Obama Following Bush Path to Killing VA

If you're familiar with Phillip Longman's work on the VA's healthcare system, you know he is by far the premier expert on the subject.

When he says this administration is doing exactly the opposite of what needs to be done to save VA healthcare, you know there's a bigger problem here.

Sad to say, the Obama administration seems clueless about what might be broken at the VA and how to fix it. Either that, or it is just cravenly saying and doing whatever it thinks is necessary to make the story go away.

Evidence for the clueless hypothesis came on Friday, when White House Deputy Chief of Staff Rob Nabors weighed in with his diagnosis (pdf) of what ails the VA. The document is extraordinary in its contradictions, sloppy formations, and non-evidence-based conclusions.

SNIP

People who truly know the VA culture will tell you the opposite story. The VA emerged as a leader in health care quality beginning in the 1990s precisely because its cental management then let go of power. This devolution unleashed the incredible talent and idealism of frontline doctors, nurses and pharmacists who were doing extraordinary innovation in the field. The VA’s vaunted electronic medical record system, for example, which still sets the worldwide standard, is essentially a bundle of open-source health IT programs written by VA docs for VA docs.

But that culture of innovation came under attack starting in the Bush Adminstration. The Bushies’ political appointees began recentralizing power in Washington partly in the name of security, after a highly publicized incident in which a VA employee had a government owned laptop stolen from his home. Then as now, sensational and misleading headlines played into the conservative forces trying to undermine the VA, as most news consumers were left with the false impression that patient records had been breached. The Bushies then went on to do further damage to the VA’s culture of innovation by outsourcing key health IT projects to favored private contractors.

Sadly, rather than reversing that trend, the Obama administation just let the centralizing continue. As Ken Kizer, Deputy Undersecretary for Health in the Clinton administration and the man most responsible for turning the VA around in the 1990s observes in a recent piece in the New England Journal of Medicine: “In recent years, there has been a shift to a more top-down style of management whereby the central office has oversight of nearly every aspect of care delivery. Indeed, over that period the VA central office staff tasked to health care adminstrative duties has grown from about 800 in the late 1990s to nearly 11,000 today.

Clueless? Yeah it would seem. Except over the weekend, the White House announced that after deep and thoughtful deliberation, it had come with just the man to turn things around at the VA, and he turned out to be a Republican soap and toothpaste salesman—a man with no experience whatsoever in running a health care or social services organization but who happens to be a close financial backer of Republican House Speaker John Boehner. No, that’s not clueless—it’s a cynical sellout of veterans by an adminstration that, in the wake of a monumental failure of the press to put this story in context, just wants to move on at any cost.

All I Want In This World is for Charlie Pierce to Be Wrong About This

Because if he's right in thinking that the Keystone Pipeline is already approved, we're all fucked.

But there are some issues on which it does not pay to be too clever by half, on which there is only one dimension in which the chess should be played. One of them is Social Security and Medicare. Another one is this damn pipeline. It is not possible to be serious about climate change and then green-light this project. This is a pipeline, so it will leak, because it always leaks. TransCanada will then lie about the leak because it is an extraction industry and that's what they do when things leak. The fuel it carries will ludicrously accelerate the pace of global climate change. And, more to the point, every case presented in its favor has turned out to be a lie. The job figures always were science fiction. It will do nothing to the price of gasoline in this country. Why we should put the Oglalla Aquifer at risk with a pipeline that the Canadians don't want to build in their own country just so that the Chinese can continue to pollute the air escapes me. I think these former campaign staffers are right. I think the bag job on this one is nearly complete.

Big Coal WATB Already Bitching About Future Regs

Seriously, morons: if you're still planning to build new coal plants you are too disconnected from reality to be making any decision more consequential than what to have for breakfast.

John Cheves at the Herald:

Nobody is likely to build more coal-burning power plants in the United States under strict emission limits proposed Friday by the U.S. Environmental Protection Agency, Kentucky coal and utility officials predicted.

That could further weaken demand for the coal of Eastern Kentucky, which has seen mines close and thousands of mining jobs disappear over the last few years. Coal counties in the mountains suffered official unemployment rates this summer between 11 and 18 percent.

Coal country unemployment is caused by falling demand, the difficulty and expense of reaching remaining seams, and the lack of non-mine employment in towns wholly owned and operated by Big Coal.

President Obama's long-overdue proposed rules have nothing to do with unemployment and everything to do with reducing the frequency of climate-change catastrophes like last week's drowning of central Colorado.

The Obama administration (pressed) ahead Friday with tough requirements for new coal-fired power plants, moving to impose for the first time strict limits on the pollution blamed for global warming.

The proposal would help reshape where Americans get electricity, away from a coal-dependent past into a future fired by cleaner sources of energy. It's also a key step in President Barack Obama's global warming plans, because it would help end what he called "the limitless dumping of carbon pollution" from power plants.

Although the proposed rule won't immediatedly affect plants already operating, it eventually would force the government to limit emissions from the existing power plant fleet, which accounts for a third of all U.S. greenhouse gas emissions. Obama has given the Environmental Protection Agency until next summer to propose those regulations.

"For power producers and coal mining companies that reject these standards, they have no reason to complain, and every excuse to innovate," said Sen. Ed Markey, D-Mass., the author of a 2009 bill to limit global warming. The legislation, backed by the White House, passed the House, but died in the Senate.

 Coal is dead. Has been for years. But the industry and Big Power refuse to bury it, so the stinking corpse continues to poison the planet with lethal carbon and the political system with stupidity and lies.

The Cost of Delaying Black Lung Regulations

Do not ever conflate Big Coal with the miners who dig it. They are its victims, not its profiters.

TPM:

The Obama administration's spring edition of its regulatory agenda, which was released on Wednesday, included yet another delay to a rule it proposed more than two and a half years ago aimed at reducing miners' exposure to coal dust, the Charleston Gazette's Ken Ward Jr. reported.

The dust causes the irreversible and potentially deadly black lung disease, which has been on the rise in recent years. The rule would seek to tighten allowable levels of coal dust exposure, and include provisions for continuous personal dust monitors for miners.

I sincerely hope the people who made that decision did so in ignorance of what Black Lung really is. Because if they know, then they are moral monsters.

From the Herald:

Roger Cook, 57, has black lung even though he started his 32 years as an underground miner in 1978, well after the new prevention standards were put in place. He is among a growing number of Eastern Kentucky miners afflicted in recent years with black lung, reversing a decades-long decline of the torturous, incurable disease.

Watch the video.