She's gonna watch. 17 TIMES

And Republicans in Iowa said they were going to prove it in a special election for a State House seat in south central Iowa which is a swing part of the state. And Republicans brought in national groups to make sure. Couldn't do it.

http://www.desmoinesregister.com/article/20090902/NEWS09/909020372/1001/NEWS

The perception is not the reality. The whole machine is trying to railroad Obama like they tried to railroad Clinton when they couldn't do it at the ballot box. There is a reason that Obama pays no attention to cable news. We shouldn't either.

Secondary benefit; It will drive teabaggers further 'round the bend and make it even more difficult for Republican leaders to justify the madness.

With so much misinformation, propaganda and PR dominating the media landscape I think it is very hard to tell where the electorate is right now. But for the last ten years at least there has been a marked divergence between public opinion as it is measured by actual elections and the media narratives that pretend to reflect those opinions. So is it worth while to engage in the battle of perceptions? I don’t think we can afford to cede that ground entirely. But we can’t afford to let that misdirect our focus on what counts; actual participation in the political process by a growing population of young and minority voters who don’t take their cues from the MSM.

So, yeah, go visit your local office and bring a friend. Be nice, be specific and follow it up with a phone call and a fax.

All authortarians may be right wing conservatives but I don't think this is a constant factor in American politics. I think this is just a dangerous political moment.

Can we assume that this is part of the dilemma; a black man is President as many white men and women begin to see that they in some sense may be a minority. This is traumatic if they assumed they would always be a majority and being a minority always implied inferiority. And the fear is that they will be treated like the minority that they have despised.

So if Democrats and progressives empathize with that and try to assure them that they will not be treated as inferior minorities then we are perceived by the aggrieved as weak and simultaneously validate their fear. If Democrats condemn the beliefs that arise from these fears it just further polarizes the situation and the situation escalates.

So either we capitulate to that fear or a charismatic conservative leader diffuses it. Or we simply, stubbornly oppose it at every turn.

The right has been called out for organizing their wacko wing into angry mobs. Their response today; get angrier and call Dems Nazis.

So extrapolate where this leads. Can we assume that the next violent outburst that results will shock everyone on the right into shame and humility? Didn’t happen with the murder of the abortion doctor. The incoherent rage ratchets up and the denial ratchets up with it. Is there anything that Obama or Democrats could do to defuse this dynamic? Is there anything that the media could do to defuse this dynamic? Is there anything that the republican leadership could do to defuse this dynamic?

The media could help defuse it but that would hurt their bottom line so that’s not gonna happen.

And the Republican leadership could stop organizing the madness and stop validating every wacko impulse but even if they did, which they won’t, I don’t think they could stop the mobs at this point.

The only thing that is going to stop these mobs at this point is capitulation on the part of Democrats and Obama. Not gonna happen.

Resolve to fight them at every turn, prepare for that now. Pretending that it can't happen here may just insure that it does at this point.

The right has been called out for organizing their wacko wing into angry mobs. Their response today; get angrier and call Dems Nazis. I don’t think this is just gutter Chicago politics.

So extrapolate where this leads. Can we assume that the next violent outburst that results will shock everyone on the right into shame and humility? Didn’t happen with the murder of the abortion doctor. The incoherent rage ratchets up and the denial ratchets up with it. Is there anything that Obama or Democrats could do to defuse this dynamic? Is there anything that the media could do to defuse this dynamic? Is there anything that the republican leadership could do to defuse this dynamic?

The only thing that is going to stop these mobs at this point is capitulation on the part of Democrats and Obama. Not gonna happen.

The media could help defuse it but that would hurt their bottom line so that’s not gonna happen.

And the Republican leadership could stop the organizing the madness and stop validating every wacko impulse but even if they did, which they won’t, I don’t think they could stop the mobs at this point.

So where is this headed?

As I understand the proposal for "best practice protocols" these protocols would not be binding. But it would be a public and political (approved by congress on a regular basis) document that families could use in the situation you describe to challenge the options that physicians offer.

And those same protocols could also be used in the opposite case where physicians may end up prolonging the suffering with endless and futile procedures. Yes that happens too as others in this thread have confirmed. One family member suffers for months on life support and then the whole family decides to make out living wills to prevent that in their own case.

The wingnuts will say Obama is trying to kill Granny but they may end up using the same protocols to make sure Granny gets the best care possible.

No, I wasn't disagreeing with you and I don't think you were saying that docs ration care in the ICU. I was clumsily trying to focus your points on Rotwang's concern about the "last week of care".

But how does that affect the medical choices offered those facing death in the last month and weeks when care costs the most? Those without insurance may not even get to the point where those choices are possible. That is where rationing happens now and where reform will be expensive if everyone is covered.

But if they end up in an ICU in a teaching hospital like I worked at I never was able to see any difference in the choices presented whether they were destitute or wealthy. Yes, the wealthy always had the option of a second opinion from the Mayo Clinic. But in that ICU I saw no difference in care wether it was paid for by insurance, medicare, medicaid or state aid.

Rotwang seems to think reform will restrict those choices but I don't see that changing either no matter what happens. Doctors will be paid less if they aren't paid fee for service. That is where money will be saved but that won't restrict the patients choices.

To grossly oversimplify it, if the patient wants to push the limits then they will get the 1% choice, if not they will get the 5% choice. But it also depends on the attending. Is she participating in research in a 1% choice or did he recently have a horrible experience last week with the 10% choice? The biggest variable may simply be on how the physician presents the choices to the patient. But there is always always a bias towards trying everything if the patient or the family insist on it.

I don't see reform changing any of those dynamics in terms of what choices are offered unless hospitals put increased restrictions on physicians when insurance doesn't cover it and doctors would fight that tooth and nail. "Hail Mary" and long shot treatments are often the leading edge of medical practice and yesterday's long shot is often tomorrow’s standard. Hospitals who limit that loose doctors and patients.

But there is one aspect of reform that does have the potential to cut costs in the last week in a major way. If the fee for service model is changed to a team oriented salary model for physicians then the cost of that last week would be greatly reduced at the physician’s expense. I don’t think that would alter the choices of treatments for the most part but it may change the type of physician who would choose to be an intensivist or hospitalist.

I have worked with both types and I want my doctor on a salary, if he’s in it for the money let him go into plastic surgery or to Wall Street.

Unless someone shows them that there is no real safety net below them besides bankruptcy and bare-bones Medicaid. Whether or not they have insurance. And insurance companies just profit from that market failure and Congress just enables them to do it.

Obama needs to go on the road with Wendell Potter for the month of August and take that case directly to the people every night in every Blue Dog district.

And it is getting increasingly clear that Josh and Joan Walsh and Arianna have no greater interest that licking those boots so they can appear on cable news to make mewling noises of mild progressive dissent.

What good is interactive media if it does nothing but let the corporate media set the agenda.

Insurance companies push patients off their rolls for trivial reasons when they become too sick and expensive to cover. Then the patient can’t get any reasonable coverage in the so-called insurance market because they now have a pre-existing condition. Why is that not worse than euthanasia?

It is not murder because the government is there to provide Medicaid or Medicare to the poor and the elderly. The taxpayer bails the insurance companies out, both in terms of accepting its profit hazard and in terms of accepting its moral hazard. “Socialized medicine” now subsidizes insurance company’s profits and relieves insurance companies of the responsibility for the lives that they discard like toxic waste.

So Republicans and Blue Dogs take insurance industry money to maintain a sick medical game of private profits and socialized losses over human lives. And then they have the gall to blame Democrats who want to reform the system for trying to euthanize the elderly and use that as just another excuse for not reforming the system. It boggles the mind.

How is that not equivalent to euthanasia in terms of disposing of human life for economic gain? Why aren’t Democrats pointing that out, loudly and repeatedly?

Until liberal web sites stop fawning at the feet of the MSM and start engaging the public with their own agenda that responds to an increasingly progressive electorate then the electorate will be encouraged to disengage from political action.

Obviously this is an 8 to 5 shop in terms of having paid reporters on the job. I did notice that one of the new positions that Josh advertised was an after hours and weekend editor. That is a start.

But when that reporting ends at 5pm then those who come home from work turn to the cable nets. They end up setting the priorities and writing the narratives for the next day and you can see it on every progressive home page the nest morning.

We need to start setting our own agenda.