Tuesday, September 30, 2008

There Is No Fourth Turning

http://www.time.com/time/nation/article/0,8599,1845655,00.html

The Bailout Defeat: A Political Credibility Crisis
By Michael Scherer / Washington Tuesday, Sep. 30, 2008

There was a lack of trust, a loss of confidence, a popular revolt.

Nearly every major political leader in the U.S. supported the $700 billion financial-bailout bill. The President. The Vice President. The Treasury Secretary. The Chairman of the Federal Reserve. The Chairman of the Securities and Exchange Commission. The Democratic and Republican nominees for President. The Democratic and Republican leadership of the House and Senate. All of them said the same thing: vote yes.

But a majority of those politicians anointed by the Constitution to reflect the will of the people voted no. This is a remarkable event, the culmination of a historic sense of betrayal that Americans have long felt for their representatives in Washington. The nation's credit crisis on Monday exposed a much deeper and more fundamental problem: a crisis of political credibility that now threatens to harm our nation further, should the markets freeze up and more companies begin to fail, as many experts predict.

The problem has been growing for years. Roughly 28% of Americans approve of President Bush. Roughly 18% of Americans approve of Congress. Now those low numbers and majority of bad feelings have manifested themselves in the starkest of terms.

Asked to take a leap of faith regarding a dizzyingly complex problem, a critical mass of voters refused to trust their leaders, turning down the medicine that was offered. And so the politicians who are most exposed to popular whims have run for cover. With an election on the horizon, 95 House Democrats and 133 House Republicans opposed the bill. Some portion voted no for clearly ideological reasons. But many more were simply doing what politicians do — responding to the will of the people.

An analysis by statistician Nate Silver, who runs FiveThirtyEight.com, made this clear. Of the 38 incumbent members of Congress from both parties who are considered vulnerable in the coming election, 30 voted against the bill (eight supported it). By contrast, members of Congress from relatively safe districts were evenly divided — 197 for it to 198 against it.

"What this showed more than anything else was that not even members of Congress can ignore a switchboard system of Capitol Hill that is so totally jammed," said Peter Sepp, a conservative opponent of the bill with the National Taxpayers Alliance.

If the experts are right, the nation now risks great financial hardship, because there was no one to stand up and explain the situation. The Dow Jones industrial average dropped 778 points on the news. Treasury Secretary Hank Paulson warned Monday afternoon that car loans and student loans were likely to tighten. Other economists have warned of the possibility of widespread corporate failures and unemployment, if the short-term credit markets freeze up. Bank failures, or mergers, are likely to continue. The taxpayer costs of federal insurance on deposits could increase.

In a worst-case scenario, economic historians may find that all of Paulson's predictions come true, leaving the cost to the Federal Government far greater than the risky $700 billion investment in the private sector. If this comes to pass, the historians will find many people to blame: Paulson and President Bush for failing to explain the plan better. The House leadership for failing to whip enough votes. Even the presidential candidates for failing to use their bully pulpit to force the issue.

But those historians should not forget that roots of the failure predate the vote on Monday, and even the mistakes of Wall Street. Years ago, the trust between the people and their politicians was broken. Credibility was lost. The reserve of goodwill went bankrupt. And when they needed it most, our nation's leaders found that they had squandered their ability to exert influence over the people who chose them to lead.

Sunday, September 28, 2008

Bailout Spin, Machine-Gunned Down

http://www.huffingtonpost.com/hale-stewart/whos-to-blame-for-the-mes_b_130044.html

THIS. Sooooo This.

http://www.realclearpolitics.com/articles/2008/09/and_it_was_written_our_blame.html

September 28, 2008
And It Was Written, Our Blame
By Rod Dreher

Novelist David Foster Wallace, who recently committed suicide at age 46, once told an interviewer that his generation had been morally "gutted" by a pseudo-sophistication that sneered at boring everyday truths. He explained that privilege had caused so many of his contemporaries to forget that plain-spoken wisdom – the sort of truisms that supposedly only children and suckers believe – is actually, you know, valid.

"The idea that something so simple and, really, so aesthetically uninteresting – which for me meant you pass over it for the interesting, complex stuff – can actually be nourishing in a way that arch, meta, ironic, pomo stuff can't, that seems to me to be important," he said. "That seems to me like something our generation needs to feel."

Mr. Wallace had his epiphany attending Alcoholics Anonymous meetings as research for his groundbreaking 1996 novel Infinite Jest.

The novelist saw that drunks who had hit rock bottom came to see self-help aphorisms as ladders out of hell. This was a new thing for him. In the light of suffering and intense human need, principles that many of us have come to disdain as sentimental clich├ęs appeared as saving truths.

Mr. Wallace's observation came to mind the other day as I watched a beleaguered Wall Street executive on MSNBC try to obfuscate his company's key role in helping cause the crisis, the near-apocalypse that has delivered the U.S. financial system to the far end of the valley of the shadow of debt, to the edge of Armageddon. The poor man gassed on for 10 minutes, using every possible verbal maneuver to avoid answering direct questions put to him by journalists.

Who can blame him? We have become used to this sort of thing. We've come to prefer comforting lies to hard truths born of observation and experience, thinking that in our brilliance we had somehow escaped the iron law of necessity. Rudyard Kipling satirized this arrogance nearly a century ago in his poem, "The Gods of the Copybook Headings" (a copybook was a primer in which British schoolchildren learned handwriting by copying familiar proverbs).

Here's a verse rather relevant to the current moment:

Then the Gods of the Market tumbled, and their smooth-tongued wizards withdrew,

And the hearts of the meanest were humbled and began to believe it was true

That All is not Gold that Glitters, and Two and Two make Four –

And the Gods of the Copybook Headings limped up to explain it once more

As it turns out, the moralistic platitudes you learned at your grandfather's knee – What goes up must come down; you can't get something for nothing – hold up better than the obscure incantations of Wall Street's pinstriped deities, those Masters of the Universe who have flattered their genius on the financial pages during our latter-day Gilded Age.

Why, it was thought by both Republicans and Democrats in the 1990s and beyond, the Great Greenspan, with his gnomic utterances, had put us on the path to permanent wealth. American market capitalism had triumphed. It was a magical idea that captivated everybody.

Though the left wishes to believe that the current crisis is a conservative invention, in the heady Bill Clinton years, even liberals heard the prosperity gospel and believed. Nobel laureate economist Joseph Stiglitz, who headed Mr. Clinton's Council of Economic Advisers, said deregulation mania and Wall Street lobbying caused Washington to throw prudence to the wind during the Clinton years and beyond.

Mr. Stiglitz made those remarks six years ago, predicting that the Enron scandal would finally arouse lawmakers and the public to the fundamental dangers of deregulation. We see today how well that worked out.

Complex financial instruments come and go, but the hearts of men remain the same. Greed, vanity and hubris we always have with us, as well as a weakness for the soft sophisticated lie over the hard plain truth. About human nature, tradition – the accumulated wisdom of mankind – is never wrong. True conservatives – as opposed to those who confuse mammon-worship with moral and intellectual principle – know that a tolerable order can only exist when most people live by the moral laws articulated in time-worn banalities.

So, send the tumbrels into the streets to carry off the heads of sophisticates who believed that we had repealed the laws of economics and human nature by our cleverness. The Gods of the Copybook Headings demand propitiation. We shall offer them scapegoats and try to forget our own complicity in the coming catastrophe.

After all, these scoundrels did not elect themselves, nor was there an outcry heard in the land against Wall Street rapacity and recklessness when our 401(k)s were rising, and all but the lowliest plebeian was moving into his very own McMansion.

Along those lines, there's one proverb that we will all become painfully acquainted with in the years to come: You reap what you sow.
Rod Dreher is a Dallas Morning News editorial columnist. His e-mail address is rdreher@dallasnews.com.

Bush Binge Drinks, We Get the Hangover

And so does the next President:

http://www.politico.com/news/stories/0908/14027.html

Bush binges; Obama and McCain will pay
By JIM VANDEHEI & MIKE ALLEN | 9/28/08 7:06 AM EDT

The bailout, the wars, and unplanned domestic spending will all help to leave a gaping hole in America's budget—a hole that the next president must fill.
Photo: Composite image by Politico.com

Barack Obama says a John McCain victory would amount to a third term of the Bush presidency. What he doesn’t say: an Obama victory would, too.

While both nominees love to talk about their big agendas for change, whoever wins will take office with their obligations defined and options constrained by what Bush dumps on their lap.

The focus right now – and probably for many months to come – is the bailout binge aimed at saving our financial system. All told, the government will likely put more than $1 trillion on the line (with hope the money will be recouped down the road).

Then there are the two wars, in Iraq and Afghanistan. The combined cost is fast approaching $1 trillion, too – and both will eat up the time and budgets of the next president.

Then there is also the prescription drug benefit Bush added to Medicare. It carries a projected price tag of nearly $700 billion over ten years and serves as a powerful reminder of how big – untenably big, many experts say – our entitlement programs have grown.

None of that spending was cooked into the federal budget when Bush took office eight years ago, leaving a budgetary hole almost too deep to comprehend. It will tie the hands of President McCain or President Obama in ways neither candidate has reckoned with yet on the campaign trail.

“It’s really a federal fiscal catastrophe in coming years,” says Chris Edwards of the Cato Institute, a libertarian-oriented think tank. “With all this stuff coming up now, it’s massive, big decisions the next president is going to have to make.”

As the candidates debate the nuances of their health care plans or tax cuts, consider:

How can you cut taxes when the government is so deep in the red? The budget deficit is projected to top $400 billion – and that was before the bailout.

How can you expand health care coverage when the country is broke? The federal debt is now expected to top $11 trillion by 2010.

How can you focus on “earmarks” and “waste” when everyone knows they make up a meaningless fraction of the federal budget?

How you tackle spending without a serious discussion of serious cuts to Medicare and Social Security, which account for 43.5 percent of federal spending?

How can you focus on anything but war, when you inherit two conflicts with outcomes that are very much in doubt? (U.S commanders say the war in Afghanistan is going worse then ever and will require many more troops to win.)

A lesson of the Bush binge is the awesome weight of the choice for president. His eight years of surprises shows that you never know exactly what you’re voting for.

He ran as a compassionate conservative who promised to restrain spending and practice a humble foreign policy. Instead, he launched two big wars and oversaw the biggest expansion of federal government in history.

He was obviously shaped by big events: the terrorist attack of Sept. 11, 2001 and now the meltdown of the nation’s financial structure. This serves as a powerful reminder that what candidates say during these campaigns usually isn’t the best guide to how they will govern in office.

In Friday's debate, the candidates paid only glancing attention to the fiscal state of the nation they will run. There was virtually no talk about rising Medicare costs or the fiscal fallout of running two wars.

Both candidates continue to talk about their plans as if it's 2000. McCain even said in a CNBC interview last week that he thinks he can still deliver on his promise to extend the Bush tax cuts and balance the budget in his first term. Good luck.

Obama seems to be catching on. In a companion CNBC interview, he suggested he would be able to stick to his plans for spending on health care, education, energy, middle-class tax cuts and the environment.

But in a later conversation on NBC’s “Today” show, he acknowledged that in light of the Wall Street package, he wouldn’t be able to do everything right away (which of course you can’t anyway, since the agenda has to go through Congress).

Now, Obama says he’ll seek to phase in his plans, though he offers little detail.

So Bush’s legacy is not just his own. He has also written an expensive, painful opening chapter for the next guy.

Alexander Burns contributed to this story.

McCain, The Gambler

http://www.nytimes.com/2008/09/28/us/politics/28gambling-web.html?_r=2&hp&oref=slogin&oref=slogin

Welcome To The Third World

http://www.latimes.com/news/opinion/commentary/la-oe-brooks18-2008sep18,0,7282720.column

Saturday, September 27, 2008

Account Overdrawn!

http://www.reuters.com/article/marketsNews/idUSPEK16693720080925

BEIJING, Sept 25 (Reuters) - Chinese regulators have told domestic banks to stop interbank lending to U.S. financial institutions to prevent possible losses during the financial crisis, the South China Morning Post reported on Thursday.

The Hong Kong newspaper cited unidentified industry sources as saying the instruction from the China Banking Regulatory Commission (CBRC) applied to interbank lending of all currencies to U.S. banks but not to banks from other countries.

"The decree appears to be Beijing's first attempt to erect defences against the deepening U.S. financial meltdown after the mainland's major lenders reported billions of U.S. dollars in exposure to the credit crisis," the SCMP said.

A spokesman for the CBRC had no immediate comment. (Reporting by Alan Wheatley and Langi Chiang; editing by Ken Wills)

Friday, September 26, 2008

Dress Code At the Polls

Don't wear any campaign shirts, buttons, pins, or other identifying stuff when you go to vote. Appparently an old law regarding electioneering may be enforced for this election:

"Please advise everyone you know that they absolutely cannot go to the polls wearing any (candidate) shirts, pins, or hats. It's against the law and will be grounds to have the Polling Officials to turn you away. That is considered campaigning and no one can campaign within X amount of feet to the polls. They are banking on us being excited and not being aware of this long standing law that you can bet will be enforced this year.

They are banking that if you are turned away, you will not go home and change your clothes. Please just don't wear (candidate) gear of any sorts to the polls! Please share this information. Oh, and for those of you who were already aware, this was not meant to insult your intelligence, I am just trying to cover all angles.

I checked this out with the County Board of Election Commission and its true that it is a long-standing law, but not something just enforced this year. Mostly, what they would say is to take off the campaign button and turn the tee-shirt inside out in order to vote.

Mostly they do this to keep campaign volunteers outside and not interfering with the voting process. Sounds reasonable to me!"

The Real Election Result

http://www.timesonline.co.uk/tol/comment/columnists/gerard_baker/article4827820.ece

From The Times
September 26, 2008
This is the election you wouldn't want to win
The bad news: November's victor could be a one-term disaster. The good news: a great president may follow him
Gerard Baker

Victorious Roman generals were reminded of the fickleness of their glory by a slave carefully positioned in earshot on the triumphal parade route.

“Memento mori,” the hapless servant would whisper to the wreathed victor as his chariot rattled along Rome's jubilant streets: “Remember you are mortal.”

They don't have slaves in America any more but perhaps the winner of November's presidential election should consider having one of his lower-paid deputy-assistants mutter something similar in his ear as he takes the tribute on Inauguration Day next January.

It is highly probable that that moment, the very hour that he takes office, will be the high point of his presidency. Whoever wins on November 4 will be ascending to the job at one of the most difficult times for an American chief executive in at least half a century. When the votes are counted his people might ruefully conclude that the victor is not Barack Obama or John McCain. The real winner will be Hillary Clinton, or Mitt Romney, or Mike Huckabee, or some now happily anonymous figure whose star will rise in the next four turbulent years.

2008 may be the best year there has been to lose an election.

This sobering reality was startlingly underscored this week by none other than Tom Daschle, the former leader of the Senate Democrats, the national co-chairman of Mr Obama's presidential campaign, and the likely White House chief of staff in an Obama administration. He told a Washington power breakfast that he thought the winner of the election would have a 50 per cent chance at best - at best - of winning a second term in 2012.

Consider the challenges.

The financial crisis and Washington's response to it have transformed the economic and fiscal environment in which the new president will take office.

The bailout/rescue plan/ socialisation of the banking system - whichever you prefer - has, in effect, already rendered null and void almost everything that the presidential candidates have been proposing for the past six months. It may not end up adding a straight $700 billion to the deficit over the next couple of years - the Treasury is surely right to insist that it will get some of that money back when the bad assets acquired from banks are sold off. But it would certainly not be prudent to expect there to be any room left over for promised tax cuts, spending increases on health, education or anything else.

The US already faced daunting fiscal challenges (admittedly smaller than those confronting most European and Asian countries). At some point reality will bite hard and politicians will discover that they simply cannot go on funding two wars, cutting taxes, creating vast new government health and pension programmes and doing the other essential things that the Federal Government does - all those bridges and roads and light-rail systems in parts of the country with closely fought congressional districts.

As some observers have noted, the bailout plan may simply have shifted the locus of the next financial crisis from the private to the public sector. This fiscal challenge is not just economic, but also geopolitical in nature. More government debt increases America's dependence on the financial interest of strangers; and not just any foreigners, but countries that hardly count as America's friends, such as China and Russia.

All this, and we almost certainly haven't even seen the worst of economic times yet.

For the past six months there's been a rather pointless debate in the US about whether the country is or is not in a “technical” recession, whatever that is. What is certain is that unemployment has risen and real incomes have declined, but now it seems that things are getting much worse. Yesterday - in one day - economic reports said that durable goods orders, everything from aeroplanes to television sets, dropped by more last month than in any month in almost two years; that jobless claims rose to their highest level since September 11, 2001; and that new home sales fell to their lowest in 17 years.

The US is now indisputably entering the darkest phase of a period that will not only produce real hardship, but could send further shocks through financial markets and cause deeper fiscal damage.

Then there is energy policy. Weaning America off its oil addiction might actually need to be a policy rather than a slogan in the next four years; but that will place new burdens on the budget and require sacrifices difficult to make in good times, let alone in economically distressed ones.

Compared with all this, foreign policy looks like a doddle.

The next president has only to complete the process of transition in Iraq, win the war in Afghanistan, face down a resurgent Russia, continue to keep its foot on the throat of stateless Islamist terrorism, stop Iran from going nuclear and figure out what to do about the challenge from China - the most serious threat to US global hegemony since America became top nation.

Oh, and I didn't mention Pakistan. Conversations this week with advisers to both campaigns suggest that both now see Pakistan - especially after last week's terrorist attack in Islamabad - as perhaps the most intractable and serious challenge of all in the next few years: they candidly admit that no one has much of a clue what to do about it.

You don't have to loathe President Bush to acknowledge that America's capabilities and standing in the world are seriously diminished at a time when its tasks are larger and more complex than they have been in decades. With its economic wherewithal now further impaired, the prospects for real success anywhere in the next four years look constrained.

Yet all this might be too gloomy a prognosis. Previous periods of apparently existential crisis in the US have certainly produced one-term disasters: James Buchanan in 1857, Herbert Hoover in 1929, Jimmy Carter in 1977 spring unpleasantly to mind. But the genius of America is that apocalyptic challenges have also, in time, produced the men to match them: Abraham Lincoln in 1861, Franklin Roosevelt in 1933, Ronald Reagan in 1981.

So perhaps, rather than simply assuring us that the man who wins in November is a sure loser, history suggests an unsettlingly binary possibility. Either the next president is destined for the cruel obscurity of one-term failure. Or he is set to join the pantheon.

Then again, look carefully at those dates and consider a crueller possibility for this year's winner: that desperate times like these actually produce both types of president, sequentially: a one-term disaster who paves the way for a true giant.

Thursday, September 25, 2008

Gambling Man

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/24/AR2008092403950.html?hpid=topnews

ANALYSIS
Selfless or Reckless? McCain Gambles On Voters' Verdict
"Now is our chance to come together to prove that Washington is once again capable of leading this country," John McCain told reporters in New York.

By Dan Balz
Washington Post Staff Writer
Thursday, September 25, 2008; Page A01

NEW YORK, Sept. 24 -- John McCain is a gambler by nature, and the bet he placed Wednesday may be among the biggest of his political life.

The Republican presidential nominee is hoping that his abrupt decision to suspend campaigning, seek a delay of Friday's debate with Democrat Barack Obama, and return to Washington to help prod negotiations over a financial rescue package will be seen as the kind of country-first, bipartisan leadership he believes Americans want.

What he risks, if things don't go as he hopes, is a judgment by voters that his move was a reckless act by an impetuous and struggling politician that hardened partisan lines in Washington at just the wrong moment and complicated efforts to deal with the biggest financial crisis in more than half a century.

McCain laid out his rationale in stark terms, saying that the economy is in crisis and that he does not believe the package now on the table in Washington can win enough votes to pass. "Americans across our country lament the fact that partisan divisions in Washington have prevented us from addressing our national challenges," he said here in New York. "Now is our chance to come together to prove that Washington is once again capable of leading this country."

In the heated atmosphere of Wednesday afternoon, as the two campaigns plotted and maneuvered around each other, it was impossible to know what the ultimate verdict would be on McCain's surprise decision. He managed once again, at least in the short term, to shake up the presidential race at a time when national and state polls show Obama opening up a clear lead. And by day's end, he had forced his rival to blink.

Obama initially resisted McCain's call to join him and return to Washington. But hours later he was forced to capitulate when President Bush called him and asked him to participate in a White House meeting with congressional leaders and his GOP rival. Shortly after that, the two candidates issued a joint statement calling for action.

But while agreeing to go back to Washington, Obama insisted Wednesday night, as he had earlier in the day, that Friday's debate go ahead as scheduled.

"I believe that we should continue to have the debate," he told reporters in Florida, where he is preparing for it. "I think that it makes sense for us to present ourselves before the American people, to talk about the nature of the problems that we're having in our financial system, to talk about how it relates to our global standing in the world, what implications it has for our national security, how it relates to critical questions like the war in Iraq and Afghanistan."

Much now will depend on whether McCain can deliver results and whether there is a constructive role for him and Obama, or whether they become a sideshow to the real negotiations. But Obama's course carries risks as well, if he looked as if he were standing on the sidelines while McCain pushed for intervention that could help avert further damage to the nation's economy.

The standoff over the debate left both candidates in potentially awkward positions, although there is plenty of time for it to be resolved. McCain may be reluctant to climb down from his insistence that the debate be delayed until there is an agreement on a package, but he could be seen as scuttling an important event for voters eager to see the two candidates side by side. Obama, on the other hand, may look high-handed if he insists on going ahead as negotiations in Washington reach a critical moment by this weekend.

At a minimum, voters were treated again to contrasting styles of leadership Wednesday, with McCain willing to act boldly, if impulsively, to inject himself into the middle of delicate negotiations to force a solution, and Obama adopting a cooler approach designed to show calm in the midst of crisis while preferring to give long-distance encouragement to all parties in the talks.

Partisan lines hardened quickly after McCain's statement.

Republican leaders rallied around McCain. Former House speaker Newt Gingrich said the decision to suspend campaigning and lend a hand to the negotiations in Washington was "the greatest single act of responsibility ever taken by a presidential candidate." He said it rivaled Dwight Eisenhower's declaration during the 1952 campaign that he would go to Korea as president, if necessary, to help end the conflict there.

"This is the day the McCain-reform Republican Party began to truly emerge as a movement which puts country first, solutions first, and big change first," he said in a statement.

House Minority Leader John A. Boehner (R-Ohio) said he strongly supported McCain's call for a bipartisan leadership meeting. "Given that it is only a few months before a new President takes the oath of office," he said in a statement, "it is vital that the next President play an active role in crafting this critical plan."

But privately, three Republican strategists were sharply critical, viewing McCain's decision as a high-risk move that entails uncertain negotiations in Washington at the possible expense of a debate they believe McCain badly needs to get back on the offensive. One strategist called the move "desperate and nuts," and another said in an e-mail, "I don't get it at all."

All spoke on the condition of anonymity because they did not want to criticize McCain publicly.

Democrats denounced McCain's move as political grandstanding, and they quickly urged Obama to stay away. Senate Majority Leader Harry M. Reid (D-Nev.), no friend of McCain's, said the country would be better served if McCain and Obama went ahead with their debate. "If that changes, we will call upon them. We need leadership, not a campaign photo op," he said in a statement.

McCain advisers dismissed Reid's statement as both raw partisanship and particularly disingenuous, coming as it did just a day after the Senate leader had urged McCain to make his views on the current financial package clear and warned him against a "no" vote that could scuttle the entire rescue.

Senate Democratic Whip Richard J. Durbin (Ill.) said McCain's move was motivated not by concerns about stock market declines but by the GOP nominee's sagging poll numbers. "It's not economic leadership that Senator McCain would bring to these negotiations," he said in a statement. "It's presidential politics -- which is the last thing we need if we really want to solve the serious problems our nation faces."

Democratic strategists were even sharper in their criticism. "McCain is doing this without having laid any predicate for the idea that his participation is crucial to the process," said pollster Geoff Garin. "His activity for the last seven days or more completely belies that. . . . This is not going to be seen as either an act of strength or act of confidence."

Mark Mellman, another Democratic pollster, said Wednesday's move, like McCain's pick of Alaska Gov. Sarah Palin as his running mate, was a political stunt aimed at stirring up the race. "McCain thinks he learned with Palin that shaking things up when you are falling behind can pay off," he said. "It did then, albeit briefly. It won't now."

McCain is betting otherwise. On the biggest issue in the election, one that favors his rival, the Republican nominee believes he can buck the odds and produce results. It may not take long to know whether the gamble paid off.

Letterman On McCain

http://www.youtube.com/watch?v=XjkCrfylq-E

Tuesday, September 23, 2008

Bedside Manner

http://newsblogs.chicagotribune.com/triage/2008/09/doctors-score-l.html

Originally posted: September 23, 2008
Doctors score low on empathy: too little, too late

It’s no secret that many doctors appear detached and unwilling to relate to patients emotionally.

Experts who specialize in medical communication understand this can interfere with the doctor-patient relationship and impair the quality of care.

Now, a small study shines new light on the subject by examining the degree to which physicians express empathy for people with lung cancer, the No. 1 cancer killer in the U.S.

The report finds that surgeons and oncologists responded to cues that lung cancer patients were sad, frightened, anxious, or otherwise emotionally agitated only 10 percent of the time. It was published today in the Archives of Internal Medicine.

"We found that patients provided multiple opportunities for physicians to express empathy, which were missed, and that where physicians did provide empathy it was too little too late," said Dr. Howard Gordon, an author and staff physician at Chicago’s Jesse Brown Veterans Affairs Medical Center.

Researchers examined transcripts of 20 doctor-patient interactions at a VA medical center in the south for the study. Coders identified every time patients expressed emotions about their illness and every acknowledgment of the emotions by physicians.

Altogether, patients articulated 384 so-called "empathetic cues" and the surgeons and oncologists responded 10 percent of the time.

"There was a clear mismatch between what patients think is important and what physicians respond to," said Dr. Diane Morse, lead author of the report and assistant professor of medicine and psychiatry at the University of Rochester School of Medicine.

That’s an even worse performance than documented in other research, which has found that primary care doctors express empathy 21 percent of the time, oncologists, 22 percent, and surgeons, 38 percent.

Notably, in the new lung cancer study physicians were least likely to address the concerns most often articulated by patients, which surrounded fear and anxiety over death and dying. Instead of openly acknowledging those feelings, doctors talked about patients’ prognosis or treatment.

There are several reasons why physicians may miss indications that patients are seeking emotional understanding, either consciously or unconsciously. Doctors may be too busy. They may believe their primary job is to diagnose and treat illness. They may assume patients are reassured by their biomedical expertise. Or they may be burned out, stressed and not recognize patients’ emotional concerns, the report suggests.

In actuality, it doesn’t take much time for a doctor to say, "I understand that must be hard," or "It sounds like you’re worried" or other brief statements that make it clear a patient is being heard, Morse says.

There are important benefits to be had from making the effort. Previous research has demonstrated empathetic responses improve patient’s satisfaction and understanding of their condition as well as their willingness to comply with recommended treatments.

For their part, people with lung cancer can try telling their doctors, "I know there isn’t anything you can do to cure me, but I just want you to know that this is something I’m worried about," Morse suggests. "Express your concerns. Ask questions. Be assertive," Gordon adds.

Have you had experienced a failure of empathy in a medical encounter? If so, what happened and how did it make you feel?

We Were For Fanny And Freddy Before We Were Against It...

http://www.iht.com/articles/2008/09/22/america/22mccain.php

Senator John McCain's campaign manager was paid more than $30,000 a month for five years as president of an advocacy group set up by the mortgage giants Fannie Mae and Freddie Mac to defend them against stricter regulations, current and former officials say.

Monday, September 22, 2008

The United States Of France

http://www.time.com/time/nation/article/0,8599,1843168,00.html?cnn=yes

How We Became the United States of France
By Bill Saporito Sunday, Sep. 21, 2008

This is the state of our great republic: We've nationalized the financial system, taking control from Wall Street bankers we no longer trust. We're about to quasi-nationalize the Detroit auto companies via massive loans because they're a source of American pride, and too many jobs — and votes — are at stake. Our Social Security system is going broke as we head for a future where too many retirees will be supported by too few workers. How long before we have national healthcare? Put it all together, and the America that emerges is a cartoonish version of the country most despised by red-meat red-state patriots: France. Only with worse food.

Admit it, mes amis, the rugged individualism and cutthroat capitalism that made America the land of unlimited opportunity has been shrink-wrapped by a half dozen short sellers in Greenwich, Conn. and FedExed to Washington D.C. to be spoon-fed back to life by Fed Chairman Ben Bernanke and Treasury Secretary Hank Paulson. We're now no different from any of those Western European semi-socialist welfare states that we love to deride. Italy? Sure, it's had four governments since last Thursday, but none of them would have allowed this to go on; the Italians know how to rig an economy.

You just know the Frogs have only increased their disdain for us, if that is indeed possible. And why shouldn't they? The average American is working two and half jobs, gets two weeks off, and has all the employment security of a one-armed trapeze artist. The Bush Administration has preached the "ownership society" to America: own your house, own your retirement account; you don't need the government in your way. So Americans mortgaged themselves to the hilt to buy overpriced houses they can no longer afford and signed up for 401k programs that put money where, exactly? In the stock market! Where rich Republicans fleeced them.

Now our laissez-faire (hey, a French word) regulation-averse Administration has made France's only Socialist president, Francois Mitterand, look like Adam Smith by comparison. All Mitterand did was nationalize France's big banks and insurance companies in 1982; he didn't have to deal with bankers who didn't want to lend money, as Paulson does. When the state runs the banks, they are merely cows to be milked in the service of la patrie. France doesn't have the mortgage crisis that we do, either. In bailing out mortgage lenders Fannie Mae and Freddie Mac, our government has basically turned America into the largest subsidized housing project in the world. Sure, France has its banlieus, where it likes to warehouse people who aren't French enough (meaning, immigrants or Algerians) in huge apartment blocks. But the bulk of French homeowners are curiously free of subprime mortgages foisted on them by fellow citizens, and they aren't over their heads in personal debt.

We've always dismissed the French as exquisitely fed wards of their welfare state. They work, what, 27 hours in a good week, have 19 holidays a month, go on strike for two days and enjoy a glass of wine every day with lunch — except for the 25% of the population that works for the government, who have an even sweeter deal. They retire before their kids finish high school, and they don't have to save for a $45,000-a-year college tuition because college is free. For this, they pay a tax rate of about 103%, and their labor laws are so restrictive that they haven't had a net gain in jobs since Napoleon. There is no way that the French government can pay for this lifestyle forever, except that it somehow does.

Mitterand tried to create both job-growth and wage-growth by nationalizing huge swaths of the economy, including some big industries, including automaker Renault, for instance. You haven't driven a Renault lately because Renault couldn't sell them here. Imagine that. An auto company that couldn't compete with a Dodge Colt. But the Renault takeover ultimately proved successful and Renault became a private company again in 1996, although the government retains about 15% of the shares.

Now the U.S. is faced with the same prospect in the auto industry. GM and Ford need money to develop greener cars that can compete with Toyota and Honda. And they're looking to Uncle Sam for investment — an investment that could have been avoided had Washington imposed more stringent mileage standards years earlier. But we don't want to interfere with market forces like the French do — until we do.

Mitterand's nationalization program and other economic reforms failed, as the development of the European Market made a centrally planned economy obsolete. The Rothschilds got their bank back, a little worse for wear. These days, France sashays around the issue of protectionism in a supposedly unfettered EU by proclaiming some industries to be national champions worthy of extra consideration — you know, special needs kids. And we're not talking about pastry chefs, but the likes of GDF Suez, a major utility. I never thought of the stocks and junk securities sold by Goldman Sachs and Morgan Stanley as unique, but clearly Washington does. Morgan's John Mack calls SEC boss Chris Cox to whine about short sellers and bingo, the government obliges. The elite serve the elite. How French is that?

Even in the strongest sectors in the U.S., there's no getting away from the French influence. Nothing is more sacred to France than its farmers. They get whatever they demand, and they demand a lot. And if there are any issues about price supports, or feed costs being too high, or actual competition from other countries, French farmers simply shut down the country by marching their livestock up the Champs Elysee and piling up wheat on the highways. U.S. farmers would never resort to such behavior. They don't have to: they're the most coddled special interest group in U.S. history, lavished with $180 billion in subsidies by both parties, even when their products are fetching record prices. One consequence: U.S. consumers pay twice what the French pay for sugar, because of price guarantees. We're more French than France.

So yes, while we're still willing to work ourselves to death for the privilege of paying off our usurious credit cards, we can no longer look contemptuously at the land of 246 cheeses. Kraft Foods has replaced American International Group in the Dow Jones Industrial Average, the insurance company having been added to Paulson's nationalized portfolio. Macaroni and cheese has supplanted credit default swaps at the fulcrum of capitalism. And one more thing: the food snob French love McDonalds, which does a fantastic business there. They know a good freedom fry when they taste one.

Wednesday, September 17, 2008

This Would Never Be Misused

http://www.cnn.com/2008/US/09/17/atf.missing.guns/index.html

New Collectibles (After Fatal Accident)

http://www.wftv.com/news/17492850/detail.html

Media Consolidation: KTVI+KPLR

http://www.stltoday.com/stltoday/news/stories.nsf/stlouiscitycounty/story/FBB72329E85ADB2B862574C70004EC36?OpenDocument

Does this mean no more stand-ups on the Tamm Avenue overpass? Where will talent and crews freeze to death anymore?

Goodbye to the historical old KTVI studios. Sky Fox will be landing somewhere else.

And what will happen to the radar on top of Deaconess?

AIG Nationalized- Confirmed

http://money.cnn.com/2008/09/16/news/companies/AIG/index.htm?cnn=yes

If Citibank goes, expect the Bank Holiday Of 1933.

Tuesday, September 16, 2008

Doggie Daycare!

http://www.telegraph.co.uk/education/main.jhtml?xml=/education/2008/09/16/fadogwork116.xml

Monday, September 15, 2008

Open Goverment!

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/13/AR2008091302284.html?hpid=topnews

http://www.washingtonpost.com/wp-dyn/content/article/2008/09/14/AR2008091401974.html?hpid=topnews

Moose Problem, Even More Clearly Stated

http://www.fivethirtyeight.com/2008/09/dems-must-give-voters-explicit.html

"When facts are used to discredit Sarah Palin, emotion trumps facts. The instinct is to defend against the facts. Consider: you meet someone and like him or her on a gut level. A stranger – someone who doesn’t have built-up personal credibility with you – gives you a list of reasons not to like that person. How do you react?

On an emotional level, you want them to be wrong, and you will take every possible favorable inference on the likable person’s behalf. Using facts is pushing a big rock uphill. You might get it to the top with a few voters, but you’re going to expend a lot of energy for only a little return."

Sunday, September 14, 2008

14 SEP 08 Observations

Waiting for Ike. Muggy, calm.

Bought more meds for Max. He's pretty stable, aside from the occasional GI episode.

Traveller going fairly well. Andy introduced a new game called "Cash And Guns", which was amusing.

Had a "row" with Mom. Not fun.

More people are jumping ship from work. Latest one is going to the Botanical Gardens.

Good meetings at church, recently. It helps.

US total situation deteriorating. Lehman Brothers is the latest casualty, and Pakistan is threatening the US. GOP now summoning Zombie White Trash Hordes with Moose Hockey Mom Spell. South now solid red, despite God giving them explicit warnings via hurricanes. Progressives just can not deal with stupid. And stupid breeds faster than you can kill them.

1968-2008. It can not, and will not, be fixed. We'll just have to live with the aftermath. Only those just being born now can hope to see a better America- in their retirement years.

Thursday, September 11, 2008

Moose Power, Explained

http://www.time.com/time/politics/article/0,8599,1840388,00.html?xid=site-cnn-partner

Culture Wars Power, personified.

A Doomsday Like Any Other

http://www.timesonline.co.uk/tol/comment/faith/article4717864.ece

Wednesday, September 10, 2008

Beer Call, Again

http://www.realclearpolitics.com/articles/2008/09/its_not_about_the_issues.html

"So while the candidates will sit down to discuss a broad range of issues, rest assured the post-debate discussion will focus on everything but policy differences. Who "won" and who "lost?" Which candidate looked "more presidential?" Who got off the best line of the night? Who committed the biggest "gaffe?"

All of this will be processed by the public into - to use Rick Davis' words - "a composite view" of Obama and McCain, which is another way of saying that the public will take what they see, hear, and feel and reconcile it with the professed narrative of each candidate.

Every four years the political intelligentsia laments the fact that the presidential race inevitably boils down to "who you'd rather have a beer with." Guess what? The public is bellying up to the bar to take the measure of these two candidates over the next eight weeks."

This Would Never Be Misused

http://news.bbc.co.uk/2/hi/uk_news/england/cornwall/7605923.stm

Sunday, September 7, 2008

Bad Week For Bullwinkle

The US just nationalized the mortgage lenders. How many moose will Sarah Barracuda have to kill to pay that off? And FDIC is next.

Hurricanes have three letters of introduction: GOP.

It's a great week to be a smartass. :)

Saturday, September 6, 2008

I Like Ike

http://www.wunderground.com/tropical/tracking/at200809.html

Children Are Off-Limits In Politics

http://online.wsj.com/article/SB122066426856206115.html?mod=googlenews_wsj

State and federal regulators on Friday shut down Silver State Bank, the latest in a series of bank failures and one that could ripple through the presidential campaign.

Until recently, the son of Republican nominee Sen. John McCain sat on Silver State's board and was a member of its three-person audit committee, which was responsible for overseeing the company's financial condition.

Family Values!

http://en.wikipedia.org/wiki/Republic_of_Gilead

This is the prototypical wet dream of the South

Family Values!

http://www.middle-east-online.com/english/?id=27668

Family Values!

A continuing series on what happens when we let religion rule our lives.

This is what The South would like America to be like. We have eight thousand years of recorded history of what that kind of disaster that would be, and it's called The Middle East.

http://www.cnn.com/2008/WORLD/meast/09/05/singer.slain.tamim.suzanne.ap/index.html

Friday, September 5, 2008

Thursday, September 4, 2008

Mike Anderson Shutting Down?

Mike is still maintaining his message boards (which require registration). The generational tone of his last (official) message is, well, interesting... :) He's always been a warm and fuzzy online persona...

http://www.stlradio.net/

Wednesday 08-27-08: A while back ...
I put out a "casting call" for someone to take over this website once I tired of it.
I received exactly one response from someone even vaguely qualified and he never responded when I asked for ideas for what he might consider the future of STLMedia.
So it's obvious that I have no heirs for the eight years of work I've done here, nor is there anyone interested in carrying on the tradition.
Ya don't want it, ya don't get it. And I've had enough of working for you for free.
Join me at Reynolds on September 12th for my 60th birthday and farewell party for STLMedia.net.
Or not. I'll enjoy my biscuits and gravy with or without you.
Time for me to move on to other things.
The STLMedia Message Board will remain in place and that's where I'll direct you to my next projects.
This is my final entry here. I'll remain active on the MB, of course. See ya there!
G'bye and thanks for all the fishes.
42.