Month: May 2015

From labor through birth to runway ready within sixteen hours.  Fit for a Duchess.

A major difference in US prenatal-birth-postnatal health care and that offered by the NHS in the UK is the role of professional midwifes.  Through the entire process, NHS midwifes are integral participants.  For uncomplicated, vaginal deliveries, services from an obstetrician/gynecologist are limited to none.  And the NHS midwife’s duties continue after the birth and release from the hospital/clinic.

While what the NHS spends on maternity/delivery/follow-up care may be a difficult number to obtain, the alternative private care cost is defined.  As reported by The Guardian  

The duchess, who received a 10% discount on the £6,000-plus fees at the Lindo wing as this was her second birth there, was looked after by consultant obstetrician Guy Thorpe-Beeston, surgeon-gynaecologist to the royal household, assisted by Alan Farthing, the Queen’s surgeon-gynaecologist.

Apparently, it was midwives Arona Ahmed and her boss, Jacqui Dunkley-Bent, Professor of midwifery at Imperial College Healthcare NHS Trust, who together delivered the Princess. …while the team of suited male surgeons, led by Mr Guy Thorpe-Beeston, Surgeon Gynaecologist to the Royal Household, looked on.  Okay, a degree of elite privilege for the Duchess, but the actual delivery and post-birth care is the NHS standard of care.  Healthy new mothers and babies go home a few hours after the birth.

The US NIH does recommend the NHS model of care for births.  However, most US births follow the hospital/doctor model and on an aggregate basis midwifery is a minor component.  Since close to half of US births are covered by Medicaid and with the expansion of Medicaid and introduction of ACA subsidized health insurance policies (and not even factoring military and Tricare covered births), a minority of US births will be paid for by the private sector and individuals.  That’s fine (a 100% would be fine by me), but dare we ask if those public dollars are being spent wisely: maximizing the health and well-being of mothers and infants and minimizing the cost?

Medscape: The Cost of Having Baby isn’t insignificant.

Medicaid payments for all maternal and newborn care involving vaginal … childbirths were $9,131 …

That’s Medicaid.  More than the private care cost of the new UK princess.  

The aggregate US C-Section rate is 32.7% and not noticeably different for Medicaid covered births.  It’s lower, but still high, in England at 26.2%.  This suggests that midwifery managed maternal care is helpful in limiting the c-section rate, it doesn’t explain why the rate has increased so quickly in the UK and why it’s now significantly higher than it is in Nordic countries where it’s below 20% (only 6.6% in Finland and Norway, both also with low infant and maternal mortality rates).  There are numerous health related reasons why high c-section rates are problematical, but along with aggregate poorer health outcomes, they cost more.  (There’s no big mystery as to why c-section rate are high in the US and UK and low in countries like Norway and Finland.  But we don’t like to talk about what that is.)

While IMHO, dispensing with monarchies and royal families would be beneficial, they aren’t going away anytime soon and in the interim some can be helpful because commoners have long attempted to emulate “royal” standards and practices.  To their detriment for centuries on the matter of maternal and infant practices.  From Queen Eleanor of Aquitaine to Queen Mary of Teck, breastfeeding just wasn’t done.  The “Queen Mum” brought changed that.  The Duchess has followed the lead of her husband’s mother, grandmother, and great-grandmother in breastfeeding and birth delivery health care.  The difference is that the royal family has been a bit more open with the public as to the Duchess’s choices and she’s made public appearances within hours of the births.  The latter to much acclaim and envy.  

But how Kate did it is within the ability of most women.  (Okay, not the $4,000 silk Jenny Packham going-home-from-the-hospital dress.)  So, why aren’t more doing it?  Would public dollars be better spent helping them to do so and leave hospital/birthing centers within a few hours and looking great?

Healthy, including healthy weight, and fit pregnant women would be beneficial to them, their babies, and aggregate US measures of health.  Midwifes and birth centers are preferable to doctors and hospitals for uncomplicated births and cost much less (and midwifes are on the front line of initiating breastfeeding).   Vaginal deliveries are preferable to c-sections (see Michael Pollan on bacteria) and cost less ($4,459 less for Medicaid).  A post-delivery two-night stay in a hospital instead of twenty-four hours or less, doubles the number of maternity rooms a hospitable has to operate, and easily doubles the number of family and friends showing up to see the mother and baby and increasing the microbial and bacterial count in a hospital.  

What’s wrong with spending a few hundred dollars (including a pretty new going-home-from-the-hospital dress) to pamper responsible new mothers?  Oh, I know.  Rightwingers couldn’t possibly handle seeing public dollars spent on nice things for poor women.  Doesn’t matter if those “nice things” are an effective incentive for women to manage their pregnancies and deliveries more responsibly.  Or that those incentives save all consumers money and cost fewer public dollars than the no nice things alternative. Just as they’d rather bitch endlessly about all the children poor women have and also blocka successful program that reduces the number of poor children having babies.

Sadly, “Do it like Kate and not Kim” will only work with a small sector of the public and most of them are probably already “doing it like Kate.”  A hospital birth (and even c-sections) and a couple of days of post-birth hospitalization offers more pampering and status than Medicaid beneficiaries experience in their day-to-day lives.  If anything, they’d like another day or two in the hospital.  So, they’re aren’t going to be clamoring for midwifes, birthing centers, and ten hour post delivery care.

The US dysfunctional, disjointed, and very expensive health care quasi-system will lumber along.  

Someone from the Bush family is trying to talk to us about foreign policy disasters. What’s the proper response to this?

It’d be one thing if they were talking about disasters of their own making, at least, if they acknowledged that they are of their own making. That’s not the case here, however.

What we have here is Jeb Bush asking us to put him in charge so his family can make some more foreign policy decisions for our country.

The simple answer to this is: “No. Next!”

I took a particular shine to Jeb’s suggestion that what we really need is for other countries to fear us more, like they used to.

I’ll admit that invading and occupying a country in retaliation for an attack carried out by someone else is a pretty good way to induce fear in other countries. It’s kind of a drunk foreign policy, though, like the guy who gets annoyed with his boss, goes home, and beats his wife and kids.

If we want people to avoid us and basically give us the equivalent of crossing the street every time they see us coming, well, then this invade-a-random-country strategy isn’t so bad.

The thing is, it’s kind of expensive.

And immoral.

I know that there are people in the world for whom Ben Carson has been an important, even life-altering, inspiration. I respect that. I really do. And I’ve wondered about how those people are dealing with Carson’s transformation into a buffoon. Someone finally got around to writing an article about this, and I guess too much time has passed by because I no longer care.

After all, I remember the late 1980’s when Donald Trump inspired countless people to go into business. Those days are so far in my rearview mirror that we might as well talk about horses and buggies.

Fools are fools and grifters are grifters. If this is a story about disappointment, well, we all get disappointed from time to time by people whom we once respected and idolized. There are people in the world who are rich today because they read Donald Trump’s book and it motivated them. There are people who listened to Ben Carson talk about his path to becoming a great neurosurgeon who are now great neurosurgeons themselves because his example gave them strength and courage.

Yet, when we look at these two aspiring Republican presidential contenders today, all we see is something more depressing than a bad joke.

This seems like a pretty good summation of how I feel about the Republican Party and their role in our political system.

It works on so many levels that it would almost be a crime to list just a few.

It’s probably not true, but it feels like every time I either write about David Brooks or link to someone who has written about David Brooks that there are commenters who take offense. This disapproval is typically expressed in just a few distinct ways.

1. He’s an idiot, why are you paying attention to him?
2. I gave up reading that corporate tool x many years ago.
3. You’re obsessed.

I have to consider the possibility that these critiques have some merit. I don’t really think that they do, but I am aware that giving a crap about what is printed on the New York Times editorial page is a form of elitism. Hell, even being aware of what is printed on the Times opinion page is a form of elitism, particularly now that it is usually behind a paywall.

I say “form” of elitism, because it isn’t so much an overt act as a status of being. There’s nothing really preventing the hundreds of people who live in the trailer park down the hill from being aware of whom writes what in the Times, but they collectively could not possibly give less of a fuck. They have “real” problems and difficulties.

And dividing myself from the trailer park folk is maybe the most archetypal kind of self-conscious elitism. I know that I am not like them, that we have different tastes, that I operate in a realm of abstract and political ideas that are removed from what is relevant in any clear and direct way to their lives.

Just saying these thing sounds obnoxious, and it could be even worse if applied to the people who live in the poor communities of our inner cities.

Maybe I cured myself a bit by going into those kinds of communities and putting aside my preconceptions and my hifalutin tastes and making myself a student and a peer, and taking their political interests as my own. Maybe I’m kidding myself.

Either way, I get that talking a lot about David Brooks can seem like a pretty wankerific habit. The thing is, it’s not just Brooks. It’s elite opinion journalism in general. Like it or not, there are people, relatively few of them really, who are in positions to make very important decisions about what kind of country we’re going to be and what kind of wars we’re going to fight. We’re pretty clear that this is a problem when we’re talking about billionaires and the CEO’s of the military-industrial complex, but we’re less aware of it when it’s a mere column in a newspaper read by our elite class. And I can’t donate a billion dollars to Bernie Sanders but I can point out that David Broder is full of crap.

I’ve gone about this battle in different ways at different times, and certainly working for ACORN was not the same as critiquing Maureen Dowd’s latest psycho-sexual drivel.

It’s all important, however. And it matters that David Brooks is beating up on the poor with bad math.

And I am going to go out on a limb here and say that ten or twelve years of bloggers critiquing our elite opinion writers has taken them down several pegs, reduced their influence in necessary ways, and been well worth the effort.

If you’ve ever read Charlie Wilson’s War, you probably have an indelible impression of Michael G. Vickers in your mind. As soon as I read that book back in 2003, I thought that Vickers had to be brought out of retirement to talk some sense into the folks who were trying to craft the “War on Terror.” I was relieved when I realized that he had been called after 9/11 and given a position of real authority. If anyone could figure out what would work and what wouldn’t, I thought it would be Vickers.

Whatever he’s been doing and whatever counsel he’s been giving is all classified, so I don’t know how to assess what he did in his second career. I do know that I would never, ever, want him as an adversary. More than any other single individual, he was responsible for helping the mujahideen run the Soviets out of Afghanistan, and I’m sure he’ll go into retirement with an impressive record of holding the people who worked on the 9/11 attacks responsible.

In the end, though, he was also responsible for helping to create the blowback from the Soviet-Afghan War that we’ve seen both here at home and throughout Europe and the Middle East. And I don’t think he had the right kind of imagination to solve the riddle he brought to life.

Maybe someone will write another book about Vickers, perhaps on his role in the drone wars and other counterterrorism measures. Only then will we be able to make a fair assessment of his performance. Did he think the War in Iraq was idiotic? Was his counsel ignored? How influential was he, really?

Hello again painting fans.

This week I will be continuing with the painting of the Cape May street scene.  The photo I am using is seen directly below.  I will be using my usual acrylics on an 8 by 8 inch gallery-wrapped canvas.

When last seen, the painting appeared as it does in the photo directly below.

Since that time I have continued to work on the painting.

I have continued to work on the windows on the left side of the building.  The tow partially hidden by the tree are now complete, the lower one in shade.  The various roofs above are now also complete.  To the extreme left, the tree is finished with a gradual darkening from left to right.  Above, the chimney has been revised and the sky has been overpainted.  Finally, the red car’s windows have been given a bit of paint.  That car will be the subject of next week’s installment.

The current state of the painting is seen directly below.

I’ll have more progress to show you next week.  See you then.

Earlier paintings in this series can be seen here.

I don’t for a moment buy that Wildstein is so stupid and politically naïve that he would engage in a political payback stunt with such serious ramifications for the general public.  (TPM report)  Sokolich’s refusal to endorse Christie for reelection was close to irrelevant.  Closing bridge access lanes could be predicted to create a traffic nightmare.  However, not so predictable that a) it would land on Sokolich’s door and b) Sokolich would connect it to his non-endorsement of Christie.

The evidence that Wildstein had been a participant in a conspiracy is solid.   It was post-toll lanes closing’s speculation that the intended target could have been Sokolich that provided Wildstein with his  least damaging explanation.  Allows him to maintain that he wasn’t much more than a flunky taking orders from Bridget Kelly and Bill Boroni.  Flunkies, after all, aren’t in a position to object to stupid stuff their superiors order them to do.  Better to be a dumb flunky engaged in a relatively petty and local plot than expose anything pointing to far more extensive corruption in the Christie administration.

Recall from WNYC

August 13, 2013
At 7:34 a.m., Bridget Anne Kelly emails David Wildstein: “Time for some traffic problems in Fort Lee.”

August 13, 2013
David Wildstein replies “Got it” to Bridget Anne Kelly at 7:35 a.m.

No other way to read that than that Kelly was giving Wildstein the go ahead for the previously planned GW Bridge toll lane closings.  (Operation began on September 9, 2013)  Formally, Kelly was not in the chain of command for Wildstein and Boroni.  She worked for the Christie administration, and Wildstein and Baroni worked for the NY/NJ Port Authority and Baroni was in the more senior position.  All were political appointees, but none were officials on Christie’s re-election team.

Fishman may have accepted the plea because it was good enough to indict Kelly and Boroni who aren’t talking at all.  Wildstein is scheduled for sentencing in August.  Unless Wildstein draws a heavy sentence and fine instead of a slap on the wrist, doubt Kelly and Baroni’s indictments will change their legal strategies.  Not likely they’ll be treated as harshly as the cheating Atlanta teachers.  

(Not going to shed a tear for Kelly.  She was imagining a high level position for herself in a President Christie’s administration and wouldn’t have shed a tear for any kids that got in the way of bombs Christie ordered to be dropped on his enemies.)

Unless Fishman has some big rabbits left to pull out of his hat, Wildstein’s plea and Kelly and Boroni’s indictments signal and end to this investigation.  As unimpressive as Patrick Fitzgerald’s indictment of Scooter Libby.  If Marilyn Mosby operated at this level of competence and diligence, it would be a year before the six Baltimore police officers were charged with misdemeanors.

This didn’t just happen because people peaceably protested.

Officer Caesar Goodson Jr., 45, who was the driver of a police van that carried Gray through the streets of Baltimore, was charged with second-degree murder, manslaughter, second-degree assault, two vehicular manslaughter charges and misconduct in office.

Officer William Porter, 25, was charged with involuntary manslaughter, second-degree assault and misconduct in office.

Lt. Brian Rice, 41, was charged with involuntary manslaughter, second-degree assault and misconduct in office.

Sgt. Alicia White, 30, was charged with involuntary manslaughter, second-degree assault and misconduct in office.

Officer Edward Nero, 29, was charged with second-degree assault and misconduct in office.

Officer Garrett Miller, 26, was charged with second-degree assault, misconduct in office and false imprisonment.

If convicted of all charges, Goodson would face up to 63 years in prison. Rice would face up to 30 years and Porter, Nero, Miller and White would face up to 20 years.

Warrants were issued for the arrest of all six officers. It wasn’t immediately clear where the officers were Friday morning.

When rioting becomes an effective way to get justice, the system has already been failing for a long time.

As a former community organizer myself, I was intrigued when I saw a couple of different headlines suggesting that the president of the United States has expressed an interest in getting back into that modest line of work when he is no longer president. Of course, the headlines are a bit misleading. There’s no going back to the old job for Barack Obama. In Breitbart’s case, they didn’t even editorialize on the story and basically just used the words “community organizer” as clickbait. It works for them because they’ve turned those words into an epithet…something worthy of contempt.

It probably bends their reader’s minds to contemplate someone who could do almost anything for almost any amount of money deciding to focus on getting good paying jobs and some decent outcomes into our poorer communities. These folks don’t understand what Jimmy Carter did with his post-presidency or why he is so widely admired.

This is what happens when you shrink-wrap your own brain.