Commentary from Dave Durenberger

May 9, 2008

NATIONAL SCENE

"LET'S KEEP MAKING HISTORY TOGETHER" is how Hillary Clinton closed her Wednesday morning thank-yous to her supporters. Indeed she is. An important part of the history of the American presidency and politics. The Democratic primaries are proving there isn't much life left in gas tax gimmicks or personal attacks. By either Hillary or the former President. Out with the old and in with the new. Barack Obama knows now that he is the "new" and the focus shifts to how we will define it. A good start Tuesday night when he qualified himself as a messenger of change, "Although an imperfect one."

MCCAIN’S FREE RIDE TO SEPTEMBER…MAYBE
This is a fascinating election year because the real presidential campaign won’t start until about September 12. Meanwhile we have a contest among Democrats like nothing we’ve ever seen in American politics. Yes, we’ve had long primaries. But none with the daily dialing of voters this one has. Bill Clinton started dialing voter opinion the day he started his campaign in 1991 and the gang of Clintonistas haven’t missed a day since then.

Hillary is a master at it - witness her dialing up the “elitist” with a summer gas tax holiday. Everyone knows it’s pandering, including John McCain who wants to run against her.

Assuming Obama survives this onslaught to become the party’s candidate, he’s the candidate best prepared for the last seven weeks of general election campaign and, hopefully, as many head-to-head debates as possible. John McCain has had time to deliver weekly position papers on the priority policy issues facing the country. So far he has a free pass from the Dems and the press which expires shortly after the Democrats select their candidate.

REPUBLICANS REMAIN REPUBLICANS
John McCain chose primary Tuesday to announce that he will follow George Bush, the religious right, and the strict constructionists in saving the nation from "the systemic abuse of our federal courts" by Democrats. Rev. Richard Land, southern Baptist, says, “He rang all the bells.” Even though, as a Senator, John McCain often combined with those of us who worked to overturn "original intent" federal court decisions on civil rights.

Newt Gingrich chose Tuesday to tell Republicans in Congress they were in as much trouble today as in 2006. To pour salt in the wounds, he came up with Dr. Newtie's prescription for change: "Take a gas tax holiday, stop filling the strategic Petroleum Reserve, and build a space-based air traffic control system."

NEWT GINGRICH - JACK KEMP - BARACK OBAMA
In the last couple weeks two former Republican members of the Congressional leadership have publicly directed invitations to Democratic candidate Barack Obama to join in discussing major policy change. Jack Kemp, who also served the Buffalo Bills as their quarterback, George Bush as his HUD Secretary, and Bob Dole as his Veep candidate, sent some strong advice to Obama on race, racial reconciliation, and tax reform in America via the opinion pages of the Wall Street Journal. Former GOP House Speaker Gingrich chose a speech at the American Enterprise Institute to suggest conversations on several other and related domestic policies.

JOE LIEBERMAN
The Connecticut Senator who is part Democrat/part Independent/part Republican and an otherwise great guy may not end up as John McCain’s running mate in September. The evidence of that comes in a Washington rumor that Lieberman and McCain are considering a prime time speech at the GOP National Convention for Joe. “If Sen. McCain, who I support so strongly, asked me to do it, if he thinks it will help him, I will,” he is quoted as saying. Lieberman has his own problems with Senate Democrats whose leader, Harry Reid, gave Joe a chairmanship this session which others are eager to take away from him if the Democratic majority expands after the 2008 election.

PEGGY NOONAN
Commenting in the Wall Street Journal on why she can’t get angry at or about Rev. Jeremiah Wright she says, “I have been watching America up close for many years…I have seen, heard, and respected the pain of people who were forced to come here when they did not want to and made to live in a way no one would want to. Who could deny them their grief or anger? I have seen radicalism and extremism too…Hatred has power in the short term, but is non-sustaining in the long…It may take a long time, but in the end we (Americans) try to do the right thing, and everyone knows it.”

AND DAVID BROOKS THIS WEEK
Commenting on the Clinton/Stephanopoulos vs. Obama/Russert Sunday TV shows. As to Clinton, “Her attempt to take over the show was nothing compared with her attempt to dominate the truth…Clinton signaled that she wasn’t going to concede even an inch to the vast elitist conspiracy.” As to Obama, “Thoughtful and conversational, he doesn’t seem to possess the trait that Clinton has: automatically assuming that critics are always wrong…His astounding composure comes across as weakness in the midst of combat with Clinton, but it is also at the core of his promise to change politics. He vows to calm hatred and heal division. This contrast between combat and composure defines the Democratic race.” Brooks reads the contrast thusly: Clinton believes we need a leader who can intimidate. Obama believes that change requires consensus, learning, and accommodation; in short, the power of communication not conquest.

ARE THERE ANY ADULTS IN THE DFL?
It is difficult to watch satirist Al Franken self-destruct as a Senate candidate and what passes for the Democratic Farmer Labor Party of Minnesota stand around acting helpless. Helpless because the so-called party of the people has opted in Mike Ciresi and Franken for self-financing candidates without the popular appeal of an Obama.

As a Republican I would like my candidate, who happens to be a Republican incumbent, to win. But I know between Norm Coleman and Al Franken we will be forced to watch $25 million in television blather this year. To what end? The re-election of one heck of a good St. Paul mayor to a national job endorsing a relatively inept President's foreign and domestic policies. (Norm's other endorsement was Rudy Giuliani, if you remember).

Norm is sort of our Fritz Mondale. He wants to be governor, but Karl Rove says you have to be senator. Near the end of a tight race, the incumbent Paul Wellstone dies a tragic death, followed by a self-destructing memorial service and the choice of a former Veep to re-run for a Senate seat to which he had been once appointed after being appointed Attorney General. Only the DFL could pull this off. Hey, you guys, where’s Tim Walz when we need a real race?

THOMAS L. FRIEDMAN
The New York Times columnist recently rated the second most influential person in the world, says our President’s latest energy initiative was to go to Saudi Arabia and beg King Abdullah to give us a little relief on gasoline prices. ”We are not as powerful as we used to be because over the past three decades the Asian values of our parents’ generation – work hard, study, save, invest, live within your means – have given way to subprime values: ‘You can have the American dream – a house – with no money down and no payments for two years.’’

Friedman also writes, “We don’t need a president who is tough enough to withstand the lies of his opponents (referring to Clinton v. Obama). We need a President tough enough to tell the truth to the American people…We are not who we think we are. We are living on borrowed time and borrowed dimes. We still have the potential for greatness, but only if we get back to work on our country.”

Tom's "first law of petro-politics" is this: “As the price of oil goes up, the pace of freedom goes down” and vice-versa. 23 countries derive more than 60% of their export revenue from oil and gas and not one is a democracy. Unless the U.S. finds a way to acknowledge that as a premise for both foreign and energy policy, currently predicted $150 a barrel oil is a floor not a ceiling and there goes our economy.

A NEW G.I. BILL
Newly elected Virginia Democratic Senator Jim Webb proposes legislation that would finance higher education for qualified veterans of the Iraq and Afghanistan wars. That puts Senator John McCain in a bit of a bind because its costs are way beyond anything the President who started the wars would ever finance. So McCain and DOD Secretary Robert Gates are producing a broad veterans’ benefits bill which would improve both health and education benefits for veterans, but not at the price we paid for the warriors who defended us in World War II.

COLLIN PETERSON is the long-time Democratic Congressman from Minnesota’s 7th District. This session he serves as chairman of the House Agriculture Committee and the key person in what is now a 16-month effort to get agreement with the Senate and the White House on an Agriculture re-authorization. Despite the time consumed with negotiating ag bill provisions with 534 members of Congress, Collin has been able to reorganize the congressional band he leads, “The Second Amendments.” Republican congressmen Kenny Hulshof (R-MO) and Dave Weldon (R-FL) must be replaced on drums and keyboard because they are leaving Congress. Likely replacements on drums Bill Sali (R-ID) and on keyboards and vocal (which Peterson also does) John Hall (D-NY) who is co-founder of the 1970s band Orleans.

RUPERT MURDOCH'S WALL STREET JOURNAL is beginning to show a predictable difference akin to the new publisher's influence on the world of government and politics. The Project for Excellence in Journalism survey says the front page political coverage has tripled. News articles are shorter and, last week, we saw the opinion pages go from two to three. We also watched the paper's managing editor and its general counsel directed to the exits.

CONGRESSIONAL ETHICS
Having run GOP Leader Tom DeLay out of the House, and sent some of his colleague followers to jail, the Democratic House wants an outside office of ethics to take over for the broken-down in-House ethics process. A task force report to create the new office passed the House 229-182, but not until the Democratic leadership had held the normal 15-minute vote open, on a procedural motion which preceded it, for 10 minutes while twisting some Democratic arms which didn’t like the outside office idea.

LAKE WOBEGON THIS WEEK
One page of Minneapolis Star Tribune headlines: “After school aide charged with sexual misconduct…St. Paul police launch new unit on elder abuse…..cause of tasered man’s death still unknown…..Mayor apologizes for DWI arrest…..state counterfeiter sentenced to 3 ½ years of real time…..armed stand-off ends with peaceful surrender…..St. Paul man slain while riding in car…..apparent confession of molestation leads man to turn himself in…..worker accused of threatening to destroy utility systems….mayor apologizes for recent remark…..body found in river identified as St. Paul man.” The Tribune also hired Blackstone Group to advise it on how to avoid bankruptcy.

GOP IN ST. PAUL
While we’re at it, those of you attending the national GOP Convention in St. Paul Sept. 1-3, 2008 will find George Bush and his fellow Texans at the Crowne Plaza Riverfront Hotel (once was a Hilton) four blocks from the Excel Energy Center; John McCain and the Arizona Republicans at the elegantly restored St. Paul Hotel just two blocks from the convention; and Pawlenty and his Minnesota friends at a Hilton Garden Suites somewhere in the city.

REPEATING THE SAME EXPENSIVE MISTAKES
Watching the Minnesota legislature in a budget-cycle year is a painful experience. As they do every year, the legislators and the Governor debate how to get to a constitutionally-mandated balanced budget by reducing the growth in spending for human services in order to maximize federal money available for infrastructure. So they play little games like helping the owners of the Mall of America finance expanded parking out of the property taxes levied across the 3 million person metro area. They "must fund" a $1 billion light rail system connecting downtowns Minneapolis and St. Paul or "lose $800 million in federal transit funds." Ditto on highways, bridges, parking ramps and other "infrastructure."

A long time ago - in the seventies and eighties - the nation's Governors, President and Congress worked together to design a "new federalism" that would call out the ideal responsibilities of a national government and those best met by states. It almost always came down to the reality that
“place oriented” investment decisions such as transportation, housing, parks and recreation, public health and safety, and investments in education were best left to states. The programs which delivered equity of access to education, health care, and income security were the accountability of a nation of taxpayers because the cost of access fluctuates with population and economic shifts and with the fiscal capacity of 50 states. Infrastructure is another story.

HEALTH POLICY

CMS ACTING ADMINISTRATOR KERRY WEEMS has been acting head of the Medicare and Medicaid agency for one week more than a year. There is no sign from the Senate Finance Committee, which held a hearing on his appointment last July, that they intend to confirm Weems any time soon. It has nothing to do with his qualifications. Weems is a professional who has served at HHS for more than 20 years without political appointment, most recently as assistant chief of staff to Secretary Leavitt. It’s all about not wanting to raise on the Senate side the kinds of policy issues raised on the House about whether the Bush administration new Medicare and old Medicaid policies are helpful or hurtful. Leave that to the next President. The committee has its hands full trying to fund no cuts in Medicare’s physician payments and some related, and highly political, tax policy issues.

GETTING IT RIGHT IN 2009
Under the auspices of NIHP, 36 “veterans” of the 1993-94 health reform debate in Washington gathered in Minnesota recently to focus on what they recommend be done to “get it right” in 2009. They worked with 40 people in leadership positions in the current healthcare delivery system. By the end there was much more consensus than anyone might have believed possible given the fact so many were polar-opposites 15 years ago.

One thing everyone agreed on is that finding consensus on what role a President is going to play in the success of health reform must begin yesterday or today, not November 10. The same applies to the role/responsibilities of Congressional leaders. Political consensus and public support in and for changes in a complex and differently understood policy priority, requires much more bi-partisan effort to find agreement than exists today. Even the debate between one party’s candidates on whose health plan can do how much for whom with minimum consequence, if it goes on too long, makes finding a way for leadership to get back on the road to consensus very difficult.

HEALTHCARE TRANSFORMERS
Some of us believe that the Democratic candidates for President are getting "down into the weeds" on details of their plans to make health care affordable to all Americans. On the other hand, Republicans have a much easier time talking about medical markets, consumer-driven choices, tax free HSAs, and "Transformation".

As chair of the national Association of Republican and Democratic Governors, our Tim Pawlenty might want to call Pennsylvania Governor Ed Rendell instead of Newt Gingrich. Rendell encouraged formation of an office of Health Care Transformation which appears to have enough independence and political muscle to be running demos and experiments in the Commonwealth on the medical home, value based purchasing and other changes which the MN transformation commission has advocated.

MORE HEALTHCARE TRANSFORMATION
Democratic leaders of the MN legislature are eager to pass some "transforming" legislation. The GOP Gov this week made his "transformation" contribution by asking them to give all state employees an option to buy high deductible major medical plans with tax-paid Health Savings Accounts.

What's transformative about this is that Minnesota in Pawlenty's first year as Governor won national awards for its creative and value-based benefit packages, including tiering of doctor prices, drugs and eventually outcomes information. State employee insurance costs stayed remarkably low as a result. The everyone-for-himself approach of the HSA abandons the pooling approach to determining value for all employees for the sake of profits for indemnity insurance sellers, HSA bankers, and doctors that resist value comparison.

WHAT'S GOING ON AT "THE U”?
The Academic Health Center at Minnesota hired a married pair of Georgia Tech medical informatics researchers October 1, 2007 in its search for a director of the School of Public Health's Division of Health Management and Policy. A stream of news stories from Atlanta and Minneapolis suggest the pair - Francois Sainfort and wife Julie Jacko - may have neglected to inform Georgia Tech of the fact that, not only had they signed with "the U", but they were drawing pay and expense reimbursements for traveling back and forth to two jobs. Senior V-P for Health Sciences at UMN Frank Cerra says not to worry while general counsel Mark Rotenberg investigates the allegations. "This is all part of the 'medical arms race' for research talent among universities."

Meanwhile, the MN legislature contributes to the medical arms race by funding three new bio-sciences buildings which will be occupied by this kind of high-priced talent at salaries which may, by the time the buildings are a reality, cost Minnesota taxpayers twice the amount we are paying Sainfort-Jacko to get one health management and policy director. This may be what bothers the Governor's spokesperson, Brian McClung, when asked why the taxpayers of this state should increase their contribution to "the U's" operating budget in order to keep tuition increases this year to 7% rather than 9.5%.

MEDICAL ETHICS
Surprise resignations last week from leadership posts at Medtronic's orthopedic division - the acquired Sofamor-Danek which made Medtronic a leader in spine technology and recently an object of investigation over payments to and relations with orthopedic surgeons. Ortho industry leaders had nothing but praise for the departing execs, which suggests that corporate ethics at the mother company may have influenced the decision.

The Association of American Medical Colleges went half-way to the same ethical end last week proposing its members adopt strong conflict-of-interest policies, ban gifts of food and travel, create alternatives to free drug distribution by drug sales reps, and audit physician speaker bureaus and education seminars for undue corporate influence.

TO WHOM MUCH HAS BEEN GIVEN
My friend Fred de Sam Lorenzo has done another insightful TPT contribution to PBS. This one on the problem of the U.S. role in meeting the hunger needs of under-developed countries. Malawi in Fred's case. With food prices world-wide as high as ever and rising, it should be a critical priority in this country to scrap the decades old U.S. farm price support policy that maximizes using only U.S. produced crops, shipped on a declining number of U.S. transport ships, to feed the hungry.

We are the biggest food producer and provider to impoverished countries. But the cost of putting food in the mouths of starving babies, or feed, seed and fertilizer in the hands of poor country farmers is exorbitant. Every international NGO has said so forever but nothing changes. President Bush said last week how about one-fourth of a new $770 million appropriation devoted to purchasing food in the countries of hunger origin. To which the farm lobby replied NO.

L.U.S.T.
Of the many legislative bills I introduced, this was the best known. At the time it was enacted. Because of it was an acronym for an environmental health problem that was “out of sight – out of mind.” This was our way of building public support to eliminate the problem of leaking underground storage tanks, in the hundreds of thousands, contaminating underground drinking water for millions. I thought the job was over and done until I read Mary Jo Webster’s “Under the Pumps” in the St. Paul Pioneer Press April 27th.

In 1984 we required underground tanks to have corrosion protection and leak detectors. We allowed the states to set the rules starting in 1988 to be fully implemented in 1998. A reporter at the Kansas City Star in 2002, Ms. Webster found Missouri way behind in enforcing EPA standards. Today, in Minnesota she finds a state that has dramatically reduced the problem, but still finds hundreds of new leaks a year. The petroleum industry supported protection when gas prices were low, even when individual owners had costly problems. But at today’s gas prices they see problems.

CALORIE COUNTING
Just how desperate are McDonald’s and Kentucky Fried Chicken to keep this calorie information out the hands of their customers? Enough to take litigation to the Federal Court of New York.
The United States District Court for the Southern District of New York upheld the constitutionality of New York City’s calorie-posting requirement. Calorie counts must be posted alongside prices in some New York food establishments. Under the rules, any chain with at least 15 outlets nationwide would have to display calorie counts on menu boards, menus or food tags. The rules would apply to roughly 2,000 restaurants, or about 10 percent of the 23,000 in the city, the health department said.
The issue came down to pre-emption and free speech. The Court ruled that the federal Nutrition Labeling and Education Act of 1990 does not pre-empt the city’s regulation, and it held that the posting requirement does not violate the free speech rights of New York State Restaurant Association members.
In a 27-page opinion, Judge Holwell accepted one of the city’s main arguments for posting calorie counts — that doing so would help reduce obesity, which city officials say has reached epidemic levels.

UWE REINHARDT AND THE WAR IN IRAQ
Princeton University health economist Uwe Reinhardt, PhD, has been known for decades as the “Comedy Central” of health policy circles. He is German by birth, married to a Taiwanese, with a marine Captain son who has done repeated tour and borne the wounds of Iraq and Afghanistan. In response to my recent Iraq policy piece by Senator Richard Lugar, he reminded me of op ed pieces he has written since early 2003 which I highly recommend to your reading. In particular, MISSION ACCOMPLISHED IN IRAQ from October 8, 2007 in www.DailyPrincetonian.com bears comment. My U.S. Senate service predates the Iranian students’ take-over of the U.S. embassy in Teheran, the U.S. aid to Saddam Hussein in his war on Iran and the “gassing of the Kurds” and the Russian invasion of Afghanistan. I served as a member of the Senate Select Committee on Intelligence for eight years and as its chair for two in 1985-86.

For all that period of time U.S. policy in the Middle East has been driven by the security of Israel and of access to petroleum resources. This policy priority preceded my election in 1978 and continues beyond my retirement in 1995. As a consequence, our relations with other countries in the region have been generally unpredictable, undependable, and inconsistent. All of this applies to elected leaders of both political parties. As a consequence, we have contributed to the gradual weakening of the Israeli “cause” for which so much blood has been shed, and to the strengthening of fundamentalist terrorist groups of Arabs, Persians, Kurds, Afghans and the list goes on.

President Jimmie Carter pleaded with me to support the sale of AWACS planes to Saudi Arabia to further those goals. Today he is writing about the futility of our policy and meeting with Hamas “leaders” on a Palestinian state. President Ronald Reagan worked overtime to sell F-16 fighters to Jordan as well as AWACs to Saudi. George H.W. Bush as President privately condemned the invasion of Palestinian farms and homes by Zionist “settlements” and today the “settlement” activity continues. President Bush also sent Dick Cheney to Saudi Arabia August 5, 1990 with “secret” evidence of Iraqi plans to invade the Arabian oil fields in order to finally convince the kingdom to allow U.S. bases in Saudi Arabia.

Uwe Reinhardt’s October op ed accurately predicts Bush-Cheney policy as the “establishment of several giant, permanent U.S. military bases right in the heartland of the Middle East” with a “puppet regime perhaps headed by…Ahmed Chalabi.” Uwe also reminds us of how unpredictable America’s leaders are by quoting Defense Secretary Dick Cheney at the end of Desert Storm in 1991 as “I think for us to get American military personnel involved in a civil war inside Iraq would literally be a quagmire…I do not think the United States want to have U. S. military forces accept casualties and accept responsibility of trying to govern Iraq. I think it makes no sense at all.”

When I listen to my former colleague John McCain talk about our role in Iraq in a McCain presidency, I can’t predict what he is likely to do except what Uwe suggests. When I listen to Clinton-Obama, I am left no better off because they cannot answer Dick Lugar’s questions either. They debate who voted for a war resolution or differences in “gradual withdrawal” of troops. You and I have no idea how our vote will affect the future of U.S. national security policy in the Middle East or south/central Asia.

UPCOMING EVENTS

The 3rd Annual World Congress Leadership Summit on Revenue Cycle Innovations | September 14 – 16, 2008 | Las Vegas, NV - will convene thought leaders from the nation’s hospitals, health systems and group practices to define the next generation of the revenue cycle and to examine strategies for remaining profitable and compliant within the ever-evolving healthcare financial environment. Save $200.00 with promotional code YBZ524. Visit www.worldcongress.com/revenue to register and to learn more about NIHP’s participation!

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