Monday, April 29, 2013
The Alleged Hatred in the Heart of White America
Leftists see hate where there is none -- because hate fills their own hearts. They judge others by themselves
It was cool and rainy Sunday morning when the bomb ripped through the building. At 10:22, a group of children was just heading into the basement to hear a sermon at the 16th Street Baptist Church in Birmingham, Ala. According to a Washington Post account at the time: Dozens of survivors, their faces dripping blood from the glass that flew out of the church's stained glass windows, staggered around the building in a cloud of white dust raised by the explosion.
Four girls were killed. The head of one little girl was found far from her body. Twenty-two others were injured. Wandering through his devastated church, the Rev. John H. Cross found a megaphone and asked the enraged and stunned crowd to disperse. "The Lord is our shepherd," he sobbed, "we shall not want."
This week, Congress marked the 50th anniversary of that terror attack by posthumously awarding the Congressional Gold Medal to Denise McNair, Carole Robertson, Addie Mae Collins and Cynthia Wesley.
We Americans are not confused about the morality of what happened in Birmingham that September morning in 1963, nor during the Jim Crow era in America generally. We do not hesitate to condemn utterly the behavior and the beliefs of the Ku Klux Klan (the perpetrators of this bombing and others) and their white supremacist fellow travelers. We do not worry that reviling white supremacists and their grotesque deeds will somehow taint all white people.
But when it comes to other groups and other motives for the same kind of terrorism — we lose our moral focus. Bill Ayers, Bernadine Dohrn and Kathy Boudin have become honored members of the faculties at leading universities. Ayers is even the friend of the president of the United States. Regarding his own record of setting bombs that kill and dismember innocent people, Ayers told The New York Times on the ironic date of Sept. 11, 2001 that "I feel we didn't do enough ... (there's) a certain eloquence to bombs, a poetry and a pattern from a safe distance." So says a retired "distinguished professor" at the University of Illinois at Chicago.
Today, American liberals are obsessed not with terrorism but with the color and ethnicity of terrorists. They can readily enough attribute violent tendencies to groups they dislike — the tea party, for example, which hasn't committed so much as a littering offense. But when it comes to Islamic terrorism, their voices falter.
Attorney General Eric Holder, asked whether three attacks on the United States (the underwear bomber, the Times Square bomber and Maj. Nidal Hassan) could be attributed to "Islamic" radicalism, refused to say so. Asked repeatedly whether religious motives played a role, Holder would say only, "there are a variety of reasons why people have taken these actions." Janet Napolitano has been quick to dismiss terror attempts as "one offs." Would Holder and Napolitano say the same about white supremacists? Each one had his own motivations and we can't surmise what those factors were?
There is a tendency among many on the left to temper their disgust and indignation at political violence (i.e. terror) if the terrorist is from the "correct" group. "Muslim ... means not being white" Peter Beinert writes in the Daily Beast.
Beinert and other liberals imagine that the U.S. is a cauldron of teeming racism with the lid barely kept down. At the first acknowledgment that Islamists (some, but by no means, all of whom are dark skinned) present a continuing threat, the lid will fly off and white American vigilantes, given permission, will start shooting black and brown people on the streets, burning their shops, and bombing mosques.
The hatred that Islamism preaches, lauds and inspires is a nuisance, liberals may concede. But the hatred in the heart of "white America" is the greater danger.
Obama’s Labor Secretary nominee, Thomas Perez, is radical and unethical
by Hans Bader
A Senate committee will soon vote on Obama’s nomination of left-wing radical Thomas Perez as Labor Secretary. Perez, currently the assistant attorney general for civil rights, has been described by Cato Institute lawyer Ilya Shapiro as a man “who personifies … this administration’s flouting of the rule of law.”
The Senate Health, Education, Labor, and Pensions Committee will decide on the Perez nomination. Shapiro provides this “recap of Perez’s nefarious dealings” (drawing on the work of journalist Quin Hillyer, who provides more detail at this link):
* Interference with the Supreme Court case of Magner v. Gallagher, getting the City of St. Paul to dismiss its appeal to prevent what would’ve been a sharp rebuke to the federal government regarding its use of “disparate impact” racial theories in housing policy. [I discussed Perez's misuse of "disparate impact" law here]
* Refusal to comply with subpoenas from the U.S. Commission on Civil Rights [which I earlier discussed here];
* Dismissal of the Justice Department’s already-won prosecution of the Black Panthers for voter intimidation during the 2008 election [which I previously discussed at this link];
* Running a department dedicated to the proposition that voting rights and other civil rights law don’t protect white people [I discussed one such example here, and federal court rulings rejecting this false proposition];
* Willfully misleading and lying to Congress under oath several times [for example, U.S. District Judge Reggie Walton concluded that Perez made false claims about the Obama Justice Department's dismissal of the case against Black Panthers for voter intimidation];
* Racial abuse of the New York fire department, to the detriment of public safety and qualified minority applicants;
* Hiring for “career” (non-political appointee) slots only attorneys who have demonstrable left-wing credentials—making Alberto Gonzales’s politicized-hiring foibles look like the model of civil service administration [see examples here];
* Trampling on religious liberties to the point the Supreme Court unanimously rejected his arguments in Hosanna-Tabor v. EEOC regarding the “ministerial exception” to employment laws;
* Conducting government business from a personal email account as many as 1,200 times (!) and now refusing to comply with congressional subpoenas to release those emails. [Lawyers at the Competitive Enterprise Institute (CEI) have repeatedly uncovered such abuses, and the use of false-identity alias email addresses, by Obama administration officials, as you can see here and here].
CEI earlier discussed the Magner case and why the Obama Administration’s position in that case could undermine the stability of the financial system and cause future financial meltdowns. (CEI joined in an amicus brief opposing the Obama Administration’s position, in the Supreme Court). It also highlighted the Obama administration’s (and Perez’s) massive, ethically dubious payoff to the City of Saint Paul to drop the case. CEI and legal commentators also chronicled the Obama Administration’s use of meritless discrimination lawsuits to pay off trial lawyers at taxpayers’ expense (culminating in a New York Times story today about massive fraud in the Pigford case).
Earlier, I discussed the Obama Administration’s extreme position in the Supreme Court’s Hosanna-Tabor case and how it would have undermined First Amendment freedoms, religious autonomy and the separation of church and state. I also chronicled the Justice Department’s politicized hiring during the Obama Administration.
As health care gets more bureaucratic, many doctors will drop out
Jeffrey A. Singer
I am a general surgeon with more than three decades in private clinical practice. And I am fed up. Since the late 1970s, I have witnessed remarkable technological revolutions in medicine, from CT scans to robot-assisted surgery. But I have also watched as medicine slowly evolved into the domain of technicians, bookkeepers, and clerks.
Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing doctors to sacrifice their independent professional medical judgment, and their integrity. The consequence is clear: Many doctors from my generation are exiting the field. Others are seeing their private practices threatened with bankruptcy, or are giving up their autonomy for the life of a shift-working hospital employee. Governments and hospital administrators hold all the power, while doctors—and worse still, patients—hold none.
The Coding Revolution
At first, the decay was subtle. In the 1980s, Medicare imposed price controls upon physicians who treated anyone over 65. Any provider wishing to get compensated was required to use International Statistical Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes to describe the service when submitting a bill. The designers of these systems believed that standardized classifications would lead to more accurate adjudication of Medicare claims.
What it actually did was force doctors to wedge their patients and their services into predetermined, ill-fitting categories. This approach resembled the command-and-control models used in the Soviet bloc and the People’s Republic of China, models that were already failing spectacularly by the end of the 1980s.
Before long, these codes were attached to a fee schedule based upon the amount of time a medical professional had to devote to each patient, a concept perilously close to another Marxist relic: the labor theory of value. Named the Resource-Based Relative Value System (RBRVS), each procedure code was assigned a specific value, by a panel of experts, based supposedly upon the amount of time and labor it required. It didn’t matter if an operation was being performed by a renowned surgical expert—perhaps the inventor of the procedure—or by a doctor just out of residency doing the operation for the first time. They both got paid the same.
Hospitals’ reimbursements for their Medicare-patient treatments were based on another coding system: the Diagnosis Related Group (DRG). Each diagnostic code is assigned a specific monetary value, and the hospital is paid based on one or a combination of diagnostic codes used to describe the reason for a patient’s hospitalization. If, say, the diagnosis is pneumonia, then the hospital is given a flat amount for that diagnosis, regardless of the amount of equipment, staffing, and days used to treat a particular patient.
As a result, the hospital is incentivized to attach as many adjunct diagnostic codes as possible to try to increase the Medicare payday. It is common for hospital coders to contact the attending physicians and try to coax them into adding a few more diagnoses into the hospital record.
Medicare has used these two price-setting systems (RBRVS for doctors, DRG for hospitals) to maintain its price control system for more than 20 years. Doctors and their advocacy associations cooperated, trading their professional latitude for the lure of maintaining monopoly control of the ICD and CPT codes that determine their payday. The goal of setting their own prices has proved elusive, though—every year the industry’s biggest trade group, the American Medical Association, squabbles with various medical specialty associations and the Centers for Medicare and Medicaid Services (CMS) over fees.
As goes Medicare, so goes the private insurance industry. Insurers, starting in the late 1980s, began the practice of using the Medicare fee schedule to serve as the basis for negotiation of compensation with the doctors and hospitals on their preferred provider lists. An insurance company might offer a hospital 130 percent of Medicare’s reimbursement for a specific procedure code, for instance.
The coding system was supposed to improve the accuracy of adjudicating claims submitted by doctors and hospitals to Medicare, and later to non-Medicare insurance companies. Instead, it gave doctors and hospitals an incentive to find ways of describing procedures and services with the cluster of codes that would yield the biggest payment. Sometimes this required the assistance of consulting firms. A cottage industry of fee-maximizing advisors and seminars bloomed....
As the third party payment system led health care costs to escalate, the people footing the bill have attempted to rein in costs with yet more command-and-control solutions. In the 1990s, private insurance carriers did this through a form of health plan called a health maintenance organization, or HMO. Strict oversight, rationing, and practice protocols were imposed on both physicians and patients. Both groups protested loudly. Eventually, most of these top-down regulations were set aside, and many HMOs were watered down into little more than expensive prepaid health plans.
Then, as the 1990s gave way to the 21st century, demographic reality caught up with Medicare and Medicaid, the two principal drivers of federal health care spending.
Twenty years after the fall of the Iron Curtain, protocols and regimentation were imposed on America’s physicians through a centralized bureaucracy. Using so-called “evidence-based medicine,” algorithms and protocols were based on statistically generalized, rather than individualized, outcomes in large population groups.
While all physicians appreciate the development of general approaches to the work-up and treatment of various illnesses and disorders, we also realize that everyone is an individual—that every protocol or algorithm is based on the average, typical case. We want to be able to use our knowledge, years of experience, and sometimes even our intuition to deal with each patient as a unique person while bearing in mind what the data and research reveal.
On more than one occasion I have seen patients develop dramatic postoperative bruising and bleeding because of protocol-mandated therapies aimed at preventing the development of blood clots in the legs after surgery. Had these therapies been left up to the clinical judgment of the surgeon, many of these patients might not have had the complication.
Operating room and endoscopy suites now must follow protocols developed by the global World Health Organization—an even more remote agency. There are protocols for cardiac catheterization, stenting, and respirator management, just to name a few.
Patients should worry about doctors trying to make symptoms fit into a standardized clinical model and ignoring the vital nuances of their complaints. Even more, they should be alarmed that the protocols being used don’t provide any measurable health benefits. Most were designed and implemented before any objective evidence existed as to their effectiveness.
One of my colleagues, a noted pulmonologist with over 30 years’ experience, fears that teaching young physicians to follow guidelines and practice protocols discourages creative medical thinking and may lead to a decrease in diagnostic and therapeutic excellence. He laments that “‘evidence-based’ means you are not interested in listening to anyone.”
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Posted by JR at 12:44 AM