Repent, for the kingdom is at hand

Supply Side Jesus | Al Franken

Click here to view Al Franken's Supply Side Jesus.

[h/t Heidi]

2010 California Marriage Protection Act

[h/t Dave]

...Scrooge, minus the change of heart

Garrison Keillor put his finger on the bruise in his column at Salon...

Christmas is one of the bulwarks of Life As We Know It, and in these parlous times we cling to its classic truth, which is: Rejoice, be not afraid, and show mercy to the poor and outcast, for it was through such people that Jesus came into the world. Dickens' ancient novella, written in a big rush because he was low on cash, is on the silver screen again, and Scrooge is moved by the Spirits to share the wealth with his downtrodden clerk. Meanwhile, the truth of Christmas is tested in Washington as we move toward some sort of semi-universal healthcare against the near-unanimous opposition of Republicans. Given the chance to be shepherds or angels, they chose instead to be Herod. Spooked by the victory of Barack Obama, they decided to fight him on all fronts, even though Americans will die as a result.

Read the whole piece at Salon...



Scrooge,courtesy mezzocielo

Pay No Attention to the Man Behind the Curtain

What happened at Tiger Woods’ residence will, it seems, stay at Tiger Woods’s residence. Which may be precisely the right outcome in light of the Florida Highway Patrol statement about Mr. Woods’ recent one-car crash. He was cited for careless driving, the investigation is concluded and that, it appears, is that so…move along, nothing to see here.

This news will prompt some people to say, “Wait, what? Tiger Woods had a car accident? Is he ok?”

Others will continue to live their lives as if they had no idea who Tiger Woods is (which they don’t) and could hardly care less (which they can’t).

And some will be frustrated if not infuriated by the news because they live for public drama and can’t imagine anything more satisfying than seeing a sports icon toppled by scandal.

Continue reading at InsideWork

The Muppets Take Mercury | Bohemian Rhapsody

Manage v Lead Part II

Jack Welch summed up his philosophy at General Electric succinctly:

“I don’t run GE,” he said, “I lead GE.”

The first half of this two-part post unpacked some thoughts on the difference between managing and leading in preparation for this: You don't have to be Jack Welch and you don't have to be responsible for the well-being of a giant corporation to make your mark as a leader.

The last two decades gave rise to all manner of initiatives and systems for managing our way to greater margins through cost savings. But no one has demonstrated how we can manage to cut our way to sustainable growth.

Continue reading at InsideWork...

Manage v Lead Part I

They should display Jack Welch’s words on the side of a building in brilliant General Electric bulbs:

“I don’t run GE,” he said, "I lead GE."

And so he did. Love ‘em or not, Welch led GE through a period of extraordinary performance. Was it a perfect run? Of course not. His tenure was marked by great risks and magnificent blunders that reaped great financial rewards and created a powerful learning organization.

Welch identified his ingredients for success in an October 2001 talk at the University of Chicago Graduate School of Business. They are, he said, “four E’s wrapped in a P.”

Energy — For Welch, energy means, “…going like a house afire.”

Energizing — Leaders “Energize people to take a chance so they succeed and build self-confidence.”

Edge — Edge means “…the ability to say ‘yes’ and ‘no’ and not maybe.”

Execute — one word: “deliver.”

Success is four E’s wrapped in a P and that P stands for Passion — “Caring more than the next person…” Welch said, “…passion for what you’re doing. It’s all that stuff in you that goes for it and you give everything you’ve got to make it happen.”

These, Welch told his B School audience, are marks of leadership, as distinct from, say, management.

Keep reading at InsideWork...

US House of Representatives Passes Historic Health Care Reform Bill

From the President of the United States; 07 November, 2009:

Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people.

The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality affordable options for those who don’t; and bring down the cost of health care for families, businesses, and the government while strengthening the financial health of Medicare. And it is legislation that is fully paid for and will reduce our long-term federal deficit.

Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year.

Letter to Congressman Bilbray | Step Up on Health Care Sir

Dear Congressman,

I urge you to distance yourself from Congresswoman Bachmann and the others who made an empty-headed spectacle of themselves on the steps of the Capitol yesterday.

The Business Roundtable, the Institute of Medicine, the AARP and the AMA are all calling for robust health care reform now and I join my voices with theirs.

You have a singular opportunity to distinguish yourself as one who stands with your constituents in this most critical domestic policy issue. Step up sir.

Sincerely,

Jim Hancock

George Barna on Jesus' Health Care Plan | A Response

As the US Congress approaches health care reform in earnest, I think it's important to hear from each other in measured tones.

In that spirit, my friend Dan sent me a link to this editorial, Jesus’ Health Care Plan, by George Barna.

I think Mr. Barna makes a category error here.

His numbers convince him that most Americans have accepted a poverty frame for the health care debate, so he addresses the question within that frame.

There is no problem with what he says, as far as it goes. The problem is that he doesn't go the right direction.

In 2004 the Institute of Medicine of the United States National Academies published the final report from a series of mandated, evidence based studies. The report is called Insuring America's Health: Principles and Recommendations.

You can read it for yourself, but I’ll highlight a few findings:

• About four out of five uninsured people in the U.S. are citizens.
• Just over 55% of uninsured Americans are in households with at least one family member who is fully employed. Nearly 14% are in households with two full-time workers.
• The cost of employment-based insurance increased by 260 percent between 1977 and 1998, and the employee’s share increased by 350 percent — while median household incomes only increased by 17 percent (all in constant 1998 dollars).
• About 58% of uninsured adults in the reporting period had changed or lost jobs in the previous year (this is all before the recent job collapse).
• The cost to the U.S. economy in lost productivity from uninsured Americans ran as high as $130 billion a year (nearly twice as much as it might have cost to insure those Americans outright).

In September, the Business Roundtable concluded a study of US health care in a report called Health Care Reform: The Perils of Inaction and the Promise of Effective Action.

For the purposes of this exchange, their findings are summarized well enough in a series of passages from the report:

The Status Quo Is a Prescription for Failure
As months of Congressional and now public debate have proved, discussion of coverage provisions and financing of health care reform is complex and controversial. The debate over health care reform is increasingly being framed as a choice between the current system and the uncertainty of what reform may bring. But the comparison should be between the uncertainty of what reform may bring and the near certainty of what inaction will bring. Doing nothing is simply no longer an option. If current trends continue, the future looks dire for the U.S. health care system and for employer-sponsored coverage that is its foundation. Without change, Hewitt projects that employer-based health care costs will increase 166% by 2019, resulting in a cost burden of $28,530 per employee. This price tag approaches three times the 2009 per-employee cost of $10,743. America’s businesses cannot win in the marketplace when bidding against global companies shouldering significantly lower health care cost burdens.

Without fundamental changes to the system that continues to push costs upward, there is no reason to expect any different trend line over the next 10 years. If that happens, costs in 2019 will be 166% higher than they are in 2009. As summarized in exhibit 2,13 the average cost to American business will be over $28,000 per employee ($28,530).

If current trends continue, the future looks dire for the U.S. health care system and employer-sponsored coverage that is its foundation. If nothing changes, by 2019, total health care spending will reach $4.4 trillion and will consume over 20% of the U.S. gross domestic product. Employer spending and associated employee contributions will significantly outstrip increases in cash wages, causing a decline in consumer purchasing power that will hinder economic growth.

Large numbers of both uninsured and underinsured Americans have filed for personal bankruptcy. One recent study reported more than one-quarter of all personal bankruptcy filings in 2001 were caused by a specific illness or injury.24 Others estimate this number to be around 30%.25, 26 Increasing the number of Americans who have health insurance, as well as ensuring that all plans provide protection from catastrophic expense, should reduce the out-of-pocket burden on individuals. In our consumer-based economy, money spent on health care becomes money not spent on other goods and services. Combined with the drag on wage growth caused by the high cost of employer-provided health insurance, ever-increasing health care costs have far-reaching effects outside the health care sector.

These two reports, one commissioned by government, one by business, both based on evidence-based research and analysis, reach compatible conclusions.

From the IOM report:

1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

The Committee calls on the federal government to take action to achieve universal health insurance and to establish an explicit schedule to reach this goal by 2010.

Imagine what the country would be like if everyone had coverage—people would be financially able to have a health problem checked in a timely manner, to obtain preventive and primary care, and to receive necessary, appropriate and effective health services. Families would have security in knowing that they had some protection against medical bills undermining their financial stability. Key community providers and health care institutions could provide care to those who need it without jeopardizing their financial stability.

This picture can become reality, with the right mix of leadership and political will. Unchecked, the costly consequences of the status quo are too large to sustain. It is time for our nation to extend coverage to everyone.

From the Business Roundtable report:

If more people were covered under the existing delivery system, overall spending would increase. The Kaiser Family Foundation estimates that total health care spending for full-year and partial-year uninsureds would add $122.6 billion to the annual cost of health care in the United States if this population became insured.16 Additional health care spending is quite likely to be a short-term result of expanded coverage as the medically underserved receive more and better care. However, there is additional evidence that the economic benefits of this increased spending in terms of improved health status, longevity, and productivity would result in a positive return on this investment. Perhaps the greatest challenge—and reward—will be to modify the underlying delivery system so that it is moved along a path of greater efficiency, quality, and lower cost trends in the future.

A reformed health insurance marketplace that eliminates preexisting condition exclusions and ensures guaranteed access to coverage would reduce or eliminate individuals’ fears that health conditions would block them from obtaining health coverage based on where they work. This would ultimately result in a more level playing field for talent between small employers and large employers.21 One out of every four employed Americans works for a company with fewer than 20 employees, and 82% of Americans are employed by companies with fewer than 500 employees.22 Businesses with fewer than 500 employees account for over 50% of private non-farm GDP and play a large role in supplying inputs and innovation to the American economy.23 Barriers to affordable health insurance hinder the growth of small, entrepreneurial business; we need to remove these barriers to stimulate small business development.

Without market pressure on unit cost and with little incentive to control utilization, the traditional supply and demand equation doesn’t work in health care.

We have established that there is a business and societal advantage to giving more people access to health insurance coverage even in a health care system plagued by obvious flaws. The positive impact can be magnified if expansion of coverage is accompanied by fundamental reform of the health care market and delivery system that underlie the insurance benefit.

The problems and the successes in the U.S. health care system developed over decades, and it would
be naïve and unrealistic to expect that a $2.4 trillion health care system can be radically overhauled very quickly. It will take time. The challenge to key stakeholders in this debate is to positively influence a solution that will first address the current inequities in the system. However, as we reap the positive benefits, it is even more important to put structures and incentives in place which, over time, will produce significant and sustainable reductions in the future cost of health care. We are at a tipping point where continued escalation of health care costs will break not only the Medicare and Medicaid systems that protect our elderly and indigent, but also the companies that the majority of Americans rely on to provide valuable health insurance protection for themselves and their families. Reform in coverage must be accompanied by changes in the underlying markets and delivery system to generate higher-quality and more efficient health care for every American.

These studies have a great deal more to say than I’ve excerpted here and it’s good reading as such things go.

What they don’t do to any significant degree is moralize the problem as George Barna does. The issues at hand do not scale as moral questions any more than interstate commerce or international banking or sickness and injury have moral standing in and of themselves. They scale as macroeconomic questions. And that’s how the delivery of appropriate health services in the US scales.

I think Mr. Barna does not answer the question he asked. Who would dispute his call to followers of Jesus to follow Jesus in caring for the poor and the sick? But that’s a Duh-rated observation. This is not, as he suggests, about “Views of Poverty.” At the least, this is something more akin to shalom and at most it is about how a nation is to conduct its internal affairs. On this subject Moses was clear that Israel was not to allow its citizens to fall into poverty when she had the capacity to prevent it. If these are questions of morality, then it’s a morality that informs their economic practices at a very practical level (as the Business Roundtable report reminds us, “In our consumer-based economy, money spent on health care becomes money not spent on other goods and services.” I agree with the inference from Mr. Barna that Jesus’ health plan isn’t about teaching the sick and the poor a blanket lesson about industry, frugality and self-discipline—especially if we don’t know how this individual or that one became sick or poor.

But when he invokes the Golden Rule and the Great Commandment he reduces them to the size of the individual or household or church or denomination. He loses me there. What if the question were framed, “If I’m to love my neighbor as myself and do to others as I would like them to do to me, would I want others to let me succumb to bankruptcy because of a multimillion dollar medical event if, collectively, we had the means to ensure that doesn’t happen to any citizen?”

And when he describes Jesus’ health care strategy as "whoever, whatever, whenever, wherever;" does that include exerting the political will to reform the system of US health care delivery and payments so it scales meet the legitimate health needs of 300MM citizens?

I don’t think Mr. Barna’s devotional on Luke addresses the questions we're asking right now (unless the questions his audience is asking are decades behind the rest of the nation). AARP and AMA this week endorsed a robust health care reform bill with a public option. I think Christian leaders who represent people who may at some point fall prey to illness or injury—or who care about others who fall prey to illness or injury—ought to do the same and tell their members of Congress about it.


Doctor Jesus (Guatemala) photo by Xeni

Medical Bankruptcies | a follow-up

A couple of months ago I wrote about the steady increase of medical bankruptcies in the US:

• 8 percent in 1981

• nearly half of all bankruptcies in 2001

• a staggering 62 percent of US bankruptcies attributed to medical crises in 2007

But 62 percent of what? How many 2007 US bankruptcies were medical bankruptcies?

Answer: 497,140. US bankruptcies were up 40 percent year over year in 2007 and almost half a million of them were precipitated by medical crises.

US bankruptcies jumped another 32 percent in 2008 topping one million. Every business day in 2008 there were more than 3,000 bankruptcy filings, with things getting worse as the year wore on.

If the 62% number from the American Journal of Medicine study held up from 2007 to 2008 (I don't have data that speaks to that one way or the other, but if that number is within the range of accuracy), that pushes the number of medical bankruptcies last year above half a million of our friends, family and neighbors.

My friends in Canada and Europe shake their heads in disbelief that we permit such economic and human devastation. I join them.

Really? | Christian Bookstore

[h/t Jay Howver]

Protect Insurance Companies PSA

Protect Insurance Companies PSA from Will Ferrell

The President's Plan for Health Reform in 4 Minutes

Here's are the highlights as a downloadable pdf. There's more at the White House website.

Garrison Keillor | Writer, 67, has stroke, lives to write about it

As summer drew to a close Garrison Keillor of Lake Wobegon, Minnesota survived a stroke in St. Paul and lived to write about it. Here's part of what Mr. Keillor wrote in his first column back at Salon.com.

The women who draw blood samples at Mayo do it gently with a whole litany of small talk to ease the little blip of puncture, and "here it comes" and the needle goes in, and "Sorry about that," and I feel some human tenderness there, as if she thought, "I could be the last woman to hold that dude's hand." A brief sweet moment of common humanity.

And that is a gift to the man who has been struck by a stroke: our common humanity. It's powerful in a hospital. Instead of a nice linen jacket and cool jeans and black T, you are shuffling around in a shabby cotton gown like Granma in "Grapes of Wrath," and you pee into a plastic container under the supervision of a young woman who makes sure you don't get dizzy and bang your noggin.

Two weeks ago, you were waltzing around feeling young and attractive, and now you are the object of Get Well cards and recipient of bouquets of carnations. Rich or poor, young or old, we all face the injustice of life -- it ends too soon, and statistical probability is no comfort. We are all in the same boat, you and me and ex-Gov. Palin and Rep. Joe Wilson, and wealth and social status do not prevail against disease and injury. And now we must reform our health insurance system so that it reflects our common humanity. It is not decent that people avoid seeking help for want of insurance. It is not decent that people go broke trying to get well. You know it and I know it. Time to fix it.

photo by L-T-L

Health Care Reform | Two Old Friends Chat Each Other Up

A note from an old friend begins...

Hey Jim, since you've gone political on us, a few questions. First, where is your proof for all these claims? Second, where is Obama's "plan" so I can read it? He's never put it in writing. It remains a moving target. Third, all these points are high claims, most of which are being disputed by reputable people and groups, even within Obama's camp (ie. the CBO). I'm sorry, but most of us don't want the government to mess with the world's best heath care. :)


And I respond...

hey; nice to hear from you. I haven't used any numbers that aren't documented in the links from the blog posts in this series on health reform. I'll be happy to dial that in for you if you have trouble finding something.

I ought to have linked this morning's post—sorry; i thought it was more widely available than perhaps it is. You can find the list of essentials here.

The Congressional Budget Office is not in President Obama's camp any more than the Institute of Medicine that produced the 2004 guiding principles was in President Bush's camp. The CBO is chartered specifically to provide economic data to Congress.

My understanding of the CBO health care numbers that seem, as far as I can tell, to be thrown around fairly haphazardly, is that they were requested and delivered in response to first drafts of the health care bill while it was still in committee—multiple committees if I have the story right.

So it's like the first blue sky draft of most any kind of budget: Everyone on the committee puts in everything he or she would like to have and, if it's a good brainstorm, nobody says "we can't afford that" because nobody knows what it costs yet and there are no bad ideas in a first draft.

It's the job of CBO to count costs, not make policy. They put a good faith estimate on what's placed before them and, in many cases—probably most—the sticker price for the gold-plated, handmade, spare not expense first draft of the plan is a splash of cold water in everybody's face. I imagine you've read some film scripts that reflect that process.

Harmonizing a bill that's actually deliverable is what the committees have to do before they put it on the floor of the House or Senate to be further amended and sent yet again to the CBO for cost analysis.

The CBO letter to Congressman Rangel on July 17, 2009 roughly projects the House bill (H.R. 3200) as proposed would produce a reduction of the deficit of about $44BN from 2010-2014 and an increase to the deficit of about $65BN from 2015-2019. These numbers are nothing like the ones thrown around in Knucklehead Nation which I think, generously, must have come from the CBO estimates on the first draft.

So, already, the bill the House is considering is more measured than most of us have been led to believe, and it will be even more realistic before they're done with it.

All this craziness about ObamaCare from the Knuckleheads has been sound and fury signifying nothing but their knuckleheadedness because, as you note, other than what he posted during the campaign (which I don't think many people actually read) he hasn't put a plan in play until now—he is not, after all a legislator and seems to respect the separation of powers to a degree that makes his predecessor look like the socialist dictator his detractors claim the president is.

Putting his plan up now, as chief executive and leader of his party seems about right to me, but I think he's mostly right about this stuff so take that for what it's worth.

...and with this I close: By the end of 2008, the percentage of Americans covered by government-sponsored health insurance plans rose to 29%. Increasingly, I think the "most of us don't want this" refrain depends on getting the right people in the room (or studio) and wording the questions very carefully. In the last decade—much of which was decidedly Republican depending on how you look at it—private health care subscribers grew by one tenth of a percent while public health care subscribers grew by nearly 30%. Assuming a lot of that growth is Boomers, we're not going to see a decline in that shift any time soon.

OK, I'll try to tackle these one at a time. My point in citing the CBO (part of the gov't.) is that it is contrary to Obama's preposterous claim that it won't cost us (the taxpayers) a nickel or add a dime to the deficit.

The Knuckleheads you talk about are, in many cases, disputing Obama's claims and can substantiate their arguments as good or better than Pres. O can. But we're just talking generalities here...

And yes, I'll stand with my comment that the President really has no "Plan". Its not written anywhere and never has been. His speeches have put it in play but its like nailing jello to the wall. Let's see the "Plan" and then lets debate the merits, the solutions and the costs. Wouldn't that be fair?

And the House Plan is so great that every member of Congress is making sure that they are exempt from it!

Well, you didn't cite the CBO, you mentioned it, vaguely and not in a particularly accurate manner. I'll be happy to have you take me to school on what the CBO has said that's more recent or factual or conclusive than the July 17, 2009 letter to Congressman Rangel I linked to above that relates to H.R.3200 as proposed, the only actual health care bill under consideration as far as I know until a) the House does its magic and b) the Senate puts a bill on the table.

No offense intended here, but if you have a case to put forward, please do so. "There are Knuckleheads who disagree" is not a case I can engage.

I couldn't agree more, with your contention that we need to see the president's plan and debate the merits, solutions and costs. That's entirely fair. At the end of the day, of course, the law that's enacted will be legislation harmonized between the House and Senate versions. I think the president is obliged to speak into that process but he's not a lawmaker anymore. American democracy is a beautiful thing...especially when everyone works together.

You're the second person who's mentioned that exemption thing today and I have to admit I'm not familiar with it. I haven't found it in H.R. 3200 (which, not to beat a dead horse, is the only bill under active consideration at present). Can you direct me to something definitive on the subject?

The exemption for Congress has been around since at least the early 90's, as far as I can tell. Here's a couple of links:

here and here.


Jim, thanks for batting this back and forth with me. But I don't want to get lost in the controversies. Can we agree on a few basic points? Would you agree:

1. that we have the best healthcare in the world?
2. that, unfortunately, healthcare insurance seems to cost way too much?
3. that it would really be nice if everyone could afford to have excellent health insurance?

I think that is the basic problem - affordability.

You wrote: "The exemption for Congress has been around since at least the early 90's, as far as I can tell..."

I suppose I hadn’t heard anything about it because it’s a red herring and hasn’t been part of the serious discussion of health care reform.

Here’s a research-based examination of the question from the St. Petersburg Times' Pulitzer Prize-winning Politifact.com.

and

"1. that we have the best healthcare in the world?"

You’d think, wouldn’t you? But the outcomes don’t support that assumption. The most recent evidence based study I know of—published by The Commonwealth Fund in May 2007—compared health care over time in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. US health care ranked sixth. You can download the report here.

and

"2. that, unfortunately, healthcare insurance seems to cost way too much?"

I wouldn’t say it’s unfortunate, I would say it’s contrary to American ideals.

and

"3. that it would really be nice if everyone could afford to have excellent health insurance?"

Yes. And I would add that I think it’s really not nice to stand in the way of that.

photo by Zavosh

we're number 37!

After days and days of earnest posting, this from Paul Hipp
(with a h/t to Heidi Wagner Turner!).

The President's Plan for Health Reform

Here are the essential features of the health care reform plan President Obama champions:

If You Have Health Insurance,
the President's Plan:

• Ends discrimination against people with pre-existing conditions.
• Limits premium discrimination based on gender and age.
• Prevents insurance companies from dropping coverage when people are sick and need it most.
• Caps out-of-pocket expenses so people don’t go broke when they get sick.
• Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.
• Protects Medicare for seniors.
• Eliminates the “donut-hole” gap in coverage for prescription drugs.

If You Don’t Have Insurance, the President's Plan:

• Creates a new insurance marketplace — the Exchange — that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices.
• Provides new tax credits to help people buy insurance.
• Provides small businesses tax credits and affordable options for covering employees.
• Offers a public health insurance option to provide the uninsured and those who can’t find affordable coverage with a real choice.
• Immediately offers new, low-cost coverage through a national “high risk” pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.

For All Americans, the President's Plan:

• Won’t add a dime to the deficit and is paid for upfront.
• Requires additional cuts if savings are not realized.
• Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality.
• Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.
• Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.
• Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.


photo by artbymags

What Sort of Health Care Reform?

In 2004, the Institute of Medicine, one of the congres-
sionally chartered United States National Academies, published the conclusion of its multi-year study of health care in the United States in the form of "a set of guiding principles based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance."

Most of what is in those reports is publicly available, with percentages updated through 2007 or later, so I won't go into detail about those numbers except to say they have tended to become more dire in the five years since publication of the final IOM report, Insuring America's Health: Principles and Recommendations (e.g. the number of excess deaths attributed to uninsurance rose from around 18,000 Americans in 2004 to around 22,000 in 2006—that's about a 20% increase in the number of Americans who died for lack of medical coverage).

Here are a few facts uncovered in the IOM's meticulously evidence-based reporting that I have not found in the discourse this year, followed by the "guiding principles" in the report:

• About four out of five uninsured people in the U.S. are citizens.

• Just over 55% of uninsured Americans are in households with at least one family member who is fully employed. Nearly 14% are in households with two full-time workers.

• The cost of employment-based insurance increased by 260 percent between 1977 and 1998, and the employee’s share increased by 350 percent — while median household incomes only increased by 17 percent (all in constant 1998 dollars)—you know how those costs have accelerated in the new century.

• About 58% of uninsured adults in the reporting period had changed or lost jobs in the previous year—this is well before the job collapse of 2008-09.

• The cost to the U.S. economy in lost productivity from uninsured Americans ran as high as $130 billion a year—nearly twice as much as it would have cost to insure those Americans outright.

The IOM report made the following recommendations in the strongest terms:

1. Health care coverage should be universal—nobody left out.
2. Health care coverage should be continuous—no gaps due to job status.
3. Health care coverage should be affordable to individuals and families—no more medical bankruptcies.
4. The health insurance strategy should be affordable and sustainable for society—weighing all outcomes, costs and savings over time, U.S. health care should benefit the nation, not run it into the ground.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable—what's not to like about better health care?

You can read all this for yourself and I hope you will. The individuals who conducted the studies and analysis and issued the guidelines were a blue-ribbon, nonpartisan committee of genuine experts. As far I can judge, no stakeholders in the future of U.S. health care were left unrepresented with the possible exception of lawyers.

They concluded with the charge:

The Committee calls on the federal government to take action to achieve universal health insurance and to establish an explicit schedule to reach this goal by 2010.

Imagine what the country would be like if everyone had coverage—people would be financially able to have a health problem checked in a timely manner, to obtain preventive and primary care, and to receive necessary, appropriate and effective health services. Families would have security in knowing that they had some protection against medical bills undermining their financial stability. Key community providers and health care institutions could provide care to those who need it without jeopardizing their financial stability.

This picture can become reality, with the right mix of leadership and political will. Unchecked, the costly consequences of the status quo are too large to sustain. It is time for our nation to extend coverage to everyone

Yes, imagine. And then communicate the substance of these recommendations to your U.S. senators and representatives—especially the knuckleheads who act as if they've never heard of the report they commissioned the Institute of Medicine to research and write (I'm looking at you Congressman Bilbray). The health care reform we need calls for the right mix of leadership and political will. This may be one of those instances in which, if the people show the will, the leaders will follow.

But don't mistake this for a political game. "Unchecked," the IOM declares, "the costly consequences of the status quo are too large to sustain (I think the economist on the committee crafted that sentence)."

"It is time for our nation to extend coverage to everyone." Now. How are we going to do it?

Health Insurance Reform | Context is Everything Beetlejuice

It doesn't seem that Beetlejuice is in any mood to be reasoned with by the likes of me.

But on the offhand chance you're still reading and thinking, I want to counter his challenge about what's on "page 16" of H.R. 3200, America’s Affordable Health Choices Act of 2009 as proposed.

In a comment, Beetlejuice wrote:

BTW-here's p. 16 which states if you don't re-up your private insurance-you have to take the govt plan.

10 (1) LIMITATION ON NEW ENROLLMENT.—
11 (A) IN GENERAL.—Except as provided in
12 this paragraph, the individual health insurance
13 issuer offering such coverage does not enroll
14 any individual in such coverage if the first ef-
15 fective date of coverage is on or after the first
16 day of Y1.

Indeed, those words are on page 16. If you note the line numbers to the far left you see immediately that what's missing is lines one through nine and 17 through the end of the page (and what comes before and after page 16 for that matter).

The lines he quotes are a subsection beneath the header:

1 SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT
2 COVERAGE.

Line three sets the agenda for the next several lines:

3 (a) GRANDFATHERED HEALTH INSURANCE COV
4 ERAGE DEFINED

You can go there yourself. What you'll find as you read the offending lines in their context is that the section is explaining the term “Grandfathered Health Insurance Coverage” which means, "individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:" (and that gets us through line nine of page 16).

In general the passage explains that existing coverage is grandfathered into the new system (hence “Protecting the Choice To Keep Current Coverage”) if the coverage is in place before the new system begins. Otherwise it is new coverage, not grandfathered coverage.

New customers can’t be enrolled in grandfathered coverage—because, by definition that would be new coverage, not grandfathered coverage. The exception to this is dependents who may be added to grandfathered coverage

The section goes on to protect those enrolled in grandfathered coverage from reductions in benefits, increases in cost-sharing and what amounts to noncompetitive raises in the rate of premium increases. Strictly speaking, I suppose the passage prohibits increasing benefits and reducing cost-sharing in grandfathered coverage...but I don’t see any clear and present danger of insurers fighting Congress for the right to offer more benefits for less money.

It goes on to say that if your grandfathered coverage does not meet minimum standards for benefits, limits on cost-sharing and no annual or lifetime limits on coverage, with certain exceptions, the plan will have a five year grace period to raise the quality of coverage to meet or exceed that standard of consumer protection or be declared a non-qualifying benefit plan.

The notion that Congress seeks to pass a law protecting citizens from abuse by corporations with a demonstrated willingness to take advantage of their customers in any way the law does not explicitly forbid isn't even a little bit threatening.

I strongly recommend we take the the lines that so frighten Beetlejuice in context, the way they were drafted; the way they were meant. Otherwise we are stuck believing there is a conspiracy afoot at the end of which is Beetlejuice's conception of Ayn Rand's worst nightmare.


photo by shadarington

The New Adventures of Knucklehead Senator

Knucklehead Senator says:

At the end of the day, my constituents can rest assured I will have done absolutely nothing to help this great nation address the staggering problems brought on by a failed health care regime. God bless America.

Knucklehead constituents say:

Yay!

it doesn't take a genius | Medical Bankruptcies in the US

In 1981, 8% of families filing for bankruptcy did so in the aftermath of a serious medical problem.*

A 2001 study in five states found that illness or medical bills contributed to about half of bankruptcies.

In 2007, using a conservative definition, The American Journal of Medicine discovered that 62.1% of all bankruptcies were medical.

Most 2007 medical debtors were well educated, owned homes, and had middle-class occupations.

Three quarters had health insurance.

Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%.

The odds that a bankruptcy had a medical cause in 2007 were nearly two and a half times higher than in 2001.

It doesn't take a genius to see where this curve leads. The knuckleheads who say we can't afford to fix health care are not thinking clearly. We can't afford not to fix it. Tell them to snap out of it and get to work.




* Sullivan TA, Warren E, Westbrook JL. The Fragile Middle Class: Americans in Debt. New Haven, CT: Yale University Press; 2000


photo by Andy Kiel

Torture Debate Lost in Maze

h/t David Wagner

Health Insurance Reform | An Exchange with Beetlejuice

I've had an interesting exchange about health care reform with someone called Beetlejuice who responded to my clipping from Garrison Keillor in London a few days ago. See what you think.

Beetlejuice said...

I'm on the right but I'm not paranoid,I just like my health care and insurance the way it is. The liberals want free healthcare for everyone including non-citizens and non-taxpayers,and taxpayers to pay for it for them.If you like socialism, that's cool.We're not paranoid,we just have a different opinion.

jim hancock said...

Beetlejuice, you've misunderstood or been misled about what liberals want in health care. We want affordable world class coverage for every citizen and we're not willing to concede that the US is the only developed nation on the planet incapable of delivering that.

Your willingness to accept second-tier economic status is inscrutable to people like me who refuse to settle for less than the American ideal. I do not like my health care the way it is—it is expensive and restrictive and getting more so every year. My health insurance premiums have risen 59.56% since 2005—my monthly insurance premiums are greater than the take home pay of a full-time minimum wage worker—and my deductible has risen to $5,000.

The US leads the OECD in health care spending measured per capita and as a percentage of GDP. US per capita spending on health insurance and administration is double that of the next ranked OECD nation.

To our shame, the US also leads the OECD in infant mortality measured by the number of children who die before reaching their first birthday.

The US—my nation and yours—lags well below the median for life expectancy among OECD states. In short, we are paying too much money for too little value and I don't think there is anything smart or noble or principled about that.

You are the tiniest bit paranoid. You're afraid thoroughgoing health care reform would inevitably lead to socialism driven by the liberals. But you've misunderstood or been misled about what we want. We want this nation to be as great in every way as we—you and I—say it is.

Beetlejuice said...

I am worried that i will pay much higher taxes AND not have a choice to get my own healthcare. We are a free country after all, Under Obama-care if I drop my current (Blue Sheild) policy with my employer I will automatically be put into the goverment plan. I believe that is page 16 of the Bill. My free choice is to have the healthcare I want, not what the govt wants me to have.Personal freedom is important.

jim hancock said...

Beetlejuice, apparently, you've never experienced the joys of COBRA coverage from an existing carrier and the search for new insurance while the 18-month clock to secure coverage winds down (tck, tck, tck). When I neared the end of my COBRA mandated coverage in 2000, my existing insurer told me they would be happy to continue my policy at a premium of $6,000 per month. I thought health insurance that cost $72,000 a year should probably come with no deductible but that, of course, was not to be.

Page 16 of H.R. 3200, America’s Affordable Health Choices Act of 2009 as proposed (I don't know what this Obama-care proposal you refer to is and find no trace of it in the public record) begins with Section 102. Protecting the Choice to Keep Current Coverage and says pretty much exactly the opposite of what you believe or have been led to believe it says.

You can find a certified US Government Printing Office copy of H.R.3200 as a downloadable pdf here.

Not to put too fine a point on it Beetlejuice but under the current regime you have virtually no rights to affordable health insurance coverage whatsoever starting 18 months and one day after you leave your current employer-provided health plan. Without health care reform, if you leave your employer-provided program, your "free choice" of insurers will be determined by what you can afford to pay ($6,000 a month in my case, but your mileage may vary). You might get another 36 months of coverage if you are HIPAA-eligible, but I wouldn't count on it if I were you.

I hope you don't find it disrespectful when I observe that we're living in a broadband world and your language suggests you've gotten most of your information about health care reform from narrowcast sources.

When you made a comment here, I offered a thoughtful response gleaned from a variety of credible, publicly available sources. Your response seems to be repeating something you heard someone say...where? on talk radio? cable tv? at a barbecue? It seems to me that one of us is doing most of the heavy lifting on something that matters a great deal to both of us.

People who lie about health care reform are not protecting democracy and they are not your friends. People who repeat lies without attempting to find out if what they're saying is true are not journalists or intellectuals or patriots, they are gossips and gossips are not to be trusted.

There's an old saying which, at the risk of being offensive, I repeat here in it's original form.

"Eat shit," the saying goes, "50 million horseflies can't be wrong."

Well...yes they can.

jim hancock said...

Oops, I forgot to speak to your concern about paying higher taxes Beetlejuice. You're partly right about that and partly wrong.

Here's a post that explains what I mean.

follow the link to the original source if you want more detail.

Beetlejuice said...

Jim, respectively, healthcare is really not a right,according to the constitution.If I choose to buy insurance on the open market that should be my choice,not Uncle Sam's.Your links and factoids may be valuable in some respects, but the bigger picture is still personal liberty.

jim hancock said...

You're spitting into the wind Beetlejuice. No one is trying to take away whatever right you believe you have to pay as much as the market will bear for as little service as the provider can get away with.

America’s Affordable Health Choices Act of 2009 is being shaped to protect that right along with providing a higher standard of care and a greater level of protection for you should your employer lay you off or decide it can no longer afford to contribute to your health plan. As things stand, if that happens, you are SOL.

And then you will have the government-guaranteed right to go to an emergency room when you're so sick you can't put it off any longer and see how that level of care suits you—knowing that taxpayers like me are footing a much higher bill for your care than we would pay if we scaled health care now so that people who want and can afford private health insurance can buy it; and people who don't want or can't afford private health insurance have access to care that keeps them out of the emergency rooms except for emergencies.

I get it. Someone has frightened you with lies and half-truths and has framed this discussion as an assault on your personal convictions so you would sooner lose your home than allow the rest of us the liberty to opt into a different, demonstrably better health care plan.

You're being punk'd, and not in the ha ha, we're all in this together, you're a good sport, let's have a beer way. Those people—the ones who know what they're doing—are not your friends.

I'm glad you think my links and factoids might be useful in some respects. I'm sad you believe people like me want to take away your personal liberty.

Thanks for the polite tone of your comments. We're in this together.

Of Health Care and Other Marks of Civilization

Get a Grip US Citizens...

Garrison Keillor writes from London:

Sunday is a day for parents to bring their children into the city to see where the parents might be living had they not had children, in the posh flats above the smart shops, leading the cool life. The children look irritated, bored, the parents thoughtful. If you're 40 and have three whiny children, 25 looks awfully good. But late last night I hiked around Chelsea and the cool life looked thin to me, the sorrows of intoxication evident everywhere, people whose big night out turned out too small, people with people they were wanting to not be with right now, the lonely late-night walkers like me.

When you walk alone, you soak up the sorrow around you until it's not bearable and you must return to the hotel, and then comes morning, a sunny day in a rainy summer, and you attend Mr. Christopher Wren's church and then hike up to Regents Park and Primrose Hill for a view of the great city, a grassy hillside populated by hundreds of Londoners sunning themselves, and you feel a sort of rarefied blessedness and lightness.

It helps that, an hour before, your sins were forgiven and the priest waved her hand and blessed you, and it also helps to be far away from America and the mounting drumbeat of Democratic defeatism on healthcare reform. Nobody is so ready to embrace martyrdom as my fellow liberals, and here they are, seven months after Mr. Obama took the oath, crying out, "Where did it go, the glory and the dream?" Get a grip. Solid majorities in the House and Senate and yet a few puffs of smoke from the other side and Democrats are full of consternation. If they back out on this young president, and if this Congress cannot pass the public option and meet the basic human needs of our people, what does this say about us?

Here in London, people are amused at the wild paranoid fantasies of the right. I don't care about that, I hold weak-kneed Democrats responsible, and if they get spooked by a few hecklers, then it's time to find replacements.

photo by chrisjohnbeckett

Health Insurance Reform | A $5,400 Metaphor

In this simple model, if US taxpayers had been covered by Medicare instead of private insurance we would pay about $7,000 in family premiums instead of the $12,400 we spent in 2006 for comparable services.

That's $5,400 less...about 45%.

Paying $7,000 for health care instead of $12,400 would have been accomplished mainly through the mechanism of higher taxes.

But taxpayers would have had an additional $5,400 in 2006 to spend or save at our discretion.

All us Costco members know the benefits of spending 45% less for quality merchandise we could buy at full retail elsewhere.

We don't mind paying the modest price of a Costco membership to enjoy that benefit. In fact, we think we're pretty smart to do so.

Something I Worry About

Suppose one reads a story of filthy atrocities in the paper. Then suppose that something turns up suggesting that the story might not be quite true, or not quite so bad as it was made out. Is one’s first feeling, ‘Thank God, even they aren’t quite so bad as that,’ or is it a feeling of disappointment, and even a determination to cling to the first story for the sheer pleasure of thinking your enemies as bad as possible? If it is the second then it is, I am afraid, the first step in a process which, if followed to the end, will make us into devils. You see, one is beginning to wish that black was a little blacker. If we give that wish its head, later on we shall wish to see grey as black, and then to see white itself as black. Finally, we shall insist on seeing everything—God and our friends and ourselves included—as bad, and not be able to stop doing it: we shall be fixed for ever in a universe of pure hatred. — C.S. Lewis, Mere Christianity, p 118

Knuckleheads | What's Your Problem with the Post Office

There's this code language about government incompetence—a sort of Manchurian Knucklehead effect—that cues off the words post office.

Really? Because I write personal checks and letters and send them to faraway places where they arrive a fews days after I hand them to the post office (cue the smirking and snorting) and I don't have to get in my car and drive ten miles or 500 or a thousand miles to hand-deliver my personal message or monetary instrument and I don't have to set an appointment to make sure the recipient will be there when my envelope arrives. I pay 44 cents for this delivery service. The recipient pays nothing.

You there...yeh, you know who you are... Stop being a knucklehead. Your argument is tired and your language is tired and your imagery is tired and you have grown tiresome. The adults are having a conversation about important things. Join the conversation or go outside and play in the yard. Your choice.



[photo by xeeliz]

Those Crazy Christians | What's Wrong with Health Insurance Reform?

I suppose I should be beyond shock about such things...but I'm not.

A shocking number of Christians in the US are stuck pretty much where the first followers of Jesus were before he gave them a bit more instruction about the way things appear and the way things are.

They think being sick or injured or otherwise infirm is a moral failing.

As he went along, he saw a man blind from birth. His disciples asked him, “Rabbi, who sinned, this man or his parents, that he was born blind?” — The Gospel of John, chapter nine, verses one and two

And, if an American family loses their insurance coverage, their livelihood and home, and if their credit rating is destroyed by catastrophic illness or accident, these Christians don't seem to see this as uniquely American tragedy (unique in the sense that no other developed nation allows it citizens to be driven into bankruptcy by medical bills). Apparently these Christians feel affirmed in their judgement of the afflicted. Or perhaps they merely take Darwinian delight in seeing the morally weak—who wouldn't be in the mess they're in if they weren't defective, right?—brought lower still.

Is this who we are?


[photo by seiuhealthcare775nw]

Cash for Clunkers: don't listen to the knuckleheads

Unsolicited Advice Alert: You did not ask my opinion about what follows. Here it is anyway.

If you need a new vehicle and if you can afford a new vehicle, the Cash for Clunkers program is a decent piece of economic stimulus.

The numbers are simple. You'll get $3500 - $4500 credit for getting rid of (and thus permanently disabling) a gas-guzzler and replacing it with a vehicle that gets at least ten miles per gallon better fuel economy.

In addition to that new car smell, you'll save something on the order of $800 a year on fuel costs and contribute to a culture less dependent on oil, with all the benefits that accrue to that shift.

Upstream from you, people keep working and adding value to the economy (and, maybe, hang onto their health coverage).

Downstream from you, people keep working and the mandatory scrapping of your old vehicle produces reclaimed steel that can be repurposed for far less than producing new metal from the ground up.

This is exactly the kind of systemic benefit the American Recovery and Reinvestment Act is designed to produce—which is why the money comes from the $787 stimulus package passed by the congress and signed by the president in February.

Don't listen to the knuckleheads. They're not trying to help you.

[photo by ThreadedThoughts]

¡ahora en español!

this little piggy went crazy cool

fresh air | Mr. Obama on the world stage

“We exercise our leadership best when we are listening, when we recognise the world is a complicated place ... when we show some element of humility and when we recognise we may not always have the best answer but we can always encourage the best answer.” Barack Obama, London, G20 Summit, 02 April, 2009. Financial Times

"Money Doesn't Talk. It swears."

Amid all the experts who failed to call this disaster, only one got it right. It was Bob Dylan, who said: “Money doesn’t talk. It swears.” — Bob Geldof in Financial Times

WE'RE NUMBER...15

What rich countries gave in foreign aid in 2208 as a percentage of GDP.

teenage drunkenness in 30 countries

From The Economist, 30 March, 2009

how do you solve a problem like communicating the true character of financial derivatives and other challenges for the new US president

A useful opinion piece by known lefty James Carville

15-year-olds + their electronic toys

The story is, this site was developed by a 15-year-old to enable users to stream and organize audio from YouTube directly to PCs. Conventional wisdom is you c heck it out before it disappears for the lack of blessings from Google, the record companies and the various rights holders to the songs.

Generation OMG

And this, from the New York Times writer Kate Zernike

a tidal wave of homeless students

rack Obama | Lincoln Birthday Speech | 12 February, 2009 | Part 02

Barack Obama | Lincoln Birthday Speech | 12 February, 2009 | Part 01

Just brilliant

Facebook + Economic Discourse II: In which we pick up the thread wall-to-wall

#1 at 9:28pm yesterday

Are you still supportive of the next bailout? It just seems really expensive to me, compared to the impact it will have on the economy. I looked at that article you linked for me. There is no doubt there are good things included in the package, but we can't afford it, and all I hear from Obama is that we can't afford not to do it. What am I missing?

#4 at 8:33am

Let's begin by reframing the question and dropping the term 'bailout' for the moment. Under the circumstances it seems moralistic and not particularly helpful for this reason: There's been a bus crash and the lives of children are in danger. The person who drove them off the road is a bad driver and possibly a bad man. He should be held responsible for his failure. Perhaps upon investigation it will turn out the driver was an honest man, trying to keep a badly designed and dangerously broken bus on the roadway — maybe the bus company is the bad actor. But the 911 call from a motorist who saw the bus leave the pavement and disappear over the embankment came hours ago. The children are exposed and injured and the sun is going down and the temperature is dropping. We know how this ends. It's not a bailout for the children. It's a rescue. We'll deal with responsibility for the crash later; right now the rescue must be undertaken with energy and imagination and at any cost. more later...

Facebook + Economic Discourse

#1 via Twitter - 4:33pm February 6
Guess I am going to need to save some money if the U.S. Government wants another $700 Billion.

Comment

#2 at 4:37pm February 6
How far are you behind on your taxes?

#1 at 4:52pm February 6
We are up to date, but another stimulus package just got passed, so someone is going to have to pay more, and I am guessing my taxes are not going down any time soon.

#3 at 5:02pm February 6
If only the government understood that lowering our taxes would give us more of a reason to spend. Plus, the new stimulus package doesn't even stimulate, its mostly pork repaying people who help Obama win! I feel your pain.

#4 at 5:14pm February 6
Come on. Read up.

#1 at 6:17pm February 6
#4 - don't leave us hanging, what are we supposed to read?

#1 at 6:24pm February 6
Including this package, the government has already given out more money in "stimulus" than we spent on the entire Iraq/Afghanistan war.

#5 at 7:26pm February 6
here's what we all need to read, to understand all the useless pork in this bill:
http://www.glennbeck.com/content/articles/article/198/21108/

#4 at 8:57pm February 6
i think the Congressional Budget Office 25 page, plain English, report of Feb 2 is pretty clear about where the money is administered and how fast it gets spent. two things worth noting: 1. we're in the fifth month of fiscal 2009, 2. this report is in plain English but written on the assumption that the readers (Members of Congress) have sufficient background to know what and where, for example, would be the economic advantage of spending $9bn to extend broadband Internet services and why that money might be spent at a lower annual rate than, say, $3.4bn to repair, maintain and renovate Dept. of Defense facilities. None of it is rocket science (except the NASA parts) but it does assume interest in and consumption of a modicum of nonpartisan research and journalism. The CBO report is here: http://www.cbo.gov/doc.cfm?index=9977

For background, i appreciated Jeff Madrick's How We Were Ruined & What We Can Do in Feb 12 New York Review of Books: http://www.nybooks.com/articles/22280

End of Thread.

InsideWork | What Are You Waiting For?

Michael Phelps | One is Left to Hope... | Update 02.06.09

Kellogg to Drop Olympian Phelps
Will Let Endorsement Deal Expire at Month's End

Feb. 5, 2009

CHICAGO (AdAge.com) -- One bong hit seen around the world and Olympian Michael Phelps is watching at least one contract go up in smoke. Kellogg will let the swimmer's contract expire at the end of the month.

"We originally built the relationship with Michael, as well as the other Olympic athletes, to support our association with the US Olympic team," a Kellogg spokeswoman said in a statement. "Michael's most recent behavior is not consistent with the image of Kellogg. His contract expires at the end of February and we have made a decision not to extend his contract."

One is left to hope that was some really good shit.

UPDATE 02.06.09

Subway Stands by Phelps
Sandwich Chain Likely to Delay TV Campaign Starring Olympian

Feb. 6, 2009

CHICAGO (AdAge.com) -- Subway has decided to stand by its man despite his bong antics, but the nation's largest fast-food chain is likely to backburner its first TV campaign starring mega-endorser and Olympian Michael Phelps.

"Like most Americans, and like Michael Phelps himself, we were disappointed in his behavior," Subway said in a statement. "Also like most Americans, we accept his apology. Moving forward, he remains in our plans."

Charles-Edward discovers the world

h/t JP

i like it like this

Sleeveface!

I love sleeveface. simple fun. [h/t JP: buy local | surf the planet]

Garrison Keillor | The Inauguration | Three Big Moments

Garrison Keillor hauled himself down to D.C. for the inauguration today. here's the end of his reflection at Salon.com

There was a profound silence when Mrs. Bush was announced and walked out. People watched the big screen and when Mrs. Obama appeared, there was a roar, and when the Current Occupant and Mr. Cheney came out of the Capitol, a low and heartfelt rumble of booing. Dignified booing. Old black ladies around me tried to shush them -- "Don't do that!" they hissed -- but it's a democracy, and how will those men know how we feel if we don't tell them?

The band tootled on and there were shouts of "O-ba-ma" and also "Yes we can" (and also "Down in front") and then he came out and the place went up. That was the first big moment. The second was when he took the oath and said, "So help me, God" and the cannons boomed and you got a big lump in your throat. And the third was afterward.

The invocation was extensive and segued into the Lord's Prayer, and the music was OK if you like Aaron Copland, and the inaugural speech was good enough, calling on us all to great deeds and sacrifice, details to be announced later. You could hear each oratorical phrase repeated over and over in the series of loudspeakers down the Mall and bouncing off stone facades, a sort of cubist effect. The inaugural poet followed, a sort of filler, with a long windup, a few good phrases in the middle ("someone is trying to make music somewhere ... a teacher says, 'Take out your pencils. Begin'"), and then it trailed off into some misty thoughts about love. And then a big horn blast of a benediction.

But the great moment came later, as the mob flowed slowly across the grounds. I heard loud cheers behind me and there on the giant screen was the Former Occupant and Mrs. Bush saying goodbye to the Obamas in the parking lot behind the Capitol, the Marine helicopter behind them.

The crowd stopped and stared, a little stunned at the reality of it.

They saw it on a screen in front of the Capitol and it was actually happening on the other side. The Bushes went up the stairs, turned, waved and disappeared into the cabin, and people started to cheer in earnest. When the blades started turning, the cheering got louder, and when the chopper lifted up above the Capitol and we saw it in the sky heading for the airport, a million jubilant people waved and hollered for all they were worth. It was the most genuine, spontaneous, universal moment of the day. It was like watching the ice go out on the river.

(Garrison Keillor is the author of a new Lake Wobegon novel, "Liberty," published by Viking.)

a short history of marketing

Barack Obama | Lincoln Memorial | 18 January, 2009

six and a half minutes of clarity. a down payment...

George W Bush | Eight Years in Eight Minutes

Hold onto your hat.



OK, this is just about the last thing I want put in this space about departing president George W. Bush. Let's get on with it.

Morgan Freeman's Other Senior Prom

i'm...speechless.

Pavarotti | Bono | Miserere | Have Mercy

Psalm 51
  For the director of music. A psalm of David. When the prophet Nathan came to him after David had committed adultery with Bathsheba.

  *Have mercy on me, O God,
according to your unfailing love;
according to your great compassion
blot out my transgressions.
Wash away all my iniquity
and cleanse me from my sin.

  For I know my transgressions,
and my sin is always before me.
Against you, you only, have I sinned
and done what is evil in your sight;
so you are right in your verdict
and justified when you judge.
Surely I was sinful at birth,
sinful from the time my mother conceived me.
Yet you desired faithfulness even in the womb;
you taught me wisdom in that secret place.

  Cleanse me with hyssop, and I will be clean;
wash me, and I will be whiter than snow.
Let me hear joy and gladness;
let the bones you have crushed rejoice.
Hide your face from my sins
and blot out all my iniquity.

   Create in me a pure heart, O God,
and renew a steadfast spirit within me.
Do not cast me from your presence
or take your Holy Spirit from me.
Restore to me the joy of your salvation
and grant me a willing spirit, to sustain me.

   Then I will teach transgressors your ways,
and sinners will turn back to you.
Deliver me from bloodguilt, O God,
you who are God my Savior,
and my tongue will sing of your righteousness.
Open my lips, Lord,
and my mouth will declare your praise.
You do not delight in sacrifice, or I would bring it;
you do not take pleasure in burnt offerings.
My sacrifice, O God, isa a broken spirit;
a broken and contrite heart
you, God, will not despise.

   May it please you to prosper Zion,
to build up the walls of Jerusalem.
Then you will delight in the sacrifices of the righteous,
in burnt offerings offered whole;
then bulls will be offered on your altar.