U.S. 'Not Getting What We Pay For'

Many Experts Say Health-Care System Inefficient, Wasteful

By Ceci Connolly
Washington Post Staff Writer
Sunday, November 30, 2008; A01

Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.

"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."

"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.

Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.

Those harsh assessments illustrate the enormousness of the challenge that awaits President-elect Barack Obama, who campaigned on the promise to trim the average American family's health-care bill by $2,500 a year. Delivering on that pledge will not be easy, particularly at a time when the economic picture continues to worsen.

Senate Finance Committee Chairman Max Baucus (D-Mont.) has already warned that improving and expanding health care will cost money in the short run -- money that his Republican counterpart, Sen. Charles E. Grassley (Iowa), argues the government does not have.

Yet among physicians, insurers, academics and corporate executives from across the ideological spectrum, there is remarkably broad consensus on what ought to be done.

Go to link on title, above for full article

One fundamental problem is how doctors are paid, he said. Under the current fee-for-service scheme, "the more you do, the more you make," Kaplan said. There is no incentive to keep people out of doctors' offices, hospitals, imaging centers and dialysis clinics.

More tests lead to more procedures, which often result in mistakes, complications, misdiagnoses or the use of untested therapies, said Donald Berwick, president of the Institute for Healthcare Improvement in Cambridge, Mass. "The current system is very hospital-centric," he said. "We wait for people to get sick, and then we invest enormous sums to fix them up. We should build primary care as the core."

It is possible to change the incentives, Kaplan said. Partnering with Starbucks and the insurer Aetna, Virginia Mason devised a new strategy for dealing with back pain, the leading medical complaint of Starbucks' coffee-pouring baristas. Virginia Mason made big money on MRIs, but there is little scientific data that the scans resolve the problem.

So they flipped the process, trying physical therapy first. To make up for some of Virginia Mason's lost revenue, Aetna increased its payment for the therapy. Today, the majority of Starbucks employees with back trouble return to work within 48 hours without an MRI or a prescription, Kaplan said.

"We've shown that you can have superior outcomes at lower costs," Kaplan bragged. He acknowledged, however, that the success on back pain is "one small vignette" in a mega-mess.

Moving from pricey, high-tech solutions such as MRIs to older, low-tech approaches such as physical therapy requires solid data and a culture change, said Helen Darling, president of the National Business Group on Health, which represents large employers. Americans are attracted to innovations, regardless of cost or whether they have been proven to achieve results.

A whole-body scan that is covered by insurance may seem like a bargain, Darling said. "But one way or another we're all paying" for it in higher premiums, increased government expenditures and even false-positive results that lead to more costly, invasive procedures.

Rush to Enact a Safety Rule Obama Opposes

By ROBERT PEAR

WASHINGTON — The Labor Department is racing to complete a new rule, strenuously opposed by President-elect Barack Obama, that would make it much harder for the government to regulate toxic substances and hazardous chemicals to which workers are exposed on the job.

The rule, which has strong support from business groups, says that in assessing the risk from a particular substance, federal agencies should gather and analyze “industry-by-industry evidence” of employees’ exposure to it during their working lives. The proposal would, in many cases, add a step to the lengthy process of developing standards to protect workers’ health.

Public health officials and labor unions said the rule would delay needed protections for workers, resulting in additional deaths and illnesses.

With the economy tumbling and American troops fighting in Iraq and Afghanistan, President Bush has promised to cooperate with Mr. Obama to make the transition “as smooth as possible.” But that has not stopped his administration from trying, in its final days, to cement in place a diverse array of new regulations.

The Labor Department proposal is one of about 20 highly contentious rules the Bush administration is planning to issue in its final weeks. The rules deal with issues as diverse as abortion, auto safety and the environment.

One rule would make it easier to build power plants near national parks and wilderness areas. Another would reduce the role of federal wildlife scientists in deciding whether dams, highways and other projects pose a threat to endangered species.

Mr. Obama and his advisers have already signaled their wariness of last-minute efforts by the Bush administration to embed its policies into the Code of Federal Regulations, a collection of rules having the force of law. The advisers have also said that Mr. Obama plans to look at a number of executive orders issued by Mr. Bush.

A new president can unilaterally reverse executive orders issued by his predecessors, as Mr. Bush and President Bill Clinton did in selected cases. But it is much more difficult for a new president to revoke or alter final regulations put in place by a predecessor. A new administration must solicit public comment and supply “a reasoned analysis” for such changes, as if it were issuing a new rule, the Supreme Court has said.

As a senator and a presidential candidate, Mr. Obama sharply criticized the regulation of workplace hazards by the Bush administration.

In September, Mr. Obama and four other senators introduced a bill that would prohibit the Labor Department from issuing the rule it is now rushing to complete. He also signed a letter urging the department to scrap the proposal, saying it would “create serious obstacles to protecting workers from health hazards on the job.”

Administration officials said such concerns were based on a misunderstanding of the proposal.

“This proposal does not affect the substance or methodology of risk assessments, and it does not weaken any health standard,” said Leon R. Sequeira, the assistant secretary of labor for policy. The proposal, Mr. Sequeira said, would allow the department to “cast a wide net for the best available data before proposing a health standard.”

The Labor Department regulates occupational health hazards posed by a wide variety of substances like asbestos, benzene, cotton dust, formaldehyde, lead, vinyl chloride and blood-borne pathogens, including the virus that causes AIDS.

The department is constantly considering whether to take steps to protect workers against hazardous substances. Currently, it is assessing substances like silica, beryllium and diacetyl, a chemical that adds the buttery flavor to some types of microwave popcorn.

The proposal applies to two agencies in the Labor Department, the Occupational Safety and Health Administration and the Mine Safety and Health Administration.

Under the proposal, they would have to publish “advance notice of proposed rule-making,” soliciting public comment on studies, scientific information and data to be used in drafting a new rule. In some cases, OSHA has done that, but it is not required to do so.

The Bush administration and business groups said the rule would codify “best practices,” ensuring that health standards were based on the best available data and scientific information.

Randel K. Johnson, a vice president of the United States Chamber of Commerce, said his group “unequivocally supports” the proposal because it would give the public a better opportunity to comment on the science and data used by the government.

After a regulation is drafted and formally proposed, Mr. Johnson said, it is “all but impossible” to get OSHA to make significant changes.

“Risk assessment drives the entire process of regulation,” he said, and “courts almost always defer” to the agency’s assessments.

But critics say the additional step does nothing to protect workers.

“This rule is being pushed through by an administration that, for the last seven and a half years, has failed to set any new OSHA health rules to protect workers, except for one issued pursuant to a court order,” said Margaret M. Seminario, director of occupational safety and health for the A.F.L.-C.I.O.

Now, Ms. Seminario said, “the administration is rushing to lock in place requirements that would make it more difficult for the next administration to protect workers.”

She said the proposal could add two years to a rule-making process that often took eight years or more.

Representative George Miller, a California Democrat who is chairman of the House Committee on Education and Labor, said the proposal would “weaken future workplace safety regulations and slow their adoption.”

The proposal says that risk assessments should include industry-by-industry data on exposure to workplace substances. Administration officials acknowledged that such data did not always exist.

In their letter, Mr. Obama and other lawmakers said the Labor Department, instead of tinkering with risk-assessment procedures, should issue standards to protect workers against known hazards like silica and beryllium. The government has been working on a silica standard since 1997 and has listed it as a priority since 2002.

The timing of the proposal appears to violate a memorandum issued in early May by Joshua B. Bolten, the White House chief of staff.

“Except in extraordinary circumstances,” Mr. Bolten wrote, “regulations to be finalized in this administration should be proposed no later than June 1, 2008, and final regulations should be issued no later than Nov. 1, 2008.”

The Labor Department has not cited any extraordinary circumstances for its proposal, which was published in the Federal Register on Aug. 29. Administration officials confirmed last week that the proposal was still on their regulatory agenda.

The Labor Department said the proposal affected “only internal agency procedures” for developing health standards. It cited one source of authority for the proposal: a general “housekeeping statute” that allows the head of a department to prescribe rules for the performance of its business.

The statute is derived from a law passed in 1789 to help George Washington get the government up and running.

The Labor Department rule is among many that federal agencies are poised to issue before Mr. Bush turns over the White House to Mr. Obama.

One rule would allow coal companies to dump rock and dirt from mountaintop mining operations into nearby streams and valleys. Another, issued last week by the Health and Human Services Department, gives states sweeping authority to charge higher co-payments for doctor’s visits, hospital care and prescription drugs provided to low-income people under Medicaid. The department is working on another rule to protect health care workers who refuse to perform abortions or other procedures on religious or moral grounds.

At the Last Minute, a Raft of Rules

Bush White House Approves Regulations on Environmental, Security Matters

By R. Jeffrey Smith and Juliet Eilperin
Washington Post Staff Writers
Sunday, November 30, 2008; A04

In a burst of activity meant to leave a lasting stamp on the federal government, the Bush White House in the past month has approved 61 new regulations on environmental, security, social and commercial matters that by its own estimate will have an economic impact exceeding $1.9 billion annually.

Some of the rules benefit key industries that have long had the administration's ear, such as oil and gas companies, banks and farms. Others impose counterterrorism security requirements on importers and private aircraft owners.

The rules cover obscure as well as high-profile social and economic issues: spelling out what kinds of records must be kept by sexually explicit performers and publications, exempting hobbyists' rocket motors from federal explosives controls, expanding the collection of DNA samples from federal prisoners.

In most cases, the new regulations are meant to spell out precisely how federal employees and private citizens must comply with laws passed by Congress. But the language in those laws often had ambiguities -- reflecting lawmakers' uncertainties or disagreements -- that gave Bush's appointees broad discretion to follow their policy preferences. Similar "midnight regulations" were approved by previous presidents.

In the environmental area, the latest rules indicate that the Bush administration wants to lend a final assist to industries that feel burdened by looming pollution controls or wilderness-protection laws. A rule approved by the White House three days after the presidential election, for example, would ease constraints on environmentally damaging oil shale development throughout the West, despite objections from Colorado Gov. Bill Ritter (D) and a majority of the state's congressional delegation.

On Nov. 17, Ritter called the decision "not just premature, it's hasty and I would even argue reckless." The Interior Departmentpublished it in the Federal Register Nov. 21, and it will take legal effect in 60 days from that date, or shortly after Congress reconvenes with a larger Democratic majority.

Top officials are still finishing work on other industry-friendly measures, including a regulation inhibiting the ability of Congress to halt logging, mining, and oil and gas extraction on public lands. Another rule would allow federal agencies to proceed with development projects without undergoing independent scientific review under the Endangered Species Act.

The Bush administration's impetus for hurrying to approve and publish so many of these regulations in the Federal Register is that those deemed to have a major economic impact -- defined by the Office of Management and Budget (OMB) as more than $100 million a year -- take legal effect after 60 days.

That means Nov. 21 was an important political deadline to ensure they become effective before President-elect Barack Obama's Jan. 20 inauguration. Less significant regulations, including many still in final stages of preparation, can take effect in 30 days or less.

Once the new rules take the form of law, Democrats can undo them only by three complicated means: through a new regulatory rulemaking that would probably take years; through congressional amendments to underlying laws; or through special, fast-track resolutions of disapproval approved by the House and Senate within a few months after the start of the new congressional session on Jan. 6.

Such a quick congressional rebuke has occurred only once before, in 2001, when a Republican-controlled Congress with President Bush's backing blocked a workplace safety regulation completed in the Clinton administration's final months. But recently, spokesmen for Senate Majority Leader Harry M. Reid (Nev.) and House Speaker Nancy Pelosi (Calif.) said Democrats were prepared to use that regulatory reversal power in consultation with Obama.

The leadership "will review what oversight tools are at our disposal regarding last-minute attempts to inflict severe damage to the law in the waning moments of the Bush administration," said Pelosi spokesman Brendan Daly.

"We will do whatever it takes," said Sen. Barbara Boxer (D-Calif.), the Environment and Public Works Committee chairman. "We're all over this. We've been waiting to pass on the information" to Obama's transition team.

A spokeswoman for the OMB, who declined to be named, said "the activity of the last three weeks is expected" because the White House had ordered that draft regulations be sent to the OMB for final review by Nov. 1. She said those regulations still being completed reflect "long-standing administration priorities."

Not every draft regulation got approved. On Nov. 19, the OMB ordered the Energy Department to kill new regulations that would have forced the federal government to buy more-energy-efficient lights, appliances, and heating and cooling systems. Daniel J. Weiss, climate strategy director at the Center for American Progress Action Fund, called that retreat from a 2005 requirement "unbelievable."

The White House also ordered the Environmental Protection Agency to withdraw a new regulation mandating that truck manufacturers install equipment to monitor vehicle pollution. It blocked the Department of Veterans Affairs from issuing new promised "user-friendly" guidance on burial and survivors benefits.

Those regulations that did get the nod came from 16 agencies and departments and will have a broad impact.

A controversial new Health and Human Services rule approved in late October, for example, cuts an estimated $2 billion in state Medicaid reimbursements for outpatient services. State officials had complained that it would jeopardize dental care for children, certain lab tests and speech and occupational therapy.

"The withdrawal of this rule should be one of the first orders of business for the Obama administration," said Rep. Henry A. Waxman (D-Calif.).

A controversial Justice Department rule approved Nov. 19 orders accelerated judicial review for death sentences. Legal groups had argued that speeding up executions makes errors more likely.

Another Justice rule approved Nov. 19 spells out the personal documentation that sexually explicit performers and related publishers must make available for government inspection. The underlying 2005 law, intended to keep minors out of such performances, has been challenged in the courts as a privacy violation by sexual swingers and the magazines in which they use explicit photos to solicit partners.

Nine days after the election, the White House approved a rule allowing trucking companies to force drivers to stay on the road for 11 hours without a rest. The American Trucking Association supported the rule, but lawmakers, unions and advocacy groups have called the extended hours dangerous.

Three days after the election, the White House also approved a regulation requiring that lenders provide home buyers with a simplified summary of their financial and legal obligations. The changes, under development at the Department of Housing and Urban Development since 2002, gained impetus after lending fraud contributed to the U.S. economic meltdown.

Industry opposed the reforms, however, and as a result, HUD dropped a proposal that settlement agents read a "closing script" as they complete a transaction.

Also, loan officers won the flexibility to change some fees based on new circumstances, which critics said would bring higher costs to borrowers. Compliance was postponed until 2010.

Business groups also successfully pushed back against provisions in counterterrorism regulations proposed by the Department of Homeland Security that could have required importers and sea carriers to detail shipment information to U.S. authorities before loading.

The "10-plus-2" rule -- so named for the extra pieces of information required -- was the most significant import industry security measure since the Sept. 11, 2001, terrorist attacks, trade officials said. But the National Association of Manufacturers and others said the rule would delay shipments by two to five days and cost as much as $20 billion a year.

As a result, the OMB agreed to give importers flexibility in complying and delay some of its implementation. It was published Nov. 24 as an interim rule, rather than a final one as originally proposed.

A second counterterrorism regulation, requiring that pilots of private planes transmit crew and passenger lists before departing or entering the United States, was approved by the OMB over that industry's opposition. But a separate regulation requiring rigorous security screening for larger private planes was delayed at industry's request.

Staff writers Spenser S. Hsu, Ceci Connolly and Carol D. Leonnig contributed to this report.

Federal Workers Unions Want 'Burrowers' Lists

By Carol D. Leonnig
Washington Post Staff Writer
Sunday, November 30, 2008; A06

Two powerful employee organizations are pressing the Bush administration to prove that in its final weeks, political aides are not improperly winning career government jobs at the expense of more qualified workers.

Leaders of the American Federation of Government Employees, the largest union of federal workers, and the Senior Executives Association, the group representing federal executives, said they want the government to release lists of political appointees who have been hired for career jobs and show whether agencies sought competition for the positions.

The two groups said they are pressing the Office of Personnel Management for this information because they are concerned the agency is not carefully overseeing last-minute hires of political aides. They point to recent reports in The Washington Post and other evidence suggesting political aides are leaping over qualified candidates or avoiding competition as they "burrow" into the civil workforce.

"The recent Post articles raise the possibility that political candidates are being placed in Senior Executive positions for which they may be unqualified or less qualified than other candidates, or that their service as political appointees was given undue weight," SEA President Carol Bonosaro and general counsel William L. Bransford wrote to the OPM. Such favoritism "is a disservice to those Senior Executives who were selected purely for merit without political assistance."

The OPM reviews the hiring by most government agencies of political appointees into permanent career posts from March until Inauguration Day. Hires made within this time frame are viewed with some suspicion by federal employee unions because they cover a period when many loyal political aides face losing their jobs and may be searching for more secure positions.

OPM Associate Director Kevin Mahoney declined last week to provide The Post with a list of political appointees his agency had approved to be moved into career jobs from March to Nov. 3. Though such hires and job titles are public, Mahoney said it was not the "general practice" of the OPM to release them. The White House did not respond to a request for the same information.

In one case The Post found, the Drug Enforcement Administration director hired a political aide to a career Senior Executive Service job -- the highest rank in federal service -- about a year after the same candidate was rejected as unqualified for a lower-level position. The Justice Department initially raised concerns about the DEA's plans to hire the employee with no competition. The DEA advertised the job for two weeks starting Oct. 26 and announced its selection Nov. 13.

Bonosaro and Bransford said veterans know that jobs can be tailored for political friends and competition can be manufactured on paper by limiting the qualifications that will be considered, advertising the job briefly and narrowly defining duties. Political influence and pressure help clinch an unfair hiring selection, they said.

"I think OPM has just turned their back on their obligation," said John Gage, president of AFGE. "If OPM would do its job, they could make sure there weren't any musical chairs to land political people in SES and other positions."

Gage said he is disturbed by reports from members that the OPM has not warned agencies this year to avoid moving around senior executives in the final months of the administration in an effort to avoid the appearance of political influence. Gage said such warnings have gone out in past turnovers, most notably during the exit of the Carter administration, when there was a freeze on such moves.

"The prevailing thought that this kind of thing happens in every administration is just not good enough for me," he said of burrowing. "It has to stop."

Putting a Face on Big Auto

Note from Greetings: The problem is not the unions. The current $70/hour salary being quoted is manufactured by those wishing to blame it on Amercian workers (who they previously "touted" during the elections), rather than put this on the backs of the CEO's and management. The people who flew in on their SEPARATE private jets to testify before Congress.

The real hourly rate of autoworkers? (The American working person, to put it properly... not "the unions".) $14-16/hour, which translates to, at best $32,000/year and on the lower end, $28,000/year.

What is the goal of those criticizing American workers trying to earn a livable income? Perhaps to get them down to $10/hour, like Walmart employees... without health care and retirement benefits. And where will that leave all American workers? Growing poorer while management and their cronies in the political parties grow richer.

by Bob Herbert

If we were interested in making the best possible decisions with regard to the U.S. auto industry, someone like Rich Breen would be seen as the face of the industry, not the chief executives of General Motors, Ford and Chrysler.

Mr. Breen is a 55-year-old member of the Teamsters union, a car hauler who delivers new vehicles for the Big Three automakers. He lives in Clinton Township, a suburb of Detroit, and he is horrified by the steady erosion of the American standard of living that he sees each day as he makes his rounds.

“I see the tool and die industry dying in the light industrial areas,” he told me in an interview just before Thanksgiving. “I see the clientele decreasing in the local barbershops, the hardware stores and the restaurants. That’s all happening from the first phase of the downsizing in the auto industry, the cutbacks and layoffs that have already occurred. It’s not from the current crisis.

“The community around me is deteriorating before my eyes. I hear people saying if G.M., Ford or Chrysler shuts down it wouldn’t affect them. They have no idea. It would have a domino effect that we’ve never had before in the United States.

“The bottom would fall out and the ripple effects would go all over the country.”

The bottom is already falling out. The question for Congress and the incoming Obama administration is whether to risk allowing the industry to collapse completely. The number of people working for the Big Three automakers has already been cut drastically, perhaps in half since 2000, and more cuts are to come, even with a government rescue effort.

The United Automobile Workers agreed to extraordinary contract concessions in negotiations that took place in 2005 and 2007. Not only will there be no raises for the four-year life of the most recent contract, but the starting pay for new hires at the Big Three has been cut by 50 percent — to $14 to $16 an hour. Benefits have also been slashed.

“Ripple effect” is too mild a term for the impact that a bankruptcy among the Big Three would have on other manufacturers, suppliers, dealers, insurance companies and thousands of businesses that at first glance would not seem to be related to the auto industry. The industry supports, in one way or another, one in every 10 jobs in the nation.

A bankruptcy would be like a hurricane blowing through the U.S. economy.

Those winds are already taking a fierce toll. Darin Gilley is a 45-year-old father of two young girls who lives in Pacific, Mo., about 30 miles southwest of St. Louis. He worked in a plant that made seats for Chrysler vehicles until he was laid off at the end of October. He’s also president of a U.A.W. local that represents employees in a plant that makes dashboards for Chrysler.

Both plants are closing.

“You can’t let this industry go down,” Mr. Gilley said. “It would be catastrophic. I’ll tell you an interesting fact: auto parts supply is the number one industrial employer in seven states, including Missouri. And it’s a top five employer in 12 other states.”

The auto industry is embedded in the very heart and soul of the United States, a nation in which people travel by car with the natural ease of birds flying. Think of service stations, body shops, tire distributorships, car washes. ...

Some analysts have suggested that even if the Big Three were to disappear, the foreign carmakers would fill the vacuum, as if the cornerstone of American manufacturing — and everything it has meant and still could mean to American life and culture — were somehow disposable, like a worn-out paper bag.

Get real.

Mr. Gilley mentioned a number of close friends and associates who have already succumbed to the crisis. “This one fellow and his wife lost their house,” he said. “It was foreclosed on. They had to send back their truck. And they’ve got two kids, younger than mine. The kids don’t stop growing just because you’ve lost your job.”

Mr. Breen, the car hauler, told me about an aunt, Lee Jones, who was the owner of Diversified Industries, a company that painted grille assemblies for the Big Three.

“It employed about 75 people on the day and night shift,” he said. “She got caught in the industry’s downsizing within the last year and a half and had to close her doors. So the jobs in her shop are just gone.”

The auto industry problem is an enormous one, with implications for every American. We can rescue and reshape the industry in a way that makes sense, economically and otherwise. Or we can close our eyes to reality, as we have so many times in recent years, and suffer the inevitable devastating consequences.

Mr. Bush and the Pardon Power

NY Times Editorial

With the Bush administration drawing to a close, it is presidential pardon season. Presidents have become increasingly shameless about issuing pardons to insulate political cronies from prosecution, even to protect themselves. We hope President Bush will not abuse the pardon power by putting his appointees, political supporters or friends above the law.

The Constitution gives the president sweeping authority to grant pardons. The founders intended for presidents to use this power as an “act of grace” or to promote the public welfare. It was never intended to be a get-out-of-jail-free card for people close to the president who stretched, bent or broke the law.

The three most recent presidents have used it in just that way. George H. W. Bush pardoned former Defense Secretary Caspar Weinberger, former Assistant Secretary of State Elliott Abrams and others involved in the Iran-contra scandal. Had they been prosecuted, Mr. Bush’s own actions might have come under scrutiny.

Bill Clinton, in his final hours in office, pardoned Marc Rich, whose ex-wife contributed heavily to his presidential library; his brother, Roger Clinton; his former housing and urban development secretary, Henry Cisneros; and Susan McDougal, an old friend and a key figure in the Whitewater scandal.

President Bush has issued one troubling commutation, of I. Lewis Libby’s 30-month prison sentence. Mr. Libby, Vice President Dick Cheney’s former chief of staff, was convicted of lying and obstruction of justice in the Valerie Wilson leak investigation.

This week, Mr. Bush granted 14 pardons and commuted two prison sentences, none for high-profile defendants. He has until Jan. 20, however, to grant more. And his record of stonewalling inquiries into his administration’s legally questionable behavior — the torture policy that led to the Abu Ghraib nightmare; illegal wiretapping; the politically motivated firing of federal attorneys — justify concern that he may be considering pardoning officials involved in those misdeeds.

The framers envisioned that presidents would be discouraged from misusing the pardon power by the threat of impeachment. But it is a fairly empty threat when they issue pardons in their final days in office.

The main check on misuse of 11th-hour pardons is the verdict of history. Mr. Bush will be leaving office with extraordinarily low approval ratings. If he wants to try to reclaim his reputation, he can start by not abusing the pardon power on his way out the door.

Medicare’s Too Costly Private Plans

NY Times Editorial

Private health insurance plans were supposed to bring better care and lower costs to elderly patients covered by Medicare. Instead they have increased the cost and complexity of the program without improving care, according to new analyses published by the respected journal Health Affairs. Congress clearly has more work to do to remove unjustified subsidies that prop up many of the most inefficient private plans.

Back in the 1980s, private plans — known as health maintenance organizations — were seen as a savior for Medicare. They could provide the same or better services as traditional fee-for-service Medicare, but because of managed care they could do it at a lower cost. Over the years Congress brought other, less managed private plans into Medicare, and in 2003 the Republican-dominated Congress substantially increased government payments to private plans.

Medicare currently pays the private plans — now called the Medicare Advantage program — 13 percent more on average than the same services would cost in the traditional fee-for-service program. Some of the added payments are used to provide extra benefits for enrollees, like reduced cost-sharing or reduced premiums for such extra benefits as vision and dental care.

The added value averages more than $1,100 a year per patient. Not surprisingly, that makes them attractive to individuals and employers seeking coverage for retirees. It has fueled an explosive growth in enrollments. Almost a quarter of all Medicare beneficiaries, more than 10 million people, are enrolled in private plans.

The managed-care plans still arguably do a better job than traditional Medicare at coordinating care and eliminating duplicative services. Unfortunately, the fastest growth has occurred in private-fee-for-service plans, which do very little to coordinate care. They simply piggyback on the traditional Medicare program, relying on the same doctors and hospitals while using their subsidies to offer cost savings or extra benefits to enrollees.

As these plans have proliferated, Medicare’s costs to cover the subsidies have risen — with the taxpayers and the beneficiaries in traditional Medicare picking up the tab. The many competing plans have also increased Medicare’s bureaucratic burden and costs. And there is no sign that these plans provide better quality of care. Congress started this year to reduce the unjustified subsidies. But a lot more needs to be done. President-elect Barack Obama called during the campaign for eliminating the excessive subsidies and paying private plans only what it would cost to treat the same patients under traditional Medicare.

That would anger millions of enrollees as well as the insurance companies that use the subsidies to attract hordes of new customers. But it is only fair to treat all Medicare beneficiaries equally. Eliminating the subsidies could provide savings to help finance broader health care reform.

Will the Washington Press Corps(e) Learn From Its Mistakes of the Past 8 years?

WEDNESDAY NOV. 26, 2008 07:44 EST
Joe Klein's extreme revisionism
by Glenn Greenwald, Salon.com
(updated below)
Joe Klein, this week's Time Magazine, on George Bush's legacy:

Bush has that forlorn what-the-hell-happened? expression on his face, the one that has marked his presidency at difficult times. You never want to see the President of the United States looking like that.

So I've been searching for valedictory encomiums. . . . I'd add the bracing moment of Bush with the bullhorn in the ruins of the World Trade Center, but that was neutered in my memory by his ridiculous, preening appearance in a flight suit on the deck of the aircraft carrier beneath the "Mission Accomplished" sign. The flight-suit image is one of the two defining moments of the Bush failure.

Joe Klein, Face the Nation, May 4, 2003, with Bob Schieffer -- 3 days after Bush's Mission Accomplished speech:

BOB SCHIEFFER: How does [the Democratic presidential primary debate] play off against the pictures we saw this week of President Bush landing on the aircraft -- aircraft carrier and appearing before these screaming, adoring groups of military people? As far as I'm concerned, that was one of the great pictures of all time. And if you're a political consultant, you can just see campaign commercial written all over the pictures of George Bush.

JOE KLEIN: Well, that was probably the coolest presidential image since Bill Pullman played the jet fighter pilot in the movie Independence Day. That was the first thing that came to mind for me. And it just shows you how high a mountain these Democrats are going to have to climb. You compare that image, which everybody across the world saw, with this debate last night where you have nine people on a stage and it doesn't air until 11:30 at night, up against Saturday Night Live, and you see what a major, major struggle the Democrats are going to have to try and beat a popular incumbent president.

I'm glad that many people, including some journalists, seem to have learned some lessons from the Bush era now that he's almost certainly the single most unpopular President in modern American history. People who regret their mistakes and learn from them should be welcomed and encouraged. But a vital aspect of what happened over the last eight years is the role the media -- our leading media stars -- played in glorifying and venerating George Bush, and that can't be re-written or forgotten.

Truly learning from one's mistakes -- as opposed to wet-finger-in-the-air abandoment of previously revered leaders when they are revealed as failures and lose their power -- requires, at the very least, an acknowledgment of one's own role in what happened. There have been very few mea culpas from establishment media journalists, many -- most -- of whom, to this day, think they did nothing wrong ("It was all Judy Miller!"). As bad as this absence of remorse is, it is simply intolerable to watch those who cheered on many of the worst excesses try now to pretend that they were skeptical, adversarial critics all along. Journalists with influential platforms have responsibilities, the primary one of which is to be accountable for what they say and do.

UPDATE: Tristam Shandy notes some other relevant highlight reels from Joe Klein.
-- Glenn Greenwald

Lest We Forget

By PAUL KRUGMAN
A few months ago I found myself at a meeting of economists and finance officials, discussing — what else? — the crisis. There was a lot of soul-searching going on. One senior policy maker asked, “Why didn’t we see this coming?”

There was, of course, only one thing to say in reply, so I said it: “What do you mean ‘we,’ white man?”

Seriously, though, the official had a point. Some people say that the current crisis is unprecedented, but the truth is that there were plenty of precedents, some of them of very recent vintage. Yet these precedents were ignored. And the story of how “we” failed to see this coming has a clear policy implication — namely, that financial market reform should be pressed quickly, that it shouldn’t wait until the crisis is resolved.

About those precedents: Why did so many observers dismiss the obvious signs of a housing bubble, even though the 1990s dot-com bubble was fresh in our memories?

Why did so many people insist that our financial system was “resilient,” as Alan Greenspan put it, when in 1998 the collapse of a single hedge fund, Long-Term Capital Management, temporarily paralyzed credit markets around the world?

Why did almost everyone believe in the omnipotence of the Federal Reserve when its counterpart, the Bank of Japan, spent a decade trying and failing to jump-start a stalled economy?

One answer to these questions is that nobody likes a party pooper. While the housing bubble was still inflating, lenders were making lots of money issuing mortgages to anyone who walked in the door; investment banks were making even more money repackaging those mortgages into shiny new securities; and money managers who booked big paper profits by buying those securities with borrowed funds looked like geniuses, and were paid accordingly. Who wanted to hear from dismal economists warning that the whole thing was, in effect, a giant Ponzi scheme?

There’s also another reason the economic policy establishment failed to see the current crisis coming. The crises of the 1990s and the early years of this decade should have been seen as dire omens, as intimations of still worse troubles to come. But everyone was too busy celebrating our success in getting through those crises to notice.

Consider, in particular, what happened after the crisis of 1997-98. This crisis showed that the modern financial system, with its deregulated markets, highly leveraged players and global capital flows, was becoming dangerously fragile. But when the crisis abated, the order of the day was triumphalism, not soul-searching.

Time magazine famously named Mr. Greenspan, Robert Rubin and Lawrence Summers “The Committee to Save the World” — the “Three Marketeers” who “prevented a global meltdown.” In effect, everyone declared a victory party over our pullback from the brink, while forgetting to ask how we got so close to the brink in the first place.

In fact, both the crisis of 1997-98 and the bursting of the dot-com bubble probably had the perverse effect of making both investors and public officials more, not less, complacent. Because neither crisis quite lived up to our worst fears, because neither brought about another Great Depression, investors came to believe that Mr. Greenspan had the magical power to solve all problems — and so, one suspects, did Mr. Greenspan himself, who opposed all proposals for prudential regulation of the financial system.

Now we’re in the midst of another crisis, the worst since the 1930s. For the moment, all eyes are on the immediate response to that crisis. Will the Fed’s ever more aggressive efforts to unfreeze the credit markets finally start getting somewhere? Will the Obama administration’s fiscal stimulus turn output and employment around? (I’m still not sure, by the way, whether the economic team is thinking big enough.)

And because we’re all so worried about the current crisis, it’s hard to focus on the longer-term issues — on reining in our out-of-control financial system, so as to prevent or at least limit the next crisis. Yet the experience of the last decade suggests that we should be worrying about financial reform, above all regulating the “shadow banking system” at the heart of the current mess, sooner rather than later.

For once the economy is on the road to recovery, the wheeler-dealers will be making easy money again — and will lobby hard against anyone who tries to limit their bottom lines. Moreover, the success of recovery efforts will come to seem preordained, even though it wasn’t, and the urgency of action will be lost.

So here’s my plea: even though the incoming administration’s agenda is already very full, it should not put off financial reform. The time to start preventing the next crisis is now.

Stimulus for Skeptics

By DAVID BROOKS
Over the past year, the federal government has poured money into the economy hundreds of billions of dollars at a time. It has also guaranteed investments, loans and deposits worth about $8 trillion. Barry Ritholtz, the author of “Bailout Nation,” points out that this project constitutes the largest infusion in American history.

If you add up just the funds that have already been committed, you get a figure, according to Jim Bianco of Bianco Research, that is larger in today’s dollars than the costs of the Marshall Plan, the Louisiana Purchase, the New Deal, the Korean War, Vietnam and the S.&L. crisis combined.

Is all this money doing any good?

The financial system seems to have stabilized, but bank lending is minimal, home prices keep falling, consumer spending is plummeting, and the economy continues to dive.

It could be we just have to endure some fundamental adjustments. Housing prices have to reach a new level. Consumption has to settle on a new trajectory. Until those fundamental shifts are made, no federal sugar rush is going to restore economic health.

That’s not a recipe for doing nothing. It’s a recipe for skepticism. And it leads to some guiding principles for those designing the $500 billion stimulus plan the next administration seems set on: Don’t just throw more money into the sugar rush. Spend money on projects that will enhance the long-term economic health of the country even without a crisis. Do what you would do anyway, just do it faster.

To understand how the short-term response might serve the country’s long-term economic interest, I called up Michael Porter, the competitiveness guru at Harvard Business School. Porter wrote an outstanding overview of America’s long-term economic challenges in the Oct. 30 issue of BusinessWeek.

Porter wrote that the U.S. economy has historically benefited from several great assets: an unparalleled environment for entrepreneurialism, a tremendous infrastructure for scientific research, the world’s best universities, a strong commitment to competition and free markets, decentralized regional economies, and efficient capital markets.

But, Porter continued, these advantages are starting to erode. The U.S. has an inadequate rate of reinvestment in science and technology. America’s confidence in free markets is waning. Lack of regulatory oversight has undermined capital markets. Universities have not sufficiently increased graduation rates. American workers do not have a credible safety net. Regulations and litigation have inflated the cost of business. Most important, there is no long-term economic strategy to organize responses to these problems.

I asked Porter how this short-term crisis might serve as an opportunity to address those long-term problems. First, he said, the Obama team will have to avoid a few temptations: Don’t just try to throw out money as fast as possible to stimulate demand. Don’t spread the spending around too thinly. Don’t try to save jobs that are going to disappear anyway.

Then he threw out a bunch of ideas that could be part of a stimulus package:

Send federal money to the states, but make sure a lot of it goes to state universities. There’s going to be increased demand for their services at the same time their budgets are cut. We can’t weaken that link in the social mobility chain.

Extend unemployment insurance, but also create vouchers and loans so workers can get the skills they need to move on.

Extend the Cobra period another 12 months to head off a rise in the uninsured during the recession.

Adjust the capital gains rate to give people the incentive to become long-term investors. Right now there’s a tension between the real economy, which is gradual, and the financial system, which is manic. Low rates shouldn’t kick in until an investment is held three to five years.

Accelerate depreciation on energy efficient goods and services. Increase tax credits for energy efficient buildings and appliances.

Porter’s basic message was that President-elect Barack Obama should do nothing in the short term that doesn’t serve a long-term goal.

To which I would add just one idea: Create a network of social entrepreneurship investment banks. These regionally operated semi-public funds would invest in the best local community organizations, so they could bring their ideas to scale.

These funds, first proposed by the group America Forward, would supplement the safety net and employ college grads entering a miserable job market. They’d have a powerful psychological effect on a country that desperately wants to feel mobilized and united.

This is a mental recession as well as an economic one. Solving it means getting more and more people involved in a fundamental rebirth.

Administration Moves to Protect Key Appointees

Political Positions Shifted To Career Civil Service Jobs
By Juliet Eilperin and Carol D. Leonnig
Washington Post Staff Writers
Tuesday, November 18, 2008; A01

Just weeks before leaving office, the Interior Department's top lawyer has shifted half a dozen key deputies -- including two former political appointees who have been involved in controversial environmental decisions -- into senior civil service posts.

The transfer of political appointees into permanent federal positions, called "burrowing" by career officials, creates security for those employees, and at least initially will deprive the incoming Obama administration of the chance to install its preferred appointees in some key jobs.

Similar efforts are taking place at other agencies. Two political hires at the Labor Department have already secured career posts there, and one at the Department of Housing and Urban Development is trying to make the switch.

Between March 1 and Nov. 3, according to the federal Office of Personnel Management, the Bush administration allowed 20 political appointees to become career civil servants. Six political appointees to the Senior Executive Service, the government's most prestigious and highly paid employees, have received approval to take career jobs at the same level. Fourteen other political, or "Schedule C," appointees have also been approved to take career jobs. One candidate was turned down by OPM and two were withdrawn by the submitting agency.

The personnel moves come as Bush administration officials are scrambling to cement in place policy and regulatory initiatives that touch on issues such as federal drinking-water standards, air quality at national parks, mountaintop mining and fisheries limits.

The practice of placing political appointees into permanent civil service posts before an administration ends is not new. In its last 12 months, the Clinton administration approved 47 such moves, including seven at the senior executive level. Federal employees with civil service status receive job protections that make it very difficult for managers to remove them.

Most of the personnel shifts have been done on a case-by-case basis, but Interior Solicitor David L. Bernhardt moved to place six deputies in senior agency positions with one stroke, including two who have repeatedly attracted controversy. Robert D. Comer, who was Rocky Mountain regional solicitor, was named to the civil service post of associate solicitor for mineral resources. Matthew McKeown, who served as deputy associate solicitor for mineral resources, will take Comer's place in what is also a career post. Both had been converted from political appointees to civil service status.

In a report dated Oct. 13, 2004, Interior's inspector general singled out Comer in criticizing a grazing agreement that the Bureau of Land Management had struck with a Wyoming rancher, saying Comer used "pressure and intimidation" to produce the settlement and pushed it through "with total disregard for the concerns raised by career field personnel." McKeown -- who as Idaho's deputy attorney general had sued to overturn a Clinton administration rule barring road-building in certain national forests -- has been criticized by environmentalists for promoting the cause of private property owners over the public interest on issues such as grazing and logging.

One career Interior official, who spoke on the condition of anonymity so as not to jeopardize his position, said McKeown will "have a huge impact on a broad swath of the West" in his new position, advising the Bureau of Land Management and the Fish and Wildlife Service on "all the programs they implement." Comer, the official added, will help shape mining policy in his new assignment.

"It is an attempt by the outgoing administration to limit as much as possible [the incoming administration's] ability to put its policy imprint on the Department of Interior," the official said.

In a Nov. 13 memo obtained by The Washington Post, Bernhardt wrote that he was reorganizing his division because the associate solicitors' original status as political appointees undermined the division's effectiveness.

"This has resulted in frequent turnover in those positions, often with an attendant loss in productivity and management continuity in these Divisions, despite the best efforts of the newly-appointed Associate Solicitors," he wrote.

But environmental advocates, and some rank-and-file Interior officials who spoke on the condition of anonymity for fear of hurting their careers, said the reassignments represent the Bush administration's effort to leave a lasting imprint on environmental policy.

"What's clear is they could have done this during the eight years they were in office. Why are they doing it now?" said Robert Irvin, senior vice president for conservation programs at Defenders of Wildlife, an advocacy group. "It's pretty obvious they're trying to leave in place some of their loyal foot soldiers in their efforts to reduce environmental protection."

In an interview yesterday, Bernhardt reiterated that he thinks the move is in the government's long-term interest.

"I believe these management decisions will strengthen the professionalism of the Office of the Solicitor and result in greater service to the Department of the Interior," he said. "However, the next solicitor and the department's management team are free to walk a different path."

One senior Interior official, who spoke on the condition of anonymity to discuss personnel matters, said an incoming interior secretary or solicitor could create new political positions upon taking office and could shift Senior Executive Service officials to comparable jobs within a few months. As a general rule, career SES employees may be reassigned involuntarily within their current commuting area within 15 days, and beyond their commuting area within 60 days, but they retain their lucrative and permanent government posts. When a new agency head is appointed, he or she must wait 120 days before reassigning career SES officials.

Outside groups are trying to monitor these moves but are powerless to reverse them. Alex Bastani, a representative at the Labor Department for the American Federation of Government Employees, said it took months for that agency even to acknowledge that two of its Bush appointees, Carrie Snidar and Brad Mantel, had gotten civil service posts.

"They're trying to burrow into these career jobs, and we're very upset," Bastani said. "Everyone should have an opportunity to apply for these positions. And certainly career people who don't have partisan bent and have 10 or 15 years in their respective fields should have a shot at these positions."

Kerry Weems, acting chief of the Centers for Medicare and Medicaid Services, said he discourages political staff from moving into career slots. "It typically doesn't work out for either party," he said. Even though Weems is a career staffer, he expects to leave the administration when the Obama team takes over.

Alphonso Jackson, who was HUD secretary under President Bush, warned his political appointees not to try to burrow in when the administration changed. But one of his regional directors objected to that flat-out prohibition, according to union leaders at HUD, and has told his colleagues that he has been promised first crack at a career position.

Staff writers Ceci Connolly and Spencer S. Hsu contributed to this report.

It's OK, Morning Joe

I've been having a bit of fun with "Morning Joe" Scarborough on his use of a four letter word on air. Today it's time to let him off the hook. Yep, many of us have let slip with something we wish we wouldn't have. Certainly not all of us. But many.

Joe had a slip of the tongue and I called him out on it, as did many other bloggers and columnists. Why? Because Joe had been so unrelentingly tough on others who had a slip of the tongue.

When commercial television is happy to run ads on erectile dysfunction during a family show that I'm watching with my child, then I'm not sure when and how the FCC can step in anywhere, really. I find it interesting that there is "parental controls" for televsion shows, but not for commercials, many of which are more offensive than some of the offending television shows.

But Morning Joe for the longest time found no quarter with any slips, such as those from Bono or Cher... something a bit different than planned out profanities or sex scenes. In fact, I blame my generation who started MTV and came of age as Executives of Television networks. Fox is the worst of the bunch, having expanded mores from its inception... followed by the astounding establishment of its antithesis, Fox News... which never comments on the loose morals of the Fox Network.

So, Morning Joe. you don't have to say it ain't so. I'm giving you a freebie. You meant it. You just didn't know you were on air. And I'm forgiving of missteps. Perhaps you'll do the same.

Addendum:

I watched this morning's Morning Joe... no, not for a potential slip of the tongue... although Mourning Mika provides many herself, albeit non-profanity laced.

I was happy to hear Joe's very pragmatic, non-ideological take on the bailout of the car companies. I quite agreed with him. Certainly, no bailout should happen with the same people remaining at the top, since they've gotten us into this mess. However, as Joe stated, American workers are great and should not have to suffer for the misdeeds of their inept CEO's.

His second take of making the bailout contingent on 1) replacing inept management; and 2) requirement of a Manhattan Project-type program of hunkering down to design cars that are visually desireable, and more importantly, green - whether it be better gas mileage or entirely new modes of propulsion.

Kudos, Morning Joe

Palinpalooza - How Can We Miss You If You Won't Go Away?

From Salon.com, Joan Walsh
How can we miss her if she won't go away? The Sarah Palin rehabilitation tour began as soon as the election ended, but so far, I'm not being won over by her attempted charm offensive. I expected Fox's Greta van Susteren to pander to her, given her employer, but I was a little surprised at Matt Lauer's friendly, supportive probing as he ate dinner with the Palin family in the kitchen in Wasilla, and tried to help the former Veepzilla tell her side of the story.

Let me say first: I agree with Palin on one thing: the anonymous McCain advisors who've savaged her since she became a drag on their ticket are cowards and jerks. Whatever her flaws, McCain is to blame for all of them, because he's the one who "went rogue" and picked her with inadequate vetting. I've said that before. But Palin isn't particularly helping her case with these interviews. If you like her, you'll like what she has to say. If you don't like her, or more relevant, don't think she ever had what it takes to be vice-president: Well, nothing in either interview will reassure you.

Hands down her worst performance came in a "Web-only" video where Lauer asks Palin about the infamous Katie Couric interview, and whether it took a toll on her confidence. She tells Lauer no, but adds: "I think it also showed, though, that certainly as a Washington outsider and not one to just I guess play even the campaigning media game that is played, in just repeating, perhaps, memorized lines in a, in a interview, that's not me." Read that again. Trademark Palin grammar, and totally unconvincing. Answering questions about foreign policy and Supreme Court decisions isn't a matter of rote memorization, it's a matter of knowledge, depth, intellectual curiosity and experience that she clearly doesn't have.

She was also borderline dishonest about the issue of whether she looked into banning books while she was Wasilla mayor, using as "proof" the fact that some people claimed she wanted to ban the "Harry Potter" series, even though it was written after she was mayor. In fact, Salon interviewed a Wasilla minister who said his book, "Pastor, I Am Gay," was on Palin's hit list. Palin can say Howard Bess is lying, but she's choosing to address only the most ludicrous claims against her. Not convincing.

She was also unconvincing when she downplayed talk of campaign infighting and dysfunction -- and then gave Lauer a great example of it. She told the story of working with two speechwriters on a version of a concession speech to give in Phoenix. But she admits she didn't know until she was walking up to the stage that she wouldn't be allowed to give it. That's dysfunction. And even though I'm sympathetic to Palin's complaints about McCain advisors' anonymous claims that she sent aides out shopping for her, her defense won't rise beyond "he said, she said" sniping until she's willing to name some names, herself. Who bought the clothes? Who does she think is behind the leaks? I'm sure she knows.

But the saddest part for me was the interview with little Piper, who tells Matt Lauer she didn't like campaign rallies, missed her friends and fell behind in school. But when Mommy asks if she'd like to do it again in 2012, Piper says sure. I found myself asking: Why wasn't Piper home attending school, like the Obama daughters did most of the time? Was Todd Palin enjoying the campaign trail too much to stay home with the family?

I'm hoping I can put Sarah Palin behind me, although she's got a big star turn Wednesday at the Republican Governor's Association meeting, including a press conference. Clearly she thinks she's ready for prime time, and that the McCain campaign hid her light under a bushel. So we'll be seeing more of her in the weeks to come. Given her plummeting poll numbers at the end of the campaign, it's just more good news for Democrats that she's fighting to emerge as a party leader in the wake of McCain's shellacking.

-- Joan Walsh

Morning Joe and Then Some... a great spoof

Before you click play, this is laced with profanities (but it should be noted, no worse than Morning Joe's profanity, below, which aired on TV.. and it ties in some previous Republican profanities from across the candidates' spectrum).

But it really sums up "Morning Joe" in one of the best spoofs I've seen. See the post below this one for the ACTUAL Joe and Mika show. Poor babies.

Joe Scarborough: Hoisted by his own sanctimonious petard

Note from Greetings: Joe Scarborough, a critic of profanity on the airwaves, uses the F-word. Should he get the heave-ho or at least be fined as he felt those he criticized should be? And why is he spending so much time defending Palin, who has no relevance now as we move forward, while at the same time going after Obama?

The MSNBC star, who today used the "F-word" on his show, has repeatedly demanded massive FCC fines for similar infractions.

Glenn Greenwald, Salon.com

Nov. 10, 2008

(updated below - Update II)

On his live MSNBC show this morning, former GOP Rep. Joe Scarborough used the phrase "fuck you" when discussing Obama's appointment of Rahm Emanuel:

I personally couldn't care any less about that. But Joe Scarborough, in the past, not only claimed to care about such things, but has been one of the most zealous crusaders against such awful filth on television.

Scarborough led the lynch mob over the 2004 Janet Jackson halftime show on CBS -- demanding that the FCC impose massive fines against CBS and MTV, among others -- and has railed against "rock stars" and entertainers who use, as he used to call it (before this morning), "the F word." Indeed, Scarborough even expressed outrage over the fact that the Government would even consider refraining from imposing substantial fines on ABC when Bono, on a live awards show, used the "F word."

Here is Scarborough, from his February 2, 2004 show -- after the Super Bowl show -- lambasting the FCC for allowing indecency over the airwaves and demanding that Michael Powell slam CBS with massive fines or be fired (while noting that the problem extended beyond this episode and was composed, at least equally, of the use of bad words):

But, first, the FCC is asleep at the wheel. And it is your family who's being hurt. . . .

Last night, as my boys and their friends sat around the TV set watching the Super Bowl, I spent the first half fielding questions about the 20 commercials for erectile dysfunction and the second half answering questions about Janet Jackson's striptease act.

But if Michael Powell and the FCC had been doing their jobs policing the airwaves over the past few years, the Jackson sideshow would have never occurred, because CBS, MTV, Viacom, and Janet Jackson would have gotten the message that polluting our airwaves comes with a price.

And they also would have easily lost lots of money. And it would have offset whatever free publicity these pathetic losers got because of Jackson's crass P.R. stunt. Just like the Reagan miniseries before it, the Janet Super Bowl proves once again that CBS just does not get it. And unless Michael Powell starts getting it soon by making CBS pay big time for their stunt, President Bush should fire the feckless FCC chairman immediately. . . .

But I have got to say, that's the problem, not just being exposed to Janet Jackson, but being exposed to the F-bomb several times from rock stars at award shows, from actresses at award shows. Unbelievable.

We are going to keep talking about this.

Two days later, Scarborough collected hordes of outraged emails from his angry viewers over Janet Jackson and flew them to Washington DC to deliver them to Trent Lott and other right-wing officials, demanding government punishment against CBS, Viacom, MTV, and even the NFL:

This year's Super Bowl halftime showed to the entire world that MTV is a cultural virus that infects our children daily. . . .

What is Capitol Hill doing to protect your family from stunts like Janet Jackson's? Well, I went to Washington to find out for you.

Now, you've, of course, sent us thousands of e-mails about the Super Bowl halftime show. And yesterday, I flew down to Washington to deliver them to the people who are going to get something done about it. Senator Trent Lott is one of them. And, of course, he's the chairman of the powerful Rules Committee. . . .

He was absolutely blown away by your response on this issue. And it sent him a strong message that you are angry. And he says something is going to happen. Of course, we've got the FCC hearing next week. . .

And we also met up with Congressman Tom Osborne, who is pushing for bigger fines for networks that broadcast indecency.

On October 27, 2003, Scarborough expressed extreme anger that the FCC refused to impose fines on ABC when Bono used "the 'F' word" during a live broadcast of the Golden Globe Awards:

The show was live, and unlike SCARBOROUGH COUNTRY, the "F" word was not bleeped out. Earlier this month, the FCC ruled that Bono's acceptance speech and his use of the word that began with an "F" was not a violation of indecency rules. . . ..

Robert, it was at 8:00. Kids were watching this. You've studied television and pop culture. What does it say about our FCC that we've come this far or you could say gone this far backward that somebody could say the "F" word on TV and get the federal government's approval?

Scarborough then even boasted to his guest that his upbringing was so fine that he was taught not to use such words:

Robert, I'm glad to hear that you don't use the words and you didn't use them growing up. All I'll say is, my mom put soap in my mouth more than once or twice.

Apparently, she didn't do it enough. On October 10, 2006, Scarborough hosted a whole segment mocking and attacking Barbra Streisand for using the same word during a concert when speaking about President Bush:

Also, Barbra Streisand gets into a four-letter fight with one of her fans. Her Bush-bashing schtick led to an angry F bomb. . . .And coming up: Barbra Streisand drops the F bomb on a fan who fights back after her Bush-bashing routine. We`ve got the star-studded reaction to the obscene outburst. . . .

Scarborough was elected to Congress in 1994, with the Gingrich-led Republican class that made family values one of its principal crusades. Using Scarborough's outraged crusades from the past, one would have to conclude that it insufficient that he merely apologize for what he said, and instead, MSNBC must be severely fined for what Scarborough said -- especially since it was heard during the morning when many of America's children could be watching. After all -- as he so eloquently put it -- "what does it say about our FCC that we've come this far or you could say gone this far backward that somebody could say the "F" word on TV and get the federal government's approval?"

UPDATE: It's true, as several commenters pointed out, that the FCC only imposes indecency fines for network television, not basic cable, though right-wing activists, including those on the FCC (such as FCC Chairman Kevin Martin), have long been agitating to vest the FCC with power to do both. Of course, Scarborough's past sermonizing doesn't depend on that jurisdictional question. It's all about the kids (as he put it on October 27, 2003: "thanks to Bono and the FCC, there are now only six words that you can't say on TV. Why is the F-word OK for your kids to hear?").

UPDATE II: From the Comment section, an outraged parent speaks out:

My kid heard that

It's funny you write about this today. I was getting ready for work this morning, watching Morning Joe (which I like despite Joe). My 10-year-old son got up, came into the living room, and is typical of a day when he doesn't have school, plopped down on the couch and started watching with me. I was just about to hand him the remote to change to less-newsy fare when Joe popped off with this. I was flabbergasted. And there's no question my kid heard that. Ugh.

One shudders to think how many other American children were exposed today to the raunchy filth of Joe Scarborough. The outraged emails are already pouring in. Keep them coming. Let me hear especially from other parents. I'm going to fly down to Washington with the emails and comments in hand (and a camera crew in tow) to demand government punishment against NBC, MSNBC, GE, Scarborough, Time-Warner, Inc. (due to Jay Carney's instigation) and others.

-- Glenn Greenwald

Beyond Election Day

By BOB HERBERT

Conservative commentators had a lot of fun mocking Barack Obama’s use of the phrase, “the fierce urgency of now.”

Noting that it had originated with the Rev. Dr. Martin Luther King Jr., Senator Obama made it a cornerstone of his early campaign speeches.

Conservatives kicked the phrase around like a soccer ball. “The fierce urgency of now,” they would say, giggling. What does it mean?

Well, if your house is on fire and your family is still inside, that’s an example of the fierce urgency of now.

Something like that is the case in the United States right now as Americans go to the polls in what is probably the most important presidential election since World War II. A mind-boggling series of crises is threatening not just the short-term future but the very viability of the nation.

The economy is sinking into quicksand. The financial sector, guardian of the nation’s wealth, is leaning on the crutch of a trillion-dollar taxpayer bailout. The giant auto companies — for decades the high-powered, gas-guzzling, exhaust-spewing pride of American industry — are on life support.

As the holiday shopping season approaches, the nation is hemorrhaging jobs, the value of the family home has plunged, retirement plans are shrinking like ice cubes on a hot stove and economists are telling us the recession has only just begun.

It’s in that atmosphere that voters today will be choosing between the crisis-management skills of Senator Obama, who has enlisted Joe Biden as aide-de-camp, and those of Senator John McCain, who is riding to the rescue with Sarah Palin and Joe the Plumber in tow.

As important as this choice has become, the election is just a small first step. What Americans really have to decide is what kind of country they want.

Right now the United States is a country in which wealth is funneled, absurdly, from the bottom to the top. The richest 1 percent of Americans now holds close to 40 percent of all the wealth in the nation and maintains an iron grip on the levers of government power.

This is not only unfair, but self-defeating. The U.S. cannot thrive with its fabulous wealth concentrated at the top and the middle class on its knees. (No one even bothers to talk about the poor anymore.) How to correct this imbalance is one of the biggest questions facing the country.

The U.S. is also a country in which blissful ignorance is celebrated, and intellectual excellence (the key to 21st century advancement) is not just given short shrift, but is ridiculed. Paris Hilton and Britney Spears are cultural icons. The average American watches television a mind-numbing 4 1/2 hours a day.

At the same time, our public school system is plagued with some of the highest dropout rates in the industrialized world. Math and science? Forget about it. Too tough for these TV watchers, or too boring, or whatever.

“When I compare our high schools with what I see when I’m traveling abroad,” said Bill Gates, “I am terrified for our work force of tomorrow.”

The point here is that as we approach the end of the first decade of the 21st century, the United States is in deep, deep trouble. Yet instead of looking for creative, 21st-century solutions to these enormous problems, too many of our so-called leaders are behaving like clowns, or worse — spouting garbage in the public sphere that hearkens back to the 1940s and ’50s.

Thoughtful, well-educated men and women are denounced as elites, and thus the enemies of ordinary Americans. Attempts to restore a semblance of fiscal sanity to a government that has been looted with an efficiency that would have been envied by the mob, are derided as subversive — the work of socialists, Marxists, Communists.

In 2008!

In North Carolina, Senator Elizabeth Dole, a conservative Republican, is in a tough fight for re-election against a Democratic state senator, Kay Hagan. So Ms. Dole ran a television ad that showed a close-up of Ms. Hagan’s face while the voice of a different woman asserts, “There is no God!”

Americans have to decide if they want a country that tolerates this kind of debased, backward behavior. Or if they want a country that aspires to true greatness — a country that stands for more than the mere rhetoric of equality, freedom, opportunity and justice.

That decision will require more than casting a vote in one presidential election. It will require a great deal of reflective thought and hard work by a committed citizenry. The great promise of America hinges on a government that works, openly and honestly, for the broad interests of the American people, as opposed to the narrow benefit of the favored, wealthy few.

By all means, vote today. But that is just the first step toward meaningful change.