Palin, Pelosi & the politics of scorn

Much ado is being made over two lady politicos these days, Sarah Palin for her six-figure fees and Nancy Pelosi for her legislative expertise. Both are commendable — depending on how one chooses to commend — but unfortunately they are continuing to feed the politics of scorn. Which is unlikely to lead to bi-partisanship or collegiality any time soon. Maybe both are dead.

Palin’s usefulness to her party is a matter of dispute. According to two prominent speakers at a Wednesday breakfast sponsored by the Christian Science Monitor (as reported by Monitor writer Dave Cook), Palin’s rise is great good news for the Democrats.

“Look at this dynamic that is produced with Sarah Palin,” said Stanley Greenberg, chairman of Greenberg Quinlan Rosner Research. “You have John McCain having to have Sarah Palin to save him [in a primary election race]…”

In the aftermath of the passage of healthcare reform, the ongoing discussion is “Barack Obama against Sarah Palin on healthcare,” he said.

Mr. Greenberg, who served as President Clinton’s pollster, argued that “The face of the Republican Party to the country is not the ‘tea party,’ it is Sarah Palin.”

James Carville, President Clinton’s campaign manager and the other speaker at Wednesday’s breakfast, suggested a test to the assembled journalists. “Do me favor. Call five Democratic consultants and leave a message and say I am doing a story on Sarah Palin and call five Republicans, and see who returns the phone call. I think we all know the answer to that. The Democrats will be on the phone so fast.”

Much as some of us do not admire Sarah Palin, the sneer factor employed by her detractors can be oppressive. (Come on, if you’re an anti-Palin, think of the slurs you have slung her way.) She is, herself, a master of derision in a by-golly sort of fashion, and it is this that brings loud huzzahs from her audiences when she takes on the Democrats.

Not to be outdone, Speaker Pelosi (whom I appreciate and respect) was heaping scorn upon the Republicans in speeches to California audiences this week,

… saying they “have nothing to sell” to the American people except a crude caricature of her as the midterm elections approach.

Pelosi, D-San Francisco, was surrounded at the Phillip and Sala Burton Center by ardent advocates of health reform, who cheered when she was cheerful and roared when she was defiant. And she was proudly defiant.

“I couldn’t care less,” she said of GOP efforts to use her as campaign fundraising bait. “I should be thanking them. … It really helps me with my fundraising.”

The issues are real, and occasionally that is made clear:

“This is a bill about the middle class. This is a bill about small businesses. This is a bill about affordability,” Pelosi said.

Still, Pelosi warned Democrats that the fight isn’t over, saying Republicans “are unabashed in wanting to rid us of this … and one way they think they can do it is by making gross misrepresentations to senior citizens” with what she called a “campaign of fear.”

Appearing before a crowd dominated by seniors carrying signs of appreciation – “Thank you, madame speaker” – Pelosi was lauded by a parade of admirers, including Rep. George Miller, D-Martinez, doctors and senior advocates who praised her tireless push for the measure.

Admittedly, Pelosi was in friendly territory this week, as Palin has been in recent days herself.

Palin last weekend put Pelosi and Democratic Senate Majority Leader Harry Reid at the center of her campaign-style speech to Tea Partiers attending a rally in Searchlight, Nev., Reid’s hometown. “You’re fired,” she said of the two Democratic standard-bearers.

This may be the way politics works. But wouldn’t it be nice if occasionally, some way could be found for opposing sides at least to be civil in the interest of the common good.

Defiant Pelosi scorns Republicans.

American rage: We the People, and our legislative leaders, are out of control

On the floor of the U.S. House of Representatives, Rep. Randy Neugebauer (R-TX), angered by Rep. Bart Stupak’s (D-Mich) support of the health reform, called the bill a “baby-killer.” Protesters screamed racial epithets at Reps. John Lewis (D-GA) and Andre Carson (D-Ind) and yelled anti-gay slurs at Representative Barney Frank (D-Mass.) This comes not that long after Rep. Joe Wilson (R-SC) shouted “You lie!” at the President of the United States during a speech to Congress.

Just in case anyone is inclined toward civility, the Rush Limbaughs (“we must defeat these bastards”) and the Glenn Becks (only “losers” need help…) of the world are fanning every little flame around. The rants and rages are not limited to right-wingers, it’s just that those are the most prominent these days, what with congressmen standing on the balcony whipping up the crowd — while anti-anti-reformers shout their own epithets.

All this rage may not be healthy. A recent ‘Personal Journal’ piece in the Wall Street Journal explored the idea that anger is, in many cases, an illness unto itself.

Scream at the boss? Snap at a colleague? Throw your cell phone into your @#$%%&* computer monitor? If so, you may find yourself headed to anger-management classes, which have become an all-purpose antidote for fit-throwing celebrities, chair-throwing coaches, vandals, road ragers, delinquent teens, disruptive airline passengers, and obstreperous employees.

Demand for such programs is coming from courts seeking alternatives to jail sentences and companies hoping to avoid lawsuits and office blowups. Aware that high-pressure jobs can make for hot tempers, some professions offer pre-emptive anger management. A few state bar associations now require “civility” training for lawyers renewing their licenses. And as of last year, hospitals must have programs for “disruptive” physicians as a condition of accreditation.

Programs run the gamut from $300-an-hour private therapists to one-day intensive seminars, weekly group sessions or online courses with no human interaction. Many advertise that they satisfy court requirements—even if all they offer is six CDs and a certificate of completion.

It’s not clear if the programs work, as few studies have analyzed their effectiveness. There are no licensing requirements for anger-management trainers—anyone can open a business. And since participants don’t usually sign up voluntarily, trainers say it’s possible to complete a program without actually changing one’s behavior.

Part of the problem is that professionals can’t agree whether a pattern of angry outbursts signals a mental illness or simply a behavior issue. As a result, people who need psychiatric help may instead get shunted into a short-term anger-management course. Employers and courts may not adequately evaluate people before sending them for anger interventions, nor provide sufficient follow-up.

There have been some notable failures—the Columbine shooters, for example, attended anger-management classes before their 1999 killing spree. Amy Bishop, the University of Alabama biologist who allegedly killed three colleagues and wounded three more last month, had been advised by prosecutors to take anger-management classes after an earlier incident in 2002. Her lawyer says he doesn’t know if she did.

It is hardly the same, but the rage that exploded into these tragedies is still akin to the shouted obscenities of recent political scenes. Maybe all those shouters aren’t mentally ill, just badly behaved. Maybe they are protected by the First Amendment. Maybe the anger and ugliness is, as more than a few defenders maintain, perfectly excusable in response to “totalitarian tactics” or other perceived wrongs. But does that make it right? Or worth the loss of civility?

Maybe a little anger management — and civility — would be a good idea.

Demand for Anger -Management Grows. But Does It Work? – WSJ.com.

Single-payer healthcare in California: Not Dead Yet

“Is there any hope for health care on the national level,” he was asked? “No.”

But Don Bechler, Chair of the California activist group Single Payer Now, was on northern California’s KZYX yesterday affirming that there is still hope for health care “if we get the insurance companies out.” California voters have twice passed single-payer health plans, both times seeing them vetoed by Governor Scwarzenegger. State Senator Mark Leno has a universal-coverage bill in the current legislature to try once more. It’s a bill anybody would love — unless you’re a body working in the insurance business.

As to the national battle, Bechler says HR 676 (sometimes known as the John Conyers bill) is the best current hope. “We haven’t really given up.” Strategies? “Talk to your congressmen, ask them to co-author HR 676. There are 87 co-sponsors so far. It’s health care for everyone, dental coverage, long-term care.” What’s not to love?

Bechler contends that Massachusetts voters who put Scott Brown did not do so out of anti-health care sentiments as has been speculated in media reports. “That’s the corporate media doing their corporate spin for their corporate buddies in the insurance industry.” Lest there be any doubt, Bechler is not much more enthusiastic about the media than about the insurance business.

As to the threat of filibuster of the current bill, which is at least more likely to pass than HR 676, Bechler suggests the Republican bluff be called. “Put it on the floor. Let the Republicans get up and talk for two months.”

Such a prospect is mind-numbing all by itself. But the national outrage might keep everyone awake.

Pelosi keeps public — and her own — options open in San Francisco talk

House Speaker Nancy Pelosi rallied the faithful in San Francisco Saturday afternoon, drawing the loudest applause (there had already been cheers for heavy-hitter Democrats, San Francisco liberal causes and hometown heroine Pelosi herself) with an assertion that passage of the health reform bill will happen soon. She said the House bill is the stronger,  and negotiations to reconcile House and Senate versions into a final bill “are intense.”

Whether that final bill will include the public option her audience of several hundred supporters clearly wanted remains in doubt – and Pelosi was keeping her own options open. “Any bill we approve will have to pass the Triple A test,” she said: “Affordability, specifically for the middle class, Accountability – insurance companies will have to be held accountable; and Accessibility.”

Accessibility, of course, brings the issue back to the public option, which the bill will have, Pelosi maintained, “…or what the public option was intended to do: keep the insurance companies honest.”

The invitation-only Saturday event was billed as a New Year Celebration, and held on the first anniversary of a similar gathering hailing her ascension to Speaker last year.  Both took place at Delancey Street, a residential self-help community founded in 1971 to help substance abusers, ex-felons and “people from America’s underclass” get back on their feet and into productive lives. A few of the 14,000+ who have graduated from Delancey Street programs mingled with the likes of former state senator and current California Democratic Party Chairman John Burton, prominent gay California State Senator Mark Leno, and San Francisco Mayor Gavin Newsom. Almost anyone who is, or aspires to be, anyone in local Democratic politics was working the room.

Pelosi worked it herself, smiling and greeting her way through the crowds for several hours. When she returns to Washington after this weekend at home, the greetings and workings are guaranteed to be a little more fractured.

Goodbye to all that — & hello 2010

It’s hard to mourn the passage of 2009. Jobless friends struggled to survive while our own family income took a dive. Gay friends watched meanness triumph over decency in equality battles. Friends of many stripes lamented choices made by the president we elected with unrealistically high hopes. And my hometown paper this morning lists, among the top stories of the year, teenage gang rape, government insolvency and a bunch of senseless killings.

Other front pages aren’t much different: my second-favorite city winds up the year in the red and worried about the shadow of 9/11 (New York Times.) Murder and assault — specifically assault compounded by injustice — are among today’s concerns in Chicago. And a couple of other former hometown papers lead off the year’s last day with stories of car crashes, shootouts (Atlanta Journal Constitution) and a tragic, child-abandoning, now dead, alcoholic mom (Richmond Times-Dispatch). Plus another doozy about four or five hundred dead animals found in one house — and that happened in Philadelphia.

Optimism, these days, is a full-time job.

But hey. We’re inching toward health reform. Umar’s bomb didn’t go off.  Some of those bad guys (above) went to jail, and a few good guys who’d been jailed as bad guys for a very long time got out of jail thanks to the Innocence Project.  And even if the best we can do for employment optimism is note that the rate of jobs lost is getting smaller — can the country’s jobless find hope in that? — the jobless recovery seems to be happening. Surely jobs will follow.

Plus: even if we don’t like all of his choices and decisions, we have an articulate president who comes across, still, as thoughtful and decent — and doesn’t make you cringe when you see him on TV. There’s hope.

And True/Slant, which you’d never heard of this time last year, is closing in on a million readers.

Happy New Year from the Boomers and Beyond page.

Tzedakah, zakat and good deeds

In the very olden days it was traditional, on December 25, for newspapers in many cities to feature front pages encircled by holly leaves and red ribbons, with banner headlines reading “Merry Christmas” or “Peace on Earth.” Another tradition was to carry, on front pages often filled before and after with stories of tragedy, only good news for this one day.

In consideration of the growing numbers of Americans who don’t celebrate Christmas, it’s probably just as well that the local paper doesn’t herald other people’s tidings for a day — assuming there are still readers of actual local papers out there. But imagine a whole page of good news. What good news that would be.

So it was heartening to wake up to the San Francisco Chronicle‘s December 25 front page: Senate passes health reform. Photos of smiling kids, street musician and revelers in Santa hats. A big sister home from Iraq. And on page 9, a banner that reads: Detroit area’s Mitzvah Day getting a boost from Muslims.

Many Jews consider Christmas Day an opportunity to serve their community while Christian neighbors celebrate their holiday. This year, what’s also known as Mitzvah Day in southeast Michigan is getting an added boost from Muslims.

For the first time, about 40 Muslims are expected to join 900 Jews for what they call their largest annual day of volunteering. Leaders say it’s a small but significant step in defusing tensions and promoting goodwill between the religions – particularly on a day that is sacred to Christianity, the third Abrahamic faith.

Mitzvah Day, a nearly 20-year tradition in the Detroit area also practiced in other communities, is so named because mitzvah means “commandment” in Hebrew and is generally translated as a good deed.

The new partnership stemmed from a recent meeting among members of the Council of Islamic Organizations of Michigan, the Jewish Community Relations Council and the Jewish Federation of Metropolitan Detroit – which said it was unaware of any similar Mitzvah Day alliances.

The Jewish groups organize Mitzvah Day, which consists of volunteers helping 48 local social service agencies with tasks such as feeding the hungry and delivering toys to children in need.

Victor Begg, chairman of the Islamic council, said he was seeking a public way for the two faith communities to “build bridges of understanding and cooperation,” which led to joining the Mitzvah Day effort.

Not only are most Muslims and Jews available to serve on Christmas Day, but leaders also recognized a shared commitment to community service. Charity in Judaism is known as tzedakah. In Islam, it’s called zakat.

In the sun-filled park en route to my San Francisco church this morning I passed a soundly sleeping, presumably homeless man. On one side of him was a plastic bag that appeared to contain most of his worldly goods. On the other was a brown bag such as Sunday School children around town decorate for the annual Pack-a-Sack program through which the Food Bank distributes bag lunches to those in need. It had a crayon drawing of Santa Claus and a reindeer or two.

So once again: Peace on earth, goodwill to all.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/12/25/MNSB1B9FGT.DTL#ixzz0aix6fvXU

The cost of trying to live forever

Why is this not an encouraging word? In a front page article, part of a Months to Live series,  New York Times writer Reed Abelson leads with a glimpse into the Ronald Reagan U.C.L.A. Medical Center, a top-rated academic hospital noted for extensive, aggressive end-of-life care (and very high costs):

‘If you come into this hospital, we’re not going to let you die,’ said Dr. David T. Feinberg, the hospital system’s chief executive.

Feinberg’s commitment to “success” might be admirable, but the statement is patently false; people die at U.C.L.A. Medical Center. This is what people do: we die. Until this culture gets its act together on that subject our health care system — whatever the reform bill eventually looks like — will continue to flounder.

Difficult as it is to talk dollars when you’re talking lives, the issue of cost has to be factored in. There are only so many dollars, and there are countless lives needing care those dollars can buy: infants, children, young adults, boomers, elderly. In each of those care-needing groups, some die.  Feinberg’s philosophy somewhere has to encounter reality.

…that ethos (keep testing, treating, keeping alive no matter what) has made the medical center a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.

That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive.

No one, not the doctors, not the patients, not the best crystal ball reader around can guarantee that this patient will die or that patient will live. If there is a good chance a patient will survive — and it would be nice to add “with a reasonable quality of life” here — everything possible, and affordable, certainly should be done. Abelson’s carefully balanced article details the arguments for going to extraordinary lengths to save lives, as well as the arguments to draw the line on end-of-life expenses.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

So…. to spend that $25,000/$50,000 or not to spend? Unless we the people somehow face the reality that living forever is not a human option, the dilemma will continue.

The benefits of coming to terms with non-optional dying could be huge. We could focus on quality living. On palliative care and hospice care and end-of-life peace and comfort. Advances in palliative care now make it possible for most of us to spend final months at home (or in special hospital rooms), in comfort, surrounded by loved ones; given the choice, would you prefer a few weeks or months in a bright-lit sterile room with a lot of tubes and wires keeping you alive? U.C.L.A. now offers the choice of palliative care. Not everyone in charge, however, is convinced.

Dr. Bruce Ferrell, who helps lead the palliative care program, recalls a patient two years ago who got a liver transplant but developed serious complications afterward and remained in the hospital for a year. “He had never, ever been told that he would have to live with a ventilator and dialysis,” Dr. Ferrell said. “He was never told that this is as good as it’s going to get.”

Dr. Ferrell talked with the patient about whether he might want to leave the intensive-care unit to go home and receive hospice care. But when the surgeon overseeing the case found out, he was furious.

“We do not use the h-word” — hospice — “on my patients,” the surgeon told Dr. Ferrell. “Don’t ever come back.”

The patient chose to leave.

But lately, Dr. Ferrell says, more of the transplant surgeons appreciate the value of what he is trying to do.

“We’re not the bad guys,” he said. “We offer options.”

We the people would do well to quit being the bad guys. To quit behaving as if death were always preventable. We could learn about the options to spending all those thousands of dollars on exhaustive, often futile treatment. We could talk about what we would or would not want for ourselves, write things down, make choices.

If more of us would do that for ourselves, the House and Senate wouldn’t have such a time trying to do it for us.