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Archive for April, 2007

Saturday, April 28th 2007

Delusional On Cornyn

The title is an overstatement. That continuing talk of Cornyn’s imminent demise doesn’t quite rise to delusional. The fact is, the more you talk about Cornyn’s weakness, the more it becomes a reality. So you can’t fault them.

But
if Burka and BOR and others think Cornyn is actually going to be taken down by absolutely anyone (short of say, Lance Armstrong…jk, kind’ve), then they must be masochistic.

Following the HB&S poll commissioned by the DSCC, comes word of a SuveryUSA poll showing even worse unfavorable numbers for Senator John Cornyn.

The Dems hope to replace Cornyn? Per Roll Call (h/t Political Insider) we’re talking about two-time Lt. Governor candidate (and loser) John Sharp, Nick Lampson, and attorney/fundraiser Mikal Watts.

Two points:

  • Are you kidding me? SuveryUSA has consistently overstated Cornyn’s unfavorables. Internal polls, Scripps-Howard, and this Hamilton-Beattie poll all show statistically significant lower unfavorables. Check this November Cornyn-Hutchinson favorable-unfavorable.
  • Who are the Dems going to put out there? As Political Insider points out – there’s almost no chance the Dem candidate will have better favorables or name recognition than Cornyn.

    John Sharp is conservative Democrat. His credentials include: a nearly decade old time as state comptroller and two failed bids for lieutenant governor. The definition of used goods.

    Mikal Watts? A wealthy, proven fundraiser. That’s no chance you’re going to be able to out spend Cornyn and the Republican establishment. So are you going to trade whatever Watts brings to the table funding wise, for his novice status? His name being thrown in can’t be anything but a tip of the hat to his service to the Democratic Party in South Texas.

    Nick Lampson is a proven politician and fundraiser, driven out of the House by Tom Delay’s redistricting. He got considerable statewide/nationwide exposure from his run for Delay’s old 22nd seat. But, I don’t care how conservative the 22nd is or how much conservative money went into the 22nd, the fact is his performance against Shelly Sekula-Gibbs was abysmal!

    42% for a write in candidate with a hyphenated name? (And I’m not kidding that that was a hindrance to people voting for her). I mean, it’s understandable why Nick Lampson would be interested in running for Senate, it is hard to imagine him holding onto his seat. But 42%? To a candidate like Shelly Sekula-Gibbs? In one of the most favorable midterm years for the Dremocratic party of all time? And you think that sets up Nick Lampson to win a statewide election? In Texas?

See…dreams of splitting Texas’ Senate seats almost rise to the level of delusional.

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Friday, April 27th 2007

More Of In Store Clinics


I Trust Wal-Mart For My Health Care Needs

The caption isn’t really fair. Let’s be clear, these in store clinics have major retailers merely acting as landlords.

Change draws criticism. And the fact is these in store clinics are expanding, despite whatever small signs otherwise, and putting new pressures on traditional health care delivery models.

In the latest news Wal-Mart sounds like it wants to forgo the big name commercial in store clinic providers (Take Care, RediClinic, MinuteClinic, et al) in favor of local providers in their bid to open 400 new in store clinics.

Should current market forces continue, the world’s largest retailer said up to 2,000 clinics could be in Wal-Mart stores over the next five to seven years.

Wal-Mart said the effort marks an expansion of a pilot program it started in 2005, when it leased space within its stores to medical clinics. Currently, it said 76 clinics are operating inside Wal-Mart stores in 12 states.

I can’t be an advocate for letting free market forces run rampant across health care (okay, that is a little hyperbole on my position), and find huge fault in these clinics. Clearly they’ll thrive or falter based on the way patients take to them as consumers. Arguments otherwise fall flat:

Retailers contend that the clinics are convenient for consumers and are particularly appealing to the uninsured. I don’t see how a clinic lodged in a big-box retailer is more convenient than a free standing walk-in clinic. And even clinic operators have already found that lower-income uninsured consumers are the slowest adopters of these pay-for-service clinic models.

Proponents of the idea contend that if there wasn’t a demand they wouldn’t be in business. And that’s just not a good enough reason. Internet pharmacies claim they fill a need but are still considered by many to be a bad solution to a struggling health care system. Is cheap, fast and in-and-out in 15 minutes really the best mission statement for a business offering medical care?

But why not? Because it’s impersonal? Because it’s dangerous? An eyebrow raising argument (And yes, I know all the challenges in quantifying preventable patient morbidity and mortality. See here, here, and here).

Look, what is and isn’t an acceptable “mission statement” or business model will, and should rightly be, determined by those making use of it. Not by high thinkers, pundits, and those with potentially conflicting interests. If these NP staffed clinics turn out to be cheaper, more convenient, and provide an acceptable quality then patients will make use of them; if the clinics fall flat on those goals, they’ll fail.

If the medical community’s (and other opponent’s) fear is that these will be forced on patients by third party payers, as a potentially dangerous (but cheaper) alternatives to more traditional medical services, then that is where the argument should be. The argument shouldn’t be over the very existence of these clinics.

Thursday, April 26th 2007

Waiting…And Waiting…And Waiting


Whatever Happened To The Avian Flu Pandemic?

An Associated Press piece tries to remind us of the impending pandemic,

Bird flu has largely flown off the radar of the Western world, but people are still dying from it nearly every week in Indonesia.

Bird flu has killed at least 172 people worldwide since it began its spread through Asian poultry in 2003, according to WHO. Most human deaths come from contact with infected birds, but experts fear it could mutate into a form that spreads easily among people.

At current we should be worried because Indonesia isn’t playing well with others over the issue of studying avian flu.

Indonesia has refused to share its samples of bird flu virus with the World Health Organization since January. Jakarta fears a vaccine produced from its specimens would be out of reach for its own citizens – too expensive and controlled by wealthy nations.

Some global health officials have accused Indonesia of holding the virus hostage and keeping experts from monitoring whether the bug is mutating into a dangerous form that could potentially spark the next pandemic that kills millions.

This article doesn’t provide nearly enough to be able to adequately judge what is going on here. For instance, does Indonesia want some sort of specific guarantee about “fair” access to any bird flu vaccine, to set its own price per unit?

I’m not sure what sort of guarantee is possible. All I can imagine is Margaret Chan meeting with Indonesia officials:

“Okay…okay, now pinky swear…no one in big pharma gets to touch this H5N1 sample unless they promise…no, no, not just promise but swear on their mother’s grave…that they’ll give us a good deal on any vaccine they develop.”

Or are they just being ornery and trying to make a point about the “exploitation” of poor countries. In that case: boo hoo.

While they bicker, avian flu slips further and further from the world’s concern. Good riddance to another false alarm.

Wednesday, April 25th 2007

Can Cornyn Be Beaten?

John Cornyn isn’t exactly a household name in Texas. Which has fueled speculation amongst Texas Democrats, and those just interested in politics, that he might be vulnerable (however you want to define that) in his 2008 re-election bid.


All The Talk Of The 2008 Race Might Be Moot:
John Cornyn May Be Gonzalez’s Replacement As AG

(Note: I’m being serious in the caption above)

Over the past several days that talk of a Democratic Texas Senator has heated up. It has done so for several reasons: the numbers don’t bode great for Cornyn, Cornyn isn’t exactly getting ready to race money wise, and the national party and committee are targeting Texas.

Read More »

Wednesday, April 25th 2007

Spurs Need A Win

We’re at the end of the first quarter of Game 2 of the Spurs-Nuggets playoff series. It is a game that the Spurs need:


I’m Glad I Was On A Plane And Didn’t Watch This

The Spurs have gotten the typical ‘end is nigh’ reaction from some in the media and certainly from fans. The Denver Post published ‘Spurs Are On Their Way Out‘ after just a single game,

With a 95-89 victory everybody else in basketball will regard as an upset, the Nuggets sent an unmistakable, undeniable message to Tim Duncan and the once-great San Antonio Spurs.

It’s over for you.

Once, as every bone in the body of San Antonio big-shot artist Robert Horry creaked as he raised himself from splatting on the floor, I swear you could see the AARP card slip from his pocket. The Spurs are old. They’re ornery. They won’t go quietly. But their roster has too much mileage to make a long playoff run.

Ridiculous says I. Mark Kiszla, the author, needs to do more research than just glancing at the television as he downs another beer. Duncan gave less than 35 minutes/game, the lowest figure of his career. Some of the oldest players on the team looked fine in Game 1 – Horry, Finley, Vaughn. Michael Finley, the knees who Kiszla should’ve heard creak, was arguably the best Spur on the floor.

Indeed, after the first quarter of Game 2 I wouldn’t say the Spurs look old. The Spurs do look slow on the defensive end but not on offense. They’re getting out and running some.

It is an ugly game, by both teams. The Nuggets have looked disjointed on offense. Which has more to do with them than the Spurs rotations or defensive presence. However, the Spurs’ defense has been helped by officials who have their whistles stuffed in their pockets. The Nuggets are playing pretty good defense at the rim. Nene is playing pretty good defense on Tim – I didn’t think a repeat of what Timmy did (or more accurately, didn’t do) in Game 1 was possible, but the way they’re defending him right now we may see another 14 point game.

That would be disastrous, even as we lead at the end of the first. Nevermind, that a performance like that would be a bad birthday present for Tim Duncan, we simply cannot win without Duncan stepping up. The Nuggets can’t continue missing open shots. True, the Spurs picked it up as the 1st quarter went on, but we’re going to need a better defensive performance and bigger offense from Tim.

Carmelo Anthony & Allen Iverson have shot 2-for-12 from their own missteps, not because of the pressure the Spurs are putting on. The Nuggets have turned the ball over an inordinate amount from simply sloppy play, no because of the pressure the Spurs are putting on.

Let’s go Spurs. Let’s pick up the defensive pressure. Let’s go Timmy. Let’s put the ball in the hole. We need this game.

*UPDATE*

Spurs Win!

Despite letting the Nuggets back in it in the final couple minutes, after controlling the game, I really don’t think this was a bad game. I don’t think it bodes for the Denver Post’s theory referenced above. The Spurs will win this series.

Wednesday, April 25th 2007

First In, First Out

Texas was the first state to mandate the HPV vaccine for middle school girls, and it will be the first state to reneg on that. A bill undoing Governor Perry’s executive order is headed to the Governor to sign (or not), having passed with veto proof margins.

The Chronicle’s Texas Politics blog thinks the only sensible thing Perry can do is:

Perry has not said what he will do with House Bill 1098. Will he veto it, setting up what appears to be an inevitable showdown with the House and Senate?

[...]

Your blog wouldn’t be surprised to see him let the measure become law without his signature, especially now that the Senate softened it with a “sunset” provision in 2011.

Not that the massive margin by which the mandate is being overturned is a surprise. It has been expected. It was interesting living in a “progressive” state for a little while.

Tuesday, April 24th 2007

Earth Like Planet Discovered?


Gliese 581 Front & Center

European astronomers have published the discovery of the smallest extrasolar planet yet. What’s making popular news however, is the fact that,

They say the benign temperatures on the planet mean any water there could exist in liquid form, and this raises the chances it could also harbour life.

“We have estimated that the mean temperature of this ‘super-Earth’ lies between 0 and 40 degrees Celsius, and water would thus be liquid,” explained Stephane Udry of the Geneva Observatory, lead author of the scientific paper reporting the result.

The Gliese 581 super-Earth is in what scientists call the “Goldilocks Zone” where temperatures “are just right” for life to have a chance to exist.

The planet, which isn’t alone in orbiting Gliese 581, circles the star in just 13 days (watch a potential orbit around Gliese 581) but because its parent star is a red dwarf, and much colder than the Sun, the temperatures on it are likely to be within a nominal range for water to exist. Couple that with its ‘earth-like’ size, which increases the likelihood that it is rocky (most exoplanets are huge, and probably represent gas giants like Jupiter), and you have the general media paying attention.

Gliese 581 would be within this frame at Wikisky. Of course it isn’t visible with the naked eye with a magnitude of ~2.5.

Pretty cool.

Tuesday, April 24th 2007

Is CHIP Hillarycare On Installment?

After going to Austin and playing advocate for extending Texas’ CHIP enrollment period to a full year, I had this to say about the State’s Children Health Insurance Program,

Not even the most cold hearted libertarian can deny the state’s responsibility to say, abandoned and orphaned children. And with strict eligibility rules applied isn’t providing for children whose parents can’t just an extension of such?

But in a year when health care is shaping up to be the domestic issue – as I’ve already commented on here and here – an Opinion Journal piece criticizes any expansion of CHIP at the federal level, by citing some disturbing trends in how states are using the funds.

[Democrats] pronounce S[-CHIP] “underfunded”–and sure enough, 2007 funding already falls short of covering enrollees in 18 states by about $900 million.

But this “crisis” arose because some states have grossly exceeded Schip’s mandate. They are using the program to expand government-subsidized coverage well beyond poor kids–to children from wealthier families and even to adults. And they’re doing so even as some 8.3 million poor children continue to go uninsured.

Arizona, Michigan, Minnesota and Wisconsin cover more adults than children. In 2005 Minnesota spent 92% of its grant insuring adults, and Arizona spent two-thirds the same way.

Yikes!


Almost As Scary As Her Plan For CHIP?
(Credit: Pajamas Media & Roman Genn)

The piece goes on to get on Clinton’s attempt to expand CHIP without establishing more accountability in keeping those who it wasn’t intended for off the rolls.

A bill introduced by Senator Clinton and Representative John Dingell would make all of this worse. It would index government Schip outlays to national health spending and growth in states’ child population. Without “quantifiable” progress–i.e., expanded rolls–funding drops. The legislation would also create incentives for states to expand Schip to the New York level of 400% of poverty. If this keeps up, a family will soon be eligible for Schip and subject to the Alternative Minimum Tax.

In other words, what began as a hard-cap grant to cover the working poor is evolving into an open-ended entitlement to cover whatever promises states make.

The Children’s Health First Act according to Clinton,

“will keep kids healthy, save lives, control costs, and end heartache and worry for so many parents. This plan is practical and fiscally responsible – it will honor our values and prevent kids from needing more costly healthcare in the future.”

Maybe. It is hard to fault a bill for not doing something outside its intended purview. So maybe we shouldn’t get on Clinton and Dingell’s plan for not limiting adult access to S-CHIP. But is 400% of the poverty line too high a level and does the new plan overfund S-CHIP?


We Can Spend Your Money For You! It Works Out Great!

True the federal poverty level is a joke. A remnant of an agricultural time, whose adjustment for inflation over the years has failed to truly reflect what equates with poverty nowadays. But as the Opinion Journal piece points out having families with children on CHIP and also paying the Alternative Minimum Tax is kind’ve ridiculous (and I don’t care how far the AMT is encroaching into “middle” America).

The liberal cry is for the eight million uninsured children. Disgraceful, I agree. But as seen above the issue really is beyond that. There is likely funding for those eight million children already in place if CHIP was properly funded and implemented by the states.

I may get myself into trouble here since I’ve spent all of a half hour educating myself on this bill but it seems that presenting Dillinger and Clinton’s plan as merely an expansion to cover those eight million children is naive and an oversimplification.

We’ll see how far this new proposal gets.

You can follow the bill on Open Congress or read the entire text on Thomas.

Tuesday, April 24th 2007

An Astronomy Themed Grand Rounds

I think I’m in love because the Grand Rounds this week is astronomy themed. Very Cool. You can find it over at Med Valley High.

Monday, April 23rd 2007

NEJM Gives Voice To Way Off Topic Physicians

The New England Journal of Medicine published two perspectives and an editorial online today concerning the recent Supreme Court case which upheld the federal government’s 2003 ban on the intact dilation and extraction/partial birth abortion method.

Whatever my personal belief on abortion the editorials reveal an alarming, egocentric view of the abortion debate which is, unfortunately, all too common.

See what you think they have in common.

Government In Medicine

[W]ith this decision the Supreme Court has sanctioned the intrusion of legislation into the day-to-day practice of medicine.

The Intimidation of American Physicians – Banning Partial Birth Abortion

The ruling creates an intimidating environment surrounding pregnancy terminations at more advanced gestational ages. The decision to pursue a second-trimester abortion is never taken lightly and usually results only after anguished discussions among the patient, her loved ones, and her health care providers. Once the decision has been made to perform a second-trimester surgical abortion, the last thing a provider needs is to have to worry that the procedure could potentially evolve into a criminal act if a fetus in breech presentation should slip out intact through a partially dilated cervix. But this is exactly the situation created by the partial-birth abortion bill.

Sadly the soundest argument, the patient centered argument, comes from an editorial written by a lawyer: “The Partial Death of Abortion Rights

[A] federal statute outlawing the use of “partial-birth abortion” is constitutional, even though many members of the medical community believe that the procedure should be available when it is the safest option for terminating a pregnancy. No exception was made for protecting a woman’s health; only a threat to a woman’s life would excuse the use of the procedure.

Ever since the 1973 decision in Roe v. Wade, it has been understood that states may regulate pre-viability abortion and outlaw post-viability abortion completely, provided that the rules protect both the life and the health of the pregnant woman.

This balance reflects the view that a woman’s interest in preserving her own health should be protected more strongly than any state interest in preserving intrauterine life.

It isn’t merely a matter of physician’s framing the issue as one of their concern. My future profession, which tries so hard to present itself as the most selfless of all professions, often appears guilty of that I imagine. No, these are examples of how pro-lifers in general simply miss the most fundamental question.

The actual, current debate over abortion really does rise to the level of absurdity. You have two arguments being made which are, when you get down to it, unrelated. The two sides aren’t even talking about the same thing:
Pro Choice: It’s a woman’s body
Pro Life: The fetus is a life

And there in is the point. No one who defined a fetus as alive would be pro choice. At least I hope not.

And it isn’t like that debate is settled (at conception v. later). Indeed, getting more philosophical, the definition of when life begins may be fluid in the future.

And so for health care professionals, of all people, to get into the mundane argument of how the Supreme Court’s decision is bad, because it will change the way physicians practice, is…disappointing. Bring the debate to its most inherent level. There’s no pro-lifer to be convinced with the argument that “the government is intimidating physicians!

The NEJM’s perspectives show a profound lack of perspective. They can’t accomplish anything except preach to the choir. In such a case, they’re a waste of paper.

You can look at the Supreme Court case yourself or read Michael Dorf’s analysis of the decision. The original arguments before the court, back in November 2006, are here and here. Kennedy’s majority opinion is here. You can also read Thomas’ consenting opinion and Ginsburg’s dissenting opinion.