Saturday, March 06, 2010

Obama calls Dems to Pickett's Charge

They started out in perfect alignment, 12,500 men stretching more than a mile, battle flags waving, bayonets fixed, and gazes focused on the enemy across the valley, tensely waiting for them on Cemetery Ridge. Less than an hour later, it was over, with more than half of them dead or wounded, their cause having reached its high-water mark and failed.

It was Pickett's Charge of the Confederates at Gettysburg in 1863, a horrendous, bloody carnage that could have been avoided, had not their commander, Gen. Robert E. Lee, been so determined to do it his way -- a massed frontal assault against a nearly impregnable position.

It is to just such a political Pickett's Charge that President Obama now summons congressional Democrats on behalf of his health care reform proposal, a last desperate gamble to overcome a sturdy, strengthening line of Republican opposition reinforced beyond measure in recent months by the knowledge they stand with a solid majority of their countrymen. Obama and Democratic brigade commanders Harry Reid and Nancy Pelosi know there will be terrible casualties among their troops come November, but still they urge them on, to sacrifice their jobs, careers and political futures for ... 2,700 pages of new bureaucratic rules, mandates, directives and edicts that will surely destroy the finest health care system in the world.

Pelosi in particular seems eager to give her troops the order to charge. She continually invokes past glories, imploring House Democrats to remember that "this will take courage. It took courage to pass Social Security. It took courage to pass Medicare. But the American people need it, why are we here? We're not here just to self-perpetuate our service in Congress." That last line may ring hollow for three dozen or so Democrats representing districts carried by Sen. John McCain in 2008, especially since there is only the faintest of possibilities that Pelosi will be a casualty, representing a district in which 80 percent of the voters think she is exactly what they need in Congress.

And there is another reason Pelosi's invocation of Social Security and Medicare votes could give many House Democrats reason to think twice about voting for Obamacare. The votes for final passage on both programs were solidly bipartisan, with clear majorities of Democrats and Republicans voting in favor. For better or worse, those programs each enjoyed a broad public consensus of support at their inception. The only public consensus now is that Congress should junk Obamacare and start over on health care reform. House Democrats should ponder Pickett's assessment of Lee years after Gettysburg: "That man destroyed my brigade."


Obama’s Gamble On Health Care Bill May Be Losing Bet

President Obama fleshed out his health care overhaul Wednesday with a few nods to GOP ideas. But with Republicans likely to collectively reject the latest last-ditch effort, some experts say the White House is really trying to get some Democrats to switch their votes from no to yes. Yet it's not at all clear House Speaker Nancy Pelosi, D-Calif., can round up the votes.

"This is where we've ended up," said Obama. "It's an approach that has been debated and changed and I believe improved over the last year. It incorporates the best ideas from Democrats and Republicans — including some of the ideas that Republicans offered during the health care summit."

The four GOP ideas in the plan were: engaging medical professionals to conduct random undercover probes to combat Medicare and Medicaid waste and fraud; more funding for demonstration projects of alternatives for resolving medical malpractice disputes; increasing Medicaid reimbursements for doctors; and ensuring Health Savings Accounts (HSAs) are in the insurance exchange.

Cosmetic, Not Bipartisan

But Minority Whip Eric Cantor, R-Va., dismissed it as "a last minute effort to try and throw a few Republican proposals on top of a trillion-dollar measure . . . that's not bipartisanship."

The White House likely isn't seeking GOP votes. Instead it wants to portray its plan as bipartisan enough to give cover to House Democrats who voted no in November to vote yes this time. "It's going to be very difficult for any Democrat to switch," said Brian Darling, director of Senate relations at the conservative Heritage Foundation. "It's one thing with retiring members since they don't have to face the voters. But any members who have to face the voters, it will be very hard to move from the no category to yes and keep their jobs, especially this close to an election."

To get Obama's plan through, the House would have to pass the Senate health bill and then make "fixes" via the reconciliation process. That requires just 51 votes to pass in the Senate, thus avoiding the 60 needed to end filibusters. Reconciliation typically is limited to budget matters. "I'm optimistic, but this is a real challenge," said Ralph Neas, CEO of the liberal National Coalition on Health Care. "The president has been showing stronger and stronger leadership, but it will take a retail effort."

Can Pelosi Find The Votes?

Democratic congressional leaders have threatened to go the reconciliation route for weeks now, but it's not clear if they have the votes, especially in the House. The House passed its version, 220-215, back in November. But Pelosi has lost four supporters with two recent retirements, the death of Rep. John Murtha, D-Pa., and Rep. Joseph Cao, R-La., the lone Republican to vote for the bill, saying he'll vote no next time. Pelosi needs 217 to pass the Senate bill and reconciliation after accounting for vacancies. But Rep. Bart Stupak, D-Mich., has threatened to vote no because the Senate bill does not have anti-abortion language strong enough to his liking. Stupak says 10 or 11 other Democrats would join him. Also, New York's Mike Arcuri and Arizona's Raul Grijalva signaled Wednesday that they will switch and oppose the Senate bill.

It's not clear where Pelosi can get additional votes. The Associated Press reported late Tuesday that there were nine Democrats who voted no in November but are uncommitted now. Three aren't running for re-election. But if the "Stu-pack" and others move to no, Pelosi would still be a few votes shy if all nine switch, and it's far from clear that they will. "It's not really a switch to say he's undecided," said a spokesman for Rep. John Tanner, D-Tenn., one of the AP nine. "We're expecting an entirely different bill than what he voted against on the House floor. He's undecided until he sees what the final bill will look like and the Congressional Budget Office score."


House, Senate Dems split on health care tactics

President Obama's latest sweeping health care proposal has pitted House and Senate Democrats against each other over who should go first in passing legislation GOP leaders promised will put them in the majority.

Even after Obama's announcement aimed at pushing his plan over the finish line, Democrats in the House were reluctant to take the lead, saying they want the Senate to first pass a bill crafted more to their liking. Animosity between the two chambers is reaching a boiling point. House lawmakers are complaining that the Senate has yet to act on about 290 bills the House has sent its way this Congress, which makes them reluctant to go first on health care. "We're waiting for that cooling saucer of democracy that is the United States Senate to get off their high horse and start to pass some of these bills," said Rep. Anthony Weiner, D-N.Y., Wednesday.

The Senate wants the House to pass their health-care reform legislation first, and then a second, smaller legislative package would be introduced containing corrective provisions sought by House lawmakers and the president.

But House Democrats fear the corrective bill will never clear the Senate, where Democrats there no longer control a 60-vote supermajority and the legislation would have to be filtered through the difficult "reconciliation" process in order to pass with just 51 votes. "I think we have 290 reasons why we don't trust them to do it," said Rep. Bart Stupak, D-Mich., who is opposed to the Senate bill because it does not prohibit subsidies for insurance policies that fund elective abortions.

House Speaker Nancy Pelosi declared that Congress is finalizing a new bill, but that the House would not be taking it up right away. Pelosi said, "We will see what the Senate can do" after the Congressional Budget Office puts a price tag on the measure.

But across the Capitol, in the offices of Senate Majority Leader Harry Reid, D-Nev., Democratic lawmakers had already made up their minds that the House should the Senate's health care bill first. When presented with the scenario put forward by Senate Democrats, one top House leadership aide signaled there was no such agreement, adding, "We're still talking."

The discord between the House and the Senate stems in part from lack of Democratic enthusiasm for the bill, which the GOP has pledged to use as a campaign weapon if it passes. Republicans have pledged their 2010 campaigns would be based on repealing the bill if it passes.

Democrats may try to find a way to pass the Senate bill and the corrections bill at the same time in order to alleviate the worries of House Democrats. "If we are going to take their dramatically deficient bill and bring it up to House standards, we are going to have to have a piece of companion legislation that moves at the same time," said Weiner.


Not One Major Poll Favors Obama's Health Proposal

by Matt Towery

In my entire career, I have never been as confounded as I am over President Obama and the Democratic leadership's obsession with a piece of legislation that not one major national poll has shown to be popular. A quick glance at this week's surveys shows about a 10 percent spread between those who favor the latest health care legislation and those who oppose it. In the world of politics, that's a blowout. So I have to ask, why are the president and the leaders of Congress willing to see their entire party and a multitude of other policy proposals go down in flames over something that the public can't stand?

Well, we could be altruistic and say they believe that strongly in the merits of health care reform. Indeed, there are parts of the proposal I might support. But I've been around this game far too long to believe in pure altruism from politicians. After all, I was one myself. This isn't to say that elected officials don't try to do the right thing. But when you see the public hating what you are doing, you generally start to question whether what you are promoting is really the right thing.

Folks, this is nothing more than a power grab. It's an effort to take one of the most essential elements of every person's life -- their health -- and put it under the control of government.

In the past, I have written about a growing "political royalty" in this nation. At first, I felt it was just developing out of benign neglect of the public and the naturally big egos that come with politicians. My opinion has changed. I now believe there are many in Washington who not only consider themselves a cut above the rest of us, but who believe they must manage every aspect of our lives because we are just the common folks who need to be tended to like cattle on a ranch.

This thing is an act of madness. What the White House and Democrats are hoping is that, after the legislation passes, people will forget about the costs and the hassles in the several years that the whole thing takes to implement. They are wrong.

And just to show that I can be even-handed in my judgment about these sorts of things, let me say that I was totally opposed to the Republican impeachment of Bill Clinton. Was the impeachment "altruistic"? Absolutely. But it got us nowhere. When we decided to release Ken Starr's report, which included rather prurient information on the Internet, I argued vehemently against it.

The GOP leadership was convinced the nation would turn on Clinton, his approval ratings would sink, and he would be asked to resign the following week. Instead, his numbers went up because we Republicans looked like we were ignoring other important issues in order to pursue Bill Clinton's removal from office -- something that was never going to happen. I guess you could say that entire impeachment episode was a power grab, as well. And it failed miserably. It also diverted our time and energy from other issues that needed to be addressed.

And that gets me back to this current insane decision by President Obama and Congress to consider a gimmick -- much like our release of the Starr Report -- of passing a health care bill as part of what is known as "reconciliation" budget legislation. (That means it would require a simple majority vote and avoid the possibility of needing 60 votes to prevent a filibuster.)

When we tried the Starr gimmick, we were too cute. The public was smart, and they viewed it as us putting sexually explicit material on the Web where kids and others might see it. Well, guess what? The public, which hates this legislation, will treat the gimmick of "reconciliation" in the same manner. And take it from me, the tumble the Democrats will take for such a silly move will be massive.


"Dysfunctional" NHS hospital kills kids

Up to half of England’s child heart surgery units are likely to close as a result of a national review triggered by concerns about the risks posed by some. The Times understands that the review will recommend the merging of smaller units such as The John Radcliffe hospital in Oxford, which has suspended services after the deaths of four children in three months. The hospital has started an investigation into the cases, conducted by one surgeon. It said that the temporary suspension was a precaution taken while reasons for the high death rate were examined.

Senior surgical sources said that the concerns “came as no surprise” at a unit which had a “culture of dysfunctionality”. It has been the subject of a number of inquiries in recent years. The national review, conducted by the National Specialist Commissioning Group, is due to report in July. It was ordered in 2008 by Sir Bruce Keogh, the NHS medical director, to ensure that the sector, considered to have the most advanced monitoring of patient outcomes in the world, can meet the rising demand for increasingly complex procedures.

The review is expected to recommend that units should have a minimum of four surgeons seeing 400 patients a year to ensure enough skill and experience are pooled and a sufficient number of difficult cases is seen. The number of units is likely to be reduced from eleven to about five or six centres of expertise.

The unit at John Radcliffe, the smallest in the country, sees just 100 cases and currently has one paediatric cardiac surgeon. Caner Salih, the surgeon linked to the four deaths, announced his resignation at the end of last year after less than a year in post. The consultant, who is considered highly skilled, is understood to have stepped down over exasperation at the working environment at the unit. The hospital would not comment on Mr Salih’s reasons for leaving or suggestions that its unit was not functioning properly. Mr Salih was recently appointed to a similar role at Guy’s and St Thomas’ Hospital trust.

The hospital said that each of the deaths of the “seriously ill children” would be reviewed, while the 26 patients due to have surgery would be sent to other units. The investigation will examine all aspects of care involving the four children who died, rather than limiting itself to the surgery. The senior source told The Times that the deaths — after the previous inquiries and several senior staff resignations — “looked very much like another example of dysfunction” at the Radcliffe. “The situation there is unstable,” the source said.

Leslie Hamilton, president of the Society of Cardiothoracic Surgery, said that sources were right to suggest that expertise was overstretched in paediatric heart surgery. “There are 25 to 30 surgeons involved in the whole country,” he said. “We feel they are spread too thinly across those units.”

Professor Keogh confirmed that the review would report in the summer, when it would be put out to consultation. He said of the Radcliffe: “This highlights the need for the current review of paediatric cardiac surgery which will result in a reduction in paediatric units. We need to concentrate expertise in fewer large units. “The quality of care across the sector as a whole is very high. Our concern is that there are areas that will have increasing difficulty coping in the future as the technical complexity of this surgery carries on increasing.”

All 11 units have been asked to submit business plans, while Sir Ian Kennedy, who conducted the inquiry into the Bristol heart scandal more than a decade ago, has been asked to assess their ability to fulfil the latest requirements.

The Oxford hospital has been subject to investigations in the past over the number of deaths linked to such surgery in adults. An investigation into adult cardiac surgery, conducted by the Healthcare Commission in 2007, concluded that while death rates were “acceptable” improvements were needed urgently. It highlighted issues over data collection, saying: “Bearing in mind the history of the cardiac unit at Oxford, and the number of questions about the trust’s rates of mortality, there had been a surprising lack of robust processes to validate and cross-check the completeness and quality of its data.”

Since the Bristol heart scandal, monitoring of all cardiac surgery has been stepped up. Any unexplained series of deaths should automatically trigger both trust and external investigations. Survival rates for heart surgery units and individual surgeons are published and can be compared. The Care Quality Commission, the health regulator, has said that it is not investigating the John Radcliffe at present, but would monitor the trust’s own review “extremely closely”.


'Scandalous' NHS maternity unit under fresh scrutiny over failures

A hospital maternity unit condemned as “scandalous” after the deaths of two babies has come under renewed scrutiny after failing to improve standards. A team of clinical advisers is being sent in to monitor services at Milton Keynes General Hospital amid concerns that it has been too slow to resolve problems which led to the children’s deaths.

Milton Keynes NHS Foundation Trust was heavily criticised last year following the death of Ebony McCall. An inquest heard that Ebony would probably have survived if her mother, Amanda, was given a Caesarean section when she asked for one. But staff were too busy and told her they would only carry out the procedure in an emergency. The scandal came despite having already been investigated over the death of Romy Feast in the same unit in 2007, who died after her heart condition was misinterpreted.

The health watchdog, the Care Quality Commission (CQC), issued a damning report last month saying the unit still had too few midwives and beds. Monitor, the independent regulator of NHS foundation trusts, has now intervened by sending in an action squad to ensure that services are improved. A spokesman for Monitor said: “Our aim in taking this regulatory action is to ensure swift progress to safeguard future access to high quality maternity care by the Trust’s patients.”

Monitor said the trust had failed to address 12 recommendations by the Healthcare Commission in 2008. Its failure to recruit a consultant midwife and a sufficient number of additional midwives was particularly worrying, Monitor said. It warned that further sanctions would be imposed if the trust does not take “rapid and effective action to deliver the necessary improvements”.

Dr Nicholas Hicks, chief executive of NHS Milton Keynes and director of public health, said: “We welcome the decision announced by Monitor which requires the hospital to appoint external expert clinical advisers. “The safety and quality of the care provided by all NHS organisations in Milton Keynes is of paramount importance to us all and we therefore welcome the steps taken to help accelerate the delivery of improvements within the hospital’s maternity service. “NHS Milton Keynes will continue to support and work with the hospital, the CQC, Monitor and other partners to ensure patients receive the quality of care they deserve. “We hope this intervention will improve public confidence in the service.”

Dr Walter Greaves, the trust’s chairman, added: “We are pleased that Monitor has examined our plan with such care and we look forward to working with these experts. “We will be working as hard as we can to ensure the very best of care for local people throughout our hospital. “Our maternity department provides a safe and quality service for local mothers, many of whom compliment us on the care they and their babies receive. I would like to reassure local women they can feel entirely safe coming to Milton Keynes Hospital to have their babies.”

At an inquest in December, Thomas Osborne, deputy coroner for Milton Keynes, said "systems failures" which were "nothing short of scandalous" contributed to the death of Ebony McCall. Miss McCall, who suffered a string of medical complications including cardiac arrest, went into labour, but by the time a Caesarean was ordered, it was it was too late to save Ebony. She was born with a faint and erratic heartbeat that had allegedly been previously undetected, and died minutes later through lack of oxygen.

The inquest heard that between January 2007 and October 2009 there were 2,114 incidents reported on the labour or maternity wards and of those, more than 25 per cent related to staff shortages.


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