American conservatives cannot fathom that a fundamental purpose of Science is to try to prove its findings wrong.
Increasingly "common sense" betrays homo sapiens' best interests.
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Carl Sagan's Renowned Antimetabole
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Wow Air's Transatlantic Flights For $100.00
Wow Air is on a mission to make flying to Europe cheaper, forever.
This airline is making flights to Europe as cheap as $99
Wow Air wants to make transatlantic travel cheaper -- forever.
Roberto A. Ferdman
Wow Air, the roughly three-year old discount air carrier, is going where few other ultra low cost airlines have gone: across the Atlantic. And if all goes according to plan, it's going to do it much cheaper than anyone else.
The budget airline, which is based in Iceland, announced last week that it will begin flying passengers non-stop from both Boston and Baltimore to Reykjavik, Iceland for as little as $99 each way. The airline will also offer one-stop flights from the two U.S. cities to London and Copenhagen, starting at $228 for a round trip. The airline will begin offering the flights next March.
"Paying even $200 for a one-way flight to, say, London, is unheard of," said Tom Parson, the CEO of bestfares.com, which tracks airline pricing. "It just doesn't exist."
The incredibly low ticket prices are real, but don't expect them to last forever. "Those are definitely opening, introductory fares," said Skuli Mogensen, Wow Air's chief executive. "On an occasional basis we hope to be able to introduce similar fares, but those very aggressive. We wouldn't be talking if I had introduced prices more commonly seen in the market, would we?"
But the airline's commitment is to offer the cheapest ticket for every route the airline flies, including transatlantic routes, Mogensen said. The prices Wow Air offers will vary by season, and depend on a number of other factors, including fuel prices and flight vacancies.
Wow Air's cheapest transatlantic offerings, by month, looked something like this on Tuesday afternoon, according to the airlines' website.
By comparison, the average price of a round-trip plane ticket between Boston and Reykjavik in March of 2015 is just under $600, by Parson's estimate. A single stop round-trip ticket between Boston and London runs about $770, while a non-stop ticket costs roughly $800.
How does Wow Air expect to pull this off? For one, by operating like all other ultra discount carries. A ticket on Wow Air will come with little more than a seat, mini-tray table, and 11 pound carry-on. Everything else will cost extra. A carry-on will cost an extra $29 when booked online, or an additional $48 when done so at the airport. Checked luggage will set one back a bit more—an extra $48 online or $67 at check-in. And extra leg room, pre-assigned seats, and, of course, food will rack up the bill, too.
But unlike Spirit Airlines, which is famous for squeezing passengers' knees, Wow Air won't skimp quite as much on leg room. The seat pitch, the distance between two seats, is between 30 and 36 inches on the Airbus A320 aircrafts flown by the airline, said Svanhvít Fridriksdóttir, Wow Air's director of communications. Most pitch sizes are about 31 inches, and many discount carrier pitch sizes are less than 30 inches. Spirit Airlines', for instance, is 28 inches.
Wow Air also expects to save money by operating as efficiently as possible. The company relies heavily on online sales and marketing, for instance, which allows it to skip the cost of middlemen. It also operates few airplanes—only four currently—but maximizes their utility. "We have extremely good aircraft utilization," said Mogensen. "Within one 24-hour cycle, a single airplane will fly from Iceland to Boston, back to Iceland, and continue to London, and then back to Iceland, each time full of passengers."
And Wow Air expects to fill all of its planes, a feat few if any airlines operating transatlantic routes have managed. "Our assumption is that we will fill every plane, and we price accordingly," said Mogensen.
But Wow Air's biggest advantage might be its headquarters. Iceland is ideal, because it gives airplanes a midpoint where they can stop to refuel. That allows the airline to fly passengers to and from Europe in smaller planes, which it can more consistently fill with passengers. It also helps the airline save money on fuel. "About 40 percent of the fuel airplanes carry is used to ferry the fuel to the final destination," said Bob Mann, an aviation industry analyst at R.W. Mann and Co. Consulting. "As you go shorter and shorter distances, you can ferry less fuel, and save money."
Convincing customers to travel with a stop over might be difficult, but if it means hundreds in savings it's hard to believe it won't be possible.
Still, the small Icelandic airline faces what some industry experts believe is a steep uphill battle. Wow Air isn't, after all, the first airline to try operating cheap transatlantic flights. Low-cost air travel pioneer Freddie Laker tried unsuccessfully to do it in the late 1970s with Laker Airways; the airline closed in the early 1980s after it couldn't stay afloat. More recently, Norwegian.com, a subsidiary of Norwegian Air Shuttle, began offering affordable transatlantic flights this summer. The pitch was London-New York flights for $241. But the flights haven't been as cheap as advertised, and the routes have been stricken with delays, according to Mann. "Norwegian has had huge difficulties," he said. "All across the summer it has been running relays for its transatlantic flights to and from New York."
The biggest obstacle to discount long distance air travel might simply be that long trips could strip an airline like Wow Air of the efficiency on which it so heavily relies. Despite Wow Air's advantage of being able to stop in Iceland, the nearly 5.5-hour flight between Boston and Reykjavik is still long by budget airline standards.
A comparatively small fleet becomes a competitive disadvantage as soon as there's a delay. "Once it starts to get off-schedule, they'll never get it back on schedule unless they start cancelling flights," said Mann. Likely for that very reason, low cost carriers have soared domestically, but shied away from routes between North America and Europe. Discount airlines currently control nearly a third of the airline market in North America, and more than third of it in Europe, but only about 1 percent of the market for transatlantic travel.
Ryanair, which operates more than 100 aircrafts in Europe has been contemplating transatlantic flights for years, but has yet to jump the gun. "If anybody was going to do it, and anybody had the greatest potential to succeed, it would be them." Mann said. "And yet they've decided it's not in the cards. That's a cautionary tale, I'd said."
Wow Air, for its part, is optimistic about its ability to offer the cheapest form of transatlantic travel. "The long haul low cost model hasn't really been implemented because it's hard to achieve the utilization needed," said Mogensen. That is, unless you have a hub in the middle. And Iceland is perfectly suited," said Mogensen.
And despite the added fees from Wow, consumers may still think they're getting a bargain. "If you think you can make it Europe with an 11 pound bag, Wow Air offers a fantastic deal," said Parson. "Even with their extras, you would still end up flying for a lot cheaper than with other carriers."
The airline plans to expand at least four more destination in North America by 2016, and fly two extra jets next year and a total of 10 airplanes by 2016.
Roberto A. Ferdman is a reporter for Wonkblog covering food, economics, immigration and other things. He was previously a staff writer at Quartz.
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What It's Like To Get A Photo I.D. When You're Disabled, Poor Or Don't Drive
An election official checks a voter's photo identification at an early voting polling site in Austin in February of this year.
Pax On Both Houses: Compendium Of Voter Fraud And Voter Suppression Posts
***
This is what it’s like to try to get a Voter ID when you’re disabled, poor or don’t drive
Emily Badger
October 29, 2014
What's the big deal about getting an ID? You need one, after all, to participate in society in all kinds of other ways — to drive, to get married, to buy beer. Surely the requirement to show an ID on Election Day can't be that burdensome.
This is a common defense of Voter ID laws like the kind now on the books in Texas, ostensibly meant to curb voter fraud. But it glosses over the reality of life for some voters, who may struggle to get around because of disabilities, who may lack the seemingly small sums necessary to pay for documentation, who may not have the flexible scheduling to visit a government office twice, or three times, or more.
Small obstacles like these are magnified in the frantic days leading up to the election — and add to this the confusion that ensues when people who have voted for years are suddenly told at their familiar polling places they don't have what they need this time.
In the end, you get scenarios like this one, described by the Brennan Center forJustice at NYU in a roundup of actual complications arising right now in Texas during early voting:
Olester McGriff, an African-American man, lives in Dallas. He has voted in several Texas elections. This year when he went to the polls he was unable to vote due to the new photo ID law. Mr. McGriff had a kidney transplant and can no longer drive; his driver’s license expired in 2008. He tried to get an ID twice prior to voting. In May, he visited an office in Grand Prairie and was told he could not get an ID because he was outside of Dallas County. In July, he visited an office in Irving and was told they were out of IDs and would have to come back another day.He is unable to get around easily. Mr. McGriff got to the polls during early voting because Susan McMinn, an experienced election volunteer, gave him a ride. He brought with him his expired driver’s license, his birth certificate, his voter registration card, and other documentation, but none were sufficient under Texas’s new photo ID requirement.
What's most alarming about stories like this is that poll workers, confronted with such a situation, seemed unfamiliar enough with the new law themselves to explain to McGriff his options. Through the prodding of McMinn, he was eventually given an absentee ballot application and was able to vote by mail. Another woman, who had trouble obtaining an ID because of disabilities, was never told that she qualified for an exemption from the law. This man was never told how to obtain an Election Identification Certificate, or the alternative available to people without a qualifying ID:
Mr. R is an American in his 30s who lives in the small southern Texas town of Edcouch. He and his wife were both turned away from the polls last week because they do not have satisfactory identification under the new ID law. Mr. R had a driver’s license that was valid until 2015, but it was taken away from him in connection with a DUI. Mr. R tried to use a driver’s license that expired in 2009 — which he had used successfully to vote at the same polling location the last time he voted — as identification. This time, when he went to the polls during early voting, he was told, “You can’t vote with this card.”
One more:
Jesus Garcia was born in Texas and lives in Mercedes. He was unable to vote with his driver’s license, which expired about a year ago. He went to the Weslaco Department of Public Safety (DPS) office twice and both times was unable to get an ID. His birth certificate was stolen and he does not have a copy. He wants to get identification, but to get both a replacement birth certificate and a new ID would be more than $30 combined. He is working a lot of hours, but money is tight. With rent, water, electricity, and everything else, Mr. Garcia is not sure he will be able to afford those documents, much less before the election.Even if he does have the money, he will need to go through the whole process of getting the documents and going to the office again, when he has already tried to vote once and gone to a DPS office twice.
These stories come from both the Brennan Center's own investigation on the ground in Texas and through advocacy organizations working with voters there. Such testimonials don't tell us much about the scale of voters blocked from voting by ID laws. But they offer a window into why the requirement to obtain an ID can be more problematic than it sounds.
Emily Badger is a reporter for Wonkblog covering urban policy. She was previously a staff writer at The Atlantic Cities.
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You Can Stop Worrying About The National Debt. Moody Says U.S. Finances "Healthy"
After six years of stormy debt clouds, it's apparently morning in America. (Bloomberg)
So it's official: No one is worried about the U.S. debt anymore. Not even Moody's, one of the nation's top ratings agencies.
In a report issued Wednesday, Moody's declared the government's finances "relatively healthy, having surpassed our prior expectations" for reducing the scary annual budget deficits that drove the debt to nearly $18 trillion and the highest level as a share of the economy since the end of World War II. After four years of deficits in excess of $1 trillion, last year's budget gap was a relatively manageable $483 billion, or 2.8 percent of the size of the economy.
"The overall message is, Number 1, we're confident in the credit-worthiness of the U.S. government for the next couple years," said Moody's Senior Vice President Steven Hess.
But -- and you knew this was coming -- there are dark clouds on the horizon. By 2018, the ratings agency expects annual deficits once again to surpass 3 percent of the size of the economy and to keep getting bigger. By 2030, debt held by outside investors is on track to rise from the current 75 percent of the size of the economy to 88 percent, an alarming increase that "likely would bring negative pressure" on the nation's sterling AAA credit rating.
The source of this additional debt? ""The rising cost of healthcare services and demand for those services due to the aging of the population," which will slowly drive spending on Medicare and Social Security through the roof.
Fortunately, Washington has plenty of options for righting its future finances. Unfortunately, all of them are what the report delicately calls "politically sensitive."
For example, policymakers could increase immigration rates, importing more workers to shore up the finances of the federal health and retirement programs and cover the cost of Baby Boom retirement benefits. They could also raise revenue, for example, by lifting the cap on Social Security taxes, which are currently paid only on annual income under $117,700. Or they could raise the Social Security tax rate, which currently stands at 12.9 percent, evenly divided between workers and their employers.
Or they could cut benefits. The report suggests limiting the share of wages replaced by Social Security benefits. Or limiting Medicare eligibility. Or charging higher Medicare premiums. Or reducing insurance subsidies for working people under President Obama's Affordable Care Act.
At a time when even Republicans are vowing to deliver "every penny" that's been promised to seniors, most of these ideas could be dismissed as non-starters in Washington. Even popular solutions, like making the well-off pay more in taxes to support Social Security, are politically fraught. And while some Democrats are holding out a higher Social-Security income cap as the answer to our budget woes, the Moody's report makes clear that that option, on its own, would fall well short of solving the problem. To stabilize the federal debt load, policymakers may need to raise taxes AND cut benefits.
Lifting the income cap for Social Security taxes -- a favorite of Democrats and many voters in both parties (represented in light blue) -- would not be enough on its own to stabilize the U.S. debt.
The good news, at least from Moody's perspective, is that the nation has bought itself some time. Though the budget battles of the past few years have been painful to watch, they did manage to restrain spending and raise a little bit of cash. So, Hess said, the ratings agency is feeling "comfortable" with the state of U.S. finances, even if nothing more gets done in the final years of Obama's presidency.
"We don't think the political configuration in Washington right now indicates they will actually do anything," Hess said. "But we're confident for the next several years."
Lori Montgomery covers U.S. economic policy and the federal budget, focusing on efforts to tame the national debt.
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James Carville: Why Republicans Want Small Government
"The poor have sometimes objected to being governed badly;
the rich have always objected to being governed at all."
the rich have always objected to being governed at all."
Gilbert Keith Chesterton
***
"You’ve got that eternal idiotic idea that if anarchy came it would come from the poor. Why should it? The poor have been rebels, but they have never been anarchists; they have more interest than anyone else in there being some decent government. The poor man really has a stake in the country. The rich man hasn’t; he can go away to New Guinea in a yacht. The poor have sometimes objected to being governed badly; the rich have always objected to being governed at all. Aristocrats were always anarchists."
Gilbert Keith Chesterton (1874-1936)
***
"You’ve got that eternal idiotic idea that if anarchy came it would come from the poor. Why should it? The poor have been rebels, but they have never been anarchists; they have more interest than anyone else in there being some decent government. The poor man really has a stake in the country. The rich man hasn’t; he can go away to New Guinea in a yacht. The poor have sometimes objected to being governed badly; the rich have always objected to being governed at all. Aristocrats were always anarchists."
Gilbert Keith Chesterton (1874-1936)
***
"The rich are the scum of the earth in every country."
G.K. Chesterton
***
G.K. Chesterton
***
Speaking about the instinct that makes people rich, Chesterton remarks:
In the olden days it... was fully understood. The Greeks enshrined it in the story of Midas, of the 'Golden Touch.' Here was a man who turned everything he laid his hands upon into gold. His life was a progress amidst riches. Out of everything that came in his way he created the precious metal. 'A foolish legend,' said the wiseacres if the Victorian age. 'A truth,' say we of to-day. We all know of such men. We are ever meeting or reading about such persons who turn everything they touch into gold. Success dogs their very footsteps. Their life's pathway leads unerringly upwards. They cannot fail.
Unfortunately, however, Midas could fail; he did. His path did not lead unerringly upward. He starved because whenever he touched a biscuit or a ham sandwich it turned to gold. That was the whole point of the story, though the writer has to suppress it delicately, writing so near to a portrait of Lord Rothschild. The old fables of mankind are, indeed, unfathomably wise; but we must not have them expurgated in the interests of Mr. Vanderbilt. We must not have King Midas represented as an example of success; he was a failure of an unusually painful kind. Also, he had the ears of an ass. Also (like most other prominent and wealthy persons) he endeavoured to conceal the fact. It was his barber (if I remember right) who had to be treated on a confidential footing with regard to this peculiarity; and his barber, instead of behaving like a go-ahead person of the Succeed-at-all-costs school and trying to blackmail King Midas, went away and whispered this splendid piece of society scandal to the reeds, who enjoyed it enormously. It is said that they also whispered it as the winds swayed them to and fro. I look reverently at the portrait of Lord Rothschild; I read reverently about the exploits of Mr. Vanderbilt. I know that I cannot turn everything I touch to gold; but then I also know that I have never tried, having a preference for other substances, such as grass, and good wine. I know that these people have certainly succeeded in something; that they have certainly overcome somebody; I know that they are kings in a sense that no men were ever kings before; that they create markets and bestride continents. Yet it always seems to me that there is some small domestic fact that they are hiding, and I have sometimes thought I heard upon the wind the laughter and whisper of the reeds.
At least, let us hope that we shall all live to see these absurd books about Success covered with a proper derision and neglect. They do not teach people to be successful, but they do teach people to be snobbish; they do spread a sort of evil poetry of worldliness. The Puritans are always denouncing books that inflame lust; what shall we say of books that inflame the viler passions of avarice and pride?
Democracy and Industrialism
***
In an essay about public health and a proposal to eliminate lice among poor people, Chesterton said: "The poor are pressed down from above into stinking and suffocating underworlds of squalor."
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E,J. Dionne: Kansas Conservatives In Open Rebellion Against Tea Party Radicals
Democratic gubernatorial candidate Paul Davis answers questions from the media after a rally at the Kansas Statehouse in Topeka, Kan., Tuesday Oct. 28, 2014.
Moderate Thunder Out Of Kansas
The several dozen people gathered at a street corner just off the main square of this southeastern Kansas town of 5,600 were polite and friendly in the Midwestern way. They did not look in the least like a band of counterrevolutionaries intent on reversing the direction of the government in Topeka.
Yet the results of the tea party rebellion four years ago have led these civic-minded, middle-of-the-road Kansans to a quiet but fierce determination to take their state back from those who once talked incessantly about taking their country back.
What brought them together this week was a visit from Paul Davis, the Democratic candidate for governor. Davis has generally been running ahead of Republican incumbent Sam Brownback in one of the country’s most consequential showdowns on Tuesday’s ballot.
Brownback set things up this way by launching what he called, proudly and unapologetically, a “real, live experiment” that he hoped would provide a model of red-state governance. He pushed steep income and business tax cuts through the legislature, insisting that his program would spur unprecedented economic growth. The results have been less than inspiring: large budget deficits, credit downgrades and substantial cuts in education spending, some of which were reversed only because of a court order. Only rarely does an election pose such a clear philosophical and policy choice.
Brownback often cited low-tax Texas as his model, prompting a ready reply from Davis. Voters “don’t want to be like Texas,” he said in an interview at his storefront headquarters here. “They just want to be Kansas.”
What it means to be Kansas is precisely what’s at stake, and it’s why Davis’s campaign uses #RestoreKansas — a traditionalist’s slogan, when you think about it — as its Twitter battle cry. The choice Davis is offering is not between liberalism and conservatism but rather between two kinds of conservatism: the deeply anti-government tea party kind, and an older variety that values prudence and fiscal restraint but also expects government to provide, as Davis put it, “the basic services that are essential to the state’s vitality.”
In his stump speech, Davis emphasizes public education, transportation, Brownback’s rejection of the Medicaid expansion under the Affordable Care Act and a widely unpopular privatization of Kansas’s Medicaid program.
What’s striking is how many Republicans have joined Davis’s effort, including a large group of Republican politicians, some of whomBrownback purged in bitter primaries. Achieving ideological purity in the GOP turns out to have high costs, and Davis spoke of “the many functions we’ve had where we had more Republicans than Democrats.
“I like those,” he adds.
Indeed he does. In a state where registered Republicans outnumber Democrats by almost 2 to 1, moderately conservative Republicans are the swing voters.
Some are shocked that Kansas is one of this year’s battlegrounds, not only in the governor’s race but also in the pivotal Senate contest between independent Greg Orman and incumbent Pat Roberts (R). But one person who is not surprised is James Roberts (no relation to the senator), Davis’s 29-year-old campaign manager.
In January 2013, the young organizer paid me a visit in Washington to explain why Kansas could swing Democratic this year. Over lunch at a Mexican restaurant this week in Lawrence, I asked him how he knew this back then. “We’re a Kassebaum-Dole-Eisenhower state,” Roberts said, referring to two legendary Republican senators and the president from Abilene, by way of stressing that Kansas is “a pragmatic, moderate state.”
“We’re not a state of radical experiments,” he said. “Anytime conservatism takes a back seat to raw ideology, Kansans rebuke that idea.”
If Republicans do as well nationwide next week as many expect, they should pay attention to the reaction unleashed here by Brownback, a former senator whom Davis regularly accuses of bringing “Washington, D.C.-style politics to Kansas,” which he equates with “hyperpartisan politics.”
Among those who came out to greet Davis here was David Toland, executive director of Thrive Allen County, a social service and economic development organization. He summarized why the decision here matters so much.
“If moderates are starting to push back against the extremism of the Republican Party in Kansas, I cannot believe they won’t be pushing back in other states,” Toland said. “This is a state with a strong conservative tradition that’s in open rebellion against the policies of its own party.”
Conservatism at its finest has been defined by a devotion to moderation. Next week, conservative Kansas may remind the nation that this is still true.
Read more from E.J. Dionne’s archive
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Pope Francis: "God Was Not A Magician." Big Bang And Evolution Square With Creation
NBC News
Pope Francis: Evolution and Big Bang Theory Are Real
VIDEO: http://www.nbcnews.com/news/world/pope-francis-evolution-big-bang-theory-are-real-n235696
Big Bang theory and evolution in nature "do not contradict" the idea of creation, Pope Francis has told an audience at the Vatican, saying God was not “a magician with a magic wand.” The Pope’s remarks on Monday to the Pontifical Academy of Sciences appeared to be a theological break from his predecessor Benedict XVI, a strong exponent of creationism.
“The beginning of the world is not the work of chaos that owes its origin to something else, but it derives directly from a supreme principle that creates out of love,” Pope Francis said. “The Big Bang, that today is considered to be the origin of the world, does not contradict the creative intervention of God; on the contrary, it requires it. Evolution in nature is not in contrast with the notion of [divine] creation because evolution requires the creation of the beings that evolve.”
The Pontiff said God created beings “and let them develop in accordance with the internal laws that he has given to each one.” He said: “When we read in Genesis the account of creation [we are] in danger of imagining that God was a magician, complete with a magic wand that can do all things. But he is not.”
Raw Story
Only A Scientist Could Fumble So Badly
The Gift Pope Francis Just Handed Science
I’m a huge fan of Why Evolution is True, the blog by University of Chicago biologist Jerry Coyne, who wrote a book by the same name.
But he’s really blowing it when it comes to Pope Francis.
You probably heard the hubbub about this Pope saying that “God was not a magician,”and that it’s important for Catholics to embrace scientific ideas like evolution and the Big Bang.
No doubt a proclamation like that is going to produce a lot of responses, some more interesting than others.
But Coyne’s response, published both at his blog and at The New Republic, really struck me as shortsighted.
Coyne pointed out that the kind of evolution Pope Francis is espousing is unscientific because it still credits God with putting souls in human beings, and for ascribing to God some kind of role in kicking off the Big Bang and getting evolution rolling.
Look, Coyne knows his stuff. He’s correct that science doesn’t need God to explain how evolution works, and that it’s silly for the Catholic Church to hold on to the idea of Adam and Eve when there’s no evidence that humanity descended from a single ancestor couple.
Pope Francis is still clinging to fairy tales, Coyne writes…
“What is clear is that creationism of some sort is still an essential part of Francis’s view of life. Although the media, intoxicated by a supposedly ‘modern’ Pope, is all excited about what Francis said, his views on evolution don’t differ in substance from that of his recent predecessors. As usual, Francis appears to be a voice for modernity but still clings to old dogma.”
Sure, Coyne is correct.
But it’s still a lame point of view, and here’s why.
If Pope Francis has embraced a version of natural history that doesn’t comport with scientific evidence, he’s also embraced a version of earth’s past that doesn’t comport with the Bible.
And that’s actually pretty huge.
The Catholic Church has been more friendly to science than other faiths for centuries, so it’s not really a surprise that it would take the lead when it comes to evolution. But the really important point is that in such a top-heavy organization, it’s the top leader himself who has just treated the Bible like it’s the precious collection of Just-So Stories that it is.
Did you get that? Pope Francis just trashed the Bible’s version of creation. That’s right, the pope.
Why does that matter? Because in a world where many of our problems stem from fundamentalist extremism, moving a billion people away from fundamentalism is really a pretty good thing.
Here’s what I’m getting at: What Pope Francis just did? That’s really what we need Islam to do.
It was Jerry Coyne himself who brought my attention to a remarkable piece by Ali A. Rizvi titled “An Open Letter to Moderate Muslims.” It’s a piece which really opened my eyes, at least, about what Islam needs to do to curb rising fundamentalism in the face of extremists like ISIS.
Here’s how Rizvi described Islam’s special problem, as opposed to other faiths that have moved away from fundamentalism…
As much as the Pope opposes birth control, abortion and premarital sex, most Catholics today are openly pro-choice, practice birth control, and fornicate to their hearts’ content. Most Jews are secular, and many even identify as atheists or agnostics while retaining the Jewish label. The dissidents and the heretics in these communities may get some flak here and there, but they aren’t getting killed for dissenting.This is in stark contrast to the Muslim world where, according to a worldwide 2013 Pew Research Study, a majority of people in large Muslim-majority countries like Egypt and Pakistan believe that those who leave the faith must die. They constantly obsess over who is a “real” Muslim and who is not. They are quicker to defend their faith from cartoonists and filmmakers than they are to condemn those committing atrocities in its name…The word “moderate” has lost its credibility. Fareed Zakaria has referred to Middle Eastern moderates as a “fantasy.” Even apologists like Nathan Lean are pointing out that the use of this word isn’t helping anyone.Islam needs reformers, not moderates. And words like “reform” just don’t go very well with words like “infallibility.”The purpose of reform is to change things, fix the system, and move it in a new direction. And to fix something, you have to acknowledge that it’s broken — not that it looks broken, or is being falsely portrayed as broken by the wrong people — but that it’s broken. That is your first step to reformation.
As Rizvi hints, this reform won’t happen overnight. But it helps to have a major figure push it along with well-timed proclamations.
So imagine now if Islam had an influential leader who came out and said that the muslims of the world should embrace scientific concepts that directly contradict the Koran. It’s really hard to do, isn’t it? But Pope Francis just did that very thing for a large slice of the world’s population, an advance that the world’s scientists, even if all of them blogged their fingers until they bled, probably couldn’t accomplish in a hundred years.
And even if an Islamic leader embraced a version of science that still had some magical thinking around its edges, and didn’t quite line up with what’s being taught in the science departments at the world’s universities, still, such a pronouncement would be a huge accomplishment. And as Rizvi argues, it’s exactly the kind of thing that Islam needs in order to move away from the trap it’s in now — with “moderates” unable to counter what the extremists are saying because they themselves can’t let go of a fundamentalist view of their holy book.
I understand Coyne. He’s right that Pope Francis still isn’t pushing a version of life’s history that lines up with the scientific record. (And as he points out, 27 percent of Catholics reject evolution anyway.)
But this world is going to be a whole lot better off when fundamentalist belief in fairy tale holy books goes away along with belief in stories of a great flood and a young earth.
And when you have the Pope behind that effort, you’re a hell of a long way down that road. So don’t blow it, science guys (and gals). Accept this gift with a smile and run like hell with it.
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Obama Urged to Apologize for Anti-Fear Remark
America: All Fear, All The Time
Tom Toles Cartoon: Self-Terrorization Is The National Pastime
***
WASHINGTON (The Borowitz Report)—President Obama is coming under increasing pressure to apologize for a controversial remark that he made on Tuesday, in which he said that the nation’s Ebola policy should be based on facts rather than fear.
While the anti-fear tenor of Mr. Obama’s comment was offensive enough to some, the President made matters worse by suggesting that science would play the leading role in guiding the nation’s Ebola protocols—a role that many Americans believe should be played by fear.
Across the country, Democratic candidates have sought to distance themselves from the President’s incendiary statement, especially in states like North Carolina, where science and facts have record-low approval ratings.
Carol Foyler, a Democratic consultant in Colorado, said that she was “smacking my head” at the President’s divisive comment.
“He’s unpopular enough as it is,” she said. “Aligning yourself with science and facts is a surefire way to alienate millions of Americans.”
www.borowitzreport.com
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The Liberal Elite Relies On Distortion And Evasion To Discredit Edward Snowden
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The History Of Corporations In The United States. A Return To Roots?
"Founding Fathers Profit-Sharing Remedy For Inequality.
Even Ronald Reagan Likes It!"
***
The History of Corporations in the United States
by William Kalle Lasn
Morrow/Eaglebrook, 1999
http://adbusters.org/magazine/28/usa.html
(excerpted from Culture Jam)
The history of America is the one story every kid knows. It's a story of fierce individualism and heroic personal sacrifice in the service of a dream. A story of early settlers hungry and cold, carving a home out of the wilderness. Of visionary leaders fighting for democracy and justice, and never wavering. Of a populace prepared to defend those ideals to the death. It's the story of a revolution (an American art form as endemic as baseball or jazz) beating back British Imperialism and launching a new colony into the industrial age on its own terms.
It's a story of America triumphant. A story of its rise after World War II to become the richest and most powerful country in the history of the world, "the land of the free and home of the brave," an inspiring model for the whole world to emulate.
That's the official history, the one that is taught in school and the one our media and culture reinforce in myriad ways every day.
The unofficial history of the United States is quite different. It begins the same way -- in the revolutionary cauldron of colonial America -- but then it takes a turn. A bit-player in the official history becomes critically important to the way the unofficial history unfolds. This player turns out to be not only the provocateur of the revolution, but in the end its saboteur. This player lies at the heart of America's defining theme: the difference between a country that pretends to be free and a country that truly is free.
That player is the corporation.
The United States of America was born of a revolt not just against British monarchs and the British parliament but against British corporations.
We tend to think of corporations as fairly recent phenomena, the legacy of the Rockefellers and Carnegies. In fact, the corporate presence in prerevolutionary America was almost as conspicuous as it is today. There were far fewer corporations then, but they were enormously powerful: the Massachusetts Bay Company, the Hudson's Bay Company, the British East India Company. Colonials feared these chartered entities. They recognized the way British kings and their cronies used them as robotic arms to control the affairs of the colonies, to pinch staples from remote breadbaskets and bring them home to the motherland.
The colonials resisted. When the British East India Company imposed duties on its incoming tea (telling the locals they could buy the tea or lump it, because the company had a virtual monopoly on tea distribution in the colonies), radical patriots demonstrated. Colonial merchants agreed not to sell East India Company tea. Many East India Company ships were turned back at port. And, on one fateful day in Boston, 342 chests of tea ended up in the salt chuck.
The Boston Tea Party was one of young America's finest hours. It sparked enormous revolutionary excitement. The people were beginning to understand their own strength, and to see their own self-determination not just as possible but inevitable.
The Declaration of Independence, in 1776, freed Americans not only from Britain but also from the tyranny of British corporations, and for a hundred years after the document's signing, Americans remained deeply suspicious of corporate power. They were careful about the way they granted corporate charters, and about the powers granted therein.
Early American charters were created literally by the people, for the people as a legal convenience. Corporations were "artificial, invisible, intangible," mere financial tools. They were chartered by individual states, not the federal government, which meant they could be kept under close local scrutiny. They were automatically dissolved if they engaged in activities that violated their charter. Limits were placed on how big and powerful companies could become. Even railroad magnate J. P. Morgan, the consummate capitalist, understood that corporations must never become so big that they "inhibit freedom to the point where efficiency [is] endangered."
The two hundred or so corporations operating in the US by the year 1800 were each kept on fairly short leashes. They weren't allowed to participate in the political process. They couldn't buy stock in other corporations. And if one of them acted improperly, the consequences were severe. In 1832, President Andrew Jackson vetoed a motion to extend the charter of the corrupt and tyrannical Second Bank of the United States, and was widely applauded for doing so. That same year the state of Pennsylvania revoked the charters of ten banks for operating contrary to the public interest. Even the enormous industry trusts, formed to protect member corporations from external competitors and provide barriers to entry, eventually proved no match for the state. By the mid-1800s, antitrust legislation was widely in place.
In the early history of America, the corporation played an important but subordinate role. The people -- not the corporations -- were in control. So what happened? How did corporations gain power and eventually start exercising more control than the individuals who created them?
The shift began in the last third of the nineteenth century -- the start of a great period of struggle between corporations and civil society. The turning point was the Civil War. Corporations made huge profits from procurement contracts and took advantage of the disorder and corruption of the times to buy legislatures, judges and even presidents. Corporations became the masters and keepers of business. President Abraham Lincoln foresaw terrible trouble. Shortly before his death, he warned that "corporations have been enthroned . . . . An era of corruption in high places will follow and the money power will endeavor to prolong its reign by working on the prejudices of the people . . . until wealth is aggregated in a few hands . . . and the republic is destroyed."
President Lincoln's warning went unheeded. Corporations continued to gain power and influence. They had the laws governing their creation amended. State charters could no longer be revoked. Corporate profits could no longer be limited. Corporate economic activity could be restrained only by the courts, and in hundreds of cases judges granted corporations minor legal victories, conceding rights and privileges they did not have before.
Then came a legal event that would not be understood for decades (and remains baffling even today), an event that would change the course of American history. In Santa Clara County vs. Southern Pacific Railroad, a dispute over a railbed route, the US Supreme Court deemed that a private corporation was a "natural person" under the US Constitution and therefore entitled to protection under the Bill of Rights. Suddenly, corporations enjoyed all the rights and sovereignty previously enjoyed only by the people, including the right to free speech.
This 1886 decision ostensibly gave corporations the same powers as private citizens. But considering their vast financial resources, corporations thereafter actually had far more power than any private citizen. They could defend and exploit their rights and freedoms more vigorously than any individual and therefore they were more free. In a single legal stroke, the whole intent of the American Constitution -- that all citizens have one vote, and exercise an equal voice in public debates -- had been undermined. Sixty years after it was inked, Supreme Court Justice William O. Douglas concluded of Santa Clara that it "could not be supported by history, logic or reason." One of the great legal blunders of the nineteenth century changed the whole idea of democratic government.
Post-Santa Clara America became a very different place. By 1919, corporations employed more than 80 percent of the workforce and produced most of America's wealth. Corporate trusts had become too powerful to legally challenge. The courts consistently favored their interests. Employees found themselves without recourse if, for example, they were injured on the job (if you worked for a corporation, you voluntarily assumed the risk, was the courts' position). Railroad and mining companies were enabled to annex vast tracts of land at minimal expense.
Gradually, many of the original ideals of the American Revolution were simply quashed. Both during and after the Civil War, America was increasingly being ruled by a coalition of government and business interests. The shift amounted to a kind of coup d'tat -- not a sudden military takeover but a gradual subversion and takeover of the institutions of state power. Except for a temporary setback during Franklin Roosevelt's New Deal (the 1930s), the US has since been governed as a corporate state.
In the post-World War II era, corporations continued to gain power. They merged, consolidated, restructured and metamorphosed into ever larger and more complex units of resource extraction, production, distribution and marketing, to the point where many of them became economically more powerful than many countries. In 1997, fifty-one of the world's hundred largest economies were corporations, not countries. The top five hundred corporations controlled forty-two percent of the world's wealth. Today corporations freely buy each other's stocks and shares. They lobby legislators and bankroll elections. They manage our broadcast airwaves, set our industrial, economic and cultural agendas, and grow as big and powerful as they damn well please.
Every day, scenes that would have seemed surreal, impossible, undemocratic twenty years ago play out with nary a squeak of dissent from a stunned and inured populace.
At Morain Valley Community College in Palos Hills, Illinois, a student named Jennifer Beatty stages a protest against corporate sponsorship in her school by locking herself to the metal mesh curtains of the multimillion-dollar "McDonald's Student Center" that serves as the physical and nutritional focal point of her college. She is arrested and expelled.
At Greenbrier High School in Evans, Georgia, a student named Mike Cameron wears a Pepsi T-shirt on the day -- dubbed "Coke Day" -- when corporate flacks from Coca-Cola jet in from Atlanta to visit the school their company has sponsored and subsidized. Mike Cameron is suspended for his insolence.
In suburban shopping malls across North America, moms and dads push shopping carts down the aisle of Toys "R" Us. Trailing them and imitating their gestures, their kids push pint-size carts of their own. The carts say, "Toys 'R' Us Shopper in Training."
In St. Louis, Missouri, chemical giant Monsanto sics its legal team on anyone even considering spreading dirty lies -- or dirty truths -- about the company. A Fox TV affiliate that has prepared a major investigative story on the use and misuse of synthetic bovine growth hormone (a Monsanto product) pulls the piece after Monsanto attorneys threaten the network with "dire consequences" if the story airs. Later, a planned book on the dangers of genetic agricultural technologies is temporarily shelved after the publisher, fearing a lawsuit from Monsanto, gets cold feet.
In boardrooms in all the major global capitals, CEOs of the world's biggest corporations imagine a world where they are protected by what is effectively their own global charter of rights and freedoms -- the Multinational Agreement on Investment (MAI). They are supported in this vision by the World Trade Organization (WTO), the World Bank, the International Monetary Fund (IMF), the International Chamber of Commerce (ICC), the European Round Table of Industrialists (ERT), the Organization for Economic Co-operation and Development (OECD) and other organizations representing twenty-nine of the world's richest economies. The MAI would effectively create a single global economy allowing corporations the unrestricted right to buy, sell and move their businesses, resources and other assets wherever and whenever they want. It's a corporate bill of rights designed to override all "nonconforming" local, state and national laws and regulations and allow them to sue cities, states and national governments for alleged noncompliance. Sold to the world's citizens as inevitable and necessary in an age of free trade, these MAI negotiations met with considerable grassroots opposition and were temporarily suspended in April 1998. Nevertheless, no one believes this initiative will remain suspended for long.
We, the people, have lost control. Corporations, these legal fictions that we ourselves created two centuries ago, now have more rights, freedoms and powers than we do. And we accept this as the normal state of affairs. We go to corporations on our knees. Please do the right thing, we plead. Please don't cut down any more ancient forests. Please don't pollute any more lakes and rivers (but please don't move your factories and jobs offshore either). Please don't use pornographic images to sell fashion to my kids. Please don't play governments off against each other to get a better deal. We've spent so much time bowed down in deference, we've forgotten how to stand up straight.
The unofficial history of America, which continues to be written, is not a story of rugged individualism and heroic personal sacrifice in the pursuit of a dream. It is a story of democracy derailed, of a revolutionary spirit suppressed, and of a once-proud people reduced to servitude.
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Dwight Eisenhower: My Fifth Favorite President After FDR, Teddy, Abe And Obama
Every gun that is made, every warship launched, every rocket fired, signifies in the final sense a theft from those who hunger and are not fed, those who are cold and are not clothed.
A people that values its privileges above its principles soon loses both.
This world of ours... must avoid becoming a community of dreadful fear and hate, and be, instead, a proud confederation of mutual trust and respect.
Though force can protect in emergency, only justice, fairness, consideration and cooperation can finally lead men to the dawn of eternal peace.
Alan: While assembling this quote compendium, I am struck by Ike's faith in the causative relationship between justice and peach and his belief that humankind can establish the foundation of eternal peace.
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"Why We Fight," A Documentary Film About The Military Industrial Complex
Starring Dwight Eisenhower
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"Conservatives Really, Really Dislike Mitch McConnell," Greg Sargeant
The enduring conservative dislike for Mitch McConnell has long been a bit amusing to liberals. From their point of view, McConnell has arguably done as much anyone to sabotage the Obama agenda, hatching a grand obstructionist strategy that has often seemed almost cartoonishly diabolical. But conservatives have long lamented that at best, he’s an insufficiently zealous warrior who blinks when the going gets rough (on thedebt ceiling), and at worst, he’s an unprincipled inside-the-Beltway dealmaking sellout.
Case in point: Ken Cuccinelli, the national Tea Party hero who boasted of being the first Attorney General to sue to block Obamacare and ultimately lost a close gubernatorial race as conservative standard bearer against Terry McAuliffe in Virginia. In an interview with the Hill, Cuccinnelli argues in scalding terms that McConnell is fighting for his political life right now, because he lacks core conservative principles:
“Mitch McConnell’s going to go to the wire, because he is vehement about not standing for anything. And he has a good long track record about not standing for much other than keeping the campaign dollars flowing. And that is not inspiring to ordinary Americans, to conservatives, even to base Republicans.”
Ouch! Democrats certainly hope Cuccinnelli is right about that. They are hoping McConnell never quite patched things up with conservative voters after the bruising primary fight with Tea Partyer Matt Bevin, and that his support on the right remains a bit soft, so that just enough conservative voters stay home to make a difference in a very tight race.
There have already been questions about how enthusiastic McConnell’s support is, and the other day Glenn Beck declared that it wouldn’t be “all that bad for the country” if McConnell lost, given what he’d done to Bevin in the primary.
Meanwhile, Irin Carmon reports that McConnell yesterday held a “sleepy, underwhelming” rally with Bevin, at which Bevin declined to endorse McConnell or even say his name.
To be sure, McConnell still holds a solid lead in the polling average. And a new Bluegrass poll is due out tonight that may well show McConnell ahead and solidifying his support with Republicans (it will be interesting to see what it shows with regard to McConnell’s right flank).
But McConnell himself seems to be taking actions to shore up that right flank. The other day, he committed the apostasy of declaring that a GOP Senate majority might have trouble repealing Obamacare, because it would “take 60 votes,” which many took to mean he wouldn’t use the procedural route of “reconciliation” to target the law with a simple majority vote. But in a statement to the Washington Examiner today, he quickly clarified that ofcourse a GOP majority would use the tactic, because his anti-Obamacare zeal is undiminished.
After all, McConnell can’t have the base thinking of him as a squish on Obamacare only five days before election day.
Greg Sargent writes The Plum Line blog, a reported opinion blog with a liberal slant -- what you might call “opinionated reporting” from the left.
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Republicans Haven't Even Won The Senate Yet And Already The GOP Base Is Pissed
Republicans haven’t even won full control of Congress yet, and they’re already starting to betray angry GOP base voters. In the Holy War against Obama tyranny writ large, Republicans are waving the white flag across the board.
We now learn from Politico that for the second time in as many months, a law firm hired by House Republicans has pulled out from its contract to handle the House’s lawsuit against President Obama. By now you may have forgotten all about the lawsuit. It was announced with great fanfare in June, with John Boehner and company saying they would take to the courts to stop the president’s usurpation of power (the delay of Obamaccare’s employer mandate, a provision they hate anyway).
The message to conservatives was clear: we’ll fight him in Congress, we’ll fight him on the campaign trail, we’ll fight him in the courts! But since then…nothing. Republicans aren’t even trying to keep up the pretense that they’re fighting this lawsuit. Don’t be surprised if they quietly drop it soon enough.
That’s not all. House Majority Leader Kevin McCarthy said earlier this week that Congressional Republicans may move to pass a long-term spending bill, in order to avoid the sort of brinksmanship of past years, allowing Republicans to develop an affirmative governing agenda. That would mean no more use of spending fights to chip away at Obama’s policy accomplishments, as conservatives would like to see. Indeed, some have remarked that this will deprive Republicans of an important weapon to block Obama’s coming expansion of deportation relief.
Meanwhile, it looks like Republicans won’t be using all the weapons at their disposal to keep up the war to repeal Obamacare. In earlier times, McConnell had planned to use the reconciliation process — where there are no filibusters and only a 51-vote majority is needed for legislation to pass — in order to repeal the law, should Republicans take control. But two days McConnell conceded that reconciliation, which only applies to budget and tax issues, won’t work.
“It would take 60 votes in the Senate, and no one thinks we’re going to have 60 Republicans,” McConnell said. So the new plan is just to try to repeal the parts that are unpopular or that Republicans particularly dislike, like the medical device tax and the employer mandate.
Other Republicans are saying the same thing. Senator John Barrasso said yesterday: “Well, I would imagine there will be a vote on repeal, but I — let’s be realistic, Barack Obama is still going to be in the White House for another two years, and he is not going to sign that.”
That’s not all. One Republican after another is moderating his or position on the ACA’s expansion of Medicaid, perhaps most notably Senate candidate Thom Tillis in North Carolina. This has resulted in some spectacular verbal gymnastics. For instance, Ohio governor John Kasich explained his acceptance the expansion by saying, “I have favored expanding Medicaid, but I don’t really see expanding Medicaid as really connected to Obamacare.” This continued expansion of the law’s benefits makes a continued scorched-earth battle against Obamacare Slavery still less likely.
If you were a conservative Republican voter who for years has been fed a steady diet of “Help us win back Congress and we’ll finally have the power we need to roll back Obama tyranny once and for all,” all this might make you feel confused, even betrayed. But it isn’t the first time this has happened. For years, base Republicans, particularly Christian conservatives, have complained that the party repeatedly puts them through a cycle of promises and disappointments. The RNC comes begging for the labor of the grassroots, telling them that once Republicans gain power, everything will change. The grassroots comes through on election day, but then finds that Roe v. Wade remains in place, gay marriage is not beaten back, and prayer has not been returned to public schools. Come the next election, the cycle begins again.
Right now Republican leaders are being perfectly rational in starting to dial back expectations for the new GOP Congressional majority right now. After all, they know that even if they take the Senate, there won’t be any successes in the war against Obama tyranny that are substantial enough to make the base happy.
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"Being Mortal," Explores The Prolongation Of Death Over The Enhancement Of Life
Atul Gawande explains why the health care system should stop trying to help everyone live longer
Atul Gawande’s current best-seller, Being Mortal, has touched a nerve regarding our medical system’s very poor handling of aging, life-altering illnesses, hospice, and palliative care. The book raises the question of why the U.S. health system prizes the length of a patient's life over the quality of that life in a person's final years.
I caught up with Gawande after he delivered a public lecture on his book. Below is an edited and condensed transcript of our conversation.
Harold Pollack: Let’s start with the craft of writing Being Mortal. You’ve written on so many different things. How did you fasten on what became this book?
Atul Gawande: I’d written a New Yorker article in 2007 about how we age. It was about the science of what happens to the body, and the ways we have made ineffective policies and planning for that. That segued three years later into Letting Go for the New Yorker. Those became the anchors for the book.
I decided to take it to a book because I realized the articles just scratched the surface. I use writing as my way of thinking out loud and investing in time to dig into a problem. And the thinking I’d done was already leading me to experiment with changes in my own practice. It seemed possible that researching and writing more would open directions for what we could do to improve care for the aged and for those at the end-of-life. There was also a global dimension as I explored these issues in India and other places. I wasn’t done thinking about the subject, and I was therefore not done writing on it.
HP: You mapped out many stories of individual patients, clinicians, and families over a reasonable period of time. How do you find those people? How do you present to them the project that you’re doing?
AG: Some of them were my own patients or family members. The sensitive part was circling back and asking if it’s all right to formally interview them for a book I was writing on how we deal with matters of aging and mortality. Some said yes. Some said no. There were lots of people I found through others, too. I asked people all over about their family and friends grappling with these kinds of experiences. I visited numerous nursing homes and home health programs, as well, across many demographics and met people that way. I tried to find stories the same way any reporter does. You snowball from one person to the next until you’ve accumulated lots of folks.
I got a lot of peoples’ stories, but I couldn’t always use them. I had to write a lot of apology notes to people who gave me a lot of time but didn’t end up in the book.
HP: There’s a lot of film on the cutting room floor.
AG: Yeah. I lost count after talking to 200 patients and family members about their experiences. I end up using only seven or eight stories really.
HP: Do you begin with a detailed war plan? Do you interview 200 people and then gradually, the story comes together? Or have you basically mapped out the book from the start, at least its main skeleton, and then you’re filling in as it goes along?
AG: “War plan” is probably a nice metaphor, because you are planning out a battle but conditions on the ground change your battle plan considerably. I always start with a frame and an outline and the direction that I think I’m going, even what I think the ending will be. I then find that it gets blown out of the water.
I learned from one writer-friend the idea that at about two-thirds or three-quarters away through your first draft is a great moment to bring a group of people to react to it and not as individuals but actually to gather them together as a group.
Each time, I’ve convened what I call my rough draft book club. I go down to New York, gather four or five of my writer-friends at a friend’s apartment, and buy them a cheap takeout dinner. They’ve all read the rough draft, so I ask some questions. One person says what he liked about it. Another says what she didn’t like about it. Then I listen as they react to one another and start getting a sense of what I can do better.
For instance, I had a structure for this book that changed dramatically after this conversation. I had to reorder my chapters, cut one out, and add a whole new chapter I hadn’t expected or wanted to write.
HP: What was that new chapter?
AG: The new chapter expanded focus on my dad. I had been hesitant to go there. Also, I had massively more information about the history of aging and nursing homes than really worked. It was full of little wonderful sidebars that weren’t connecting. They were interesting, but ultimately were just kind of woolly ideas that didn’t go anywhere.
HP: One tough question. I watched your lecture today with some primary care physicians. Their reaction was to say, “Of course all this information about the need for conversation in end-of-life care was revelatory to you, Dr. Gawande. You’re a surgeon.” In your telling of the story, how much did the culture of specialty care fail to prepare you adequately for the challenges recounted in your book?
AG: Look I’m a surgeon--highly procedural, geared towards always being able to offer something more. It’s no surprise that this field did have prepared us formally for these kinds of conversations. Furthermore, I’m in an academic medical center, high-end Mecca. Many people come there because they want that experimental therapy, the last ditch maneuver against all odds.
Part of the reason to get out and about, however, is not just to look at my own particular experiences, but to take a broader view. If these conversations are so important--and people across other fields seem to know it--we’re still not having them. It’s not happening for two-thirds of people with advanced cancers for example. We have evidence that these conversations are even less likely to happen for other common things people die of: congestive heart failure, for example.
Maybe that’s because families and patients tend to move on to a specialist rather than the primary care doctor for these conversations, but I often find primary care doctors aren’t having them, either.
HP: I’ve heard from primary care doctors and geriatricians that the surgeon or the oncologist is the person who has the real authority to have that conversation--
AG: And we don’t do it.
HP: Even if they had the skill to have the conversation, that’s not really who the patients are looking to for these conversations.
AG: If you look at the studies, they find that having a palliative care doctor or geriatrician more closely involved in care can lead people to forego aggressive therapy sooner and have better outcomes--not only less suffering but even improved survival. But we don’t have enough of these doctors to go around. Furthermore, there’s something wrong with the idea that you outsource this kind of decision-making and discussion. It needs to be considered a basic part of what we do, and I don’t think there’s a reason that people who are in oncology, or in cardiology, or in surgery who have the most ready and up-to-date knowledge about a person’s condition can’t do this…
Also, it allows for more nuance in care. It’s not just “Do we do the surgery or do we not?” Even if we’re doing the surgery, what is the goal--for somebody who has a chronic illness or has a terminal illness--besides just winning the lottery ticket and living longer? What is the point where as even when you’re in the midst of the operation, what are they willing to sacrifice along the way, and what are they not willing to sacrifice?
I agree that the specialty professions have been loathe to admit our limitations and to cope with our limitations in talking to patients. But I’m not willing to give up and simply say that it’s not possible for our professions to take those responsibilities. We’ll be much more effective if medicine is incorporating these kinds of complex end-stage decisions with all the different specialties involved.
HP: Since back surgery is the paradigmatic case of over-use, it raises economic questions. We’re having this conversation in the department of geriatrics. As you note, the geriatrics profession seems to really be suffering right now. You present a terrible anecdote, in which a geriatric team at the University of Minnesota demonstrated in a randomized trial that they could dramatically reduce disability and depression, as well as the need for home health services. For their troubles, that department was dismantled. To simplify, they could not economically justify the added $1,350 per-patient they expended, given the incentives of our fee-for-service system.
Leaving aside the economics, there are cultural factors at play, too. We have trouble recruiting social work students to go into geriatrics. It’s a lot easier to get many of our students excited about working with children and youth. How do we deal with these challenges?
AG: First there’s the economics of where we are. We’re now in a post ACA world. Before the ACA, about 5% of the country was under alternative non-fee-for-service payment systems. We’re now at about 20%. That’s not enough yet to produce an enormous number of job openings in geriatric social work, palliative care medicine and so on—the providers who can effectively ensure that people are getting higher quality and what turns out to be lower-cost care.
But that shift to 20% will reach 30%, then 40%. The demand will gradually rise. It will eventually be there. Progress will just be slower than we would like it to be. Often, the students are the last to figure it all out.
HP: They’re watching who’s driving the Mercedes in the parking lot….
AG: Right… But I think there’s also a second level. This concerns people’s imaginations--even my own imagination about what I was doing, what my job was, what I was really excited about in medicine.
The paradigmatic example for me was being able to do an appendectomy. Someone had a fixable problem that would kill him. I could go in and save his life, with a really simple thing I could do in an hour. He is grateful for it and we all move on.
It’s harder to convey the value and reward of helping people manage unfixable problems, like frailty or a terminal condition. It’s hard to explain except that I’m finding right now that my most gratifying experiences as a doctor are coming from starting to feel competent at how to help people navigate serious potentially incurable illness, how to navigate being really sick. We in the medical profession have not been very effective at even articulating such tasks require or what the goals even are. We don’t teach the skills or expose students to them in action. It’s not surprising that they therefore don’t choose professions like geriatrics. But learning how to arrive at good answers means getting to grapple with the meaning of life for people.
HP: You used the terms confidence and competence. These get people excited that they have a sense of that in what they’re doing.
AG: Whatever we do, we’re excited about our ability to solve problems and to develop and show confidence and competence to accomplish things other people can’t do.
HP: One of your book’s saddest quotes comes from a hospice patient, who says: “The oncologist and the heart doctor told me that there’s nothing more they can do for me.” It’s as if palliative care and hospice are the consolation prizes we give you when we really can’t do anything more.
AG: There’s a profound sense of abandonment. That abandonment comes when the doctors wash their hands of the situation. “Well, there’s nothing more I can do.” Or, “If you want to, you can choose not to take what I’m offering.” Instead of helping people address the real question: “What are you ultimately fighting for here? Let me help in doing that, even if it means not choosing the therapeutic modality I initially recommended.” And so yes. All the other options appear like, “Well, you can give up.”
Even when we are needing to handoff, I’m involving someone who is going to have palliative care or hospice or primary care team. I’m not involving them because there’s nothing more I can do. I’m involving them because we require other people’s expertise to help us achieve what we’re trying to do.
I’ll give you another example. When people with severe back pain go to see a spine surgeon alone, the spine surgeon tends to say either you can take my solution or I’ve got nothing to offer.
In contrast, when people go to a comprehensive spine clinic, they see both a surgeon and a physical therapist. The physical therapist talks about what physical therapy involves, and the spine surgeon talks about what the surgery involves. In this situation, many more people choose physical therapy because it’s not the surgeon saying, “Well, there’s nothing more I can do. Go home and live in misery.” You had a non-surgical option that the surgeon was saying was okay, that this is an appropriate part of care.
HP: I felt a tension reading your book. You’ve done all this work on checklists. Yet aspects of end-of-life care feel like more of a craft. There’s human nuance in which doctors and other must have a feel for people, how to talk to people about intimate and painful subjects. Is this something we can operationalize and define in specific process measures to know that we’re providing proper care?
AG: In surgery, when you bring in the checklist, it’s about assuring a minimum level of performance. We can measure it in complications and death rates. But it’s harder to define and measure what the minimum level of performance is for patient-doctor communication about serious illness. What is the measure that we’re going for? The closest thing I can get to is something like this: How many people feel that their clinicians understand their priorities and goals besides just living longer? We’d probably find out that we’re not performing very well, and that we could do better and better with time.
We still want to measure survival. We still want to measure complication rates and all of those things. But we also want to know that we’re not sacrificing what people consider to be the reasons they want to be alive.
HP: How is the end of life care and palliative care experience different at different ages? Some of your stories involve very young people, for example Sara Monopoli. How is their experience different from those of older people?
AG: There are a few populations where it’s strikingly different. Younger people are much more likely to get aggressive therapy till the end, have much more suffering at the end, and have their families experience PTSD and depression after their passing.
In part, that’s because it’s such a violation that any young person should die. It’s hard to back off the goal of trying for more time no matter what, towards insuring as good a life as possible in the time we have remaining with them.
Certain minorities, in particular African American patients, are much more likely to have a negative experience with these kinds of conversations. They are much more likely to seek aggressive care at the end of life, and to die in the ICU. It speaks to how much mistrust many African Americans feel about whether people in the health system really care about them, whether they’re being deprived of options that we would be offering to other people.
HP: One additional factor may come into play . You don’t get a second chance to make a first impression. Many minority families have had specific negative experiences with the health care system. These experiences may have nothing to do with the current care team. These still shape families’ understanding.
AG: This comes up routinely in emergency situations. One of my colleagues named Dr. Zara Cooper is a surgeon who does palliative care and is studying this. In the emergency setting, you’ve never met somebody before. You need to break bad news about where things are going. Often, no one has had any previous conversation about the end of life, instead there was only talk about the hopeful things. So a patient or family member is hearing the bad news from a stranger, a stranger trying to get them to grapple with the possibility that going to surgery or trying the emergency maneuver may be worse than other options. Do they trust you? Often people don’t. But it is not a bad outcome that you’ve started the conversation. Perhaps they still go ahead and opt for a treatment of unlikely benefit. There are still many gates along the road for someone at the end of life. At a certain point, people develop what I call the ODTAA syndrome: It becomes one damn thing after another.
When it does, at least you’ve said, “Yes, okay. We’ll try putting your dad on the ventilator, or try this last ditch operation, but in three days, let’s reassess where we are.” If you do it right, you have set some expectations. You’ve said that we hope all will be well, but if not, we’re prepared. You’ve started that conversation for down the road.
If, however, you’ve decided that you’re only going to talk about the hopeful things and never bring up the possibility that things do go awry, it comes as a shocking surprise. The family’s confidence in you can be undermined. And you’ve only made it that much harder to sort out when the plan isn’t working.
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Tyrannical Chris Christie Tries To Bully Good Citizen: "Sit Down And Shut Up"
ORIGINALLY POSTED TO SCOUT FINCH ON THU OCT 30, 2014 AT 11:43 AM PDT.
ALSO REPUBLISHED BY CHRISTIE WATCH.
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Koch Brothers Upset By Rolling Stone Exposé. Their Riposte Backfires
No one has given it more attention, it seems, than the notoriously thin-skinned Kochs. In typical Koch fashion, they don't argue the facts of Dickinson's story. They attack Dickinson,who responds here.
![David Koch, executive vice president of Koch Industries, attends an Economic Club of New York event in New York, December 10, 2012. REUTERS/Brendan McDermid (UNITED STATES - Tags: BUSINESS POLITICS) - RTR3BFKF]()
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David Koch, not holding up well under scrutiny.
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The Republican Party's Intellectual Sparkle
"Brazen Lies About Obama"
"Obama Hatred"
The American Conservative: "Obama Is A Republican"
"People Who Watch Only Fox News
Know Less Than People Who Watch No News"
Too stupid to know they're stupid.
And not just stupid, but ignorant.
And not just ignorant, but aggressively ignorant.
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What's Wrong With Obamacare Is That Republicans Wouldn't Let It Be Single Payer
"Obama's Preference For Single Payer Healthcare"
Pax on both houses: Vermont Committed To Single Payer ...
paxonbothhouses.blogspot.com/.../home-who-we-are-what-is-single-pay...
Sep 28, 2013 - Help keep Single Payer on the legislative agenda by signing up for our E-Pax on both houses: Progressives and Conservatives Agree ...
paxonbothhouses.blogspot.com/.../progressives-and-conservatives-agree....
Aug 25, 2014 - Progressives and Conservatives Agree: Single Payer Healthcare Is Inevitable ... Speaking in Virginia, former House Speaker and presumed ...Pax on both houses: Obamacare Launched Single-Payer In ...
paxonbothhouses.blogspot.com/.../obamacare-launched-single-payer-in....
Nov 26, 2013 - Vermont is using authority granted under the Affordable Care Act to start a single-Pax on both houses: Physicians for Single Payer Healthcare
paxonbothhouses.blogspot.com/.../daily-dose-11911-physicians-for-sing...
Nov 10, 2011 - In this milieu, mounting millions of Americans – “on both sides of the ... Furthermore, the per capita cost of single payer care is, on average, ...Pax on both houses: "Single Payer Healthcare" As Essential ...
paxonbothhouses.blogspot.com/.../single-payer-healthcare-as-essential.ht...
Pax on both houses: Obamacare: Spawned By Satan (And ...
paxonbothhouses.blogspot.com/.../obamacare-spawned-by-satan-and-not...
Dec 19, 2013 - Had The Muslim rammed single payer down America's throat when he had majorities in both houses, Romney would be president now and ...Pax on both houses: Single Payer Health Care in Vermont
paxonbothhouses.blogspot.com/.../single-payer-health-care-in-vermont.h...
Oct 18, 2011 - "Under the plan, single payer coverage will be a right and not a privilege, and will not be connected to employment," he wrote in a recent blog ...Pax on both houses: Why Obamacare -- A Textbook ...
paxonbothhouses.blogspot.com/.../why-obamacare-textbook-political.ht...
Sep 28, 2013 - The State of Vermont is committed to creating the nation's first single payer system. http://www.vermontforsinglepayer.org/. Pax tecum. Alan
Confronting Republican opposition, a political sausage was the best that could be done.
What's more...
If Obama had "rammed single payer down the nation's throat," Mitt Romney would now be president and Obamacare would be repealed.
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Haaretz Cartoon Of Terrorist Netanyahu Striking The United States Sparks Outrage
"Is Israel The World's Worst Terror State? An Israeli General's Son Thinks So"In the wake of a report that an Obama administration official used a barnyard epithet defying Hebrew translation to refer to Prime Minister Benjamin Netanyahu, the Israeli newspaper Haaretz published a cartoon onthe strained relations between Washington and Jerusalem that compared the Israeli leader to the hijackers who attacked the United States on Sept. 11, 2001.
As the image circulated online, readers across the political spectrum in Israel and the United States expressed outrage at the depiction of a smiling Mr. Netanyahu piloting a plane at the World Trade Center.
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Why Rutherford B. Hayes Is A Really, Really Big Deal In Paraguay
Jorge Saenz/AP
Rutherford B. Hayes, the 19th U.S. president, doesn't get much respect. He's remembered, if at all, for losing the popular vote in 1876 but winning the presidency through Electoral College maneuvering. That gave rise to his nickname, "Rutherfraud."
But there's one place where Hayes stands as a historical heavyweight: in the tiny South American nation of Paraguay.
In fact, an industrial city on the banks of the Paraguay River is named Villa Hayes — Spanish for "Hayesville"— in his honor.
Here's why: Hayes took office in 1877 in the aftermath of the Triple Alliance War, a conflict that nearly destroyed Paraguay. The country lost huge chunks of territory to victorious Brazil and Argentina. Later, Argentina later tried to claim the Chaco, the vast wilderness region of northern Paraguay.
At the time there was no United Nations or World Court. So the two sides asked the United States to settle the dispute — and President Hayes sided with Paraguay. The decision gave Paraguay 60 percent of its present territory and helped guarantee its survival as a nation, says Maria Teresa Garozzo, director of the Villa Hayes Museum.
Jorge Saenz/AP
"Hayes is a giant," Garozzo says. "He is a spectacular, immortal figure for us."
At the museum, Garozzo shows me Hayes' portrait and a copy of his handwritten decision favoring Paraguay that was announced on Nov. 12, 1878. That day is now a holiday in Villa Hayes, which is the capital of a state called Presidente Hayes.
Next, some of the townsfolk lead me to the local elementary school where a bust of Hayes adorns the courtyard.
There is also a Paraguayan soccer team named after Hayes, while a postage stamp bears his likeness. Hayes is such a big deal that people here find it a little disappointing that most Americans are clueless about him.
Ricardo Nuñez, mayor of Villa Hayes, recalls a recent trip to Washington, D.C., and how people responded when he asked them if they knew about his city's namesake.
"They say, 'Who?'" he says, laughing. "'Hayes? Who is Hayes?'"
Nuñez is even more surprised when I tell him about Hayes' derogatory nickname.
"Rutherfraud? Wow!" he exclaims. "Amazing!"
After his controversial election in 1876, Hayes served just one term, and he usually comes in slightly below average in rankings of U.S. presidents. He and first lady Lucy Hayes are best remembered for the changes they brought to the White House, says Nan Card of the Hayes Presidential Center in Fremont, Ohio.
"He was the first president to have a telephone in the White House. They banned liquor from the White House, and they began the Easter Egg Roll," she says.
Although Hayes' territorial decision was crucial for Paraguay, the issue occupied very little of his time, says Card.
"We've looked at his diaries, his letters. There are some Paraguayan books in his collection," she says. "But I think he depended pretty much on the secretary of state and people on the ground there and then he made the final decision."
For Garozzo, the museum director, none of that matters.
"We are Paraguay because of him," she says. "Hayes will never be forgotten."
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