Tilting at Windmills

It is a sad fact of Washington life that members of Congress, however ungifted they may seem in other respects, are geniuses in finding ways to evade ethics rules. Consider the new ethics law passed this year. It provides that lobbyists cannot pay for parties for a member of Congress during a national convention. These parties have become a favorite way for lobbyists to court legislators.

Here’s how the Ethics Committee has decided to interpret the new law. Parties for one member are prohibited, but parties for several members are still just dandy.

Recent polls have shown the war in Iraq has dropped to third or fourth or fifth in the concerns of the American people, with the economy now in first place. I hope that by the time this magazine appears, Democrats will be reminding voters that the war has crippled our ability to meet economic problems at home. Ending it will free hundreds of billions of dollars to stimulate the economy.

The filibuster has become a major factor in the gridlock that has come close to paralyzing Congress in recent years. It explains why Democrats keep saying they need sixty votes. What many people don’t know is that the threat was rarely employed before the Senate changed its rules in 1975 to permit cloture with three-fifths of the votes instead of two-thirds.

Before the rule change, resort to filibusters usually only happened when a minority felt its most vital interests were at stake, most often when southerners were faced with a civil rights bill.

When the three-fifths rule was adopted, it was considered a great blow to tyranny by a minority. An unfortunate, unintended consequence has been that minorities have come to think they are freer to use the dreaded filibuster. This trend has culminated in the Senate Republicans using the threat to stop any legislation they don’t like.

The new National Intelligence Estimate stating that Iran stopped trying to develop a nuclear weapon in 2003 has been hailed as a sign of a newly courageous intelligence community in articles in the New York Times and the Wall Street Journal. I hope the articles are right, but I have this word of caution: Bureaucrats always become more courageous in the final months of a presidency. The politicians who would have cracked down on them have left, are leaving soon, or are preoccupied with sending out their resumes and looking for their next job. The bureaucrat is free to speak out. Unfortunately, that doesn’t guarantee that he will also speak out when a new administration comes with the power to determine the bureaucrat’s future for four or eight years.

I had previously voiced my concern that the AARP, which began its life as a tool of one insurance company, has come full circle and is now in bed with another, UnitedHealth. If you assume that company is devoted to the interests of AARP members, consider the case of William W. McGuire, UnitedHealth’s chief executive until very recently. He has been found guilty of backdating stock options by the SEC. Investigators discovered a curious coincidence between the dates on the options and the dates the stock value was low. The result, of course, was that the value of the options was much greater than what it would have been had McGuire not fiddled with the dates.

What should be interesting to AARP members is the value of the options. Those that McGuire has been forced to surrender totaled $620 million. He has been allowed to keep options worth $800 million. How much could those amounts, not to mention the money involved with the backdated options that were awarded to other executives, have reduced the cost of the premiums paid by AARP members?

Many of us have been shocked by the misleading ads for prescription drugs that seem to appear every ten minutes on our television screens. The latest example is the Lipitor ad featuring an endorsement of the drug by Dr. Robert Jarvik, who is not only not a cardiologisthe is not even licensed to practice medicine, much less prescribe drugs.

One reason for the misleading ads is that the FDA does not have the power to review them in advance. Only after the ads appear can the agency punish the advertisers who deceive. But even then, it reviews only 35 percent of drug advertising, according to Francesca Lunzer Kritz, writing in the Los Angeles Times.

Why so few? Because the FDA is absurdly understaffed. Indeed, according to a Government Accountability Office report summarized by Gardiner Harris of the New York Times: “The FDA is so understaffed … [it] will need at least twenty-seven years to inspect every medical device plant that exports to the United States, thirteen years to inspect any foreign drug plant, and 1,900 years to inspect every foreign food plant.”

The reason regulatory agencies like the FDA are understaffed is that right-wingers who cannot succeed in abolishing them emasculate these agencies with niggardly budgets. Another example of this problem that has recently become prominent is the Consumer Product Safety Commission, where enough scandals have occurred to attract major attention from the press, and thereby inspired legislation that will give it more staff. My only concern is that the new employees will be hired by Nancy Nord, a Bush appointee who has been unrelentingly hostile to regulation. Wouldn’t it be better to give hiring power to the next head of the agency who will assume the office in January?

This reminds me of an important warning I have for Congress. Do notI repeat, do notconfirm a Bush appointee to replace David Walker, the head of the Government Accountability Office who recently resigned. The GAO plays a crucial role as a watchdog for government agencies. The job has an unusual tenure of fifteen years.

One troubling fact about the two leading Democratic candidates is that neither has run any organization larger than their Senate staff. Some enterprising reporter should investigate how well they carried out even these modest executive responsibilities, for a president does have to manage the government, despite Barack Obama’s notion that the job of the president is not to “go in and run some bureaucracy.” Indeed, his attitude betrays a troubling ignorance.

Franklin Roosevelt thought his managerial responsibilities so important that he established the agency now known as the OMB to be his eyes and ears, overseeing the operations of the federal government. He was also famous for enlisting friends and associates, most notably his wife, Eleanor, to go around the country to see how New Deal programs were actually working. He even used Eleanor’s lesbian lover, Lorena Hickok, a veteran journalist, to report on the effectiveness of the WPA.

During the 1952 election, Harry Truman was fond of noting that Dwight Eisenhower would be in for a shock if he ever got elected, because he would expect running the government to be like running the Army.

“He’ll sit here,” Truman would say, according to Richard Neustadt’s Presidential Power, “and he’ll say, ‘Do this!’ ‘Do that!’ And nothing will happen. Poor Ikeit won’t be a bit like the Army. He’ll find it very frustrating.”

Truman’s prediction proved to be right about Ike and the civilian bureaucracy. On the other hand, Ike’s intimate knowledge of the defense establishment meant that he stands out among the presidents who have followed him in his ability to detect the BS in Pentagon budget requests.

One line of Hillary Clinton’s that most of the media has swallowed hook, line, and sinker is that she has “been working to bring about positive change for thirty-five years.” The exception is Matt Stearns of the McClatchy newspapers, who points out that she “spent fifteen of those 35 years at one of Arkansas’s most prestigious corporate law firms, where she represented big companies and served on corporate boards.”

Speaking of Hillary, do you remember the movie Primary Colors, in which the character modeled on her, upon learning that her husband’s opponent had possibly used cocaine twenty years earlier, immediately ordered a staff member to confirm the dirt so that it could be used against him? I recalled this episode when I realized that there had been at least three occasions when Obama’s admitted adolescent cocaine use had been brought up by Clinton’s surrogates. All three were close associates of the ClintonsWilliam Shaheen, Robert Johnson, and Mark Penn, her leading strategist. If you think Hillary Clinton was not involved, you must still believe that Bill Clinton “did not have sexual relations with that woman.”

Among the many billing problems that encourage mischief, two show signs of reform. One involves lawyers, the other political consultants. For lawyers, it’s billable hours; with consultants, it’s percentage billing.

The billable hour requires lawyers to break down their day into time segments, often as short as fifteen minutes, and assign each segment to work for a specific client. The practice tempts lawyers to lie about the time or work too hard. In many cases, they do both. The result is inflated bills to the client and exhausted lawyers. The good news is that the clients are waking up, with the dash of cold water sometimes coming in the form of a bill for more than twenty-four hours of work in the same day from the same lawyer. The result, according to Slate‘s Lisa Lerer, is that clients are insisting on negotiating flat fees.

As for political consultants, the racket involved taking a percentage of the “buy,” the major element of which is usually television time. This tempts the consultant to play Iago, constantly whispering into the client’s ear that more tele-vision commercials in New York or Los Angeles or wherever will guarantee victory at the polls. This billing system cost the 2004 Kerry campaign $9 million, paid to just five consultants, led by Robert Shrum.

But this year, according to the New York Times, the top Democratic candidates have joined the Republicans in negotiating flat fees or placing a cap on the amount the consultant can charge. The fact that Clinton consultant Mark Penn took away $3.8 million for January alone suggests that reform still has a way to go.

Israel’s nuclear weapons are never mentioned by our government, and only rarely discussed by the media, so I welcomed Lew Butler’s recent op-ed in the San Francisco Chronicle, “It’s Time to Talk About Israel’s Nukes, and Ours Too.” Iran knows that Israel has nuclear weaponsButler estimates two hundred or so. Although I’m definitely not eager for Iran to acquire nukes, it seems understandable for Iranians to ask, Why shouldn’t we have them too? Our concern about nukes seems to apply only to our enemies and not to our friends. This is bound to make us seem hypocritical to the rest of the world.

My prediction in the December issue that the Republican right wing would keep John McCain from getting the party’s nomination turns out to have been dead wrong. It reminds me of another time our prophetic powers failed us. In 1979 we published a cover article that proclaimed that the next years would bring a New Idealism to America. Instead, we got the explosion of greed of the 1980s that continues to this day.

One unfortunate result of that explosion is that it drew many of our best and brightest to Wall Street, where they have devoted themselves to schemes to make themselves rich that far too often have turned out to be elaborate shell games that now threaten to cause economic catastrophe.

But we should be grateful for how one group of the best and brightest chose to make money. It was the entrepreneurs who gave us the giant technological advances that have occurred during the same period that their fleece-the-sucker contemporaries flourished on Wall Street. Indeed, one can say that Wall Street represents what has gone wrong since 1980, while Silicon Valley represents our ability to make good by making something useful.

One consequence of the real estate boom that ended last year was escalating assessments. The boom has clearly passed, but many of the higher assessments remain on the books, meaning more trouble for homeowners who find themselves paying higher taxes for real estate that has lost much of its value. An example of how taxes have increased, for which I’m indebted to Mike Smith of the Associated Press, is what has happened to Maurice Gunyon of Indianapolis. In 2005, his property tax was $2,900. Last year it was $4,600. This year it is $7,500. Gunyon is retired and doesn’t know how he is going to pay.

Some states have already bowed to pressure from homeowners to reduce their property taxes. Unfortunately, this also means reduced revenues, which in turn means reduced services to the public.

In one state, however, it looks like reduced services will have at least one salutary effect. California plans to release 22,000 nonviolent inmates from its prisons.

I’ve long thought that the primary purpose of prisons should be to protect the rest of us from the violent. Probation is the best solution for most first-time nonviolent offenders, and short sentences are usually enough to punish the rest of the nonviolent who live each day in prison in terror of the violent.

During the Democratic debate at St. Anselm College, Charles Gibson, the moderator, expressed his concerns at proposals by Barack Obama and John Edwards to raise the cap on payroll taxes on income above $100,000. Won’t that hurt you St. Anselm professors who are married and whose combined income is more than $200,000? asked Gibson. The professors in the audience laughed. Obviously, not a lot of them made $100,000. Gibson, hearing the laughter, suggested that many New York City schoolteachers made more than $100,000. Again, he was wrong, which illustrates one of my favorite points, which is that media heavyweights make so much money that they have lost touch with the reality lived by most Americans80 percent of whom not only make less than $100,000, they make less than $80,000.

Another example of this ignorance is the drumbeat for relief of the alternative minimum tax, which largely affects those making more than $100,000, from the editorial pages of the Washington Post and the New York Times, which led to the quick passage of a bill giving relief even though it contained no corresponding revenue from other sources to make up what is lost by the bill.

I worry that NASA is again trying to move too fast, scheduling six shuttle launches this year, according to the Washington Post‘s Marc Kaufman, twice the number of flights it has managed in each of the last two years. This reminds me of the pressure from NASA executives to launch the first shuttle against the early warnings from this magazine’s Gregg Easterbrook of defects, including the danger that the booster rocket would blow up. That is, of course, what happened to the Challenger one cold morning after Thiokol engineers had spent the night desperately warning NASA executives that the booster’s O-rings would contract from the cold, resulting in escaping gas that would cause the rocket to explode. NASA executives ignored the warning, because, one has to suspect, they wanted Ronald Reagan to laud the flight in his State of the Union address that night.

Another thing that inspires worry about NASA’s current leadership is the way they have handled a survey of commercial and general aviation pilots about safety concerns. When the Associated Press first asked NASA to release the report, they refused, saying that “publication might affect the public’s confidence in airlines,” a statement that did not tend to inspire confidence in either the airlines or NASA. Demand grew for the report’s release. NASA finally published it. The only problem is that it has more redactions than even Dick Cheney’s office would dare attempt. But the redacted report contains just enough evidence of pilot fatigue, even a “pilot asleep on the flight deck,” “incidents of engine failure,” and “fires aboard,” to make you very curious about the redactions. Former NTSB chairman Jim Hall nailed NASA in this comment to the Washington Post: “When a government agency is not transparent to the American people, particularly of issues of safety, they are not fulfilling their responsibilities and earning their pay.”

The Golden Rule is for me and many others the most sublime expression of the Christian faith. I have to admit, however, that it does not always apply in a literal sense. George Bernard Shaw identified one problem when he wrote, “Do not do unto others as you would have them do unto you; their tastes may be different.” I’ve found another approach in the funeral program of my old friend Richard Graham. Some of his sayings were printed on the program. Among them was this: “You shouldn’t do unto others what you wouldn’t want done to you.” This one struck me as absolutely foolproof.

Another old friend, Dr. Ronald Glasser, recently underwent a hip operation, followed by a stay in the hospital limited to two days by his insurance company. This led him to reflect on what has gone wrong with the practice of medicine in recent years:

“Ten years ago, the standard admission for a hip replacement was a seven- to ten-day affair with inpatient physical therapy twice a day throughout the admission. But it isn’t just hips. In the early 1990s, if you had a gall bladder removed you stayed in the hospital eight days. Now, if you have your gall bladder removed at eight in the morning, you are sent home at noon. Ten years ago, open-heart surgery meant a minimum of ten days in the hospital; now, if you have a mitral or aortic valve replaced, you are sent home on day four. If you have breast cancer and a mastectomy to be followed by outpatient chemotherapy and radiation, you are home within eighteen hours of the mastectomy, drains and all. If you have a radical prostectomy for prostate cancer, you are home on day three with a bladder catheter in place and instructions for your wife or daughter on how to handle the indwelling catheter and how to clean the urine bag so you don’t develop a bladder infection. Have a laminectomy on Tuesday for a slipped disc and you are home Thursday. Forget about being able to bend to pick up something from the floor, and forget about being able to turn over in bed. While I and my hip, and apparently everyone else, weren’t looking or paying attention, patient care in America had undergone a profound change.

“The facts about early discharges are quite stunning. The average length of stay following admissions to a hospital are not only less than a quarter of what they were ten years ago; they are also on average four to six days less per surgical procedure in America than in Canada, Germany, or France.

“By the end of the 1990s, hospital administrators began to decrease their length-of-stay policies to cover decreased payments as well as lure more health plan patients. No one said a word. After all, everyonehealth plans, hospitals, physicians, and surgeonswere now in the exact same payment boat, but they could all do well if they all went along. The only ones left out of the mix were the patients.

“An internist recently admitted a patient in his early sixties with an unsteady gait and a few falls at home to the hospital in order to monitor his heart rhythms. After eighteen hours the hospital’s ward coordinator reminded him that the patient had not shown any dizziness since admission and the monitor had not indicated a significant conduction defect, and so the patient should be sent home. The internist felt he had no choice. On the way out of the hospital, the patient developed a ventricular tachycardia. He was saved. Another five minutes and he’d most likely have died in the car taking him home. That could have been any one of us who are no longer twenty or thirty years old.

“Physicians and surgeons have to stand up and fight for what is right, and that means what is best for the patient. But that is a bit problematical. There is business involved. It simply doesn’t pay for the office manager or the clinic administrator to have the doctor follow a patient after the patient is finished with the procedure, operated on, or discharged after an admission to the hospital.

“Like the family doctor in an office over the drugstore, the old idea of one physician as being in charge or being the quarterback running the whole show is over.”

When the popular TV show COPS runs film of a perpetrator being arrested, it protects itself from legal trouble by getting the alleged criminal to sign a release. “Twenty years ago, it was harder to get releases,” the show’s producer tells the Washington Post‘s Peter Carlson. “Now, it’s way over 90 percent of people who sign.”

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Charles Peters

Charles Peters is the founding editor of the Washington Monthly.