Democrats have a survey too — they just don't call it a Census

In the interest of fair-and-balanced commentary in this space, we want to report receipt of an Official Document from the Democrats. This one, unlike that decidedly suspect missile from the Republicans last week, does not advertise itself as an Official Census Document and does not raise the fear level to code red. It advertises itself as a 2010 Priority Issues Survey, which, in fact, it is.

The envelope, though, does bear the admonition: Do Not Tamper. We wonder who’s been tampering with Democratic issues, other than the hapless invaders of Louisiana Senator Mary Landrieu’s office. We’re not even sure how one can Tamper with an Official Document.

Nevertheless. Because the Democratic Party Headquarters bothered to send a fairly straightforward questionnaire, with a minimum of weighted sentences, below are listed a few considered responses to this “opportunity to help shape Democratic priorities and build a brighter future for America.” You are invited to send your own answers to www.dccc.org, even if you lack an Official Survey Registration number, and we’ll see who’s paying attention. One citizen’s response:

Yes, I believe waterboarding is torture and the U.S. has a moral responsibility to not engage in or condone any form of torture.

Yes, every American should be guaranteed access to affordable, quality health care.

No, I don’t support privatization of Social Security, but Yes, the Medicare prescription benefit plan should be reformed so the government can negotiate lower drug prices with big pharmaceutical companies. (Good luck with that, government.)

Yes, the federal government would do well to provide more assistance to Americans who want to continue their education beyond high school. Cutting student loan interest rates, increasing college tuition tax deductions, increasing Pell grants – all sound good to me.

Weighted question next: How concerned are you about the environmental damage resulting from last-minute Bush Administration maneuvers to weaken laws like the Clean Air Act, Clean Water Act and Endangered Species Act. Well, since I happen to agree, pretty darned concerned.

Slightly different phraseology question: How serious a threat is global warming? Thanks for not asking, as the Republicans did, if I believe it’s real. I’ll go with Very Serious.

That’s about it for the Democrats. They do also provide a postage-paid envelope, and they also invite your contribution.

If the Independents have an Official Survey going, it will be duly reported in this space.

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.

Figuring out Joe Lieberman

New York Times columnist Gail Collins offers a few choice answers to today’s most pressing question: ‘What is it with Joe Lieberman?’

Lieberman’s apparently successful attempt to hijack health care reform and hold it hostage until it had been amended into something that liberals couldn’t stomach has mesmerized the nation’s political class. This was, after all, a guy who has been a liberal on domestic issues since he was a college student campaigning for John F. Kennedy. A guy who was in favor of the public option, of expanding Medicare eligibility, until — last week.

The theories about Why Joe Is Doing It abound. We cannot get enough of them! I have decided to start a rumor that it all goes back to the 2004 presidential race, when Lieberman not only failed to win any primaries, but was also bitten by either a rabid muskrat or a vampire disguised as a moose.

Other than that, my favorite explanation comes from Jonathan Chait of The New Republic, who theorized that Lieberman was able to go from Guy Who Wants to Expand Medicare to Guy Who Would Rather Kill Health Care Than Expand Medicare because he ‘isn’t actually all that smart.’

It’s certainly easier to leap from one position to its total opposite if you never understood your original stance in the first place, and I am thinking Chait’s theory could get some traction. ‘When I sat next to him in the State Senate, he always surprised me by how little he’d learned about the bill at the time of the vote,’ said Bill Curry, a former Connecticut comptroller and Democratic gubernatorial nominee.

Collins favors the not-that-bright theory (‘in part because it’s as good an explanation as any, and in part because it will definitely drive Lieberman nuts’), but she provides greater insight by drawing the comparison between the records of failed national candidates Al Gore and John Kerry, who moved on to useful pursuits, and those of John McCain and Joe Lieberman who are ‘work(ing) out barely suppressed rage by attacking things (they) used to be for.’

Maybe the difference comes from self-image. Lieberman and McCain both thought of themselves as ‘character’ candidates whose success was due to the love and trust of the public, and whose ultimate failure was the work of evil forces beyond their control. Kerry and Gore never believed their success was due to their innate likability. When they lost the presidency, a part of them probably shrugged and remembered that they weren’t all that popular in prep school, either.

Politicians switch direction all the time, but the Lieberman experience has been weird because he doesn’t seem to feel as though he’s changed. He bounds around happily, doing the talk shows, confident that he’s the same independent-minded independent who believes in independence as always. Observers who have known him for a long time feel as though they’re living out a scene in a science-fiction movie when the guy who’s just been bitten by the vampire-moose comes home and sits down to dinner, unaware that he’s sprouting antlers.

I used to cover Lieberman when he was the majority leader of the State Senate in Connecticut. We got along very well, except for one interview, during which he talked about working for J.F.K., and how he kept a Mass card from Robert Kennedy’s funeral to remind him of the principles to which he had dedicated his career. Showing me the card, he remarked casually that he hadn’t looked at it for some time.

I wrote an article using the neglected Kennedy card as a metaphor for Lieberman’s fall from his old ideals into the pragmatic politics of a party leader. He was outraged and wounded, and I believe I apologized.

Collins is now taking back that apology. I think it is Joe Lieberman who needs to apologize to the American people. We voted for health reform, we’ve watched the key parts get tossed for the likes of those insurance folks who so strongly support him, and now we’re feeling a little helpless as he enjoys his position of fame and glory and power.

Lieberman may not be that smart, and he’s certainly not wise. Unfortunately, he is shrewd.

Op-Ed Columnist – Sorry, Senator Kerry – NYTimes.com.

Doctors oppose abortion cuts in health bill

The San Francisco Medical Society has come out in opposition to removal of abortion coverage in the health reform bill, pointing out the potential danger to women’s lives if they are denied access to such care. Charles Wibbelsman, MD, President of SFMS, writes in today’s San Francisco Chronicle that the board of directors will urge congressional representatives to find a compromise.

It is a shame that such a complex issue as health care reform has been hijacked in the form of the Stupak amendment, which would ban all public funding for abortion (“Amendment to House bill reignites abortion debate,” Nov. 10).

Experience has shown that denying coverage of abortion does not stop or even curtail it, but rather shifts the costs elsewhere, and threatens to delay a woman in seeking and obtaining this medical procedure, thus potentially endangering her.

The San Francisco Medical Society’s board of directors has voted to urge our elected officials, particularly Sens. Dianne Feinstein and Barbara Boxer, to find a compromise that will not ban such funding and keep women with unwanted pregnancies safe.

Women’s lives should not be held hostage to politics.

At last, a ray of sanity from the medical community. I, for one, am proud of SFMS for standing up for the uncounted thousands of women, most of them poor and disadvantaged, who will suffer harm from denial of access to care should the conservatives and the U.S. Conference of Catholic Bishops win the day on this matter.

via Stupak amendment hijacks health care reform.

Abortion, health reform and me: who is making our choices?

Am I the only person around who is squirming — make that fuming a little — over the concessions made to the anti-choice guys before the House passed its health reform bill? Does no one else find it offensive to turn from reading on page one of today’s New York Times about this sad state of events to page 14 for a large photo of President Obama shaking hands with Cardinal Sean O’Malley? They were meeting at the funeral for Senator Ted Kennedy in August, where reportedly the good clergyman told the president that the Congress of Catholic Bishops really wanted to support health reform ——– oh, but only if everybody caved to their wishes that abortion remain unavailable.

It is not as if we weren’t forewarned. I posted a brief note in this space a few days ago (see Abortion Foes Winning Health Concessions, 11/4, below) and tried to resume a position of calm.

It is hard to remain calm. Somewhere the lines about separation of church and state have to fuzz themselves back into reality. I believe in the right of the U.S. Congress of Catholic Bishops to tell Catholics how to behave (despite the fact that of my many Catholic friends I know almost none who pay any attention in matters of personal choice.) I even believe in the right of the Pope to tell the Bishops to tell their parishioners how to behave. I even believe in the responsibility of all individuals, including my Presbyterian self, to behave according to their conscience and their faith. I just hate being governed by someone else’s faith.

This is not a small distinction. My own church, admittedly starting with a small group here in woo-woo San Francisco, passed a fairly strong national resolution denouncing our country’s torturing folks and seeking justice. As far as I know, no one threatened the president about withholding support for these occasionally immoral wars we keep fighting unless the instigators of torture-in-our-name were sent to jail. However strongly I would like to see the latter happen, I believe there are limits to what faith communities should do.

I had personal experience with back-alley abortion, in the dark days pre-Roe v Wade. It was not pleasant. Is there any way a celibate Catholic bishop could even remotely understand the horrors to which he is condemning poor, desperate pregnant women with the relentless push to make abortion totally unavailable? No. I wish there were.

We still have got to have health reform. But what prices we are paying.

End-of-life counseling stays in health care bill

Here’s a piece of very good news just in from Associated Press reporter Ricardo Alonzo-Zaldivar:

It’s alive. The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to “death panels” for seniors is staying in the latest Democratic health care bill unveiled Thursday. The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

The business of thinking ahead toward end-of-life decisions and making  one’s own wishes known through legal documents such as advance directives has long been encouraged by federal policies. But when coverage for talking things over with one’s doctor was incorporated into health reform it was quickly distorted by Republicans.  Sen.Charles Grassley led the successful campaign to strike it from the Senate bills. But saner heads have prevailed in the House.

“There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,” said Rep. Earl Blumenauer, D-OR. “I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it’s been kept in the bill.” The legislation would allow Medicare to pay for a counseling session with a doctor or clinical professional once every five years. The bill calls for such sessions to be “completely” voluntary, and prohibits the encouragement or promotion of suicide or assisted suicide.

The counseling provision is supported by doctors’ groups and AARP, the seniors’ lobby. It was not included in health care bills passed by two Senate committees.

It’s alive! End-of-life counseling in health bill.