Wash Your Hands

[quote]Dr. Peter Pronovost sought to reduce the incidence of hospital-borne infections by promoting a simple checklist of ICU procedures governing physician hand-washing and other sterilization procedures.

Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them.

When David Goldhill learned of this very shortly after his own father died from just such an infection he began to investigate the real problems in our health care system. As a grieving son, he wished for a culprit only to find that there really is no bad guy, no incompetent doctors, greedy insurance or drug companies, or any other scapegoat. The problem his research exposed was a system of perverse incentives and unrealistic expectations (like expecting that hundreds of thousands of deaths per year from hospital infections is acceptable or unavoidable and expecting someone else to pick up most of the cost of our care). Like Goldhill, anyone wishing to tackle the issue of health care must wash their hands of pre-programmed political prescriptions and rampant half-truths being promoted by people on all sides of the debate.
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Constitutional Amendment 25

I’m curious about what prompted Congress to finally address the issue of presidential succession when they did, but there were actually two proposals for the 25th Amendment. One would have given Congress the power to determine the presidential succession by law. The other stipulated the succession in the Constitution itself.

Section 1. In case of the removal of the President from office or of his death or resignation, the Vice President shall become President.

Section 2. Whenever there is a vacancy in the office of the Vice President, the President shall nominate a Vice President who shall take office upon confirmation by a majority vote of both Houses of Congress.

Section 3. Whenever the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that he is unable to discharge the powers and duties of his office, and until he transmits to them a written declaration to the contrary, such powers and duties shall be discharged by the Vice President as Acting President.

Section 4. Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

Thereafter, when the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that no inability exists, he shall resume the powers and duties of his office unless the Vice President and a majority of either the principal officers of the executive department or of such other body as Congress may by law provide, transmit within four days to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office. Thereupon Congress shall decide the issue, assembling within forty-eight hours for that purpose if not in session. If the Congress, within twenty-one days after receipt of the latter written declaration, or, if Congress is not in session, within twenty-one days after Congress is required to assemble, determines by two-thirds vote of both Houses that the President is unable to discharge the powers and duties of his office, the Vice President shall continue to discharge the same as Acting President; otherwise, the President shall resume the powers and duties of his office.

It’s a long amendment because it is meant to cover any contingency but I’d hate to think how political the congressional maneuvering and manipulation could get if the amendment has simply stipulated that Congress could decide. To get an idea just look at the situation in Massachusetts where the (Democratic) legislature made a law that the governor (a Republican at the time) could not appoint a successor if one of their Senate seats (both held by Democrats) became vacant. Now with the death of Senator Kennedy they want to override that law because they have a Democratic governor again.

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Constitutional Amendment 24

I would guess that poll taxes made more sense before the government adopted income taxes but because poll taxes could be abused (and were being abused) the nation used the 24th Amendment to end the practice of poll taxes and to make failure to pay taxes insufficient reason to deny the right to vote.

The right of citizens of the United States to vote in any primary or other election for President or Vice President, for electors for President or Vice President, or for Senator or Representative in Congress, shall not be denied or abridged by the United States or any State by reason of failure to pay any poll tax or other tax.

Notice that this is the fourth amendment that was at least partially aimed at leveling the field for civic participation of minorities (specifically blacks). Imagine what Congress could have done with “Comprehensive Slavery Reform” rather than the iterative approach we took – we’d probably be even worse off than we are now.

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The Politics of Fear

Fear
photo credit: ag2r

I was listening to NPR this morning on the way to work and they were discussing the use of fear as a political tactic. The story was not what I would consider fair and balance as they asserted that only those who oppose health care reform are making use of the tactic, but one of the people being interviewed about why fear is such an effective tool in blocking legislation stated that fear has the effect of causing us to focus on the problem and divert our energies to addressing the cause of our fear. Of course the implication is that we stop being rational when we are motivated by fear.

As I thought about that it really irked me that they paint people as nothing more than animals – it’s all biology. The truth is that while we are prone to act less than rationally when we are consumed by fear we also have a heightened capacity to think clearly in many high-pressure situations. The key to thinking clearly is that we must not let the fear overwhelm us – let the adrenaline enhance our senses without letting go of our capacity to look at the evidence and make deliberate choices. Continue reading

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Senator Ted Kennedy

After a constant barrage of news coverage and a few questions from my own acquaintances asking about my views on Ted Kennedy I thought it appropriate to pay this tribute to The Lion of the Senate.

Few men have likely done more to earn the title of “Senator” in the history of our nation. I say this with all sincerity despite the fact that my own political views are very different from those espoused by Ted Kennedy. Of course I did not know him personally, but based on all the stories that are told of his work in the Senate (and I have seen no cause to doubt any of the accounts) he was a rare example of a Senator who truly understood the nature of the work that elected officials in the senate are called upon to do. Comparing him to others who hold or aspire to hold seats in the Senate consistently results in the others looking like pretenders.

He was well known for his ability to hold fast to his principles while still knowing how to work with people who did not agree with those principles. Our own Senator Hatch is a prime example. Despite any personal weaknesses he was willing and able to stand firm against any opposition to a position he held on principle. I believe it is because of his unwavering devotion to principle that I discovered that when he disagreed with Senator Hatch (who is ideologically closer to me than Kennedy is) at least half the time it was Kennedy that I agreed with – it was when the two of them agreed that I was more likely to disagree.

Perhaps the highest tribute I could give would be to share my belief that, in a nation where more people identify themselves as conservative than as liberal it was the sustained effort of this one principled liberal in the senate for the last few decades that has ensured that out government has moved inexorably toward more liberal positions. I hope that I can one day see a conservative Senator who works as hard and holds to his principles as well as Ted Kennedy did for so long.

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Constitutional Amendment 23

Reacting to changes in society that the founders could not have anticipated, the 23rd Amendment provided representation in the electoral college to residents of Washington D.C. in presidential elections.

The District constituting the seat of government of the United States shall appoint in such manner as the Congress may direct:

A number of electors of President and Vice President equal to the whole number of Senators and Representatives in Congress to which the District would be entitled if it were a state, but in no event more than the least populous State; they shall be in addition to those appointed by the States, but they shall be considered, for the purposes of the election of President and Vice President, to be electors appointed by a State; and they shall meet in the District and perform such duties as provided by the twelfth article of amendment.

To get an idea of how they might have made this oversight, we should look at what the founders envisioned for the seat of government. They would have anticipated an essentially agrarian society, a federal government with limited power, and therefore a city that would not draw any particularly large number of people. Many of those who would be drawn there would, in their expectations, have been temporary residents – members of Congress and federal employees – who would have the right to cast their votes in their states of residence.

Those who would live their permanently would likely have been farmers. The Constitution stipulates that the capital city not exceed 10 square miles which is 6400 acres. In 1865 freed slaves were initially promised 40 acres and a mule. I think it is safe to assume that, as this was a promise to ex-slaves, 40 acres was not a particularly large amount of land for one family. in other words, if the entire city were populated by farmers it would have a population of no more than 160 families – and representatives in Congress were to represent at least 30,000 people according to the Constitution. It is understandable that they would not think it necessary to give those few people a vote in the electoral college.

In many ways the 23rd Amendment was a half measure. Considering the expanded (and expanding) breadth of congressional authority (especially over Washington D.C.) it is very reasonable for the residents of Washington D.C. to desire a voting representative in the House. In order to achieve that we will need to pass another constitutional amendment.

Perhaps it is because they have been breathing the capital air too long (and because previous attempts to amend the Constitution have been rejected for overreaching by seeking full statehood) the residents of D.C. have spent their energy trying to circumvent the Constitution in their efforts to gain that otherwise well-deserved voting representation.

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Big Government = Big Solutions

Bite Sized
photo credit: angel_shark

If you want to walk a thousand miles you do it one step at a time. If you want to eat an elephant you do it one bite at a time. The genius of big government is that Congress believes that since there are more than 500 of them they can swallow any elephant-sized problem in one bite time after time. They forget that putting two geniuses to work on one problem does not double their IQ nor guarantee that their solution will be twice as good. Not only do they forget that but they go further and assume that 100 Senators must produce legislation that is 100 times as good as what any one of them would propose, that 400 Representatives will produce a law 400 times as good as what one of them would come up with, and that the combined efforts of the House and the Senate will generate results better than what either chamber had passed in isolation.

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Money Down the Drain

A little statement from an article titled “Cash For Clunkers”: Did It Work? got me wondering about the fate of three hundred million dollars.

When the $3 billion is exhausted, roughly 600,000 vehicles will have been swapped for more fuel-efficient models, based on statistics released from the government so far.

Do the math there and we find that if every single “Cash for Clinkers” deal returned the maximum $4500 to the person trading their car in there was still another $500 paid by the government for the deal. For 600,000 cars that makes $300,000,000 that went into someones pocket. (This does not count any other hidden costs of the system which may never be revealed in losses to other businesses or interest paid by people who already had a working vehicle that they owned outright.) I’d like to know how much of it went to dealers, how much went to paying for the destruction of the “clunkers” and how much was government setting up a website and processing paperwork.

One thing is for sure, we have a huge double standard operating when insurance companies are considered greedy when 2% of their gross income is profit while government is considered efficient when only 10% of their cost goes directly to program overhead.

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The Economic Bill of Rights

During his final State of the Union address Franklin Delano Roosevelt spoke about what he said could be considered a second bill of rights which may be referred to as The Economic Bill of Rights. In his address he said some important things that ring true such as:

We cannot be content, no matter how high that general standard of living may be, if some fraction of our people — whether it be one-third or one-fifth or one-tenth — is ill-fed, ill-clothed, ill-housed, and insecure.

He described the original Bill of Rights as proving itself inadequate:

This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights — among them the right of free speech, free press, free worship, trial by jury, freedom from unreasonable searches and seizures. They were our rights to life and liberty.

As our nation has grown in size and stature, however — as our industrial economy expanded — these political rights proved inadequate to assure us equality in the pursuit of happiness.

This is very likely the first and most blatant blurring of the nature of rights ever promoted by a president. It has set the tone for our widespread misunderstanding of what rights are as a majority (or at least a vast minority) have come to view the following as rights equal to the rights described and protected in the Bill of Rights.

  • The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;
  • The right to earn enough to provide adequate food and clothing and recreation;
  • The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
  • The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
  • The right of every family to a decent home;
  • The right to adequate medical care and the opportunity to achieve and enjoy good health;
  • The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;
  • The right to a good education.

As someone else has said – these are all goods, but only one of them is a “right.” The only real right is the right to trade goods and skills in an atmosphere free from unfair competition. The rest of this list are only protected as far as that one right extends – that every person has the right to not have others undercut their efforts as they labor to acquire a useful and remunerative job, enough money to provide adequate food, clothing, and recreation, a decent home, adequate medical care, protection from economic fears, and a good education.

Along with the first example I cited of things that ring true in his words is this:

People who are hungry and out of a job are the stuff of which dictatorships are made.

Both of those truisms however are incomplete. To the first I would add that no matter how low our standard of living we cannot afford to give up on true principles in exchange for popular sentiment. To the second I would alter it to say that people who are dependent on a central political authority for food and work are the true stuff of which dictatorships are made – being hungry and out of a job only make them ripe for recruitment.

It is interesting to note that as we have pursued policies to provide government funded education, economic security, and now health care in order to eliminate sickness and the economic distress of unemployment and underemployment the result is more widespread economic fears. Because of the ubiquitous belief in these so called rights many people wish to turn to government for security even where the government is the cause of the insecurity in our nation.

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Constitutional Amendment 22

Off and on in various circles the idea of mandating term limits for various elected officials is discussed with varying degrees of interest. I wonder if many of these discussions would  exist in the absence of the 22nd Amendment.

No person shall be elected to the office of the President more than twice, and no person who has held the office of President, or acted as President, for more than two years of a term to which some other person was elected President shall be elected to the office of the President more than once. But this Article shall not apply to any person holding the office of President when this Article was proposed by the Congress, and shall not prevent any person who may be holding the office of President, or acting as President, during the term within which this Article becomes operative from holding the office of President or acting as President during the remainder of such term.

The two sides of the debate can be generally summarized as “we need fresh ideas/faces in Congress, incumbents have too much advantage in elections, the office is more important than the person holding it” and “the people should be free to decide when to replace their elected officials without being tied to an artificial limit, these jobs benefit from experience, constant turnover favors special interests.”

In my view each side has some valid concerns. Conveniently the 22nd amendment seems to feel non-restrictive of the peoples ability to choose because only one president ever served more than two terms in 160 years under the Constitution before it was adopted and as far as I know only one president since has made any vocal portion of the voters wish to not be limited to two terms.

I have not yet decided for sure whether an artificial limit placed on a really good elected leader would be less burdensome than the common practice of perpetual incumbency – I suspect that it would. What i know is that I would like to see a lot more turnover among elected officials so that people are reminded that whoever they elect is replaceable – ideally that would happen without having to impose artificial limits as it has for our presidency for the majority of our nations history.

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