"Do or Do not. There is no try."

Interim Meeting of The American Medical Association-Atlanta, Georgia

I’m sure some of you may have noticed my lack of postings over the last several days. I want to assure you that I am still alive and well. As a physician, one of the most important functions for me is advocating on behalf of “Patients” and our Profession of Medicine. We generally meet on a national level at least twice per year at various sites across the country. There are over 530 delegates representing every state and virtually every speciality and sub-speciality that you can imagine. Additionally, each delegate has an alternate. Today, we have multiple ongoing Reference Committees, during which anyone can make his/her case for a particular issue. We are the official body of The House of Delegates to the American Medical Association. I am presently in one reference committee discussing such topics as merging of Health Insurance Companies, Veterans Health, Pain Manangemet, Opioid Abuse, Access To Care,Women’s Health and their decision to determine their health care desires for themselves. This is in no way all encompassing, only a snapshot of this one committee. The General Meeting started with a “Big Bang”….A movement by a few obstructionists (we have them here too) for the AMA to  support the defunding of Planned Parenthood was resoundingly smacked down, not once but twice. It’s not over till it’s over,  so I am waiting to see what parliamentary methods will be conjured up to somehow come back to this issue.

So, this is my focus right now and through mid-week. I’ll be back to my regular routine as soon as possible, but for now, I’m in this fight to the end. I’ll rejoin you as soon as I can!


RAEMD95, November 15, 2015


November 15, 2015 Posted by | Access To Care, Health Care, Health Insurance Companies | , , , , | 2 Comments

“The Party That Couldn’t Kabuki Straight”: Prone To Fights To The Death Over Strategy, Tactics And Above All, Symbolism

If you have been following the intra-GOP brouhaha in the U.S. House semi-carefully, you probably realize that much of the conflict between Freedom Caucus bravos and the other Republicans has been over how much hysteria to expend on efforts to force presidential vetoes of prized legislation instead of letting their bills succumb to Senate filibusters. Perhaps some of these birds actually do believe Obama would allow them to kill funding for Planned Parenthood or revoke his executive actions on immigration or mess up Obamacare in the face of a government shutdown or a debt limit default. But for the most part they seem to think there’s vast electoral or psychological or moral gold to be mined from showing exactly what they would do if one of their hirelings was in the White House.

Presumably that’s why the Kabuki Theater exercise of sending Obama a budget reconciliation bill–which cannot be filibustered–that “defunds” Planned Parenthood and repeals key parts of Obamacare has run afoul of right-wing opposition, per a report from Politico‘s Seung Min Kim:

[T]hree conservative members of Senate Majority Leader Mitch McConnell’s conference — Sens. Ted Cruz of Texas, Marco Rubio of Florida and Mike Lee of Utah — have already vowed to vote against the current reconciliation package that repeals major parts of Obamacare, arguing it doesn’t go far enough. If those votes don’t budge, McConnell can’t afford to lose any more votes from his 54-member ranks.

Meanwhile, a provision in the reconciliation bill that defunds Planned Parenthood for one year could cause some heartburn for moderates who don’t support stripping money from the women’s health group.

A draft bill did pass the House on Friday, but over the opposition of Heritage Action, which will make another effort to blow it up in the Senate unless the Obamacare repeal language is broader. But that could make the bill vulnerable to a parliamentarian’s ruling that it violates the Byrd Rule limiting reconciliation bills to provisions germane to the federal budget.

You will note that Marco Rubio, the smart-money favorite to become the Republican Establishment’s darling and win the GOP presidential nomination, is right there with Ted Cruz on obstructing any bill that leaves any significant element of Obamacare standing–on paper, of course. This is presumably a gesture by Rubio to reassure ideologues he would make the executive branch an instrument of their will should they allow his name to grace the top of the ballot next year.

This is the congressional party Paul Ryan will apparently try to lead as Speaker–one prone to fights to the death over strategy, tactics and above all symbolism.


By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, October 26, 2015


October 26, 2015 Posted by | House Freedom Caucus, House Republicans, Paul Ryan | , , , , , , , , | Leave a comment

“House Freedom Caucus Demands”: Granting The Insurgents Continuing Power To Be Disruptive

It is looking likely that Rep. Paul Ryan will be elected Speaker of the House next week. Who knows what has transpired behind closed doors, but the word is that he and the Freedom Caucus reached a deal that won enough of them over for him to be elected.

What we also know is that the Freedom Caucus designed a questionnaire for speaker candidates. Kevin Quealy and Carl Hulse have done us all a service by translating those demands from Congressional legalese into plain English.

In looking at the list of 21 items, a lot of the things they are pushing for would simply undo the reforms instituted by Newt Gingrich that put power in the hands of the House Leadership – specifically the Speaker. In that way, they grant the insurgents continuing power to be disruptive.

But there are a few things that would mean pretty immediate chaos. For example, item 13 asks: are you willing to hold the debt limit hostage until we prevail on other issues? Specifically, the Freedom Caucus wants “structural entitlement reforms” in the 2016 budget and the Default Prevention Act (which President Obama has promised to veto) included in any legislation that raises the debt ceiling.

Given that the Treasury has informed Congress that the debt limit will be reached November 3rd – exactly one week after the House votes for a new Speaker – that doesn’t give Paul Ryan a lot of time to work this one out.

Making that job even harder is item 7 which seeks to institutionalize the so-called “Hastert Rule.” It would require that Republicans consider only legislation that has the support of the majority of their party. That would eliminate the possibility for Ryan to develop a coalition of moderate Republicans and Democrats to raise the debt ceiling.

If all that weren’t bad enough, item 15 demands that the new Speaker refuse to pass a budget that contains funding for Planned Parenthood, “unconditional amnesty,” the Iran deal and Obamacare. In other words…”We demand a government shutdown!”

There are several other interesting items, like a demand to impeach the IRS Commissioner, turn the highway program over to states, stick to the spending caps in sequestration, etc. But in a deliciously hypocritical move, item 6 demands that Republicans who signed the discharge petition to fund the Ex-Im Bank be punished, while items 4 & 5 demand that members who oppose rule changes and/or vote their conscience not be punished.

If Rep. Ryan has in any way agreed to these demands, things are going to blow up in the House very quickly. If he and the Freedom Caucus simply put off dealing with them, things are going to blow up in the House very quickly. Get my drift?


By: Nancy LeTourneau, Political Animal Blog, The Washington Monthly, October 24, 2015

October 25, 2015 Posted by | Debt Ceiling, House Freedom Caucus, Paul Ryan, Speaker of The House of Representatives | , , , , , , , , | 2 Comments

“Whistling Past The Graveyard”: Why The Raging Dysfunction In Washington Is The New Normal

When Majority Leader Kevin McCarthy abruptly withdrew from his frontrunning candidacy to succeed John Boehner as speaker of the House, it underscored just how dysfunctional the “governing” Republican Party has become. The dispute within the party is not ideological — the degree of policy consensus within the Republican conference is remarkable. Rather, the dispute is tactical. Some party elites, like Boehner, understand that there’s no chance that Republican objectives like repealing the Affordable Care Act and defunding Planned Parenthood can be achieved with Barack Obama in the White House. Members of the Freedom Caucus, conversely, believe (or pretend to believe) that threatening government shutdowns and debt defaults can somehow force Obama to sign bills erasing his primary policy achievements. No wonder nobody wants the job.

It’s tempting to think that this rolling crisis, in which threats to the basic functioning of government become routine, is a temporary phenomenon. But there is a very real and frightening possibility: This is the new normal. The presence of two ideologically coherent parties, combined with the separation of legislative and executive authority, is probably going to produce similar results whenever there’s divided government.

There is a tendency to assume that the American constitutional order is inherently functional, and that there’s no problem that can’t be solved by replacing some bad actors in the legislature and/or judiciary. Nostalgic appeals to a more functional era are pervasive. In a recent interview with Gawker‘s Hamilton Nolan, for example, the dark-horse presidential candidate and legal scholar Lawrence Lessig asserted that the government “has no capacity to make decisions any more” and “it’s trivially easy for any major reform on the left or the right to be blocked,” but that “it’s a 20-year problem” based on the fact that “such a tiny number of people are funding campaigns.”

This is a happy story, despite the outward appearance of despair. If American constitutionalism is essentially functional, but has been ruined by some 5-4 campaign finance decisions issued by the Supreme Court, the problems can be solved. Not easily, but it’s possible to think that the next unified Democratic government can restore order.

But the truth is considerably darker. First of all, Lessig underestimates how difficult major social reform has always been in the United States. It was “trivially easy” for any major reform to be stopped before the author of Citizens United had even been born. The vast majority of the federal welfare and regulatory state was passed during two very brief periods: FDR’s first term and LBJ’s first three years in office. Otherwise, the alleged Golden Age of American politics was largely defined by statis.

Furthermore, it’s not a coincidence that the brief periods of reform occurred during periods of unusually large Democratic supermajorities in Congress. And even these periods were far from unalloyed liberal triumphs: The New Deal, for example, gave disproportionately fewer benefits to African-Americans to win support from Southern Democrats. The American constitutional order was designed to make major changes difficult, and it has largely succeeded.

Lessig is right, however, that some things have gotten worse in the last 20 years. It’s never been easy to pass major reform legislation, and as the first two years of the Obama administration shows, it’s still possible given enough Democrats in Congress. What has changed is that it used to be possible to do basic tasks like keeping the executive and judicial branches properly staffed and the government funded. Congress could also at least pass compromises on issues of lower-order importance. Things have gotten genuinely worse in recent decades in these respects.

Where Lessig is wrong is to think that there’s a magic bullet that can fix the problem. Reducing the role of money in politics and increasing access to the ballot are salutary initiatives that would improve things at the margin, but the dysfunction of American government is rooted deeply in the American constitutional order.

As Matt Yglesias recently explained at Vox, the fundamental problem is the diffusion of accountability that comes from separating the legislative and executive branches. As Yglesias observes, “Within a presidential system, gridlock leads to a constitutional trainwreck with no resolution.” Whether Democrats or Republicans are blamed for dysfunction in a period of divided government depends largely on who voters tend to support on a tribal level.

A paradox of the American separation-of-powers system is that actions like a government shutdown can hurt the reputation of Congress as a whole without threatening the electability of most individual members, a paradox Senate Majority Leader Mitch McConnell has exploited brilliantly. Whereas congressional leaders in the opposition used to think that they had to collaborate on at least some issues with a president to avoid being punished, McConnell and other contemporary leaders have recognized that denying the president accomplishments hurts the president more than it hurts them. And lest any Republican member of Congress consider returning to the old norms for the good of the country — I know, but let’s pretend for a second — they’re likely to face a viable primary challenge.

Does this mean, as Yglesias argues, that American democracy is “doomed”? This is unclear. But it does mean that the dysfunction in Washington, D.C., is likely to get worse before it gets better. And pretending that any single reform — no matter how worthy in itself — can solve these deeper problems is whistling past the graveyard.


By: Paul Lemieux, The Week, October 20, 2015

October 24, 2015 Posted by | Democracy, Governing, Separation of Powers | , , , , , , , | 2 Comments

“This Hearing Was A Dreadful Mistake”: GOP’s Benghazi Committee Comes Unglued

It’s easy to forget that when the Republicans’ Benghazi Committee initially sought testimony from Hillary Clinton, GOP officials wanted her to provide private, closed-door testimony. The former Secretary of State was eager to answer questions publicly, for all the world to see, but Republicans desperately wanted the discussion to be kept far from public view.

And after watching this farce unfold today, we now know why.

It’s hard to say exactly when today’s hearing descended into total farce, but it was arguably when Committee Chairman Trey Gowdy (R-S.C.), for reasons that didn’t appear to make any sense, quizzed Clinton repeatedly on her correspondence with informal adviser Sidney Blumenthal. The New Republic’s Brian Beutler highlighted the problem.

Republicans have intoned darkly about this relationship and played up, in deceptive fashion, Blumenthal’s influence over Clinton’s policy in Libya – despite the fact that he has no Libya expertise, and has apparently never been there. Republicans even deposed him for hours. But here’s the catch: while they continue to make an issue of Blumenthal’s relationship with Hillary Clinton, and their email correspondence, they’ve refused to release the transcript of that deposition, where he had a full opportunity to contextualize it.

Today, after Gowdy pressed Clinton on this – reinforcing every suspicion about the entire exercise being brazenly partisan and political – Ranking Member Elijah Cummings (D-Md.) couldn’t take it anymore. The Maryland Democrat insisted that if Republicans are going to reference Blumenthal’s role, then the committee has a responsibility to release the full transcript of Blumenthal’s testimony to the public.

Gowdy refused and a shouting match ensued. The far-right chairman, however, simply couldn’t defend his position or explain why GOP lawmakers insisted on keeping relevant information hidden from view.

It was arguably a low point in the hearing, but it had plenty of competition in the category.

It’s practically impossible to go through the several hours’ worth of exchanges we’ve seen so far, but I sincerely hope that it’s dawned on Republicans that this hearing was a dreadful mistake.

Whether GOP lawmakers realize it or not, they created a platform for the leading Democratic presidential candidate to speak before the nation and appear knowledgeable, articulate, compassionate, and competent. Simultaneously, the committee’s Republicans, who spent months preparing for today’s epic showdown, were hopelessly clueless and small.

Which strategic genius in Republican Party thought it’d be a good idea to pit Hillary Clinton against obscure, unprepared, far-right members of Congress? Why on earth would the GOP go out of its way to make the frontrunner for the Democratic nomination look like the adult in the room?

Clinton has often been blessed by incompetent opponents, but this is ridiculous.

What’s more, it’s too common. In early August, congressional Republicans scheduled hearings on the international nuclear agreement with Iran, and despite having months to prepare their best arguments and sharpest questions, they had nothing. Slate’s William Saletan attended all three hearings and came away flabbergasted: “Over the past several days, congressional hearings on the deal have become a spectacle of dishonesty, incomprehension, and inability to cope with the challenges of a multilateral world…. I came away from the hearings dismayed by what the GOP has become in the Obama era. It seems utterly unprepared to govern.”

A month later, congressional Republicans scheduled hearings on Planned Parenthood, and once again, they had months to prepare, organize their thoughts, coordinate their lines of attack, read their own charts, etc. And yet, they again seemed hopelessly lost.

As we discussed in September, conservative partisans should see congressional Republicans as poor allies, in large part because they don’t seem to do their homework especially well. They create opportunities to advance their interests, but then let those opportunities pass as a result of negligence and incompetence.

Disclosure: My wife works for a Planned Parenthood affiliate, but she played no role in this report and her work is unrelated to the September congressional hearing.


By: Steve Benen, The Madow Blog, October 22, 2015

October 23, 2015 Posted by | GOP, Hillary Clinton, House Select Committee on Benghazi, Trey Gowdy | , , , , , , | 1 Comment


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