I took up my first tenure as an analyst with the Nevada-Utah Medicare QIO, where much of my work initially involved analytical data mining of the Part-A acute care hospitalization claims databases (today known as the CMS ISAT data).

Then, in the spring 1996, I was summarily thrown into the world of the medically indigent as next-of-kin caregiver to my terminally ill daughter, Sissy. Later that year, my then- 80 yr old Dad came to the brink of dying from heart valve failure. An aortic valve replacement and bypass would forestall his demise.

Sissy died in 1998 in the wake of a horrific and expensive struggle against metastatic liver cancer (paid for mostly by federal and California taxpayers via Medi-Cal). Notwithstanding that we were not legally on the hook for Sissy's expenses, still, we wearily shlepped back to Vegas from Hollywood in the summer of 1998 tens of thousands of dollars in debt in the wake of the experience.

Several years later -- the day after the 9/11 terror attacks in 2001, to be precise -- my Dad, who'd never fully recovered cognitively from his heart surgery, keeled over at home in Florida in cardiac arrest. EMTs revived him, and, after several week in acute care, he was transferred to a nursing home, where he would subsequently languish for years in an increasingly befuddled, often shit-and-urine-soiled state of dementia.

Fast-forward to 2004, where my Mother, then 82 and increasingly enfeebled, would spend most of the fall in revolving-door acute and rehab unit care (and I would spend much of my time on the Delta red-eye from Vegas to Melbourne). An attorney drew up the papers appointing me her Attorney-in-Fact, and I would subequently end up increasingly running most aspects of her logistical and financial life. In December of 2004, doctors would forestall her demise via a pacemaker implant. She'd gotten so wobbly from her increasing cardiac instability that she'd become a constant, serious fall risk. She'd already had one hip replacement. Another fall might well kill her.

In 2007 I moved them both to Las Vegas, Pop to a nursing home, and Ma into assisted living. She lasted all of 9 days. Fell while in the bathroom, and was transported to nearby St. Rose hospital, whereupon she suffered a recurrence of the enervating C-diff infection and UTI that had kept her in Florida hospitals most of the first six months of 2007. She spent the remainder of the year in and out of hospitals and rehab facilities.

My requisite POA pen ever at the ready.

She never made it back to assisted living (I wasted ten grand on that Quixotic effort; her remaining furnishings and effects we'd shipped from Palm Bay and lovingly moved into her new apartment now sit in a storage unit a few blocks from my house). Mother is now bedridden and wheelchair-bound in a nearby nursing home. Private pay (Medicare does not pay for long-term care). I now cut a check for about $6,300 a month on her behalf. She's now 87. I sit with her nearly every day, ongoing.

Dad finally died last year, just shy of his 92nd birthday, and five months after I'd spent close to $4,000 in legal fees to obtain Legal Guardian status, owing to my concern that my POA on my Ma would die with her, and he had no legal cognitive ability to grant me POA on him (she had it on him, but it was non-transferable to me).

Just one personal story. And, I have not the slightest doubt that I'm in extensive company (increasingly so). The ethical issues and quandaries pertaining to the just allocation of health care resources are myriad and maddeningly complex (I addressed that two posts ago in citing the 1994 works of Elhauge and Dr. James). These serious sociopolitical issues deserve orders of magnitude higher-level policy discourse than those proffered by the ignorant, cynical likes of a Virginia Foxx or a Family Resource Council.

My kin have undoubtedly "cost the health care system" millions during the past dozen years or so. How much of that went into actual necessary clinical care and its requisite support services, and how much went into the multi-million dollar compensation packages of for-profit "health care" executives, I have no formal way to calculate. But, look at the "Cost of a Long Life" graphic above.

What would you estimate?
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Doing some basic health care reform math

Wed, 1 Jul 2009 22:07:09 -0400

Some necessary basic arithmetic

The image above is taken from a quick Excel spreadsheet I put together and uploaded here. You can download it and play with it as you wish. The user input cells are the 1st, 2nd, and 6th respectively ("Total Population," "Total Current Expenditure," and "Pct spending reduction."

[NOTE: to speculate on the effects of spending increases, simply enter a negative decimal fraction, e.g., enter "-.25" to see the upshot of a 25% increase, and so forth.]

In my lengthy post "The U.S. health care policy morass," I cited some aggregate health care expenditure data proffered by the bipartisan National Coalition on Health Care.

In 2008, total national health expenditures were expected to rise 6.9 percent -- two times the rate of inflation. Total spending was $2.4 TRILLION in 2007, or $7900 per person1. Total health care spending represented 17 percent of the gross domestic product (GDP).

I roughly estimated the 2007 figure up in the spreadsheet to $2.55 trillion for 2008. The rest is simple long division and percentage math. Nothing fancy.

As I've observed in comments elsewhere, some analysts have argued that we can in fact cover everyone, with materially better outcomes, and save perhaps 30% in the process. Even so, do the per capita math (sit down first). 2008 estimated U.S. "health care" spending ~= $2.55 trillion. Divide by a 307 million U.S. population. Decrement by 30%. You still get more than $5,800 per year per person. And, substantially more if you restrict the gross "population" figure to only adult civilian non-institutionalized, i.e., those actually or potentially on the hook for payment. Now, of course, Congress is not buying the "save money" part. The draft Senate bill only speaks to reducing "the growth in spending" (link to that 852 page draft legislation document in my blog post appendix). So, re-do the math. Give yourselves more heartburn.

Recognizing that it's never going to be allocated strictly "per capita," (e.g., just look at the monthly "family of 4" data), then the essentially zero-sum game becomes deciding who (individually) or which socioeconomic strata have to pay proportionally more. It's worth noting that, even were we to somehow miraculously cut the NHE (National Health Expenditure) by 50% [1], the resulting aggregate amount would still be more than twice our military budget.

[1] Take out the military and those incarcerated or otherwise institutionalized, ratcheting down the population to, say, an even 300 million, enter a 50% aggregate cost reduction; you still would have more than $1,400 per month for a family of four. If you further deduct an estimated "retired" subset cohort from among the 39 million people over the age of 65 -- those who would now be almost exclusively recipient-beneficiary health care system users rather than tax/premium contributors, the per capita numbers worsen concomitantly, rather dramatically so.

I'm not making any of this up. This is just grade-school arithmetic based on some published national numbers, along with some readily adjustable Excel "what-ifs?"

A big problem.

___

JULY 22nd UPDATE

Well, I watched the President's much anticipated "health care news conference" tonight. Not much really new there. He still claims that he and Congress must -- and will -- get health policy reform legislation agreed to, passed, and signed into law this year.

A core theme in all of this remains "making health care affordable" -- both for individuals and for the nation, given its impact on both personal and public budgets.

What do we mean by "affordable"? Who decides? I simply decide for myself that I cannot afford a Lexus or Dom Pérignon champagne, or caviar, or vacations in Monaco, etc. Others with more substantive financial assets decide otherwise, as is their free choice. But, what about health care insurance? Many people today "decide" that they cannot "afford" it (should it not be provided as part of their employment compensation). Meaning that their own value preferences dictate that they allocate their finite financial resources toward other freely chosen ends (this usually pertains to younger, healthier people).

But, now, we're being told that we all have to contribute in some fashion. No more "free riders," because, should you get seriously injured or ill and have no coverage, society will in fact be picking up your tab.

Stipulated. That is unlikely to change materially, should you find yourself in life-threatening circumstances and bereft of resources.

It's also increasingly increasingly argued of late (albeit not universally) that health care is a fundamental "right." Now, as a matter of long-settled law and policy -- as I pointed out in my prior post -- access to health care is indeed a "right," but it is a "right of last resort," a contingent, means-tested safety net "right" that comes with economic destitution (or close enough to it).

And, as of now, once you reach the age of 65 (I'm 18 months out), it becomes simply an "entitlement" right in no way contingent on personal income or net worth -- i.e., Medicare.

But, now, we're being told that we all have to contribute in some fashion

Well, consider military defense, and police and fire protection. We regard those without a second thought as basic "rights,"[**] and we assume that our various tax contributions suffice to provide them. Taxes may go up or down, defense, police, and fire department budgets may rise or fall, but we don't expect an annual arithmetic average "per capita" bill from the government for them. You earn more, you pay more. Justifiably so, it is argued, because you have more to lose (whether that should properly be progressively so is another argument for another topic).
** And, we readily recognize that those with sufficient means and desires can freely purchase enhanced protections via private security services and/or moving to more affluent areas -- e.g., gated communities -- that accord greater protective amenities.

Look at my spreadsheet example above. How many families could be expected to "afford" a monthly health care premium of of $2,769, or even $1,938 a month in the wake of a 30% decrement in annual costs?

THE CURRENT DRAFT HOUSE BILL: "AFFORDABILITY CREDITS"

Having taken a "social insurance" basic "entitlement" model off the table, federal policymakers are now busy hastily constructing yet another inscrutably complex system via which to assess and provide for "affordability." For example, from page 135 of the 1,018 page draft House bill:

The requisite individual "affordable contribution credit" is to be capped at 11% of income for those at a maximum of 400% of the "Federal Poverty Limit (FPL)."

(Click any of these images to inflate them for easier viewing, btw.) That 2nd graphic is from page 137. Let's take a look at the most recent stratified FPL table (just for the lower 48 states and DC; Hawaii and Alaska are perhaps 20-25% higher)

OK, sticking with our "family of 4" meme, 11% of $22,050 divided by 12 months comes out to $202.13 per month ($2,425.50 a year) for a 4-person household with an income of $88,200 (4x the FPL).

A couple of observations:

This look distressingly like "corporate welfare," in that the government will be expected to make up the difference between the "market price" of insurance coverage and your "affordable contribution" (just as is the case with the Federal Employees Benefit Plan) should you not be otherwise covered through your employer (or via your own wealth enabling you to purchase coverage and/or services at retail). Perhaps this explains why "Harry and Louise" are now on board ad nauseum of late touting reform. Forcibly bring in 40+ million new "policyholders," without having to charge them anywhere near full retail, while still making bank via the U.S. Treasury? What's not to love?

It also looks distressingly like -- well -- "welfare," overtly (begging yet again the question of health care as a fundamental "right" like national defense). We will need another numbing federal bureaucracy within which to vet "affordability eligibility" ongoing for millions. And, while some people are inveterate wards of the state, many others move repeatedly up and down in the socioeconomic strata. Eligibility will have to be re-determined at least annually. Take a number. Now serving number 342 at window 8. Provide two photo IDs and your last IRS 1040. No, I'm sorry, we do not recognize Power of Attorney, your mother must come here in person. Yes, I understand that she's bedridden in a nursing home. Sorry. She must appear in person. Two photo IDs, and last Form 1040. No, your place in the queue expires at 5 pm today.

In my prior post I concluded:
We seem to be headed toward an inscrutably hyper-complex re-jiggering of our no-value-adding "health care" paper-pushing industry. I hope I'm wrong.

I'm not yet seeing much to allay that concern.
___

JULY 30TH UPDATE

The draft House bill -- "America's Affordable Health Choices Act of 2009" -- now has a number, H.R.3200. Now, recall my concern set forth just above in the 2nd bullet point:

"We will need another numbing federal bureaucracy within which to vet "affordability eligibility" ongoing for millions. And, while some people are inveterate wards of the state, many others move repeatedly up and down in the socioeconomic strata. Eligibility will have to be re-determined at least annually."

Well, here you go:

H.R.3200, SEC. 245. INCOME DETERMINATIONS.

(a) In General- In applying this subtitle for an affordability credit for an individual for a plan year, the individual's income shall be the income (as defined in section 242(c)) for the individual for the most recent taxable year (as determined in accordance with rules of the Commissioner). The Federal poverty level applied shall be such level in effect as of the date of the application.

(b) Program Integrity; Income Verification Procedures-

(1) PROGRAM INTEGRITY- The Commissioner shall take such steps as may be appropriate to ensure the accuracy of determinations and redeterminations under this subtitle.

(2) INCOME VERIFICATION-

(A) IN GENERAL- Upon an initial application of an individual for an affordability credit under this subtitle (or in applying section 242(b)) or upon an application for a change in the affordability credit based upon a significant change in family income described in subparagraph (A)--

(i) the Commissioner shall request from the Secretary of the Treasury the disclosure to the Commissioner of such information as may be permitted to verify the information contained in such application; and

(ii) the Commissioner shall use the information so disclosed to verify such information.

(B) ALTERNATIVE PROCEDURES- The Commissioner shall establish procedures for the verification of income for purposes of this subtitle if no income tax return is available for the most recent completed tax year.

(c) Special Rules-

(1) CHANGES IN INCOME AS A PERCENT OF FPL- In the case that an individual's income (expressed as a percentage of the Federal poverty level for a family of the size involved) for a plan year is expected (in a manner specified by the Commissioner) to be significantly different from the income (as so expressed) used under subsection (a), the Commissioner shall establish rules requiring an individual to report, consistent with the mechanism established under paragraph (2), significant changes in such income (including a significant change in family composition) to the Commissioner and requiring the substitution of such income for the income otherwise applicable.

(2) REPORTING OF SIGNIFICANT CHANGES IN INCOME- The Commissioner shall establish rules under which an individual determined to be an affordable credit eligible individual would be required to inform the Commissioner when there is a significant change in the family income of the individual (expressed as a percentage of the FPL for a family of the size involved) and of the information regarding such change. Such mechanism shall provide for guidelines that specify the circumstances that qualify as a significant change, the verifiable information required to document such a change, and the process for submission of such information. If the Commissioner receives new information from an individual regarding the family income of the individual, the Commissioner shall provide for a redetermination of the individual's eligibility to be an affordable credit eligible individual.

(3) TRANSITION FOR CHIP- In the case of a child described in section 202(d)(2), the Commissioner shall establish rules under which the family income of the child is deemed to be no greater than the family income of the child as most recently determined before Y1 by the State under title XXI of the Social Security Act.

(4) STUDY OF GEOGRAPHIC VARIATION IN APPLICATION OF FPL- The Commissioner shall examine the feasibility and implication of adjusting the application of the Federal poverty level under this subtitle for different geographic areas so as to reflect the variations in cost-of-living among different areas within the United States. If the Commissioner determines that an adjustment is feasible, the study should include a methodology to make such an adjustment. Not later than the first day of Y2, the Commissioner shall submit to Congress a report on such study and shall include such recommendations as the Commissioner determines appropriate.

(d) Penalties for Misrepresentation- In the case of an individual intentionally misrepresents family income or the individual fails (without regard to intent) to disclose to the Commissioner a significant change in family income under subsection (c) in a manner that results in the individual becoming an affordable credit eligible individual when the individual is not or in the amount of the affordability credit exceeding the correct amount--

(1) the individual is liable for repayment of the amount of the improper affordability credit; and

(2) in the case of such an intentional misrepresentation or other egregious circumstances specified by the Commissioner, the Commissioner may impose an additional penalty.

"Provide two photo IDs and your last IRS 1040. No, I'm sorry, we do not recognize Power of Attorney, your mother must come here in person. Yes, Iunderstand that she's bedridden in a nursing home. Sorry. She must appear in person. Two photo IDs, and last Form 1040. No, your place in the queue expires at 5 pm today."

As I've also stated before: We seem to be headed toward an inscrutably hyper-complex re-jiggering of our no-value-adding "health care" paper-pushing industry.

And, should these provisions survive to become part of any passed legislation, this requisite new "affordability eligibility" bureaucracy will be a big part of it, diverting scarce, precious clinical health care dollars into clerical verification cubicles as "the Commissioner shall establish...for the verification of income for purposes of this subtitle..."
___

IT GETS WORSE

Under this legislation, we've obviously given up on the concept of health care as a "right" in favor of viewing it as a personal responsibility -- enforceable under tax law via IRS scrutiny. You are to be additionally taxed should you not be able to produce documentation of your having "acceptable health care coverage."

TITLE IV--AMENDMENTS TO INTERNAL REVENUE CODE OF 1986

Subtitle A--Shared Responsibility

PART 1--INDIVIDUAL RESPONSIBILITY

SEC. 401. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.

(a) In General- Subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new part:

`PART VIII--HEALTH CARE RELATED TAXES

`subpart a. tax on individuals without acceptable health care coverage.
`Subpart A--Tax on Individuals Without Acceptable Health Care Coverage
`Sec. 59B. Tax on individuals without acceptable health care coverage.

`SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.

`(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of--

`(1) the taxpayer's modified adjusted gross income for the taxable year, over
`(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.

`(b) Limitations-

`(1) TAX LIMITED TO AVERAGE PREMIUM-

`(A) IN GENERAL- The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.
`(B) APPLICABLE NATIONAL AVERAGE PREMIUM-

`(i) IN GENERAL- For purposes of subparagraph (A), the `applicable national average premium' means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins.

`(ii) FAILURE TO PROVIDE COVERAGE FOR MORE THAN ONE INDIVIDUAL- In the case of any taxpayer who fails to meet the requirements of subsection (e) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting `family coverage' for `self-only coverage'.

`(2) PRORATION FOR PART YEAR FAILURES- The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the amount of tax so imposed (determined without regard to this paragraph and after application of paragraph (1)) as--
`(A) the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection (d), bears to

`(B) the entire taxable year.

`(c) Exceptions-
`(1) DEPENDENTS- Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as such taxable year.

`(2) NONRESIDENT ALIENS- Subsection (a) shall not apply to any individual who is a nonresident alien.

`(3) INDIVIDUALS RESIDING OUTSIDE UNITED STATES- Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable.

`(4) INDIVIDUALS RESIDING IN POSSESSIONS OF THE UNITED STATES- Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year.

`(5) RELIGIOUS CONSCIENCE EXEMPTION-

`(A) IN GENERAL- Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.

`(B) EXEMPTION- An application for the exemption described in subparagraph (A) shall be filed with the Secretary at such time and in such form and manner as the Secretary may prescribe. Any such exemption granted by the Secretary shall be effective for such period as the Secretary determines appropriate.
`(d) Acceptable Coverage Requirement-

`(1) IN GENERAL- The requirements of this subsection are met with respect to any individual for any period if such individual (and each qualifying child of such individual) is covered by acceptable coverage at all times during such period.

`(2) ACCEPTABLE COVERAGE- For purposes of this section, the term `acceptable coverage' means any of the following:

`(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE- Coverage under a qualified health benefits plan (as defined in section 100(c) of the America's Affordable Health Choices Act of 2009).

`(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER GRANDFATHERED EMPLOYMENT-BASED HEALTH PLAN- Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102 of the America's Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).

`(C) MEDICARE- Coverage under part A of title XVIII of the Social Security Act.
`(D) MEDICAID- Coverage for medical assistance under title XIX of the Social Security Act.
`(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE)- Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

`(F) VA- Coverage under the veteran's health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary in coordination with the Health Choices Commissioner to be not less than the level specified by the Secretary of the Treasury, in coordination with the Secretary of Veteran's Affairs and the Health Choices Commissioner, based on the individual's priority for services as provided under section 1705(a) of such title.

`(G) OTHER COVERAGE- Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner, recognizes for purposes of this subsection.

`(e) Other Definitions and Special Rules-

`(1) QUALIFYING CHILD- For purposes of this section, the term `qualifying child' has the meaning given such term by section 152(c).

`(2) BASIC PLAN- For purposes of this section, the term `basic plan' has the meaning given such term under section 100(c) of the America's Affordable Health Choices Act of 2009.

`(3) HEALTH INSURANCE EXCHANGE- For purposes of this section, the term `Health Insurance Exchange' has the meaning given such term under section 100(c) of the America's Affordable Health Choices Act of 2009, including any State-based health insurance exchange approved for operation under section 208 of such Act.

`(4) FAMILY COVERAGE- For purposes of this section, the term `family coverage' means any coverage other than self-only coverage.

`(5) MODIFIED ADJUSTED GROSS INCOME- For purposes of this section, the term `modified adjusted gross income' means adjusted gross income--

`(A) determined without regard to section 911, and
`(B) increased by the amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.

`(6) NOT TREATED AS TAX IMPOSED BY THIS CHAPTER FOR CERTAIN PURPOSES- The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.

`(f) Regulations- The Secretary shall prescribe such regulations or other guidance as may be necessary or appropriate to carry out the purposes of this section, including regulations or other guidance (developed in coordination with the Health Choices Commissioner) which provide--

`(1) exemption from the tax imposed under subsection (a) in cases of de minimis lapses of acceptable coverage, and

`(2) a process for applying for a waiver of the application of subsection (a) in cases of hardship.'.
(b) Information Reporting-

(1) IN GENERAL- Subpart B of part III of subchapter A of chapter 61 of such Code is amended by inserting after section 6050W the following new section:

`SEC. 6050X. RETURNS RELATING TO HEALTH INSURANCE COVERAGE.

`(a) Requirement of Reporting- Every person who provides acceptable coverage (as defined in section 59B(d)) to any individual during any calendar year shall, at such time as the Secretary may prescribe, make the return described in subsection (b) with respect to such individual.

`(b) Form and Manner of Returns- A return is described in this subsection if such return--

`(1) is in such form as the Secretary may prescribe, and
`(2) contains--
`(A) the name, address, and TIN of the primary insured and the name of each other individual obtaining coverage under the policy,
`(B) the period for which each such individual was provided with the coverage referred to in subsection (a), and
`(C) such other information as the Secretary may require.

`(c) Statements To Be Furnished to Individuals With Respect to Whom Information Is Required- Every person required to make a return under subsection (a) shall furnish to each primary insured whose name is required to be set forth in such return a written statement showing--

`(1) the name and address of the person required to make such return and the phone number of the information contact for such person, and

`(2) the information required to be shown on the return with respect to such individual.

The written statement required under the preceding sentence shall be furnished on or before January 31 of the year following the calendar year for which the return under subsection (a) is required to be made.

`(d) Coverage Provided by Governmental Units- In the case of coverage provided by any governmental unit or any agency or instrumentality thereof, the officer or employee who enters into the agreement to provide such coverage (or the person appropriately designated for purposes of this section) shall make the returns and statements required by this section.'.

(2) PENALTY FOR FAILURE TO FILE-
(A) RETURN- Subparagraph (B) of section 6724(d)(1) of such Code is amended by striking `or' at the end of clause (xxii), by striking `and' at the end of clause (xxiii) and inserting `or', and by adding at the end the following new clause:

`(xxiv) section 6050X (relating to returns relating to health insurance coverage), and'.

(B) STATEMENT- Paragraph (2) of section 6724(d) of such Code is amended by striking `or' at the end of subparagraph (EE), by striking the period at the end of subparagraph (FF) and inserting `, or', and by inserting after subparagraph (FF) the following new subparagraph:

`(GG) section 6050X (relating to returns relating to health insurance coverage).'.

(c) Return Requirement- Subsection (a) of section 6012 of such Code is amended by inserting after paragraph (9) the following new paragraph:

`(10) Every individual to whom section 59B(a) applies and who fails to meet the requirements of section 59B(d) with respect to such individual or any qualifying child (as defined in section 152(c)) of such individual.'.

(d) Clerical Amendments-

(1) The table of parts for subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:

`Part VIII. Health Care Related Taxes.'.

(2) The table of sections for subpart B of part III of subchapter A of chapter 61 is amended by adding at the end the following new item:

`Sec. 6050X. Returns relating to health insurance coverage.'.

(e) Section 15 Not To Apply- The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.

(f) Effective Date-

(1) IN GENERAL- The amendments made by this section shall apply to taxable years beginning after December 31, 2012.

(2) RETURNS- The amendments made by subsection (b) shall apply to calendar years beginning after December 31, 2012.

What will be the bureaucratic FTE necessarily devoted to determining compliance with the myriad foregoing provisions? How many childhood immunizations, annual checkups, MRIs, arthroscopic surgeries, splints, and rounds of chemo and radiation would these FTE otherwise pay for?

___

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My friend Rick, the double murderer

Sat, 27 Jun 2009 01:06:47 -0400

"Rick Stevens," real name Donald Stevenson, inmate at California's Mule Creek State Prison. Now serving up to life for killing three people. A drug dispute thing gone tragically wrong, I am told, decades ago. It has rather haunted me ever since I learned of it.

In 1967 -68 I lived in North Beach in San Francisco, playing guitar in a local lounge band. We called ourselves "Four of a Kind." We also jokingly called ourselves to ourselves "the Spic, the Spook, the Wop, and the Mick" -- i.e. Joey (Jose Simón), our Mexican bass player, the black Rick Stevens on vocals (bottom left with the shades, 'fro, and western fringe shirt in the pic above), our Italian drummer, Fred, and me, the Irishman. We eventually added a 5th member on percussion -- Mike Carabello, who would go on to Santana and Woodstock.

Me, I moved to Seattle with the birth of my first child in June of 1968. Rick and I stayed in touch for a while afterward...

___

Rick went on to become lead vocalist with the the now-venerable Tower of Power (a number of whom I now count among my friends) . As recounted by The East Bay Express in 2002:

Rick Stevens was the first singer for Oakland's Tower of Power, that funky, tight, syncopated horn-fest that vividly put the East Bay on the soul map and played up its Oakland connection -- even championed it -- at a time when the San Francisco scene was getting all of the attention during the '60s. Stevens, who will turn 62 in late February, has been in prison for the last 26 years after receiving two seven-years-to-life sentences for a much more heinous crime: double murder."

He shot up three people," recalls Emilio "Mimi" Castillo, sax player and founding member of the group. "He tied up this lady and left her in a trunk -- pretty gruesome stuff." Although Stevens had been out of the group for a few years at the time of the incident, the media played up the Tower of Power connection anyway, much to the dismay of the band, which already had moved on to singer Lenny Williams. "Rick was a really great guy," says Castillo. "But he got strung out on hard narcotics -- when he was in that state of mind, he was not a nice guy."

The singer's belligerence got him booted from the band, despite many members' still-strong feelings that he was the best vocalist ever for Tower of Power. "Let me tell you something about Rick Stevens," says Castillo with dramatic pause. "That guy was one of the greatest singers that ever lived. Unbelievable. And if it hadn't been for the drugs, he'd have been a huge star." On top of his musical skills, Stevens had a charisma and compelling stage presence. That's his lead vocal on "You're Still a Young Man," which arguably was the band's biggest hit, as well as being the song that Prince claims he lost his virginity to.

Rick had an obvious serious drug Jones back when I knew him, often doing crazy stuff like taking LSD and shooting smack at the same time. But, he seemed overall to keep it together. He'd come up to Seattle with Tower, and get me comped in to their shows. I never detected anything spinning out of control.

But, it certainly did.

Rick/Donald is now 69, and has been before the parole board a number of times. Denied. There are some people arguing ongoing for his parole, but, I don't know. The moral politics of a double murder (one death was ruled self-defense manslaughter). Can there be redemption? I would say 'yes,' but others would surely disagree, and not all of them driven simply by a desire for vengeance.

By all accounts, Rick is "rehabilitated," and a totally productive, model prisoner. One who appears by all accounts (that I can glean) to pose no further risk to society. But, is that enough?

Given that my wife now has to now mostly live in a small apartment in Walnut Creek, CA for work -- not all that far from Mule Creek prison -- I feel compelled to go see for myself one of these trips over, and to drive over to Ione and re-connect with my old long-lost musical colleague and friend.

I have a full and rich life, within which I now promote the finest band in Las Vegas, Santa Fe and The Fat City Horns -- a crushingly fine Tower of Power on Red Bull and salsa. I lament that I will likely never have my old friend come sit at my side at my front row table from where I do my gig photography. These cats would blow his mind.

I have no idea why I posted this. Maybe it's just given all the buzz over Michael Jackson's demise. Emilio on Rick: "That guy was one of the greatest singers that ever lived. Unbelievable. And if it hadn't been for the drugs, he'd have been a huge star."

AUGUST 12TH UPDATE

I am now in contact with Rick, and just filled out and returned a "Visitor Approval Request" form. I assume it will be approved, and ASAP thereafter I will be on my way over to see my old friend, for, as he put it, "catching up during lunch at the vending machines." They let you bring in a maximum of $20, LOL. No recording devices (including cameras), no cell phones, no pen/pencils & paper, one photo ID, and your car key alone. Strict dress code: no denim or khaki (and blue or red are discouraged by knowledgeable outsiders -- gang colors). In signing the app, you attest that you understand that the Department of Corrections doesn't do hostage negotiations, so if violent takeover stuff goes down while you're there and you are captured, well, too bad. A bracing thought, that.

NOVEMBER UPDATE

Sadly, Rick was given a three year parole denial. By all accounts, the grounds for this were tangential and spurious, and his attorney claims there are grounds to appeal their decision in court (though, as a practical matter, no one is gonna take this up pro bono).

I am told that, whereas parole boards in California are by law supposed to be similar in citizenry composition to "a jury of your peers," they are in fact overwhelmingly composed of ex-law enforcement individuals and victims' rights advocacy activists (and, unsurprisingly, tend toward skepticism if not outright hostility toward the inmate going in). Moreover, there is little continuity; you typically never face the same parole board twice, so you're always starting from scratch, with many new people unfamiliar with your case and incarceration record.

Rick had recently had a string of one-year denials, and is no longer opposed for parole by the DA's office, so this was a harsh and unexpected outcome.

It saddens me greatly.

___

Richard Nixon wanted my daughter aborted

Thu, 25 Jun 2009 02:06:54 -0400

Tapes Reveal Nixon Pro-Mixed Race Abortions

Tape recordings of former US President Richard Nixon have revealed that he believed abortion was "necessary" in mixed race pregnancies.

Richard Nixon is the only president in history to resign

Nixon's bizarre comments are contained in hundreds of hours of tapes he made while in the White House which have now been released by his presidential library.

After the US Supreme Court had ruled abortion legal, Nixon tells aide Charles Colson: "I admit, there are times when abortions are necessary, I know that."

He then gave "a black and a white" as an example...

____

Let me respond to that revelation with an excerpt from a 2008 blog post of mine.

CODA

There's a maxim among trial lawyers: "He with the best story wins." So, perhaps a closing anecdote is in order to bring the grand abstract reproductive "rights" moral issue down to eye level, so indulge me a short story.

The year is 1969, the place, suburban Seattle. A young couple chafes within the throes of an ill-advised (and ultimately doomed) marriage. They have an infant girl, on whom the young father joyfully dotes. The one unequivocally bright spot. Parenthood, at least, suits him, so it seems.

The young wife announces one day that she is again pregnant. But, while the husband is thrilled at the news, she exudes an inexplicable anxious and distant air. In the subsequent weeks, her smoldering anxiety morphs into a controlled state of cornered panic, and the devastating truth must finally be aired one night; she had had a recent transient sexual dalliance, and this unwanted pregnancy is almost certainly the upshot. To make matters even more complex, the cuckolding paramour is a black man (this couple is white).

Thermonuclear agonies ensue, regarding which, words utterly fail.

The young woman is beyond frantic to obtain an abortion (circumstances being exacerbated by the fact that her own father is an overt racist), but, this being an era prior to Rove vs Wade, abortions are proscribed by law in Washington state. Her subsequent attempts to procure one illegally fail, and she realizes she will have to carry this fetus to term.

She is then advised by state social services agencies that she may indeed relinquish the newborn sight-unseen for adoption, and wishes to opt for that alternative to end this nightmare, however imperfectly. This, though, requires the husband's written assent, which, for reasons not entirely clear to him, he declines to provide. In part, one can safely assume, hoping against hope that this is all a cruel, horrific dream, and the child will in fact prove to be biologically his.

An uneventful delivery obtains in the hospital in Renton in July of 1970, a 7 lb. 6 oz. healthy baby girl. The young man hesitantly approaches the glass partition of the nursery unit. The moment of truth in a glance:'Nope, well, this is definitely not your child.' A fleeting, wracked feeling of being summarily dropped down an open elevator shaft gives way within seconds to a subsequent flustered internal flurry:

'Now what? Whatever will become of this child? None of this shit is her fault...'

He turns and heads down the hall to the office, whereupon he signs the requisite parental paperwork. He will be her "father." Not even legally her "adoptive father," simply her father, DNA be damned. His bigoted father-in-law be damned. Subsequent hushed gossip and furtive glances within his social cohort be damned.

Fast forward four years to a Clark County, Washington courtroom. The young man is granted an uncontested divorce, along with sole custody of his two girls. The henceforth ex-wife does not attend the hearing.

Fast forward yet again. Knoxville, Tennessee a decade later, a dining room discussion ensues during which the younger daughter learns for the first time the full story.

"Thanks, Dad, you saved my life."

They laugh. It is good.

__________

The foregoing is no mere illustrative fictional anecdote conjured up for emotional impact. I am that father.

Father to a young woman, now approaching age 38 at this writing, who has gone on to obtain a Master's degree and a position as the highly successful local Executive Director of a major non-profit youth golf organization, following lengthy prior stints as a hospital chaplain, and a wildly successful grantwriter for a national social services foundation.

Proud grandfather to her amazing son, now 14, who had become ranked 43rd in the nation in his U.S. Tennis Association age division by the time he was 12, and who has just been awarded a full-ride private high school scholarship in recognition of his ongoing honor student academic track record.

While such achievements and accolades are really just the icing on the cakes (my love for my kids is unconditional), I am today the proud papa of offspring who bring so much good, and so much joy, to my life and to our world.

We laugh. All the time. It is good.

DNA is simply irrelevant.

I shudder to think what I would have missed. I am blessed to be the father that I am.

Where is this man buried? Ahhh...never mind. Withdrawn. I yield to themadgreek's observation.

___________

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