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Wednesday, July 22, 2009
Tuesday, July 21, 2009
Cry wolf [Three updates]
[Updated July 28, 2009, about 8am: I have more to say about Section 1233 of HR3200 and have done so in a series of (so far) four posts:
A sting, a smell, an apology, and a really long footnote
Speaking in tongues
You claim that mish-mash is a defense?
Now I can sleep
All these posts in the series are filed under the category “Me And 1233”.]
[I've now updated this twice once with a response to comments by JohnMc and once with a link to something Grim wrote. Both updates are at the bottom of the post.]
[An Instalanche, an Instalanche. Welcome, everyone.]
The Right leaning blogs are up in arms over a provision in HR3200, the House’s health care bill. According to the New York Post (emphasis mine):
The Post’s interpretation of Section 1233 has been picked up by a whole armful of bloggers. See Grim’s Hall, Little Miss Attila, and RedState, for example. Instapundit has linked to RedState. Meanwhile The Anchoress links to Catholic Online which refers to an interview Betsy McCaughey did with Fred Thompson in which she claims (at about 1:20):
Um, no. That’s not what HR3200 says. Here’s the short version of what it really says:
The section under question is Section 1233 of HR3200 (the House health care bill) and it is amending subsection s(2) of Section 1861 of the Social Security Act (42 U.S.C. 1395x). Section 1233 of HR3200 adds new sub-paragraph (FF) to the list of what Medicare will pay for as defined in Section 1861 of the Social Security Act.
Section 1233 is saying that Medicare will pay for an "advance care planning consultation" no more often than once every five years unless the patient's health status changes as a result of certain diagnoses or the patient is admitted to a nursing home, long-term care facility, or hospice. Such a consultation may result in a written directive about care and that directive may include information about such areas as antibiotics and intravenous feeding and hydration as well as the usual DNR instructions and any wishes with regard to facility transfer.
In other words, Section 1233 is creating a new type of “treatment” that will be paid for by Medicare. It will only pay for one such consultation every five years unless the patient’s health status changes, in which case Medicare will pay for a consultation when that change occurs. This is not a mandate; this is a new entitlement. It may not be an entitlement everyone likes but it is still something extra for those on Medicare.
Here’s the long version in which I show you how to follow the trail yourself:
You can access the House’s health care bill (HR3200) via THOMAS. Say you want to search by bill number and enter “HR3200” in the search box. Say you want “Text of Legislation”. Click on the hyperlink for “SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.” This section is amending Section 1861 of the Social Security Act (42 U.S.C. 1395x) by adding a new subparagraph (FF).
Now take a look at the Social Security Act. You can find the home page for it here. Click on the hyperlink for “Social Security Act Table of Contents”, then click on the hyperlink for “Title XVIII Health Insurance for the Aged and Disabled”, then on the hyperlink for “Sec. 1861. Definitions of services, institutions, etc.”
I’ve sent you the long way around because if you just start with Section 1861 you don’t really know where you are. If you want to go straight to that Section simply click here.
Hunt down the page until you find the centered heading “Medical and Other Health Services”. Directly under that is subsection (s) which begins:
and goes on to list 31 “medical and other health services” concluding with:
before moving on to subparagraph (3) which deals with diagnostic X-rays.
Section 1233 of HR3200 will add:
to the bottom of that list. It will also add the definition in subsection (hhh)(1) at the very end of Section 1862, below subsections (ggg)(1-4) which define “Kidney Disease Education Services”.
In other words, “Advance Care Planning Consultation” will be no more “compelled” than the “intensive cardiac rehabilitation program” listed in (DD) or the “kidney disease education services” listed in (EE). The five years is a limitation not a requirement: Medicare will not pay for such a consultation more often than once every five years unless:
This doesn’t mean Medicare will pay for more frequent consultations for individuals in facilities but rather that it will pay for a consultation when they enter such a facility even if their previous consultation was less than five years previously.
Section 1233 of HR3200 also amends Section 1848(j)(3) of the Social Security Act to include the newly defined (FF) in the list of services that will be paid for. It then amends Section 1862(a) to make it clear Medicare will not pay for advance care planning consultations that take place more frequently than allowed (that is, every five years except in the case of a significant change in health status.)
Section 1233 of HR3200 then requires the Secretary to include:
while also requiring the Secretary to publish the metrics he plans to use and invite public comment on them.
Section 1233 of HR3200 concludes by requiring the Secretary of Health and Human Services to include information about these changes to the Social Security Act in subsequent editions of the Medicare & You Handbook.
So Advance Care Planning Consultations are not compelled, required, or mandated. Is it weird they’re in this bill? Maybe, maybe not. Section 1233 is part of “Subtitle C - Miscellaneous Improvements” under “TITLE II - MEDICARE BENEFICIARY IMPROVEMENTS”. Subtitle C includes:
In addition to these changes to Medicare, a lot of the other parts of this bill also deal with Medicare. So it’s entirely possible that having Medicare pay for Advance Care Planning Consultations is an idea that’s been kicking around for a while and got stuck in this bill along with, say, Section 1231 which seems to provide a longer term of coverage for kidney related conditions. It would be nice to ask someone involved in drafting Section 1233 why they decided to include this. I can believe there were requests for it. If my aunt had had such a consultation with her doctor, in which she could have made it crystal clear that she wanted all the stops pulled out as long as there was any hope at all, she might be alive today. Furthermore, Section 1233 says that the Secretary’s reporting metrics must “measure both the creation of and adherence to orders for life-sustaining treatment.” In other words, if you say you want the doctors to do everything to keep you alive then theoretically someone will be watching to be sure they do so.
What makes this benign explanation hard to accept, of course, is the perception that the Left is quite comfortable with - and possibly even enthusiastic about - not “wasting” health care dollars. Obama’s exchange with Jane Sturm back in June doesn’t totally support this perception but it doesn’t do much to challenge it either - particularly if all you hear from it are his comments about not considering a patient’s spirit when making medical decisions and, even worse, that horrible sentence fragment: “maybe you're better off not having the surgery, but taking the painkiller.” Furthermore, Obama explicitly talks about living wills:
Given all this, I can see why those on the Right would find it easy to believe Democrats would write a health care bill that requires the old and the ill to sit down with their doctors and talk about how to end their lives. Nonetheless, if the goal is to convince voters who are waffling on the health care bill to call their Congressmen and oppose it then the Right’s decision to put forth a specious claim about such a serious matter was a very bad mistake.
Here’s how this plays out. The Right claims the House health care bill will force old people to sit down and talk about end of life issues including - as McCaughey put it - declining nutrition and hydration; the wafflers are appropriately horrified; it turns out not to be true. How much attention are those same wafflers going to pay when the Right argues that, okay, the bill doesn’t exactly require such consultations but it does say the government will pay for them and, hey, look what Klein and Yglesias and Obama himself are saying about this stuff? My guess would be, not much. After the stronger claim has been discredited no one is going to be interested in the weaker but more credible claim; the Right has blown its euthanasia cred by, yes, overreaching.
Even worse this mistake is strike two. Strike one was the Right’s claim that:
It turned out that once you got to page 19 you were allowed to buy individual coverage “as an Exchange-participating health benefits plan.” Compared to such coverage being outlawed, the Exchange sounds so good no one even seems to care what it is. Without such a comparison, some of those wafflers might be inspired to ask, “What the heck is the Exchange?” If the Right wants to credibly oppose HR 3200 - or any universal health care bill - it needs to be very sure of its facts in the future. The next error is strike three.
And it’s not like there’s nothing real to oppose. I think the Democratic plan to overhaul the entire health insurance system is a big - and unnecessary - mistake. I certainly think that trying to pass a bill this huge so fast almost guarantees disaster somewhere down the road. If nothing else, can we at least agree we won’t go any further with it until THOMAS is able to give us a Summary? You know, HR3200 in a semblance of plain English?
More specifically, I think it’s almost certain the decision to pay for advance care planning consultations will result in big problems. As I said over at Grim’s:
Apart from these financial scams, I do see that the advance care planning consultations can become the first step in a slippery slope and take seriously the concerns of those who fear they could lead to government-encouraged suicide and euthanasia. However, none of the very real problems with HR3200 or with Section 1233 make an untruth true.
It’s distressing how much the claim that Section 1233 compels end of life counseling reminds me of the claim that Sarah Palin quit as mayor of Wasilla without finishing out her term. The story about Palin is a deliberate lie, of course, while the story about Section 1233 seems to have started as an honest error, but the two stories share many of the same characteristics. Both fit perfectly into desired images: Palin is a quitter; the Democrats want to euthanize old people. Both spread quickly, repeated over and over by people who didn’t bother to check the accuracy of what they were saying - including people who should have known better. Neither one passes the most rudimentary smell test. And there’s no place to go to say, “But that’s not right” with any hope that the truth will be spread as far as the lie. Or even any hope that those doing the spreading are interested in knowing what the truth really is.
*****
Updated, July 22, 2009, around 10:45am
In the comments, JohnMc thinks I’ve missed the forest for the trees and raises some specific issues. Responding to him got long enough - and I think important enough - to warrant an update to the post.
Not really seeing that. (hhh)(1) provides for (among other things):
But F(i-iii) limit these types of consultations to States with a standardized “program for orders for life sustaining treatment”. That is, physicians must do the check-off thing in (hhh)(1)(A-E) only in States that have created check-off type programs - including standard forms - for end of life issues and that train their practitioners on how to tell patients about these standardized programs.
No. (iii) is a list of the requirements a State must meet to be considered to “[have] in effect a program for orders for life sustaining treatment”. Only in States that have such a program in place - and “in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings” - will practitioners be required to include the specific items in (hhh)(1)(A-E).
Here’s the deal. I live in New Jersey. If I go to the hospital, they ask me if I have an advance directive. If I say no, they ask if I want one. If I say yes, they hand me a form that asks a few basic questions, I check the boxes, and that gives them a rough idea of when to pull the plug. However, I have both a living will and a medical power of attorney. So I don’t check the form, I just give them a copy of those documents.
Bottom line: This bill requires that certain standard areas be covered in a consultation if and only if the State the patient and practitioner are in has established a standardized program for end of life issues, including forms that are legal without the help of a lawyer. Nowhere does it say that creating your own documents with your own lawyer is not allowed, not legal, or not acceptable.
First, that little “Of course”? Kind of ugly. I have very strong convictions about the importance of assuming good will even on the part of those with whom I disagree. I appreciate the same assumption from those who disagree with me.
Substantively, I certainly understand that fears about rationing are well-founded. Once you accept that medical care taking an increasing percent of the GDP is a problem - which I’m not sure I do - and you realize that better treatment means higher costs - which I realize very well - and you realize that older people and sicker people need more care - which I realize very, very well - you’re going to be stuck with rationing as the only way out. Fear of rationing is a perfectly valid reason to oppose this bill and any similar health care bill. It is NOT a perfectly valid reason to misinterpret the bill or - worse yet - to deliberately misstate what’s in the bill.
As for missing the forest for the trees, I did not set out to argue HR 3200 is a good bill. Nor did I say that slippery slope concerns were not valid. What I said was that the claim of mandated, required, compelled end of life counseling was inaccurate.
I short while ago I was reading a blog where an argument was raging over whether Sarah Palin billed rape victims for evidence kits. (Yes, recently. Yes, still.) One of the commenters didn’t seem to think it mattered what the facts were: the story was intended as an emotional truth. I’m apparently one of the few remaining people on the face of the earth who thinks emotional truth is not the same as actual truth and not even within shouting distance of fact. If we all define our own truth based on what “feels” accurate then we really are living in a postmodern world where, as Brad Holland put it:
*****
Updated, July 22, 2009, around 6pm: Grim and I had an email exchange about this post and I he has posted a large portion of that exchange at his blog. I think it's an interesting view of this issue and one I would never have thought of. Grim argues that the Right is taking the correct tack rhetorically. Read the whole thing here.
Grim's logic and argument are impeccable as always and all I can offer by way of rebuttal is this (also from our email exchange):
A sting, a smell, an apology, and a really long footnote
Speaking in tongues
You claim that mish-mash is a defense?
Now I can sleep
All these posts in the series are filed under the category “Me And 1233”.]
[I've now updated this twice once with a response to comments by JohnMc and once with a link to something Grim wrote. Both updates are at the bottom of the post.]
[An Instalanche, an Instalanche. Welcome, everyone.]
The Right leaning blogs are up in arms over a provision in HR3200, the House’s health care bill. According to the New York Post (emphasis mine):
One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."
The Post’s interpretation of Section 1233 has been picked up by a whole armful of bloggers. See Grim’s Hall, Little Miss Attila, and RedState, for example. Instapundit has linked to RedState. Meanwhile The Anchoress links to Catholic Online which refers to an interview Betsy McCaughey did with Fred Thompson in which she claims (at about 1:20):
... and one of the most shocking things I found in this bill - and there were many - is on page 425 where the Congress would make it mandatory, absolutely required, that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner. How to decline nutrition, how to decline being hydrated, how to go into hospice care. And, by the way, the bill expressly says that if you get sick somewhere in that five-year period, if you get a cancer diagnosis, for example, you have to go through that session again. All to do what’s in society’s best interests or your family’s best interests and cut your life short.
Um, no. That’s not what HR3200 says. Here’s the short version of what it really says:
The section under question is Section 1233 of HR3200 (the House health care bill) and it is amending subsection s(2) of Section 1861 of the Social Security Act (42 U.S.C. 1395x). Section 1233 of HR3200 adds new sub-paragraph (FF) to the list of what Medicare will pay for as defined in Section 1861 of the Social Security Act.
Section 1233 is saying that Medicare will pay for an "advance care planning consultation" no more often than once every five years unless the patient's health status changes as a result of certain diagnoses or the patient is admitted to a nursing home, long-term care facility, or hospice. Such a consultation may result in a written directive about care and that directive may include information about such areas as antibiotics and intravenous feeding and hydration as well as the usual DNR instructions and any wishes with regard to facility transfer.
In other words, Section 1233 is creating a new type of “treatment” that will be paid for by Medicare. It will only pay for one such consultation every five years unless the patient’s health status changes, in which case Medicare will pay for a consultation when that change occurs. This is not a mandate; this is a new entitlement. It may not be an entitlement everyone likes but it is still something extra for those on Medicare.
Here’s the long version in which I show you how to follow the trail yourself:
You can access the House’s health care bill (HR3200) via THOMAS. Say you want to search by bill number and enter “HR3200” in the search box. Say you want “Text of Legislation”. Click on the hyperlink for “SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.” This section is amending Section 1861 of the Social Security Act (42 U.S.C. 1395x) by adding a new subparagraph (FF).
Now take a look at the Social Security Act. You can find the home page for it here. Click on the hyperlink for “Social Security Act Table of Contents”, then click on the hyperlink for “Title XVIII Health Insurance for the Aged and Disabled”, then on the hyperlink for “Sec. 1861. Definitions of services, institutions, etc.”
I’ve sent you the long way around because if you just start with Section 1861 you don’t really know where you are. If you want to go straight to that Section simply click here.
Hunt down the page until you find the centered heading “Medical and Other Health Services”. Directly under that is subsection (s) which begins:
(s) The term “medical and other health services” means any of the following items or services:
(1) physicians' services;
(2)(A) services and supplies (including drugs and biologicals which are not usually self-administered by the patient) furnished as an incident to a physician's professional service, of kinds which are commonly furnished in physicians' offices and are commonly either rendered without charge or included in the physicians' bills (or would have been so included but for the application of section 1847B);
and goes on to list 31 “medical and other health services” concluding with:
(DD)[450] items and services furnished under an intensive cardiac rehabilitation program (as defined in subsection (eee)(4));[451]
(EE)[452] kidney disease education services (as defined in subsection (ggg));
before moving on to subparagraph (3) which deals with diagnostic X-rays.
Section 1233 of HR3200 will add:
(FF) advance care planning consultation (as defined in subsection (hhh)(1));
to the bottom of that list. It will also add the definition in subsection (hhh)(1) at the very end of Section 1862, below subsections (ggg)(1-4) which define “Kidney Disease Education Services”.
In other words, “Advance Care Planning Consultation” will be no more “compelled” than the “intensive cardiac rehabilitation program” listed in (DD) or the “kidney disease education services” listed in (EE). The five years is a limitation not a requirement: Medicare will not pay for such a consultation more often than once every five years unless:
there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.
This doesn’t mean Medicare will pay for more frequent consultations for individuals in facilities but rather that it will pay for a consultation when they enter such a facility even if their previous consultation was less than five years previously.
Section 1233 of HR3200 also amends Section 1848(j)(3) of the Social Security Act to include the newly defined (FF) in the list of services that will be paid for. It then amends Section 1862(a) to make it clear Medicare will not pay for advance care planning consultations that take place more frequently than allowed (that is, every five years except in the case of a significant change in health status.)
Section 1233 of HR3200 then requires the Secretary to include:
quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.
while also requiring the Secretary to publish the metrics he plans to use and invite public comment on them.
Section 1233 of HR3200 concludes by requiring the Secretary of Health and Human Services to include information about these changes to the Social Security Act in subsequent editions of the Medicare & You Handbook.
So Advance Care Planning Consultations are not compelled, required, or mandated. Is it weird they’re in this bill? Maybe, maybe not. Section 1233 is part of “Subtitle C - Miscellaneous Improvements” under “TITLE II - MEDICARE BENEFICIARY IMPROVEMENTS”. Subtitle C includes:
SEC. 1231. EXTENSION OF THERAPY CAPS EXCEPTIONS PROCESS.
SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.
SEC. 1234. PART B SPECIAL ENROLLMENT PERIOD AND WAIVER OF LIMITED ENROLLMENT PENALTY FOR TRICARE BENEFICIARIES.
SEC. 1236. DEMONSTRATION PROGRAM ON USE OF PATIENT DECISIONS AIDS.
In addition to these changes to Medicare, a lot of the other parts of this bill also deal with Medicare. So it’s entirely possible that having Medicare pay for Advance Care Planning Consultations is an idea that’s been kicking around for a while and got stuck in this bill along with, say, Section 1231 which seems to provide a longer term of coverage for kidney related conditions. It would be nice to ask someone involved in drafting Section 1233 why they decided to include this. I can believe there were requests for it. If my aunt had had such a consultation with her doctor, in which she could have made it crystal clear that she wanted all the stops pulled out as long as there was any hope at all, she might be alive today. Furthermore, Section 1233 says that the Secretary’s reporting metrics must “measure both the creation of and adherence to orders for life-sustaining treatment.” In other words, if you say you want the doctors to do everything to keep you alive then theoretically someone will be watching to be sure they do so.
What makes this benign explanation hard to accept, of course, is the perception that the Left is quite comfortable with - and possibly even enthusiastic about - not “wasting” health care dollars. Obama’s exchange with Jane Sturm back in June doesn’t totally support this perception but it doesn’t do much to challenge it either - particularly if all you hear from it are his comments about not considering a patient’s spirit when making medical decisions and, even worse, that horrible sentence fragment: “maybe you're better off not having the surgery, but taking the painkiller.” Furthermore, Obama explicitly talks about living wills:
But, look, the first thing for all of us to understand is that we actually have some choices to make about how we want to deal with our own end-of-life care. And that's one of the things, I think, that we can all promote. And this is not a big government program. This is something that each of us individually can do, is to draft and sign a living will so that we're very clear with our doctors about how we want to approach the end of life.
Given all this, I can see why those on the Right would find it easy to believe Democrats would write a health care bill that requires the old and the ill to sit down with their doctors and talk about how to end their lives. Nonetheless, if the goal is to convince voters who are waffling on the health care bill to call their Congressmen and oppose it then the Right’s decision to put forth a specious claim about such a serious matter was a very bad mistake.
Here’s how this plays out. The Right claims the House health care bill will force old people to sit down and talk about end of life issues including - as McCaughey put it - declining nutrition and hydration; the wafflers are appropriately horrified; it turns out not to be true. How much attention are those same wafflers going to pay when the Right argues that, okay, the bill doesn’t exactly require such consultations but it does say the government will pay for them and, hey, look what Klein and Yglesias and Obama himself are saying about this stuff? My guess would be, not much. After the stronger claim has been discredited no one is going to be interested in the weaker but more credible claim; the Right has blown its euthanasia cred by, yes, overreaching.
Even worse this mistake is strike two. Strike one was the Right’s claim that:
Right there on Page 16 is a provision making individual private medical insurance illegal.
It turned out that once you got to page 19 you were allowed to buy individual coverage “as an Exchange-participating health benefits plan.” Compared to such coverage being outlawed, the Exchange sounds so good no one even seems to care what it is. Without such a comparison, some of those wafflers might be inspired to ask, “What the heck is the Exchange?” If the Right wants to credibly oppose HR 3200 - or any universal health care bill - it needs to be very sure of its facts in the future. The next error is strike three.
And it’s not like there’s nothing real to oppose. I think the Democratic plan to overhaul the entire health insurance system is a big - and unnecessary - mistake. I certainly think that trying to pass a bill this huge so fast almost guarantees disaster somewhere down the road. If nothing else, can we at least agree we won’t go any further with it until THOMAS is able to give us a Summary? You know, HR3200 in a semblance of plain English?
More specifically, I think it’s almost certain the decision to pay for advance care planning consultations will result in big problems. As I said over at Grim’s:
If this bill passes there's no doubt in my mind that sleazy operators are going to start doing cable TV ads offering to help seniors meet their counseling "requirement" or suggesting seniors should get "everything they're entitled to" under Medicare. Those same sleazy operators are going to sit down with the seniors for 5 minutes, have them sign some bogus document that has nothing to do with what they really want but is still legally binding, and bill the government for the work. I predict 3 months after the bill passes before we start hearing stories of seniors who were not treated as they actually wanted because they signed a badly done advance directive.
I'm also sure some care facilities are going to pretty much coerce their patients into these counseling sessions to make some more money. Of course those facilities have an incentive to make the resulting advance directives as optimistic as possible - if the patient dies, the facility stops getting paid.
Apart from these financial scams, I do see that the advance care planning consultations can become the first step in a slippery slope and take seriously the concerns of those who fear they could lead to government-encouraged suicide and euthanasia. However, none of the very real problems with HR3200 or with Section 1233 make an untruth true.
It’s distressing how much the claim that Section 1233 compels end of life counseling reminds me of the claim that Sarah Palin quit as mayor of Wasilla without finishing out her term. The story about Palin is a deliberate lie, of course, while the story about Section 1233 seems to have started as an honest error, but the two stories share many of the same characteristics. Both fit perfectly into desired images: Palin is a quitter; the Democrats want to euthanize old people. Both spread quickly, repeated over and over by people who didn’t bother to check the accuracy of what they were saying - including people who should have known better. Neither one passes the most rudimentary smell test. And there’s no place to go to say, “But that’s not right” with any hope that the truth will be spread as far as the lie. Or even any hope that those doing the spreading are interested in knowing what the truth really is.
*****
Updated, July 22, 2009, around 10:45am
In the comments, JohnMc thinks I’ve missed the forest for the trees and raises some specific issues. Responding to him got long enough - and I think important enough - to warrant an update to the post.
A doctor will consult on the legal aspects and also provide applicable paperwork
Not really seeing that. (hhh)(1) provides for (among other things):
B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.
(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.
But F(i-iii) limit these types of consultations to States with a standardized “program for orders for life sustaining treatment”. That is, physicians must do the check-off thing in (hhh)(1)(A-E) only in States that have created check-off type programs - including standard forms - for end of life issues and that train their practitioners on how to tell patients about these standardized programs.
So if I have my own living will drafted by my attorney the State will refuse to recognize it? (F)(I)(iii)
No. (iii) is a list of the requirements a State must meet to be considered to “[have] in effect a program for orders for life sustaining treatment”. Only in States that have such a program in place - and “in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings” - will practitioners be required to include the specific items in (hhh)(1)(A-E).
Here’s the deal. I live in New Jersey. If I go to the hospital, they ask me if I have an advance directive. If I say no, they ask if I want one. If I say yes, they hand me a form that asks a few basic questions, I check the boxes, and that gives them a rough idea of when to pull the plug. However, I have both a living will and a medical power of attorney. So I don’t check the form, I just give them a copy of those documents.
Bottom line: This bill requires that certain standard areas be covered in a consultation if and only if the State the patient and practitioner are in has established a standardized program for end of life issues, including forms that are legal without the help of a lawyer. Nowhere does it say that creating your own documents with your own lawyer is not allowed, not legal, or not acceptable.
Of course you didn't address it but what is being missed in all this is that any of the current bills (there are three in the docket) all have implied rationing.
First, that little “Of course”? Kind of ugly. I have very strong convictions about the importance of assuming good will even on the part of those with whom I disagree. I appreciate the same assumption from those who disagree with me.
Substantively, I certainly understand that fears about rationing are well-founded. Once you accept that medical care taking an increasing percent of the GDP is a problem - which I’m not sure I do - and you realize that better treatment means higher costs - which I realize very well - and you realize that older people and sicker people need more care - which I realize very, very well - you’re going to be stuck with rationing as the only way out. Fear of rationing is a perfectly valid reason to oppose this bill and any similar health care bill. It is NOT a perfectly valid reason to misinterpret the bill or - worse yet - to deliberately misstate what’s in the bill.
As for missing the forest for the trees, I did not set out to argue HR 3200 is a good bill. Nor did I say that slippery slope concerns were not valid. What I said was that the claim of mandated, required, compelled end of life counseling was inaccurate.
I short while ago I was reading a blog where an argument was raging over whether Sarah Palin billed rape victims for evidence kits. (Yes, recently. Yes, still.) One of the commenters didn’t seem to think it mattered what the facts were: the story was intended as an emotional truth. I’m apparently one of the few remaining people on the face of the earth who thinks emotional truth is not the same as actual truth and not even within shouting distance of fact. If we all define our own truth based on what “feels” accurate then we really are living in a postmodern world where, as Brad Holland put it:
Postmodernists believe that truth is myth, and myth, truth. This equation has its roots in pop psychology. The same people also believe that emotions are a form of reality. There used to be another name for this state of mind. It used to be called psychosis.
*****
Updated, July 22, 2009, around 6pm: Grim and I had an email exchange about this post and I he has posted a large portion of that exchange at his blog. I think it's an interesting view of this issue and one I would never have thought of. Grim argues that the Right is taking the correct tack rhetorically. Read the whole thing here.
Grim's logic and argument are impeccable as always and all I can offer by way of rebuttal is this (also from our email exchange):
The only point I can bring up that may mean you're wrong about the Right being right to pursue this tactic is the asymmetrical force levels. If it is the case that most of the media is heavily tilted in favor of Obama, in favor of the Democrats, and in favor of this bill (or one similar to it), it will be difficult for the Right to be heard making these charges and it will be easy for the Democrats (with the assistance of the media) to cast those charges as the deranged ravings of Rove-Cheney type politicians who will tell any kind of lie to get their own way. Imagine if the Right had attempted to do to Obama what was done to Palin: spin fantastic tales out of half-truths at best, thin air at worst. They would never have gotten traction. We'll see if they can get traction on the health care bill.
Wednesday, July 15, 2009
Salons and solons
On July 2, Politico broke the story on the Washington Post’s plan to sell seats at their own form of dinner theater:
I like the word “even” there at the end, as if somehow WaPo selling access to its own employees is more remarkable than it selling access to government officials. Yet much of the commentary I’ve read does focus on how terrible it is for the paper to apparently sell access to its staff. The story came to light because a lobbyist who was solicited for the events “felt it was a conflict for the paper to charge for access to ... its ‘health care reporting and editorial staff.’" Along the same lines, a Howard Kurtz article in WaPo itself reports:
An article by the Post’s ombudsman quotes Katharine Weymouth, Post publisher and hostess of the salons as saying:
Certainly the idea that a newspaper might be willing to sell its reporting to a series of dinner guests is deeply disturbing. But what is far more interesting and disturbing to me is the idea that a newspaper can - for the right price - deliver up members of the Administration and of Congress. Am I the only person upset by this? True, both Kurtz’ article and the ombudsman’s article raise this issue albeit somewhat briefly:
Note however that while both Kurtz and the ombudsman are suggesting it is probably unethical for the Post to promise lobbyists that their money will buy government officials as fellow dinner guests, neither appears to even consider that the Post might not be able to deliver on that promise.
To his credit, Jim Cooper, the Congressman who agreed (perhaps understandably) to attend the first Post salon has said (via a spokesman) that once he understood the nature of the dinner “he would not have attended ‘a radioactive event. . . . You don't want to be put in a position as a congressman where someone's buying access to you.’” Similarly, the White House has denied that any Administration official had agreed to attend any of the salons and has taken this opportunity to remind staffers of the ethics rules under which they work.
All well and good. But unless the Washington Post is suffering from delusions of grandeur - and those outside the Post who are writing about this story share that delusion - the Post would have been able to deliver up public officials to lobbyists willing to pay for them. Call me old-fashioned but that seems at least as wrong as the Post delivering up its own employees for cash on the barrelhead.
I’m almost sorry this story broke before the first salon: it would have been interesting to see which non-paying, non-Post guests would have made an appearance.
Washington Post publisher Katharine Weymouth said today she was canceling plans for an exclusive "salon" at her home where for as much as $250,000, the Post offered lobbyists and association executives off-the-record access to "those powerful few" — Obama administration officials, members of Congress, and even the paper’s own reporters and editors.
I like the word “even” there at the end, as if somehow WaPo selling access to its own employees is more remarkable than it selling access to government officials. Yet much of the commentary I’ve read does focus on how terrible it is for the paper to apparently sell access to its staff. The story came to light because a lobbyist who was solicited for the events “felt it was a conflict for the paper to charge for access to ... its ‘health care reporting and editorial staff.’" Along the same lines, a Howard Kurtz article in WaPo itself reports:
Executive Editor Marcus Brauchli said he was "appalled" by the plan. "It suggests that access to Washington Post journalists was available for purchase," Brauchli said. The proposal "promises we would suspend our usual skeptical questioning because it appears to offer, in exchange for sponsorships, the good name of The Washington Post."
An article by the Post’s ombudsman quotes Katharine Weymouth, Post publisher and hostess of the salons as saying:
Sponsorship of events, like advertising in the newspaper, must be at arm's length and cannot imply control over the content or access to our journalists.
Certainly the idea that a newspaper might be willing to sell its reporting to a series of dinner guests is deeply disturbing. But what is far more interesting and disturbing to me is the idea that a newspaper can - for the right price - deliver up members of the Administration and of Congress. Am I the only person upset by this? True, both Kurtz’ article and the ombudsman’s article raise this issue albeit somewhat briefly:
Even without the newsroom's participation, the aggressively worded pitch conveys the impression that The Post is offering special interests access to administration officials and lawmakers, raising a separate set of concerns about a dubious partnership with those covered by the newspaper. The Post often questions whether corporations, unions and trade associations receive access or favors in return for campaign contributions. [snip]
Tom Fiedler, dean of Boston University's College of Communication, said news organizations should be a neutral broker among differing interests and that "what The Post was looking to do was to make a profit on the role of the convener. . . . The idea of crossing a boundary line that seems to me painted so brightly white, I'm astonished that it got this far."
The problem: The Post often decries those who charge for access to public officials. This raised the specter of a money-losing newspaper doing the same thing -- and charging for access to its own reporters and editors as well.
Note however that while both Kurtz and the ombudsman are suggesting it is probably unethical for the Post to promise lobbyists that their money will buy government officials as fellow dinner guests, neither appears to even consider that the Post might not be able to deliver on that promise.
To his credit, Jim Cooper, the Congressman who agreed (perhaps understandably) to attend the first Post salon has said (via a spokesman) that once he understood the nature of the dinner “he would not have attended ‘a radioactive event. . . . You don't want to be put in a position as a congressman where someone's buying access to you.’” Similarly, the White House has denied that any Administration official had agreed to attend any of the salons and has taken this opportunity to remind staffers of the ethics rules under which they work.
All well and good. But unless the Washington Post is suffering from delusions of grandeur - and those outside the Post who are writing about this story share that delusion - the Post would have been able to deliver up public officials to lobbyists willing to pay for them. Call me old-fashioned but that seems at least as wrong as the Post delivering up its own employees for cash on the barrelhead.
I’m almost sorry this story broke before the first salon: it would have been interesting to see which non-paying, non-Post guests would have made an appearance.
Sunday, July 12, 2009
The birth of a lie
[Update at the bottom of the post.]
I often find myself wondering where some of the lies about Sarah Palin come from. I’m in the middle of tracking down where the rape kit slur started and how it grew but I think we’re seeing the birth of a new lie right now:
A brief background: Palin’s last term as Mayor of Wasilla would have ended October 7, 2002. Wasilla elections are held the first Tuesday in October; in 2002, this would have been October 1. The mayor takes office the following Monday; in 2002, this would have been October 7. So the story is that Palin did not remain in office until her successor, Dianne Keller, took over on October 7, 2002. This is a lie.
The earliest statement of this I’ve found so far was in a comment on Wonkette, posted by Alaska Girl on July 4, at 1:26am:
Wonkette promptly promoted it to “Comment of the Day”. By July 6, this lie had shown up at Celtic Diva as a post (which said it was “absolutely correct”) and at an Atlantic blog as a comment (this is where I first saw it).
By July 7, Paul Begala had a commentary up at CNN in which he says:
The Begala article has been reproduced far and wide: searching for keywords from his article returns 529 hits in Google. Today, July 12, I heard Nina Totenberg repeat this lie on Inside Washington, a show which was apparently taped on July 10. (The transcript is not yet up; the video is accessible here. I cannot access it - no Microsoft viewer - but Totenberg’s comment came near the end of the show.)
As far as I know, Palin stepped down as councilwoman after she was elected mayor: running for a higher office while already holding office is a very common practice. I believe our current President did that himself recently. There is no evidence she resigned her position on the Alaska Oil and Gas Conservation Commission to run for Governor: she resigned in 2004 and was elected Governor in 2006. Clearly she has resigned as Governor. However.
Sarah Palin did not quit her job as mayor of Wasilla to run for Lieutenant Governor.
Palin ran in the Republican Primary for Lieutenant Governor in 2002, lost, and finished her last term as Mayor (term limits prevented her from running for a third term). Even if she had won the primary and gone on to win the Lieutenant Governorship, she would have been able to finish her term as mayor which ended in October of 2002 before being sworn in as Lieutenant Governor in December of 2002.
Determining that Sarah Palin did not leave early as Mayor of Wasilla simply took a search of the Anchorage Daily News. Behind the fee-to-read wall are 5 articles about the 2002 Wasilla mayoral race. One, dated October 1, 2002, is about the process of counting the votes. Three others are virtually identical (emphasis mine):
The fifth article begins this way:
This is not rocket science; it’s basic due diligence. One of the most amazing things about the Sarah Palin phenomenon has been how eager those who oppose her are to believe virtually anything without making the slightest effort at verification. Apparently Mark Twain was correct:
*****
Update, July 13, 2009, 11:15am: I’ve now paid to read the Anchorage Daily News articles behind the fee-to-read wall and they make it clear Sarah Palin was mayor when Dianne Keller took office on October 7, 2002. I’ve also found an article in the Mat-Su Valley Frontiersman that begins:
The date of the article is September 30, 2002.
Odd that it is this little lie that puzzles me most, that angers me most. Perhaps it is because it is such a pointless lie: the election is over, the other guys won. It serves no rational purpose. It is simply a cruel and dehumanized vandalism:
I often find myself wondering where some of the lies about Sarah Palin come from. I’m in the middle of tracking down where the rape kit slur started and how it grew but I think we’re seeing the birth of a new lie right now:
Sarah Palin quit as mayor of Wasilla before finishing her second term.
A brief background: Palin’s last term as Mayor of Wasilla would have ended October 7, 2002. Wasilla elections are held the first Tuesday in October; in 2002, this would have been October 1. The mayor takes office the following Monday; in 2002, this would have been October 7. So the story is that Palin did not remain in office until her successor, Dianne Keller, took over on October 7, 2002. This is a lie.
The earliest statement of this I’ve found so far was in a comment on Wonkette, posted by Alaska Girl on July 4, at 1:26am:
She didn’t finish her term as mayor, stepping down to run for Lt. Governor.
Wonkette promptly promoted it to “Comment of the Day”. By July 6, this lie had shown up at Celtic Diva as a post (which said it was “absolutely correct”) and at an Atlantic blog as a comment (this is where I first saw it).
By July 7, Paul Begala had a commentary up at CNN in which he says:
The speculation is that, rather than returning to being a private citizen, Palin aspires to the presidency. Good luck. She quit her job as city councilwoman to run for mayor of Wasilla. She quit her job as mayor of Wasilla to run for lieutenant governor. She quit her job as the head of the Alaska Oil and Gas Conservation Commission to run for governor. And now she's quitting her job as governor to ... be a private citizen? Right.
The Begala article has been reproduced far and wide: searching for keywords from his article returns 529 hits in Google. Today, July 12, I heard Nina Totenberg repeat this lie on Inside Washington, a show which was apparently taped on July 10. (The transcript is not yet up; the video is accessible here. I cannot access it - no Microsoft viewer - but Totenberg’s comment came near the end of the show.)
As far as I know, Palin stepped down as councilwoman after she was elected mayor: running for a higher office while already holding office is a very common practice. I believe our current President did that himself recently. There is no evidence she resigned her position on the Alaska Oil and Gas Conservation Commission to run for Governor: she resigned in 2004 and was elected Governor in 2006. Clearly she has resigned as Governor. However.
Sarah Palin did not quit her job as mayor of Wasilla to run for Lieutenant Governor.
Palin ran in the Republican Primary for Lieutenant Governor in 2002, lost, and finished her last term as Mayor (term limits prevented her from running for a third term). Even if she had won the primary and gone on to win the Lieutenant Governorship, she would have been able to finish her term as mayor which ended in October of 2002 before being sworn in as Lieutenant Governor in December of 2002.
Determining that Sarah Palin did not leave early as Mayor of Wasilla simply took a search of the Anchorage Daily News. Behind the fee-to-read wall are 5 articles about the 2002 Wasilla mayoral race. One, dated October 1, 2002, is about the process of counting the votes. Three others are virtually identical (emphasis mine):
Author: S.J. Komarnitsky
Anchorage Daily News
Staff
Date: October 2, 2002
Publication: Anchorage Daily News (AK)
Page: A1
Word count: 578
Wasilla chose a city council member as its new mayor Tuesday, while Matanuska-Susitna Borough residents filled two positions on the Assembly.
The races were among a string of city and boroughwide contests in Mat-Su.
In Wasilla, Dianne Keller will take over the city's top job from outgoing Mayor Sarah Palin, who could not run again because of term limits. Keller beat three other candidates, including Palin's stepmother-in-law, Faye Palin, to take the [Read article (fee)]
The fifth article begins this way:
LETTERS
Author: Commentary
Date: October 7, 2002
Publication: Anchorage Daily News (AK)
Page: B3
Word count: 348
Thank you, Wasilla, for allowing me to be your mayor. I have cherished this time of serving you and now look forward to working with our new mayor as Dianne Keller helps guide Alaska's fastest-growing community.
Best wishes to the Keller administration. I am confident we'll see invigorated, courageous leadership in pursuit of a larger vision for our community. The Valley is on the cusp of reaching so much potential. We can reach it with the perseverance of residents [Read article (fee)]
This is not rocket science; it’s basic due diligence. One of the most amazing things about the Sarah Palin phenomenon has been how eager those who oppose her are to believe virtually anything without making the slightest effort at verification. Apparently Mark Twain was correct:
A lie can travel halfway around the world while the truth is still putting on its shoes.
*****
Update, July 13, 2009, 11:15am: I’ve now paid to read the Anchorage Daily News articles behind the fee-to-read wall and they make it clear Sarah Palin was mayor when Dianne Keller took office on October 7, 2002. I’ve also found an article in the Mat-Su Valley Frontiersman that begins:
When Wasilla Mayor Sarah Palin dismissed deputy administrator John Cramer last month she said that Cramer was let go so the next administration could have a smooth transition when the next mayor takes control after Tuesday's election.
The date of the article is September 30, 2002.
Odd that it is this little lie that puzzles me most, that angers me most. Perhaps it is because it is such a pointless lie: the election is over, the other guys won. It serves no rational purpose. It is simply a cruel and dehumanized vandalism:
Good name in man and woman, dear my lord,
Is the immediate jewel of their souls.
Who steals my purse steals trash; 'tis something, nothing;
'Twas mine, 'tis his, and has been slave to thousands;
But he that filches from me my good name
Robs me of that which not enriches him,
And makes me poor indeed.
Tuesday, July 7, 2009
A Fish in the Kool-Aid
When I wrote my recent post on Sarah Palin’s resignation speech, I believed I was one of the few people in the world to whom her speech made sense. Today I ran across a post by Stanley Fish at the New York Times. Fish seems to agree with me and thinks the confusion on the part of the pundits is about their limitations rather than Palin’s lack of clarity:
Read the whole thing.
Fish also thinks the rambling nature of her speech was a feature, not a bug: the very fact that Palin clearly wrote it herself emphasizes that it was not a calculated political move. Form followed function, in other words. Perhaps he’s right and my wish that she’d had a good wordsmith tighten it up was off-base. I suspect when you’re Sarah Palin, it doesn’t matter how carefully you speak, how tightly you script, how many red pencils edit and re-edit your words: most people - and almost all pundits - are going to hear what they expect to hear. Very few are going to hear what is actually said.
It is true that her statement was not constructed in a straightforward, logical manner, but the main theme was sounded often and plainly: This is not what I signed up for. I’m spending all my time and the state’s money responding to attack after attack and they aren’t going to let up because, “It doesn’t cost the people who make these silly accusations a dime.” [snip] And in the end she earned the declaration that “I have given my reasons plainly and candidly.”
But the pundits didn’t want to hear them or, rather, they were committed to believing that the real reasons lay elsewhere, and were strategic. They couldn’t fathom the possibility that she was just giving voice to her feelings. It must, they assumed, be a calculation, and having decided that, they happily went on to describe how bad a calculation it was.
Read the whole thing.
Fish also thinks the rambling nature of her speech was a feature, not a bug: the very fact that Palin clearly wrote it herself emphasizes that it was not a calculated political move. Form followed function, in other words. Perhaps he’s right and my wish that she’d had a good wordsmith tighten it up was off-base. I suspect when you’re Sarah Palin, it doesn’t matter how carefully you speak, how tightly you script, how many red pencils edit and re-edit your words: most people - and almost all pundits - are going to hear what they expect to hear. Very few are going to hear what is actually said.
Monday, July 6, 2009
Redefinition
John McCain delivered the weekly Republican address (I didn’t even realize there was one) on the Fourth of July. Reading his words, I really, really wish he was President. I know Obama is nuanced and careful and so on and so forth but I sincerely believe there are times when and issues about which the United States simply has to take a stand. McCain’s words on Iran take that stand and I appreciate them.
Another part of his address caught my attention also:
This echoes something I have long believed. The United States as we know it began with the utterance of the words:
When this was written, the “men” who were created equal were a select group: wealthy, white, and literally men. The history of the United States has been the slow but steady redefinition of the word “men” to include those who are not wealthy, those who are not white, and those who are not male. To, in other words, make “all” the reality.
Those who founded this country did not believe they were forming an absolutely perfect Union, simply one more perfect than before. It is easy to point out their faults and flaws, their weaknesses and failures. But they did the best they could in their time and that was far, far better than anyone had done before or has done since. Their wisdom and their courage gave us a country, a Constitution, and a set of ideals that have allowed us, down through all these years, to make our Union more perfect still. For that I am deeply grateful.
Here’s to the next 233 years.
Another part of his address caught my attention also:
The signers put their names and ransomed their lives to a universal, not just a national ideal; that all human beings everywhere, not just Americans, not just the mostly well-off white men gathered in Philadelphia for the occasion, 'are created equal, and endowed by their Creator with certain unalienable rights; among these are life, liberty and the pursuit of happiness.'
We've not always been true to that ideal, and the rights guaranteed by our Constitution. Slavery, Jim Crow, the disenfranchisement of women were betrayals of the principles enshrined in our founding documents, and had to be conquered before we could claim without qualification to be firmly on the right side of history. But we overcame our faults, corrected our mistakes and in the unfinished story of our Republic, we continue our progress toward 'a more perfect union.' And, in the struggle to do so, we have achieved greatness.
This echoes something I have long believed. The United States as we know it began with the utterance of the words:
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
When this was written, the “men” who were created equal were a select group: wealthy, white, and literally men. The history of the United States has been the slow but steady redefinition of the word “men” to include those who are not wealthy, those who are not white, and those who are not male. To, in other words, make “all” the reality.
Those who founded this country did not believe they were forming an absolutely perfect Union, simply one more perfect than before. It is easy to point out their faults and flaws, their weaknesses and failures. But they did the best they could in their time and that was far, far better than anyone had done before or has done since. Their wisdom and their courage gave us a country, a Constitution, and a set of ideals that have allowed us, down through all these years, to make our Union more perfect still. For that I am deeply grateful.
Here’s to the next 233 years.
Sunday, July 5, 2009
Palin Kool-Aid
Apparently the cheap pink wine I tried for the first time Thursday night was actually Kool-Aid: Sarah Palin’s resignation speech makes sense to me. Of course, I read the whole thing. A lot of people who have written about it seem to have heard or read only the part that begins:
By that point, you’ve already missed over a third of her speech and, more importantly, you’ve missed her primary argument for not running for re-election and for resigning. Here’s how I see it.
Palin’s speech begins with what sounds like a pretty standard political introduction - she’s proud of Alaska, it means the world to her, she’s humbled by the chance to serve. This introduction, however, presages her main point: Alaska is an important state, Alaskans need to understand that fact, Alaska has responsibilities to the United States as a whole.
Then Palin begins the meat of her argument: her Administration is doing well. She expands on that theme with a list of accomplishments. I believe it’s important and telling that most of her list is understandable only to Alaskans. A petroleum integrity office; Point Thomson; AGIA; ACES; the dairy business; her education initiatives; filling public safety positions; the new prison; even the Supreme Court decisions in Alaska’s favor: none of these are comprehensible to a national audience. She does get in the usual suspects - holding the line on government growth; opposing special interests on wildlife management; rejecting some stimulus money; cutting back on office perqs; turning down pay raises; the liberalism of the Ninth Circuit - but the bulk of her accomplishments are Alaska specific.
Then she reaches the linchpin of her speech:
That’s her whole point right there: she has become a distraction, she stands between what Alaska is accomplishing and the media’s reporting of those accomplishments.
It’s here that she begins the part of the speech most people seem to have read or heard - or at least the part most people are talking and writing about:
She does so by detailing the impact the continuing “digging for dirt” has taken on Alaska’s time and money and on her own finances.
Palin then begins talking about choices and her speech becomes less straight line. Boiled down: she decided running for re-election was unproductive for her and for Alaskans; that she would be wasting her time and energy - and the State’s time and money - by re-upping for another term where she would simply spend herself fighting more of the same.
Palin now goes off on a tangent. The same logic - the desire not to waste her time and energy and the State’s time and money - would lead smoothly into her decision to resign. Instead, she wanders off into lame-duck land. I don’t know where that stupid duck came from. Maybe someone suggested to her that she should not run for re-election, collect her paycheck, and use gubernatorial junkets to raise her political profile and she was so horrified by the idea that she needed to rant about it. Maybe she was thinking about Mark Sanford - a lame-duck with a serious junket problem. Maybe she was just trying to up her cred as a maverick. Wherever that crippled “small aquatic bird of the family anatidae” came from, I wish it had stayed there.
At any rate, she staggers through lame-duck land then gets back on the logic train when she says:
Her point-guard analogy comes here - I think it’s a good one - and then a little more of the logic train and a segue to the kids with:
Then comes the paragraph that has some pundits claiming - incorrectly - that she’s quitting because “they’re being mean to her children”, especially Trig:
What she actually said was that she thinks the child who was so emphatic about wanting her out of the Governor’s office was so because all the children were upset by the cracks about Trig. All Palin says about herself and Trig is that she wishes people could see how much Trig has to offer.
Then Palin talks about visiting the troops and how they have chosen to serve a cause greater than themselves and to “build up”. She loads the troops aboard that logic train of not wasting time and resources:
Wrapping up, Palin provides a summary:
She then says she hopes her story won’t discourage other Alaskans from entering politics; revisits the point guard metaphor briefly; reiterates her belief in Alaska’s importance; says her successor is capable and she’ll help with the transition; and winds up with a nice quote (apparently, sadly, attributed to the wrong person).
So the speech makes sense. Stripped down to bare bones, she decided not to run for re-election because her notoriety is overshadowing everything her Administration is accomplishing and everything her State has to offer. Once she decided not to run for re-election, there was no point to staying in office where her notoriety would continue to overshadow everything her Administration is accomplishing and everything her State has to offer. She’s leaving office, the jackals will follow her, and her successor and her State can get on with their lives in peace and quiet.
Is there more to it than that? Almost certainly. If nothing else, I’m sure Palin realized that once she announced she wasn’t running for re-election she would be not merely a lame duck but a dead one. The constant ethics complaints and constant media blitz had already compromised her ability to do her job. Combine that with the natural loss of influence experienced by any executive who will be gone on a known date and she would be even less able to get anything done. That would be bad for Alaska and would probably drive Palin crazy.
Do I wish the speech was better organized? You betcha. Palin desperately needs a speech writer. Not to make her say things she wouldn’t but to help her make her points more clearly. I read once that a good speech consists of the following: tell ‘em what you’re gonna tell ‘em; tell ‘em; tell ‘em what you told ‘em. I can see the vague outline of those elements in Palin’s speech but with about 15 minutes input from a good wordsmith it could have been tightened up and clarified a lot. Palin gives a speech as if she’s talking to you in her living room and there’s a lot of power and charisma in that approach. But to convince, to lead, to explain not one-on-one over coffee but one-on-millions over miles requires more focus. She needs someone who can leave her voice alone while organizing her presentation of her thoughts. I thought both her Republican convention speech and her feminism speech were excellent, which tells me she probably doesn’t need to find one particular magic speechwriter, just a good solid professional with the sense to let her be herself only clearer.
I have no idea what Palin is going to do now. (Of course, neither does anyone else - possibly even Palin herself. I’m just willing to admit it.) However, I do have some thoughts on what triggered her decisions to not run for re-election and to resign. She says this has been in the works for a while but “a while” is pretty indefinite. My guess is that the pipeline deal and the media’s indifference to it were the triggering events. That deal is apparently a huge accomplishment for Palin and yet what Palin news was the media covering 24/7 when this deal was reached? The Letterman “jokes”. Similarly, the recent Vanity Fair profile of Sarah Palin could not spare any of its 9800 words to so much as mention the pipeline deal.
Maybe up to this point Palin was able to believe that while her notoriety was a drain on the State’s time and money it would at least mean when something great did happen in Alaska the rest of the world would hear about it. However, when even an accomplishment as significant as the pipeline couldn’t get coverage, I imagine Palin had to accept that nothing good in Alaska would get coverage as long as she was the face of the State. To go back to her basketball analogy, Palin must have realized clearly that no matter how many shots she made, none of them would show up on the scoreboard. Bad for Palin, worse for Alaska.
Whatever triggered the decision, I’m sorry it’s worked out this way. I was hoping Palin could settle back into her job as governor, run for re-election, put in some more solid years in Alaska, then see where she stood. After hearing her speech, I realize that was incredibly unrealistic of me: can you imagine the combination of media circus and feeding frenzy if she’d run for governor again? I can and it gives me the cauld grue. Unfortunately, I think Palin has made the only rational decision possible. I wish her well and look forward to seeing what she does next and what she’s doing 10 years from now.
*****
Reading: There are a million posts about Palin’s resignation all over the place. These are just a few that I found interesting.
Allahpundit and Reclusive Leftist are examples of bloggers who consider her reasoning to begin with the “Some say things changed for me” line in her speech.
The Optimistic Conservative: Someone else who thinks Palin’s speech makes sense - even more so than I do. The author also thinks Palin’s “not politics as usual” message will resonate widely.
Blue Lyon: In the “politics make strange bedfellows” department, a liberal agrees with Optimistic Conservative. Palin is articulate, clear, refreshing, and her statement “will appeal to a whole lot of folks tired of the same old political bullshit.”
Matthew Continetti at The Weekly Standard: I disagree with his emphasis here but his last lines are interesting:
Continetti may be right the Palin-haters aren’t going away but from Yahoo comes the news that the Palin’s attorney is giving fair warning: the Palins are not going to stand by while they’re defamed by “most notably liberal Alaska blogger Shannyn Moore” and “those who re-publish the defamation, such as Huffington Post, MSNBC, the New York Times and The Washington Post.” (From a quick look at her blog archives and her Huffington Post entries, Moore appears to be yet another member of the wildly successful Let’s Put Alaskans Who’ll Trash Sarah Palin To Work Program.)
Runner’s World: The magazine interviewed Palin. It has nothing to do with her resignation but I ran across it somewhere and in it Palin just sounds so incredibly normal. Which ties in with my last link:
Cutting Bait by Mark Steyn: Even though I don’t believe Palin is quitting because “they’re mean to her kids”, I think this is the best Palin resignation article out there.
Some say things changed for me on August 29th last year – the day John McCain tapped me to be his running-mate – I say others changed.
By that point, you’ve already missed over a third of her speech and, more importantly, you’ve missed her primary argument for not running for re-election and for resigning. Here’s how I see it.
Palin’s speech begins with what sounds like a pretty standard political introduction - she’s proud of Alaska, it means the world to her, she’s humbled by the chance to serve. This introduction, however, presages her main point: Alaska is an important state, Alaskans need to understand that fact, Alaska has responsibilities to the United States as a whole.
Then Palin begins the meat of her argument: her Administration is doing well. She expands on that theme with a list of accomplishments. I believe it’s important and telling that most of her list is understandable only to Alaskans. A petroleum integrity office; Point Thomson; AGIA; ACES; the dairy business; her education initiatives; filling public safety positions; the new prison; even the Supreme Court decisions in Alaska’s favor: none of these are comprehensible to a national audience. She does get in the usual suspects - holding the line on government growth; opposing special interests on wildlife management; rejecting some stimulus money; cutting back on office perqs; turning down pay raises; the liberalism of the Ninth Circuit - but the bulk of her accomplishments are Alaska specific.
Then she reaches the linchpin of her speech:
But you don’t hear much of the good stuff in the press anymore, do you?
That’s her whole point right there: she has become a distraction, she stands between what Alaska is accomplishing and the media’s reporting of those accomplishments.
It’s here that she begins the part of the speech most people seem to have read or heard - or at least the part most people are talking and writing about:
Some say things changed for me on August 29th last year – the day John McCain tapped me to be his running-mate – I say others changed.
Let me speak to that for a minute.
She does so by detailing the impact the continuing “digging for dirt” has taken on Alaska’s time and money and on her own finances.
Palin then begins talking about choices and her speech becomes less straight line. Boiled down: she decided running for re-election was unproductive for her and for Alaskans; that she would be wasting her time and energy - and the State’s time and money - by re-upping for another term where she would simply spend herself fighting more of the same.
Palin now goes off on a tangent. The same logic - the desire not to waste her time and energy and the State’s time and money - would lead smoothly into her decision to resign. Instead, she wanders off into lame-duck land. I don’t know where that stupid duck came from. Maybe someone suggested to her that she should not run for re-election, collect her paycheck, and use gubernatorial junkets to raise her political profile and she was so horrified by the idea that she needed to rant about it. Maybe she was thinking about Mark Sanford - a lame-duck with a serious junket problem. Maybe she was just trying to up her cred as a maverick. Wherever that crippled “small aquatic bird of the family anatidae” came from, I wish it had stayed there.
At any rate, she staggers through lame-duck land then gets back on the logic train when she says:
My choice is to take a stand and effect change – not hit our heads against the wall and watch valuable state time and money, millions of your dollars, go down the drain in this new environment.
Her point-guard analogy comes here - I think it’s a good one - and then a little more of the logic train and a segue to the kids with:
Some Alaskans don’t mind wasting public dollars and state time. I do. I cannot stand here as your Governor and allow millions upon millions of our dollars go to waste just so I can hold the title of Governor. And my children won’t allow it either.
Then comes the paragraph that has some pundits claiming - incorrectly - that she’s quitting because “they’re being mean to her children”, especially Trig:
In fact, this decision comes after much consideration, and finally polling the most important people in my life - my children (where the count was unanimous... well, in response to asking: "Want me to make a positive difference and fight for ALL our children's future from outside the Governor's office?" It was four "yes's" and one "hell yeah!" The "hell yeah" sealed it - and someday I'll talk about the details of that... I think much of it had to do with the kids seeing their baby brother Trig mocked by some pretty mean-spirited adults recently.) Um, by the way, sure wish folks could ever, ever understand that we all could learn so much from someone like Trig - I know he needs me, but I need him even more... what a child can offer to set priorities right – that time is precious... the world needs more "Trigs", not fewer.
What she actually said was that she thinks the child who was so emphatic about wanting her out of the Governor’s office was so because all the children were upset by the cracks about Trig. All Palin says about herself and Trig is that she wishes people could see how much Trig has to offer.
Then Palin talks about visiting the troops and how they have chosen to serve a cause greater than themselves and to “build up”. She loads the troops aboard that logic train of not wasting time and resources:
These Troops and their important missions – those are truly the worthy causes in this world and should be the public priority with time and resources and not this local / superficial wasteful political bloodsport.
Wrapping up, Palin provides a summary:
First things first: as Governor, I love my job and I love Alaska. It hurts to make this choice but I am doing what’s best for Alaska. I’ve explained why… though I think of the saying on my parents’ refrigerator that says “Don’t explain: your friends don’t need it and your enemies won’t believe you anyway.”
But I have given my reasons… no more “politics as usual” and I am taking my fight for what’s right – for Alaska – in a new direction.
She then says she hopes her story won’t discourage other Alaskans from entering politics; revisits the point guard metaphor briefly; reiterates her belief in Alaska’s importance; says her successor is capable and she’ll help with the transition; and winds up with a nice quote (apparently, sadly, attributed to the wrong person).
So the speech makes sense. Stripped down to bare bones, she decided not to run for re-election because her notoriety is overshadowing everything her Administration is accomplishing and everything her State has to offer. Once she decided not to run for re-election, there was no point to staying in office where her notoriety would continue to overshadow everything her Administration is accomplishing and everything her State has to offer. She’s leaving office, the jackals will follow her, and her successor and her State can get on with their lives in peace and quiet.
Is there more to it than that? Almost certainly. If nothing else, I’m sure Palin realized that once she announced she wasn’t running for re-election she would be not merely a lame duck but a dead one. The constant ethics complaints and constant media blitz had already compromised her ability to do her job. Combine that with the natural loss of influence experienced by any executive who will be gone on a known date and she would be even less able to get anything done. That would be bad for Alaska and would probably drive Palin crazy.
Do I wish the speech was better organized? You betcha. Palin desperately needs a speech writer. Not to make her say things she wouldn’t but to help her make her points more clearly. I read once that a good speech consists of the following: tell ‘em what you’re gonna tell ‘em; tell ‘em; tell ‘em what you told ‘em. I can see the vague outline of those elements in Palin’s speech but with about 15 minutes input from a good wordsmith it could have been tightened up and clarified a lot. Palin gives a speech as if she’s talking to you in her living room and there’s a lot of power and charisma in that approach. But to convince, to lead, to explain not one-on-one over coffee but one-on-millions over miles requires more focus. She needs someone who can leave her voice alone while organizing her presentation of her thoughts. I thought both her Republican convention speech and her feminism speech were excellent, which tells me she probably doesn’t need to find one particular magic speechwriter, just a good solid professional with the sense to let her be herself only clearer.
I have no idea what Palin is going to do now. (Of course, neither does anyone else - possibly even Palin herself. I’m just willing to admit it.) However, I do have some thoughts on what triggered her decisions to not run for re-election and to resign. She says this has been in the works for a while but “a while” is pretty indefinite. My guess is that the pipeline deal and the media’s indifference to it were the triggering events. That deal is apparently a huge accomplishment for Palin and yet what Palin news was the media covering 24/7 when this deal was reached? The Letterman “jokes”. Similarly, the recent Vanity Fair profile of Sarah Palin could not spare any of its 9800 words to so much as mention the pipeline deal.
Maybe up to this point Palin was able to believe that while her notoriety was a drain on the State’s time and money it would at least mean when something great did happen in Alaska the rest of the world would hear about it. However, when even an accomplishment as significant as the pipeline couldn’t get coverage, I imagine Palin had to accept that nothing good in Alaska would get coverage as long as she was the face of the State. To go back to her basketball analogy, Palin must have realized clearly that no matter how many shots she made, none of them would show up on the scoreboard. Bad for Palin, worse for Alaska.
Whatever triggered the decision, I’m sorry it’s worked out this way. I was hoping Palin could settle back into her job as governor, run for re-election, put in some more solid years in Alaska, then see where she stood. After hearing her speech, I realize that was incredibly unrealistic of me: can you imagine the combination of media circus and feeding frenzy if she’d run for governor again? I can and it gives me the cauld grue. Unfortunately, I think Palin has made the only rational decision possible. I wish her well and look forward to seeing what she does next and what she’s doing 10 years from now.
*****
Reading: There are a million posts about Palin’s resignation all over the place. These are just a few that I found interesting.
Allahpundit and Reclusive Leftist are examples of bloggers who consider her reasoning to begin with the “Some say things changed for me” line in her speech.
The Optimistic Conservative: Someone else who thinks Palin’s speech makes sense - even more so than I do. The author also thinks Palin’s “not politics as usual” message will resonate widely.
Blue Lyon: In the “politics make strange bedfellows” department, a liberal agrees with Optimistic Conservative. Palin is articulate, clear, refreshing, and her statement “will appeal to a whole lot of folks tired of the same old political bullshit.”
Matthew Continetti at The Weekly Standard: I disagree with his emphasis here but his last lines are interesting:
But Palin may also be thinking that her retirement from office will cause her critics to stop attacking her. She would be wrong to think so. Neither Palin nor the Palin-haters are going away.
Continetti may be right the Palin-haters aren’t going away but from Yahoo comes the news that the Palin’s attorney is giving fair warning: the Palins are not going to stand by while they’re defamed by “most notably liberal Alaska blogger Shannyn Moore” and “those who re-publish the defamation, such as Huffington Post, MSNBC, the New York Times and The Washington Post.” (From a quick look at her blog archives and her Huffington Post entries, Moore appears to be yet another member of the wildly successful Let’s Put Alaskans Who’ll Trash Sarah Palin To Work Program.)
Runner’s World: The magazine interviewed Palin. It has nothing to do with her resignation but I ran across it somewhere and in it Palin just sounds so incredibly normal. Which ties in with my last link:
Cutting Bait by Mark Steyn: Even though I don’t believe Palin is quitting because “they’re mean to her kids”, I think this is the best Palin resignation article out there.
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