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Even Without That Task, Huge Agency Poses Challenges
With Thomas A. Daschle, as secretary of health and human services, focused health-care legislation, the agency will need strong deputies, experts said. (By Charles Dharapak -- Associated Press)
Under the best of circumstances, overseeing the Department of Health and Human Services is an enormous undertaking. With 65,000 employees and a budget of $707.7 billion, it accounts for nearly one-quarter of all federal spending, second only to the Defense Department.
But in the Obama administration the job is taking on a second, perhaps more daunting, responsibility: shepherding health-care reform legislation through Congress.
Unlike his predecessors, Thomas A. Daschle, President-elect Barack Obama’s choice for HHS secretary, will be given an expanded role, leading administration efforts to overhaul the U.S. health system.
“This really creates a new type of secretary,” said Charles N. “Chip” Kahn III, president of the Federation of American Hospitals. In the past, “HHS was more or less a service organization to the White House,” while White House advisers drove policy initiatives.
In broad terms, Obama campaigned on the idea of reducing medical costs, improving quality and eventually achieving universal insurance coverage. He promised to cover every child and to reduce the average family’s medical bill by $2,500 a year. He advocated a greater emphasis on prevention and expanding participation in the government-subsidized Medicare and Medicaid programs.
“There are two aspects to the challenge of pushing for health reform,” said Dan Mendelson, a budget and health adviser in the Clinton administration. “One is to get the right concepts together with what Congress wants to do, and the other is managing the disparate concepts and generous egos.”
A serious restructuring of the health system will require extensive data and analytic capabilities to dissect the proposed changes and the impact they might have, said Karen Davis, president of the Commonwealth Fund, a private, nonpartisan research foundation. “Right now, there’s nothing other than the Office of the Actuary to do back-of-the-envelope estimates,” she said.
With the expectation that Daschle, a former Senate majority leader, will focus heavily on crafting and pushing legislation, there will be an even greater need for a strong No. 2. HHS is a collection of 11 agencies including the Food and Drug Administration, the National Institutes of Health, the Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention.
“He’ll need to have deputies who are well-versed in the agency as a whole and who can manage the ongoing operation of HHS while he leads the health reform discussions,” said Len Nichols, director of health policy at the New America Foundation. One of those will likely be Jeanne Lambrew, a veteran of the Clinton administration and a co-author of Daschle’s book “Critical: What We Can Do About the Health-Care Crisis.”
Lambrew, in a chapter of a book published by the liberal Center for American Progress outlining a proposed agenda for the incoming president, agreed that fixing the health system is a top priority. However, she noted, “these urgent problems overshadow persistent, neglected and potentially deadly infrastructure gaps in the system.”
According to her assessment, the nation’s ability to respond to natural or man-made crises is weak, as evidenced by the poor response to Hurricane Katrina. Chronic illnesses such as diabetes have been given short shrift, and little has been done to prepare for the long-term health needs of an aging population.
The Commonwealth Fund, after interviewing two dozen health leaders, issued its own set of recommendations. It urged the next administration to make a “real focus on what it takes to improve health outcomes,” as opposed to secondary issues related to insurance markets, Davis said. That means tackling childhood obesity, racial disparities and preventable illnesses.
Daschle appearing here at DNC - is looking forward to his job in the Obama administration.
WASHINGTON (CNN) — Former Senate Majority Leader Tom Daschle told CNN Thursday that he is excited about the possibility of heading Health and Human Services in an Obama administration where he would be a point person in helping to reform the nation’s healthcare system.
Daschle, a close advisor to President-elect Barack Obama, is expected to be nominated for this Cabinet-level position if he passes the vetting process. His top priority as HHS secretary would be healthcare, one of Obama’s signature policy issues during the campaign.
“I hope to have the plan enacted by next year, and then it will take several years to implement,” said Daschle, as he waited to board a plane in Washington, DC bound for Obama’s hometown of Chicago.
When asked if the U.S., in this current economic climate, could afford to reform the healthcare system, Daschle said it is imperative.
“We can’t afford not to do it,” he said. “If we do nothing, we’ll be paying twice as much on healthcare in 10 years as we do today.”
Daschle served as Democratic leader in the Senate from 1995 until he lost reelection in 2004. Representing South Dakota, Daschle was first elected as a congressman in 1978 and served in the House until he was elected to the Senate in 1986.
Daschle recently authored a book on healthcare titled “Critical: What We Can Do About the Health-Care Crisis.”
Source: CNN PoliticalTicker
WASHINGTON (Reuters) – President-elect Barack Obama has chosen former U.S. Senate Democratic leader Tom Daschle to be Health and Human Services secretary, news media reported on Wednesday, citing sources close to Obama’s transition team.
Daschle, of South Dakota, was an early supporter of Obama’s, encouraging the first-term senator from Illinois to make his presidential run.
He currently serves as the head of Obama’s health-care policy group as the president-elect prepares to take office on January 20.
His appointment was reported by CNN and Roll Call, the Capitol Hill newspaper.
Daschle served as the top Democrat in the Senate between 1994 and 2004, and was as majority leader when Democrats controlled the chamber between 2001 and 2003. He was elected to the Senate in 1986 and before that served eight years in the House of Representatives.
Since losing his re-election bid, Daschle has worked as a public-policy advisor for the law firm Alston and Bird.
He was not immediately available for comment.
Daschle was reported to be a candidate for Obama’s chief of staff before that job went to Illinois Rep. Rahm Emanuel.
Though Bill Richards might be very good for relations with South America. Although I like Clinton’s stance on dealing with the Arabs on oil ~ when she say Bush begging the Arabs to lower the price that this was his administration’s energy plan. Then we have to remember that Hillary’s big thing is health ~ she might better serve here.
Andrea Mitchell has a huge scoop — or a big red herring.
The part that really jumps out is the secret trip to Chi-town.
The Clinton camp –which has shot down these kinds of reports before — isn’t denying (read after excerpt):
- Two Obama advisers have told NBC News that Hillary Clinton is under consideration to be secretary of state. Would she be interested? Those who know Clinton say possibly. But her office says that any decisions about the transition are up to the president-elect and his team.
- Clinton was seen taking a flight to Chicago today, but an adviser says it was on personal business. It is unknown whether she had any meeting or conversation with Obama while there.
- Other Democrats known to want the State Department post are Sen. John Kerry and Gov. Bill Richardson. A possible compromise choice would be former Sen. Tom Daschle.
Clinton, who ridiculed Obama during the primaries as inexperienced on foreign affairs, has previously poo-pooed SoS chatter.
Clinton spokesman Philippe Reines: “[A]ny speculation about cabinet or other administration appointments is really for President-Elect Obama’s transition team to address.”
The first Obamaaide we got on the phone wouldn’t confirm or deny.
WASHINGTON (CNN) – President-elect Barack Obama could reverse some of President Bush’s most controversial executive orders, including restrictions on embryonic stem cell research, shortly after taking office in January.
Two other executive orders from Bush — one dealing with a so-called “gag” order on international aid organizations regarding abortion, the other with oil and gas drilling on federal lands — also are receiving increased scrutiny.
Obama’s transition team is reviewing hundreds of Bush’s executive orders, according to John Podesta, Obama’s transition co-chair.
New presidents often use executive orders to put their stamp on Washington quickly. Unlike laws, which require months to complete and the consent of Congress, presidents can use their executive authority to order federal agencies to implement current policies.
“Much of what a president does, he really has to do with the Congress — for example, budgeting, legislation on policy — but executive actions are ones where the president can act alone,” said Martha Kumar of the White House Transition Project, a nonpartisan group established to help new presidential administrations.
Source: CNN
This was an historic, transformational election. The American people have voted overwhelmingly for change. Americans of all different backgrounds from all over this nation have sent a clear message: it is time to create a new American Dream.
Election Videos: ER stars along to help get out the vote
Find out more at the SEIU on healthcare
While Americans eagerly vote for the next president, here’s a sobering reminder: As of Tuesday, George W. Bush still has 77 days left in the White House — and he’s not wasting a minute.
President Bush’s aides have been scrambling to change rules and regulations on the environment, civil liberties and abortion rights, among others — few for the good. Most presidents put on a last-minute policy stamp, but in Mr. Bush’s case it is more like a wrecking ball. We fear it could take months, or years, for the next president to identify and then undo all of the damage.
Here is a look — by no means comprehensive — at some of Mr. Bush’s recent parting gifts and those we fear are yet to come.
CIVIL LIBERTIES We don’t know all of the ways that the administration has violated Americans’ rights in the name of fighting terrorism. Last month, Attorney General Michael Mukasey rushed out new guidelines for the F.B.I. that permit agents to use chillingly intrusive techniques to collect information on Americans even where there is no evidence of wrongdoing.
Agents will be allowed to use informants to infiltrate lawful groups, engage in prolonged physical surveillance and lie about their identity while questioning a subject’s neighbors, relatives, co-workers and friends. The changes also give the F.B.I. — which has a long history of spying on civil rights groups and others — expanded latitude to use these techniques on people identified by racial, ethnic and religious background.
The administration showed further disdain for Americans’ privacy rights and for Congress’s power by making clear that it will ignore a provision in the legislation that established the Department of Homeland Security. The law requires the department’s privacy officer to account annually for any activity that could affect Americans’ privacy — and clearly stipulates that the report cannot be edited by any other officials at the department or the White House.
The Justice Department’s Office of Legal Counsel has now released a memo asserting that the law “does not prohibit” officials from homeland security or the White House from reviewing the report. The memo then argues that since the law allows the officials to review the report, it would be unconstitutional to stop them from changing it. George Orwell couldn’t have done better.
THE ENVIRONMENT The administration has been especially busy weakening regulations that promote clean air and clean water and protect endangered species.
Mr. Bush, or more to the point, Vice President Dick Cheney, came to office determined to dismantle Bill Clinton’s environmental legacy, undo decades of environmental law and keep their friends in industry happy. They have had less success than we feared, but only because of the determined opposition of environmental groups, courageous members of Congress and protests from citizens. But the White House keeps trying.
Mr. Bush’s secretary of the interior, Dirk Kempthorne, has recently carved out significant exceptions to regulations requiring expert scientific review of any federal project that might harm endangered or threatened species (one consequence will be to relieve the agency of the need to assess the impact of global warming on at-risk species). The department also is rushing to remove the gray wolf from the endangered species list — again. The wolves were re-listed after a federal judge ruled the government had not lived up to its own recovery plan.
In coming weeks, we expect the Environmental Protection Agency to issue a final rule that would weaken a program created by the Clean Air Act, which requires utilities to install modern pollution controls when they upgrade their plants to produce more power. The agency is also expected to issue a final rule that would make it easier for coal-fired power plants to locate near national parks in defiance of longstanding Congressional mandates to protect air quality in areas of special natural or recreational value.
Interior also is awaiting E.P.A.’s concurrence on a proposal that would make it easier for mining companies to dump toxic mine wastes in valleys and streams.
And while no rules changes are at issue, the interior department also has been rushing to open up millions of acres of pristine federal land to oil and gas exploration. We fear that, in coming weeks, Mr. Kempthorne will open up even more acreage to the commercial development of oil shale, a hugely expensive and environmentally risky process that even the oil companies seem in no hurry to begin. He should not.
Soon after the election, Michael Leavitt, the secretary of health and human services, is expected to issue new regulations aimed at further limiting women’s access to abortion, contraceptives and information about their reproductive health care options.
Existing law allows doctors and nurses to refuse to participate in an abortion. These changes would extend the so-called right to refuse to a wide range of health care workers and activities including abortion referrals, unbiased counseling and provision of birth control pills or emergency contraception, even for rape victims.
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The administration has taken other disturbing steps in recent weeks. In late September, the I.R.S. restored tax breaks for banks that take big losses on bad loans inherited through acquisitions. Now we learn that JPMorgan Chase and others are planning to use their bailout funds for mergers and acquisitions, transactions that will be greatly enhanced by the new tax subsidy.
One last-minute change Mr. Bush won’t be making: He apparently has decided not to shut down the prison in Guantánamo Bay, Cuba — the most shameful symbol of his administration’s disdain for the rule of law.
Mr. Bush has said it should be closed, and his secretary of state, Condoleezza Rice, and his secretary of defense, Robert Gates, pushed for it. Proposals were prepared, including a plan for sending the real bad guys to other countries for trial. But Mr. Cheney objected, and the president has refused even to review the memos. He will hand this mess off to his successor.
We suppose there is some good news in all of this. While Mr. Bush leaves office on Jan. 20, 2009, he has only until Nov. 20 to issue “economically significant” rule changes and until Dec. 20 to issue other changes. Anything after that is merely a draft and can be easily withdrawn by the next president.
Unfortunately, the White House is well aware of those deadlines.
2008 Presidential Candidate Comparison
Here’s a look at the candidates’ positions on several key issues. For more information, visit www.nea.org/educationvotes
Click to Enlarge
Someone else said that with the money we are spending in Iraq – we could put solar panels on every roof that feed into the grid (those who have had panels hooked up in this way report bills as low as $5/month). It would take a lot of convincing to tell people that the war in Iraq is not for oil – one, there’s a horrible human tragedy just down the road in Darfur – and no one is rushing to restore order in that region. So what we are doing / allowing the few to decide that we are going to go to war for oil (read democracy), so that a few oil companies can continue to make money from a global economy that runs on oil – something that we no longer need to do.
I was very interested in what Barack Obama said about, the inventions sitting in people garages. People are driving around now with prototype magnetic/electric hybrid motors. (If we are not careful Japan is going to so whop our asses on this one!) But we also have these inventors who have working magnetic motors in the States. We now have electric cars which are more powerful than gas guzzlers – accelerating from 0 -112 mph in 11 secs, beating out any Porsche. These ‘top guys’ have made their money of the war and the oil, but let them have it – because the real currency – the currency of the future is in technological advancements – and this is where we are just beginning. Imaging 100 years from now still driving around in one of these inefficient gas guzzling cars – because some one in the oil industry ‘needed’ to continue to make money – their profits would have ‘gone down’ if we were to change technology. It’s the case for the oil lamp vs. the light bulb.
Hello!!
See magnetic and electric cars and bikes here.
McCain and Palin are motioning for a war in Georgia (near Russia ~ that one!), but that’s all about a oil/ gas pipeline. Palin has stated that if they are elected McCain would place her in charge of energy, and she has stated that ‘we can drill our way out of our difficulties’. This is like the brain dead plan for the future – a future without vision. And what’s worst the experts are saying that they have sunk test wells around ANWR – and through technology they are able to check the area within its perimeter – and the findings are not all that were hoped. The oil leaving Alaska through the pipeline has halved in so many years. If elected it is likely that Palin would create an energy policy based on unsubstantiated facts. She would lead us on a wild moose chase.
http://www.whatwecouldhavedonewiththemoney.com/
KNOXVILLE, Tenn. — When the Sunday morning political pundits began talking last year about the tab for the war in Iraq hitting $1 trillion, Rob Simpson sprang from his sofa in indignation.
“Why aren’t people outraged about this? Why aren’t we hearing about it?” Simpson said. And then it came to him: “Nobody knows what a trillion dollars is.”
The amount _ $1,000,000,000,000 _ was just too big to comprehend.
So Simpson, 51, decided to embark “on an unusual but intriguing research project” to put the dollars and cents of the war into perspective. He hired some assistants and spent 12 months immersed in economic data and crunching numbers.
The result: a slim but heavily annotated paperback released, “What We Could Have Done With the Money: 50 Ways to Spend the Trillion Dollars We’ve Spent on Iraq.”
Simpson is no geopolitical, macro-economic, inside-the-Beltway expert. He’s an armchair analyst and creative director for an advertising agency, a former radio announcer and music critic in Ontario and a one-time voiceover actor.
His alternative spending choices reflect his curiosity and wit.
He calculates $1 trillion could pave the entire U.S. interstate highway system with gold _ 23.5-karat gold leaf. It could buy every person on the planet an iPod. It could give every high school student in the United States a free college education. It could pay off every American’s credit card. It could buy a Buick for every senior citizen still driving in the United States.
“As I started exploring, I was really taken aback by some of the things that can be done, both the absurd and the practical,” Simpson said.
America could the double the 663,000 cops on the beat for 32 years. It could buy 16.6 million Habitat for Humanity houses, enough for 43 million Americans.
Now imagine investing that $1 trillion in the stock market _ perhaps a riskier proposition today than when Simpson finished the book _ to make it grow and last longer. He used an accepted long-term return on investment of 9 percent annually, with compounding interest.
The investment approach could pay for 1.9 million additional teachers for America’s classrooms, retrain 4 million workers a year or lay a foundation for paying Social Security benefits in 65 years to every child born in the United States, beginning today.
It’s too recent to make Simpson’s list, but that $1 trillion could also have paid for the Bush administration’s financial bailout plan, with $300 billion to spare. It might not be enough, however, to pay for the war in Iraq. Nobel Laureate Joseph Stiglitz has recently upped his estimate of the war’s cost to $3 trillion.
Simpson created a Web site companion to his book that lets you go virtual shopping with a $1 trillion credit card. Choices range from buying sports franchises to theme parks, from helping disabled veterans to polar bears.
Click on Air Force One, the president’s $325 million airplane. The program asks: “Quantity?”
“At one point we couldn’t find anybody who actually stuck with it long enough to spend $1 trillion,” Simpson said. “It will wear you out.”
Source: HP
So John McCain doesn’t want you to enjoy the same kind of health care plan he enjoys as a Federal employee ~ that ain’t right!!
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Kay Hagan for U.S. Senate (North Carolina) |
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| As a state Senator in North Carolina, Kay Hagan has been an effective leader in the fight for better public schools and fiscal responsibility. Hagan is taking on incumbent Sen. Elizabeth Dole. If elected, Hagan will fight for sustainable energy, access to health care and more in the Senate. Hagan is in a tight race with an opponent who knows how to raise a lot of money. However, it’s one of the most competitive Senate races for a Democratic challenger. Can you pitch in to help flip this seat? (FEC ID: C00440859) |
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Jeff Merkley for U.S. Senate (Oregon) |
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| Jeff Merkley is running for Senate against Gordon Smith. Merkley is the Democratic Speaker of the House in Oregon. The Oregonian called Jeff’s session as Speaker, “Oregon’s most productive in a generation.” Merkley is pro-choice, pro-environment, pro-worker and supports an exit from Iraq. His opponent, Gordon Smith, was once known as the Senator with the “golden putter.” (FEC ID: C00437277) |
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Jim Martin for U.S. Senate (Georgia) |
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| This is an exciting race that is tightening up as we speak. Martin is a Vietnam veteran running against conservative Republican, Saxby Chambliss. Chambliss won his seat by smearing another Vietnam veteran, Max Cleland in one of the ugliest races of the last eight years. Martin wants to cut taxes for the middle class, increase consumer protections and end corporate welfare. He also opposed the Wall Street bailout. Can you chip in to help him win? (FEC ID: C00447714) |
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Betsy Markey for Congress (Colorado’s 4th District) |
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| Betsy Markey is running against one of the most conservative members of the House–Marilyn Musgrave. Musgrave is famous for leading the charge for a Constitutional amendment to bar any recognition of same-sex marriage or “legal incidents thereof.” Markey is unequivocal about the need to end the war in Iraq and wants to expand access to affordable healthcare for all Americans. Can you chip in to help her win? (FEC ID: C00436063) |
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Fifteen days before the election, serious gaps remain in the public’s knowledge about the health of the presidential and vice-presidential nominees. The limited information provided by the candidates is a striking departure from recent campaigns, in which many candidates and their doctors were more forthcoming.
In past elections, the decisions of some candidates for the nation’s top elected offices to withhold health information turned out to have a significant impact after the information came to light. This year, the health issue carries extraordinary significance because two of the four nominees have survived potentially fatal medical problems that could recur.
If elected, Senator John McCain of Arizona, 72, the Republican nominee, would be the oldest man to be sworn in to a first term as president and the first cancer survivor to win the office. The scars on his puffy left cheek are cosmetic reminders of the extensive surgery he underwent in 2000 to remove a malignant melanoma.
Last May, his campaign and his doctors released nearly 1,200 pages of medical information, far more than the three other nominees. But the documents were released in a restricted way that leaves questions, even confusion, about his cancer.
A critical question concerns inconsistencies in medical opinions about the severity of his melanoma; if the classification of his melanoma is more severe, it would increase the statistical likelihood of death from a recurrence of the cancer.
Senator Joseph R. Biden Jr. of Delaware, 65, the Democratic vice-presidential nominee, had emergency surgery in 1988 for an aneurysm in an artery in his brain and elective surgery for a second one. His campaign released 49 pages of medical records to The New York Times late last week showing that he was healthy, but the documents did not indicate whether he had had a test in recent years to detect any new aneurysm.
The two other nominees are younger and apparently in good health, but less is known about their medical history. Senator Barack Obama of Illinois, 47, the Democratic presidential nominee, released a one-page, undated letter from his personal physician in May stating that he was in “excellent” health. Late last week, his campaign released the results of standard laboratory tests and electrocardiograms from his checkups in June 2001, November 2004 and January 2007. The findings were normal.
Gov. Sarah Palin of Alaska, 44, Mr. McCain’s running mate, has released no medical information.
There may be no serious problems with the health of any of the nominees. But absent fuller disclosure, there is no way for the electorate to know.
The health of the four nominees is a matter of concern because in the past a number of candidates, and in some cases their doctors and aides, have distorted, kept secret or spoken about the facts only at the last minute when medical events forced the issue. Examples include Senator Thomas F. Eagleton (depression), Senator Paul E. Tsongas (cancer), Senator Bill Bradley (heart rhythm abnormality) and, as a vice-presidential nominee, Dick Cheney (heart disease).
I am a physician who has covered the health of presidential candidates for 36 years. Since 1980, The Times has made it a practice to question nominees for president and other high political offices and, with their permission, their doctors about their health.
The Times has requested such interviews with Mr. Obama since last spring and with Mr. McCain and his doctors since March 2007. None were granted. More recently, The Times sent letters to all four nominees requesting interviews about their health with them and their doctors. None agreed.
The candidates’ health has drawn little attention for most of this long campaign season despite the importance of the issue. But since Mr. McCain selected Ms. Palin as his running mate in August, questions about his health have intensified. In recent weeks, more than 2,700 physicians have signed a petition that ran as an advertisement demanding that Mr. McCain fully release his health records; the petition is sponsored by Brave New Films, the company led by Robert Greenwald, a Hollywood filmmaker who has contributed $2,250 to Democratic candidates and has made a number of anti-McCain videos. Beyond the advertisement, Mr. McCain’s health has become the subject of both speculation and distortion on the Internet and other media.
The following is a summary of the publicly known medical information about all four nominees and the outstanding questions about each.
John McCain
The scars on John McCain’s puffy left cheek are reminders of the extensive surgery he underwent in 2000 to remove a malignant melanoma.
Mr. McCain’s difficulty raising his arms and his sometimes awkward gait are remnants of severe, untreated injuries he suffered in Vietnam. Mr. McCain, a Navy pilot, broke both arms and his right knee when his jet was shot down over North Vietnam in 1967. He experienced additional wounds while being tortured during his five and a half years as a prisoner of war. Mr. McCain may eventually need joint replacements, according to his doctor at the Mayo Clinic in Scottsdale, Ariz.
Mr. McCain has released more details about his health than the other three nominees, though he has done so in a phased way and has apparently not agreed to any extensive interviews about his health. A handful of reporters were allowed to view his records during his bid for the 2000 Republican presidential nomination. Another group of reporters were permitted to see newer records last May. By not allowing reporters to interview him or his doctors extensively about his entire medical history, he has made it impossible to get a complete picture of his diagnoses and treatment.
In 1999, early in his first run for the presidency, Mr. McCain allowed a small number of reporters, including me, to review an estimated 1,500 pages of his medical records without photocopying or recording the information.
In doing so, Mr. McCain gave the public its broadest look at the psychological profile of a presidential candidate. He released psychological records about him that were amassed as part of a Navy project to gauge the health of former prisoners of war. Assessments were based on standard psychological tests and what Mr. McCain told his doctors after his release. The records mentioned that in 1968, about eight months after his capture and after some particularly brutal beatings from his North Vietnamese captors, Mr. McCain attempted suicide, trying to hang himself with his shirt.
The records and his doctors, whom I interviewed with the senator’s permission in 1999, said he had never been given a diagnosis of a mental health disorder or treated at the project’s center for a mental health disorder.
The records also showed that a surgeon removed a melanoma from Mr. McCain’s left shoulder in 1993. Melanomas can be a far more deadly form of skin cancer than the more common basal cell and other types.
In early August 2000, just as Mr. McCain’s rival George W. Bush was about to receive the Republican presidential nomination, Dr. John F. Eisold, the attending physician at the United States Capitol, detected two more melanomas, Mr. McCain’s second and third.
One on Mr. McCain’s left arm was determined to be the least risky type, in situ. But the one on his left temple was dangerous.
A few days after detection of the melanomas, Mr. McCain sought care for them at the Mayo Clinic in Scottsdale. Mr. McCain’s campaign said this year that the left-temple melanoma was 2.2 millimeters at its thickest part and graded as Stage IIA on a scale in which Stage IV is the worst. Stage II meant that the melanoma had not spread into the lymph nodes. The number of melanomas is less significant than the thickness measured in the pathology assessment of any one of them.
Mr. McCain underwent extensive surgery on his face and neck for the melanoma on Aug. 19, 2000. Surgeons removed more than 30 lymph nodes, and pathologists then determined that all of them were cancer free.
In March 2007, as Mr. McCain was making his second bid for the Republican nomination, The Times began asking his campaign for permission to speak with the senator and his doctors, citing the history of such interviews.
On May 6, 2008, Jill Hazelbaker, a McCain spokeswoman, denied the requests, writing in an e-mail message that The Times was “not at the top of the list” and including a link to a Times editorial that had criticized Mr. McCain for not disclosing health information and Senator Hillary Rodham Clinton of New York for not disclosing financial records.
On May 23, Mr. McCain allowed a small pool of journalists, including three doctor-reporters, though none from The Times, to spend three hours reviewing a newer set of his Mayo Clinic records. That set, 1,173 pages, included records from 2000 to 2008 but none of the records made available in 1999. Again, the campaign did not allow the journalists to photocopy any documents.
Mr. McCain’s Mayo Clinic doctors answered selected reporters’ questions by telephone, but only for 45 minutes instead of the scheduled two hours. The McCain campaign did not allow New York Times reporters to ask questions in the teleconference.
The clinic doctors said that Mr. McCain was in good health and that no medical reason precluded him from fulfilling all the duties of president.
The doctors said that a fourth melanoma they detected on the left side of his nose in 2002 was also in situ, the least dangerous type. All four melanomas that Mr. McCain experienced were primary, or new, and there was no evidence that any of them had spread, the doctors said.
However, the reporters’ summary cited a report dated Aug. 9, 2000, from two pathologists at the Armed Forces Institute of Pathology in Washington who examined a biopsy of the melanoma taken from Mr. McCain’s left temple a few days earlier.
The Armed Forces pathologists suggested that the left-temple melanoma had spread from another melanoma, known as a metastasis or satellite lesion. “The vertical orientation of this lesion,” the report said, “with only focal epidermal involvement above it is highly suggestive of a metastasis of malignant melanoma and may represent a satellite metastasis of S00-9572-A,” which is the “skin, left temple, lateral” biopsy.
The pool report was by nature unable to provide a complete portrait of Mr. McCain’s recent medical history. It left several questions, including about the number of biopsies and when they were done. On Aug. 18, 2000, Dr. John D. Eckstein, Mr. McCain’s personal physician at the Mayo Clinic in Scottsdale, noted in Mr. McCain’s records that there were two biopsies of the left temple. Dr. Eckstein’s note did not say where and when the biopsies were performed. The Armed Forces report cited one biopsy, so presumably a second was performed in Scottsdale. The Armed Forces pathologists said a melanoma had developed over a skin scar whose origin was unclear.
A skin lesion, not one of the four melanomas, had been removed from Mr. McCain’s left temple in 1996 and interpreted as being benign; some experts have speculated that it might have been misdiagnosed, and thus the origin of the 2000 melanoma.
The Armed Forces pathologists did not speak in the teleconference in May 2008, and questions raised by their report have remained unanswered. The selected reporters did not ask about that report, and the Mayo Clinic doctors did not discuss it. A complete Mayo pathology report was apparently not included in the pool summary.
In interviews, several melanoma experts questioned why the Mayo Clinic doctors had performed such extensive surgery, because the operation was usually reserved for treatment of Stage III melanoma, not Stage IIA.
On Aug. 18, 2000, the day before Mr. McCain’s operation, his surgeon, Dr. Michael L. Hinni, wrote in the records that he planned to do the extensive operation because of the size and location of Mr. McCain’s melanoma. In the teleconference in May 2008, Dr. Hinni explained that because the melanoma was two centimeters across he had to make “a 6-by-6-centimeter island of skin, a fairly sizable wound” to remove it.
If Mr. McCain’s 2000 left-temple melanoma was a metastasis, as the Armed Forces pathologists’ report suggested, it would be classified as Stage III. The reclassification would change his statistical odds for survival at 10 years from about 60 percent to 36 percent, according to a published study.
The greatest risk of recurrence of melanoma is in the first few years after detection. His age, his sex and the presence of the melanoma on his face increase the risk.
The fact that Mr. McCain has had no recurrence for eight years is in his favor. But cancer experts see the 10th anniversary as an important statistical benchmark, and that would not occur until 2010.
In May, his dermatologist at the Mayo Clinic, Dr. Suzanne M. Connolly, said in the teleconference that though there was no way to predict with certainty Mr. McCain’s chance of a recurrence, she judged it to be less than 10 percent. But melanoma is known to be quirkier than most cancers; doctors cite occasional cases in which melanomas come back after 15 or 20 years.
Melanomas can spread to various areas in the body, including the skin and any internal organ. In general, such spreading means the melanoma would not be curable. Treatment would depend in part on what organ or tissues are involved and could include additional surgery, chemotherapy, biologics, vaccines and radiation.
Many such treatments can be debilitating and impair an individual’s physical and mental stamina. If the patient was the president, the location of a recurrence and its treatment could raise the need to invoke the 25th Amendment, elevating the vice president to president, at least temporarily.
On the trail, Mr. McCain has played down concerns about his age by pointing to the vigor of his mother and her twin sister at age 96. Mr. McCain’s father died in 1981 at age 70 after a heart attack.
In the May teleconference, Dr. Eckstein said that he had not detected any memory deficits in Mr. McCain and that the senator had not reported any. Dr. Eckstein did not report whether Mr. McCain had taken any baseline cognitive tests.
Mr. McCain has kidney stones and takes a statin for high cholesterol but has no evidence of significant heart disease, his doctors said.
In making his medical information public, Mr. McCain released his confidentiality in the traditional patient-doctor relationship.
For its part, the Mayo Clinic says it agreed to yield control over all of Mr. McCain’s medical information to his campaign and to refer all questions to the campaign. Pool reporters inspected the records at a hotel near the clinic, which sent the records there under security. In the teleconference, the doctors answered questions by telephone at the clinic with no reporters present.
Dr. Eckstein, Mr. McCain’s doctor, said he understood that the campaign had released all the McCain records to the pool reporters. But a spokeswoman at the Mayo Clinic in Scottsdale, asked if the institution could verify that the campaign had released all the records to the reporters, said she did not know whether the doctors had checked to be sure.
Last week, The Times contacted the McCain campaign to fill in gaps in the medical records. Ms. Hazelbaker, the McCain spokeswoman, wrote in an e-mail message: “As you know, we disclosed over 1,200 pages of Senator McCain’s medical history to Dr. Altman’s colleagues in the press earlier this year. We also arranged a Mayo Clinic briefing with three of Senator McCain’s physicians that Dr. Altman listened to by phone. Additionally, we released a detailed document outlining his most recent physical and lab test results. It was an unprecedented level of disclosure, and Dr. Altman can look at the public document on our Web site if he wishes to do so. It was certainly more significant than the one-page doctor’s note Obama released, though I have little hope The Times will report it that way.”
Barack Obama
Barack Obama, who started smoking at least two decades ago, has had trouble quitting. Mr. Obama says he quit last year but has “bummed” cigarettes.
On May 29, six days after the McCain campaign’s disclosures about his recent health, Mr. Obama’s campaign released an undated, single-page letter from his doctor in Chicago attesting to Mr. Obama’s “excellent health.”
The six-paragraph letter from Dr. David L. Scheiner said Mr. Obama had no known medical problems that would affect his ability to serve as president. Until the release of test results last week, the letter was the only information that Mr. Obama had made public about his health.
Dr. Scheiner’s assessment was based on regularly examining Mr. Obama since March 23, 1987. Mr. Obama’s last checkup was on Jan. 15, 2007, a day before he created a presidential exploratory committee and more than a year before his campaign released the letter from Dr. Scheiner, a general internist who practices at the University of Chicago Hospitals and the Rush University Medical Center.
The letter was short, the Obama campaign said, because Mr. Obama had not had any serious health problems. The campaign declined to make Dr. Scheiner available for an interview.
Mr. Obama has had a notable medical problem: a difficulty in stopping smoking. It is not known how heavily he smoked. Dr. Scheiner wrote that Mr. Obama began smoking at least two decades ago and had made several efforts to stop. Mr. Obama has used Nicorette gum “with success,” Dr. Scheiner wrote, without defining success.
Nicorette, which contains smaller amounts of nicotine than cigarettes do, is a replacement therapy intended to ease the craving for nicotine and other withdrawal effects of cigarette smoking.
Dr. Scheiner did not say when Mr. Obama had started using Nicorette, how much he had used or for how long he had used it. Reporters have often observed him chewing it.
Mr. Obama said he quit smoking in 2007 when he began his presidential campaign. But he has “bummed” cigarettes since then, he has said.
Also, Dr. Scheiner did not provide a standard measure of smoking risk. It is known as pack years — the number of packs smoked a day multiplied by the number of years a person has smoked. The pack-year number is used to help determine a patient’s risk of developing lung cancer, heart disease and other tobacco-related ailments.
Information about Mr. Obama’s smoking is relevant because studies show that the risk of cancer and other tobacco-related serious diseases declines after an individual stops smoking, but not until then.
According to the newly released documents, in January 2007 Mr. Obama had a total cholesterol level of 173 (HDL 68 and LDL 96) and triglycerides of 44. Those levels were normal.
Sarah Palin
Nothing is known publicly about Sarah Palin’s medical history, aside from the birth of her child last April.
Nothing is known publicly about Ms. Palin’s medical history, aside from the much-discussed circumstances surrounding the birth of her fifth child last April. Ms. Palin has said that her water broke while she was at a conference in Dallas and that she flew to Anchorage, where she gave birth to her son Trig hours after landing.
Last week Maria Comella, a spokeswoman for Ms. Palin, said the governor declined to be interviewed or provide any health records.
Joseph R. Biden Jr.
Joseph R. Biden Jr. in 1988, after he had emergency surgery for an aneurysm in an artery in his brain.
In 1988, Mr. Biden was working out on a shoulder press weight machine in the Senate gym when a pain shot through his neck. On the train home to Wilmington, Del., the neck pain returned more severely. His head ached. The right side of his body went numb. A doctor later diagnosed a pinched nerve, and a pain clinic prescribed a neck brace.
Shortly thereafter, on a trip to Rochester, Mr. Biden was alone in his hotel room when he felt a sharp stab in the back of his neck and a lightning flash in his head. The rip of pain was like none he had ever experienced. Nothing Mr. Biden did, including curling up in the fetal position, relieved the pain. He lay unconscious on the floor for five hours, he wrote in his autobiography, “Promises to Keep” (Random House, 2007).
The next morning, he felt somewhat better and flew home. His wife, Jill, summoned from the school where she taught, immediately took him to a hospital. Doctors determined he had a berry-shaped bulge in an artery that was leaking blood into his brain. Such bulges, or aneurysms, can tear at any time. Ruptured aneurysms are fatal in about 50 percent of cases. Up to 20 percent of survivors remain severely disabled. A Roman Catholic priest gave Mr. Biden last rites.
After a harrowing ambulance trip to Walter Reed Army Medical Center in Washington, a team of neurosurgeons put a clip on the artery to stop the bleeding. While recuperating, he suffered a major complication: a blood clot lodged in his lung.
A few weeks later, surgeons operated on a second aneurysm on the opposite side of his brain. Though it had caused no symptoms, it still could have burst as the first one did.
Mr. Biden returned to the Senate after a seven-month absence.
Now, a question arises: Has Mr. Biden developed a new aneurysm over the last two decades that could burst?
Doctors, who long thought that berry aneurysms were a once-in-a-lifetime event, now generally believe that they can recur. About 5 percent or less of patients who have had a berry aneurysm develop new ones at the original site or elsewhere in the brain.
“Over the last two decades,” said Dr. Robert F. Spetzler of the Barrow Neurological Institute in Phoenix, “we have learned much more about aneurysms, and the fact is that when you have had one aneurysm, you are more likely to develop another one. Although the likelihood is very low, it does exist.”
Doctors’ views vary widely on what types of brain imaging tests to recommend to patients who have had a berry aneurysm and when to do them. Some conduct no tests. Others periodically conduct tests like magnetic resonance angiograms.
Mr. Biden has “recovered fully without continued effects” from the aneurysm, Dr. Eisold, the Capitol physician, said in a letter released by the campaign. Dr. Eisold, a specialist in internal medicine, has a longstanding policy not to talk to reporters about his patients, even with their permission.
The Obama-Biden campaign referred me to Dr. Matthew A. Parker, an internist in Washington, who reviewed Mr. Biden’s records and also spoke with Dr. Eisold about them. Dr. Parker said that Dr. Eisold told him that brain imaging tests were not needed now because Mr. Biden had done well for the 20 years after the aneurysm. “It is a nonissue,” Dr. Parker said Dr. Eisold told him.
Dr. Parker, who is associated with George Washington University Hospital and Sibley Memorial Hospital, said he had not treated or met with Mr. Biden and did not have a direct connection to the campaign. Federal Election Commission records show that Dr. Parker contributed the maximum, $2,300, to Mr. Obama’s presidential campaign on March 13, 2008.
The medical records released by the campaign contain a summary of Mr. Biden’s operation and hospital stay in 1988 but no notes from a neurologist or neurosurgeon since then. So it is not known whether Mr. Biden has had recent brain imaging scans or has been evaluated by a neurologist or neurosurgeon recently. Dr. Parker said he did not ask Dr. Eisold when a neurologist or neurosurgeon last examined Mr. Biden.
Four leading neurosurgeons interviewed separately in this country and Europe said that as a vice-presidential nominee, Mr. Biden should have had recent brain imaging studies to detect any new aneurysm, because if one is found he might face more neurosurgery and be out of work for weeks or longer.
“What would I do in this situation?” said Dr. Eugene S. Flamm, the chairman of the department of neurological surgery at Montefiore Medical Center in the Bronx. “I would say, get an M.R.A. and check. You can’t just play the statistics.”
Doctors caring for political leaders and other prominent people often face difficulty in ordering tests that might clarify a situation for such patients but that are not recommended for all patients.
Dr. Parker said, “Some people will say, well, given the high-profile nature of the situation, we should do the test to be sure.” But, he added, “that is not necessarily wise.”
Among the reasons is a desire to avoid anxiety among patients and because doctors may not know what to do about an equivocal finding.
Dr. Parker said that even when he “pressed Dr. Eisold on the very same thing, given the circumstances” with Mr. Biden, Dr. Eisold “was very definitive about” not doing brain scan tests now.
The question of an aneurysm aside, the documents show Mr. Biden to have relatively minor health problems, including chronic sinusitis and allergies. He has an enlarged prostate, but a biopsy showed no evidence of cancer. With the help of a statin, he has normal cholesterol levels: 173 (HDL 47 and LDL 98) and triglycerides of 133.
In Summary
All in all, the gaps and paucity of information leave the electorate with insufficient information to fully judge the health of the nominees. The information that has been released is a retreat from the approach that most campaigns took over the last 10 elections.
In an earlier time, there was a kind of gentlemen’s agreement between officials and the news media that permitted serious health conditions to be played down or kept secret.
Franklin D. Roosevelt was crippled by polio more than a decade before he became president and, by his fourth term, he had developed serious heart disease, but the public was largely shielded from the profound effects. And while much was made of John F. Kennedy’s bad back and the rocking chair that gave him relief, it was only in the years after his assassination that his case of Addison’s disease, a hormonal disorder, became widely known.
What might be called the modern era of disclosure arguably began in 1972, when Mr. Eagleton had to step down as the Democratic vice-presidential nominee because he had not informed his running mate, Senator George McGovern, of his history of depression.
In 1992, Mr. Tsongas, who was seeking the Democratic nomination for president, spoke to me to assure the public that he was free of non-Hodgkins lymphoma, after a bone marrow transplant in 1986. In interviews, his doctors at the Dana-Farber Cancer Institute backed his assertion that he was cancer free. But in fact the cancer had recurred, and Mr. Tsongas eventually withdrew from the race. He died two days before his first term would have ended.
Other candidates who made themselves and their doctors available include the elder George Bush, Bob Dole, Al Gore and John Kerry. A leading example of openness was Ronald Reagan, whose age, 69, had become an issue in the 1980 election. Mr. Reagan authorized his doctors to be interviewed. He also agreed to an interview himself, against the wishes of his aides, answering all my questions, including what would he do if he became senile as president.
“Resign,” he said.
Women Against McCain-Palin have released this short, emotionally blunt advertisement in which a young woman relates how Sarah Palin’s policies could have played out in her life, to her detriment.
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“I was raped, and then I got pregnant. Sarah Palin believes the government should be able to force me to carry the pregnancy to term. Sarah Palin believes that the government should make that choice. Not me. Governor Palin, I didn’t have a choice about being raped. But I should have a choice about this.”
It’s a fitting reminder of how McCain and Palin would extend the intrusive hand of government into affairs in which it should hold no sway. I’d also remind you that McCain thinks that the those who are concerned about the health and well-being of women are “extreme.” I’d remind you that when McCain and Palin disclosed Palin’s daughter’s pregnancy, they took pains to state that Bristol “made the decision on her own to keep the baby,” which makes no sense, since they do not in any way acknowledge that Bristol’s choice in the matter, matters. I’d remind you that Sarah Palin believes that rape victims should bear the cost of investigating their own cases. And I’d remind you that when asked to consider what a rape victim should do, given Sarah Palin’s antipathy to her plight, a die-hard McCain/Palin supporter said, “She should die.” All of these things are worth remembering.
Source: HP
Some voters in the latest New York Times/CBS News poll were disappointed by John McCain’s attacks and running mate choice. The poll found Barack Obama was supported by majorities of men and independents.
Backfired
The McCain campaign’s recent angry tone and sharply personal attacks on Senator Barack Obama appear to have backfired and tarnished Senator John McCain more than their intended target, the latest New York Times/CBS News poll has found.
McCain Campaign Attacks
After several weeks in which the McCain campaign unleashed a series of strong political attacks on Mr. Obama, trying to tie him to a former 1960s radical, among other things, the poll found that more voters see Mr. McCain as waging a negative campaign than Mr. Obama. Six in 10 voters surveyed said that Mr. McCain had spent more time attacking Mr. Obama than explaining what he would do as president; by about the same number, voters said Mr. Obama was spending more of his time explaining than attacking.
Election Supposition
Over all, the poll found that if the election were held today, 53 percent of those determined to be probable voters said they would vote for Mr. Obama and 39 percent said they would vote for Mr. McCain.
Debate
The findings come as the race enters its final three weeks, with the two candidates scheduled to hold their third and last debate on Wednesday night, and as separate polls in critical swing states that could decide the election give Mr. Obama a growing edge. But wide gaps in polls have historically tended to narrow in the closing weeks of the race.
Opinions
Voters who said their opinions of Mr. Obama had changed recently were twice as likely to say they had grown more favorable as to say they had worsened. And voters who said that their views of Mr. McCain had changed were three times more likely to say that they had worsened than to say they had improved.
Gov. Sarah Palin Choice
The top reasons cited by those who said they thought less of Mr. McCain were his recent attacks and his choice of Gov. Sarah Palin of Alaska as his running mate. (The vast majority said their opinions of Mr. Obama of Illinois, the Democratic nominee, and Mr. McCain of Arizona, the Republican nominee, had remained unchanged in recent weeks.) But in recent days, Mr. McCain and Ms. Palin have scaled back their attacks on Mr. Obama, although Mr. McCain suggested he might aggressively take on Mr. Obama in Wednesday’s debate.
Confidence
With the election unfolding against the backdrop of an extraordinary economic crisis, a lack of confidence in government, and two wars, the survey described a very inhospitable environment for any Republican to run for office. More than 8 in 10 Americans do not trust the government to do what is right, the highest ever recorded in a Times/CBS News poll. And Mr. McCain is trying to keep the White House in Republican hands at a time when President Bush’s job approval rating is at 24 percent, hovering near its historic low.
Obama vs. McCain
While the poll showed Mr. Obama with a 14 percentage-point lead among likely voters in a head-to-head matchup with Mr. McCain, when Ralph Nader and Bob Barr, the Libertarian candidate, were included in the question, the race narrowed slightly, with 51 percent of those surveyed saying that they were supporting Mr. Obama and 39 percent supporting Mr. McCain, with Mr. Nader getting the support of 3 percent and Mr. Barr 1 percent. Other national polls have shown Mr. Obama ahead by a smaller margin.
Members of Congress
The poll suggested that the overwhelming anxiety about the economy and distrust of government have created a potentially poisonous atmosphere for members of Congress. Only 43 percent of those surveyed said that they approved of their own representative’s job performance, which is considerably lower than approval ratings have been at other times of historic discontent. By way of comparison, just before the Democrats lost control of Congress in 1994, 56 percent of those polled said that they approved of the job their representative was doing.
Republican vs. Democrat Rule
And after nearly eight years of increasingly unpopular Republican rule in the White House, 52 percent of those polled said that they held a favorable view of the Democratic Party, compared with 37 percent who said they held a favorable view of the Republican Party. Voters said they preferred Democrats to Republicans when it came to questions about who would better handle the issues that are of the greatest concern to voters — including the economy, health care and the war in Iraq.
Nationwide Telephone Poll
The nationwide telephone poll was conducted Friday through Monday with 1,070 adults, of whom 972 were registered voters, and it has a margin of sampling error of plus or minus three percentage points for both groups.
Past Associations
After several weeks in which the McCain campaign sought to tie Mr. Obama to William Ayers, a founder of the Weather Underground terrorism group, 64 percent of voters said that they had either read or heard something about the subject. But a majority said they were not bothered by Mr. Obama’s background or past associations. Several people said in follow-up interviews that they felt that Mr. McCain’s attacks on Mr. Obama were too rooted in the past, or too unconnected to the nation’s major problems.
Issues vs. Attacks
“What bothers me is that McCain initially talked about running a campaign on issues and I want to hear him talk about the issues,” said Flavio Lorenzoni, a 59-year-old independent from Manalapan, N.J. “But we’re being constantly bombarded with attacks that aren’t relevant to making a decision about what direction McCain would take the country. McCain hasn’t addressed the real issues. He’s only touched on them very narrowly. This is a time when we need to address issues much more clearly than they ever have been in the past.”
Independents
The poll found that Mr. Obama is now supported by majorities of men and independents, two groups that he has been fighting to win over. And the poll found, for the first time, that white voters are just about evenly divided between Mr. McCain and Mr. Obama, who, if elected, would be the first black president. The poll found that Mr. Obama is supported by 45 percent of white voters — a greater percentage than has voted for Democrats in recent presidential elections, according to exit polls.
Favorability
Mr. McCain was viewed unfavorably by 41 percent of voters, and favorably by 36 percent. Ms. Palin’s favorability rating is now 32 percent, down 8 points from last month, and her unfavorable rating climbed nine percentage points to 41 percent. Mr. Obama’s favorability rating, by contrast, is now at 50 percent, the highest recorded for him thus far by The Times and CBS News.
Prepared
There were still some strong findings for Mr. McCain. Sixty-four percent of voters polled said Mr. McCain, 72, was well-prepared for the presidency, which has been a central theme of his campaign. Fifty-one percent said Mr. Obama, 47, was.
Temperament
But roughly 7 in 10 voters said Mr. Obama had the right kind of temperament and personality to be president; just over half said the same of Mr. McCain.
Enthusiasm
Mr. Obama’s supporters continued to be more enthusiastic about him than Mr. McCain’s supporters, the poll found, and more of those surveyed said they had confidence in Mr. Obama than in Mr. McCain to make the right decisions about the economy and health care. And while more than 6 in 10 said Mr. Obama understood the needs and problems of people like them, more than half said Mr. McCain did not.
Source: NYT
Obama health care plan has one up it’s sleeve that has not been put forward in the McCain plan and that is – mass screenings for illnesses before they arise – by checking the population for illnesses – and providing treatment at the early stages – or encouraging people to alter their lifestyles – could mean a massive reduction in the overall cost of healthcare.
In addition McCain’s plan makes no mention of dealing with the insurance industry on non-payment or refusing to insure those with pre-existing conditions.
Under Obama’s plan there will be a kind of insurance pool – where individuals and business owners could buy into – which together would lower the rate people pay.
McCain's Healthcare Plan - Cut Medicaid/Medicare, introduce a health benefit tax on employers contributions, then offer tax credit to buy insurance - could be described as juggling and it does not cover as many people as Obama's plan.
John McCain would pay for his health plan with major reductions to Medicare and Medicaid, a top aide said, in a move that independent analysts estimate could result in cuts of $1.3 trillion over 10 years to the government programs.
The Republican presidential nominee has said little about the proposed cuts, but they are needed to keep his health-care plan “budget neutral,” as he has promised. The McCain campaign hasn’t given a specific figure for the cuts, but didn’t dispute the analysts’ estimate.
In the months since Sen. McCain introduced his health plan, statements made by his campaign have implied that the new tax credits he is proposing to help Americans buy health insurance would be paid for with other tax increases.
But Douglas Holtz-Eakin, Sen. McCain’s senior policy adviser, said Sunday that the campaign has always planned to fund the tax credits, in part, with savings from Medicare and Medicaid. Those government health-care programs serve seniors, poor families and the disabled. Medicare spending for the fiscal year ended Sept. 30 is estimated at $457.5 billion.
Mr. Holtz-Eakin said the Medicare and Medicaid changes would improve the programs and eliminate fraud, but he didn’t detail where the cuts would come from. “It’s about giving them the benefit package that has been promised to them by law at lower cost,” he said.
Both Sen. McCain and his Democratic rival, Sen. Barack Obama, have recently sought to refocus on health care. The issue once ranked at the top of voters’ domestic concerns, but has in recent months been eclipsed by energy and the economy.
Sen. McCain charges that the Obama plan, which would create a government-run marketplace in which people could buy coverage, would lead to government-run health care. Sen. Obama charges that Sen. McCain’s plan would leave many people unable to get insurance.
Sen. Obama’s campaign turned up the volume in a major push on health care over the weekend with two days of attacks from the stump, four new television advertisements, a series of health-care events across the country and fliers to voters’ homes in swing states.
Sen. Obama is focused on Sen. McCain’s plan to offer a new tax credit of $2,500 per person and $5,000 per family toward insurance premiums. This would allow people to buy health coverage on the open market, where they may have more choices and might look for a better bargain.
In exchange, the government would begin taxing the value of health benefits people get through work. If an employer spends $10,000 to buy a worker health insurance, the worker would pay taxes on that money.
“It’s a shell game,” Sen. Obama told an outdoor rally of 28,000 people Sunday in Asheville, N.C. “Sen. McCain gives you a tax credit with one hand — but raises your taxes with the other.”
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The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The plan would allow as many as five million more people to have insurance, it estimates.
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Sen. Obama also would rely on some Medicare savings to pay for his health-care plan, which would offer subsidies to help consumers pay for premiums. The Tax Policy Center estimates that his plan would cost $1.6 trillion over 10 years and cover 34 million more people.
Source: WSJ
Good article – one of the main points is Palin’s coldness or detachment from emotion. You can see an example of this in her answer here – when she was asked on abortion and what if her teenage daughter was raped and become pregnant – it is interesting to see the difference between her answer and the answer given by the others – responding to the same question.
This article makes reference to Palin’s answer in the VP debate – to what if the worst happened – to your respective – presidential running mates – when it was Palin’s turn – through the next two statements she was smiling – glee she seemed hard pressed to control – the writer calls it weird – I’m glad I’m not the only one who found it more than strange.
More when she was asked the question in the debate on what would be an acceptable trigger for use of a nuclear weapon – Palin was way to flippant for me — nervousness about Palin – might be the least of out problems.
See OFKR take on the VP Debate here.
SARAH PALIN’S post-Couric/Fey comeback at last week’s vice presidential debate was a turning point in the campaign. But if she “won,” as her indulgent partisans and press claque would have it, the loser was not Joe Biden. It was her running mate. With a month to go, the 2008 election is now an Obama-Palin race — about “the future,” as Palin kept saying Thursday night — and the only person who doesn’t seem to know it is Mr. Past, poor old John McCain.
To understand the meaning of Palin’s “victory,” it must be seen in the context of two ominous developments that directly preceded it. Just hours before the debate began, the McCain campaign pulled out of Michigan. That state is ground zero for the collapsed Main Street economy and for so-called Reagan Democrats, those white working-class voters who keep being told by the right that Barack Obama is a Muslim who hung with bomb-throwing radicals during his childhood in the late 1960s.
McCain surrendered Michigan despite having outspent his opponent on television advertising and despite Obama’s twin local handicaps, an unpopular Democratic governor and a felonious, now former, black Democratic Detroit mayor. If McCain can’t make it there, can he make it anywhere in the Rust Belt?
Not without an economic message. McCain’s most persistent attempt, his self-righteous crusade against earmarks, collapsed with his poll numbers. Next to a $700 billion bailout package, his incessant promise to eliminate all Washington pork — by comparison, a puny grand total of $16.5 billion in the 2008 federal budget — doesn’t bring home the bacon. Nor can McCain reconcile his I-will-veto-government-waste mantra with his support, however tardy, of the bailout bill. That bill’s $150 billion in fresh pork includes a boondoggle inserted by the Congressman Don Young, an Alaskan Republican no less.
The second bit of predebate news, percolating under the radar, involved the still-unanswered questions about McCain’s health. Back in May, you will recall, the McCain campaign allowed a select group of 20 reporters to spend a mere three hours examining (but not photocopying) 1,173 pages of the candidate’s health records on the Friday of Memorial Day weekend. Conspicuously uninvited was Lawrence Altman, a doctor who covers medicine for The New York Times. Altman instead canvassed melanoma experts to evaluate the sketchy data that did emerge. They found the information too “unclear” to determine McCain’s cancer prognosis.
There was, however, at least one doctor-journalist among those 20 reporters in May, the CNN correspondent Sanjay Gupta. At the time, Gupta told Katie Couric on CBS that the medical records were “pretty comprehensive” and wrote on his CNN blog that he was “pretty convinced there was no ‘smoking gun’ about the senator’s health.” (Physical health, that is; Gupta wrote there was hardly any information on McCain’s mental health.)
That was then. Now McCain is looking increasingly shaky, whether he’s repeating his “Miss Congeniality” joke twice in the same debate or speaking from notecards even when reciting a line for (literally) the 17th time (“The fundamentals of our economy are strong”) or repeatedly confusing proper nouns that begin with S (Sunni, Shia, Sudan, Somalia, Spain). McCain’s “dismaying temperament,” as George Will labeled it, only thickens the concerns. His kamikaze mission into Washington during the bailout crisis seemed crazed. His seething, hostile debate countenance — a replay of Al Gore’s sarcastic sighing in 2000 — didn’t make the deferential Obama look weak (as many Democrats feared) but elevated him into looking like the sole presidential grown-up.
Though CNN and MSNBC wouldn’t run a political ad with doctors questioning McCain’s medical status, Gupta revisited the issue in an interview published last Tuesday by The Huffington Post. While maintaining a pretty upbeat take on the candidate’s health, the doctor-journalist told the reporter Sam Stein that he couldn’t vouch “by any means” for the completeness of the records the campaign showed him four months ago. “The pages weren’t numbered,” Gupta said, “so I had no way of knowing what was missing.” At least in Watergate we knew that the gap on Rose Mary Woods’s tape ran 18 and a half minutes.
It’s against this backdrop that Palin’s public pronouncements, culminating with her debate performance, have been so striking. The standard take has it that she’s either speaking utter ignorant gibberish (as to Couric) or reciting highly polished, campaign-written sound bites that she’s memorized (as at the convention and the debate). But there’s a steady unnerving undertone to Palin’s utterances, a consistent message of hubristic self-confidence and hyper-ambition. She wants to be president, she thinks she can be president, she thinks she will be president. And perhaps soon. She often sounds like someone who sees herself as half-a-heartbeat away from the presidency. Or who is seen that way by her own camp, the hard-right G.O.P. base that never liked McCain anyway and views him as, at best, a White House place holder.
This was first apparent when Palin extolled a “small town” vice president as a hero in her convention speech — and cited not one of the many Republican vice presidents who fit that bill but, bizarrely, Harry Truman, a Democrat who succeeded a president who died in office. A few weeks later came Charlie Gibson’s question about whether she thought she was “experienced enough” and “ready” when McCain invited her to join his ticket. Palin replied that she didn’t “hesitate” and didn’t “even blink” — a response that seemed jarring for its lack of any human modesty, even false modesty.
In the last of her Couric interview installments on Thursday, Palin was asked which vice president had most impressed her, and after paying tribute to Geraldine Ferraro, she chose “George Bush Sr.” Her criterion: she most admires vice presidents “who have gone on to the presidency.” Hours later, at the debate, she offered a discordant contrast to Biden when asked by Gwen Ifill how they would each govern “if the worst happened” and the president died in office. After Biden spoke of somber continuity, Palin was weirdly flip and chipper, eager to say that as a “maverick” she’d go her own way.
But the debate’s most telling passage arrived when Biden welled up in recounting his days as a single father after his first wife and one of his children were killed in a car crash. Palin’s perky response — she immediately started selling McCain as a “consummate maverick” again — was as emotionally disconnected as Michael Dukakis’s notoriously cerebral answer to the hypothetical 1988 debate question about his wife being “raped and murdered.” If, as some feel, Obama is cool, Palin is ice cold. She didn’t even acknowledge Biden’s devastating personal history.
After the debate, Republicans who had been bailing on Palin rushed back to the fold. They know her relentless ambition is the only hope for saving a ticket headed by a warrior who is out of juice and out of ideas. So what if she is preposterously unprepared to run the country in the midst of its greatest economic crisis in 70 years? She looks and sounds like a winner.
You can understand why they believe that. She has more testosterone than anyone else at the top of her party. McCain and his surrogates are forever blaming their travails on others, wailing about supposed sexist and journalistic biases around the clock. McCain even canceled an interview with Larry King, for heaven’s sake, in a fit of pique at a CNN anchor, Campbell Brown.
We are not a nation of whiners, as Phil Gramm would have it, but the G.O.P. is now the party of whiners. That rebranding became official when Republican House leaders moaned that a routine partisan speech by Nancy Pelosi had turned their members against the bailout bill. As the stock market fell nearly 778 points, Barney Frank taunted his G.O.P. peers with pitch-perfect mockery: “Somebody hurt my feelings, so I will punish the country!”
Talk about the world coming full circle. This is the same Democrat who had been slurred as “Barney Fag” in the mid-1990s by Dick Armey, a House leader of the government-bashing Gingrich revolution that helped lower us into this debacle. Now Frank was ridiculing the House G.O.P. as a bunch of sulking teenage girls. His wisecrack stung — and stuck.
Palin is an antidote to the whiny Republican image that Frank nailed. Alaska’s self-styled embodiment of Joe Sixpack is not a sulker, but a pistol-packing fighter. That’s why she draws the crowds and (as she puts it) “energy” that otherwise elude the angry McCain. But she is still the candidate for vice president, not president. Americans do not vote for vice president.
So how can a desperate G.O.P. save itself? As McCain continues to fade into incoherence and irrelevance, the last hope is that he’ll come up with some new game-changing stunt to match his initial pick of Palin or his ill-fated campaign “suspension.” Until Thursday night, more than a few Republicans were fantasizing that his final Hail Mary pass would be to ditch Palin so she can “spend more time” with her ever-growing family. But the debate reminded Republicans once again that it’s Palin, not McCain, who is their last hope for victory.
You have to wonder how long it will be before they plead with him to think of his health, get out of the way and pull the ultimate stunt of flipping the ticket. Palin, we can be certain, wouldn’t even blink.
The fact that John McCain plans to the tax the insurance payment contributions that you get from your employers – fits right in with what one of his advisers on healthcare said – when he commented that if they had their way government would cease and desist from saying that anyone is not insured – but rather note where that person got their healthcare from – if a person receives their healthcare from a doctor – than this would be seen as one provider – whereas if a person got their healthcare from the emergency room (ER) – then this could also be seen as a healthcare provider – but the one of last resort. It would simply be noted.
Obama plans to work with employers to help lower insurance costs – not put a tax on it.
Under Obama’s plan it appears there is going to be some sort of insurance shake up – in order to get people insured at a reasonable rate – with a policy that looks similar to what John McCain and members of Congress already enjoy.
Here’s Obama’s new ad off the debate, touching, as we wrote last night, on the push the campaign had already begun on McCain’s healthcare plan.
This one’s airing on national cable. Obama has another ad — which I haven’t seen on line — also directly attacking McCain’s plan.
As Jonathan and I wrote:
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Obama’s aides said the campaign would key in not on something Palin said, but rather on what she didn’t: Her failure to offer a detailed defense of McCain’s plan to finance a $5,000 healthcare tax credit by
treating employers’ healthcare payments as taxable – something Democrats relish hitting both as a “radical” healthcare scheme and a tax hike.
The campaign had already decided to attack McCain’s healthcare plan, and the debate exchange will help drive that focus, they said.
“We’re on a big offensive on John McCain’s healthcare plan,” said Obama campaign manager David Plouffe. “I think Sen. Biden did a terrific job today of describing why middle class families should fear
John McCain’s health care plan. She didn’t answer the attack.”
Palin’s silence – she attacked Obama’s plan as “government run,” but didn’t return to McCain’s – was “a huge missed opportunity,” Plouffe said, “because I will assure you this: Every voter in every
battleground state is going to know that John McCain is taxing healthcare for the very first time. Twenty-one million people lose their healthcare because small businesses will drop it.”
Obama has already begun airing one ad that casts his plan as a commonsense alternative to McCain’s “extreme,” and aides said he would begin to push the issue much more intensely across battleground states.
In Missouri, for example, it will be part of a broad push to raise voters’ doubts about McCain’s healthcare plan, Obama’s Missouri State Director Buffy Wicks said. Along with the ad, expected to begin airing here soon, the campaign has planned four pieces of direct mail attacking McCain’s plan.
Source: Politico
While John McCain was giving his economic speech I actually noticed his left eye acting strangely. And you got the sense that he wasn’t well – not with the flue – but sick ~ with something. I surprised to hear people talking about it today – it directs attention to his health.
Mind you George Bush’s eyes looked pretty perturbed during his address to the nation on the current financial crisis. He deserves to be shocked –
and for that matter so does McCain – when a million homes are in foreclosure and you are saying that the economy is strong – here’s a reality check for the self styled Deregulation John.
He probably needed to suspend the campaign to slow down and get a needed medical check. That eye didn’t look good.
Out Foxing Karl Rove 
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