I'm worried about the Roberts Court

Apparently, they've fallen into a vortex in which the passage of time no longer moves uniformly from "before" to "after", because they no longer have the ability that you and I callously take for granted to distinguish between what political candidates do before an election and what they do after taking office:

The appearance of influence or access, furthermore, will not cause the electorate to lose faith in our democracy. By definition, an independent expenditure is political speech presented to the electorate.... The fact that a corporation, or any other speaker, is willing to spend money to try to persuade voters presupposes that the people have the ultimate influence over elected officials.

I'm particularly afraid for Justice Anthony Kennedy, since this vortex has evidently caused him particular distress; I can only conclude that in this other universe it is possible for campaign contributions to both corrupt elected officials and be completely irrelevant to their conduct. Since it would be uncouth to criticize a ruling written by five old conservative Catholic men in weird robes under the trying circumstances of crossing over into an alternate universe, I urge readers to refrain from speculation on the question of whether policies popular with the public are generally enacted if wealthy interests are aligned against them, or whether these kinds of donations buy influence. Now is not the time for such bickering and arguing.

Rather, since apparently they are close enough to an interdimensional portal to render judicial opinions that obey the laws of grammar and matter that prevail in our universe (I think the logical fallacies and specious reasoning are fairly attributed to crossing the boundary between dimensions), let us hope that the justices can find a rope, throw it back through the portal, and let the remaining justices pull them back to safety. With two ladies on the other side, I don't know if it'll work. Maybe Alito's hired Tim Tebow as a clerk in case any feats of strength are required in chambers? I shudder to contemplate Roberts, Alito, Scalia, Thomas, and Kennedy vanishing from our universe without a trace.

Thanks Again, Grey Lady

The rancor and belligerence surrounding the decision to try the 9/11 conspirators in New York is regrettable. Yet, there are still those out there who will practice good manners in the debate. For example, in the interests of hearing all positions on the matter, the New York Times editorial page has politely waived any elitist or arrogant demands that writers of letters to the editor maintain an attachment to facts in their letters, so long as they represent a constituency that has some symbolic connection to the attacks.

The plan to bring the terrorists to New York City is an abomination and easily the most pernicious step the Obama administration has taken to date. It is almost certain that such a monumentally misguided decision will have a chilling and deleterious effect not only on our ability to prosecute current and future detainees, but also on our ability to prosecute the overall war on terror. These are war criminals, not American citizens.

The reason you have a Guantánamo in the first place is to avoid the circus that this will inevitably become. In so doing, the president has placed politics above principle and consequently has violated his most sacred oath: the protection of American citizens.

James McCaffrey
Yonkers, Nov. 14, 2009

The writer is a lieutenant in the New York Fire Department and a 9/11 family member.

Only an ill-bred jerk would point out that the President makes no oath to defend Americans, but only to defend the Constitution.

Sometimes Impoliteness Overtakes Me

And I notice things like this in airport bookstores, and start to think quite nasty thoughts, like "other than having the superfluous word "BY" in it, this headline is quite apt. Perhaps she will henceforth be known to internet wits as TETTGEW...."

It's impolite, I know, but the stress of traveling makes one susceptible to the lures of the easy joke.

How Not to Discuss a Previously Foreseen Outcome

If anyone out there intends to discuss recent developments in the health care debate, here is a model of how NOT to initiate the discussion:

Say, Barack Obama: You bent over the entire left wing of your party and pissed all over your most loyal supporters to foster a back-room deal with AHIP in which you gave them the store while they used Max Baucus to give the public the shaft. Then they looked at the atrocious corporate welfare bill that the Baucus Dogs in Finance produced (on their orders), and decided that it did not go far enough to serve their special interests, and went all Harry and Louise on you. The insurance companies are a bunch of fucking snakes and if you didn't see that stab in the back coming, you are truly retarded.

Statements like this are completely uncouth and should not be uttered in polite society.

If Politico is to be believed, the White House did not see this coming.

UPDATE: An administration official called. The White House isn't happy.

AHIP chief Karen Ignagni met with White House and Senate Finance officials last week, and she said they were "a ways away from doing an analysis," the official said. "There is a feeling among White House officials that they were misled."

If this is accurate, it calls to mind frogs, scorpions, and aquatic adventures that end badly for everyone. The reliability of Politico is probably also a subject best excluded from polite conversation, however.

UPDATE: Speaking of which:

Nancy-Ann DeParle, director of the White House Office of Health Reform, said she was surprised by the report because she met last week with Ms. Ignagni and they vowed to work together.

An uncouth person might be tempted to remind DeParle about the worth of industry promises when political negotiatons turn away from their preferred outcomes and the track record of the insurance industry with regard to health reform, perhaps suggesting a degree of naivete or "retardation" on the part of the Office of Health Reform. A polite person would repress that temptation as if their life depended on it.

I've Got No Choice: Medicare Billing Perversities Will Force Me to Bilk the Public

At risk of being uncouth, there appeared today in the New York Times a letter to the editor by Dr. Richard Bazarian of Portland, Maine, that I found rather curious. Dr. Bazarian opined that the capricious decisions of medicare bureaucrats portend disastrous consequences under national public health insurance.

A foreshadowing of what is to come under government-led health care reform: An anonymous Medicare bureaucrat decides to change the billing code for a $30 drug so that physicians are reimbursed only about 25 percent of their cost. The annual savings nationwide: about $11 million.

Unintended consequences: The ophthalmologists who had been offering the drug, Avastin, off-label are unwilling to take the loss, and justifiably recommend that their patients switch to Avastin’s sister drug, Lucentis, which costs more than $2,000 per monthly dose. The annual cost to taxpayers: hundreds of millions of dollars.

In other words, an eye doctor stands to eat 75% of $30--$22.50-- each time he prescribes Avastin to a patient. Divided up, the $11 million estimated national savings reflects about 489,000 annual prescriptions of Avastin. Remember that number.

What's a rationally operating capitalist physician to do? Why, refer his patients to a drug that is sixty-six times as expensive and recoup all of the cost. At 489,000 prescriptions a year, that would translate not to "hundreds of millions of dollars," but nearly a billion. Of course, Dr. Bazarian magnanimously offers his patients a choice:

Today, an average day in my office, of 14 patients to be treated, 8 were scheduled for Avastin and 6 for Lucentis. When shown your article, all agreed to change to Lucentis. While they would like to be socially responsible, they don’t want to see their physician lose money on their treatment.

An uncouth person might suggest that a doctor has undue influence over his elderly patients, who are likely experiencing some anxiety over their impending blindness. Since these patients have no personal financial stake in the prescription decision, while the prescribing physician does, an uncouth observer might also point out the presence of a conflict of interest. An uncouth observer might also speculate that Dr. Bazarian and his colleagues, were they to express in writing this particular situation to their Congressmen or Congresswomen, or to the professional associations to which they belong, might have some influence to produce a productive remedy without resorting to an apparently spite-driven recourse of screwing Medicare.

A really uncouth person might engage in basic math and assess the outcomes of this typical day. Dr. Bazarian presses his elderly patients to adopt the name-brand drug in order to avoid harming the nice doctor who is helping them to retain their sense of sight. How does it work out for Medicare? Instead of (8*$4.50)+(6*2000)=$12,036, Medicare is on the hook for 14*$2000=28,000, a net loss of $15,964 . As for the doctor, by shifting eight patients to the name brand drug he saves himself $180. A spectacularly uncouth person might ask of Dr. Bazarian what he intends to do when his individually rational actions, replicated by his colleagues across the country, have the predictable systemic consequence of bankrupting Medicare and his pool of clients dwindles to the independently wealthy sufferers of macular degeneration in southern Maine. Might the doctor inquire of one of his Senators whether some sort of systematic overhaul of the health financing system might alleviate this one bizarre incentive? Might the doctor participate with others in an effort to remedy a procedural fault in the system that creates a perverse incentive? Might the doctor, to use the unfortunately coarse parlance of our times, suck it up and take one for the team, as most people in these troubled economic times have had to do? After all, the fact that the doctor claims to have offered his patients the final decision suggests that he recognizes the basic absurdity of his position, that his potential individual loss of an Andrew Jackson should outweigh the public interest of saving two large. It's not as though he has any choice in the matter. His patients insist that he give them the most expensive drugs the taxpayers can buy.

As a gentleman, however, I find it absolutely reprehensible that an honest physician would be forced by the absolutely irresistable power of perverse economic incentives to inflict eighty-three fold on the taxpayer the losses that public insurance would inflict on him, and therefore am swayed by the sheer power of this isolated anecdotal argument to reject the public option entirely.

True Gentleman-Lady: Judith Warner

Warner gets it: when people like Michael Moore attempt to shame and humiliate the malefactors of great wealth, they create hard feelings and no one can be happy. It would be far more polite and effective to invite the management ranks of Goldman Sachs and JP Morgan over for some coffee and really listen to them. Hear about their dreams, understand how bad it makes them feel to be called bloodsucking evil parasites. With a little understanding, they might be convinced to slightly modify the publicly visible manifestations of their ill-gotten wealth, which would allow everyone to live comfortably in the belief that nothing's wrong.

Also, Warner displays an astute political insight when she observes this:

Maybe Moore has spent too much time documenting the other side. He seems to have lost sight of the fact that the other side is out of power. Why play their game and risk letting them win?

See, Republican hissy-fits are the most potent political weapon in the land. If Democrats concede all matters of economic and social policy to them, thus neutralizing the power of manufactured outrage, there is a chance that Democrats may preside over a more polite and sane America, in which we are free to raise our precocious and well-adjusted children with common names spelled according to European conventions. Which is what we all want and need so desperately. It's a slim chance, but, since raising issues of governance, social responsibility, and systemic inequalities is totally gauche, it's the only chance we've got.

Unless they turn to Plan B, spite politics. Nothing beats that.

That's Uncouth: Alan Grayson

This cad has some nerve. Imagine the gall of pointing out GOP obstructionism, and then stubbornly refusing to apologize for this breach of decorum. Then arrogantly claiming that some sort of "public" interest is more important than bipartisan civility in the halls of Congress. Then, treating the noble and informed queries of the journalistic classes with utter contempt! Why, when Borger compared his comments to Joe Wilson's, Grayson ignored their nominally common rudeness and insisted that each statement be evaluated on its factual merit. And when Blitzer invoked Professional Journalistic Balance by comparing his words to Sarah Palin's accusation that health reform would create death panels, Grayson not only insulted the honor and virtue of a lady by suggesting that she was an ill-informed scaremongering twit, but again demanded that his statement be evaluated on factual merit.

Alan Grayson is still wet behind the ears as a Congressman, but he's achieved levels of uncouthness in eight months on the job that it's taken Barney Frank decades to master. If he plays his cards right, he may make a run at the Hall of Uncouth.