Thursday, October 5, 2017

Baseball, Hot Dogs, Apple Pie, Chevrolet and Mass Killings

Starting a collection...

The 1927 Bombing That Remains America’s Deadliest School Massacre
Ninety years ago, a school in Bath, Michigan was rigged with explosives in a brutal act that stunned the town

Elaine race riot -- Wikipedia article

Tulsa Race Riots (May 31-June 1, 1921)

The Colfax massacre, or Colfax riot the events are termed on the 1950 state historic marker, occurred on Easter Sunday, April 13, 1873, in Colfax, Louisiana, the seat of Grant Parish, when approximately 150 black men were murdered by white Southern Democrats.

And finally, this summary prompted by the Las Vegas massacre which prompted this post...

Al Jazeera noticed the same items. Hard to know which was first.

Monday, September 25, 2017

The War Over MOC Heats Up

This important Medscape article is easier to read in single-page form. Go to the link for heavily-notated notes & supporting sources deleted here. 

The Growing Anti-MOC Movement

Although many things make doctors angry, only one issue has made them angry enough to join together in a unified effort to demand relief from their medical societies and representatives in state legislatures: mandatory maintenance of certification (MOC), particularly for hospital credentialing and insurance network membership.

Pressing state lawmakers to enact anti-MOC legislation has become a cause célèbre for disparate grassroots doctor organizations that have sprung up from Florida to California. Among them are the National Board of Physicians and Surgeons (NBPAS), American Association of Physicians and Surgeons (AAPS), Practicing Physicians of America (PPA), and the Association of Independent Doctors (AID).

"We have amassed almost 50,000 physicians who are communicating about this on Facebook," claims Westby Fisher, MD, director of cardiac electrophysiology at NorthShore University Health System in Evanston, Illinois. Dr Fisher is a cofounder and treasurer of PPA. Formed this year, PPA is a coalition of grassroots physician groups.

These groups are joined by a growing cadre of physician bloggers, some claiming to have tens of thousands of readers. Dr Fisher, who is author of the blog Dr Wes, in which he posts regular updates on the progress of anti-MOC legislation, says he has almost 17,000 followers on Twitter.

Individual doctors are also emailing, writing, and calling their state medical societies and legislators to demand relief from MOC.

Together, these forces have coalesced into a movement that has been influential in spurring medical societies to propose legislation to ban mandatory MOC requirements by hospitals and insurers in at least 17 states this year.

"What these groups have in common is that their members are exhausted by the liberties taken by unaccountable organizations, at the expense of patients and physicians," says Marni Jamison-Carey, executive director of AID.

Formidable MOC Proponents

Seeking to block anti-MOC legislation, say movement leaders, are the American Board of Medical Specialties (ABMS), which sets the standards for physician certification in partnership with 34 member boards, and some hospitals and health insurers operating in a given state.

These pro-MOC forces have mounted lobbying campaigns to convince state legislators that hospitals requiring MOC for physician credentialing and insurers requiring MOC for physician reimbursement and network participation should be permitted to continue in the interest of quality of care and patient safety, say physician-legislators who have sponsored anti-MOC legislation.

"It's a David vs Goliath battle," Dr Fisher says.

As to why MOC should remain mandatory, Susan Morris, ABMS director of communications, sent the board's rationale to Medscape in an email:

Patients rely on certification by an ABMS Member Board as an indicator that their physician has the knowledge, skills, and professionalism to practice in a specialty. The ABMS Boards concluded decades ago, based on substantial evidence, that ongoing assessment is necessary to assure that their knowledge and clinical judgment are up to date in their specialty.

Legislation being introduced in states across the country seeks to remove requirements that physicians demonstrate that they are up to date in their specialty. Some of these bills would prevent hospitals or health plans from requiring physicians to hold a current certificate. Others would regulate private, voluntary certification programs to lower competency standards for medical specialists.

ABMS believes that this legislation puts patients at risk. Patients deserve to know that their physicians are up to date. Faced with a physician who was initially certified after residency but who has not kept the certificate current, patients will be in the dark. They will not know whether that physician chose not to participate, or failed to earn recertification, or was denied the certificate for unprofessional behavior.

But doctors in the anti-MOC movement charge that whereas initial board certification is a legitimate requirement, MOC has evolved into a money-making scheme that forces them to pay recertification testing fees that are too costly and are required too often.

"ABMS has been desperate to maintain the monopoly of their testing cartel using strongman tactics against us," contends Dr Fisher. "The fight against the onerous and expensive ABMS continuous certification requirement that was born of an insatiable thirst for physician testing and educational fees in the name of healthcare 'quality' was the catalyst that finally sparked the war between these opposing forces."

"Every time you reach into your wallet to get $2800 to pay for recertification every 10 years, you start thinking, 'Why am I doing this?'" Dr Fisher says. "I have recertified three times. Each time, it has gotten more laborious, with more time away from my patients and family. Who are these people to tell me how to practice medicine? I've been doing this for 30 years. They have no idea of what we do in our individual practice settings."

ABMS has tried to meet the doctors halfway. "Physicians have raised several legitimate concerns about the MOC process and the ABMS Member Boards have adopted several changes that lower the costs, increase the relevance of the process to practice, increase flexibility for meeting the standards, and make the whole process more convenient," the email from Morris explained.

Among the changes ABMS cites are remote proctoring or online assessment and other innovations that eliminate the expense and time cost of the exam; the use of resources to simulate the way physicians practice at the bedside; new testing approaches that are more customized to practice and more formative, to help doctors focus their learning; a focus on clinical judgment and decision-making rather than recall of medical facts; and more convenient access to practice-relevant learning and improvement activities.

However, none of these attempts at appeasement, or anything short of making MOC nonmandatory, is stopping doctors in the anti-MOC movement from seeking legislative relief. How successful have their efforts been? Let's take a look.

MOC Battles in Arizona, Kentucky, and Michigan

Meg Edison, MD, a pediatrician in Grand Rapids, Michigan, is author of the blog Rebel MD, in which she tracks legislative skirmishes over MOC in the states. "The states are laboratories of democracy," Dr Edison observes, "and as these MOC battles demonstrate, each state tackles the issue in different ways that best suit their legislative climate."

Last year, medical societies in Arizona, Kentucky, and Michigan tried to get legislation passed to stop MOC from being used as a precondition for hospital credentialing and insurance network membership. But the bills that were passed fell short of this goal. They only stipulated that state medical boards "may not require a specialty certification or maintenance of a specialty certification as a condition for licensure," as the Arizona law put it. Any mention of hospitals or insurers was dropped.

Decoupling MOC from medical licensure is a solution in search of a problem, Dr Edison believes, because no state currently conditions medical licensure on MOC. But in 2012, the Federation of State Medical Boards (FSMB) sought to convince the Ohio legislature to require MOC for medical licensing renewal in the state. Over 15,000 Ohio doctors rebelled, uniting 15 Ohio medical organizations to successfully defeat the measure.

This factual account was meticulously detailed in an article in the Journal of Community Hospital Internal Medicine Perspectives by Paul Kempen, MD, PhD.

However, Lisa Robin, FSMB's Chief Advocacy Officer, disputes this version of events. "We never advocated that any state medical board require MOC for renewal of licensure," she insists. "There was no effort in Ohio to require MOC for licensing renewal. That simply did not happen. It was a myth that just went viral."

Be this as it may, many doctors fear this could happen in other states, so passing a law that explicitly forbids it does address a real concern, even if removal of mandatory MOC requirements by hospitals and insurers are battles to be waged another day.

In Michigan, Dr Edison's state, where she had high hopes, the result was even more disappointing. "The legislation didn't go anywhere," she says. "We had a hearing, and it never went to a vote or even get out of committee, because the pressure from the insurers and the hospitals was just too great. So we had to put ours on pause."

This year, four significant attempts to get anti-MOC legislation passed have already taken place—in Oklahoma, Tennessee, Florida, and Georgia.

Oklahoma: A Win Overturned on a Technicality

In 2016, the Oklahoma State Medical Association (OSMA) supported anti-MOC legislation coauthored by Rep Mike Ritze, DO, a family physician. "For many physicians, MOC makes sense," OSMA said in a statement. "But it is not a one-size-fits-all solution for all physicians. [The bill] would still allow hospitals and health plans to 'fast track' someone who has MOC, but it would say MOC can't be the only way in and would require them to have some alternate pathway by which physicians could be credentialed."

For example, NBPAS offers an alternative to ABMS testing for recertification.[6] A doctor is required to take 100 hours of continuing medical education (CME) in the previous 24 months, and prove it with either CME certificates or transcripts from the CME provider. The cost of a recertification certificate is $169.

The bill passed the state House of Representatives and the state Senate unopposed. On April 12, 2016, Governor Mary Fallin signed it into law. Oklahoma thus became the first state to enact legislation aiming to remove MOC as a requirement for physicians to obtain a license, get hired and paid, or secure hospital admitting privileges.

"Oklahoma stunned everyone last year when they passed the first Right-to-Care legislation protecting patients and their doctors from MOC red tape, in bipartisan fashion, without a hitch," Dr Edison observes. "Unfortunately," she adds, "the language was not as tight as first thought, and hospitals found wiggle room to continue forcing MOC on some doctors while exempting 'grandfathered' doctors."

Dr Ritze introduced a new bill earlier this year to clarify the language for hospitals.

"The bill looked like a slam dunk," Dr Edison recalls. "The hospitals didn't seem to oppose it. The medical society didn't even make it a priority for physicians to call prior to the vote." But in the final 24 hours before the vote, she says, ABMS and Oklahoma hospitals "went on a lobbying and misinformation tirade, pouring incredible amounts of lobbying pressure and money upon the legislature."

"The bill, as drafted, unnecessarily interferes with the ability of Covered Hospitals to select the best-trained and most appropriate individuals to staff their facilities and unduly burdens their ability to contract with such individuals," countered an ABMS legal analysis that offered talking points to hospitals and insurers opposed to the legislation. "Please do not let Oklahoma become the only state in the nation that puts its patients' quality of care at risk by removing Maintenance of Certification requirements for physicians practicing specialized medicine."

"The doctors were caught off guard and were completely flatfooted to respond to such an outpouring of lobbying power and misleading information," Dr Edison blogged. In the end, the bill "failed miserably 71-22." The previously passed anti-MOC law still stands but remains "in legal limbo."

"Not surprisingly, those who are profiting from MOC don't want their gravy train to end and have launched a disinformation campaign to scare my fellow legislators into blocking this needed reform," Dr Ritze responded. "And unfortunately, they have succeeded in stopping [the revised bill] this year." He vowed to keep fighting. "Take a moment today and contact your state legislators and ask them to support MOC reform in 2018," he urged Oklahoma doctors.

"The takeaway point here," Dr Edison concludes, "is that ABMS will spare no expense to stop state legislation."

Tennessee: An 'Elegant' Bill Rendered 'Impotent

In 2016, the Tennessee Medical Association passed a resolution to "oppose and defeat efforts by American Board of Medical Specialties and the Federation of State Medical Boards to require physicians to impose mandatory Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) as conditions of employment, licensure, reimbursement or professional insurance coverage."

"Imposing such certification requirements upon the practice of medicine in Tennessee amounts to interference in the patient-physician relationship and threatens to interpose needless regulation between physician and patients in Tennessee," the resolution continued. "There is no evidence that MOC and MOL requirements improve patient care, but rather decrease access to physicians by excluding non-certified licensed physicians who do not repeatedly re-certify, thereby placing an undue time and financial burden on physicians and encouraging early retirement."

The resolution became the basis of an anti-MOC bill that was introduced in the Tennessee State Assembly in April.

"An elegant MOC bill," Dr Edison deemed it. But, she continued, "the hospitals and insurers had such a fit and lobbied so hard against the bill, pushing delay upon delay, that the senate subcommittee had to strip any mention of hospitals and insurers from the bill for it to move forward. The sad, impotent Tennessee bill now simply says that MOC can't be required for a medical license."

"We were running into a lot of opposition," concedes cardiothoracic surgeon Richard Briggs, MD, the Tennessee state senator who sponsored the bill. "It was going to be a tough sell—with two or three insurance companies; some hospitals; and HCA Healthcare, a for-profit hospital chain headquartered here, opposed to it."

Cigna led the opposition among insurers. BlueCross BlueShield of Tennessee, the state's largest insurer, doesn't require its member physicians to maintain their certification. "They have said they couldn't maintain their networks if they did," Dr Briggs says. An ABMS representative also flew down to Knoxville, the state capital, to testify against the bill, he recalls.

Dr Briggs could have made a convincing case to his colleagues in the General Assembly about the problems with mandatory MOC, based on his own experience.

"Even though I'm a cardiothoracic surgeon, I haven't done heart or lung transplants since the 1980s," he explains. "We don't even admit children to my hospital. But if I have to take maintenance of certification, I've got to take courses on heart transplants, lung transplants, and congenital heart surgery. That's very expensive, and it has nothing to do with my specialty. Why not do the things I need to do for my continuing medical education that actually affect my patients—transarterial valve replacements, for example, and robotic coronary artery bypass grafts, robotic mitral valves, and minimally invasive lung surgery that would really improve the quality of care in our entire region?"

"The other issue I have as a state senator is that ABMS is usurping our authority to decide who practices medicine here in Tennessee and who doesn't," Dr Briggs says. "ABMS is a testing company. It's not a professional organization. It isn't the American College of Surgeons. It isn't the American Association for Thoracic Surgery. We should not be allowing a for-profit corporation to decide who practices medicine in the state of Tennessee. It needs to be our own Board of Medical Examiners."

But those arguments, for the most part, didn't get made. "I had several other bills I was sponsoring, and I couldn't work on all of them at once," Dr Briggs admits. However, "we plan to have a 'summer study,' where we sit down with the folks from ABMS this summer and look at this together, because we're going to bring the bill back next year. It's the number-one legislative priority of the Tennessee Medical Association, and I think we have a good chance of getting this thing through."

Florida: Realpolitik or Act of Betrayal?

A bill drafted by the Florida Medical Association (FMA) was introduced in the Florida legislature in Tallahassee in April. It precluded the state board of medicine, department of health, licensed healthcare facilities, and health insurers operating in Florida from requiring recertification "as a condition of licensure, reimbursement, employment, or admitting privileges for a physician who practices medicine and has achieved initial board certification in a subspecialty."

"Finally, legislators are taking notice of the abuse of MOC in Florida and proposing laws to stop it," proclaimed St Petersburg neurosurgeon David McKalip, MD, president of the Florida chapter of AAPS, which had helped to shape the legislation.

But then something unexpected happened.

Florida has more doctors (over 52,000) than any state except California and Texas. With a constituency that large, and with ample funding to lobby state legislators, FMA should have had the clout to get the legislation passed, Dr McKalip contends. It didn't. To get the bill out of committee, FMA was forced to rewrite it from scratch.

The new version did not address the MOC concerns of Florida doctors at all. On the contrary, it directed the state to regulate its subspecialty boards, with a complicated plan to control MOC rather than make it voluntary. As long as a subspecialty board registers with the state, is a 501(c)(3) corporation, has a brick-and-mortar building with full-time employees, and doesn't require additional testing, the doctors under its aegis could be compelled to maintain their certification in order to say they are board-certified.

For Dr McKalip, the completely rewritten legislation was an act of betrayal. "No one in medicine wants that," he told Medscape. "Why would we ever want the government to have more authority to put a seal of approval on MOC?"

The final draft of the legislation "was made to differ from the initially filed bill because we were told that if the bill wasn't changed, it wasn't going to get a hearing," explains Jeffrey Scott, JD, FMA's general counsel. "It would have died exactly as it was. So we took our direction from the committee chairman, who was also the bill sponsor. When the sponsor who chairs the committee the bill's being heard in tells you to do something if you want to have any chance of moving forward, you do it."

FMA was directed to rewrite the legislation because ABMS, the Florida Hospital Association, and the Florida Healthcare Association, representing the state's insurers, applied significant pressure, Scott maintains. "A number of senators on the Health Policy Committee expressed some concern," he says. "To get the bill out of that committee, it needed to be less controversial."

The earliest FMA could introduce a new bill that addresses MOC requirements in the Florida state legislature is 2018, Scott says. "We're going to be meeting with all the folks who have an interest in coming up with a game plan," he adds. "I can't say at this point what it will be. We're going to study it over the summer."

Georgia: A True Anti-MOC Bill Becomes Law

Georgia's anti-MOC legislation, proposed by the Medical Association of Georgia (MAG) in January, states that MOC "shall not be required as a condition of licensure to practice medicine, employment in certain facilities, reimbursement, or malpractice insurance."

The state House of Representatives passed the bill on March 1 (the vote was 171-2). The state Senate passed the bill on March 28 (the vote was 52-1). Governor Nathan Deal signed the bill into law on May 8, making Georgia the only state that currently lifts MOC requirements for staff privileges at "certain" hospital facilities and for insurance network membership, as well as for medical licensure.

"That was pretty stunning," Dr Edison remarks. "That one went completely under the radar. No drama. That was a pretty big win."

"Georgia was a biggie," Dr Fisher agrees. "That's got all the conflicts. They can't use MOC for hospital credentialing. They can't use it for licensure. Or for insurance reimbursement of physicians. So it fills the entire bill."

What accounts for this political victory? Dr Fisher credits the leadership of Rep Betty Price, MD, who cosponsored the bill. Dr Price, an anesthesiologist, is married to Health and Human Services Secretary Tom Price. "She made a very compelling argument for why this is bad for patients," Dr Fisher maintains.

But compelling arguments for removing MOC requirements have been made in other states, without success. Why no drama in Georgia? Georgia has over 23,000 practicing physicians. Oklahoma, with only 8854 physicians, had plenty of drama. Why didn't ABMS, and Georgia's hospitals and insurers, mount an effective lobbying campaign to defeat or at least water down the bill, as they have done in other states?

As it turns out, ABMS did make an effort to block the Georgia bill. "ABMS contacted several lobbying firms to see whether they could have that battle fought down here, and I think many of them declined," says Derek Norton, MAG's Director of Government Relations. "With the strength of our legislative team and our position in the capital, I don't think they thought they could win that battle."

However, the law prevents MOC from being mandated at certain facilities, Norton emphasizes. The key word is "certain." The removal of MOC requirements only applies to state hospitals. The bill does not apply to general hospitals in Georgia that require MOC for credentialing. "That's why the Georgia Hospital Association didn't mount a big fight," Norton explains. "It really wasn't a huge deal to them."

The initial draft of the legislation was directed at all the hospitals in the state. "Once we took that out, the hospital association was okay with it," Norton says, "and so we just went forward from there."

Georgia has six state hospitals, which are covered by the new law. But the state has nearly 150 acute care hospitals, 17 long-term and rehabilitation hospitals, and 20 psychiatric and chemical dependency facilities that are still free to require MOC.

The law represents progress for the anti-MOC movement, but it's not as dramatic a win as some observers believe. In Norton's words, "It was more of a preemptive strike."

Other States to Watch This Year

Anti-MOC legislation is currently pending in Maryland, Missouri, North Carolina, and Texas, and bills have been introduced earlier this year in Alaska, California, Maine, Massachusetts, New York, and Rhode Island.

California, with over 100,000 physicians, is often a bellwether state. The California Medical Association considered but didn't pass an anti-MOC resolution at its October meeting, according to Los Angeles anesthesiologist Karen Sullivan Sibert, MD, who reports on anti-MOC legislation in the state in her blog A Penned Point. "However," she says, "there is enthusiasm for pursing the resolution again in 2017, and it appears to have a strong chance of passing." The title of the resolution: "Maintenance of Certification should not be used as criteria to assess physician competence."

In Alaska, passage of anti-MOC legislation is a practical necessity, Dr Edison believes. "It doesn't make any sense that nonprofit companies in the lower 48 states should have any influence on a doctor's ability to practice medicine in Alaska," she reasons. "If you try to do your MOC, and you live and practice a long way from a city where you can attend a board review class and then take your exam, as many doctors in Alaska do, it would mean taking weeks off from work. It's a big deal, and you'd be leaving patients in your community for significant periods of time without a doctor."

In Texas, "an anti-MOC bill unanimously passed in the House and went to the Senate, where their public health committee passed it on May 16," Dr Edison reports. "Now it's just waiting to be scheduled for a vote. But it's moving forward despite significant opposition from different special interest groups. I'm very confident in Texas being able to do this." People in Alaska and Texas are fiercely independent, she says.

Last year, the movement got a boost from the House of Delegates of the American Medical Association (AMA), which adopted a policy stating that "MOC should not be a mandated requirement for licensure, credentialing, reimbursement, network participation or employment."

In April, the AMA's leadership went a step further, proposing model anti-MOC legislation. Medscape obtained a copy via a personal communication. It is difficult to find online. Called "The Right to Treat Act," it provides state legislators with a template for drafting new anti-MOC laws, and it lends medical establishment legitimacy to the anti-MOC movement. "No facility...shall deny a physician a hospital's staff or admitting privileges based solely on the physician's decision not to participate in maintenance of certification," a key clause reads. States another, "A health insurance entity...shall not deny reimbursement to or prevent a physician from participating in any of the entity's provider networks based solely on a physician's decision not to participate in maintenance of certification."

Meanwhile, What Recourse Do Doctors Have?

As the movement seeks to involve more doctors and broadens its fight to other states, what about in the meantime? Do you have any option other than to periodically recertify, and pony up the fee, if hospitals and insurers in your state require it?

Dr Fisher doesn't beat around the bush. "No option," he flatly states. "And therein lies the problem."

Dr Edison actually tried to buck the system. "On December 17, 2015, in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics (ABP) certification," she recalls. "They say recertification is voluntary. So I said, 'Let's see how voluntary it is.'"

Dr Edison had passed her pediatrics boards twice. She had recruited patients for research projects and submitted her data to the board, as she was asked to do. She had completed the mandatory CME. "It came down to them saying, 'Give us $1300 or you lose your certification,' she told Medscape. From an educational standpoint, I didn't need to recertify until 2023. Yet every few years, they want me to give them more money. So I said, 'You know what? I'm not going to pay.' It's ridiculous!"

Last year, she sent an outraged letter to ABP and posted it on her blog for other physicians to read. "Within days, I had 40,000 views," she claims. "Within weeks, I had 100,000. Clearly, I had hit a nerve."

Her name abruptly vanished from the database of board-certified pediatricians on the ABP website. "You cease to exist," Dr Edison says. "It's as if you never passed your boards to begin with. And it caused all sorts of grief with insurers."

Within days after her name was removed, Blue Cross Blue Shield of Michigan, the state's largest insurer, contacted her. "They aggressively hunt down doctors, and if you aren't doing MOC, they kick you off their panels, Dr Edison explains. "They told me I was no longer board-certified. I had to pay the money or I wasn't going to see my patients. Right away, they were sending letters to my patients telling them that I was no longer a Blue Cross provider and that they were going to be reassigned to a new doctor. My patients were calling the office, upset. My billers were stressed out. I couldn't put my patients and staff through that. So I paid the money—$1300, plus a $200 late fee. Within seconds, I was emailed a PDF file saying that I was magically board-certified again. Within hours, Blue Cross backed down. It's all about the money."

"What some doctors in Michigan who don't want to do MOC are doing is hiring nurse practitioners (NPs) and physician assistants (PAs) to see their patients, because the insurance company will credential an NP or PA," Dr Edison says. "But they won't credential a doctor with years of experience, and who has passed multiple board exams, but who finally decides that they're done with MOC."

The only other alternative is to join the fight. "If you live in a state where MOC is mandatory, it's all about getting anti-MOC legislation to a vote," Dr Edison says. "It's calling up your lawmakers. Doctors, like most people, often don't know who their lawmakers are, so it can be intimidating. But once you jump in, it's nice. You get to talk to people who are creating the laws in your state, and they care about you calling. I don't think doctors call that much, so when one of us does, they listen to our concerns."

The movement is gaining momentum, Dr Fisher believes. "There's a growing group of us who get up every day and head out to work, and in brief moments of quiet, we are sending messages to our friends and working hard to get the word out that we need to stop this," he says. "If nothing else, it's helped us regain our profession and understand what really matters."

Medscape Business of Medicine © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this article: Neil Chesanow. The War Over MOC Heats Up - Medscape - Jun 21, 2017.

Wednesday, September 20, 2017

Noah Smith's Economics Lesson About Immigrants, Economics & Taxes

Noah Smith is an economist who needs no introduction. 
Today's Twitter thread about immigrants and immigration policy is short & easy to grasp.

Get it?
It's not about wages or welfare spending.
It's about identity. 
If you don't know by now that means "white nationalism" you haven't been doing enough homework. 

Friday, September 15, 2017

Iceland -- The Government Falls

A salacious tale of corruption is breaking in Iceland. This twitter thread offers a synopsis.

heard of this source but it appears to be in Iceland. 

Update and follow-up, September 18, 2017
I am surprised that at this writing over two-thousand visitors have been to this link. I never imagined a scandal in Iceland would trigger so much interest. 
While you're here, newcomers, feel free to drill around in my little web-scrapbook. 
My bio is in the sidebar and this is my post-retirement playground and journal.

More at the link...

Sunday, September 10, 2017

2008 New Year's Day Notes

From my old blog in 2008, the year Barack Obama first ran for president. 

Retrospective bits for New Year's Day...
Jacques Barzun turned 100 a few weeks ago. It is unlikely that casual readers of this blog will have any knowledge of this name, but he was part of my education by way of his Darwin, Marx, Wagner: Critique of a Heritage, written in 1941, which I came across about eighteen years later in a quest to de-provincialize myself in the stacks of a public library. Giving a kid a twenty-dollar bill and sending him off to the mall is one form of neglect, but it can be far more risky to let him loose in a library where alien ideas can infect pliable young minds. Little did my parents suspect that their child's tight, safe little Southern world was being assaulted by cultural seducers like Barzun. It was strong medicine for a teen, but I drank it all the same. I almost forgot, but my memory was refreshed by tributes to Barzun on the occasion of his passing the century mark.

No need to relive that part of the past, but Gerald J. Russello's tribute in First Things is worth a look.

...what appears to be stagnation in one era may appear to be something else to another. Religious belief, in particular, was not afflicted by boredom; indeed, “fundamentalisms are vocal everywhere; religious issues and personalities occupy the media as never before.” Islam “is again fighting the West, and where it conquers it is much more intolerable than it was in the sixteenth century.” In light of these contradictions, Barzun explores what it may mean to live at the close of a cultural epoch and what may be worth fighting for. The result is a nuanced and innovative look at Western culture. Contra the left, Barzun does not believe that all cultures are equal, and contra the right, a culture of Birkenstocks may still better than one of burqas. What is needed is an understanding of what it means when a society adopts, say, athletes and pop stars as role models and how we can distinguish those models of legitimacy and authority from those of other times and places. Further, Barzun’s analysis can help tell us whether, in the face of our new threat, decadence can be halted.

Later he comments...
...American style was defined by the large expanse of country that softened the edges of the Old World, giving everyone a place to settle. Moreover, Barzun writes, our mad dash of industrialization forced everyone to get along, so that “[i]n Europe a thousand years of war, pogroms and massacres settle nothing. Here two generations of common schooling, intermarriage, ward politics, and labor unions create social peace.” This process has been messy, and with some serious failings, but nonetheless it represented a new type of social order – unplanned, but ultimately wildly successful.

Reading these observations, I wonder if we have not lost some of that creative energy and imagination. The current crop of political wannabes to a man (er, uh...person, I should say) are pussy-footing through a minefield of cultural/ethnic bias that continues to reinfect our national persona. Simply saying the word immigration out loud is enough to trigger a discussion in which polite people first palpate one anther's attitudes before revealing in many cases nothing more than old-fashioned racism in modern patriotic, legalistic, isolationist clothing.

As Barzun noted, two generations in North America can be the equivalent of centuries of ferment in Old Europe. Just yesterday I heard someone commenting on classical music, mentioning how images of the East, particularly Turkey, became stylish among the Eighteenth Century elite. Mozart and others nakedly played to this trend in music, appealing to the romantic images of the day. But up close and personal the shimmering beauty of fantasy reveals warts and scars not seen at a distance. Sure enough, the visceral cultural hatred dividing Greeks and Turks is every bit as savage at that between Arabs and Jews, Koreans and Japanese, Tutsis and Hutus...or Anglos and Latinos. Or even, I dare add, Christians and Muslims. That cute reference to Birkenstocks and burqas is enough to animate a prickly debate.

Nouri Lumendifi is a brilliant youngster whose blog I have been following since he was in high school. He is now off at college, on the way to becoming a Jacques Barzun in his own right. With penetrating insights and the disciplined concentration of a good scholar he looks at conflicts and contradictions in the Arab world with the same detachment that Barzun looked at what we now quaintly call Western Culture (even though it is not strictly Western nor particularly cultural any more).

Nouri looks at the Levant and Mahgreb and sees a hodge-podge of ethnic/tribal/cultural communities at odds with one another and the world beyond. Commenting on an Al Jezeera poll showing over half their viewers to be in basic sympathy with the activities and/or views of Al Qaeda, he notes....

As most of the poll's participants were most likely not Algerians, but Arabs from across the Arab region, with the bulk of them probably being in Levantine countries, the Gulf and Egypt, I would say that it also reveals a popular lack of information and sympathy about and for the Maghreb in the Arab east. Whereas North African newspapers and television stations were quick to denounce the attacks, eastern Arabs often cheered or blamed the attacks on the US. While Algerians had their own conspiracy theories, the other Arabs either looked at the attacks in the context of some Western conspiracy to control the Muslim world, rather than a power struggle within Algeria itself. Major Arab news outlets tend to ignore political happenings in the Maghreb, contributing to a dearth of information and a flourishing ignorance of Maghreb affairs in the Gulf and the Levant.

Culturally and politically, the Arab world is ignorant of its brotherly west. A common stereotype in eastern Arab regions is that Algerians do not speak Arabic, but French. More pernicious stereotypes paint North Africans as ignorant of language, religion, and history. A Mauritanian colleague once told me that on meeting a Levantine woman in Boston, she remarked to him "You speak Arabic so well! Where did you learn to speak it?" Little did she know that of all Arabic dialects, Hassaniya, the dialect spoken through most of the southern and western Sahara (including Mauritania), is closest to classical Arabic. At al-Azhar University, Mauritanians were known for being exceptional students above others when it came to grammar and religion.

But one cannot ascribe such ignorance to eastern Arabs alone; Maghrebines tend to be almost as ignorant of the internal workings of say, Lebanese or Palestinian political life. They also follow the same pattern of turning somewhat of a blind eye to terrorist atrocities, particularly in Iraq. But because the Arab media is so dominated by Mashreqi personalities and happenings, they tend to have a firmer grasp on things eastern than their cousins in the Mashreq have on things western. A superficial sense of solidarity creates an "any means necessary" attitude that leads a nihilistic and cold world view in which even fellow Arab and Muslims are expendable if their deaths aid in the march against the enemy. The same bizarre thinking that causes some Arabs to question the identity of the 9/11 hijackers cause the same ones to condone acts of mass violence against themselves. While the results of the Aljazeera poll are not indicative of the opinions of the vast majority of any Arab polity, they do highlight a continuing problem within a specific sector of the Arab population; the minority that cheers on terrorists and other fanatics and straps bombs to their bellies and head into "battle" against children. Sadly, poll's results are neither surprising nor heartening, but they do not represent scientific data and are taken from anyone who passed through website. My question is this: if the same bombings took place in Qatar, would Aljazeera have run the same poll?

I know from personal acquaintance that what he says about the speaking of Arabic is true. I have had the privilege to meet and know an Oxford-educated man from Egypt who assures me that the Arabic spoken in Egypt is to the rest of the Arabic-speaking world what British English is to our own mother tongue world-wide. It is considered the gold standard. This little personal insight makes the whole essay ring true to me.

One final note before I start my day, also related to cultural changes. With a great sigh of relief I see that the Brits have taken a step in the right direction by cutting loose from the inflammatory language of "war on terror."

The words "war on terror" will no longer be used by the British government to describe attacks on the public, the country's chief prosecutor said Dec. 27.

Sir Ken Macdonald said terrorist fanatics were not soldiers fighting a war but simply members of an aimless "death cult."
The Director of Public Prosecutions said: 'We resist the language of warfare, and I think the government has moved on this. It no longer uses this sort of language."

London is not a battlefield, he said.

"The people who were murdered on July 7 were not the victims of war. The men who killed them were not soldiers," Macdonald said. "They were fantasists, narcissists, murderers and criminals and need to be responded to in that way."

[H/T TimN at YAR who found it a Boing Boing]

It has taken several years and thousands of lives lost for real steps to be taken in what can correctly be called counter-insurgency. Ever since I read Abu Khaleel's sketch about Nihad Had to Die I have known without further elaboration that for every innocent victim killed there are extended families and networks of acquaintances more alienated from those responsible and ripe for conversion by those we call insurgents.

All along, there have been voices calling for a different approach. Thomas Ricks was among the most persuasive, and General Petraeus himself, who literally wrote the book on counterinsurgency, was brought to the front in a last-ditch effort to make things better. Unfortunately, anything he has done (and it has been noteworthy as recent stats from Iraq show) has been too little, too late. And even now, as we flounder about in Afghanistan and Pakistan like a bull in a china shop, his type of approach can find no purchase.

So I start the new year with a renewed commitment to hope. Seems like that is some one's buzzword these days. I watched him on C-SPAN giving a speech in Iowa Sunday afternoon and among other things he admitted to being a "hope-monger." The Iowa caucus is not for a few more days, and I have little expectation that he will prevail, mostly because he is "too nice." Guilty as charged, it seems. But still, we cling to hope.

Sunday, September 3, 2017

Cheryl Rofer Comments DPRK tests

Cheryl Rofer speaks about the Iran nuclear deal at Ripon College in Wisconsin on September 30, 2015. (Photo credit: Becky Bajt/RiponCollege)
Cheryl Rofer, a chemist, retired from Los Alamos National Laboratory in 2001 after a 35-year career in which she worked on projects dealing with environmental cleanup at Los Alamos and in Estonia and Kazakhstan, disassembly and decommissioning of nuclear weapons, and chemical weapons destruction, along with many other issues. Nowadays she spends a good part of her time writing for the blog Nuclear Diner, which she and two fellow Los Alamos alumnae, Molly Cernicek and Susan Voss, founded in 2011.
-- Arms Control Association, 2016

The following screencaps are from this thread.

This delightful excerpt from Nuclear Diner, April 27 is a taste of the Rofer wit & insight. Do take time to read the whole post, and take a look at the complete image above. 

Cognitive linguist George Lakoff has explained much conservative thinking, including support for President Donald Trump, through a “strict father” model. It’s easy for us to think of the nation as a family and the leaders as parents. For conservatives, the strict father knows best and makes sure his children and his spouse do what he says. Progressives, in contrast, tend toward a nurturant parent model of leadership, which de-emphasizes gender while providing protection and valuing empathy and mutual responsibility. The bluster toward North Korea is that of the strict father, a model of domestic stability imposed on the realm of foreign relations.

In dealing with North Korea and China, the urge to resort to the paternal model is compounded by a long-standing stereotype of Asians as irresponsible children. Colonial propaganda depicted them as small, childlike, and in need of guidance from the adults of the West. Rudyard Kipling famously referred to America’s new Philippine subjects as “half-devil and half-child.” That went double for Asian men, whose features were caricatured as soft and childlike; it got another boost with America’s role in post-war Japan, lifting the infant Japanese into democracy. The boyish features of the young Kim Jong Un don’t help. Although the North Korean physically resembles his grandfather, the father of his country, Westerners are inclined to see him as a toddler in the pram. Kim-as-baby is a regular resort of cartoonists, as in last year’s New Yorker cover depicting Kim at play with missiles in a sandbox (at top).

Meanwhile, millions in South Korea are going about their business as usual. Terry Moran, Chief Foreign Correspondent, ABC News, posts this Tweet.

Friday, September 1, 2017

Facebook Community Standards Twitter Thread

Self-explanatory screencaps underscore the Wild West lawlessness of social media. "Community standards" test the margins of libel, slander, threats, bullying and harassment.

Monday, August 28, 2017

Who is Mark Lilla?

Ignorance is like cancer. It lies quietly, sometimes for years, growing and spreading until it is discovered, hopefully in time to ameliorate the damage done and corrected in time to avert further problems. That's where I have been since the presidential election. Like everyone else shocked to see the results of that election, I have spent many hours trying to discover what the heck happened. What went wrong? And in the words of David Remnick "Why is it now possible to drive across the country for thousands of miles without hitting a blue state or county?"

I never heard of Mark Lilla until a couple days ago. He's younger than I (b.1956 when I was 12) and a product of the academic world of professional intellectuals, a card-carrying member of the cognoscenti. When I was drafted as a conscientious objector in 1965 he was still in elementary school and about the time he was finishing high school I was getting married, abandoning academia and embarking on several decades rearing a family, joining a Sandwich Generation taking care of a geriatric population and what has come to be called Generation X. Until now our paths never crossed.

A Facebook link to the New Yorker, A Conversation with Mark Lilla on His Critique of Identity Politics, is what brings Lilla to my attention. I spent the better part of a day plowing through the transcript of an interview set me to doing homework. I learned that
  • Mark Lilla is a very smart, well-read man, quick on his feet and good at threading rhetorical needles,
  • is regarded by today's progressives as someone not to be trusted, perhaps a "Richard Spencer lite" and
  • like many other people these days has yet another book to sell
Here are a few Facebook remarks and comments I want to keep for future reference...
As an old guy who missed most of the last three or four decades supporting a family and staying employed, I have the advantage of latter-day ignorance, despite having once been an activist who became and remained a life-long liberal. I never heard of Mark Lilla prior to this, but after reading this interview, and listening to another at Slate (in which he seemed to employ many of the same phrases and arguments verbatim) I think he's on to something important -- elusive, for sure, but more than rhetorical trickery.

Before tossing aside this link, I suggest listening to the Slate interview. Be warned that the transcript starts out pretty close, but toward the end long parts, both questions and responses, have been omitted. It may have been to save time or space, but I couldn't help thinking it may also be to dilute Lilla's points.

This is the link.

At 25:52 the transcript skips a huge swath of the interview, much of which is compelling, both questions and responses.

Transcript misses much after this: "Liberal elites in this country—and not just in the party but also in media, in the legal profession—are produced by the university now. Democratic Party elites used to be mayors, governors, county commissioners, union officials—people and farmers who are shaped by those experiences out in the world after the ’72 election that changes the rules. Those people were pushed out of power, and now it’s the college-educated who run the party and are the leading figures in American progressivism and liberalism. They come out of this university, and this way of looking at politics rubs off on them."

=> All content from that point for the next ten minutes is left out for some reason. It resumes about 34:05 with "I write in the book about the websites of the Republican Party the Democratic Party. You look at the website of the Republican Party and smack in the middle of it is a list of 11 principles, 11 sentences of what we stand for. That’s the product of thought, and that’s the product of a lot of debates that happen in the conservative movement."

Sorry to be nit-picking, but for someone like me, trying to ingest ideas that are new, and in this case both elusive and controversial, leaving out that much material, though it may have been "inadvertent" makes me wonder if it might have been intentional.

I'm open to arguments against what Lilla says, but I find what he says both persuasive and well-said. This snip from Remnick hits the mark, especially that line that "citizens are not roadkill."

My long-time web buddy Tom Watson commented "What bothers me is that an academic can make so many obvious errors. Most egregious? Stating that Clinton lost women - she won! But of course, the really offensive stuff is the class trumps all business. So upsetting."
And he's right. 

You're right. Another interview at Slate pointed that out in the transcript. (I got a screencap of that -- but it was not mentioned in their interview.)
I never heard of this guy before yesterday, but only because I lost the better part of four decades of academic/intellectual discussion while keeping a job, supporting a family and leaving my youthful activist impulses on the shelf.
Before (and after) linking this discussion, I had to catch up finding out who the heck this guy Lilla is and where he falls in the political ecosystem.
Turns out he's something of a not-so-closeted conservative, part of the academic cognoscenti, whom most contemporary progressives consider something of a "Richard Spencer lite". So anything he says is subject to the filter of suspicion and countered with adroit arguments.

Time permitting, check out that interview, but don't just read the transcript. A whole chunk of their conversation is omitted, beginning at about 26 minutes and doesn't pick up until ten minutes later. During that time I heard a commercial for ZIP Recruiter (which reminded me of Cambridge Analytica, but that's off topic) and Lilla laid out a taxonomy of academic programs that conservatives put in place years ago aimed at coaching, grooming and shaping lawyers and others in the ideological mold from which Gorsuch and others were hatched. The thrust of his points about the Federalist Society and others strike me as repellent -- brought back my old college days disgust with YAF (Young Americans for Freedom). But his general argument is spot on.
Here is the Slate link.
I just looked up YAF and notice that the acronym now stands for Young America's Foundation. But a separate Wikipedia article for "Young Americans for Freedom" indicated it was absorbed by a more reactionary outfit with the same acronym.
"On March 16, 2011, Young Americans for Freedom passed National Board Resolution #001, unifying the Young America's Foundation with Young Americans for Freedom on April 1, 2011."
(Reminds me of how the old SSOC was absorbed by SDS and subsequently disbanded. Organizational morphing never seems to end, with big fish eating the little ones even in that part of the woods.)
In any case the "Young Americans for Freedom" article has a fascinating list of "Conservative or libertarian organizations" that doesn't appear at the other YAF article.
But I digress...
It's the middle of the night and I need to go back to bed. Hope you get a chance to hear this other interview.

Later I added this...

Looking more closely at the Wikipedia article on Young Americans for Freedom (YAF, not to be confused with Young America's Foundation) I notice a list of current and former elected representatives who matriculated through that now extinct organization. This is an impressive list that shows a depth of thought and influence that I, as a former activist with the political/philosophical Left, did not experience.

Perhaps the old Liberal world view was just that, a "world" view -- not looking through the lens of nationalism. That may be what resulted in today's conservative heirs to those roots having the power we saw surfacing during the Obama years, and becoming manifest in this last presidential election. Many of us respected the intellect of Buckley and courage of "Rockefeller Republicans". Their "Sharon Statement" is pretty thin gruel beside the Port Huron Statement, but it was the start of a movement in those ranks that grew slowly but provided deep roots for what was to become the libertarian-tainted hybrid that gave us Paul Ryan.

Sad to say, all these years conservatives have been toiling away, working the grass roots, while we on the Left have micromanaged with the best of good intentions a multitude of allied groups -- neglecting the need for a strong bond lacing them together into an effective national political force.
We love Occupy and take pride in that old Will Rogers line about "I'm not a member of any organized political party -- I'm a Democrat." But Occupy turned out to be a one night stand and the Democrat Party today lies in shambles. 

I wish I could advance a good remedy, but the best I can come up with is the hope that all who claim leadership, fellow-travelers and all, can somehow stop the infighting, join forces and get serious (as Lilla clearly suggested) to come against the MRSA infection now spreading in American politics.

I see the "old" YAF article now has one of those Wikipedia flags indicating it is apt to be altered from it's present form, and considering how swiftly the new YAF is able to move, it may even vanish from the site or be amended with enough material to make it even more marginal than it has become. 

Tom responded "I wouldn't overplay the shambles aspect. Compared to, say, Labour in UK, we're very effective opposition."
Again, he's right. But this was how I responded...

Of course. The parliamentary system consists of coalitions as a matter of design, and our two-party system is obliged to be better organized and open to compromise. That Will Rogers quote is a way to brag about the "big tent" Democrats have always had. But I'm coming to the conclusion that while advertising a "come one, come all" invitation we have inadvertently overlooked too many ordinary people -- people for whom the world of politics consists of slogans, sound bites and tag lines. This is a segment of the population that never darkens the door of a voting place unless something is twisting their tails or they feel threatened by something.
Unlike many I consider low voter turnout as a sign that stuff is mostly pretty good for a lot of people. But when groups get pissed or feel threatened they become more prone to become involved.

In the case of the presidential election, the outfit that got my attention was Cambridge Analytica, widely used by business and industry to target market opportunities and convert the results of focus groups into revenue streams for whatever is being sold (both goods and services -- that commercial message at Slate for ZIP Recruiters is a good example). In the case of Bannon and company (Mercers, etc) the impact on targeted political pay dirt, together with gerrymandering and the Teaparty vanguard, has put a creature into the oval office that none of us ever imagined had a chance.

I'm haunted by those questions Remnick raised, "Why is it now possible to drive across the country for thousands of miles without hitting a blue state or county? How did the Democrats lose a decisive number of Obama voters to someone like Donald Trump?"


Addendum Sept 7
Ta-Nehisi Coates mentions Lilla in an Atlantic tour-de-force, The First White President.

Mark Lilla’s New York Times essay “The End of Identity Liberalism,” published not long after last year’s election, is perhaps the most profound example of this genre. Lilla denounces the perversion of liberalism into “a kind of moral panic about racial, gender and sexual identity,” which distorted liberalism’s message “and prevented it from becoming a unifying force capable of governing.” Liberals have turned away from their working-class base, he says, and must look to the “pre-identity liberalism” of Bill Clinton and Franklin D. Roosevelt. You would never know from this essay that Bill Clinton was one of the most skillful identity politicians of his era—flying home to Arkansas to see a black man, the lobotomized Ricky Ray Rector, executed; upstaging Jesse Jackson at his own conference; signing the Defense of Marriage Act. Nor would you know that the “pre-identity” liberal champion Roosevelt depended on the literally lethal identity politics of the white-supremacist “solid South.” The name Barack Obama does not appear in Lilla’s essay, and he never attempts to grapple, one way or another, with the fact that it was identity politics—the possibility of the first black president—that brought a record number of black voters to the polls, winning the election for the Democratic Party, and thus enabling the deliverance of the ancient liberal goal of national health care. “Identity politics … is largely expressive, not persuasive,” Lilla claims. “Which is why it never wins elections—but can lose them.” That Trump ran and won on identity politics is beyond Lilla’s powers of conception. What appeals to the white working class is ennobled. What appeals to black workers, and all others outside the tribe, is dastardly identitarianism. All politics are identity politics—except the politics of white people, the politics of the bloody heirloom.

Lilla (at least through this lens) is another cog in the machine we dare not name, a perpetual motion white supremacy contraption. Coates is spot-on. I now need to find Lilla's place in the taxonomy of that universe. I dare say he never thought of himself in that way.

Wednesday, August 16, 2017

Noah Smith on Political Alliances

Noah Smith looks at recent history in terms of when to make alliances with disagreeable forces...