Monday, November 30, 2009

Politico SEVEN OBAMA QUESTIONS worth reading

7 stories Obama doesn't want told John F. Harris


Presidential politics is about storytelling. Presented with a vivid storyline, voters naturally tend to fit every new event or piece of information into a picture that is already neatly framed in their minds.

No one understands this better than Barack Obama and his team, who won the 2008 election in part because they were better storytellers than the opposition. The pro-Obama narrative featured an almost mystically talented young idealist who stood for change in a disciplined and thoughtful way. This easily outpowered the anti-Obama narrative, featuring an opportunistic Chicago pol with dubious relationships who was more liberal than he was letting on.

A year into his presidency, however, Obama’s gift for controlling his image shows signs of faltering. As Washington returns to work from the Thanksgiving holiday, there are several anti-Obama storylines gaining momentum.

The Obama White House argues that all of these storylines are inaccurate or unfair. In some cases these anti-Obama narratives are fanned by Republicans, in some cases by reporters and commentators.

But they all are serious threats to Obama, if they gain enough currency to become the dominant frame through which people interpret the president’s actions and motives.

Here are seven storylines Obama needs to worry about:

He thinks he’s playing with Monopoly money

Economists and business leaders from across the ideological spectrum were urging the new president on last winter when he signed onto more than a trillion in stimulus spending and bank and auto bailouts during his first weeks in office. Many, though far from all, of these same people now agree that these actions helped avert an even worse financial catastrophe.

Along the way, however, it is clear Obama underestimated the political consequences that flow from the perception that he is a profligate spender. He also misjudged the anger in middle America about bailouts with weak and sporadic public explanations of why he believed they were necessary.

The flight of independents away from Democrats last summer — the trend that recently hammered Democrats in off-year elections in Virginia — coincided with what polls show was alarm among these voters about undisciplined big government and runaway spending. The likely passage of a health care reform package criticized as weak on cost-control will compound the problem.

Obama understands the political peril, and his team is signaling that he will use the 2010 State of the Union address to emphasize fiscal discipline. The political challenge, however, is an even bigger substantive challenge—since the most convincing way to project fiscal discipline would be actually to impose spending reductions that would cramp his own agenda and that of congressional Democrats.


Too much Leonard Nimoy

People used to make fun of Bill Clinton’s misty-eyed, raspy-voiced claims that, “I feel your pain.”

The reality, however, is that Clinton’s dozen years as governor before becoming president really did leave him with a vivid sense of the concrete human dimensions of policy. He did not view programs as abstractions — he viewed them in terms of actual people he knew by name.

Obama, a legislator and law professor, is fluent in describing the nuances of problems. But his intellectuality has contributed to a growing critique that decisions are detached from rock-bottom principles.

Both Maureen Dowd in The New York Times and Joel Achenbach of The Washington Post have likened him to Star Trek’s Mr. Spock.

The Spock imagery has been especially strong during the extended review Obama has undertaken of Afghanistan policy. He’ll announce the results on Tuesday. The speech’s success will be judged not only on the logic of the presentation but on whether Obama communicates in a more visceral way what progress looks like and why it is worth achieving. No soldier wants to take a bullet in the name of nuance.

That’s the Chicago Way

This is a storyline that’s likely taken root more firmly in Washington than around the country. The rap is that his West Wing is dominated by brass-knuckled pols.

It does not help that many West Wing aides seem to relish an image of themselves as shrewd, brass-knuckled political types. In a Washington Post story this month, White House deputy chief of staff Jim Messina, referring to most of Obama’s team, said, “We are all campaign hacks.”

The problem is that many voters took Obama seriously in 2008 when he talked about wanting to create a more reasoned, non-partisan style of governance in Washington. When Republicans showed scant interest in cooperating with Obama at the start, the Obama West Wing gladly reverted to campaign hack mode.

The examples of Chicago-style politics include their delight in public battles with Rush Limbaugh and Fox News and the U.S. Chamber of Commerce. (There was also a semi-public campaign of leaks aimed at Greg Craig, the White House counsel who fell out of favor.) In private, the Obama team cut an early deal — to the distaste of many congressional Democrats — that gave favorable terms to the pharmaceutical lobby in exchange for their backing his health care plans.

The lesson that many Washington insiders have drawn is that Obama wants to buy off the people he can and bowl over those he can’t. If that perception spreads beyond Washington this will scuff Obama’s brand as a new style of political leader.


He’s a pushover

If you are going to be known as a fighter, you might as well reap the benefits. But some of the same insider circles that are starting to view Obama as a bully are also starting to whisper that he’s a patsy.

It seems a bit contradictory, to be sure. But it’s a perception that began when Obama several times laid down lines — then let people cross them with seeming impunity. Last summer he told Democrats they better not go home for recess until a critical health care vote but they blew him off. He told the Israeli government he wanted a freeze in settlements but no one took him seriously. Even Fox News — which his aides prominently said should not be treated like a real news organization — then got interview time for its White House correspondent.

In truth, most of these episodes do not amount to much. But this unflattering storyline would take a more serious turn if Obama is seen as unable to deliver on his stern warnings in the escalating conflict with Iran over its nuclear program.

He sees America as another pleasant country on the U.N. roll call, somewhere between Albania and Zimbabwe

That line belonged to George H.W. Bush, excoriating Democrat Michael Dukakis in 1988. But it highlights a continuing reality: In presidential politics the safe ground has always been to be an American exceptionalist.

Politicians of both parties have embraced the idea that this country — because of its power and/or the hand of Providence — should be a singular force in the world. It would be hugely unwelcome for Obama if the perception took root that he is comfortable with a relative decline in U.S. influence or position in the world.

On this score, the reviews of Obama’s recent Asia trip were harsh.

His peculiar bow to the emperor of Japan was symbolic. But his lots-of-velvet, not-much-iron approach to China had substantive implications.

On the left, the budding storyline is that Obama has retreated from human rights in the name of cynical realism. On the right, it is that he is more interested in being President of the World than President of the United States, a critique that will be heard more in December as he stops in Oslo to pick up his Nobel Prize and then in Copenhagen for an international summit on curbing greenhouse gases.


President Pelosi

No figure in Barack Obama’s Washington, including Obama, has had more success in advancing his will than the speaker of the House, despite public approval ratings that hover in the range of Dick Cheney’s. With a mix of tough party discipline and shrewd vote-counting, she passed a version of the stimulus bill largely written by congressional Democrats, passed climate legislation, and passed her chamber’s version of health care reform. She and anti-war liberals in her caucus are clearly affecting the White House’s Afghanistan calculations.

The great hazard for Obama is if Republicans or journalists conclude — as some already have — that Pelosi’s achievements are more impressive than Obama’s or come at his expense.

This conclusion seems premature, especially with the final chapter of the health care drama yet to be written.

But it is clear that Obama has allowed the speaker to become more nearly an equal — and far from a subordinate — than many of his predecessors of both parties would have thought wise.

He’s in love with the man in the mirror

No one becomes president without a fair share of what the French call amour propre. Does Obama have more than his share of self-regard?

It’s a common theme of Washington buzz that Obama is over-exposed. He gives interviews on his sports obsessions to ESPN, cracks wise with Leno and Letterman, discusses his fitness with Men’s Health, discusses his marriage in a joint interview with first lady Michelle Obama for The New York Times. A photo the other day caught him leaving the White House clutching a copy of GQ featuring himself.

White House aides say making Obama widely available is the right strategy for communicating with Americans in an era of highly fragmented media.

But, as the novelty of a new president wears off, the Obama cult of personality risks coming off as mere vanity unless it is harnessed to tangible achievements.

That is why the next couple of months — with health care and Afghanistan jostling at center stage — will likely carry a long echo. Obama’s best hope of nipping bad storylines is to replace them with good ones rooted in public perceptions of his effectiveness.

Sunday, November 29, 2009

Single payer health care best - just ask people who have it!

A recent study found that 90 percent of Canadians support universal, single-payer health care. A poll taken last summer shows 82 percent of Canadians believe their health care system to be better than the US's, despite constant grumbling about waiting times for treatment of non-life-threatening conditions.

Seven issues amending healthcare bill

Seven issues to watch as Senate begins amending healthcare bill
By Jeffrey Young - The Hill

Senators will be asked to cast their votes on numerous amendments as they begin a debate to reshape the country’s healthcare system.

Some amendments will be designed to improve the bill, some to satisfy a special interest or pet peeve. Still others will be presented as poison pills.

Here are seven issues likely to arise during the amendment process.

Public option: An issue that unites Republicans and divides Democrats on ideological grounds inevitably was bound to haunt the Senate Democratic leadership. The notion of creating a government-run health insurance plan to compete with private companies is seen as vital by liberal Democrats but centrists range from skeptical to deeply antagonistic, even though states could opt out.
The best hope for a positive outcome for the Democrats could rest on the chances that liberal Sen. Chuck Schumer (D-N.Y.) along with centrist public option supporter Sen. Tom Carper (D-Del.) can forge yet another compromise version of the program to satisfy centrists such as Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.), who have threatened to filibuster the bill over the public option. Sen. Olympia Snowe (R-Maine) is waiting in the wings with her “trigger” compromise.

Abortion: It wouldn’t be American politics if the forces on both sides of the abortion issue weren’t at loggerheads. The healthcare bill already includes language that is supposed to keep federal dollars away from abortion funding but the Catholic bishops, and Nelson, don’t think it goes far enough. Democratic Sens. Bob Casey Jr. (Pa.) and Kent Conrad (N.D.) each voted in committee to beef up the abortion restrictions so their actions on the floor will be key. Sen. Orrin Hatch (R-Utah) authored the failed committee amendments and is sure to raise objections to the bill on abortion.

Health insurance excise tax: The proposed tax on high-cost health insurance plans, a key to raising revenue and reducing long-term healthcare costs according to the Congressional Budget Office, may enjoy support in the White House but many Democrats and labor unions remain staunchly opposed to what they view as a middle-class tax hike. Already scaled down several times – the original idea was to tax the value of all workplace health benefits – Sen. Debbie Stabenow (D-Mich.) and others will look to shrink it further, if not eliminate it, but will need to raise additional taxes to make up the difference.

Prescription drugs: The pharmaceutical industry struck a grand bargain this summer with the White House and Senate Finance Committee Chairman Max Baucus (D-Mont.) to limit its financial exposure from healthcare reform to $85 billion and to support the Democrats’ efforts. That deal has held uneasily since and Democrats are eyeing the chance to take a bite out of a long-time nemesis. Like in the House, Democrats are eager to require larger rebates from pharmaceutical firms who sell drugs to state Medicaid programs and use the additional money to sweeten the Medicare prescription drug benefit. A handful of Republicans such as Sens. John McCain (Ariz.) and David Vitter (La.) would likely join, or even start, any effort to permit the import of medicines from abroad.

Affordability: Because almost everyone would be required to obtain health coverage, providing fair and adequate subsidies to low- and middle-income people has presented a challenge for lawmakers trying to keep the bill on budget. Liberal Democrats get more attention when they talk about the public option but they have complained about the subsidy levels almost as much, while Snowe has also been adamant that the bill does too little to ensure insurance is less expensive. Sen. Mary Landrieu (D-La.), a key swing vote, wants more help for small businesses and the self-employed. Trouble is, every dollar of assistance paid out has to come from somewhere.

Insurance exchanges: The concept of creating an online marketplace where consumers can comparison-shop for healthcare hasn’t been very controversial. But what types of plans people could buy and who will be allowed to buy them has been a point of contention. Democrats will be looking to provide access to the most generous but most affordable plans they can. Meanwhile, Sen. Ron Wyden (D-Ore.), under an agreement with Reid and Baucus, will offer an amendment to let more people beyond individuals and small-business employees buy insurance on the exchanges. The exchanges wouldn’t launch until 2014, either, so Landrieu and others want to move that date closer.

Medicare cuts: Republicans have railed about the hundreds of billions of dollars in cuts to Medicare contained in the bill though Democrats insist they are seeking to make the program more efficient and are not cutting anyone’s benefits. Because these cuts are essential to financing the rest of the bill, however, they’re here to stay – though some could be scaled back. The deep cuts to private Medicare Advantage plans, for instance, could be mitigated to assuage senators from states with large senior populations. Medical interests from physicians to home healthcare providers will also be seeking concessions.

Wednesday, November 25, 2009

Who's watching Glenn Beck?

LATimes Tim Rutten

Much like the Depression-era demagogue Father Charles Coughlin, the Fox News personality is promoting a mass movement. Should his bosses be pulling the plug?

For nearly a century, the Anti-Defamation League has stared unflinchingly into the dark corners of America's social psyche -- the places where combustible tendencies such as hatred and paranoia pool and, sometimes, burst into flame.

As a Jewish organization, the ADL's first preoccupation naturally is anti-Semitism, but in the last few decades it has extended its scrutiny to the whole range of bigoted malevolence -- white supremacy, the militia movement, neo-nativism and conspiratorial fantasies in all of their improbable permutations. These days, the organization's research is characterized by the sense of proportion and sobriety that long experience brings.

That makes its recent report on the extremist groups and propagandists that have emerged since President Obama's election -- "Rage Grows In America: Anti-Government Conspiracies" -- particularly notable. For the first time in living memory, the ADL is sounding the alarm about a mainstream media personality: Fox News' Glenn Beck, who also hosts a popular radio show.

The report notes that while "other conservative media hosts, such as Rush Limbaugh and Sean Hannity, routinely attack Obama and his administration, typically on partisan grounds, they have usually dismissed or refused to give a platform to the conspiracy theorists and anti-government extremists." By contrast, "Beck and his guests have made a habit of demonizing President Obama and promoting conspiracy theories about his administration. ... Beck has even gone so far as to make comparisons between Hitler and Obama."

What gives all of this nonsense an ominous twist is Beck's announcement that he intends to use his TV and radio shows to promote a mass movement that will involve voter registration drives, training in community organizing and a series of regional conventions that will produce a "100-year plan" for America to be read from the steps of the Lincoln Memorial to a mass rally Aug. 28.

As Beck wrote on his website, "I know that the bipartisan corruption in Washington that has brought us to this brink and it will not be defeated easily. It will require unconventional thinking and a radical plan to restore our nation to the maximum freedoms we were supposed to have been protecting. ... All of the above will culminate in The Plan, a book that will provide specific policies, principles and, most importantly, action steps that each of us can take to play a role in this Refounding."

Hard times predictably throw up their demagogues. Still, even allowing for the frenetic pace of our wired world's 24-hour news cycle, it's remarkable how quickly the arc of Beck's career has come to resemble that of the Great Depression's uber-demagogue, Father Charles Coughlin. In the months after the crash of '29, Coughlin turned what had been a conventionally religious weekly radio broadcast into a platform for championing the downtrodden working man. He was an early supporter of the New Deal, coining the slogan "Roosevelt or Ruin," but quickly turned on the president for a variety of complex ideological and personal reasons. Coughlin flirted with Huey Long, launched an unsuccessful political party, published a popular newspaper, Social Justice, and even inspired and supported a kind of militia, the Christian Front, some of whose members were arrested by the FBI and charged with plotting a fascist coup.

As the 1930s dragged on, Coughlin, a longtime admirer of Francisco Franco, became virulently anti-Semitic, isolationist and pro-German. He also was extraordinarily popular. At their height, his weekly broadcasts attracted more than 40 million listeners. Still, after he lashed out at German Jews in the wake of Kristallnacht, many major urban radio stations dropped his program. Influential American prelates, the Vatican and prominent Catholic New Dealers had worked for some time to persuade Coughlin's superior, the archbishop of Detroit, to silence him. Shortly before the U.S. entered World War II, a new bishop was installed, and Coughlin was ordered to cease broadcasting. He accepted the clerical discipline and retired into a long life of bitter silence.

It's hard to imagine any contemporary cable system dropping Fox News simply because Beck is an offensively dangerous demagogue -- not with his ratings at least. His new foray into politics, though, presents Rupert Murdoch's network with a profound challenge. Is it willing to become the platform for an extremist political campaign, or will it draw a line as even the authoritarian Catholic Church of the 1940s did? CNN recently parted ways with its resident ranter, Lou Dobbs -- who now confirms he's weighing a presidential bid.

Does Fox see a similar problem with Beck -- and, if not, why?

White House defends costs

White House defends costs, cuts in health bill
CHARLES BABINGTON Associated Press

The Obama administration pushed back Wednesday against claims that it's not doing enough to slow the growth of health care costs, a topic senators will debate heavily in coming weeks.

White House budget director Peter Orszag cited economists and analysts who say a pending Senate bill would take several steps in that direction. And Orszag left no doubt that the administration supports a provision disliked by many House Democrats, union activists and others: a new tax on generous health insurance plans offered by employers.

A rival health care bill passed by the House would, instead, place a new surtax on millionaires' incomes. Lawmakers must resolve such differences if Congress is to send a bill to President Barack Obama's desk.

Republicans kept up their criticisms Wednesday, saying the Senate bill would reduce the federal deficit only by raising taxes and cutting Medicare.

The goal is to drive down health care costs, not increase them along with taxes, Senate Minority Leader Mitch McConnell, R-Ky., said.

"That's not reform," McConnell said.

In a conference call with reporters, Orszag said such critics are overlooking key provisions in the Senate bill. He cited a recent letter from 23 prominent economists praising four main features:

_ Making the federal deficit level or lower over 10 years.

_ Taxing high-cost, employer-provided insurance plans, which are blamed for overuse of medical care.

_ Creating a commission to recommend ways to control Medicare costs.

_ Taking preliminary steps to encourage more efficient ways to deliver health care.

The Senate bill "includes these four pillars," Orszag said.

Previous efforts by Congress to rein in health care costs have done little. For instance, vows to trim Medicare reimbursements to doctors are routinely overturned.

The same has been true for efforts to stop what many consider government overpayments to Medicare Advantage, a privately administered program.

But "it's going to happen this year," said Obama health adviser Nancy-Ann DeParle, who also was on the conference call.

The nonpartisan Congressional Budget Office says the Senate bill would reduce deficits by $130 billion over the next decade. It would do so partly by raising various taxes and by reducing federal spending on Medicare, Medicaid and other programs by $491 billion over 10 years.

Republicans say such details are lost on many Americans, who might be led to believe the pending legislation would actually reduce overall spending on health care.

"All the Democrats' health care bills will increase costs, slash Medicare and raise taxes," said Antonia Ferrier, spokeswoman for House Republican leader John Boehner of Ohio.

Karen Ignagni, president of America's Health Insurance Plans, also criticized the Democratic proposals. She said the Senate bill would increase costs "by encouraging people to wait until they get sick to get insurance, adding new taxes on health care coverage and failing to include systemwide cost-containment provisions."

Ralph G. Neas, head of the Washington-based National Coalition on Health Care, which comprises unions, business groups, patient groups and others, called the House and Senate bills a good start. But Neas urged lawmakers to toughen the bills by including "a strong fail-safe provision" to ensure that segments of the health industry deliver cost savings they have promised.

Hart -- President Barack Obama

Hart --

Tomorrow, Thanksgiving Day, Americans across the country will sit down together, count our blessings, and give thanks for our families and our loved ones.

American families reflect the diversity of this great nation. No two are exactly alike, but there is a common thread they each share.

Our families are bound together through times of joy and times of grief. They shape us, support us, instill the values that guide us as individuals, and make possible all that we achieve.

So tomorrow, I'll be giving thanks for my family -- for all the wisdom, support, and love they have brought into my life.

But tomorrow is also a day to remember those who cannot sit down to break bread with those they love.

The soldier overseas holding down a lonely post and missing his kids. The sailor who left her home to serve a higher calling. The folks who must spend tomorrow apart from their families to work a second job, so they can keep food on the table or send a child to school.

We are grateful beyond words for the service and hard work of so many Americans who make our country great through their sacrifice. And this year, we know that far too many face a daily struggle that puts the comfort and security we all deserve painfully out of reach.

So when we gather tomorrow, let us also use the occasion to renew our commitment to building a more peaceful and prosperous future that every American family can enjoy.

It seems like a lifetime ago that a crowd met on a frigid February morning in Springfield, Illinois to set out on an improbable course to change our nation.

In the years since, Michelle and I have been blessed with the support and friendship of the millions of Americans who have come together to form this ongoing movement for change.

You have been there through victories and setbacks. You have given of yourselves beyond measure. You have enabled all that we have accomplished -- and you have had the courage to dream yet bigger dreams for what we can still achieve.

So in this season of thanks giving, I want to take a moment to express my gratitude to you, and my anticipation of the brighter future we are creating together.

With warmest wishes for a happy holiday season from my family to yours,

President Barack Obama

A Milestone in the Health Care Journey

A Milestone in the Health Care Journey
When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won't succeed unless it "bends the curve" in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. "The bottom line," Nichols says, "is the legislation is sending a signal that business as usual [in the medical system] is going to end."

Both the Senate bill's priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts--such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don't insure their workers--Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill's fiscal strategy, and its vision of how to "bend the curve," almost completely follows Baucus' path from September. Baucus' bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that's the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas' for shifting the medical payment system away from today's fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus' most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that's just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn't likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end "Cadillac" insurance plans; to pursue "aggressive" tests of payment reforms that will "provide incentives for physicians and hospitals to focus on quality" and provide "care that is better coordinated"; and establish an independent Medicare commission that can continuously develop and implement "new efforts to improve quality and contain costs." Finally, they said the Congressional Budget Office "must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter."

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.) "Let's use the metric of that letter," said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. "Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar."

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag's assessment of it. "It has got all four of those elements in it," McClellan said in an interview. "They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go."

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax "will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount." Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn't increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. "They held pretty strong," said one administration health care expert. "It's not like unions haven't been making the case that it shouldn't have been a much higher number."

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. "The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that," said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don't. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such "value-based purchasing" toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as "a death panel by proxy"-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a "values based payment modifier" that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. "It will, we believe, have the same net effect [as the original proposal]," said the Democratic aide. "It should change behavior around that threshold."

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led "accountable care organizations" to more comprehensively manage patients' care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of "bundled" payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.


Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that's attracted the most attention is an independent "Medicare Advisory Board." Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or "ration care," and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers' revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that's not surprising. "CBO is there to score savings for which we have a high degree of confidence that they will materialize," says Reischauer, now president of the Urban Institute. "There are many promising approaches [in these reform ideas] but you...can't deposit them in the bank." In the long run, Reischauer says, it's likely "that maybe half of them, or a third of them, will prove to be successful. But that would be very important."

While generally supportive of Reid's approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. "Ideally you'd both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job," he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don't provide efficient and effective care. "There are a lot of carrots and not so many sticks," he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.
[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don't oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties' on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber's legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a "b" rather than an "a"; the other is he'd like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn't able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. "One never knows whether we're turning the corner or if this is just playing the same old game for another inning," he says. "But I sense there's something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve." If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

Saturday, November 21, 2009

MEDIA MATTERS weekly update on stuff that matters!

Media Matters: The Palin chronicles

It was all too predictable.

From the moment Sarah Palin was airlifted out of the Alaska hinterlands by John McCain and plopped onto the national stage, she's been telling anyone who will listen how poorly she's been treated by the media, the Democrats, the blogosphere, etc. After she did her part in scuttling McCain's already foundering campaign, she added to her list of personal persecutors the same McCain staffers who made her a household name in the first place. The conservative media have cheered on her personal pity party every step of the way, adamantly refusing to acknowledge that Sarah Palin -- perfect Sarah Palin, conservatism's hockey-mom messiah -- has done anything wrong.

So it was inevitable that when Palin and her ghostwriter teamed up to produce her newly release memoir, Going Rogue: An American Life, it would be anything but a tedious exercise in self-martyrdom. The second half of the book, which recounts her time with McCain and the aftermath of the presidential campaign, is a litany of complaints peppered with absolutions of any errors on her part. Palin's account of her disastrous interviews with CBS anchor Katie Couric consists mainly of attacks on Couric for "badgering" her, "edit[ing] out substantive answers," and trying to "frame a 'gotcha' moment." She chastises McCain campaign staffers for having "no script to begin with," for not following her advice and talking about Rev. Jeremiah Wright, and for nurturing the "wardrobe fairy tale" so they could throw her "under the media bus" after the campaign ended.

When not complaining about how ill-treated she was, Palin wildly revised her own history, showcasing her penchant for falsehoods both big and small. She claims that the media were reporting "lies" about the Bridge to Nowhere, when it was she who, from the very start, lied about her own position on the bridge. She claims that she immediately liked the idea of going on Saturday Night Live, even though internal campaign emails show that she was initially reluctant because of the show's "gross" treatment of her family, going so far as to call the SNL crew "whack." She claims that there is no aerial hunting in Alaska, even though she proposed legislation supporting that very practice. The list goes on and on.

But remember, this is Sarah Palin we're dealing with here, and no matter how self-discrediting and ridiculous her book was, the conservative media would leap to her defense, claiming (once again) that she was the victim of a vicious liberal onslaught. Palin herself got the ball rolling before the book was even released, chastising the Associated Press (which got its hands on a copy prior to the release date) for assigning 11 reporters to fact-check it, saying that their time would be better spent fact-checking "what's going on with Sheik Mohammed's trial." Palin made no attempt to respond to the several factual errors and distortions the AP found, and neither did Fox News, which picked up where Palin left off and ran a breathless segment wondering why, exactly, the AP had assigned so many reporters to the book.

Then there's Rush Limbaugh, Palin's staunchest defender and perhaps the conservative media personality most disconnected from reality -- two traits that are in no way mutually exclusive. On November 13, Rush proclaimed that Going Rogue is "one of the most substantive policy books I've read." He must have received a special unabridged edition, because to every other observer -- even Fox News campaign reporter/operative Carl Cameron -- the book's policy prescriptions are few and far between, and rarely more detailed than "Ronald Reagan was right." In the conservative blogosphere, the adoration was even more comical: John Ziegler, the devoted Palinista who is -- and forgive the indelicate bluntness, but there is no better word -- an idiot, called the book the "greatest literary achievement by a political figure in my lifetime."

Meanwhile, the mainstream press ties itself into knots with their obsessive Palin coverage, trying to explain how it is that a riotously unpopular and ill-informed ex-governor speaks for legions of Americans. Newsweek undercut whatever merit its critical analysis of Palin's role in the political world had by festooning it with sexist Palin imagery. David Brooks continues to vacillate in his opinion of Palin, at various times calling her "smart," "a joke," "courageous and likeable," and a "cancer." PBS' Gwen Ifill said women "will be drawn to her story," even though Palin's popularity among women is in the toilet.

None of this is to say that Palin isn't shrewd. She's figured out that she can say whatever she pleases, lie freely, quit elected office to become a professional Facebook bomb-thrower, cash in on a ridiculous book she didn't even write, and still enjoy the adoration of her conservative fan base, as well as the attentions of the mainstream press.

Other major stories this week
KSM trial drives conservatives into hypocritical hysterics

On May 3, 2006, Bill O'Reilly led off his Fox News show with the sentencing of Zacarias Moussaoui, who was tried in civilian court and handed several consecutive life terms for his role in the September 11 terrorist attacks. According to O'Reilly: "The al Qaeda savage promptly thanked them by saying 'America, you lost. I won.' But like what most of this degenerate says, he is wrong. Moussaoui is condemned to rot in his cell until he does die and if the Federal penitentiary is run properly, Moussaoui will be denied any and all privileges." O'Reilly explained that "by not executing Moussaoui, the U.S.A. shows the world we are a nation of laws, a nation that puts power in the hands of regular folks."

Now fast-forward a few years -- the Democrats take control of the White House, and the new president announces he's bringing Khalid Shaikh Mohammed to New York to face trial before a civilian court. O'Reilly, who praised the civilian trial of Moussaoui, says of the decision to Bush White House adviser Karl Rove: "Khalid Shaikh Mohammed, that is a terrible decision. ... Because you know, I know, and everybody knows it's going to cost the city of New York between $75 and $100 million. These animals are going to get up there. They're going to lie. The lawyers are going to turn it into an anti-Bush, anti-CIA, anti-American extravaganza."

Just think about that one for a moment -- O'Reilly, who praised the civilian prosecution of Moussaoui in 2006, is complaining about the White House's civilian prosecution of Mohammed in 2009, to a person who was part of the White House that decided to prosecute Moussaoui in a civilian court.

O'Reilly wasn't the only person to pull the ol' Moussaoui/Mohammed switcheroo on Fox News. Former New York mayor and 9-11 enthusiast Rudy Giuliani appeared on Neil Cavuto's show last Friday to attack the Mohammed decision as a "terrible, terrible mistake," explaining that the terrorist "should be prosecuted in a military tribunal." Cavuto neglected to point out that in 2006, Giuliani said of the Moussaoui trial: "It does demonstrate that we can give people a fair trial, that we are exactly what we say we are. We are a nation of law."

Indeed, confusion abounded among conservatives everywhere. Morning Joe namesake Joe Scarborough declared it "unprecedented" to try a terrorism suspect in the U.S. judicial system. To his credit, Scarborough later corrected this false assertion.

No one expects conservatives to support President Obama, particularly on issues of national security. But is a little consistency too much to ask? Well, maybe consistency is too much -- how about something less than outright hypocrisy?

Rupert's "racist" revisionism

Last week, Media Matters chronicled News Corp. chairman Rupert Murdoch's humanitarian efforts to help recuperate ailing Fox News superstar Glenn Beck by going on TV and announcing that Beck was right to call Obama a "racist." It was a curious comment for several reasons -- Fox News had already dismissed Beck's statement as an expression of opinion and not the position of the network, and people were already painfully aware that Beck hadn't faced any repercussions for his outburst. So in throwing his lot in with Beck, all Murdoch did was essentially confirm that outlandish attacks on the Democratic president are nothing short of official policy over at Fox News.

Then, of course, came the inevitable denial, in which Murdoch's spokesman stated without elaboration that his boss "does not at all, for a minute, think the president is a racist." Perhaps he was unaware that when you say things on TV, lots of people see it (unless, of course, you say it on Fox Business Network).

So you can understand why we were feeling a bit confused. Does Rupert Murdoch think President Obama is a racist or not? Well, there was only one way to get an answer -- ask Rupert himself. And that's exactly what we did. Confronted by Media Matters and asked which comment of the president's he considered racist, Murdoch responded: "I denied that absolutely. ... I don't believe he's a racist."

Well, that clears things up.

Wait. Actually, no ... it doesn't.

It's funny, in a way, to watch all this play out. Murdoch and his Fox News underlings know that even they have lines they can't cross, such as lobbing accusations of racism at the president, but they do it anyway, seemingly unable to help themselves. And when they do get in trouble, their response is always the same -- deny you said that thing that millions of people saw you say, make sure absolutely no one faces any consequences whatsoever, and move on to the next ridiculous story about Obama, which this week was the hyperventilating obsession over Obama's bow to the Japanese emperor.

Fox News would like everyone to believe that they operate under some sort of journalistic standard. If you want to be extremely generous and grant that this standard does in fact exist, then it's irreparably broken. Misbehavior is rewarded, accountability is nonexistent, and the ethical cues coming from upper management are hardly worth emulating.

Friday, November 20, 2009

DAVID BROOKS What Geithner Got Right

NYTimes

It’s amazing to go back and read what people were saying about Timothy Geithner in the spring. Many people said he looked terrified as the Treasury secretary, like Bambi in the headlights. The New Republic ran an essay called “The Geithner Disaster.” Portfolio magazine ran a brutal, zeitgeist-capturing profile that concluded by comparing Geithner to Robert Redford’s hollow man character in “The Candidate.”

The criticism of his plan to stabilize the financial system came from all directions. House Republicans called it radical. Many liberal economists thought the plan was the product of hapless, zombie thinking and argued that only full bank nationalization would end the crisis. The Wall Street Journal asked 49 economists to grade Geithner. They gave him an F.

Well, the evidence of the past eight months suggests that Geithner was mostly right and his critics were mostly wrong. The financial sector is in much better shape than it was then. TARP money is being repaid, and the debate now is what to do with the billions that were never needed. It now seems clear that nationalization would have been an unnecessary mistake — potentially expensive and dangerously disruptive.

The course of events has vindicated the administration’s handling of its first big challenge. Obama could have flinched when the torrent of criticism was at its peak. But the president’s support for Geithner never wavered. Geithner never lost confidence in his policy. Rahm Emanuel mobilized to improve the presentation of the policy. The political team worked hard to deflect criticism from Geithner onto themselves.

In retrospect, their performance during this trial was impressive.

Events also vindicate Geithner’s basic policy instincts. The criticism back then was that Geithner was neither bold nor visionary. He was too cautious, too much the insider and bureaucrat.

But this prudence was the key to his effectiveness. In interviews and testimony, Geithner uses the word “balance” a lot. He talks about finding the right balance point between competing priorities. He also talks like a historian who sees common tendencies in certain contexts, not a philosopher who seeks clear general principles that apply across contexts.

This mentality makes it hard for him to project bold conviction, but it makes him flexible in the face of specific problems. When financial confidence is cratering, Geithner concluded, government should generally be as aggressive as possible, as early as possible. At the same time, it should try not to do things that the market does better, like set prices or run companies.

Geithner’s path was a middling one, but it helped the country muddle toward recovery.

If you wanted to step back and define Geithner’s philosophy, you’d probably say that he starts with a set of fairly conservative instincts about the role of government, which put him on the centrist edge of the Democratic Party.

In an interview on Wednesday, for example, I asked Geithner what government could do to help promote innovation. Usually when I ask leaders that, they reel off some cool technologies that government should promote — windmills, nanotechnology, etc. Often they sound like children trying to play at being entrepreneurs. Geithner didn’t do that. He said that government’s limited job was to get the underlying incentives right so the market could figure out what innovations work best. That suggests a pretty constrained view of government’s role.

On the other hand, you would also have to say that Geithner, like many top members of the Obama economic team, is extremely context-sensitive. He’s less defined by any preset political doctrine than by the situation he happens to find himself in.

In the next few months, Geithner will be confronted with a cross-cutting set of pressures. First, the need to reduce the deficits, which is uppermost on his mind. Second, the rising populism in Congress, which has to be battled sometimes and appeased sometimes by an administration that hopes to get things passed. Third, intense public cynicism about government, which means that every debate is washed in negativity.

Most important, there’s the jobs situation. If job growth returns, that will be a sign that the recovery is normal and Geithner and the administration can return to a more moderate path. If employment does not rebound or the economy double dips, that will be a sign of systemic problems. Geithner and his colleagues will probably adopt a much more activist posture and have to throw their lot in with the left.

I hate to rely on the most overused categories in punditry, but they really do apply here. Some administrations are staffed by hedgehogs, who are guided by a few core principles. But this one is staffed by foxes, who respond flexibly to situations. In the administration’s first big test, that sort of pragmatism paid off.

The Big Squander PAUL KRUGMAN

NYTIMES:

Earlier this week, the inspector general for the Troubled Asset Relief Program, a k a, the bank bailout fund, released his report on the 2008 rescue of the American International Group, the insurer. The gist of the report is that government officials made no serious attempt to extract concessions from bankers, even though these bankers received huge benefits from the rescue. And more than money was lost. By making what was in effect a multibillion-dollar gift to Wall Street, policy makers undermined their own credibility — and put the broader economy at risk.

For the A.I.G. rescue was part of a pattern: Throughout the financial crisis key officials — most notably Timothy Geithner, who was president of the New York Fed in 2008 and is now Treasury secretary — have shied away from doing anything that might rattle Wall Street. And the bitter paradox is that this play-it-safe approach has ended up undermining prospects for economic recovery. For the job of fixing the broken economy is far from done — yet finishing the job has become nearly impossible now that the public has lost faith in the government’s efforts, viewing them as little more than handouts to the people who got us into this mess.

About the A.I.G. affair: During the bubble years, many financial companies created the illusion of financial soundness by buying credit-default swaps from A.I.G. — basically, insurance policies in which A.I.G. promised to make up the difference if borrowers defaulted on their debts. It was an illusion because the insurer didn’t have remotely enough money to make good on its promises if things went bad. And sure enough, things went bad.

So why protect bankers from the consequences of their errors? Well, by the time A.I.G.’s hollowness became apparent, the world financial system was on the edge of collapse and officials judged — probably correctly — that letting A.I.G. go bankrupt would push the financial system over that edge. So A.I.G. was effectively nationalized; its promises became taxpayer liabilities.

But was there any way to limit those liabilities? After all, banks would have suffered huge losses if A.I.G. had been allowed to fail. So it seemed only fair for them to bear part of the cost of the bailout, which they could have done by accepting a “haircut” on the amounts A.I.G. owed them. Indeed, the government asked them to do just that. But they said no — and that was the end of the story. Taxpayers not only ended up honoring foolish promises made by other people, they ended up doing so at 100 cents on the dollar.

Could things have been different? Some commentators argue that government officials had no way to force the banks to accept a haircut — either they let A.I.G. go bankrupt, which they weren’t ready to do, or they had to honor its contracts as written.

But this seems like a na├»ve view of how Wall Street works. Major financial firms are a small club, with a shared interest in sustaining the system; ever since the days of J.P. Morgan, it has been common in times of crisis to call on the big players to forgo short-term profits for the industry’s common good. Back in 1998, it was a consortium of private bankers — not the government — that put up the funds to rescue the hedge fund Long Term Capital Management.

Furthermore, big financial firms have a long-term relationship, both with the government and with each other, and can pay a price if they act selfishly in times of crisis. Bear Stearns, the investment bank, earned itself a lot of ill will by refusing to participate in that 1998 rescue, and it’s widely believed that this ill will played a major factor in the demise of Bear Stearns itself, 10 years later.

So officials could have called on bankers to offer a better deal, for their own sake, and simultaneously threatened to name and shame those who balked. It was their choice not to do that, just as it was their choice not to push for more control over bailed-out banks in early 2009.

And, as I said, these seemingly safe choices have now placed the economy in grave danger.

For the economy is still in deep trouble and needs much more government help. Unemployment is in double-digits; we desperately need more government spending on job creation. Banks are still weak, and credit is still tight; we desperately need more government aid to the financial sector. But try to talk to an ordinary voter about this, and the response you’re likely to get is: “No way. All they’ll do is hand out more money to Wall Street.”

So here’s the real tragedy of the botched bailout: Government officials, perhaps influenced by spending too much time with bankers, forgot that if you want to govern effectively you have retain the trust of the people. And by treating the financial industry — which got us into this mess in the first place — with kid gloves, they have squandered that trust.

Wednesday, November 18, 2009

Sarah from Alaska "how did she get elected GOV?"

from HUFFINGTON POST


I have, of course, all my life read. I'm a lover of books, magazines, and newspapers."
- Former Alaska Governor Sarah Palin

"Sometimes, big shot, you don't seem to give me credit for very much intelligence at all. I've been to school in my life - and I'm a magazine reader!"
- Baby Doll

Sarah Palin took her book tour to the Rush Limbaugh Show this morning. The Oprah and Barbara Walters interviews have been fun, because they mostly just asked her about Levi Johnston, and it's gratifying that God sent him to ruin her life and save the Republic. (Sometimes God opens a door. And it's to Bristol's room.) But the Rush interview was different. To Rush's credit, he actually asked her about politics.

Policy. That's where she shines.

See if you can pick out a theme to her answers.

Unemployment?

But those commonsense solutions there, especially with the cutting taxes on the job creators? That's not even being discussed.
Healthcare reform?

Not when there are commonsense solutions to meeting health care challenges in our country... So lots of commonsense solutions that need to be plugged in before ever considering federal government taking it over.
The 2010 elections?

It's all about Americans who are hurting right now and what those solutions are that are so obvious, so commonsense that need to be plugged in.
The recent special congressional election in New York State?

They are seeking commonsense, conservative solutions to all the challenges that we're facing. I'm glad to see this.
Independent voters?

Todd's not a Republican and yet he's got more commonsense conservatism than a whole lot of Republicans that I know... But in answer to your question, I don't think that the third party movement will be what's necessary to usher in some commonsense conservative ideals... In Alaska, about 70% of Alaskans are independent. So that's my base. That's where I am from and that's been my training ground, is just implementing commonsense conservative solutions.
The Future of the Republican Party?

Let's go back to what Reagan did in the early eighties and stay committed to those commonsense free market principles that worked.
The overall message of her book?

It was just a lot of hard work and it was a lot of very commonsense measures that I undertook politically and practically speaking, and the book is about that, and hopefully people will read it and enjoy it and learn something from it.
In answering about a dozen questions, Palin said some combination of "solutions," "conservative" and "commonsense" twenty-five times. Is this an interview or a drinking game? Was Rush rewarding her by tossing her fish?

Her excitement got the better of her when she said, "But those common sense solutions there." This was a shoehorn too far, as the correct form, in Hillbilly, is obviously "Those there commonsense solutions."

Mencken identified those-there this as a perfectly good hill country adverbial pronoun. (His example, from everyday use: "Those-there wops has all took to the woods.") But he warned that the adverb promised to coalesce with the pronoun so completely as to obliterate all sense of its distinct existence, even as a false noun or adjective. Little did he know.

But splitting an adverbial pronoun, just to squeeze in one more "commonsense?" That's just wrong.

To be fair to Barbara Walters, she did ask Sarah Palin at least one political question: Did Palin think President Obama deserved a Nobel Prize?

Palin replied:

Maybe someday there will be some deserved event, and issues that he tackles that will allow that presentation of Nobel Peace Prize, and I'll be the first to applaud that but two weeks into office and he's already nominated? That's premature. -- Sarah Palin, Author
H.L. Mencken, your move.

Monday, November 16, 2009

BLOOD SUCKERS part #2 Questions About Cholesterol Drug’s Benefit

Study Raises Questions About Cholesterol Drug’s Benefit NYTimes NATASHA SINGER

ORLANDO, Fla. — For patients taking a statin to control high cholesterol, adding an old standby drug, niacin, was superior in reducing buildup in the carotid artery to adding Zetia, a newer drug that reduces bad cholesterol, according to a new study.

The results of the study, published in The New England Journal of Medicine, were presented here Sunday night at an annual meeting of the American Heart Association.

The study has been a polarizing topic here and has also attracted the attention of a powerful senator who has been investigating the conduct of two drug makers, Merck and Schering-Plough, in relation to their sales and marketing of Zetia and a combination cholesterol drug, Vytorin, which includes Zetia. The drug makers merged this month.

The small study, with only 208 patients, has attracted outsize attention because the researchers did a head-to-head comparison of niacin and Zetia, which has been heavily marketed.

The Food and Drug Administration approved Zetia in 2002 to lower bad cholesterol, a risk factor for heart disease. But the drug has not yet proved to have a longer-term clinical benefit in reducing heart attacks and deaths. Merck, the maker of the drug, is conducting a clinical trial on that issue involving up to 18,000 patients. Statins like Lipitor have proved in studies to significantly lower the risk of heart attack.

Some cardiologists here hailed the study as an indication that the popularity of Zetia and Vytorin, which had combined sales last year of about $4.6 billion, has far outstripped their evidence of a concrete benefit on heart health. Other doctors here dismissed the study because it did not directly measure the drugs’ effects on reducing heart attacks.

Nevertheless, this study has the potential to make big waves in the use of cholesterol drugs.

“It will certainly strengthen the idea that, after you give a statin, the weight of the evidence is that, as a second agent, you should give niacin,” said Dr. Roger S. Blumenthal, a professor of medicine at the Johns Hopkins University Medical School. “That is the implication of the study.”

But Dr. Peter S. Kim, the president of Merck Research Laboratories, said Sunday in an interview that the study was limited because it did not compare the groups of patients taking a statin and a second drug to a placebo group. Furthermore, he said, a drug’s ability to improve artery-wall thickness has not been proved to automatically correlate with a reduction in heart attacks.

Zetia, he said, lowers bad cholesterol and lowering bad cholesterol is a known good.

The study results “should be compared to the overwhelming body of evidence that lowering LDL cholesterol is an important thing to do to improve cardiovascular health,” Dr. Kim said.

The study randomly assigned patients who were taking a statin and who had heart disease or a risk of heart disease to additionally take either Zetia or Niaspan.

Statins are a class of drug which lowers LDL, known as bad cholesterol because it can cause arterial thickening and lead to heart problems. The drugs work by inhibiting the production of cholesterol in the liver.

Zetia, which inhibits the absorption of cholesterol in the intestines, lowers bad cholesterol.

Niaspan is a prescription extended-release form of niacin, not the over-the-counter vitamin. Niacin increases HDL, known as “good cholesterol.” Niaspan is made by Abbott Laboratories, which financed the study.

Over the course of the 14-month study, the bad cholesterol of the patients on Zetia decreased by 19.2 percent, but the patients’ arterial wall thickness stayed the same, the study said. In the niacin group, good cholesterol increased by 18.4 percent and the carotid wall thickness decreased.

By itself, the study does not have major significance, said Dr. James H. Stein, a professor at the University of Wisconsin medical school. But taken in the context of more than 30 years of research on and use of niacin, he said, the study adds to the weight of evidence that it can a great benefit to patients with heart disease, he said. “Compare that to Zetia where there is not a shred of evidence that it does anything good for blood vessels or heart disease,” Dr. Stein said.

On Friday, Senator Charles E. Grassley, Republican of Iowa, wrote to the Department of Health and Human Services, asking its director, Kathleen Sebelius, what action she intended to take in light of the study results. Mr. Grassley sits on the Senate Finance Committee which has jurisdiction over Medicare and its drug spending. In 2006 and 2007, the drug makers made more than $300 million through Medicare Part D in sales of Vytorin, a drug that combines Zetia and a statin, Mr. Grassley wrote.

In response to a query from a reporter, a Merck spokesman said the small trial did not change the company’s belief in the demonstrated ability of Zetia and Vytorin to reduce bad cholesterol.

DRUG Makers are BLOOD SUCKERS!

Drug Makers Raise Prices in Face of Health Care Reform


Even as drug makers promise to support Washington’s health care overhaul by shaving $8 billion a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years.

In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation’s drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.

The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year.

Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years.

“When we have major legislation anticipated, we see a run-up in price increases,” says Stephen W. Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. He has analyzed drug pricing for AARP, the advocacy group for seniors that supports the House health care legislation that the drug industry opposes.

A Harvard health economist, Joseph P. Newhouse, said he found a similar pattern of unusual price increases after Congress added drug benefits to Medicare a few years ago, giving tens of millions of older Americans federally subsidized drug insurance. Just as the program was taking effect in 2006, the drug industry raised prices by the widest margin in a half-dozen years.

“They try to maximize their profits,” Mr. Newhouse said.

But drug companies say they are having to raise prices to maintain the profits necessary to invest in research and development of new drugs as the patents on many of their most popular drugs are set to expire over the next few years.

“Price adjustments for our products have no connection to health care reform,” said Ron Rogers, a spokesman for Merck, which raised its prices about 8.9 percent in the last year, according to a stock analyst’s report.

This year’s increases mean the average annual cost for a brand-name prescription drug that is taken daily would be more than $2,000 — $200 higher than last year, Professor Schondelmeyer said.

And this means that the cost of many popular drugs has risen even faster. Merck, for example, now sells daily 10-milligram pills of Singulair, the blockbuster asthma drug, at a wholesale price of $1,330 a year — $147 more than last year. Singulair is now selling at retail, on drugstore.com, for nearly $1,478 a year.

The drug companies “can charge what they want — it’s not fair,” Eric White, the 42-year-old owner of a small jewelry store in Queens, said as he left a pharmacy recently.

Despite having drug insurance, Mr. White says he now pays $110 a month out of pocket for two brand-name allergy medicines, even as he has cut prices in his jewelry store by at least 40 percent to keep customers coming through the door.

He shook his head. “What can I do?” he said. “I need my medicines.”

The drug industry has actively opposed some of the cost-cutting provisions in the House legislation, which passed Nov. 7 and aims to cut drug spending by about $14 billion a year over a decade.

But the drug makers have been proudly citing the agreement they reached with the White House and the Senate Finance Committee chairman to trim $8 billion a year — $80 billion over 10 years — from the nation’s drug bill by giving rebates to older Americans and the government. That provision is likely to be part of the legislation that will reach the Senate floor in coming weeks.

But this year’s price increases would effectively cancel out the savings from at least the first year of the Senate Finance agreement. And some critics say the surge in drug prices could change the dynamics of the entire 10-year deal.

“It makes it much easier for the drug companies to pony up the $80 billion because they’ll be making more money,” said Steven D. Findlay, senior health care analyst with the advocacy group Consumers Union.

Name-brand prices have risen even as prices of widely used generic drugs have fallen by about 9 percent in the last year, Professor Schondelmeyer said. But name brands account for 78 percent of total prescription drug spending in this country. And as long as a name-brand drug still has patent protection it faces no price competition from generics.

Ken Johnson, senior vice president of the industry association — the Pharmaceutical Research and Manufacturers of America — criticized the analysis Professor Schondelmeyer had conducted for AARP, saying it was politically motivated.

“In AARP’s skewed view of the world, medicines are always looked at as a cost and never seen as a savings — even though medicines often reduce unnecessary hospitalization, help avoid costly medical procedures and increase productivity through better prevention and management of chronic diseases,” he said.

But Professor Schondelmeyer’s analysis — which found prices for the name-brand drugs most widely used by the Medicare population rising by 9.3 percent in the last year, the fastest rate since 1992 — is in line with the findings of a leading Wall Street analyst, too. The report was released on Monday.

Catherine J. Arnold, a drug industry analyst at Credit Suisse, said her latest study of the nation’s eight biggest pharmaceutical companies showed markedly similar results: list prices rising an average of 8.7 percent in the 12 months ending Sept. 30 — the highest rate of growth since at least 2004.

As does Professor Schondelmeyer, Ms. Arnold based her price calculations on reported wholesale prices and a formula that puts more emphasis on each company’s best-selling drugs.

Ms. Arnold said the prospect of cost containment under health care reform, as well as the tougher business environment, entered into the decisions of manufacturers to raise prices this year.

The industry stands to gain about 30 million customers with drug insurance from the legislation pending in Congress. But the industry also faces the prospect of tougher negotiations from both public and private buyers as the government tries to squeeze savings out of the health system.

“If you’re going to take price increases,” Ms. Arnold said, “here and now might be the place to do that, because the next year and the year after that might be tough.”

Mr. Johnson did not dispute the Credit Suisse study or deny Ms. Arnold’s finding that American drug makers have raised prices at the fastest rate in five years.

He said both studies were incomplete by failing to include rebates that drug makers give distributors. But Ms. Arnold, Professor Schondelmeyer and a 2007 Congressional study of Medicare said the rebates often accrue to the middlemen, not consumers, and higher manufacturer prices lead to higher retail prices.

And the drug industry’s own major consulting firm, IMS Health, has also reported a significant run-up in prices. Back in April, IMS predicted that United States drug sales might actually decline this year.

Billy Tauzin, president of the industry’s trade association, highlighted the gloomy prediction in a June 1 letter to President Obama shortly before striking the deal to cut drug costs by $80 billion. In negotiating the deal, the drug makers argued that they could not afford to give up more than that.

But in October, IMS made an unusual change in the middle of its forecasting cycle, saying it now believed United States sales would grow at least 4.5 percent in 2009 — or $21 billion more than expected six months earlier.

A major reason, IMS said, was higher-than-expected price increases for drugs in the United States.

For Some Smokers, Even Home Is Off Limits

NYTimes C. J. HUGHES

The movement to ban smoking in New York City has grown so quickly that no place seems immune — certainly not restaurants or bars, and public beaches and parks may not be far behind. Now the efforts are rapidly expanding into the living room.

More landlords are moving to prohibit smoking in their apartment buildings, telling prospective tenants they can be evicted if they light up in them.

This month, the Related Companies will ban smoking at some of its downtown apartment buildings because of health concerns about secondhand smoke, according to company officials.

Smokers who already live in any of these buildings will not be affected, according to Jeff Brodsky, a president of Related, which is a national developer with 17 buildings in Manhattan.

But any new renters must promise not to smoke at home, even if they continue to elsewhere.

Kenbar Management, a local developer, is going a step further. When its new project, 1510 Lexington Avenue, opens in December, smoking will be banned in all 298 units, in addition to private and shared terraces.

And the typical smoker’s refuge — directly outside the building — is also off limits; tenants must agree not to smoke on any of the sidewalks that wrap around the building, which takes up most of a block in East Harlem, according to Kinne Yon, a Kenbar principal.

The trend has predictably divided smokers and nonsmokers in New York.

“I think it’s absolutely absurd,” said Bryan Marx, 53, a cabinetmaker who has lived at Tribeca Park, a Related building on Chambers Street, since 1999. He smokes hand-rolled cigarettes in his apartment, but said that he cut back on a cigar habit a few years ago to appease a neighbor.

“How about a little tolerance?” Mr. Marx added. “Smokers have become the whipping boys for everything that’s unhealthy about living in New York City.”

Across the country, the movement to ban smoking in residential buildings is gaining traction. The Department of Housing and Urban Development has strongly encouraged public housing agencies to ban smoking in some or all of their units.

So far, about 50 public housing agencies have now forbidden smoking, according to Betsy Feigin Befus, a lawyer with the National Multi Housing Council, a landlord trade group that has tracked the efforts.

Other cities, through legislation or by initiatives of developers, have taken similar steps. In California, for example, all apartments and condos in Richmond, near San Francisco, must outlaw cigarette smoking, according to an ordinance passed in July. Across the bay in Belmont, a ban on smoking in apartments took effect in January after a 14-month grace period, with $100 fines possible for offenders.

While there is no question about the dangers of secondhand smoke, there is debate about whether the amount of smoke that may be transmitted from one apartment to another is harmful. A recent study by New York City’s health department found that about 57 percent of nonsmokers had been exposed to substantial levels of cigarette smoke, raising suspicions among experts that apartment dwellers might be susceptible to secondhand smoke from their neighbors.

New York City has been at the forefront of efforts to ban smoking in bars and restaurants, and the city’s health commissioner, Dr. Thomas A. Farley, said in September that he supported a ban on smoking at city beaches and parks. But the city, he said, has no plan to push for a smoking ban in public housing developments.

The city did help Related research the health effects of smoke in apartment buildings, Dr. Farley said, adding, “Our focus would be on individuals having their homes smoke-free.”

Pan Am Equities, a real estate management company, may have been one of the first in New York to introduce a smoking ban to an apartment building. About 18 months ago, the company asked new renters to promise not to smoke; the ban did not affect existing tenants, according to David Iwanier, a company vice president.

All of Pan Am’s rentals — which include 270 Park Avenue South, 145 West 67th Street and 60 West 23rd Street — are affected, though Mr. Iwanier would not discuss the reasons for the ban.

“It was just something we decided to do,” he said. And in terms of lease renewals, he added, “we’ve not had any negative feedback.”

Mr. Brodsky, of Related, said that existing tenants would be reassured that they would not be evicted or pressured to leave. He would not specify which of the developer’s buildings are in line for the ban, saying only that they are among the six in or near Battery Park City and Chelsea. Those include Tribeca Park; the Caledonia, which abuts the High Line park; and Tribeca Green in Battery Park City, which bills itself as “New York’s most environmental rental.”

“I think it’s a bloody good thing,” said Dale Smith, 41, a Broadway producer who formerly worked in the health care industry. A resident of Tribeca Green for nearly three years, Mr. Smith, who does not smoke, said he had complained to his landlord about secondhand smoke in his apartment.

“A policy that is in place because something has proven to be hazardous in eating establishments should be effective in the home,” he said.

Experts say there is no known law in the United States that prohibits landlords from banning smoking in their buildings, and many trial judges have sided with the nonsmoker. In New York, for example, a 2006 decision found that tenants had the right to break a lease because the landlord failed to safeguard an apartment from secondhand smoke.

Co-ops and condominiums have been somewhat slower to embrace such bans, according to real estate lawyers.

In interviews with several lawyers who represent real estate concerns, only one, Stuart Saft, knew of any buildings that had instituted a smoking ban. He said that of the 100 or so co-op buildings he represents on the Upper East and West Sides of Manhattan, only two have banned smoking outright in the last few years.

A poll commissioned by the NYC Coalition for a Smoke Free City suggested that a residential smoking ban might not hurt rentals or sales. The survey of 1,000 New Yorkers, which was administered by Zogby International in July, found that 58 percent would pay more to live in smoke-free housing; 68 percent might not live in a smoking building in the first place.

Yet some real estate brokers question the wisdom of instituting a smoking ban during a housing downturn, with vacancy rates climbing.

That 950,000 New Yorkers — or 16 percent of the population — call themselves smokers, according to the city’s health department, is not insignificant, said Daniel Baum, chief executive at the Developers Group/The Real Estate Group of New York, a brokerage that focuses on rentals.

“I think in general it’s probably not an ideal time to try to limit potential tenants,” Mr. Baum said. “Every occupied apartment counts.”

And Audrey Silk, the founder of Citizens Lobbying Against Smoker Harassment, a nine-year-old advocacy group, said the trend was troubling from a civil liberties perspective.

“If we’re talking about annoying odors, where do you draw the line?” she said. “What about cooking odors, from fish or curry?”

Yet some smokers seemed resigned to their fate. Brian Mossotti, 28, a day trader, moved into the Pan Am-run building on 23rd Street 14 months ago, after the developer’s ban had taken effect. After receiving three warnings from management about fumes in the hallway, including a stern letter in September, Mr. Mossotti finally agreed to take his two-a-day cigarette habit to the sidewalk, he said.

“You can’t smoke in bars because of the whole secondhand smoke thing, so it doesn’t surprise me,” he said. “But it is irritating.”

Friday, November 13, 2009

Palin's book goes rogue on some facts

FACT CHECK: Palin's book goes rogue on some facts
By CALVIN WOODWARD Associated Press

Sarah Palin's new book reprises familiar claims from the 2008 presidential campaign that haven't become any truer over time.

Ignoring substantial parts of her record if not the facts, she depicts herself as a frugal traveler on the taxpayer's dime, a reformer without ties to powerful interests and a politician roguishly indifferent to high ambition.

Palin goes adrift, at times, on more contemporary issues, too. She criticizes President Barack Obama for pushing through a bailout package that actually was achieved by his Republican predecessor George W. Bush — a package she seemed to support at the time.

A look at some of her statements in "Going Rogue," obtained by The Associated Press in advance of its release Tuesday:

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PALIN: Says she made frugality a point when traveling on state business as Alaska governor, asking "only" for reasonably priced rooms and not "often" going for the "high-end, robe-and-slippers" hotels.

THE FACTS: Although travel records indicate she usually opted for less-pricey hotels while governor, Palin and daughter Bristol stayed five days and four nights at the $707.29-per-night Essex House luxury hotel (robes and slippers come standard) overlooking New York City's Central Park for a five-hour women's leadership conference in October 2007. With air fare, the cost to Alaska was well over $3,000. Event organizers said Palin asked if she could bring her daughter. The governor billed her state more than $20,000 for her children's travel, including to events where they had not been invited, and in some cases later amended expense reports to specify that they had been on official business.

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PALIN: Boasts that she ran her campaign for governor on small donations, mostly from first-time givers, and turned back large checks from big donors if her campaign perceived a conflict of interest.

THE FACTS: Of the roughly $1.3 million she raised for her primary and general election campaigns for governor, more than half came from people and political action committees giving at least $500, according to an AP analysis of her campaign finance reports. The maximum that individual donors could give was $1,000; $2,000 for a PAC.

Of the rest, about $76,000 came from Republican Party committees.

She accepted $1,000 each from a state senator and his wife in the weeks after the two Republican lawmakers' offices were raided by the FBI as part of an investigation into a powerful Alaska oilfield services company. After AP reported those donations during the presidential campaign, she said she would give a comparative sum to charity after the general election in 2010, a date set by state election laws.

PALIN: Rails against taxpayer-financed bailouts, which she attributes to Obama. She recounts telling daughter Bristol that to succeed in business, "you'll have to be brave enough to fail."

THE FACTS: Palin is blurring the lines between Obama's stimulus plan — a $787 billion package of tax cuts, state aid, social programs and government contracts — and the federal bailout that Republican presidential candidate John McCain voted for and President George W. Bush signed.

Palin's views on bailouts appeared to evolve as McCain's vice presidential running mate. In September 2008, she said "taxpayers cannot be looked to as the bailout, as the solution, to the problems on Wall Street." A week later, she said "ultimately what the bailout does is help those who are concerned about the health care reform that is needed to help shore up our economy."

During the vice presidential debate in October, Palin praised McCain for being "instrumental in bringing folks together" to pass the $700 billion bailout. After that, she said "it is a time of crisis and government did have to step in."

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PALIN: Says Ronald Reagan faced an even worse recession than the one that appears to be ending now, and "showed us how to get out of one. If you want real job growth, cut capital gains taxes and slay the death tax once and for all."

THE FACTS: The estate tax, which some call the death tax, was not repealed under Reagan and capital gains taxes are lower now than when Reagan was president.

Economists overwhelmingly say the current recession is far worse. The recession Reagan faced lasted for 16 months; this one is in its 23rd month. The recession of the early 1980s did not have a financial meltdown. Unemployment peaked at 10.8 percent, worse than the October 2009 high of 10.2 percent, but the jobless rate is still expected to climb.

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PALIN: She says her team overseeing the development of a natural gas pipeline set up an open, competitive bidding process that allowed any company to compete for the right to build a 1,715-mile pipeline to bring natural gas from Alaska to the Lower 48.

THE FACTS: Palin characterized the pipeline deal the same way before an AP investigation found her team crafted terms that favored only a few independent pipeline companies and ultimately benefited a company with ties to her administration, TransCanada Corp. Despite promises and legal guidance not to talk directly with potential bidders during the process, Palin had meetings or phone calls with nearly every major candidate, including TransCanada.

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PALIN: Criticizes an aide to her predecessor, Gov. Frank Murkowski, for a conflict of interest because the aide represented the state in negotiations over a gas pipeline and then left to work as a handsomely paid lobbyist for ExxonMobil. Palin asserts her administration ended all such arrangements, shoving a wedge in the revolving door between special interests and the state capital.

THE FACTS: Palin ignores her own "revolving door" issue in office; the leader of her own pipeline team was a former lobbyist for a subsidiary of TransCanada, the company that ended up winning the rights to build the pipeline.

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PALIN: Writes about a city councilman in Wasilla, Alaska, who owned a garbage truck company and tried to push through an ordinance requiring residents of new subdivisions to pay for trash removal instead of taking it to the dump for free — this to illustrate conflicts of interest she stood against as a public servant.

THE FACTS: As Wasilla mayor, Palin pressed for a special zoning exception so she could sell her family's $327,000 house, then did not keep a promise to remove a potential fire hazard on the property.

She asked the city council to loosen rules for snow machine races when she and her husband owned a snow machine store, and cast a tie-breaking vote to exempt taxes on aircraft when her father-in-law owned one. But she stepped away from the table in 1997 when the council considered a grant for the Iron Dog snow machine race in which her husband competes.

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PALIN: Says Obama has admitted that the climate change policy he seeks will cause people's electricity bills to "skyrocket."

THE FACTS: She correctly quotes a comment attributed to Obama in January 2008, when he told San Francisco Chronicle editors that under his cap-and-trade climate proposal, "electricity rates would necessarily skyrocket" as utilities are forced to retrofit coal burning power plants to reduce carbon dioxide emissions.

Obama has argued since then that climate legislation can blunt the cost to consumers. Democratic legislation now before Congress calls for a variety of measures aimed at mitigating consumer costs. Several studies predict average household costs probably would be $100 to $145 a year.

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PALIN: Welcomes last year's Supreme Court decision deciding punitive damages for victims of the nation's largest oil spill tragedy, the Exxon Valdez disaster, stating it had taken 20 years to achieve victory. As governor, she says, she'd had the state argue in favor of the victims, and she says the court's ruling went "in favor of the people." Finally, she writes, Alaskans could recover some of their losses.

THE FACTS: That response is at odds with her reaction at the time to the ruling, which resolved the long-running case by reducing punitive damages for victims to $500 million from $2.5 billion. Environmentalists and plaintiffs' lawyers decried the ruling as a slap at the victims and Palin herself said she was "extremely disappointed." She said the justices had gutted a jury decision favoring higher damage awards, the Anchorage Daily News reported. "It's tragic that so many Alaska fishermen and their families have had their lives put on hold waiting for this decision," she said, noting many had died "while waiting for justice."

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PALIN: Describing her resistance to federal stimulus money, Palin describes Alaska as a practical, libertarian haven of independent Americans who don't want "help" from government busybodies.

THE FACTS: Alaska is also one of the states most dependent on federal subsidies, receiving much more assistance from Washington than it pays in federal taxes. A study for the nonpartisan Tax Foundation found that in 2005, the state received $1.84 for every dollar it sent to Washington.

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PALIN: Says she tried to talk about national security and energy independence in her interview with Vogue magazine but the interviewer wanted her to pivot from hydropower to high fashion.

THE FACTS are somewhat in dispute. Vogue contributing editor Rebecca Johnson said Palin did not go on about hydropower. "She just kept talking about drilling for oil."

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PALIN: "Was it ambition? I didn't think so. Ambition drives; purpose beckons." Throughout the book, Palin cites altruistic reasons for running for office, and for leaving early as Alaska governor.

THE FACTS: Few politicians own up to wanting high office for the power and prestige of it, and in this respect, Palin fits the conventional mold. But "Going Rogue" has all the characteristics of a pre-campaign manifesto, the requisite autobiography of the future candidate.