On Jan. 30 Gov. Peter Shumlin appeared before a chamber of commerce legislative breakfast in St. Johnsbury. During the question period he reported how his good friend Quebec Premier Jean Charest had told him that many companies had asked him about locating a plant in Vermont, New Hampshire, Maine or Quebec, and Charest had gotten all of them to choose Quebec because of Quebec’s single payer health care system. There are some who will be skeptical of this report.

Later I had the chance to ask a question: “Governor, since you mentioned Quebec, can you tell us how your Green Mountain Care will differ in any material respect from the Quebec single payer system?”

His reply was this: “In Quebec health care providers work for the government. They will stay private in Vermont. Vermonters will have universal access.”

In the first place, Canadian Medicare is more universal than Green Mountain Care will be. It covers all Canadians except those in the armed forces or in prison. To distinguish Green Mountain Care as being more universal is, frankly, ridiculous.

The other part of Shumlin’s answer is more troubling. He actually believes that Canadian health care providers are employed by the government. That’s true in the United Kingdom’s National Health Service, but it is unarguably false with respect to Quebec. Shumlin’s Green Mountain Care will operate exactly like Quebec Medicare, right down to the controlling board, government definition of essential benefits, setting compensation rates for providers, writing all the checks to pay private providers, and setting a global budget in the name of cost containment.

I am shocked that Gov. Shumlin is so totally ignorant about the system just 50 miles north of Montpelier, while he is trying to impose exactly that system on Vermonters.

VTDigger

From the recently released study done by Lawrence O. Picus and Associates, a study commissioned by the Legislature last spring, we know that how the money gets into the Education Fund is equitable across all Vermont towns and cities, that a penny on the tax rate does indeed raise the same amount of money in all towns. We also know that when money is distributed on an equalized per pupil basis that spending also has achieved equity.

But we do not know from the Picus study whether that equity of input of money to the Education Fund purchases equal educational opportunity for all Vermont’s children as required by the Supreme Court in “Brigham,” “that to fulfill its constitutional obligation the State must ensure substantial equality of educational opportunity throughout Vermont.”

To address that question, the towns of Dover and Wilmington, home of some of Vermont’s many, many small schools, believe from the many years of crafting their school budgets under the constraints of Act 60/68 that the equity of input to education funding does not buy equal education opportunity for its children. Therefore, the two towns commissioned a study by Northern Economic Consulting of Westford, Vt., to find out. That study was released on  Jan. 16. Among its finding are that:

•While under Act 60/68 the same school tax rate will allow the same dollar spending per pupil across Vermont towns, the same school tax rate does not lead to equal education opportunities.

•It also found that since 1997-98 per pupil spending nationally rose 30 percent, but in Vermont it rose 60 percent.

•And, finally, it found that student performance did not improve during the years when Act 60/68 governed, when compared with like demographic in other states.

What both studies tell us is that outcomes for all Vermont children are not consistent with the amount of money we spend. What the studies do not tell us is why, for all the money we spend, we don’t provide a world-class education for all Vermont children.

What else don’t we know about our education funding system?

For one, where is accountability in this system for outcomes and how is it linked to how much has been and needs to be spent? Under Act 60/68 the state has taken over the financing of education, yet has failed to establish the link to accountability for outcomes. At the state level, we are reduced to “asking” school budgets to remain level without any idea of what that means to the education outcomes of our children.

Why have we not put in place a uniform code of accounts for all schools so that we might finally be able to establish how the $1.3 billion in the education fund is really being spent and how that relates to student achievement.

If we continue on the track we’ve been on where the economic principle of economy of scale drives decisions at the state level, which now holds the power of the purse, at the same time local schools  nd their voters are driven by the commitment to the best education for their children, we will remain in the current status where there exists an abyss between the state and local school districts where the levers of accountability between spending and outcomes simply don’t exist.

No amount of moving the pieces of the system around, say fewer supervisory districts or having the commissioner of Education report to the governor or creating Regional Education Districts (REDs) or other such districts will solve that problem.

We simply have put in place a system of funding education, while equitable in raising the money that goes into the Education Fund, has not gone the next step of putting in place a system from the state on down to local schools of delivering education where there is direct accountability between the decision to raise and spend and the results for our children.

VTDigger

Defying the will of Vermonters, Entergy Nuclear has successfully won the first stage of its trial to allow it to break its word and to usurp the rights of the Vermont Legislature. Judge J. Garvin Murtha effectively delivered a slap in the face to the people of Vermont by saying that [contrary to prior Supreme Court judgements] the Legislature has no right to regulate the operation of the Vermont Yankee nuclear reactor. The Public Service Board is now the only state entity that has the power to decide Vermont Yankee’s future.

The judge also bought Entergy’s argument that he should base his judgement not upon the written legislation in question, but rather by retroactively reading the minds of the legislators to judge what they were thinking at the time.

This ruling goes hand in glove with current federal policies that enrich the 1% and keep power firmly in the hands of America’s largest corporations. It affirms that corporate profits trump the interests of the citizenry. It attempts to belittle the state Legislature and misrepresents their legislation while defending the laughable notion that only the federal government can be trusted to keep us safe from radiological accidents caused by corporate malfeasance and profit-driven lax practices.

More significantly, the ruling should serve as the catalyst to spark Vermonters who have been watching this struggle from the sidelines to join the citizen effort to shut down Vermont Yankee before an accident shuts it down for us.

The executives of Entergy have lied under oath repeatedly to the Vermont Legislature, tried to bribe the Legislature (in Louisiana talk, they called it a gift offer) and have run roughshod over every aspect of the state’s self governance, relying on their tight association with the Nuclear Regulatory Commission, which abets rather than regulates the industry, to ensure that their reprehensible actions are allowed to occur unchecked.

The State of Vermont can fight back, trying to rein in this corporate behemoth, but federal law and the courts are limiting the state’s possible responses.

A majority of Vermonters know that Vermont Yankee has run its course and needs to be shut down as originally licensed. Now people are turning to their neighbors to organize. Affinity groups are forming throughout the region. Sagealliance.net http://sagealliance.net/ is providing non-violence trainings to people who are willing to risk arrest.

March is going to be a month for taking action. Students at Greenfield Community College are organizing a walk from GCC to the reactor on March 3. On March 11, the anniversary of the ongoing Fukishima nuclear disaster in Japan, commemorations will be held at the reactor and various locations throughout the state. There will be a shut it down rally at the Statehouse with our state representatives on March 21. On April 1, a major rally (without a civil disobedience component) will be held in Brattleboro, where Vermonters will make clear our support for the state’s right to regulate our utilities. Civil disobedience and direct action will be doubtlessly be directed towards Entergy Nuclear if they continue to operate past the March 21 license expiration date.

Our state will continue to assert its right to control our energy generating future, but it needs our help. Only with a strong partnership of people power and government action will we be able to achieve victory over the entrenched interests of the money powered corporate oligarchy.

Vermonters are determined to thwart those who would put us at risk for the sake of their profits. The Arab Spring and the Occupy movement have shown us the potential power of the people. When we stand by and watch our leaders lead, we often find ourselves in peril. When we assert our own sovereign power we take the first step towards building a better future for us all.

VTDigger

I chair the Green Mountain Care Board, which is responsible for reducing health care cost growth in Vermont by changing health care payment and encouraging change in health care delivery. We are charged with making sure that cost containment results from real efficiencies, not arbitrary constraints.

When I speak with health care practitioners around the state, I try to make three central points:

•Significant transformation in our health care system to reduce cost growth is absolutely necessary and unavoidable;

•Doctors and other health care practitioners must lead this transformation, or we will get it wrong, and;

•Health care providers can’t tackle this challenge alone. State government, the federal government, hospital administrators, private payers and patients have to be part of the solution. Vermont has to embrace changes in health care delivery as a community.

Health care costs rise, in Vermont, at two to three times the rate of growth in the economy. That trend is impossible to sustain. We currently spend about one out of every five dollars we earn on health care, and we spend more with each passing year. If health care costs continue to rise at five percent per year (a reasonable expectation) and the state economy grows at two percent per year (also reasonable), health care costs would absorb 100 percent of gross state product around 2045.

This concept is ludicrous: We could not spend all of our income on health care. As with a family budget, we, as a state, have to buy food, housing and all other things that are essential. Yet we have seen the effect of rising health care costs on our spending. A recent Health Affairs article documented that, between 1999 and 2009, Americans, on average, gave up all real increases in their incomes to health care costs.

We won’t let it get that bad. The question is how will we stop it? If history is a guide, Medicare and Medicaid use the only tool that has any meaningful impact – provider fee reductions – to moderate overall health care cost growth. Public and private payers also will try to influence health care use, by requiring providers to ask for permission, requiring them to file paperwork, or second-guessing their decisions. That’s not the right way to reduce health care costs.

This is why providers must lead in crafting a solution. Health care practitioners have to own this one, and we must develop reforms that enhance their role in the health care system, which has been sadly diminished in recent years. They know there are better ways to reduce health care cost growth. Not easier, but better. There is avoidable hospital use. There are avoidable readmissions. There is better management of chronic conditions. There are better approaches to end-of-life care.

We know that, when doctors provide evidence-based care to patients, costs are reduced and quality is enhanced. The current system constrains them from providing evidence-based care – it forces providers to shorten visits, refer the patient up the line, or order stuff they might not think is necessary. Both the reimbursement system and the liability system encourage this.

Health care providers cannot do this alone. They need support and cooperation to change the health care delivery system, to make it more efficient and effective. They need public and private payment policies that pay fairly for doing the right thing. They need hospital administrators who support them. And perhaps most importantly, they need patients whose expectations and personal behavior are consistent with a system that rewards value. This is difficult to achieve, but essential to our success, as a community – a full community, not just a medical community – at health care reform.

Our goal, as a board, is to create an environment – in terms of payment, regulation and public policy – that supports health care practitioners in creating the best possible health care system for Vermont. To say we need their help in this endeavor would be an understatement – we need them to lead it.

VTDigger

Editor’s note: This op-ed is by Deb Katz, executive director of Vermont Citizens Action Network, an anti-nuclear group. http://www.vtcitizen.org/

How can a judge get it so wrong and the will of the people be so right?

On January 19 Judge Murtha issued his controversial decision to support a rogue corporation in its evisceration of state’s rights. When Murtha ruled that Entergy was no longer bound by contracts it signed with the state of Vermont in 2002, and until 2010 repeatedly sought state approval for its actions, it undermined Vermont’s authority. When the judge further ruled that the Vermont legislature could not determine its own energy future, he eviscerated the democratic process.

Act 160 passed unanimously by both houses of the Vermont legislature; Republicans and Democrats alike, and signed into law by Republican Gov. Jim Douglas. This law empowered the legislature to decide whether Vermont Yankee’s continued operation was in the public good not based on safety but on economics, reliability and the environment. Yet Murtha, by accepting Entergy’s cherry-picked record chose to determine what was in the hearts and minds of legislators based on comments of a few. He opted to second-guess 180 legislators rather than accepting the law as written. What is in the hearts of legislators is better left to confessionals and fortune tellers than to a federal court judges.

Catch-ww

Murtha stated that although legislators never mentioned safety in Act 160 that’s what they really meant; they really wanted to wrestle federal control — pre-emption of nuclear power out of the government’s hands. Entergy, with its endless leaks and lies, its systemic mismanagement at VY and its other plants, and duplicity is the poster child for what was wrong in the nuclear industry. Entergy’s failing record demonstrates the abdication by the federal government to actually address safety.

The NRC approved Vermont Yankee’s license for continued operation days before the core meltdowns at the Fukushima reactors, (sister plants to VY) and then reaffirmed days later that VY was “safe” to operate. Although the state had good reason to pre-empt the federal government in its blatant disregard for health and safety, it did not. Act 160 specifically addressed state’s rights and responsibilities upheld in a previous Supreme Court ruling.

It’s curious that the state’s act of defiance would go unrecognized by the federal government; the DOJ chose not to intervene in the case, and in fact NRC’s Chairman Jaczko stated that nothing Vermont was doing violated NRC rules or regulations. Instead of looking at the written law, Judge Murtha opted to buy into a conspiracy theory that a handful of legislators were able to manipulate not one, but two separately elected bodies in the legislature.

So did Murtha do anything right?

Murtha sent the case back to the Vermont Public Service Board, a quasi-judicial entity, to determine whether Entergy is entitled to a Certificate of Public Good to operate in the state after March 2012. Although he put some constraints on the state, he upheld the state’s ability to decide whether it was in the best interests of the state to have a rogue corporation operate and erect a high-level waste dump along the banks of the Connecticut River. The judge also issued a permanent injunction which permits Entergy to continue to operate until the CPG is granted or rejected.

What can citizens do to ensure that democracy prevails?

It is essential that the governor and the attorney general understand how important this issue is to all of us. We are asking Vermonters to contact Shumlin and Attorney General Bill Sorrell, and thank them for the good work they have done on our behalf and urge them to continue to fight this bad decision and this equally bad corporation.

It is essential that the legislators act to hold this slippery corporation accountable for its waste, its thermal pollution of the Connecticut River and it corporate irresponsibility. With Murtha’s ruling ,Entergy has grown bolder in its disregard for the state. Entergy is now refusing the state’s request to continue the testing of contaminated wells to determine the level of contamination. Entergy now is also requesting that instead of inspecting the ancient steam dryers for cracks every 18 months that they be allowed to do so only every 10 years!

We call upon the Vermont legislature to do what Judge Murtha refused to do, which is to hold Entergy accountable to its remaining commitments to rehabilitate the site to greenfield status and cease denigrating our environment.

VTDigger

(This slightly revised excerpt is from Dr. Hendricks’ original letter to his good friend, Ayn Rand.)

To: Vermont’s Legislature
From: Dr. Thomas Hendricks
Re: Health Care Reform

Should Vermont’s single-payer health care proposal go forward as envisioned, know that I shall quit when medicine is placed under state control.

Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go into acquiring this skill?

This is what I will not place at the disposal of Vermont’s Legislature, whose sole qualification to rule me is their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun.

I will not let Vermont’s Legislature dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward.
I have observed that in all the discussions that has preceded the eventual enslavement of medicine; men discussed everything — except the desires of the doctors.

Here, when discussing Dr. William Hsaio’s single-payer proposal, in this Feb. 18, 2011, one-minute video, the Vermont Legislature’s House Health Care Committee displays the arrogance to which I write of: http://www.youtube.com/watch?v=EPnxG0IUKTo&feature=youtube_gdata

These legislators supposedly consider only the “welfare” of the patients, with no thought for those who are to provide it. That a doctor should have any right, desire or choice in the matter seems regarded as irrelevant, selfishness; his is not to choose, they say, but “to serve.”

I have often wondered at the smugness at which Vermont’s Legislature asserts their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it they expect to depend on, when they lie on an operating table under my hands?

The Vermont Legislature’s moral code has taught them to believe that it is safe to rely on the virtue of their victims.

Well, that is the virtue I have withdrawn.

Let the Vermont Legislature discover the kind of doctors that their system will now produce.

Let the Vermont Legislature discover, in the operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man they have throttled.

It is not safe; if he is the sort of man who resents it — and still less safe, if he is the sort who doesn’t.

VTDigger

Judge Murtha’s Vermont Yankee decision ignores basic principles of legal interpretation and effectively overturns the existing court precedent concerning regulation of nuclear power. It should be reversed.

The Atomic Energy Act clearly establishes a role for the states as well as for the federal government in regulating nuclear power plants, a point clearly articulated by the Nuclear Regulatory Commission in its regulations. In the Pacific Gas & Electric case, the Supreme Court, explicitly refusing to look at legislative history upheld California’s moratorium on nuclear plant construction. While declaring that the field of radiological safety is clearly preempted from state legislation, the unanimous PG&E court asked only “whether there is a nonsafety rationale,” and went on to find that: “it is clear that the States have been allowed to retain authority over the need for electrical generating facilities easily sufficient to permit a State so inclined to halt the construction of new nuclear plants by refusing, on economic grounds, to issue certificates of public convenience in individual proceedings.”

In stark contrast, rather than closely examining the text of the laws the Vermont Legislature actually wrote to discern their meaning and intent, Judge Murtha gathered random tidbits from a highly selective sampling of legislative history, and made no effort at all to relate them to the actual text of the law as passed. Many of these quotes might relate to passages of legislation that were never enacted. Indeed, quite a few might not relate to legislation at all. Assembling random quotes with no context gives us no way of knowing.

For example, quoting one legislator saying, “Let’s find another word for safety,” Judge Murtha concludes that the law which results is “motivated by safety.” But the judge simply assumes the answers to a whole series of questions. Was that legislator’s suggestion ever followed? What new words were chosen? Is the wording in question still in the law? If so, where do they appear? Does the context suggest, as the judge implicitly deems self-evident, that the intent is merely to use a different word to discuss a pre-empted topic, or has the text now evolved to something entirely different?

In undisputed fact, the actual language of the legislation Vermont passed contains nothing about nuclear or radiological safety, and no words which somehow mask any such intent. The very structure of Act 160, the vast bulk of which (Section 4) establishes a detailed set of studies and procedures necessary for legislators to determine whether the plant is in the “public good,” makes the Legislature’s intent quite clear. These studies specifically relate to the very issues the Atomic Energy Act leaves in state hands: need for power, economic impacts on the state, etc. Indeed, they closely mirror the very issues which would be raised in a CPG proceeding, and have, in fact, been entered as testimony in PSB Docket 7440.

By contrast, these same provisions are totally inconsistent with the notion that the Legislature was motivated by safety considerations to shut the plant down. The suggestion that the entire Legislature and a conservative Republican governor endorsed a vast conspiracy to spend hundreds of thousands of dollars in meetings and studies solely to mask their “real” safety-driven purpose strains credibility.

The judge’s conclusions cannot be reconciled with actual historical facts. Indeed strikingly, Act 160 passed unanimously and was signed into law by Jim Douglas, an ardent supporter of Vermont Yankee’s continued operations.

There is no way to connect the laws passed to the intent that Judge Murtha tries to infer from the remarks he’s selected. But that’s precisely what one would expect when an interpreter fails to examine the text itself. In sum, as a matter of law, there is no violation of federal supremacy in the laws which Judge Murtha seeks to overturn, because there is no reference in them to the areas pre-empted by Congress.

Overturning legitimate legislation for specious reasons and allowing the plant to operate beyond its permitted time is bad enough, but this decision has nefarious and far-reaching unintended consequences as well.

Federal preemption laws do not abridge the free speech rights of legislators, who remain free to think and say whatever they like. The purpose of pre-emption is to prevent states from regulating areas declared to be solely within the purview of the federal government. But legislators do far more than regulate; they play a central role in the broad political dialogues – with constituents, with lobbyists, with administration officials, and even with federal agencies — which constitute our representative democracy.

When, for example, Yankee’s cooling towers collapsed, the NRC’s David Lew declared this to be a “very, very low significance issue.” Nonetheless, Vermonters, including legislators were concerned. Murtha’s decision absurdly suggests that giving any voice to that concern, especially if the word “safety” happens to be uttered, is somehow pre-empted under federal law, if it happens in a legislative committee and on tape. That conclusion doesn’t pass the straight-face test.

But the fallout from this decision will go well beyond that. In a citizen legislature, most elected representatives do not come to their jobs with legal, technical or any other expertise concerning the dozens of issues they must confront. With no staff beyond shared legislative counsel, they do not have the luxury of consulting in-house experts either. Instead, they are forced to learn on the job and on the record, by bringing in citizens, lobbyists, legal and technical experts, etc., to teach them what they need to know while drafting legislation.

In an area like nuclear power, where both legal and technical issues of considerable complexity abound, it is totally unsurprising to find legislators discussing issues about which they will, in the course of time, learn that they may not regulate. At the same time, some of the witnesses who offer testimony will be completely unaware of the legal niceties, and discussions of matters which cannot be regulated at the state level will ensue. As legislation moves forward, legislators hone their sense of what is and isn’t permitted. Illegal or wrong-headed provisions get re-crafted or dropped altogether. In the end, the only thing that matters is the result, that is: the law as enacted.

Judges must interpret laws to mean what they say, not what any of the witnesses or legislators who happened to be present in a committee room might have said. The Legislature does not enact and the governor does not sign legislative drafts, floor speeches, or committee discussions.

Just as Judge Murtha quotes the Second Circuit expressing the fear that legislatures could “nullify nearly all unwanted federal legislation by simply publishing a legislative committee report articulating some state interest or policy – other than frustration of the federal objective – that would be tangentially furthered by the proposed state law,” so too, if this ruling stands, legislators could nullify any state legislation merely by inserting terms pre-empted by federal legislation into the legislative history of otherwise perfectly permissible legislation. Even more absurdly, Judge Murtha’s methodology means that legislators don’t even have to succeed in introducing them into the law as passed.

If this ruling stands, no legislature could afford to be caught listening to any witnesses unschooled in the minute details of pre-emption law, when drafting legislation which could later be challenged. The legal chicanery feared by the Second Circuit is not a one-way street; but it is both a legislative and an interpretative cul-de-sac.

Finally, if the economic implications of safety issues and the rate implications of utility contracts are pre-empted, as Judge Murtha suggests, then the dual regulatory scheme established by Congress becomes a farce. This ruling makes it impossible to conduct the cost-benefits analysis needed to reach rational regulatory conclusions about the economic implications of housing a nuclear power plant in Vermont, ironically the very points Act 160 was intended to address.

Assume, for example, that the NRC is correct in assessing Vermont Yankee’s tritium leaks as having no safety consequence. That premise does not lead to the conclusion that the leaks are without economic impacts on tourism, on Vermont’s brand, and thus on a host of local businesses for whom the image of natural purity is crucial. Nor does it even relate to the fact that Entergy officials misled the state about the piping which could potentially carry tritium underground, thus creating an atmosphere of extreme distrust about a corporation attempting to do business in Vermont (while effectively poisoning the discussion of eventual decommissioning liabilities, which was the context in which the questions were raised in the first place). All of these matters are state responsibilities; the NRC has no authority over any of them.

Telling legislators and PSB regulators simply to ignore all this effectively instructs them to ignore the costs in cost-benefit analysis. That makes any regulating the state could possibly undertake a truly hollow enterprise. But without such regulation, we are left with a regulatory vacuum, which the PG&E declares was clearly not the intent of Congress. In other words, this decision subverts not only Vermont law, but federal law as well. It must be appealed.

VTDigger

In all likelihood the Republican presidential primary is down to two. Yes, as of this writing Rick Santorum and Ron Paul are still in the race and both have declared that they are in it for the long haul. However, the pressure on these two to get out of the race will be mounting as the slugfest between the Newt and the Mitt continues in debate after debate after debate.

The many debates that these candidates have had have served a purpose. They have helped to educate Republican voters on their possible choices for the candidate of their choice to go up against an incumbent president who’s had the luxury of sitting back and watching the show.

And what a show it has become. We’ve seen Mr. Santorum wearing his conservatism on his sleeve, but for some unexplained reason he doesn’t seem to excite the conservative base. Perhaps it could be because he’s not that exciting; certainly not a disqualifier for serving as president (remember, we sent Calvin Coolidge down there, ya know).

Then there’s Ron Paul. Here is a man who has tossed out ideas that even I have liked. For instance, he’s not a big fan of jumping into war willy-nilly, as our previous president was fond of doing. However, he does come across as the crazy uncle at the family Thanksgiving dinner. (I can forgive him for that as there are those in my family who’d put me in that category as well. I love them just the same.)

So the Republicans are seemingly left between a guy who wants us to move to the moon and a guy who has never held fewer than two positions on every issue imaginable. The Republicans have strived, begged and pleaded for someone, anyone to come forward other than the Mitt. Michelle Bachmann, the slightly more than moderately insane congresswoman from Minnesota, was originally the darling of the party, but she quickly fell from grace once she began speaking.

Rick Perry led the pack briefly until he couldn’t remember the third agency that he would abolish, thus providing Americans of all stripes with one of the most excruciating video clips ever recorded. I’ve never been a big fan of Texas governors, but I would hope that there was not one among us who couldn’t feel a little sympathy for this guy. Notwithstanding the fact that he was not presidential timber, all of us over 50 can be a little forgiving of someone forgetting something.

There wasn’t a lot of forgiveness to be had with Herman Cain, with the exception of Stephen Colbert who invited Cain to campaign with him in South Carolina. One wonders who does the vetting of these guys. Cain was a bus accident waiting to happen. The only question is what took so long.

John Huntsman was apparently the only rational one of the bunch. It was very clear from the start that he was not going to last long.

Now we’re down to two (not counting the other two); a Mitt and a Newt. They are fun to watch. You may remember not too long ago, after Newt led the impeachment of Bill Clinton, that the term “family values” was the standard bearer of the Republican Party. What a difference a decade or so makes. Newt is a serial adulterer. He was committing adultery while he was persecuting a president for doing the same thing. No double standard there. He was brought up on ethics charges while serving this country and paid a hefty fine. His colleagues stripped him of his position as Speaker of the House. Maybe he’ll do better on the moon.

That leaves us with the candidate in the primary that 76 percent of Republicans don’t want to see as their candidate; the Mitt. Why would Republicans distrust this man so? Could it be because he supported a woman’s right to choose before he opposed it (John Kerry comes to mind)? Could it be because he supported mandatory health care before he opposed it? Maybe because he supported climate change before he opposed it, or that he supported the bank bailouts before he opposed them?

John Kerry got his clocked cleaned, for among other reasons, because he was perceived as a flip-flopper on the Iraq War. Apparently now if a candidate flip-flops on key issues and core beliefs, all is forgiven; or maybe not.

The Republicans are in a tough spot. It appears as though their candidate is going to be the poster child for the 1 percent. He’s incredibly wealthy having made a fortune, not by manufacturing anything of value, but by being a predator buying up marginal businesses, loading them with debt and then selling them off for a profit, while ruining lives of everyday people. He’s also known for having tied his dog to the roof of his car and driving to Canada on a family trip.

It’ll be interesting to see how President Obama fares. Perhaps he’s not been a great president, but he did kill Bin Laden and didn’t tie his dog on the roof of his car.

VTDigger

Originally House bill SOPA (Stop Online Piracy Act) and Senate bill PIPA (Protect IP Act) were bipartisan bad policy. The Senate version was reported unanimously from the Judiciary Committee and was supported not only by Chairman Patrick Leahy (D-Vt.) but also by the senior Republican on the committee, Orrin Hatch (R-Utah).

These bills, written largely by Hollywood lobbyists, would have done great harm to Internet-enhanced freedom both in the United States and around the world. They were a massive overreaction to the real (although not well quantified) problems of content piracy and counterfeit goods on the Internet. Oh yeah, they also helped protect Hollywood from “new media,” legitimate or otherwise.

Internet denizens used the net and social media to fight back … and companies like Google and Facebook lobbied in more traditional ways as well. Wikipedia went dark for a day in protest exciting a rebuke from former Sen. Chris Dodd – yeah, the guy who received special treatment from the mortgage companies he defended in Congress, who is now the CEO of the Motion Picture Association of America:

“It is an irresponsible response and a disservice to people who rely on them for information and use their services.

“It is also an abuse of power given the freedoms these companies enjoy in the marketplace today. It’s a dangerous and troubling development when the platforms that serve as gateways to information intentionally skew the facts to incite their users in order to further their corporate interests.”

Wikipedia, of course, is a free service; it’s supported by donations. But Dodd thinks it is inappropriate for it to withhold service for a day to make a point. Of course, we all know what happens if a content provider can’t reach agreement with a cable service — blackout. But that’s OK; it’s just about the money. But I digress.

By and large the first politicians to desert SOPA and PIPA were Republicans. This surprised many of my more liberal friends since, at heart, this is a civil liberties issue and they think of Democrats as being more committed to civil liberties. Here’s Dan Gillmor:

“Two more Republican senators have withdrawn support for Internet censorship today, adding to a growing unease in Congress over what lawmakers had been poised to do with SOPA/PIPA. But the Democrats, for the most part, are still firmly in support of this pernicious legislation.

“For example, both California senators, Dianne Feinstein and Barbara Boxer, are co-sponsors of PIPA. They’ve taken Hollywood’s side against Silicon Valley and the great majority of their constituents — choosing to help an industry that holds back progress over one that creates it …

“I lived in Vermont for many years, and was a huge fan of Patrick Leahy, the longtime Democratic senior senator from the Green Mountain State. His ardent desire to pass PIPA is a sad reminder of how a man who once believed in civil liberties — freedom of speech in this case — has become a bought-and-paid-for hack on some issues, such as this one.

“Yes, many powerful GOP members — especially Texas Rep. Lamar Smith, chief sponsor and author of SOPA — remain firmly on the copyright cartel’s side. But it won’t be long, if current trends, before we’ll have to call the Republicans the party of progress on this issue.”

Now I do hope Republicans can become known as “the party of progress” on many issues, but I’m afraid I know the true reasons why Republicans quickly switched sides on this debate. It wasn’t even the campaign contributions.

It was the content.

In domestic movies, Republican types are often the villains — evil bankers, car company executives, nuclear power plant operators, defilers of the environment. Oh, they don’t always wear GOP pins, but we know who they are.

On the other hand, how many movies have you seen about evil environmental activists, labor leaders (since “On The Waterfront”), alternative energy developers or community activists.

These are always the good guys. And obviously Democrats.

When push came to shove, the Democrats stuck with the people who have portrayed them so nicely … and the Republicans got their revenge.

Don’t worry, though; there’s sure to be a sequel.

VTDigger

Women’s health care reform is sadly neglected in the larger reform debate, even though women are major players in the market. The single biggest obstacle to progress is never addressed: the fact that men are still in charge.

You could say it’s the 900-pound gorilla in the delivery room.

“Obstetrics and gynecology,” as the guys have named it, is a surgical specialty. Most OBGYN programs are chaired by men. Even though most OBGYN trainees are women, their practice styles retain the flavor of their training. They’ve drunk the Kool-Aid. They’re trained to perform procedures, not to prevent them.

One index of poor performance in maternity care is a high surgical-birth (cesarean) rate. Fletcher Allen Health Care’s is 27 percent — though the hospital posts a misleading “primary” (first pregnancy only) cesarean rate of 14 percent.

The acting CEO of FAHC is John Brumsted, an OBGYN.

Vermont’s overall surgical-birth rate is 27 percent — up from 16 percent in 1996. The World Health Organization says that the surgical-birth rate should be no higher than 15 percent.

Vermont alone produces 30-plus new obstetrician-gynecologists every 10 years.
How do you get to be a surgeon? Practice, practice, practice. The dozen or more residents in the UVM program expect to perform as many surgical births as possible in the four years of their training. Surely they are not interested in reducing the number of practice cesareans.

They enter the market with high debt loads and high income expectations. The oversupply of OBGYNs is the real reason why Vermont, and the nation’s, surgical-birth rates are so high; why hysterectomy is the second most common major procedure for women; and why urogynecology is now the hottest surgical subspecialty – even as the FDA has issued alerts about one of its best-sellers, the “sling” device for urinary problems.

We won’t even go into the overuse problem with procedures like the “vaginal probe” ultrasound. According to BISCHA, Vermont hospitals perform nearly 4,000 ultrasounds on a pregnant population of about 5,200. The average cost is $600 a pop. There are no long-term outcome studies on the effects of high-frequency sonograms on children, and little evidence that the widespread use of prenatal ultrasound has improved outcomes in maternity care.

Many women now expect sonograms throughout pregnancy, even though they hate the “vaginal probe” part of the deal. They post the images on their refrigerators and Facebook pages. But it wasn’t the patients who drove the market for this profitable procedure.

Since the advent of “actively managed” pregnancy and childbirth, with ultrasound, epidurals, Pitocin and skyrocketing rates of surgical birth, we’ve also seen an increase in childhood brain disorders: autism spectrum and attention-deficit problems. Obstetricians will say that there are no studies showing that autism spectrum disorder and ADD/ADHD are caused by any procedures or drugs used in pregnancy and birth. They certainly aren’t doing the research. Perhaps they should.

The prevailing myth is that there aren’t enough obstetricians. In fact, the guys of OBGYN are fighting to take over as “primary care” providers. That’s nonsense. They are surgical specialists. We need fewer of them, not more.

What we need is OBGYN reform.

UVM OBGYN Roger Young is the Vermont section chief of ACOG, the American Congress of Obstetricians and Gynecologists – the political-action trade group of OBGYNs. Three out of four Vermont ACOG officers are men.

At the University of Vermont, Dr. Mark Phillippe is the chair of OBGYN — as he was during the hospital’s recent attempt to close its beloved midwifery service. Women took to the streets to prevent that move.

Even though women’s preference for out-of-hospital birth is rising, nationally and in Vermont, support for home-birthing women has vanished under Dr. Phillippe’s regime. Instead of a “back-up” plan with a provider she knows, a laboring woman who needs to transfer from home now gets a random OB trainee, whom she’s never met, and who has no prior knowledge of the course of her pregnancy. So much for continuity of care.

In more enlightened areas, women and their midwives can make “transport” agreements with family docs or OBs, so if transfer to hospital is needed, a woman will be met by someone familiar to her and to her midwife.

In some places, maternity staff will write the names of women who are laboring at home on their white board, so that if someone needs transport, they’re ready to receive her. Otherwise,
the hospital sends a “Welcome Baby” card.

When asked about this, Dr. Phillippe said, “Oh, we couldn’t do that here.”

Vermont is one of two New England states that still lack a freestanding birth center, largely due to decades of opposition by the guys of OBGYN.

Dr. Phillippe was recently named to the Fletcher Allen board of trustees.

These docs are personally very nice guys whom we know and love. But they’re terribly misguided and mis-trained. They’re doctor-centered, not patient-centered. They now see us as a market to be experimented on, and exploited, not a population to be served.

It’s kind of like having the Qadaffis in charge of civil rights. Is it time for regime change?

And the guys in charge still ignore The Most Important Question In Life: What do women want?

We want more midwives and family docs — and fewer surgeons — providing our care. We want a voice in designing that care. We want better outcomes. We want more relationships — and less corporate hype — from our providers. We want more cooperation — and fewer turf wars — among our practitioners.

And we want more women in charge.

VTDigger