Thursday, August 23, 2007
Monday, July 23, 2007
Senators Endorse the Irresponsible and Recalcitrant
While I would have difficulty finding in the constitution provisions granting the Congress power to appropriate funds for state efforts for substance abuse treatment, the Senate Appropriations Committee has found a way to make bad things worse. The Bush Administration had proposed that states adopt outcome measures for their substance abuse treatment programs. This proposal carried with it a 5% reduction in state grants for states that did not adopt such measures or report the results. Sadly this was too much oversight of federal spending for the committee. In their committee report on the appropriations bill for the Department of Health, Education and Welfare, the good senators had this to say about these limited measures to establish some accountability for the nearly 1.8 BILLION dollars to be appropriated for the Substance Abuse Block Grant.
"The committee has not included bill language requested by the administration to withhold at least 5% of the block grant funds from States unable to submit National Outcome Measures [NOMs] data. The Committee strongly opposes this proposal and believes that punitive policies could threaten or interrupt service delivery."
NOMs is a project of the Substance Abuse and Mental Health Administration to implement continuous quality improvement techniques. If we have to spend money without constitutional authority surely we would want to do it in a way that ensures the services purchased are not measured or improved. Holding states accountable for the use of grant funds is "punitive" and really bad mojo if it interrupts the delivery of services for which no outcome measures have been adopted. Way to go Senate Appropriations.
While I would have difficulty finding in the constitution provisions granting the Congress power to appropriate funds for state efforts for substance abuse treatment, the Senate Appropriations Committee has found a way to make bad things worse. The Bush Administration had proposed that states adopt outcome measures for their substance abuse treatment programs. This proposal carried with it a 5% reduction in state grants for states that did not adopt such measures or report the results. Sadly this was too much oversight of federal spending for the committee. In their committee report on the appropriations bill for the Department of Health, Education and Welfare, the good senators had this to say about these limited measures to establish some accountability for the nearly 1.8 BILLION dollars to be appropriated for the Substance Abuse Block Grant.
"The committee has not included bill language requested by the administration to withhold at least 5% of the block grant funds from States unable to submit National Outcome Measures [NOMs] data. The Committee strongly opposes this proposal and believes that punitive policies could threaten or interrupt service delivery."
NOMs is a project of the Substance Abuse and Mental Health Administration to implement continuous quality improvement techniques. If we have to spend money without constitutional authority surely we would want to do it in a way that ensures the services purchased are not measured or improved. Holding states accountable for the use of grant funds is "punitive" and really bad mojo if it interrupts the delivery of services for which no outcome measures have been adopted. Way to go Senate Appropriations.
Sunday, July 22, 2007
Multiple Sclerosis in Gulf War Veterans
Today's daily press has an article titled "Group eyes possible links between MS, Gulf War." The article is available online here. In the article a National Multiple Scleroris Society spokesman refers to a study showing increasing incidence of MS in Kuwait after 1993 as support for urging Congress to appropriate $15 million to see if there is a connection to military service in the Gulf War. As is frequently the case there are no links to the source documents in the Daily Press online article.
A review of the National Multiple Sclerosis Society site did not turn up any research that seemed related to this subject. Although the Society's spokesperson was asking for $15 million defense dollars and was quoted in the press on the subject, I thought it strange to not find any mention on their website.
A Google search did lead me to a 2005 article published in European Neurology,
Epidemiology of Multiple Sclerosis in Kuwait: New Trends in Incidence and Prevalence
A.F. Alshubaili, K. Alramzy, Y.M. Ayyad, Y. Gerish
Department of Neurology, Ibn Sina Hospital, Safat, Kuwait
The article is not available free but the abstract does cite "Gulf War as a key term and reads:
The epidemiology of multiple sclerosis (MS) is undergoing dramatic changes; MS is occurring with increased frequency in many parts of the world. In this retrospective study, we examined the changes in incidence and prevalence of MS in Kuwait in the period between 1993 and 2000. We analyzed the records of patients with clinically defined and laboratory supported MS. The total incidence rate increased from 1.05/100,000 population in 1993 to 2.62/100,000 in 2000. The increased incidence of MS was most pronounced among Kuwaiti women (from 2.26/100,000 in 1993 to 7.79/100,000 in 2000. The total prevalence rate increased from 6.68/100,000 in 1993 to 14.77/100,000 in 2000. It was much higher for Kuwaitis (31.15/100,000), as compared to non-Kuwaitis (5.55/ 100,000), in a complete reversal of the pattern observed before 1990. The prevalence was also higher among Kuwaiti women (35.54/100,000), as compared with Kuwaiti men (26.65/100,000). In conclusion, the incidence and prevalence of MS in Kuwait has increased between the early and late 1990s with no signs of leveling off. In a geographic area that was previously associated with low prevalence, local environmental factors may be responsible for these dramatic changes.
On its face it would suggest that the reported increase relating to the Gulf War time period and the associated war time environmental factors might bear connection. And if a connection existed perhaps a common etiology existed for Gulf War veterans. The Google search (multiple sclerosis kuwait) that turned up this article had 122,000 citations, rich fruit for a little further research. This lead me to Disability Online and then to the Multiple Sclerosis International Federation which has an excellent search tool. A search for "prevalence" brought 93 results.
Here are just some of the abstracts:
Although there are many more the articles abstracted above all seem to point to a increasing general incidence or among women (as the Kuwait article does), and in areas considerably removed from the effects of the Gulf War. One might conclude that the connection is more tenous than $15,000,000 would support.
Today's daily press has an article titled "Group eyes possible links between MS, Gulf War." The article is available online here. In the article a National Multiple Scleroris Society spokesman refers to a study showing increasing incidence of MS in Kuwait after 1993 as support for urging Congress to appropriate $15 million to see if there is a connection to military service in the Gulf War. As is frequently the case there are no links to the source documents in the Daily Press online article.
A review of the National Multiple Sclerosis Society site did not turn up any research that seemed related to this subject. Although the Society's spokesperson was asking for $15 million defense dollars and was quoted in the press on the subject, I thought it strange to not find any mention on their website.
A Google search did lead me to a 2005 article published in European Neurology,
Epidemiology of Multiple Sclerosis in Kuwait: New Trends in Incidence and Prevalence
A.F. Alshubaili, K. Alramzy, Y.M. Ayyad, Y. Gerish
Department of Neurology, Ibn Sina Hospital, Safat, Kuwait
The article is not available free but the abstract does cite "Gulf War as a key term and reads:
The epidemiology of multiple sclerosis (MS) is undergoing dramatic changes; MS is occurring with increased frequency in many parts of the world. In this retrospective study, we examined the changes in incidence and prevalence of MS in Kuwait in the period between 1993 and 2000. We analyzed the records of patients with clinically defined and laboratory supported MS. The total incidence rate increased from 1.05/100,000 population in 1993 to 2.62/100,000 in 2000. The increased incidence of MS was most pronounced among Kuwaiti women (from 2.26/100,000 in 1993 to 7.79/100,000 in 2000. The total prevalence rate increased from 6.68/100,000 in 1993 to 14.77/100,000 in 2000. It was much higher for Kuwaitis (31.15/100,000), as compared to non-Kuwaitis (5.55/ 100,000), in a complete reversal of the pattern observed before 1990. The prevalence was also higher among Kuwaiti women (35.54/100,000), as compared with Kuwaiti men (26.65/100,000). In conclusion, the incidence and prevalence of MS in Kuwait has increased between the early and late 1990s with no signs of leveling off. In a geographic area that was previously associated with low prevalence, local environmental factors may be responsible for these dramatic changes.
On its face it would suggest that the reported increase relating to the Gulf War time period and the associated war time environmental factors might bear connection. And if a connection existed perhaps a common etiology existed for Gulf War veterans. The Google search (multiple sclerosis kuwait) that turned up this article had 122,000 citations, rich fruit for a little further research. This lead me to Disability Online and then to the Multiple Sclerosis International Federation which has an excellent search tool. A search for "prevalence" brought 93 results.
Here are just some of the abstracts:
| . | Prevalence of Multiple Sclerosis Door-to-Door Survey in Maltepe, Istanbul, Turkey | 20 Jun 2006 |
| This study investigates the prevalence of MS in the district of Maltepe, Istanbul, Turkey. The prevalence rates ofMS in the Turkish population living in a district of Istanbul are considerably higher than originally thought and similar to those recently recorded in Sicily and Germany. | ||
| Prevalence of multiple sclerosis in Belgrade, Yugoslavia | 20 Aug 2002 |
| A study of MS prevalence with information about disease course in a modern population in Yugoslavia. Between 1985 and 1996 the prevalence of MS in this region seemed to be increasing | |
| Trends in prevalence and incidence of multiple sclerosis in Bajo Aragon, Spain. | 17 Nov 2003 | |
| An increased prevalence of MS in the area of Bajo Aragon, northeastern Spain, has been calculated between 1994 and 2002. This increased prevalence is more likely to be due to improvement on case ascertainment than to increasing incidence. However, further prospective incidence studies in larger populations are warranted. | ||
| Progressive increase in incidence and prevalence of multiple sclerosis in Newcastle, Australia: a 35-year study. | 05 Aug 2003 | |
| This epidemiological study shows an increase in incidence (new cases) and prevalence (total number of cases) of multiple sclerosis over the last five decades in an area of Australia. | ||
| . | Prevalence estimates for MS in the United States and evidence of an increasing trend for women | 22 Jan 2002 | |||
A 50% increase was observed in the number of women reporting MS for 1991 through 1994 vs 1982 through 1986.
| |||||
Although there are many more the articles abstracted above all seem to point to a increasing general incidence or among women (as the Kuwait article does), and in areas considerably removed from the effects of the Gulf War. One might conclude that the connection is more tenous than $15,000,000 would support.
Saturday, July 21, 2007
Virginia Virtucon has a great post on "The Jumble of Contradictions that make up Jim Webb's Core Philosophy." He concludes "let’s all sit back and reflect on the jumble of contradictions that is Jim Webb (D-WaPo)." I take up the gauntlet. On July 9, Senator Webb introduced an amendment to the Defense Authorization Act. The hand marked up version of the amendment is available here.
The amendment while couched in terms of supporting the troops and assuring them proper rest and recuperation at home, is actually a nasty piece of business that would destroy unit readiness and cohesion, while preventing units from being filled in with experienced veterans. The bill requires that each unit and each person being deployed to OIF and OEF have been home at least as long as its previous deployment.
Imagine yourself as a company commander living with this nightmare of legislation. Your unit completed a year long deployment 15 months ago. Your unit meets the minimum stay at home requirement. But 2nd and 3rd platoon have newly assigned senior non-commissioned officers. The NCOIC in 2nd platoon is a combat veteran who returned from OIF 11 months ago. His experience and effective leadership have made 2nd platoon a cohesive and effective force. The lives of the men in 2nd platoon depend on this effective leadership. In order to deploy you must transfer this effective veteran and replace him with a less experienced and effective leader. In doing so you realize that the safety of your men may be compromised by this decision. What a tangled Webb.
No clear thinking trained military officer would ever want to be put into this trap. It is further evidence of Senator Webb's mental breakdown that Virginia Virtucon identifies.
The amendment while couched in terms of supporting the troops and assuring them proper rest and recuperation at home, is actually a nasty piece of business that would destroy unit readiness and cohesion, while preventing units from being filled in with experienced veterans. The bill requires that each unit and each person being deployed to OIF and OEF have been home at least as long as its previous deployment.
Imagine yourself as a company commander living with this nightmare of legislation. Your unit completed a year long deployment 15 months ago. Your unit meets the minimum stay at home requirement. But 2nd and 3rd platoon have newly assigned senior non-commissioned officers. The NCOIC in 2nd platoon is a combat veteran who returned from OIF 11 months ago. His experience and effective leadership have made 2nd platoon a cohesive and effective force. The lives of the men in 2nd platoon depend on this effective leadership. In order to deploy you must transfer this effective veteran and replace him with a less experienced and effective leader. In doing so you realize that the safety of your men may be compromised by this decision. What a tangled Webb.
No clear thinking trained military officer would ever want to be put into this trap. It is further evidence of Senator Webb's mental breakdown that Virginia Virtucon identifies.
Friday, July 20, 2007
From Juan Williams on Bill Oreilly tonight to Cliff Garstang on Cobalt 6 the mantra seems to be any one who criticizes withdraw now supporters is questioning their patriotism, and that violates their first amendment rights and is un-American. Since Cobalt 6 provides such a good example, let's examine this issue more closely.
Cobalt 6: SWAC Girl and other local reactionary blogs (I won’t link to them, they aren’t hard to find) have put out the call for counter-demonstrators and have referred to the pro-peace group as “anti-American.”
Ok we have something to work with here. Lets find where SWAC Girl claims a pro-peace group is "anti-American." Since Cobalt 6 disdains to link to SWAC Girl and her reactionary friends, I will provide the link directly here. And voila, does anti-American appear in SWAC Girl's post? Well no, not really. So how can Cobalt 6's claim be true?
SWAC Girl doesn't actually say the pro-peace group is anti-American, or even imply it, yet surely Cobalt 6's claim could not be made entirely without basis. Cobalt 6 does identify the pro-peace group consists of Cindy Sheehan and all of us who oppose the war in Iraq.
Has Cindy Sheehan said anything which reasonable folks would construe as anti-American?
Well there is this one: "I was raised in a country by a public school system that taught us that America was good, that America was just. America has been killing people... since we first stepped on this continent; we have been responsible for death and destruction. I passed on that bulls**t to my son, and my son enlisted. I'm going all over the country telling moms this country is not worth dying for."
I would not consider this a particularly pro-American comment but it is not anti-American. A little irrational perhaps, if America refers to the American government than it could not have been killing people since "we" first stepped on this continent, whoever "we" is. If the "we" is Europeans than I don't think we can equate America with Europeans. In any case I don't see Cindy Sheehan self convicting herself of being anti-American.
If SWAC Girl doesn't call Cindy Sheehan, or all of us who oppose the war in Iraq anti-American, doesn't use the words anti-American, than Cobalt 6 appears to be unjustifiably tarring SWAC Girl.
Cobalt 6: SWAC Girl and other local reactionary blogs (I won’t link to them, they aren’t hard to find) have put out the call for counter-demonstrators and have referred to the pro-peace group as “anti-American.”
Ok we have something to work with here. Lets find where SWAC Girl claims a pro-peace group is "anti-American." Since Cobalt 6 disdains to link to SWAC Girl and her reactionary friends, I will provide the link directly here. And voila, does anti-American appear in SWAC Girl's post? Well no, not really. So how can Cobalt 6's claim be true?
SWAC Girl doesn't actually say the pro-peace group is anti-American, or even imply it, yet surely Cobalt 6's claim could not be made entirely without basis. Cobalt 6 does identify the pro-peace group consists of Cindy Sheehan and all of us who oppose the war in Iraq.
Has Cindy Sheehan said anything which reasonable folks would construe as anti-American?
Well there is this one: "I was raised in a country by a public school system that taught us that America was good, that America was just. America has been killing people... since we first stepped on this continent; we have been responsible for death and destruction. I passed on that bulls**t to my son, and my son enlisted. I'm going all over the country telling moms this country is not worth dying for."
I would not consider this a particularly pro-American comment but it is not anti-American. A little irrational perhaps, if America refers to the American government than it could not have been killing people since "we" first stepped on this continent, whoever "we" is. If the "we" is Europeans than I don't think we can equate America with Europeans. In any case I don't see Cindy Sheehan self convicting herself of being anti-American.
If SWAC Girl doesn't call Cindy Sheehan, or all of us who oppose the war in Iraq anti-American, doesn't use the words anti-American, than Cobalt 6 appears to be unjustifiably tarring SWAC Girl.
Thursday, July 19, 2007
Even the NY Times notices the new Virginia Abusive Driver Fees. And they don't even apply to NY drivers. (Link requires registration). Usual liberal slant, Women and minorities most affected etc. The article notes: “We’ve heard the public’s concerns, and we take that seriously,” said the governor’s press secretary, Kevin Hall. “The legislature can revisit these issues when they reconvene in January.” No hint here of any special session. This is a well covered topic in many other blogs today including:
Virginia Federalist: Notes this is developing story.
Doug Mataconis at Below the Beltway thinks any hope of Gov. Kaine taking up the repeal cause is lost.
The Ward View takes a dim view of any official who continues to support the abuser fees.
Jim Hoeft at Bearing Drift thinks the press release speaks for itself and does not require comment.
Lowell at Raising Kaine also seems to take a dim view of the Governors press release position.
While the Shad Plank notes the size of the opposition as evidenced by 100,000+ signatures on a petition against the fees.
There are comments by BlackNell and Sic Semper Tyrannis as well.
But last and certainly not least mention goes to someone (Kenton Ngo at 750 Volt) who will be being abused longer than the rest of us if the abuser fees remain unchanged and has a great You Tube capture of part of the Assembly debate.
Virginia Federalist: Notes this is developing story.
Doug Mataconis at Below the Beltway thinks any hope of Gov. Kaine taking up the repeal cause is lost.
The Ward View takes a dim view of any official who continues to support the abuser fees.
Jim Hoeft at Bearing Drift thinks the press release speaks for itself and does not require comment.
Lowell at Raising Kaine also seems to take a dim view of the Governors press release position.
While the Shad Plank notes the size of the opposition as evidenced by 100,000+ signatures on a petition against the fees.
There are comments by BlackNell and Sic Semper Tyrannis as well.
But last and certainly not least mention goes to someone (Kenton Ngo at 750 Volt) who will be being abused longer than the rest of us if the abuser fees remain unchanged and has a great You Tube capture of part of the Assembly debate.
Wednesday, July 18, 2007
Before going on to my earlier related post, what about those 46 million without health insurance. Astute Bloggers has a great post here which suggests that that number may be sort of like the 600,000 Iraqis killed by the US and the 800,000 that Cheney killed in New Orleans with his Katrina remote control and dynamiting the levees.
In a press release today Consumers for Health Care Choices announced the creation with 25 other healthcare organizations of a new Health Care Freedom Coalition. (Disclosure: I am a member of Consumers for Health Care Choices)
The press release stated that Congressman Mike Pence (R-IN) was on hand to welcome the group and applaud the push for health care reform based on free markets rather than top-down, expanded government programs. He said there are 110 Members of Congress "ready to hit the airwaves" in support of the Freedom Agenda.
The release also reported that Merrill Matthews, of the Council for Affordable Health Insurance, welcomed the reporters in attendance and introduced the other speakers, which included --
- Roberto de Posada, Latino Coalition
- Matt Kibbe, FreedomWorks
- Jim Martin, 60 Plus
- Grover Norquist, Americans for Tax Reform
- Greg Scandlen, Consumers for Health Care Choices
- Pete Sepp, National Taxpayers Union
The Coalition's Statement of principles said, "We, the Health Care Freedom Coalition, believe the solution to the nation's health care problems is to make health care affordable for all Americans through a competitive, open, and transparent health care system where America's families choose their own doctor and health care plans."
The statement went on to say that any comprehensive reform proposal should include the following --
- Free Choice of Doctors, Hospitals, and Health Plans
- HSAs Option for all Americans
- Tax Fairness and Simplification
- Affordable Health Insurance for Small Business
- Buying Health Insurance Across State Lines
- Health Care Price Disclosure
- High Risk Pools for People Who Are Sick
- Convert DSH Payments into Health Insurance Block Grants
- Allow nonprofit, faith-based alternatives for health insurance
- More competition between facilities
The statement explains each of these ideas in more detail and also warns of things that should be avoided. The complete statement is available at CAHI's web site.
While I would like to expand on each of the items in the list, for today health care price disclosure worth talking about. In no other economic transaction do we have so little financial disclosure and negotiation. Health care purchases are economic transactions. Just ask those who do not have health insurance. They must pay for every purchase or depend on those providers (emergency rooms) who must provide care without demanding payment up front. Try that at Farm Fresh, your friendly auto dealer, or the DMV. All others with some sort of health care payer scheme only have to worry about our own share of the price, if any.
We are not confronted with the actual price of the care we demand. As a result we have an occult system with choices not being made on a rational basis by those receiving the services. If health care were paid for by the consumer, then price and performance would become direct issues to the consumer and more rational choices of what constitutes value to the consumer would be made.
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