Bacteria, Part of Us? Its Ubiquitous, Symbiotic & Competing Relationship With The Human Body

This article--the proposition it offers, the images it creates--may not be what you were seeking or expecting today. In fact, you might find it all unwelcome, and more than a little unsettling--maybe even repulsive. But from a physiological point of view, it is likely correct. And from a health and medical possibilities point of view, it offers real hope to many sufferers of disease or physiological dysfunction for whom medical science has had no answers. From the always informative Science and Technology section of The Economist:

 

People are not just people. They are an awful lot of microbes, too.

 

[I]n the nooks and crannies of every human being, and especially in his or her guts, dwells the microbiome: 100 trillion bacteria of several hundred species bearing 3 million non-human genes. [B]iological [revolutionaries] believe these should count, too; that humans are not single organisms, but superorganisms made up of lots of smaller organisms working together.

 

It might sound perverse to claim bacterial cells and genes as part of the body, but the revolutionary case is a good one. They are, rather, fully paid-up members of a community of which the human “host” is but a single (if dominating) member. This view is increasingly popular: the world’s leading scientific journals, Nature and Science, have both reviewed it extensively in recent months. It is also important: it will help the science and practice of medicine (see the more detailed Economist article linked below).

 

All in this together

 

The microbiome does many jobs in exchange for the raw materials and shelter its host provides. One is to feed people more than 10% of their daily calories. These are derived from plant carbohydrates that human enzymes are unable to break down. And not just plant carbohydrates. Mother’s milk contains carbohydrates called glycans which human enzymes cannot digest, but bacterial ones can. This alone shows how closely host and microbiome have co-evolved over the years. But digestion is not the only nutritional service provided. The microbiome also makes vitamins, notably B2, B12 and folic acid. It is, moreover, capable of adjusting its output to its host’s needs and diet. The microbiomes of babies make more folic acid than do those of adults. And microbiomes in vitamin-hungry places like Malawi and rural Venezuela turn out more of these chemicals than do those in the guts of North Americans.

 

The microbiome also maintains the host’s health by keeping hostile interlopers at bay. An alien bug that causes diarrhea, for instance, is as much an enemy of the microbiome as of the host. Both have an interest in zapping it. And both contribute to the task. Host and microbiome, then, are allies. But there is more to it than that. For the latest research shows their physiologies are linked in ways which make the idea of a human superorganism more than just a rhetorical flourish.

 

These links are most visible when they go wrong. A disrupted microbiome has been associated with a lengthening list of problems: obesity and its opposite, malnutrition; diabetes (both type-1 and type-2); atherosclerosis and heart disease; multiple sclerosis; asthma and eczema; liver disease; numerous diseases of the intestines, including bowel cancer; and autism. The details are often obscure, but in some cases it looks as if bugs are making molecules that help regulate the activities of human cells. If these signals go wrong, disease is the consequence. This matters because it suggests doctors have been looking in the wrong place for explanations of these diseases. It also suggests a whole new avenue for treatment. If an upset microbiome causes illness, settling it down might effect a cure.

 

[…]Two other areas look promising. One is more sophisticated deployment of the humble antibiotic, arguably the pharma industry’s most effective invention. At the moment antibiotics are used mainly to kill infections. In the future they might have a more subtle use—to manipulate the mix of bugs within a human, so that good bugs spread at the expense of bad ones.

 

The other field that may be changed is genetics. Many of the diseases in which the microbiome is implicated seem to run in families. In some, such as heart disease, that is partly explained by known human genes. In a lot, though, most notably autism, the genetic link is obscure. This may be because geneticists have been looking at the wrong set of genes—the 23,000 rather than the 3m. For those 3m are still inherited. They are largely picked up from your mother during the messy process of birth. Though no clear example is yet known, it is possible that particular disease-inducing strains are being passed down the generations in this way.

 

As with all such upheavals, it is unclear where the microbiome revolution will end up. Doctors and biologists may truly come to think of people as superorganisms. Then again, they may not. What is clear, though, is that turning thinking inside out in this way is yielding new insights into seemingly intractable medical problems, and there is a good chance cures will follow.

 

---“Microbes maketh man,” The Economist, Leaders section (8.18.2012)

 

In the same edition of The Economist is broader, more detailed article on the same topic: “The Human Microbiome: Me, Myself, Us.” It is worth the read.

 

 

Back-up links:

(1) http://www.economist.com/node/21560559

(2) http://www.economist.com/node/21560523

 

Embracing the Implications of Increasing Latino Populations and Voters

I did not grow up in a community that exposed me to many Latinos (or Latin-Americans, a term I would more likely have used). I was raised in Rhode Island, where my relatives and  ancestors had evolved a rather disciplined, Yankee-white-bread identity of understated but respectable life and accomplishment. And while mine was also the experience of growing up with the children and grandchildren of the great European migrations to America--"Give me your tired, your poor, your huddled masses yearning to be free..."—not many Latinos who shared that same description and aspiration had found their way to Coventry, Rhode Island.

 

But since I left high school for the Marine Corps in the '60's, my experience there, and later in Boston at college, graduate school, and ever since and wherever I was, the issues and challenges of growing Latino populations, assimilation, education, and immigration have moved with increasing speed toward the front of America's important domestic issues. I can still remember in the early '70s, in Boston, struggling to understand it all. There were the discussions about the need for bi-lingual education with old friend and bi-lingual Spanish teacher, Mary Furman--and with her good friend, Jorge Quiroga, a reporter for a TV station for whom being a Latino and advocating for strong and self-respecting Latino identity in America seemed a very personal cause.

 

It's been a long road for Latinos since then, and in that time my understandings have expanded, perhaps sharpened, too. And with them the understanding that Latinos and all the issues surrounding them are now of such importance and materiality that they are changing both the face and future of American life. And we need to embrace that fact and the implications.

 

Foreign Affairs asked Ray Suarez, Senior Correspondent for PBS NewsHour, to review an important new book, Latinos in the New Millennium: An Almanac of Opinion, Behavior, and Policy Preferences. It appears to be packed with research data and informed analysis. Ray Suarez brings his personal and journalistic experience and balance to the review. Mr. Suarez:

 

[…] Latinos in the New Millennium represents a potential antidote to this vapid [politically-driven] discourse and a data-rich corrective to the stereotypes that too often define Hispanics in the United States. Aptly describing the book as an almanac, its authors, a group of academic experts, have collected and synthesized a massive quantity of data on the political and personal sentiments of Latinos across all lines of national origin, citizenship and immigration status, and income and educational levels. Their findings simultaneously clarify and complicate the reductive portrait of Latinos that frames discussions of their social and political relevance.

 

Strategists and theorists from both major political parties take heed: making [Latinos] yours in the years to come might be much harder than you think. Doing so will require contending with a set of contradictory qualities: progressive politics mixed with conservative values, assimilationist ideals in conflict with hardening ethnic identities, and meritocratic aspirations bumping up against the reality of academic underachievement.

 

---“Latin Lessons: Who Are Hispanic Americans, and How Will They Vote?” by Ray Suarez, Foreign Affairs (September-October 2012)

 

Doesn’t it always come back to education, sooner or later? And the productivity of our society is just an extension of how well we fulfill the education potential of every American—and the most compelling areas of focus must include those areas and groups for whom academic underachievement has too often been the reality. That includes many Latin-Americans. And Mr. Suarez chooses that point to stress in closing:

[...] Whatever the reasons for it, academic underachievement among Latinos is a challenge far more important than any effort to understand Latinos for short-term political gain. That is because of the degree to which the United States’ success in the coming half century will depend on Latino success. In a few decades, the US economy will increasingly rest on a largely nonwhite, heavily Latino work force providing services and care to millions of mostly white retirees. As Latinos become a larger part of the American whole, quietly consigning them to failure and isolation is hardly a recipe for national prosperity and stability, Whether they realize it or not, all Americans are now deeply invested in the successful integration of Latinos. Their own future affluence and well-being might well depend on it.

 

Latinos in the New Millennium appears a book well worth reading and understanding—especially if we really do want to better understand the social, political and economic implications of this large and growing Latino population.

 

 

Link (may provide only limited access):

http://www.foreignaffairs.com/articles/138020/ray-suarez/latin-lessons

 

The Economist: So, Mitt, what do you really believe?

The Economist--that figurative fortress on the high ground of market economics, that most respected voice in defense of the free marketplace--they like a lot about Mitt Romney's history of leadership success, both as CEO of Bain and as Governor of Massachusetts. But they are trying to figure out what happened to that Mitt Romney, and who he really is today. They'd like to be able to endorse him, but...

 

But we’re getting out ahead of ourselves, aren’t we? Let’s start with their opening statement of reasons for concern about who Mitt Romney really is today, but also the reasons they liked who he was, and for their early enthusiasm about his candidacy. The Economist:

 

WHEN Mitt Romney was governor of liberal Massachusetts, he supported abortion, gun control, tackling climate change and a requirement that everyone should buy health insurance, backed up with generous subsidies for those who could not afford it. Now, as he prepares to fly to Tampa to accept the Republican Party’s nomination for president on August 30th, he opposes all those things. A year ago he favoured keeping income taxes at their current levels; now he wants to slash them for everybody, with the rate falling from 35% to 28% for the richest Americans.

 

All politicians flip-flop from time to time; but Mr Romney could win an Olympic medal in it (see [Briefing] article). And that is a pity, because this newspaper finds much to like in the history of this uncharismatic but dogged man, from his obvious business acumen to the way he worked across the political aisle as governor to get health reform passed and the state budget deficit down. We share many of his views about the excessive growth of regulation and of the state in general in America, and the effect that this has on investment, productivity and growth. After four years of soaring oratory and intermittent reforms, why not bring in a more businesslike figure who might start fixing the problems with America’s finances?

 

---“So, Mitt, what do you really believe?” The Economist, Leaders section (8.25.2012)

 

And by the way, in that early going, there were many of we independents giving him a fair hearing, as well. I, too, liked the same things about Governor Romney. But then, sooner or later, we all saw and heard the same things the good folks at The Economist did, didn’t we? But let’s hear it from them:

 

But competence is worthless without direction and, frankly, character. Would that Candidate Romney had indeed presented himself as a solid chief executive who got things done. Instead he has appeared as a fawning PR man, apparently willing to do or say just about anything to get elected. In some areas, notably social policy and foreign affairs, the result is that he is now committed to needlessly extreme or dangerous courses that he may not actually believe in but will find hard to drop; in others, especially to do with the economy, the lack of details means that some attractive-sounding headline policies prove meaningless (and possibly dangerous) on closer inspection. Behind all this sits the worrying idea of a man who does not really know his own mind. America won’t vote for that man; nor would this newspaper. The convention offers Mr Romney his best chance to say what he really believes.

 

You can judge for yourself whether Mr. Romney’s speech at the GOP convention cleared everything up for you. Suffice it to say, it left me with only more questions about him, and less confidence in him. But it’s also true that I support Barack Obama’s re-election. I thought he did as effective and honorable a job as could be done having inherited two questionable wars, a growing budget deficit, the worst financial and economic crisis since the Great Depression, and an obstructionist Republican Congress intent on denying him every initiative whether it was good for the country or not. Yes, there were things I was unhappy with him about, but on the whole, a good job. (And as we are discussing, I’ve not yet seen or heard anything that would make me consider throwing him over for Mitt Romney.)

 

This article in The Economist goes on to provide more detail about their particular policy concerns, but I’ll leave you to click on the link to read more about that, and you may read more still in the larger, related “Briefing” article later in this same edition. But allow me to end with the articles final comments, and then a few of my own:

Playing dumb is not an option 

Mr Romney may calculate that it is best to keep quiet: the faltering economy will drive voters towards him. It is more likely, however, that his evasiveness will erode his main competitive advantage. A businessman without a credible plan to fix a problem stops being a credible businessman. So does a businessman who tells you one thing at breakfast and the opposite at supper. Indeed, all this underlines the main doubt: nobody knows who this strange man really is. It is half a decade since he ran something. Why won’t he talk about his business career openly? Why has he been so reluctant to disclose his tax returns? How can a leader change tack so often? Where does he really want to take the world’s most powerful country? 

It is not too late for Mr Romney to show America’s voters that he is a man who can lead his party rather than be led by it. But he has a lot of questions to answer in Tampa.

And so, I can only repeat the question I posed above: Did Mr. Romney’s speech in Tampa clarify things for you? Are your concerns now allayed? Are you feeling more confident about Mitt Romney as our Presidential leader?

 

Of course, depending on your political orientation, and your notion of honorable and effective government, you might be greatly relieved, or despondent, or even terrified to remember Grover Norquist’s comments during the 2012 GOP primaries. The influential Mr. Norquest—many would say, powerful—author, Congressional recruiter and enforcer of the so-called “No-Tax Pledge,” remarked that it didn’t matter who won the primary, so long as he won the general election. Because with the GOP majorities in the House also expected in the Senate, it would be the GOP Congress that would control legislative initiative and passage. “ We just need a President to sign this stuff,” he said—and also suggested that a President Romney would do what he is told. Yes, Mr. Norquist was and is that arrogant, that full of himself, that he actually said that with a complete sense of authority and impunity. (For more details about all that just Google “Grover Norquist, We just need a president…”)

 

I don’t know if that makes you feel better or worse about a Romney presidency. For me, it’s clearly more a feeling of surrealistic foreboding.

 

But hey, let’s think a little crazy here. No, really crazy. Let’s just assume that no one could be so bereft of personal integrity as to flip-flop so often on such material matters of principle and policy—and especially not a religious man who had previously conducted himself quite honorably, at least within the context and expectations of his vocations and roles. Since I’ve now openly crossed into the realm of the surreal, why not contemplate a Mitt Romney authoring a quiet, self-effacing strategy--a conspiracy, really-- to undermine or frustrate the greatest hopes and aspirations of the ascendant Right Wing of the GOP. Let’s imagine him insinuating himself into the playbook of Mr. Norquist and the Right Wing leadership, casting himself as the pliable, witless stooge of a president that they seek.

 

Of course, we would have to assume a failed re-election bid by Barack Obama—which, right now, would appear to require the President’s purposeful effort to craft the worst possible campaign directions and strategies, and then make them worse still. I’m just saying. Then, President Romney, seeing it as his patriotic duty to restore a more balanced, responsible Republican Party, makes common cause with Congressional Democrats and the remaining few moderate Republicans to frustrate the purposes and legislative success of the GOP’s Right Wing majority. He restores his previously unerring bearings, and his former mantle of leadership and success. He restores broad respect for more centrist thinking, politics and collaboration. The country’s electorate now sees clearly its waywardness, and in the future votes more responsibly for statesmen and deal makers, more moderate progress builders of both parties.

 

Ah, down the rabbit hole with Alice. But I ask you, which is more surrealistic, my sojourn in restoration reverie, or the unnerving realities of today’s extreme political characters—caricatures, really—and the dysfunctional political environment of their creation? It’s a close call, isn’t it?

 

 

Link:

http://www.economist.com/node/21560864

 

Grand Visionary or Myopic Ideologue? Joe Klein on Paul Ryan; FOXNEWS.com on His Speech

Does Paul Ryan offer a fresh, grand vision for America--or merely reflect the myopia and limitations of recycled Ayn Rand Objectivism? Let's join the discussion with Time's Joe Klein, then look at an utterly unexpected review of Paul Ryan’s GOP convention speech by Sally Kohn for FOXNEWS.com. First, Joe Klein:

 

Paul Ryan, 42, is the perfect picture of a traditional Republican Vice President.

 

But there is something radically different about the Ryan pick, something I've never seen before. This presidential campaign is now, substantively, all about him. The maddeningly vague Mitt Romney has effectively outsourced his job as intellectual leader of the ticket to his occasionally specific junior partner. Romney seems to have mixed feelings about that, flipping another flop on the Ryan budget, which he once called "marvelous" and now has walked away from, saying he's going to come up with a budget of his own one of these days. Romney also had a fair amount of trouble describing his view of Ryan's plan to voucherize Medicare. The Ryan pick may have energized the Republican base, but Romney remains the same old awkward, evasive Romney.

 

And so we seem to be headed for a campaign of ideas--Ryan's ideas--and that may or may not be a good thing. Yes, it's important to have a ground-zero discussion about the sort and size of government we want to have. The trouble with Ryan's deep thinking on so many of these issues, though, is that it's not very deep at all. He lives in a libertarian Disneyland where freedom is never abused, where the government is an alien entity whose only function is to flummox the creative intelligence of übermensches like Ayn Rand's hero, the architect Howard Roark. It is remarkable and, frankly, a bit terrifying that this puerile vision has become the operating philosophy of the Republican Party.

 

---“Paul Ryan's Grand Vision,” by Joe Klein, Time (8.23.2012)

 

As a young man, I felt it important to expose myself to the range of political philosophies and ideological perspectives that, in part, also informed the more broadly embraced, more practicable, political paths in the middle. One of those was a purist form of libertarianism and laissez faire capitalism: “Objectivism,” so-called by its principle author and advocate, Ayn Rand. She was a Russian émigré with some understandably strong views and apparent scars formed by her years in the workers’ paradise.

 

She advocated a "full, pure, uncontrolled, unregulated laissez-faire capitalism,” and viewed it as the only moral social system. And her Objectivism held that the proper functions of a government are "the police, to protect men from criminals—the armed services, to protect men from foreign invaders—the law courts, to settle disputes among men according to objectively defined laws," the executive, and legislature.  Furthermore, in protecting individual rights, the government is acting as an agent of its citizens and "has no rights except the rights delegated to it by the citizens." And that’s about it: uncontrolled, unregulated capitalism, and a minimalist government with the simple charter to maintain and support the police, army, and court functions for the protection of people’s property, their person, and their individual rights. [Quotes from Wikipedia: Objectivism (Ayn Rand)]

 

She was best known for her several novels with that same clear and consistent Objectivist message. Although I've not read The Fountainhead, with its celebrated hero Howard Roark. I did read her magnum opus, Atlas Shrugged, pursuing the answers to her opening question, Who is John Galt? And I was provoked by the title to also read The Virtue of Selfishness, which continued to beat the same drum one too many times for me. I later added a reference copy of Capitalism the Unknown Ideal, a compilation of essays based on Objectivist thinking written by Rand and her two protégés, Nathaniel Branden and Alan Greenspan (yes, that Alan Greenspan). Forty-some years later, that is the only volume of hers I retain; but I remain familiar enough with Ayn Rand and Objectivism.

 

I mention all this because Time’s Joe Klein draws the parallel between the more pure libertarian and capitalist views of Mr. Ryan and the Fountainhead hero, Howard Roark--and because the parallel appears so apt. As we mature with the experience, realities and responsibilities of a greater sense of community and state, we become more socially accountable as participants in political and economic life. And it becomes clear how lacking in dimensions and answers—how impractical and inadequate, really—Objectivism, or other strains of pure libertarianism and unregulated capitalism, are to satisfying the conditions for a vibrant, yet resilient economy. And then there are the social needs of a citizenry that must be well educated, kept healthy, and supported when unable to do so themselves. These too are essentials for a strong, resilient economy and and stable polity—but also for an advanced, accountable society.

It seems to me easy to see the parallels between the thinking and policy positions of Ayn Rand and Paul Ryan; for both, it is all more about minimalist government structures and roles, the ideal of a more pure laissez faire capitalist system, and the incentives for the intellectual elite that drive it. The rest of the people may succeed, fail or suffer under it; but that is not their focus.

 

So, there are reasons that most libertarian candidates find themselves marginalized at the end of the day, just as Ron Paul did. While they have some very valid, even important, points to make, some worthy issues to raise, and some attractive ideas to voice and share, they also ignore or disavow so many other important points, issues and ideas that are important to a modern, socially-accountable economy and society. And sooner or later, most people come to recognize this—and they will with Mr. Ryan, as well. More from Joe Klein:

 

Worse, some of Ryan's most important ideas have been tried and proved failures. Ryan has produced various plans, proposals and two actual federal budgets, and they all have one thing in common: they cut taxes drastically. In his 2011 budget, which he sent to the Congressional Budget Office for scoring, he estimated that despite the drastic cut in rates, the revenue would remain the same as a percentage of gross domestic product. This is supply-side economics, the utterly uncorroborated theory that the less people pay in taxes, the more they'll produce. Ryan's mentor Jack Kemp sold Ronald Reagan on it in 1980. The result was such a huge hole in the federal deficit that in 1982, Reagan was forced to come back with one of the largest proportional tax increases in American history. Supply-side tax cuts didn't work for George W. Bush either. By contrast, Clinton raised taxes and the economy boomed. Who knew?

 

In Ryan's 2010 budget, all taxes on capital gains were lifted. By this standard, according to the Atlantic, Romney would have paid a tax rate of less than 1% in 2010, the only year for which we have his returns. In some of his proposals, Ryan has replaced the capital gains tax with a sales tax, or VAT, which would have the perverse effect of raising taxes on the middle class and poor while lowering them for the rich. In Ryan's world--in Rand's fantasy--average folks are taxed because they haven't had the good sense to become wealthy.

 

Because of the hilariously inappropriate tax cuts, Ryan's budget doesn't reduce the deficit very quickly, but it is imbalanced on the backs of the poor and elderly. I believe that poverty is often the result of inappropriate behavior--out-of-wedlock births, dropping out of school, crime and drugs--which should not be rewarded. But often it isn't, and common decency requires that we take care of the least of these. Ryan's Medicare proposal is Exhibit A when it comes to his casual inhumanity: he would force the elderly, many of whom are addled and decrepit, to make market choices in one of the most complicated, opaque markets around. Ryan's Medicaid proposal would eviscerate long-term care for the elderly poor. Republicans whine about class warfare, but what is this? It is a reversion to a more brutal, less humane state of nature. It is an "idea" whose time has gone.

 

Joe Klein is usually more tempered in his tone and views than in this piece—at least that’s my personal take on his writing style. But I am a fan. I think he’s just so concerned that Mr. Ryan is trying to fly under the radar and avoid being outed for his more extreme views regarding social issues, especially those affecting the retired, elderly and unable. And there’s more to be concerned about, much more, but I will allow this most surprising FOXNEWS.com review of Paul Ryan’s GOP convention speech on Wednesday night to speak for itself--and for me. From Sally Kohn, a writer and contributor to FOXNEWS.com:

Aug. 29, 2012: Republican vice presidential nominee Paul Ryan addresses the Republican National Convention in Tampa, Fla.  

1. Dazzling 

At least a quarter of Americans still don’t know who Paul Ryan is, and only about half who know and have an opinion of him view him favorably. So, Ryan’s primary job tonight was to introduce himself and make himself seem likeable, and he did that well. 

[…] To anyone watching Ryan’s speech who hasn’t been paying much attention to the ins and outs and accusations of the campaign, I suspect Ryan came across as a smart, passionate and all-around nice guy — the sort of guy you can imagine having a friendly chat with while watching your kids play soccer together. And for a lot of voters, what matters isn’t what candidates have done or what they promise to do —it’s personality. On this measure, Mitt Romney has been catastrophically struggling and with his speech, Ryan humanized himself and presumably by extension, the top of the ticket. 

2. Deceiving 

On the other hand, to anyone paying the slightest bit of attention to facts, Ryan’s speech was an apparent attempt to set the world record for the greatest number of blatant lies and misrepresentations slipped into a single political speech. On this measure, while it was Romney who ran the Olympics, Ryan earned the gold. 

[…] Fact: While Ryan tried to pin the downgrade of the United States’ credit rating on spending under President Obama, the credit rating was actually downgraded because Republicans threatened not to raise the debt ceiling. 

Fact: While Ryan blamed President Obama for the shutdown of a GM plant in Janesville, Wisconsin, the plant was actually closed under President George W. Bush. Ryan actually asked for federal spending to save the plant, while Romney has criticized the auto industry bailout that President Obama ultimately enacted to prevent other plants from closing. 

Fact: Though Ryan insisted that President Obama wants to give all the credit for private sector success to government, that isn't what the president said. Period. 

Fact: Though Paul Ryan accused President Obama of taking $716 billion out of Medicare, the fact is that that amount was savings in Medicare reimbursement rates (which, incidentally, save Medicare recipients out-of-pocket costs, too) and Ryan himself embraced these savings in his budget plan. 

Elections should be about competing based on your record in the past and your vision for the future, not competing to see who can get away with the most lies and distortions without voters noticing or bother to care. Both parties should hold themselves to that standard. Republicans should be ashamed that there was even one misrepresentation in Ryan’s speech but sadly, there were many. 

3. Distracting 

And then there’s what Ryan didn’t talk about.  

Ryan didn’t mention his extremist stance on banning all abortions with no exception for rape or incest, a stance that is out of touch with 75% of American voters. Ryan didn’t mention his previous plan to hand over Social Security to Wall Street. Ryan didn’t mention his numerous votes to raise spending and balloon the deficit when George W. Bush was president.  

Ryan didn’t mention how his budget would eviscerate programs that help the poor and raise taxes on 95% of Americans in order to cut taxes for millionaires and billionaires even further and increase — yes, increase —the deficit.  

These aspects of Ryan’s resume and ideology are sticky to say the least. He would have been wise to tackle them head on and try and explain them away in his first real introduction to voters. But instead of Ryan airing his own dirty laundry, Democrats will get the chance. 

Ryan may have helped solve some of the likeability problems facing Romney, but ultimately by trying to deceive voters about basic facts and trying to distract voters from his own record, Ryan’s speech caused a much larger problem for himself and his running mate. 

---“Paul Ryan’s Speech in Three Words,” by Sally Kohn, FOXNEWS.com (8.30.2012)

I must confess my surprise at a review so openly and unreservedly critical of Paul Ryan and his speech allowed space on FOXNEWS.com. And the last two subtopics were written with a tone of genuine disapproval and conviction. Is FOX NEWS actually seeking more openly opposing views? Or has Ms. Kohn written her last piece for them?

 

Regardless, it appears to me both accurate and fair enough, even if the tone of it is honed to a fine if intemperate edge. I tip my hat to FOX NEWS for publishing a review and point of view clearly at odds with the general bent and positions of the FOX network.


Links:

http://www.foxnews.com/opinion/2012/08/30/paul-ryans-speech-in-three-words/

http://www.time.com/time/magazine/article/0,9171,2122234,00.html
 

How to Deliver Lower-Cost Health Care--With Better Results

Fareed Zakaria, Time:

When listening to the debate about American health care, I find that many of the most fervent critics of government involvement argue almost entirely from abstract theoretical propositions about free markets. One can and should reason from principles. But one must also reason from reality, from facts on the ground. And the fact is that about 20 foreign countries provide health care for their citizens in some way or other. All of them--including free-market havens like Switzerland and Taiwan--have found that they need to use an insurance or government-sponsored model. All of them provide universal health care at much, much lower costs than we do and with better results. 

---Health Insurance Is for Everyone," by Fareed Zakaria, Time (3.26.2012)

Mr. Zakaria, in his focused, pragmatic approach, offers more examples and data points to the body of evidence that more overwhelmingly than ever supports universal health insurance as the only defensible, accountable direction a country can take to create a new system or reform a dysfunctional one like ours. In this case, he focuses on two other free-market economies, Switzerland and Taiwan, one that has worked within a market model with notable success, and one that, like many other countries, has achieved even more success under a single-payer government insurance program. So, let's read some of what Mr. Zakaria has to share with us about the two approaches:

The centerpiece of the case against Obamacare is the requirement that everyone buy some kind of health insurance or face stiff penalties--the so-called individual mandate. It is a way of moving toward universal coverage without a government-run or single-payer system. It might surprise Americans to learn that another advanced industrial country, one with a totally private health care system, made precisely the same choice nearly 20 years ago: Switzerland. The lessons from Switzerland and other countries can't resolve the constitutional issues, but they suggest the inevitability of some version of Obamacare. 

Switzerland is not your typical European welfare-state society. It is extremely business-friendly and has always gone its own way, shunning the euro and charting its own course on health care. The country ranks higher than the U.S. on the Heritage Foundation's Index of Economic Freedom. 

Twenty years ago, Switzerland had a system very similar to America's--private insurers, private providers--with very similar problems. People didn't buy insurance but ended up in emergency rooms, insurers screened out people with pre-existing conditions, and costs were rising fast. The country came to the conclusion that to make health care work, everyone had to buy insurance.  

So the Swiss passed an individual mandate and reformed their system along lines very similar to Obamacare. The reform law passed by referendum, narrowly. The result two decades later: quality of care remains very high, everyone has access, and costs have moderated. Switzerland spends 11% of its GDP on health care, compared with 17% in the U.S. Its 8 million people have health care that is not tied to their employers, they can choose among many plans, and they can switch plans every year. Overall satisfaction with the system is high. 

[...] When Taiwan--another country with a strong free-market economy--decided to create a new health care system in the mid-1990s, it studied every existing model. It too chose a model of universal access and universal insurance but decided against having several private insurers, as Switzerland and the U.S. do. Instead it created a single insurer, basically a version of Medicare. The result: universal access and high-quality care at stunningly low costs. Taiwan spends only 7% of its GDP on health care [vs. 11% in Switzerland and 17% in the US].

Unsurprisingly, the data and experience of these two countries also support the importance of universal health insurance and universal participation. And while it indicates we should expect Obamacare to offer Americans better health care at lower cost, it also indicates that a government single-payer approach to national health insurance will provide the best health care to all at the lowest cost. This is consistent with what I and others have written about the uniques dynamics of delivering "public goods" equitably to all people. But given the political climate in the US, it is clear that the Obamacare model is a necessary stepping stone to the more efficient govermment-payer model.

But the question always remains, Has enough of a sense of national humility found it's way into our national identity, enough to temper our reflexive and brittle national hubris?  Is it now possible we could be open-minded enough to learn something from Switzerland and Taiwan--and England, France, Canada, Japan and other countries, too?  And especially with so many US financial and political interests marketing misinformation to protect their status quo? Progress will likely continue to be made, but only in slowly evolving stages, it seems. It is the American way.

Link:

http://www.time.com/time/magazine/article/0,9171,2109128,00.html
 

Fareed Zakaria: A Case for Better Gun Regulation

So when people throw up their hands and say we can't do anything about guns, tell them they're being un-American--and unintelligent. 

---"The Case for Gun Control: Why limiting easy access to guns is intelligent and American," by Fareed Zakaria, Time (8.20.2012)

I am a fan of Fareed Zakaria. He brings a fresh, global, and multicultural perspective--a well-schooled, researched and thoughtful perspective--to whatever topic he is addressing. He so often gives us a more insightful way of seeing a problem or solution. More, he almost always leaves us better informed and appropriately challenged by reading what he has to say. And that is no less true because he recently admitted to using some material from another writer without proper attribution. He has offered his mea culpa and apologies, and I, for one, accept them, and think it unlikely to happen again. He is just too important a voice not to forgive his unfortunate journalistic faux pas, and quickly restore his balanced commentary to the pages of Time.

But the subject is gun control and regulation. And Mr. Zakaria ably takes us on an efficient tour of recent mass homicides with firearms, the issues involved, the history, the constitution, and what is both wise and possible--even if some information is not properly cited. I really have little more to say that he doesn't say better. These excerpts from his Time article:

Gun violence in America is off the chart compared with every other country on the planet. The gun-homicide rate per capita in the U.S. is 30 times that of Britain and Australia, 10 times that of India and four times that of Switzerland. When confronted with such a large deviation, a scholar would ask, Does America have some potential cause for this that is also off the chart? I doubt that anyone seriously thinks we have 30 times as many crazy people as Britain or Australia. But we do have many, many more guns. 

[...] The effect of the increasing ease with which Americans can buy ever more deadly weapons is also obvious. Over the past few decades, crime has been declining, except in one category...firearm homicides. What can explain this anomaly except easier access to guns? ...Confronted with this blindingly obvious causal connection, otherwise intelligent people close their eyes.  

[...] Adam Winkler, a professor of constitutional law at UCLA, documents the actual history in Gunfight: The Battle over the Right to Bear Arms in America. Guns were regulated in the U.S. from the earliest years of the Republic. Laws that banned the carrying of concealed weapons were passed in Kentucky and Louisiana in 1813. Other states soon followed: Indiana in 1820, Tennessee and Virginia in 1838, Alabama in 1839 and Ohio in 1859. Similar laws were passed in Texas, Florida and Oklahoma. As the governor of Texas (Texas!) explained in 1893, the "mission of the concealed deadly weapon is murder. To check it is the duty of every self-respecting, law-abiding man." 

Congress passed the first set of federal laws regulating, licensing and taxing guns in 1934. The act was challenged and went to the U.S. Supreme Court in 1939. Franklin Delano Roosevelt's solicitor general, Robert H. Jackson, said the Second Amendment grants people a right that "is not one which may be utilized for private purposes but only one which exists where the arms are borne in the militia or some other military organization provided for by law and intended for the protection of the state." The court agreed unanimously. 

Things started to change in the 1970s as various right-wing groups coalesced to challenge gun control, overturning laws in state legislatures, Congress and the courts. But Chief Justice Warren Burger, a conservative appointed by Richard Nixon, described the new interpretation of the Second Amendment in an interview after his tenure as "one of the greatest pieces of fraud--I repeat the word fraud--on the American public by special-interest groups that I have ever seen in my lifetime."

But just to be clear: I'm very comfortable with registered firearms for hunting and sporting pursuits. I was reared in a family of wing-shooters (bird hunters). Growing up, German short-haired pointers, English setters and shotguns were a Sunday afternoon ritual with generations of men in my family. (Although guns were broken down at all other times, and ammunition was stored in different places than guns.) And I can also live with reasonable, approriate weapons for self protection, I guess--if someone is so insecure and uninformed about the dangers of intruders that they feel they must have them. (All the research shows that handguns result in far more household injuries and deaths of innocents than anything else). But I got the family gene for fly-fishing, not hunting, so I don't even own a shotgun. And I am completely convinced that nothing good or actually self-protecting will come of keeping a firearm in my home, not a handgun or rifle--and certainly not an automatic weapon.

 

(And in addition to shotguns, I am not unfamiliar or timid with rifles, handguns, and other weaponry, having spent six years in the Marine Corps where I consistently qualified as expert with the rifle and 45 pistol. And yes, I can get a rush from a powerful weapon as much as the next guy.)

 

But for all the years I have considered these issues and questions, for all my understanding and support of responsible sportsmen, I cannot and likely will never understand why some people have problems with firearms registration and their regulation for public safety. And I don't even know what to say about those who believe they need high-powered automatic weapons, and need to keep them in their homes or on their private premises. That is what I call a threat to public safety. The very fact that they are out there in private hands makes me feel more at risk--and I have good reason to feel that way. I continually read of one depressed, deluded or deranged person after another wading into crowds of people firing automatic weapons. And I do not feel any safer because I too can buy an AK-47 and keep it under my bed or in my closet.

 

 

Link:

http://www.time.com/time/magazine/article/0,9171,2121660,00.html  

 

Thomas Friedman: We Need a 'Conservative' Party

Thomas Friedman, three-time Pulitzer Prize winner and columnist for the NYT, has often offered us more insightful thinking about global, economic, political and societal issues than other sources. Most of us know him best for his best-seller on globalization, The World is Flat.

But in this piece from the Op-Ed pages of the NYT, he takes on the elephant in the room: the radicalization of the Republican Party. He does not shrink from the realities, that GOP leaders will brook no disagreement or compromise, either among themselves or with the Democrats. And they would rather see important roles and functions of government fail than raise taxes, even when taxes are at their lowest rates in memory. Of course, the true ideological agenda is to reduce taxes for the very purpose of "starving" government to cripple or, better still, eliminate those government roles and functions. And the severe economic and societal consequences that necessarily must result are apparently all right with them, too. They appear much more at home with 19th-century American society and economics. The only problem is that it's the 21st century.

(Of course, Social Security, Medicare, and Medicaid must be reformed to more cost-efficiently serve well those who are actually in need. And public education reform is long overdo. But reform and cost-efficiency is what's called for, not crippling or privatizing social programs that can only be carried out effectively when treated and administered as public goods. )

Mr. Friedman calls for a return of the Republican Party and it's leadership to a responsible conservatism, a more center-right posture where it's leadership used to be, where reasonable compromises can be made, where progress on critical issues can move forward, where government and its leadership can again function properly.

From Mr. Friedman:

There has been lots of talk that Paul Ryan's nomination ensures that we'll now have a "real" debate about the role of government... And even if Ryan's entry does spark a meaningful debate about one of the great issues facing America — the nexus of debt, taxes and entitlements — there is little sign that we'll seriously debate our other three major challenges: how to generate growth and upgrade the skills of every American in an age when the merger of globalization and the information technology revolution means every good job requires more education; how to meet our energy and climate challenges; and how to create an immigration policy that will treat those who are here illegally humanely, while opening America to the world's most talented immigrants, whom we need to remain the world's most innovative economy.  

But what's even more troubling is that we need more than debates. That's all we've been having. We need deals on all four issues as soon as this election is over, and I just don't see that happening unless "conservatives" retake the Republican Party from the "radicals" — that is, the Tea Party base. America today desperately needs a serious, thoughtful, credible 21st-century "conservative" opposition to President Obama, and we don't have that, even though the voices are out there.  

Imagine if the G.O.P.'s position on debt was set by Senator Tom Coburn, the Oklahoma Republican who has challenged the no-tax lunacy of Grover Norquist and served on the Simpson-Bowles commission and voted for its final plan (unlike Ryan). That plan included both increased tax revenues and spending cuts as the only way to fix our long-term fiscal imbalances... True conservatives know that both Ronald Reagan and George H.W. Bush used both tax revenue and spending cuts to fix budget shortfalls.  

[...] Imagine if the G.O.P.'s position on immigration followed the lead of Mayor Michael Bloomberg and Rupert Murdoch, chief executive of the News Corporation. Bloomberg and Murdoch recently took to the road to make the economic case for immigration reform...The Times quoted the Australian-born Murdoch, who's now a naturalized American, "Right now, if we get qualified people in, there shouldn't be any nonsense about it." Regarding the "so-called illegal Mexicans," Murdoch added, "give them a path to citizenship. They pay taxes; they are hard-working people. Why Mitt Romney doesn't do it, I have no idea, because they are natural Republicans."  

Imagine if the G.O.P. position on energy and climate was set by Bob Inglis, a former South Carolina Republican congressman (who was defeated by the Tea Party in 2010). He now runs George Mason University's Energy and Enterprise Initiative, which is based on the notion that climate change is real, and that the best way to deal with it and our broader energy challenge is with conservative "market-based solutions" that say to the fossil fuel and wind, solar and nuclear industries: "Be accountable for all of your costs," including the carbon and pollution you put in the air, and then we'll "let the markets work" and see who wins. 

Imagine if G.O.P. education policy was set by former Gov. Jeb Bush of Florida, without having to cater to radicals, who call for eliminating the Department of Education and view common core standards as some kind of communist conspiracy. Mr. Bush has argued that a conservative approach to education for 21st-century jobs would embrace more effective teacher evaluation and common core standards, but add a bigger element of choice in the form of charter schools and vouchers, the removal of union rules that limit new technology — and combine it all with greater autonomy and accountability for individual principals. When parents can choose and school leaders can innovate, good things happen.  

We are not going to make any progress on our biggest problems without a compromise between the center-right and center-left. But, for that, we need the center-right conservatives, not the radicals, to be running the G.O.P., as well as the center-left in the Democratic Party. Over the course of his presidency, Obama has proposed center-left solutions to all four of these challenges. I wish he had pushed some in a bigger, consistent, more daring and more forceful manner — and made them the centerpiece of his campaign. Nevertheless, if the G.O.P. were in a different place, either a second-term Obama or a first-term Romney would have a real chance at making progress on all four. As things stand now, though, there is little hope this campaign will give the winner any basis for governing. Too bad — a presidential campaign is a terrible thing to waste.  

---"We Need a 'Conservative' Party," by Thomas L. Friedman, The New Your Times, Op-Ed Page (8.21.2012)

  Imagine. Yes, we can imagie. But that may be as close as we can now get to the classically center-right conservative GOP leadership we need to work with center-left Democrats to restore the ability of congress to govern. 

Link:

http://www.nytimes.com/2012/08/22/opinion/friedman-we-need-a-conservative-party.html?_r=1&smid=fb-share
 

West Coast Accreditor Raises Bar on For-Profits, Community Colleges, and Elite Universities Alike

The scattered, uncoordinated, and uneven patch-work quilt that is higher education accreditation has outlived its usefulness. It no longer has the ability to meet the needs of a large and growing, more diverse and demanding higher education environment--and hasn't for a lpng time. And now the constituencies and customers of higher education, the students, public and the government, are in clear need of a more comprehensive, standardized system that measures and reports how effectively it actually educates its various student populations. The time has come, and yes, it doubtless must fall to the government, federal or state, to administer or oversee it.

But it will take some time to generate consensus among higher education institutions, their constituencies and the government. As we will see, the most prestigious of schools want no part of such a a change, nor do most others. But there is at least one regional accreditor which is getting out ahead of the curve, one which is taking on the charter of moving the existing accreditation process in that new direction.

From The Chronicle of Higher Education:

Too often, accreditors react to criticism with a defensive crouch. So it's been gratifying to watch one regional accreditor, the Western Association of Schools and Colleges, or WASC, take a different approach in recent weeks, setting an example for others to follow. 

WASC oversees higher education in California, Hawaii, and the Pacific islands. In early July it rejected an application from the high-flying publicly traded company Bridgepoint Education. Although Bridgepoint's corporate headquarters are in a downtown San Diego office tower, the anchor of its fast-growing online operation, Ashford University, is in Clinton, Iowa, at the former home of Franciscan University of the Prairies. 

[...] Seven years, more than 200,000 students, vast sums of taxpayer-supported financial aid, and several Congressional hearings later, Bridgepoint had apparently worn out its welcome with Franciscan's former accreditor, and decided to look for approval closer to its corporate home. But WASC turned it down, for reasons that included a paucity of faculty at Ashford and the fact that 128,000 out of 240,000 students had dropped out over the last five years. "That level of attrition," said WASC's president, Ralph A. Wolff, "is, on its face, not acceptable." 

WASC did something else that day which received much less publicity but was, in the long run, probably more important: It posted its rejection letter to Bridgepoint on the Internet for the world to see.  

WASC has also swum into the politically treacherous waters of judging colleges based on whether students graduate and how much they learn. Most colleges gather little or no information about success rates among the profitable and growing adult-student population. WASC will soon require detailed information about the success of nontraditional students. 

More controversially, WASC is asking four-year colleges and universities to provide some evidence of how much their students are learning, and to compare that success to similar institutions. This is just common sense.  

[...] Yet WASC's proposal has met with fierce opposition from the region's elite research universities, including Stanford and the University of California. This is unsurprising, if depressing... The richest, most famous, most exclusive institutions with the most Nobel Prize winners on the faculty are presumed to offer the highest-quality undergraduate education. It's not true, but there's a lot of money and power tied up in the fiction that it is.  

[...] Elite universities have an enormous capacity to set tone and precedent in higher education, as Stanford and others have done recently, to their credit, in legitimizing low-cost online courses. If high-profile institutions embraced the idea of being accountable and transparent for student learning, others would follow. By rejecting such accountability, Stanford and universities like it are helping to perpetuate a system in which far too many college students receive a substandard education. 

---"Why One Accreditor Deserves Some Credit. Really." by Kevin Carey, The Chronicle of Higher Education (7.30.2012)

I wish I had something profound or useful to add to this article. But it really says it all. As it also notes, accreditors have origins and a long history that stressed a "voluntary, peer-based approach [which] made sense in an era when higher education was a smaller, more private affair." But from the period following WWII until today, the expansion and increasing complexity of public and private nonprofit higher education--and now, for-profit higher education--has been driven by increasing public demand by more diverse student populations with increasing reliance on government educational loans to finance them. And the accreditation process has had to scramble to expand and become more sophisticated and relevant in the process. As noted, the assessment of it's success today has varied, but with increasing criticism about the relvance of its charter and ability to carry it out. 

Can existing regional higher education accreditors evolve enough--and quickly enough--to meet today's and tomorrow's accreditation needs? Can they bring more standardization to broader measures and processes?  Can they remove the sensed need to look to the government to assume or oversee this role? Perhaps. But as encouraging as this stance by the WASC is, it is just an isolated ray of hope in this mired and dispiriting business. And the expected failure of many other accreditors to follow suit will just make more clear the need for government standardization and oversight, and the lack of any effective alternative.

Link:

http://chronicle.com/article/Why-One-Accreditor-Deserves/133179/

For-Profit Hospital Chain Performs Unnecessary Cardiac Work

From The New York Times:

In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company's hospitals in Florida...[T]he Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.   

HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing.  

Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.   

At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages... 

On Monday morning, in a conference call with investors, company executives disclosed that in July the civil division of the United States attorney's office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at 10 of its hospitals, located largely in Florida, but also two or three hospitals in other states. In the conference call and in a statement on its Web site, the company also referred to inquiries by The Times. HCA's stock ended nearly 4 percent lower Monday, at $25.55.   

In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...HCA also declined to show that it had ever notified patients, who might have been entitled to compensation from the hospital for any harm.    

---"Hospital Chain Inquiry Cited Unnecessary Cardiac Work," by Reed Abelson and Julie Creswell, The New York Times (8.6.2012)

Because medical insurance, generally, pays doctors and hospitals primarily for office visits and procedures (rather than patient wellness), we can't be surprised that doctors might stress more office visits and procedures--but this is especially true at for-profit hospital chains like HCA. That's just the way the financial incentives work. And too often the result can be patients put at risk rather than protected in their wellness. And it implies tacit approval, or more, by the medical profession and government. Of course, overt approval and public advocacy marks the beneficiaries at every profit point for medical equipment, medications, tests, and skilled medical services--and for medical insurers, too. When it is about income and profit first, you know that whatever the product or service, it will not be treated and delivered as a public good, and in the case of health care services, when there is a conflict of interests, patient wellness will too often come second.

As I use the term, broadly and socially speaking, "public goods" are goods and services necessary or appropriate for the protection, including social protection, and economic strengthening of a state or country. And they are meant to be available equally to all its people. Think national defense and national security, public safety, transportation and travel infrastructure, but also social goods like social welfare programs, education, and, yes, health care. They are deemed important to the welfare and advancement--including economic advancement--of the country as a whole as well as to the individual.

(And yes, health care should be approached as a public good, too. That's what experience makes evident and what most people intuitively understand: better, more affordable, preventative and basic healthcare more broadly strengthens individual health and, in turn, economic productivity and civic contribution. That's also the conclusion of most other industrialized countries.)

So, when the delivery of "public goods" are undertaken with a for-profit model, we cannot be surprised that things go awry. This report about the for-profit hospital chain HCA is just the latest example of how the profit motive distorts public services values and undermines the process of delivering competent, trustworthy, and affordable healthcare to the public (which is delivered as a public good in many other industrialized countries at half our cost).

I've also recently posted about how for-profit higher education is most often delivering a subpar product (or service) at an unaffordable price, a price beyond the means of it's mostly nontraditional students, a price that can only be financed through US government educational loans (i.e., by taxpayers). And the result in most cases is debt without benefit, because it must be borne by the students, most of whom soon drop out of the programs. There's a lot wrong with that picture.

But too many people just don't appreciate this key distinction, this difference, that inheres in public goods--or they don't want to. Markets, by definition, discriminate between customers based on quality and abilty to pay for the product or service. That means some get a product of inferior quality, and some get less of it or none at all. For delivery of public goods, profit motive and market mechanisms simply undermine success in meeting the public need and national goal.


Link to NYT article:

http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?_r=1&smid=fb-share