Friday, December 26, 2008

Comments to Spanish government-owned TV blog "Porque tú lo vales"

Comments to Spanish government-owned TV network blog "Desde Camelot", post "Porque tú lo vales", Dec 26, 2008:

hola, al respecto del comentario "Y los nombramientos no necesitan el visto bueno del Senado", implicando que es un favor inmerecido a la Secretaria y, además, se burlan los deseos del legislador, deseamos hacer algunos comentarios:

1 en realidad, tanto la cámara baja como el senado federales decidieron en una ley cuántos nombramientos para el centro Kennedy hace cada una de las cámaras o el Ejecutivo - esa ley está codificada en el capítulo 20 U.S.C. 76h, y apartado (b) dice, de los más de treinta miembros nombrados por el jefe del Ejecutivo, que "[p]ersons appointed to the Advisory Committee on the Arts, including officers or employees of the United States, shall be persons who are recognized for their knowledge of, or experience or interest in, one or more of the arts in the fields covered by the John F. Kennedy Center for the Performing Arts" [1];

2 hay un ministro federal ya en ese consejo, Norman Mineta - quizá influye que no se le nombre tanto que es Demócrata...

3 dado que la ministro Condoleezza Rice ha presentado los últimos cuatro años la entrega de menciones honoríficas del Kennedy Center (ejemplo, la entrega de menciones a Barbra Streisand y Morgan Freeman, entre otros [2]) y dado su nivel como músico (suficiente para acompañar al piano al violonchelista Yo-yo Ma, abril de 2002 [3]), parece que se cumplen varios de los requisitos exigidos en "one or more of the arts in the fields covered by the John F. Kennedy Center for the Performing Arts";

4 la Sra. Rice es tan buen músico o mejor que los siguientes miembros del Congreso también presentes en el Kennedy Center: Senator Harry Reid (D), Senator James Inhofe (R), Senator Dianne Feinstein (D), Rep. Nancy Pelosi (D) [hay más demócratas que republicanos porque son mayoría en ambas cámaras].

No ponemos en duda que, en el futuro, habrá injustas críticas contra el futuro presidente federal cuando haga lo mismo con su capacidad de nombramiento. Eso no hace justas las críticas al actual presidente federal.

Quedamos a su disposición para cualquier ampliación sobre cualquier asunto relacionado con los EE UU o los estados miembros.

Best Regards/Cordialement/Atentamente,

Jorge Mata
Press Office
Bipartisan Alliance,
a Society for the Study and Defense of the US Constitution


[1] There shall be an Advisory Committee on the Arts composed of such members as the President of the United States may designate, to serve at the pleasure of the President. Persons appointed to the Advisory Committee on the Arts, including officers or employees of the United States, shall be persons who are recognized for their knowledge of, or experience or interest in, one or more of the arts in the fields covered by the John F. Kennedy Center for the Performing Arts.

[2] Secretary Condoleezza Rice: Remarks at the Kennedy Center Honors Dinner. Benjamin Franklin Room, Washington, DC. December 6, 2008.

[3] Cellist Yo-Yo Ma and then National Security Advisor Condoleezza Rice take their bow after performing a duet to a Brahms sonata at the presentation of awards by the National Endowment for the Arts and Humanities at Constitution Hall in Washington, D.C., USA, April 22, 2002.

UPDATE, Dec 27, 2008: they posted the text there,, and replied to it,

Gabriel Herrero dijo

Hola Jorge. Es un placer y un honor tenerte en el blog. Los puntos que señalas son correctos y estoy de acuerdo con todos ellos. Todos. Sin embargo discrepo en la raiz, en tu interpretación de la frase "Y los nombramientos no necesitan el visto bueno del Senado". No implico que sea un favor inmerecido. Merecido, en términos genéricos, lo puede ser. Sin duda Condoleeza posee un magnífico cerebro y es un músico excelente. No lo pongo en duda. Tampoco doy a entender que el nombramiento de Bush sea ilegal. Hasta ahí podíamos llegar. Si lo fuera, el tono del post sería mucho más ácido.
Otra cuestión es el uso que ha hecho Bush de los nombramientos a dedo durante su administración. Desde la financiación de los grupos antiabortistas a los últimos regalos de Nochebuena. Es su privilegio como jefe del Ejecutivo. Pero no me gusta. En el contexto de su trayectoria, creo que es criticable. Con todo, no es lo que más me repatea de él. Por eso sólo merece un párrafo. En todo caso, lo dicho, es un placer tenerte como lector y aprecio tus comentarios.

27 Diciembre 2008, 06:07

Community health centers in medically underserved areas - review

In The NYT: Expansion of Clinics Shapes Bush Legacy. By Kevin Sack
December 26, 2008

NASHVILLE — Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.

For those in poor urban neighborhoods and isolated rural areas, including Indian reservations, the clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases.

As a crucial component of the health safety net, they are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care.

Despite the clinics’ unprecedented growth, wide swaths of the country remain without access to affordable primary care. The recession has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs.

In response, Democrats on Capitol Hill are proposing even more significant increases, making the centers a likely feature of any health care deal struck by Congress and the Obama administration.

In Nashville, United Neighborhood Health Services, a 32-year-old community health center, has seen its federal financing rise to $4.2 million, from $1.8 million in 2001. That has allowed the organization to add eight clinics to its base of six, and to increase its pool of patients to nearly 25,000 from 10,000.

Still, says Mary Bufwack, the center’s chief executive, the clinics satisfy only a third of the demand in Nashville’s pockets of urban poverty and immigrant need.

One of the group’s recent grants helped open the Southside Family Clinic, which moved last year from a pair of public housing apartments to a gleaming new building on a once derelict corner.
As she completed a breathing treatment one recent afternoon, Willie Mai Ridley, a 68-year-old beautician, said she would have sought care for her bronchitis in a hospital emergency room were it not for the new clinic. Instead, she took a short drive, waited 15 minutes without an appointment and left without paying a dime; the clinic would bill her later for her Medicare co-payment of $18.88.

Ms. Ridley said she appreciated both the dignity and the affordability of her care. “This place is really very, very important to me,” she said, “because you can go and feel like you’re being treated like a person and get the same medical care you would get somewhere else and have to pay $200 to $300.”

As governor of Texas, Mr. Bush came to admire the missionary zeal and cost-efficiency of the not-for-profit community health centers, which qualify for federal operating grants by being located in designated underserved areas and treating patients regardless of their ability to pay. He pledged support for the program while campaigning for president in 2000 on a platform of “compassionate conservatism.”

In Mr. Bush’s first year in office, he proposed to open or expand 1,200 clinics over five years (mission accomplished) and to double the number of patients served (the increase has ended up closer to 60 percent). With the health centers now serving more than 16 million patients at 7,354 sites, the expansion has been the largest since the program’s origins in President Lyndon B. Johnson’s war on poverty, federal officials said.

“They’re an integral part of a health care system because they provide care for the low-income, for the newly arrived, and they take the pressure off of our hospital emergency rooms,” Mr. Bush said last year while touring a clinic in Omaha.

With federal encouragement, the centers have made a major push this decade to expand dental and mental health services, open on-site pharmacies, extend hours to nights and weekends and accommodate recent immigrants — legal and otherwise — by employing bilingual staff. More than a third of patients are now Hispanic, according to the National Association of Community Health Centers.

The centers now serve one of every three people who live in poverty and one of every eight without insurance. But a study released in August by the Government Accountability Office found that 43 percent of the country’s medically underserved areas lack a health center site. The National Association of Community Health Centers and the American Academy of Family Physicians estimated last year that 56 million people were “medically disenfranchised” because they lived in areas with inadequate primary care.

President-elect Barack Obama has said little about how the centers may fit into his plans to remake American health care. But he was a sponsor of a Senate bill in August that would quadruple federal spending on the program — to $8 billion from $2.1 billion — and increase incentives for medical students to choose primary care. His wife, Michelle, worked closely with health centers in Chicago as vice president for community and external relations at the University of Chicago Medical Center.

And Mr. Obama’s choice to become secretary of health and human services, former Senator Tom Daschle of South Dakota, argues in his recent book on health care that financing should be increased, describing the health centers as “a godsend.”

The federal program, which was first championed in Congress by Senator Edward M. Kennedy, Democrat of Massachusetts, has earned considerable bipartisan support. Leading advocates, like Senator Bernie Sanders, independent of Vermont, and Representative James E. Clyburn, Democrat of South Carolina, the House majority whip, argue that any success Mr. Obama has in reducing the number of uninsured will be meaningless if the newly insured cannot find medical homes. In Massachusetts, health centers have seen increased demand since the state began mandating health coverage two years ago.

At $8 billion, the Senate measure may be considered a relative bargain compared with the more than $100 billion needed for Mr. Obama’s proposal to subsidize coverage for the uninsured. If his plan runs into fiscal obstacles, a vast expansion of community health centers may again serve as a stopgap while universal coverage waits for flusher times.

Recent job losses, meanwhile, are stoking demand for the clinics’ services, often from first-time users. The United Neighborhood Health Services clinics in Nashville have seen a 35 percent increase in patients this year, with much of the growth from the newly jobless.

“I’m seeing a lot of professionals that no longer have their insurance or they’re laid off from their jobs,” said Dr. Marshelya D. Wilson, a physician at the center’s Cayce clinic. “So they come here and get their health care.”

Studies have generally shown that the health centers — which must be governed by patient-dominated boards — are effective at reducing racial and ethnic disparities in medical treatment and save substantial sums by keeping patients out of hospitals. Their trade association estimates that they save the health care system $17.6 billion a year, and that an equivalent amount could be saved if avoidable emergency room visits were diverted to clinics. Some centers, including here in Nashville, have brokered agreements with hospitals to do exactly that.

Many centers are finding that federal support is not keeping pace with the growing cost of treating the uninsured. Government grants now account for 19 percent of community health center revenues, compared with 22 percent in 2001, according to the Health Resources and Services Administration, which oversees the program. The largest revenue sources are public insurance plans like Medicaid, Medicare and the State Children’s Health Insurance Program, making the centers vulnerable to government belt-tightening.

The centers are known for their efficiency. Though United Neighborhood Health Services has more than doubled in size this decade, Ms. Bufwack, its chief executive, manages to run five neighborhood clinics, five school clinics, a homeless clinic, two mobile clinics and a rural clinic, with 24,391 patients, on a budget of $8.1 million. Starting pay for her doctors is $120,000. Patients are charged on an income-based sliding scale, and the uninsured are expected to pay at least $20 for an office visit. One clinic is housed in a double-wide trailer.

Because of a nationwide shortage of primary care physicians, the clinics rely on federal programs like the National Health Service Corps that entice medical students with grants and loan write-offs in exchange for agreements to practice as generalists in underserved areas. Of the 16 doctors working for United Neighborhood, seven are current or former participants.

Dr. LaTonya D. Knott, 37, who treated Ms. Ridley for her bronchitis, is among them. Born to a 15-year-old mother in south Nashville, she herself had been a regular childhood patient at one of the center’s clinics. After graduating as her high school’s valedictorian, she went to college on scholarships and then to medical school on government grants, with an obligation to serve for two years.

She said she now felt a responsibility to be a role model. “I do a whole lot of social work,” she said, noting that it was not uncommon for children to drop by the clinic for help with homework, or for a peanut butter sandwich. “It’s not just that we provide the medical care. I’m trying to provide you with a future.”

Despite such commitment, national staffing shortages have reinforced concerns about the quality of care at health centers, notably the management of chronic diseases. This year, the government started collecting data at the centers on performance measures like cervical cancer screening and diabetes control.

“The question is not just, ‘Are you going to have more community health centers?’ ” said Dr. H. Jack Geiger, founder of the health centers movement and a professor emeritus at the City University of New York. “It’s, ‘Are you going to have adequate services?’ ”

A deeper frustration for health centers concerns their difficulty in securing follow-up appointments with specialists for patients who are uninsured or have Medicaid. All too often, said Ms. Bufwack, medical care ends at the clinic door, reinforcing the need to expand both primary care and health insurance coverage.

“That’s when our doctors feel they’re practicing third world medicine,” she said. “You will die if you have cancer or a heart condition or bad asthma or horrible diabetes. If you need a specialist and specialty tests and specialty meds and specialty surgery, those things are totally out of your reach.”

Ignatius: A New Partner In Syria?

In the WaPo: A New Partner In Syria? By David Ignatius
Wednesday, December 24, 2008; A11

DAMASCUS, Syria -- President Bashar al-Assad says he doesn't want to send a message to Barack Obama, exactly, but to express a three-part hope for the incoming administration's Middle East policy:

First, he hopes Obama won't start "another war anywhere in the world, especially not in the Middle East." And he trusts that the doctrine of "preemptive war" will end when George W. Bush leaves office.

Second, Assad said, "We would like to see this new administration sincerely involved in the peace process." He hopes that Obama will back Syria's indirect negotiations with Israel, and he urges the new administration to pursue "the Lebanese track and the Palestinian track, as well."
Asked whether he would mind if the Syrian track went first (a sequence that has worried some Syrians who prefer the ideological purity of following the Palestinians), Assad answered: "Of course not. Each track will help the other."

Third, he says he wants Syria and the United States to work together to stabilize Iraq as American troops begin to leave. "We can't turn the clock back," Assad said. "The war happened. Now we have to talk about the future. We have to forge a process, a political vision and a timetable for withdrawal."

In all three "hopes," Assad seemed to be looking for a new start with Obama after years of chilly relations with Bush. Assad said he knew little about Obama or his policies but has heard that he is more in contact with ordinary people than Bush has been, which, Assad contended, would give Obama a better understanding of America.

Assad spoke in English during the 30-minute interview Monday. He was accompanied only by his political and media adviser Bouthaina Shaaban. This time, in contrast to my interview with him in 2003, when Assad was often stiff and doctrinaire, he was loose and informal, breaking several times into laughter.

Assad's easy demeanor suggested that he's more firmly in charge now. The Bush administration's attempt to isolate Syria has failed, even in the judgment of senior White House officials. That leaves Assad in the catbird seat, courted by European and Arab nations and conducting back-channel talks through Turkey with his erstwhile enemy Israel.

Asked, for example, about reports that Saudi Arabia is seeking to improve its relations with Damascus because it sees U.S. engagement with Syria ahead and fears that "the train may be leaving the station," Assad laughed.

"Maybe it has already left the station," he said. But he vows that he is ready to receive any emissaries. "I have no problem with the Saudis. We would like good relations with every country in this region."

Assad said that he is ready to move to direct talks with Israel as soon as he receives clarification on two points: One, he wants assurance that the Israelis will withdraw fully from the Golan Heights. To clarify that issue, he sent a "borders document" to the Israelis this month that highlights some points along the pre-1967 border. As of Monday, he said, he hadn't received an Israeli response. His second condition for direct talks is that the United States join as a sponsor.

On the crucial question of Syria's future relations with Iran, Assad was noncommittal. He said the relationship with Iran wasn't about the "kind of statehood" Syria has or its cultural affinities but about protecting Syrian interests against hostile neighbors. "It's about who plays a role in this region, who supports my rights," he said. "It's not that complicated."

Asked whether Syria was prepared to restrain Hezbollah, the Iranian-backed Shiite militia in Lebanon, Assad said this was a matter the Israelis should sort out in separate negotiations with the Lebanese. Indeed, he promoted the idea of the other negotiating tracks -- which would draw in, at least indirectly, Hezbollah and Hamas.

"The longer the border, the bigger the peace," Assad said. "Hezbollah is on the Lebanese border, not Syrian. Hamas is on the Palestinian border. . . . They should look at those other tracks. They should be comprehensive. If you want peace, you need three peace treaties, on three tracks."

A relaxed Assad clearly believes that Syria is emerging from its pariah status. An international tribunal is still scheduled to meet in The Hague to weigh Syria's alleged role in the 2005 assassination of former Lebanese prime minister Rafiq al-Hariri. But in the meantime, Assad is receiving a stream of visiting diplomats. He looks like a ready partner for Obama's diplomacy, but a cautious one -- waiting to see what's on offer before he shows more of his hand.

The writer is co-host of PostGlobal, an online discussion of international issues.

Rich people should be forced to invest 2 pct of their wealth in government bonds paying a maximum interest of 2.5 pct

Der Spiegel: German Politician Wants Compulsory Bond for Rich People
Dec 22, 2008

A Social Democrat fighting an uphill campaign in the state of Hesse has an idea to raise €50 billion to help fight the looming recession. Rich people, he says, should be forced to invest two percent of their wealth in government bonds paying a maximum interest of 2.5 percent. Response has been muted.

Thomas Schäfer-Gümbel, a little-known Social Democrat candidate fighting to be governor of the western German state of Hesse in an election on January 18, has come up with an unconventional idea that is attracting the -- presumably desired -- attention of the media.

He says wealthy people with cash and real estate assets exceeding €750,000 ($1.04 million) should be forced to lend the state two percent of their assets for a period of 15 years, and at an interest rate no higher than 2.5 percent.

"A compulsory state bond would be a rapidly effective instrument to mobilize additional funds to overcome the economic crisis," Schäfer-Gümbel, 39, told Bild newspaper on Monday. "That would be very fair because only the very wealthy would be drawn on."

The projected proceeds of €50 billion would fund energy-saving buses and trains for public transport, new research projects and energy savings technologies, he added.

Schäfer-Gümbel was plucked from obscurity to fight the Hesse election next month. He was chosen after previous SPD candidate Andrea Ypsilanti stepped aside following her repeated failure to form an alliance with the Left Party to remove conservative Hesse governor Roland Koch from power in the wake of an inconclusive state election last January.

He is trailing Koch by 20 points, according to an opinion poll published last week.

A German government spokesman dismissed the idea on Monday. "Not every noise made in the Hesse campaign brings results in Berlin," said Thomas Steg on Monday.