The way the Fillibuster has been used by the Republicans this year is not what it was intended for. It's being used to stop EVERYTHING; it's mere threat..."/>

REAL WORLD EVENT DISCUSSIONS

Do away with the Fillibuster?

POSTED BY: NIKI2
UPDATED: Thursday, January 28, 2010 07:14
SHORT URL:
VIEWED: 2490
PAGE 2 of 3

Tuesday, January 26, 2010 12:00 PM

SIGNYM

I believe in solving problems, not sharing them.


Quote:

Might even say, I provoke to further the discussion. To broaden horizons, say...
Broad horizons??? YOU??? You live in a mental straightjacket, hon!

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Tuesday, January 26, 2010 12:00 PM

WULFENSTAR

http://youtu.be/VUnGTXRxGHg


All the time it took you to figure out those cute little avatar type emoticons... dont you think it could have been better used looking for a job?

Just a thought.

(Im sorry, that was mean... that was mean, right... heheheh lol)

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Tuesday, January 26, 2010 12:05 PM

WULFENSTAR

http://youtu.be/VUnGTXRxGHg


"Broad horizons??? YOU??? You live in a mental straightjacket, hon!"

Yep, thats me. That crazy little freak yelling over there in the corner.

:)

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Tuesday, January 26, 2010 12:05 PM

RUE

I have a vote and I'm not afraid to use it!


Wulfie

Here's some good advice for you: "You've got to sharpen your views and have them make sense before I'll leave you alone."

B/c last time I looked, you have a VERY poor track record of doing what you demand ! (no less) that others do.

As far as you're concerned, I don't think you've come up with any convincing arguments, or come up with any at ALL, come to think of it. Just fictional videos which you seem to mistake for reality; personal attacks, racism and hate; standards of 'proof' which you yourself have no thought of requiring of yourself (still waiting for your sources that 'prove' mine are left-leaning, btw); poor logic; bad spelling .. but wait ! there's more !

Do you really think you've 'sharpened' our views ? Do you really think you've provided anything that resembles 'sense' ?

If you do, then you are even more seriously deluded than I imagined.

So, let me give you another friendly word of advice. You need to stop feeling like you are all that, b/c you're not. And I'd sure hate to see you send up like Rap or PN, poor sods.

Of course I would.

***************************************************************

Silence is consent.

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Tuesday, January 26, 2010 12:09 PM

WULFENSTAR

http://youtu.be/VUnGTXRxGHg


"You need to stop feeling like you are all that, b/c you're not. And I'd sure hate to see you send up like Rap, poor sod. "

And WHAT exactly happened to Rap? Now that you mention it, I havn't seen him around for a while. Was that a threat? Or what?

Seriously.

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Tuesday, January 26, 2010 12:11 PM

RUE

I have a vote and I'm not afraid to use it!


What about PN ? Is THAT a threat ?

I can wait for you to work out the logic.

***************************************************************

Silence is consent.

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Tuesday, January 26, 2010 12:14 PM

WULFENSTAR

http://youtu.be/VUnGTXRxGHg


Are you saying Rap is/was PN?

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Tuesday, January 26, 2010 12:18 PM

RUE

I have a vote and I'm not afraid to use it!


Still waiting for you to work it out.

Also still waiting for your proof that my sources are left-leaning.

***************************************************************

Silence is consent.

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Tuesday, January 26, 2010 12:18 PM

BYTEMITE


Niki is in her sixties from what I understand, and was forced into retirement from her corporate job.

Just so you know. The disability thing isn't her getting out of work.

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Tuesday, January 26, 2010 12:34 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by Jongsstraw:
Quote:

Originally posted by rue:
"Cause, you know... the Washington Post is as fair and as balanced as Fox News."

Of course there was that ABC report where 62 % favored it that was mentioned in the quote. But I forgot myself ... you don't know how to read very well. (And heaven help us, you actually think you're teaching others how to read.)

So, for people who DO know how to read:

June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 ... (New York Times/CBS News poll)

78% percent said that a pubic option was either extremely important of very important. (Survey USA)

60% said they wanted a public option under any healthcare reform legislation. (Thompson Reuters Survey)

76% said a public option was either extremely or quite important. (Wall Street Journal)

I'm betting that Wulfie won't be able to read this either, btw.

***************************************************************

Silence is consent.


Polls from June mean nothing now. They didn't get it done when they had some support before the Summer, now it's way way down. 8 dem reps have announced they won't seek re-election, and one has actually switched to Republican. The guy yesterday said he thinks his party is suicidal. Biden's son dropped out of the Senate race in Delaware. Dodd is retiring, and Reid is toast in Nevada. New Gallop Poll says 70+% now glad Dem supermajority is gone. But nevermind all that, libs just know what's right for everyone I guess.

From Rassmussen:
Date
Favor ..top #
Oppose ...bottom #

Jan 20-21
40%
58%

Jan 16-17
38%
56%

Jan 8-9
40%
55%

Jan 3
42%
52%

Dec 29
39%
58%

Dec 27
40%
55%

Dec 18-19
41%
55%

Dec 12-13
40%
56%

Dec 4-5
41%
51%

Nov 29
41%
53%

Nov 21-22
38%
56%

Nov 13-14
47%
49%

Nov 7-8
45%
52%

Oct 30-31
42%
54%

Oct 24-25
45%
51%

Oct 16-17
42%
54%

Oct 10-11
44%
50%

Oct 2-3
46%
50%

Sep 24-25
41%
56%

Sep 16-17
43%
56%

Sep 15-16
44%
53%

Sep 14-15
42%
55%

Sep 13-14
45%
52%

Sep 12-13
51%
46%

Sep 11-12
48%
48%

Sep 10-11
47%
49%

Sep 9-10
46%
51%

Sept 8-9
44%
53%

Aug 25-26
43%
53%

Aug 9-10
42%
53%

Jul 26-27
47%
49%

Jul 20-21
44%
53%

Jul 10-11
46%
49%

Jun 27-28
50%
45%


From Gallup :

New Poll Shows Most Americans Want A Healthcare Bill That The GOP Can Endorse
January 26, 2010 by Personal Liberty News Desk
According to a new Gallup poll, the majority of Americans believe that President Obama and other Democratic leaders should postpone debate on the current healthcare reform bill and consider alternative legislation that would garner more GOP support.

The poll, conducted by USA Today, found that 55 percent of those surveyed feel that Congress should suspend work on the healthcare bill that was almost assured passage before Democrats lost a filibuster-proof majority in the Senate following the election of Massachusetts Republican Scott Brown on Tuesday.

Approximately 72 percent of respondents felt that the result in Massachusetts "reflects frustrations shared by many Americans, and the president and members of Congress should pay attention to it," according to the news source.





Jongs, couldn't I validly argue that the poll results you show only prove the corrosive influence of so much corporate money pouting into the system? After all, it was after June when "Big Pharma" and "Big Insurance" started dumping a million dollars plus PER DAY into the lobbying efforts against reform.

Guess that's the price and cost of "free speech" these days - a million bucks a day, and more.

Mike

Work is the curse of the Drinking Class.
- Oscar Wilde

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Tuesday, January 26, 2010 12:34 PM

NIKI2

Gettin' old, but still a hippie at heart...


"That crazy little freak yelling over there in the corner."
HE GOT IT AGAIN!! Wulf! Now, that's YOUR mantra: "I'm just tThat crazy little freak yelling over there in the corner; I'm just tThat crazy little freak yelling over there in the corner." Good boy!

"All the time it took you to figure out those cute little avatar type emoticons... dont you think it could have been better used looking for a job?" No, tiny dick, I collected them over the years as they came my way. Took me LOTS less time than it did you to look up all your ridiculous fantasy hero videos. Considering all the time you spend here, what are YOU doing at your job?

Thanx, Byte, but he only bothered me with one single post; beyond that, he's not worth being bothered by or explaining things to.

Rue, I hope you're not holding your breath waiting for him to work out the logic...you realize "Wulf" and "logic" don't go together...

I really have to back out. But dealing with Wulf can be such a fun diversion from using my brain and communicating with adults, sometimes it's tempting; kind of like playing with the husies. Nonetheless, it gives him too much of the attention his little-boy soul lives for--you know--

So I really should get back to the adult discussion (thank you Mike) or go...



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Tuesday, January 26, 2010 12:41 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by Niki2:
"I provoke to further the discussion. To broaden horizons, say"

"You've got to sharpen your views and have them make sense before I'll leave you alone"

"Then again, I could just be an asshole" HE GOT IT! For one brief moment, Wulf touched down on Earth...we should have a party...well, if we gave a damn...






Yup, he got it, and in only three tries!

You should see him when you ask him which hand is his right and which his left. Sometimes he's able to figure it out in as little as TWO tries. :)

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Tuesday, January 26, 2010 12:46 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Rappy ran away from RWED, vowing never to return, because he got his ass utterly and completely kicked, on a regular basis (regular as in, DAILY, if not hourly) by some posters here.

Once the '08 election went down, and didn't go the way he guaranteed it would, he threw a fit and ran away with his tail tucked between his legs.

He just popped up here last week in one thread, then vanished just as quickly. He stays out of the deep end now, and sticks to the other areas of FFF.net.

Mike

Work is the curse of the Drinking Class.
- Oscar Wilde

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Tuesday, January 26, 2010 12:53 PM

SIGNYM

I believe in solving problems, not sharing them.


JONGSSTRAW
Quote:

The poll, conducted by USA Today, found that 55 percent of those surveyed feel that Congress should suspend work on the healthcare bill that was almost assured passage before Democrats lost a filibuster-proof majority in the Senate following the election of Massachusetts Republican Scott Brown on Tuesday. Approximately 72 percent of respondents felt that the result in Massachusetts "reflects frustrations shared by many Americans, and the president and members of Congress should pay attention to it," according to the news source.
yes, and you can count me IN in that poll. But don't misintepret the results: If you simply ask people yay or nay, you'll miss the point that frustration is coming from BOTH ends of the political spectrum, not just the right.

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Tuesday, January 26, 2010 1:05 PM

NIKI2

Gettin' old, but still a hippie at heart...


Gosh, Mike, in only two tries? Wow, that's pretty impressive!

Yup, Sig, as usual you summed up the entire situation in a couple of quick sentences. Hey, wait, you edited!

Ah-HAH! I found the original. Here's what Sig initially wrote:
Quote:

There's another thing about peeps not wanting the healthcare reform AS WRITTEN: It fails the sniff test from both the right AND the left! Everyone can see it for what it REALLY is... yet another giveway of our TAX MONEY TO THE RICH.
I liked that "sniff test" bit, we shouldn't lose it...

What happened to "Wulfie"? He get scared and run away? I understand why some of you call him Wulfie, finally (took me long enough!). He IS kinda like having a two-year-old running around the house, isn't he?

Okay, okay, I'll stop now and go to something actually constructive...like walk the dogs...



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Tuesday, January 26, 2010 1:08 PM

SIGNYM

I believe in solving problems, not sharing them.


Could you take the Wulfie for a walk, too? I think he needs to go out and pee.

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Tuesday, January 26, 2010 1:08 PM

RUE

I have a vote and I'm not afraid to use it!


"Rappy ran away from RWED, vowing never to return ..."

Oh, but you missed the best part - he became increasingly irrational beforehand. And while I actually DID try to warn him in a truly well-meant way, the lesson I learned from watching it boomerang was that sometimes good advice is a potent weapon.

***************************************************************

Silence is consent.

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Tuesday, January 26, 2010 1:10 PM

NIKI2

Gettin' old, but still a hippie at heart...


Oh, damn, Sig...there went my ice tea, all over the keyboard! Just the picture; two huskies and a wulfie, all on leashes following sedately behind, tongues lolling out...as they stop at a tree, Wulfie sniffs, lifts...

Oh, shit, I gotta get outta here, it's bad for my self-discipline...AND my keyboard!



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Tuesday, January 26, 2010 2:08 PM

FREMDFIRMA



Mikey, I actually laid off him, towards the end, cause I could literally SEE his mental condition starting to deteriorate so badly I worried for his health - not that I ain't capable of that sort of malice, but the idea of driving someone to complete psychological destruction made me feel a little ill when it seemed so damned unnecessary, he wasn't even making coherent arguments anymore, just spouting hatred, racism, intolerance and bile in every direction, leaving nothing TO argue, one could only just sit and watch in horror as the truth behind that civilized mask was revealed in full.

While his mental health is probably best served by staying away, I think it was a real learning experience what lies behind the phony mask of reason and logic most hard-righters present to the world, and I think that revelation is what caused most of the others to flee with him, even more than the election results, which I had told them eighteen months in advance - but since when have hard-righters ever accepted even obvious realities...

Hell, I'm surprised they're not still curled up in a corner trying to wish it all away by pretending otherwise.

All that said, we seriously need to wreck the hell out of the two party system, and so far, so good, all that sand in the gears is starting to jam them up quite nicely - we just need some real third party (as opposed to the GOP-Lite bullshit of the co-opted Barr faction of the *snicker* 'libertarians') candidates to find a pair and step up to the plate.

-F

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Tuesday, January 26, 2010 2:24 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

All that said, we seriously need to wreck the hell out of the two party system, and so far, so good, all that sand in the gears is starting to jam them up quite nicely - we just need some real third party (as opposed to the GOP-Lite bullshit of the co-opted Barr faction of the *snicker* 'libertarians') candidates to find a pair and step up to the plate.



Well, yeah... but as with most things, if you get what you wish for, you likely ain't gonna like it. We ARE seeing the possible impending death of the two-party system. Unfortunately for us, it's looking to be replaced with the 20-corporation system. Instead of seeing titles like "Joe Lieberman, (I - Conn)", you'll just see "Senator Joe Lieberman, Aetna Life & Casualty, MetLife, The Hartford".

Not sure I see the improvement. :(

Mike

Work is the curse of the Drinking Class.
- Oscar Wilde

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Tuesday, January 26, 2010 10:48 PM

PERFESSERGEE


Quote:

Originally posted by rue:
BTW - I find the fillibuster to be very much like California's 'supermajority' (2/3) requirement for passing the budget. In other words, a perfectly bad idea.

While the fillibuster in theory might provide time for reflection on hasty legislation, in practice a small minority can block necessary legislation. Wielded with malice, it is a powerful tool for obstructionists who only want to make the 'other side' lose.

Either they should lose the fillibuster - or the democrats should ALSO play the game. Otherwise, it's worse than a joke.

***************************************************************

Silence is consent.



Rue,

You are much too kind to our fellow Californian electors who passed the 2/3 requirement for new taxes and the annual budget for the CA govt. It's not merely a "perfectly bad idea" (though that is indeed true), it's a stupendously idiotic, shoot-yourself-in-the-left-eye kind of idea. The filibuster didn't use to be such a bad idea when it wasn't being used by hose-headed idealogues whose heads are very firmly wedged and who are intent on blocking everything that comes before them (such as anything that actually might make the govt. work).

No one who actually believes in democracy - or even democratic principles within a representative republic - could argue that the filibuster has any place in such a government. Those who would argue in favor of it are self-serving antidemocratic hypocrites. Whether they are Democrats, Republicans, Independents of hermaphrodites.

To hell with the filibuster!

perfessergee

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Wednesday, January 27, 2010 2:11 AM

JONGSSTRAW


Quote:

Originally posted by Kwicko:

Jongs, couldn't I validly argue that the poll results you show only prove the corrosive influence of so much corporate money pouting into the system? After all, it was after June when "Big Pharma" and "Big Insurance" started dumping a million dollars plus PER DAY into the lobbying efforts against reform.

Guess that's the price and cost of "free speech" these days - a million bucks a day, and more.


I posted on the other board strong opposition to the Supreme Court's decision, and the ads we saw and still see prove the point. Advocacy ads make me very ill, even if I agree with them...I just don't want to see that crap all year. And politically, it now takes approx. $8 million dollars to run for Congress. That's not a lot of money to big corporations, more like a rounding error. On the other hand, this has been going on for a long time. At least McCain-Feingold provided some restraint, flawed as it was.

Go beyond the ads and the hype. Just look at what the Dems have done openly....bribed 2 Senators (of their own Party) with tax-payer dollars, meaning other states would have to pay their Medicare bills, and granted tax immunity to Unions that backed Obama for President. They don't have to pay higher taxes on their policies, just everybody else. I think all that crap was the tipping point. Also, having video aired over and over of Obama pledging 8 or 9 times to be transparent on the Healthcare debate by putting it on C-Span, and then behaving as they did really rubs a lot of folks the wrong way.

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Wednesday, January 27, 2010 2:15 AM

JONGSSTRAW


Quote:

Originally posted by SignyM:
JONGSSTRAW
Quote:

The poll, conducted by USA Today, found that 55 percent of those surveyed feel that Congress should suspend work on the healthcare bill that was almost assured passage before Democrats lost a filibuster-proof majority in the Senate following the election of Massachusetts Republican Scott Brown on Tuesday. Approximately 72 percent of respondents felt that the result in Massachusetts "reflects frustrations shared by many Americans, and the president and members of Congress should pay attention to it," according to the news source.
yes, and you can count me IN in that poll. But don't misintepret the results: If you simply ask people yay or nay, you'll miss the point that frustration is coming from BOTH ends of the political spectrum, not just the right.


It seems that almost anything Obama does these days pisses off the Left & the Right. Maybe that's his strategy to get back those all important Independents. He carried them big time during the Presidential election, but since then they've abandoned him. Independents broke 2-1 against him in NJ & Va.'s Governor's races, and they broke from Obama 3-1 in Massachusetts. You'll see his SOTU speech tonite as big play to get them back.

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Wednesday, January 27, 2010 4:08 AM

SIGNYM

I believe in solving problems, not sharing them.


Bascially, Obama will swing to the right and lose his base.

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Wednesday, January 27, 2010 4:35 AM

JONGSSTRAW


I don't think he'll ever "lose" his base. They may not like what he's doing (ie. Howard Dean's rant with Mathews on MSNBC last week), but they're sure not going to support any Republican, just like Conservatives still supported McCain and Bush right to the bitter end. Conservatives have been ideologically opposed to Obama on principle every step of the way, and Liberals are frustrated that he's broken so many of his promises to them. So it's all about Independents. Whether they believe Obama's re-fit remains to be seen.

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Wednesday, January 27, 2010 4:52 AM

SIGNYM

I believe in solving problems, not sharing them.


Jongs, Dems are NOT like Republicans: they dont' vote "party" as much as Repubs do. So, yes, he will. They may not vote Republican, but they'll stay home. Or vote third party, like I did when Clinton ran the second time.

And here's the deal: Clinton got ONE thing right: It's the economy, stupid. The Dems have not distinguished themselves in ANY WAY in terms of helping the average American. The stimulus? Pfffft! So much chaff in the wind, compared to the trillions going to the banksters and military.

Right now, ALL the Democratic party has is Obama's personal popularity, and that is going to disappear. All those energized voters, who thought they'd really see Hope and Change*? Well, they're going to disappear too. There's a groundswell of populism which the Dems have missed (so far) because they were too busy making backroom deals and pulling their porks (Where is the emoticon for someone jacking off when you need it?) and the Republicans, who're actually WORSE than the Dems when it comes to screwing the average person have been smart enough (so far) to ride it.

What most people don't realize is that populism is a danger as well as an oppty. It was populism that brought Hitler and Moussolini into power.

*BTW, I guess we can say that we got at least half of that promise. After all, didn't we wind up with change??? (Nickels, dimes, quarters)

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Wednesday, January 27, 2010 4:55 AM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by Jongsstraw:
I don't think he'll ever "lose" his base.




Wanna bet?


Obama's well on his way to losing any support I might give him, either in the 2010 mid-terms OR in the 2012 presidential election.

And no, I'm not likely to support any Republican at the national level (unless something REALLY revolutionary happens within that party); I'm more likely to just stay home, like I did in '96. In '92 I voted for Perot mostly as a protest vote, but in '96 there wasn't even that option, so I didn't even waste my time going to the polls. First and only time I ever did that in a presidential election. Obama's shooting for number two, and so far, he's doing a great job of losing my interest and support.

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Wednesday, January 27, 2010 4:56 AM

BYTEMITE


Quote:

No one who actually believes in democracy - or even democratic principles within a representative republic - could argue that the filibuster has any place in such a government. Those who would argue in favor of it are self-serving antidemocratic hypocrites. Whether they are Democrats, Republicans, Independents of hermaphrodites.


Nothing quite so ideologuing as calling someone "undemocratic" for not agreeing with you. Or "hermaphroditic," which, is that an insult? You can disparage parties AND independents as much as you want, obviously all three have problems getting anything done and Dems and Indys are so divided as to be pretty much worthless in regards to the process. But leave hermaphrodites out of it. They have nothing to do with the FILTH of the political arena, and you can't help how you're born.

But okay, on principle, you have a point. The point of a fillibuster as used in a republic setting is to prevent a majority group of lawmakers to push things past a minority group. Which, if you assume that because one group is the majority because the PUBLIC as a majority supports them, then yeah, it only serves as a disruption of the democratic process.

Unfortunately, on principle, a republic-system were votes are not issue by issue is no longer a democratic process in the first place. Representatives on both sides ignore what the public wants, and pass things like the goddamn PATRIOT ACT or decide on a troop surge in Afghanistan.

So fuck them, fuck their process, and if they in their infinite pettiness want to make the entire legislative process a goddamn circus and never get anything done, then the public is no worse off than they started. And then the ADULTS can talk, and compromise, and get things done. Unlike these mewling power hungry ambitious sons of jackals who'd sell us out first chance they get.

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Wednesday, January 27, 2010 5:11 AM

JONGSSTRAW


Quote:

Originally posted by Kwicko:
Quote:

Originally posted by Jongsstraw:
I don't think he'll ever "lose" his base.




Wanna bet?


Obama's well on his way to losing any support I might give him, either in the 2010 mid-terms OR in the 2012 presidential election.

And no, I'm not likely to support any Republican at the national level (unless something REALLY revolutionary happens within that party); I'm more likely to just stay home, like I did in '96. In '92 I voted for Perot mostly as a protest vote, but in '96 there wasn't even that option, so I didn't even waste my time going to the polls. First and only time I ever did that in a presidential election. Obama's shooting for number two, and so far, he's doing a great job of losing my interest and support.


Wow! I guess I don't really understand the passion that Liberals have then. You would choose not to vote for a Dem you didn't like by staying home, rather than vote for him anyway as a measure to cancel out a Republican's vote. That is remarkable, and quite noble.

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Wednesday, January 27, 2010 5:16 AM

JONGSSTRAW


Quote:

Originally posted by SignyM:
Jongs, Dems are NOT like Republicans: they dont' vote "party" as much as Repubs do. So, yes, he will. They may not vote Republican, but they'll stay home. Or vote third party, like I did when Clinton ran the second time.


Not to be argumentative here, but didn't we all witness a huge reconcilliation of the Hillary supporters to Obama? At the time, I was hoping/expecting that a large chunk of women & Hillary supporters in general would not support Obama, and I thought a sizeable percentage of them would go for McCain/Palin. Well that didn't happen at all. Looks to me like RWED Liberals are more principled than your average variety Democrat. I find that admirable.

ps. The first time I ever voted for President was in 1972. The next time was 2000. All those years in between I couldn't have cared less. I was building a life with career and family, and "politics' was not something I felt all too concerned about. Cable news and the internet brought me back, and sometimes I wonder if all the energy and passion that I and everyone else spends on these things is worth the time.

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Wednesday, January 27, 2010 5:56 AM

BYTEMITE


Quote:

Looks to me like RWED Liberals are more principled than your average variety Democrat. I find that admirable.


I suspect most of the RWED supported Obama in the first place and never switched over from Hillary anyway. Though I could be wrong, since I wasn't really around when the presidential debates were raging.

I was actually dismayed after his election when he appointed Hillary to Secretary of State. That was pretty much watching the wolf EATING the sheepskin before your eyes.

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Wednesday, January 27, 2010 6:15 AM

SIGNYM

I believe in solving problems, not sharing them.


Quote:

And then the ADULTS can talk, and compromise, and get things done.
Yeah, really? Great idea, but how're you gonna do it?

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Wednesday, January 27, 2010 6:18 AM

SIGNYM

I believe in solving problems, not sharing them.


S'wenyways... back to the fillibuster: I know this has been brought up before, but the whole idea of less than a majority being able to block legislation is stupid. That's why the CA budget process is such a clusterf*ck: a mere 33% of the State Legislature can block 67%. How stupid is that???

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Wednesday, January 27, 2010 6:24 AM

RUE

I have a vote and I'm not afraid to use it!


"The point of a fillibuster as used in a republic setting is to prevent a majority group of lawmakers to push things past a minority group."

Just a small quibble. When you say a 'minority group' you imply that somehow that group is united in a common but majority-opposed position. While in our two-party system that's often the case, it's not always so. It is possible for several different groups to take a common position for entirely different reasons, either political or policy.

***************************************************************

Silence is consent.

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Wednesday, January 27, 2010 6:37 AM

BYTEMITE


There's a couple of ideas I've been thinking about in regards to healthcare.

Clearly there's local credit unions everywhere, right? And they exist despite the big credit card companies and big banks.

Now, I don't know if when someone starts up a credit union, if some piece of legislation or another gives them tax breaks or subsidies or anything, but even if there's nothing like that, what's to stop a local well respected honest business man or woman from creating a health care co-op? If people hate big insurance as much as they say they do, then they'll drop their policies and switch over if given the chance, won't they?

Now, the other problem is the COST of healthcare. Which mostly is the fault of the pharmaceutical companies and is an unfortunate side effect of the amount of money it costs for a would-be doctor to go to medical school. The pharmaceutical problem could be helped with important pharmaceuticals from other countries, though the FDA would have to actually DO THEIR JOB because there are obvious quality control and smuggling concerns.

Something we could do for the cost of training doctors is to make a vocational system in public schools which might involve something like college courses for the necessary biology requirements and an apprenticeship with a doctor for actual college credits. And finding ways to reduce the cost of attending a university.

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Wednesday, January 27, 2010 6:58 AM

RUE

I have a vote and I'm not afraid to use it!


"If people hate big insurance as much as they say they do, then they'll drop their policies and switch over if given the chance, won't they?"

Probably not. IF you have insurance it will (hopefully) cover things that your local co-op can't.

"... the COST of healthcare ... is the fault of the pharmaceutical companies and ... the amount of money it costs ... to go to medical school."

Not true. It is due to medical people (doctors, hospitals, labs, independent testing centers for MRIs etc, and yes, pharmaceutical companies) doing things that get them more money, rather than deliver better medical care. And to some extent it is due to malpractice insurance companies which have not dropped their rates even though in many places awards have been capped and payout has gone down to next to nothing.


The Cost Conundrum
What a Texas town can teach us about health care


It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. “Lonesome Dove” was set around here.

McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

The explosive trend in American medical costs seems to have occurred here in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”

The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.

From the moment I arrived, I asked almost everyone I encountered about McAllen’s health costs—a businessman I met at the five-gate McAllen-Miller International Airport, the desk clerks at the Embassy Suites Hotel, a police-academy cadet at McDonald’s. Most weren’t surprised to hear that McAllen was an outlier. “Just look around,” the cadet said. “People are not healthy here.” McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate.

One day, I went on rounds with Lester Dyke, a weather-beaten, ranch-owning fifty-three-year-old cardiac surgeon who grew up in Austin, did his surgical training with the Army all over the country, and settled into practice in Hidalgo County. He has not lacked for business: in the past twenty years, he has done some eight thousand heart operations, which exhausts me just thinking about it. I walked around with him as he checked in on ten or so of his patients who were recuperating at the three hospitals where he operates. It was easy to see what had landed them under his knife. They were nearly all obese or diabetic or both. Many had a family history of heart disease. Few were taking preventive measures, such as cholesterol-lowering drugs, which, studies indicate, would have obviated surgery for up to half of them.

Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low. Rates of asthma, H.I.V., infant mortality, cancer, and injury are lower, too. El Paso County, eight hundred miles up the border, has essentially the same demographics. Both counties have a population of roughly seven hundred thousand, similar public-health statistics, and similar percentages of non-English speakers, illegal immigrants, and the unemployed. Yet in 2006 Medicare expenditures (our best approximation of over-all spending patterns) in El Paso were $7,504 per enrollee—half as much as in McAllen. An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.)

Was the explanation, then, that McAllen was providing unusually good health care? I took a walk through Doctors Hospital at Renaissance, in Edinburg, one of the towns in the McAllen metropolitan area, with Robert Alleyn, a Houston-trained general surgeon who had grown up here and returned home to practice. The hospital campus sprawled across two city blocks, with a series of three- and four-story stucco buildings separated by golfing-green lawns and black asphalt parking lots. He pointed out the sights—the cancer center is over here, the heart center is over there, now we’re coming to the imaging center. We went inside the surgery building. It was sleek and modern, with recessed lighting, classical music piped into the waiting areas, and nurses moving from patient to patient behind rolling black computer pods. We changed into scrubs and Alleyn took me through the sixteen operating rooms to show me the laparoscopy suite, with its flat-screen video monitors, the hybrid operating room with built-in imaging equipment, the surgical robot for minimally invasive robotic surgery.

I was impressed. The place had virtually all the technology that you’d find at Harvard and Stanford and the Mayo Clinic, and, as I walked through that hospital on a dusty road in South Texas, this struck me as a remarkable thing. Rich towns get the new school buildings, fire trucks, and roads, not to mention the better teachers and police officers and civil engineers. Poor towns don’t. But that rule doesn’t hold for health care.

At McAllen Medical Center, I saw an orthopedic surgeon work under an operating microscope to remove a tumor that had wrapped around the spinal cord of a fourteen-year-old. At a home-health agency, I spoke to a nurse who could provide intravenous-drug therapy for patients with congestive heart failure. At McAllen Heart Hospital, I watched Dyke and a team of six do a coronary-artery bypass using technologies that didn’t exist a few years ago. At Renaissance, I talked with a neonatologist who trained at my hospital, in Boston, and brought McAllen new skills and technologies for premature babies. “I’ve had nurses come up to me and say, ‘I never knew these babies could survive,’ ” he said.

And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.

Nor does the care given in McAllen stand out for its quality. Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen’s five largest hospitals performed worse, on average, than El Paso’s. McAllen costs Medicare seven thousand dollars more per person each year than does the average city in America. But not, so far as one can tell, because it’s delivering better health care.

One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.

Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.

“Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.

Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.

“It’s malpractice,” a family physician who had practiced here for thirty-three years said.

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted.

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ”

Everyone agreed that something fundamental had changed since the days when health-care costs in McAllen were the same as those in El Paso and elsewhere. Yes, they had more technology. “But young doctors don’t think anymore,” the family physician said.

The surgeon gave me an example. General surgeons are often asked to see patients with pain from gallstones. If there aren’t any complications—and there usually aren’t—the pain goes away on its own or with pain medication. With instruction on eating a lower-fat diet, most patients experience no further difficulties. But some have recurrent episodes, and need surgery to remove their gallbladder.

Seeing a patient who has had uncomplicated, first-time gallstone pain requires some judgment. A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate. The patient wasn’t going to moderate her diet, they tell themselves. The pain was just going to come back. And by operating they happen to make an extra seven hundred dollars.

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

“Oh, she’s definitely getting a cath,” the internist said, laughing grimly.

To determine whether overuse of medical care was really the problem in McAllen, I turned to Jonathan Skinner, an economist at Dartmouth’s Institute for Health Policy and Clinical Practice, which has three decades of expertise in examining regional patterns in Medicare payment data. I also turned to two private firms—D2Hawkeye, an independent company, and Ingenix, UnitedHealthcare’s data-analysis company—to analyze commercial insurance data for McAllen. The answer was yes. Compared with patients in El Paso and nationwide, patients in McAllen got more of pretty much everything—more diagnostic testing, more hospital treatment, more surgery, more home care.

The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.

That’s because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely. After all, some hundred thousand people die each year from complications of surgery—far more than die in car crashes.

To make matters worse, Fisher found that patients in high-cost areas were actually less likely to receive low-cost preventive services, such as flu and pneumonia vaccines, faced longer waits at doctor and emergency-room visits, and were less likely to have a primary-care physician. They got more of the stuff that cost more, but not more of what they needed.

In an odd way, this news is reassuring. Universal coverage won’t be feasible unless we can control costs. Policymakers have worried that doing so would require rationing, which the public would never go along with. So the idea that there’s plenty of fat in the system is proving deeply attractive. “Nearly thirty per cent of Medicare’s costs could be saved without negatively affecting health outcomes if spending in high- and medium-cost areas could be reduced to the level in low-cost areas,” Peter Orszag, the President’s budget director, has stated.

Most Americans would be delighted to have the quality of care found in places like Rochester, Minnesota, or Seattle, Washington, or Durham, North Carolina—all of which have world-class hospitals and costs that fall below the national average. If we brought the cost curve in the expensive places down to their level, Medicare’s problems (indeed, almost all the federal government’s budget problems for the next fifty years) would be solved. The difficulty is how to go about it. Physicians in places like McAllen behave differently from others. The $2.4-trillion question is why. Unless we figure it out, health reform will fail.

I had what I considered to be a reasonable plan for finding out what was going on in McAllen. I would call on the heads of its hospitals, in their swanky, decorator-designed, churrigueresco (having elaborate symmetrical ornamentation) offices, and I’d ask them.

The first hospital I visited, McAllen Heart Hospital, is owned by Universal Health Services, a for-profit hospital chain with headquarters in King of Prussia, Pennsylvania, and revenues of five billion dollars last year. I went to see the hospital’s chief operating officer, Gilda Romero. Truth be told, her office seemed less churrigueresco than Office Depot. She had straight brown hair, sympathetic eyes, and looked more like a young school teacher than like a corporate officer with nineteen years of experience. And when I inquired, “What is going on in this place?” she looked surprised.

Is McAllen really that expensive? she asked.

I described the data, including the numbers indicating that heart operations and catheter procedures and pacemakers were being performed in McAllen at double the usual rate.

“That is interesting,” she said, by which she did not mean, “Uh-oh, you’ve caught us” but, rather, “That is actually interesting.” The problem of McAllen’s outlandish costs was new to her. She puzzled over the numbers. She was certain that her doctors performed surgery only when it was necessary. It had to be one of the other hospitals. And she had one in mind—Doctors Hospital at Renaissance, the hospital in Edinburg that I had toured.

She wasn’t the only person to mention Renaissance. It is the newest hospital in the area. It is physician-owned. And it has a reputation (which it disclaims) for aggressively recruiting high-volume physicians to become investors and send patients there. Physicians who do so receive not only their fee for whatever service they provide but also a percentage of the hospital’s profits from the tests, surgery, or other care patients are given. (In 2007, its profits totalled thirty-four million dollars.) Romero and others argued that this gives physicians an unholy temptation to overorder.

Such an arrangement can make physician investors rich. But it can’t be the whole explanation. The hospital gets barely a sixth of the patients in the region; its margins are no bigger than the other hospitals’—whether for profit or not for profit—and it didn’t have much of a presence until 2004 at the earliest, a full decade after the cost explosion in McAllen began.

“Those are good points,” Romero said. She couldn’t explain what was going on.

The following afternoon, I visited the top managers of Doctors Hospital at Renaissance. We sat in their boardroom around one end of a yacht-length table. The chairman of the board offered me a soda. The chief of staff smiled at me. The chief financial officer shook my hand as if I were an old friend. The C.E.O., however, was having a hard time pretending that he was happy to see me. Lawrence Gelman was a fifty-seven-year-old anesthesiologist with a Bill Clinton shock of white hair and a weekly local radio show tag-lined “Opinions from an Unrelenting Conservative Spirit.” He had helped found the hospital. He barely greeted me, and while the others were trying for a how-can-I-help-you-today attitude, his body language was more let’s-get-this-over-with.

So I asked him why McAllen’s health-care costs were so high. What he gave me was a disquisition on the theory and history of American health-care financing going back to Lyndon Johnson and the creation of Medicare, the upshot of which was: (1) Government is the problem in health care. “The people in charge of the purse strings don’t know what they’re doing.” (2) If anything, government insurance programs like Medicare don’t pay enough. “I, as an anesthesiologist, know that they pay me ten per cent of what a private insurer pays.” (3) Government programs are full of waste. “Every person in this room could easily go through the expenditures of Medicare and Medicaid and see all kinds of waste.” (4) But not in McAllen. The clinicians here, at least at Doctors Hospital at Renaissance, “are providing necessary, essential health care,” Gelman said. “We don’t invent patients.”

Then why do hospitals in McAllen order so much more surgery and scans and tests than hospitals in El Paso and elsewhere?

In the end, the only explanation he and his colleagues could offer was this: The other doctors and hospitals in McAllen may be overspending, but, to the extent that his hospital provides costlier treatment than other places in the country, it is making people better in ways that data on quality and outcomes do not measure.

“Do we provide better health care than El Paso?” Gelman asked. “I would bet you two to one that we do.”

It was a depressing conversation—not because I thought the executives were being evasive but because they weren’t being evasive. The data on McAllen’s costs were clearly new to them. They were defending McAllen reflexively. But they really didn’t know the big picture of what was happening.

And, I realized, few people in their position do. Local executives for hospitals and clinics and home-health agencies understand their growth rate and their market share; they know whether they are losing money or making money. They know that if their doctors bring in enough business—surgery, imaging, home-nursing referrals—they make money; and if they get the doctors to bring in more, they make more. But they have only the vaguest notion of whether the doctors are making their communities as healthy as they can, or whether they are more or less efficient than their counterparts elsewhere. A doctor sees a patient in clinic, and has her check into a McAllen hospital for a CT scan, an ultrasound, three rounds of blood tests, another ultrasound, and then surgery to have her gallbladder removed. How is Lawrence Gelman or Gilda Romero to know whether all that is essential, let alone the best possible treatment for the patient? It isn’t what they are responsible or accountable for.

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.

If doctors wield the pen, why do they do it so differently from one place to another? Brenda Sirovich, another Dartmouth researcher, published a study last year that provided an important clue. She and her team surveyed some eight hundred primary-care physicians from high-cost cities (such as Las Vegas and New York), low-cost cities (such as Sacramento and Boise), and others in between. The researchers asked the physicians specifically how they would handle a variety of patient cases. It turned out that differences in decision-making emerged in only some kinds of cases. In situations in which the right thing to do was well established—for example, whether to recommend a mammogram for a fifty-year-old woman (the answer is yes)—physicians in high- and low-cost cities made the same decisions. But, in cases in which the science was unclear, some physicians pursued the maximum possible amount of testing and procedures; some pursued the minimum. And which kind of doctor they were depended on where they came from.

Sirovich asked doctors how they would treat a seventy-five-year-old woman with typical heartburn symptoms and “adequate health insurance to cover tests and medications.” Physicians in high- and low-cost cities were equally likely to prescribe antacid therapy and to check for H. pylori, an ulcer-causing bacterium—steps strongly recommended by national guidelines. But when it came to measures of less certain value—and higher cost—the differences were considerable. More than seventy per cent of physicians in high-cost cities referred the patient to a gastroenterologist, ordered an upper endoscopy, or both, while half as many in low-cost cities did. Physicians from high-cost cities typically recommended that patients with well-controlled hypertension see them in the office every one to three months, while those from low-cost cities recommended visits twice yearly. In case after uncertain case, more was not necessarily better. But physicians from the most expensive cities did the most expensive things.

Why? Some of it could reflect differences in training. I remember when my wife brought our infant son Walker to visit his grandparents in Virginia, and he took a terrifying fall down a set of stairs. They drove him to the local community hospital in Alexandria. A CT scan showed that he had a tiny subdural hematoma—a small area of bleeding in the brain. During ten hours of observation, though, he was fine—eating, drinking, completely alert. I was a surgery resident then and had seen many cases like his. We observed each child in intensive care for at least twenty-four hours and got a repeat CT scan. That was how I’d been trained. But the doctor in Alexandria was going to send Walker home. That was how he’d been trained. Suppose things change for the worse? I asked him. It’s extremely unlikely, he said, and if anything changed Walker could always be brought back. I bullied the doctor into admitting him anyway. The next day, the scan and the patient were fine. And, looking in the textbooks, I learned that the doctor was right. Walker could have been managed safely either way.

There was no sign, however, that McAllen’s doctors as a group were trained any differently from El Paso’s. One morning, I met with a hospital administrator who had extensive experience managing for-profit hospitals along the border. He offered a different possible explanation: the culture of money.

“In El Paso, if you took a random doctor and looked at his tax returns eighty-five per cent of his income would come from the usual practice of medicine,” he said. But in McAllen, the administrator thought, that percentage would be a lot less.

He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said. They were innovative and aggressive in finding ways to increase revenues from patient care. “There’s no lack of work ethic,” he said. But he had often seen financial considerations drive the decisions doctors made for patients—the tests they ordered, the doctors and hospitals they recommended—and it bothered him. Several doctors who were unhappy about the direction medicine had taken in McAllen told me the same thing. “It’s a machine, my friend,” one surgeon explained.

No one teaches you how to think about money in medical school or residency. Yet, from the moment you start practicing, you must think about it. You must consider what is covered for a patient and what is not. You must pay attention to insurance rejections and government-reimbursement rules. You must think about having enough money for the secretary and the nurse and the rent and the malpractice insurance.

Beyond the basics, however, many physicians are remarkably oblivious to the financial implications of their decisions. They see their patients. They make their recommendations. They send out the bills. And, as long as the numbers come out all right at the end of each month, they put the money out of their minds.

Others think of the money as a means of improving what they do. They think about how to use the insurance money to maybe install electronic health records with colleagues, or provide easier phone and e-mail access, or offer expanded hours. They hire an extra nurse to monitor diabetic patients more closely, and to make sure that patients don’t miss their mammograms and pap smears and colonoscopies.

Then there are the physicians who see their practice primarily as a revenue stream. They instruct their secretary to have patients who call with follow-up questions schedule an appointment, because insurers don’t pay for phone calls, only office visits. They consider providing Botox injections for cash. They take a Doppler ultrasound course, buy a machine, and start doing their patients’ scans themselves, so that the insurance payments go to them rather than to the hospital. They figure out ways to increase their high-margin work and decrease their low-margin work. This is a business, after all.

In every community, you’ll find a mixture of these views among physicians, but one or another tends to predominate. McAllen seems simply to be the community at one extreme.

In a few cases, the hospital executive told me, he’d seen the behavior cross over into what seemed like outright fraud. “I’ve had doctors here come up to me and say, ‘You want me to admit patients to your hospital, you’re going to have to pay me.’ ”

“How much?” I asked.

“The amounts—all of them were over a hundred thousand dollars per year,” he said. The doctors were specific. The most he was asked for was five hundred thousand dollars per year.

He didn’t pay any of them, he said: “I mean, I gotta sleep at night.” And he emphasized that these were just a handful of doctors. But he had never been asked for a kickback before coming to McAllen.

Woody Powell is a Stanford sociologist who studies the economic culture of cities. Recently, he and his research team studied why certain regions—Boston, San Francisco, San Diego—became leaders in biotechnology while others with a similar concentration of scientific and corporate talent—Los Angeles, Philadelphia, New York—did not. The answer they found was what Powell describes as the anchor-tenant theory of economic development. Just as an anchor store will define the character of a mall, anchor tenants in biotechnology, whether it’s a company like Genentech, in South San Francisco, or a university like M.I.T., in Cambridge, define the character of an economic community. They set the norms. The anchor tenants that set norms encouraging the free flow of ideas and collaboration, even with competitors, produced enduringly successful communities, while those that mainly sought to dominate did not.

Powell suspects that anchor tenants play a similarly powerful community role in other areas of economics, too, and health care may be no exception. I spoke to a marketing rep for a McAllen home-health agency who told me of a process uncannily similar to what Powell found in biotech. Her job is to persuade doctors to use her agency rather than others. The competition is fierce. I opened the phone book and found seventeen pages of listings for home-health agencies—two hundred and sixty in all. A patient typically brings in between twelve hundred and fifteen hundred dollars, and double that amount for specialized care. She described how, a decade or so ago, a few early agencies began rewarding doctors who ordered home visits with more than trinkets: they provided tickets to professional sporting events, jewelry, and other gifts. That set the tone. Other agencies jumped in. Some began paying doctors a supplemental salary, as “medical directors,” for steering business in their direction. Doctors came to expect a share of the revenue stream.

Agencies that want to compete on quality struggle to remain in business, the rep said. Doctors have asked her for a medical-director salary of four or five thousand dollars a month in return for sending her business. One asked a colleague of hers for private-school tuition for his child; another wanted sex.

“I explained the rules and regulations and the anti-kickback law, and told them no,” she said of her dealings with such doctors. “Does it hurt my business?” She paused. “I’m O.K. working only with ethical physicians,” she finally said.

About fifteen years ago, it seems, something began to change in McAllen. A few leaders of local institutions took profit growth to be a legitimate ethic in the practice of medicine. Not all the doctors accepted this. But they failed to discourage those who did. So here, along the banks of the Rio Grande, in the Square Dance Capital of the World, a medical community came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers.

The real puzzle of American health care, I realized on the airplane home, is not why McAllen is different from El Paso. It’s why El Paso isn’t like McAllen. Every incentive in the system is an invitation to go the way McAllen has gone. Yet, across the country, large numbers of communities have managed to control their health costs rather than ratchet them up.

I talked to Denis Cortese, the C.E.O. of the Mayo Clinic, which is among the highest-quality, lowest-cost health-care systems in the country. A couple of years ago, I spent several days there as a visiting surgeon. Among the things that stand out from that visit was how much time the doctors spent with patients. There was no churn—no shuttling patients in and out of rooms while the doctor bounces from one to the other. I accompanied a colleague while he saw patients. Most of the patients, like those in my clinic, required about twenty minutes. But one patient had colon cancer and a number of other complex issues, including heart disease. The physician spent an hour with her, sorting things out. He phoned a cardiologist with a question.

“I’ll be there,” the cardiologist said.

Fifteen minutes later, he was. They mulled over everything together. The cardiologist adjusted a medication, and said that no further testing was needed. He cleared the patient for surgery, and the operating room gave her a slot the next day.

The whole interaction was astonishing to me. Just having the cardiologist pop down to see the patient with the surgeon would be unimaginable at my hospital. The time required wouldn’t pay. The time required just to organize the system wouldn’t pay.

The core tenet of the Mayo Clinic is “The needs of the patient come first”—not the convenience of the doctors, not their revenues. The doctors and nurses, and even the janitors, sat in meetings almost weekly, working on ideas to make the service and the care better, not to get more money out of patients. I asked Cortese how the Mayo Clinic made this possible.

“It’s not easy,” he said. But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible.

No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs.

“When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing,” Cortese told me.

Skeptics saw the Mayo model as a local phenomenon that wouldn’t carry beyond the hay fields of northern Minnesota. But in 1986 the Mayo Clinic opened a campus in Florida, one of our most expensive states for health care, and, in 1987, another one in Arizona. It was difficult to recruit staff members who would accept a salary and the Mayo’s collaborative way of practicing. Leaders were working against the dominant medical culture and incentives. The expansion sites took at least a decade to get properly established. But eventually they achieved the same high-quality, low-cost results as Rochester. Indeed, Cortese says that the Florida site has become, in some respects, the most efficient one in the system.

The Mayo Clinic is not an aberration. One of the lowest-cost markets in the country is Grand Junction, Colorado, a community of a hundred and twenty thousand that nonetheless has achieved some of Medicare’s highest quality-of-care scores. Michael Pramenko is a family physician and a local medical leader there. Unlike doctors at the Mayo Clinic, he told me, those in Grand Junction get piecework fees from insurers. But years ago the doctors agreed among themselves to a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates. Problems went down. Quality went up. Then, in 2004, the doctors’ group and the local H.M.O. jointly created a regional information network—a community-wide electronic-record system that shared office notes, test results, and hospital data for patients across the area. Again, problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.

Grand Junction’s medical community was not following anyone else’s recipe. But, like Mayo, it created what Elliott Fisher, of Dartmouth, calls an accountable-care organization. The leading doctors and the hospital system adopted measures to blunt harmful financial incentives, and they took collective responsibility for improving the sum total of patient care.

This approach has been adopted in other places, too: the Geisinger Health System, in Danville, Pennsylvania; the Marshfield Clinic, in Marshfield, Wisconsin; Intermountain Healthcare, in Salt Lake City; Kaiser Permanente, in Northern California. All of them function on similar principles. All are not-for-profit institutions. And all have produced enviably higher quality and lower costs than the average American town enjoys.

When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

There is no insurance system that will make the two aims match perfectly. But having a system that does so much to misalign them has proved disastrous. As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

One afternoon in McAllen, I rode down McColl Road with Lester Dyke, the cardiac surgeon, and we passed a series of office plazas that seemed to be nothing but home-health agencies, imaging centers, and medical-equipment stores.

“Medicine has become a pig trough here,” he muttered.

Dyke is among the few vocal critics of what’s happened in McAllen. “We took a wrong turn when doctors stopped being doctors and became businessmen,” he said.

We began talking about the various proposals being touted in Washington to fix the cost problem. I asked him whether expanding public-insurance programs like Medicare and shrinking the role of insurance companies would do the trick in McAllen.

“I don’t have a problem with it,” he said. “But it won’t make a difference.” In McAllen, government payers already predominate—not many people have jobs with private insurance.

How about doing the opposite and increasing the role of big insurance companies?

“What good would that do?” Dyke asked.

The third class of health-cost proposals, I explained, would push people to use medical savings accounts and hold high-deductible insurance policies: “They’d have more of their own money on the line, and that’d drive them to bargain with you and other surgeons, right?”

He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”

Instead, McAllen and other cities like it have to be weaned away from their untenably fragmented, quantity-driven systems of health care, step by step. And that will mean rewarding doctors and hospitals if they band together to form Grand Junction-like accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering. Under one approach, insurers—whether public or private—would allow clinicians who formed such organizations and met quality goals to keep half the savings they generate. Government could also shift regulatory burdens, and even malpractice liability, from the doctors to the organization. Other, sterner, approaches would penalize those who don’t form these organizations.

This will by necessity be an experiment. We will need to do in-depth research on what makes the best systems successful—the peer-review committees? recruiting more primary-care doctors and nurses? putting doctors on salary?—and disseminate what we learn. Congress has provided vital funding for research that compares the effectiveness of different treatments, and this should help reduce uncertainty about which treatments are best. But we also need to fund research that compares the effectiveness of different systems of care—to reduce our uncertainty about which systems work best for communities. These are empirical, not ideological, questions. And we would do well to form a national institute for health-care delivery, bringing together clinicians, hospitals, insurers, employers, and citizens to assess, regularly, the quality and the cost of our care, review the strategies that produce good results, and make clear recommendations for local systems.

Dramatic improvements and savings will take at least a decade. But a choice must be made. Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world.

Something even more worrisome is going on as well. In the war over the culture of medicine—the war over whether our country’s anchor model will be Mayo or McAllen—the Mayo model is losing. In the sharpest economic downturn that our health system has faced in half a century, many people in medicine don’t see why they should do the hard work of organizing themselves in ways that reduce waste and improve quality if it means sacrificing revenue.

In El Paso, the for-profit health-care executive told me, a few leading physicians recently followed McAllen’s lead and opened their own centers for surgery and imaging. When I was in Tulsa a few months ago, a fellow-surgeon explained how he had made up for lost revenue by shifting his operations for well-insured patients to a specialty hospital that he partially owned while keeping his poor and uninsured patients at a nonprofit hospital in town. Even in Grand Junction, Michael Pramenko told me, “some of the doctors are beginning to complain about ‘leaving money on the table.’ ”

As America struggles to extend health-care coverage while curbing health-care costs, we face a decision that is more important than whether we have a public-insurance option, more important than whether we will have a single-payer system in the long run or a mixture of public and private insurance, as we do now. The decision is whether we are going to reward the leaders who are trying to build a new generation of Mayos and Grand Junctions. If we don’t, McAllen won’t be an outlier. It will be our future.


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Wednesday, January 27, 2010 7:07 AM

NIKI2

Gettin' old, but still a hippie at heart...


Frem, I wish I’d been here to see all that for myself. Would have been a balm to the soul after eight years of the crap I heard every way I turned! However, I don’t see people of either ilk who are as blind and “hard-whatever” as being able to SEE the deterioration of one of their own as you suggested; I’d chalk it up more to the election, which had to be a major shock to them. And I gotta caveat what you said with the fact that it’s just the hard-righters NOW, it can be either, yes?

Mike, you eloquently expressed my own fears…we shall have to wait and see, eh?

Perfesser, a truly accurate description of our CA debacle, I couldn’t agree more. Add to that the stupid Prop. 13 which has virtually bankrupted the state, and we’re not too smart out here, is we?

Correct me if I'm wrong, JS but I don't think the "cadillac tax" of unions was quite as you thought. It was my understanding that the unions agreed in bargaining to accept less pay so that they could keep their health insurance...so now going and CHARGING them for it is kind of wrong, don't you think? If they'd been given an exemption "just 'cuz", I'd agree, but I don't think that was so.

I certainly understand how the things you mentioned rub people the wrong way, and they do me as well in some cases. But the two senators you spoke of essentially BLACKMAILED the rest of the Dems into buying their votes or the Health Care bill wouldn't pass--which is wrong, and it's wrong of the Dems to give in, but I don't see it quite the same way as you do.

On the transparency thing, we fully agree. But as to conservatives supporting McCain to the bitter end, there’s already a movement afoot to oust him by the good old conservative-conservatives. So unless you mean the REPUBLICANS, I guess you’re wrong. Big difference these days between “conservative” and “Republican”, and growing moreso daily, it would seem.
Quote:

these mewling power hungry ambitious sons of jackals who'd sell us out first chance they get.
Oooo, I LIKE it, very visceral, felt gooood.

However, I’m forced to back off and play devil’s advocate in one respect, and one respect only. House is elected by population; Senate automatically gives two Senators to every state. Ergo, the Senate doesn’t necessarily reflect the MAJORITY of American people. Ergo, filibuster in itself is not letting the “minority” rule—I don’t know about currently, not bothering to check it out. That is the ONLY caveat I give, because I sincerely believe that the filibuster is on its way to becoming an impossible block to everything used by both parties. I’m not sure whether the Democrats will ever be as hard-nosed and stupid as the Republicans are right NOW, because they’ve always been more independent, but if they don’t, and the Republicans like this strategy, it will only be a Republican majority that will ever get anything done in future. I like that even less than BOTH parties abusing the filibuster.

Sorry, I don’t think there’s anything “noble” about staying home. If you don’t vote, you deserve what you get, as the saying goes. I won’t stay home….I’ve spent the majority of my adult life voting for the “least worst”, and I’ll continue to. Until and unless the Republicans were to actually put someone up I could believe in, which gets less and less possible as time goes on, it seems.

JS, to me the “Cougars” were as small an actual minority then as the Tea Partiers are now…vocal as hell, but not strong enough to carry much of anything. I was proud of Hillary for conceding, that’s something you rarely see in a politician, however bad the numbers. And I think she knew she didn’t have the numbers, but still, most politicians will fight to the very end. I’m not as vituperative about Hillary as many are, so I guess I’m prejudiced on the issue.
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Yeah, really? Great idea, but how're you gonna do it?
Yes, Sig; “adult” and “politician” are an oxymoron, have been for ages, will continue to be I think.
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…somehow that group is united in a common but majority-opposed position
Rue, I agree with you in principle, but at PRESENT I think that IS the case. We can’t even know what most of the Republicans in Congress THINK, they are following party line currently, and party line is “No”. I’m only saying that about NOW, but it’s pretty obvious to me that’s the case. I’d actually like to know what any Republican who hasn’t been shooting off their mouth does think, because I think there might be some who disagree with their party’s chosen line. Maybe… or not.



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Wednesday, January 27, 2010 7:40 AM

BYTEMITE


Interesting. Of course I know some doctors go into the business to make money for as little service provided as possible (the old golfing jokes), but I hadn't realized it was a mindset that had become systematic.

It is only two hospitals we're comparing here, so I'm not going to assume everywhere is one or the other or that most places are like McAllen. But the idea of doctors working together to get more money, maybe starting as innocently as a more experienced doctor asking a new doctor to send patients over to him if such-and-such, and that referral list growing as the young doctor continues to get contacts at a hospital and creating an "I'll scratch your back if you scratch mine" sort of dynamic... Well, you do see that.

And I'm familiar with Intermountain HealthCare. The only hospital regionally that comes close in terms of care is the University of Utah, and I suspect that's only because it's a research hospital that gets a lot of untarnished med students and because it has a much higher patient load to offset losses.

Honestly, regular hospitals are losing business. If this is the big problem, then systems like the Mayo clinic are going to win out over greed. Legislating may not help anything long term because it won't change the mindset, only evidence that long term McAllen model hospitals aren't viable and will lose patients will win in the end.

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Wednesday, January 27, 2010 7:48 AM

RUE

I have a vote and I'm not afraid to use it!


A government-run healthcare option where patients get the care they NEED instead of the care that makes someone the most profit would provide good national competition to our current greed-driven capitalistic system.


But anyway - off of health care and back to the filibuster ...

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Wednesday, January 27, 2010 8:07 AM

BYTEMITE


Oh, I like a public option, that's part of why the mandatory health insurance garbage annoys me so much, because there isn't one being offered with it. And provided we can balance the budget and make enough cuts that we could SUPPORT the thing.

But yes, you're right. Filibuster.

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Wednesday, January 27, 2010 8:33 AM

JONGSSTRAW


Amazing how the Republicans get blamed for the woes that Pelosi & Reid have gone through on Healthcare. Republicans have NOT fillibustered Healthcare, and everyone knows it was Democrats who have screwed the whole thing up. From Baucus to Stupak-Pitts, from Landrieu to Nelson, and from Liebermann to Obama's lock-step Unions....ALL Democrat roadblocks and payoffs. So please stop the ideological spinning on this. Polls and trends are showing that tired song is dropping fast in the charts.

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Wednesday, January 27, 2010 8:42 AM

RUE

I have a vote and I'm not afraid to use it!


I guess I haven't been paying attention. Could you point out where republicans are being unfairly blamed ? I thought that their use of the filibuster threat is pretty well documented and a fair criticism, not just where its applied to health care reform, but everything else ...

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Wednesday, January 27, 2010 8:52 AM

JONGSSTRAW


Sorry, didn't mean to necessarily apply that statement to the RWED, but it has been a central theme by Obama's Administration and their media supporters time and time again. A "threat" of a fillibuster should not stop true believers from moving forward. Back last Summer, I fully expected Obamacare to pass, and he would sign the new Law. But it was one thing after another, one delay by Democrats themselves after another. I am simply stunned that they could not get it done. I never heard much rancor about the age-old Senate practice of fillibuster when Democrats fillibustered lots of proposed Republican-majority legislation during Bush's first 6 years, including one fillibuster by Dems in 2006 that killed Fannie-Freddie reform. Of course Senators Dodd and Obama, recipients of lots of Fannie-Freddie campaign cash supported the fillibuster.

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Wednesday, January 27, 2010 9:06 AM

BYTEMITE


Well, this begs the question of whether Democrats really wanted to pass healthcare reform in the first place, because it does seem like a convenient excuse.

But that might be too conspiracy theory, so... Insurance industry threatened to pull campaign contributions, and Democrats are generally less secure with the industries?

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Wednesday, January 27, 2010 9:07 AM

NIKI2

Gettin' old, but still a hippie at heart...


JS, I call your argument fallacious.
Quote:

Amazing how the Republicans get blamed for the woes that Pelosi & Reid have gone through on Healthcare. Republicans have NOT fillibustered Healthcare
As I quoted far above,
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The most widely cited enabler for the recent acceleration was a 1975 Senate rule change—one that, coming at a time when filibusters were on the rise, sought to reduce them by lowering the cloture requirement from 67 to 60 votes. But this fix (combined with a less widely cited earlier procedural change made in 1961) inadvertently increased the filibuster's use by ushering in the so-called "procedural" filibuster, a sort of filibuster-lite that allowed the minority to block legislation without a dissenting senator's having to speechify himself hoarse.

In the modern filibuster, the senators trying to block a vote do not have to hold the floor and continue to speak as long as there is a quorum. In the past, when one senator became exhausted, another would need to take over to continue the filibuster. Ultimately, the filibuster could be exhausted by a majority who would even sleep in cots outside the Senate Chamber to exhaust the filibusterers. Today, the minority just advises the majority leader that the filibuster is on. All debate on the bill is stopped until cloture is voted by three-fifths (now 60 votes) of the Senate.

http://www.slate.com/id/2241233/?from=rss

All the Republicans had to do was inform the Democrats of their intent to call a procedural filibuster, and the Democrats had to come up with 60 votes to overcome it. “all the woes” you speak of have been necessary because of that fact; if the health care reform bill could be voted on by a simple majority, none of this would have been necessary and we’d have the bill by now. It passed, in a better form, through the House with no problem. So there’s no unfair blaming of the Republicans; purely and simply, they made all the wrangling necessary, period.

As to the lack of rancor about Dems’ use of the filibuster; they never used it universally, declaring themselves the party of no and saying quite plainly that they wouldn’t vote for ANYTHING...they have used the filibuster--via “procedural filibuster”--more than it has ever been used in the history of this country. That misuse of it is what is bringing about the cry to do away with it. The traditional use of the filibuster has disappeared with the Republicans’ decision to use it virtually universally, forcing a sixty-vote majority on everything.



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Wednesday, January 27, 2010 9:22 AM

JONGSSTRAW


Niki, I don't have the mental chops to split existential hairs with you or most of your comrades here. And it's difficult for me to respond to long, cherry-picked objections to my rather pedestrian points. I write what I believe, and what I believe is going on in America. If I'm wrong I usually admit it. Good luck with your agenda.

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Wednesday, January 27, 2010 9:27 AM

NIKI2

Gettin' old, but still a hippie at heart...


I don't have an "agenda", JS, only opinions (yeah, I caught the snark). It's not an existential question, and I wasn't "cherry-picking", I was responding to your entire post on the subject.

To put it as concisely as I can: You commented rather forcefully about all the problems the Dems have had in passing health care, that the Repubs haven't filibustered and it was "ideological spinning" to blame them. I was trying to give you quotes to explain they don't NEED to anymore; they merely have to inform the other party of a "procedural filibuster" then sit back and wait for that party to try and come up with 60 votes, which is what caused all the problems. That's all.



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Wednesday, January 27, 2010 9:37 AM

JONGSSTRAW


I said good luck with your agenda, and I what I meant to say is good luck with whatever you want. There was no snark intended, but I can see how it appeared that way so I apologize. I get caught sometimes between facts and sarcasm, especially when I'm mentally worn down at work.

In recent history, has there been a Supermajority before? I cannot recall that situation, so it's natural to think that an extraordinary situation would necessitate extraordinary means of countering the "un-stoppable" majority.

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Wednesday, January 27, 2010 10:01 AM

RUE

I have a vote and I'm not afraid to use it!


"Robert Byrd, a Democrat from West Virginia, was majority leader in 1988, when Democrats controlled 54 seats and wanted to push through campaign finance reform.

But Republican minority leader Alan Simpson of Wyoming was easily able to block it by sitting on the Senate floor and occasionally noting the absence of a quorum, thwarting a vote.

"Alan Simpson basically guarded the floor and the other Republicans simply went home," says Dove.

Byrd, fed up and deprived of the spectacle of non-stop-speechifying, ordered the sergeant-at-arms to arrest Sen. Bob Packwood (R-OR) and physically carry him to the Senate floor so he could be counted in a quorum call. Such a move is within the legal right of a majority leader, but it backfired when the sergeant-at-arms accidentally injured the 6'6", 235-pound Packwood.

Byrd and Senate Democrats eventually gave up. "I don't like to do things on a win-lose basis. I would rather say that we apparently have prevailed," Simpson boasted at the time.

Dove concurs with Simpson's political scorekeeping. "It was almost a farce," says Dove. "The bottom line is the bill never passed.""

So, republicans don't actually have to talk to block a vote: all they have to do is send everyone home except one lone scout.



BTW - that peak in 1993-1994 ? Republicans were the minority. That dip in 2003-2004 ? Democrats were the minority. That off-the-charts rise at the end ? Republicans.

Either way, Jong, I think, I hope you know at this point that republicans have pretty much abused the procedure, while democrats have demonstrably not. That is a fact, and trying to erase it by calling us 'comrades' doesn't cut it.

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Wednesday, January 27, 2010 11:44 AM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by Jongsstraw:
Quote:

Originally posted by Kwicko:
Quote:

Originally posted by Jongsstraw:
I don't think he'll ever "lose" his base.




Wanna bet?


Obama's well on his way to losing any support I might give him, either in the 2010 mid-terms OR in the 2012 presidential election.

And no, I'm not likely to support any Republican at the national level (unless something REALLY revolutionary happens within that party); I'm more likely to just stay home, like I did in '96. In '92 I voted for Perot mostly as a protest vote, but in '96 there wasn't even that option, so I didn't even waste my time going to the polls. First and only time I ever did that in a presidential election. Obama's shooting for number two, and so far, he's doing a great job of losing my interest and support.


Wow! I guess I don't really understand the passion that Liberals have then. You would choose not to vote for a Dem you didn't like by staying home, rather than vote for him anyway as a measure to cancel out a Republican's vote. That is remarkable, and quite noble.




Nope, not remarkable, and certainly not noble. I just couldn't, in good conscience, vote for Clinton. Or Dole. Something intensely sleazy about ol' Slippery Bill, just like there was always an "ick" factor about John Edwards, even before his affairs came out. Sometimes you just get a bad vibe off someone; Clinton does that to me. It's not exactly a brimstone smell; more like Aqua Velva and Hai Karate. :)

And I just couldn't support a doddering old fool like Dole, could I?

So I didn't take the noble path or do anything remarkable; I took the lazy man's path, and stayed home and watched TV. :)

And really, I've never regretted that decision. I don't think I'd have really regretted it if Dole had somehow won, because nothing would have changed, I don't think. It felt like one of those rare occasions where your vote profoundly DOESN'T matter - and that's coming from an old-school government major.

Mike

Work is the curse of the Drinking Class.
- Oscar Wilde

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