Taking Note

McCain Explodes Conservatives' Nuclear Myths

In his address on nuclear weapons at the University of Denver Tuesday, Senator John McCain signaled a retreat from the in-your-face unilateralism of the Bush-Cheney years. He is prepared to do what his fellow partisans for the past eight years have adamantly rejected: negotiate significant reductions in nuclear weapons levels with Russia, sign and abide by legally binding treaties, and invest in a stronger, independent International Atomic Energy Agency (IAEA). On doomsday weaponry, at least, we see traditional "realists" in the Republican national-security elite gaining the upper hand over the hard-liners plotting a "new American century."

Is Israel’s Prime Minister Going Out on a High Note?

Investigations into Israeli PM Ehud Olmert’s predilection for cash-filled envelopes reached a new milestone today with the testimony of Morris Talansky. New York-based Talansky confirmed that he had “transferred Olmert some $150,000 over 15 years, and that Olmert had tried to aid a Talansky business venture”, but that “he [Talansky] never had any personal benefits from this relationship whatsoever.” As more information is made public in this case the pundit-class is increasingly adamant that Olmert will not be able to politically survive this storm.            

Fairly or not, Ehud Olmert is likely to be tagged as Israel’s most dishonest Prime Minister—yet in many ways he has been more honest to his public about Israel’s regional predicament and the steps it needs to take than almost any of his predecessors. In his latest outpouring of home truths, Olmert yesterday told one of his detractors that anyone who believes that it’s possible to hold onto the greater land of Israel, the territories captured in ’67, is “delusional”. With the resumption of talks with Syria last week, despite a distinct lack of enthusiasm from the Bush administration, it seems that Olmert maybe going out on a high and is leaving an interesting diplomatic legacy.

Demographic Totalitarianism

Surely one of the most tragic images observers will carry away from the Chinese earthquake is of parents, doubled over with grief, the corpse of their child lying below them. Parents must now bury their only child. Nowhere but in China would one have so many single child families in an area as poor as Sichuan Province.

This is a tragedy that should never have occurred, not simply for the obvious reason that schools should have been built to withstand an earthquake, but because the one-child policy that forced such drastic contraction of family size in China is a disgrace.

The decision to have a child is one of the most important and private decisions a person or a couple can make. Yet the totalitarian impulse to force cuts or increases in the number of children a woman bears was acted out again and again in the twentieth century. Whether in Indira Ghandi’s India, Nicolae Ceauşescu’s Romania, or Mao Zedong’s China, ruling elites determined that fertility decisions were too important to be left to families. By decree, fertility decisions were centralized.

Public Calls for Energy Transition Away from Oil

Gas and oil both reached record highs this week, just in time for Memorial Day weekend travelers to hit the road. Gas clocked in at $3.83 a gallon yesterday, and oil hit $135.09 a barrel in trading Wednesday night.

There’s little sign that these prices are hitting their peaks, either. A Goldman Sachs analyst predicts that prices of “$150-$200 per barrel seems increasingly likely over the next six to 24 months,” and this week’s numbers seem to be proving him right.

The public agrees, too. A late January survey by WorldPublicOpinion.org found that 88 percent believe that the price of oil will be much or somewhat higher 10 years from now than it is today. Just 7 percent thought it would remain the same, and 6 percent thought it would be lower.

More on Medical Malpractice

Most malpractice suits are not frivolous. Take a close look at a large sample of claims and you’ll discover that the patient died or suffered a significant disability roughly 80 percent of the time. But when researchers at Harvard’s School of Public Health scrutinized cases involving some 33,000 physicians, 61 acute care hospitals and 428 outpatient facilities nationwide, they discovered that only sixty-three percent of the injuries were caused by medical error or negligence.

In other words, 37 percent of the claims were unfounded. But most plaintiffs had no way of knowing that there was no basis for the suit because once they began to ask questions, both doctors and the hospital clammed up. Traditionally hospital lawyers have told medical personnel that if the patient or his relatives are unhappy with the outcome, don’t say anything. Keep in mind, “anything you say could be used against you in court.”

As a result, the Harvard researchers explained, “our findings underscore how difficult it may be for plaintiffs and their attorneys to discern what has happened before the initiation of a claim and the acquisition of knowledge that comes from the investigations, consultation with experts, and sharing of information that litigation triggers.”

In other words, the only way to find out that you have no reason to sue is by suing—and triggering the costly and time-consuming process of legal “discovery” that will give you access to all of the facts.

As I explained in part 1 of this post, The New York Times recently reported   that a few hospitals are now experimenting with candor: rather than denying, they are revealing what happened, and apologizing. But this violates the received wisdom that a doctor who says “I’m sorry” to a patient will soon find himself saying “I’m sorry” to a jury. And, as some physicians who have been dragged through the process warn, that doctor will never have a chance to explain that while he wishes every day that things had gone differently, the situation was a little more complicated that the plaintiff’s attorney would have you believe...

Obama's Next Pitfall?

Senator Jim Webb (D-VA) says Appalachian whites have opposed Barack Obama's candidacy in the primaries not so much because they're racist, but because of their opposition to a policy that has thus far received little overt attention in the campaign:  affirmative action.  With anti-affirmative action ballot initiatives expected on the ballot in as many as three states this November, the issue could be the next Rev. Wright for Obama's candidacy.  Alternatively, as I argue in an article in Guardian America, Obama could turn it around and embrace a new class-based policy that would help both low income people of color and Appalachian whites.

Referring to working class white voters in places like Kentucky, West Virginia and Pennsylvania, Webb told MSNBC: "We shouldn't be surprised at the way they are voting now.  This is a result of how affirmative action, which was basically a justifiable concept when applied to African-Americans, expanded to every single ethnic group in America that was not white.  And these were the people who had not received benefits and were not getting anything out of it."

The Wild Blue Yonder

When I read that nine big airlines had been put on credit watch, with likelihood that their bond ratings would be downgraded, what surprised me was that there still were nine big airlines! Over the past two decades the parade of airlines going out of business has been a depressingly routine feature of the industry. In fact, long before the current crunch caused by high fuel prices and a weak dollar, it was clear that our national policy of airline deregulation, started during the Carter Administration, was not working as planned. One after another major carriers slipped into bankruptcy, smaller cities were abandoned, and service deteriorated. A crazy quilt of fare policies rounded out the bewildering changes wrought in the name of “improving the experience for passengers.” And, job losses and pension shortfalls have wound up costing taxpayers lots of money – a result that partially offsets any gains from lower fares. Now add-on charges and unreliable equipment make travel an increasingly uncomfortable experience.
It is time for a fresh look at deregulation.

Is Paul Volcker Right About Inflation? Maybe Not This Time

It is hard not to admire Paul Volcker.  He is that odd thing in contemporary America, a truly dedicated public servant to whom, it seems, making money in the private sector was always secondary.   He is a straight shooter. He tells it like he sees it.

As Federal Reserve chairman, appointed by Jimmy Carter in 1979, he eventually broke the back of inflation by imposing a harsh monetary policy of very high interest rates.  For this, he is canonized today. But inflection points in economic trends are hard to spot. Now, there is an increasingly voluble group of analysts who are warning that we are in the early stages of a new inflationary era. And the inflation hawks among the governors are speaking loud and clear.   Oil is up, food is up, some surveys of inflationary expectations up.

Volcker has not joined the alarmists, but he is saying in public speeches that we should at the least be wary of inflation again, drawing parallels to the high-inflation 1970s that was so painful for the nation. Rising food and fuel prices sound awfully familiar. In other words, he is telling the central bank not to be too loose with monetary policy, that maybe they let rates go too low, and perhaps it is time to stop the generosity.

 

Medical Malpractice: Fiction, Facts and the Future

“There are two things to fear in life,” Justice Brandeis once said: “death and litigation.” Most physicians would agree.  Win or lose, the process of being sued for malpractice will forever change the way he views both his profession and his patients. No wonder fear of malpractice drives so much costly and potentially hazardous “defensive medicine.”  Nevertheless, some have argued that malpractice suits protect patients by forcing hospital boards to take a closer look at patient safety issues. Perhaps—but the high administrative costs associated with malpractice suits, combined with the effect they have had on the doctor-patient relationship suggests that there should be a better way to shield the sick.

An article in Sunday’s New York Times points to a new approach. “For decades,” the Times reported, “malpractice lawyers and insurers have counseled doctors and hospitals to ‘deny and defend.’  Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.” But with providers “choking on malpractice costs and consumers demanding action against medical errors,” some of the nation’s leading hospitals are trying out what is, for them, a new strategy—reveal and apologize.  It’s a simple solution: telling the truth. The mounting cost of malpractice claims may finally be having a constructive effect. The evidence suggests that if more hospitals adopt this approach, there could be great benefits, both for physicians and for patients.

Nevertheless, there are risks for health care providers. “Disclosure is the right thing to do,” an article published in Health Affairs last year observed,  but as “pressure mounts on physicians and hospitals to disclose adverse outcomes…and medical injuries” they should be aware that the volume of claims would rise and providers should be ready for “the financial consequences.”

After all, we are, as everyone knows, a litigious society. President Bush has warned us, repeatedly, of “what’s happening all across this country...lawyers are filing baseless suits against hospitals and doctors. That’s just a plain fact. And they’re doing it for a simple reason. They know the medical liability system is tilted in their favor.” In the nation’s “judicial hellholes,” the President of the United States cautions us, “every claim filed by a personal-injury lawyer brings the chance of a huge payoff or a profitable settlement out of court...This liability system of ours is out of control.”

The President is not alone:  you have read the news stories about the multi-million dollar cases, and the op-ed pieces declaring that they are now the norm:  emotional juries and prejudiced courts are persecuting blameless doctors, driving up the cost of health care while forever ruining careers.

As is so often the case, what “everyone knows” just isn’t true. 

The Road to Nowhere

This is one of those times of maximum mismatch between the optimistic rhetoric of peace process declarations and expectations and the gloomy reality of daily experience and prospects on the ground. The Annapolis architect, President George W. Bush, was back in the Middle East, still declaring the worthy goal of peace in '08. But the fundamentally flawed logic of the process initiated last year is increasingly transparent.

The economic, social and health conditions of Gazans collapse further as the siege continues; rockets fall on southern Israel; settlements keep growing, and, not surprisingly, Palestinians and Israelis scoff at the peace merry-go-round. The centerpiece of the current effort is to conclude negotiations outlining a two-state agreement between Israeli Prime Minister Ehud Olmert and PLO chairman Mahmoud Abbas.