Sunday, 26 October 2014

Cuomo, Christie celebrate Hallowe'en early

It’s Hallowe’en, so our esteemed governors have decided to put on clown suits.

The Daily News, which should be ashamed of itself, says the Cuomo announcement to quarantine medical workers coming from West Africa even without symptoms “eases fears” on Ebola. Exactly wrong: he is giving those fears a major boost.

There is so much wrong with this demagogic announcement from Cuomo and Christie that the mind boggles. First of all, what is Cuomo doing sharing a podium with that thug? The exploitation of the mass dementia in tandem with Christie shows that they understand each other perfectly and that alleged differences are secondary to their personal ambition.

Next, WTF? Did these two public health experts even think to check in with the CDC or their own health departments before coming up with this harebrained scheme? Everyone actually trying to respond to the situation—as opposed to furthering their own political careers—thinks dumping people into glorified jails just for traveling to Liberia is a really, really stupid idea. What medical professional with a life is going to volunteer to help out in that extremely dangerous and difficult environment knowing that they will immediately have to spend three weeks when they get back in a cage while a bunch of jerk-offs peer at their poop?

Much more likely that returning volunteers will disguise their movements and slip into the country somewhere else, defeating the whole purpose. As will anyone trying to avoid this Draconian, unscientific and completely ham-handed move.

But a lot of ignoramuses—the real audience for this announcement—will applaud the two goofball governors because, as people used to say about HIV, “Better safe than sorry,” thereby justifying all sorts of useless, counterproductive and stigmatizing exclusions and other hateful acts. All of which did nothing to stop the spread of HIV, but it made people feel safe for a while—kind of like the War on Terror, the torture regime at Guantánamo Bay, and the invasion of Iraq. Those strategies have turned out swell, as we know.

Less than a day later, Cuomo is already backpedaling—a bit, saying that people can enjoy their quarantine at home. Tim Horn at Treatment Action Group has composed a sample letter to be sent to the governors, which can be found on the ACT UP NY Facebook page. (I don’t see it anywhere else yet.) It looks like only sustained public humiliation will get these guys to put public health ahead of their sleazy ambitions.

Saturday, 25 October 2014

Bad vs horrible? or bad vs bad?

Two long profiles pieces in weekly magazines—one of Rand Paul in the New Yorker, and a Harper’s anti-profile of Hillary Clinton—have got me thinking about the wacky hypothetical of a Clinton-Paul face-off in 2016. It’s fun to do the thought experiment especially in the light of the Dilma Rousseff-Aécio Neves battle taking place in Brazil tomorrow, the standard-bearer of the erstwhile leftish Workers Party shooting for a fourth WP term in office v/s the Brazilian version of a suit.

From afar, one assumes that most people favor keeping the corrupt business class out of power and oppose the conservative candidate. But given the disappointments of the Lula-Dilma regimes, including gross corruption fully in the spirit of the Brazilian Way, one has to ask what is lost by continuing to have a cardboard version of a progressive in office while carring out an uber-business-friendly program.

Meanwhile, São Paulo may be out of water in a few weeks, a detail Dilma’s workers have been ignoring just like the bosses did while pushing for more hydroelectric plants in the Amazon and doing little to stop the ravages of the zone’s ecology. All of which makes that election sound more and more like a fight between the People’s Front of Judea and the Judean People’s Front. But I digress.

Rand Paul is just unorthodox enough to be less than 100% hateful, capable of taking good positions on excessive prison terms and a less hawkish foreign policy. No doubt if he gets anywhere near seriousness as a candidate, both will be quickly bullied out of him, and there are signs he’s starting to conform to the wacko brigades’ demands already. But just for fun, what if he continued to be a libertarian Republican, hostile to abortion and gay rights, but determined to put an end to foreign wars of conquest?

How would one feel about opposing him to support a gay-friendly imperialist like Madame Clinton making noises about, say, bombing Iran, sending troops to Moldava or some other Russian frontier zone, and promising to further enable the CIA’s secret armies and the NSA snoopfest?

Or to put it another way, Is it better to have someone in office who makes rhetorial nods at worthy goals and takes note of problems that do exist—for example, the Democrats’ newfound interest in economic inequality while they do everything necessary to protect and sustain the power of the superrich? Or might it be simply bad in a different way to have the right-wing program carried out by real right-wingers with all the collateral damage that would entail?

It’s an interesting moral choice even given the likelihood that none of it will matter and the shadow state will make our decisions for us no matter who happens to be its public face. The only thing that will slow down the ever-tinier elites is popular opposition expressed in concrete ways such as the upheaval in Ferguson or the old Occupy movement—not by voting habits.

I hate to be a broken record, but the example of the decade is the Chilean student movement, extra-parliamentary, uncompromising and based on physical presence in the streets. They were uninterested in promises they had no reason to believe and did not fall for the Woo-Woo! Look at those bad guys over there! routine, even when the bad guys in question were the remnants of the Pinochet dictatorship.

Instead, they harassed the authorities relentlessly, and the result was a new president promising to eliminate university tuition. The story is not over, but our creaky democratic apparatus is

Wednesday, 22 October 2014

Bad guys target journalists

Peter Grieste is the Australian reporter sitting in an Egyptian jail cell since last December for the crime of journalism. He and two Al-Jazeera colleagues, Abdullah Elshamy and were found guilty of abetting terrorism (as well as “spreading false news”) by the Egyptian military regime based on the usual absurd evidence. Now serving a 7-year sentence, he composed a speech, for Britain’s Frontline Club awards ceremony, put together by friends and family based on conversations they had with him, and it’s pretty dramatic.

Grieste says he’s had time to think about what is going on today in the world of journalism given his own case and the appalling on-camera murders of two free-lancers in Syria. He is duly shocked by those crimes, and he also reminds us that demonizing reporters didn’t start with the Islamic State.

As much as we abhore and condemn the [ISIS] executions of James and Steven, it was George Bush who set the ground rules in the wake of 9/11 when he declared that you’re either with us or with the terrorists. That single statement made it impossible for reporters to hold to the principles of balance and fairness without being accused of acting as an agent for the enemy.

Al Jazeera learned that to its cost when the US hit its offices in Baghdad during the invasion to oust Saddam. And in Afghanistan one of its camermen, Sami al Haj, was arrested. He spent seven years in Guantanamo Bay before being released without charge.

Greste warns against enjoying a convenient episode of amnesia that would allow us to see the brutality in the jihadists’ treatment of reporters and forget certain precedents set by the invaders. He doesn’t mention, but could have, the act that impelled Chelsea Manning to release classified U.S. government documents to Wikileaks—the suppressed video of the American troops killing a news cameraman in Iraq.

Grieste puts the blame on the amorphous “war on terror.” He says that a conflict that “by its very nature is indefinable, with no clear physical or ideological boundaries, with a title that means everything and nothing,” creates the conditions for a “war against telling the truth and reporting facts.”

[I]n all of these battlegrounds, whether hot or cold, journalists are no longer on the front lines. We are the front lines. In this wider conflict, there is no such thing as a neutral, independent reporter. In the view of both sides, if you cross the lines in pursuit of our most fundamental principles of balance, fairness and accuracy, you effectively join the enemy.

Since the War on Terror began, all manner of abuse of journalists and attacks on human rights and press freedoms have been excused as necessary evils, and by governments across the globe. It almost feels like a kind of globalised McCarthyism, where simply invoking terrorism is enough, in some cases, to get away with murder.

Getting away with murder has been deemed essential to Keeping Us Safe. Now reporters are fair game for both sides.

Tuesday, 14 October 2014

Why do we hear nothing about the main enemy? Saudi Arabia

With the appearance of the Islamic State, the Global War on Terror launched originally by GW Bush is now a miserable failure. A sworn enemy of the United States that delights of public brutality wields an effective military force, holds huge swaths of territory in the heart of the Middle East and openly defies its enemies. Perversely, its mystique is so potent that hundreds, perhaps thousands of Europeans including non-Muslims, flock to its banner.

Thus both the neocons’ “hard” and “soft” weapons, the vast array of firepower and the sustained ideological campaign against terrorism—whatever that has come to mean—are ineffective if not counterproductive. The only remaining question is whether the present failure will be turned in a catastrophe and from there into a debacle.

It is startling to see, even at this late date in the terrorism game, a Western TV reporter quizzing a member of this suddenly new player, the IS army, as to whether he endorses the terrorist killings of innocent women and children. She apparently sees no irony in asking that question of an individual who has seen nothing but such deaths in his immediate vicinity for well over a decade. But since 9/11 onward, any attempt at understanding what might be in the minds of the official bad guys is dismissed as disrespectful and subversive. We now see the results in our institutional and collective cluelessness about what to expect next.

It’s hard to know where to begin to untangle the mass of bad news emerging from those lands, but one good starting point is an important piece of collective amnesia that it goes back to 9/11 itself: the permanent collusion of the Saudis in everything that went wrong then and continues to do so today. Who even remembers that most of the Trade Center hijackers were Saudi citizens? Or that Bush’s team quickly whisked members of the bin Laden extended family out of the country before they could be lynched or even questioned about the activities of their famous relative?

Washington’s permanent wink-wink at the Saudis’ nefarious activities in the region, including their vast funding of Islamic zealots, has now resulted in the IS Frankenstein. As Patrick Cockburn outlines regularly, funds for the psycho bandits of IS have flowed in vast amounts from the oil-rich sheikdoms, but given the Saudis’ and Qataris’ ostensible position in Washington’s back pocket, no harm ever comes to them for doing it. Their role in bringing down the Soviet occupation of Afghanistan was considered such a rousing success that our leadership cabal has decided to let them keep it up. If God is indeed great or even pretty okay, the caliph-worshippers eventually will sweep away the hateful Saudi royal family itself.

The attempt to exercise greater and more direct control over everybody in that part of the world has now collapsed to such a point that weakening one enemy only strengthens another. Does Obama blast Isis and give the loathsome Assad a free hand? Does the Turkish president press on to undermine Assad and generate the byproduct of a massacre of Syrian Kurds? Does that then restart his civil war with the Kurdish minority? Does the Shiite-dominated Iraqi government get help from the U.S. to recover territory, thus unleashing anew the Shiite death squads that pushed Sunnis into Isis’s hands? If the whole sorry scenario weren’t so horrifying, it would merit a Marx Brothers routine.

And of course then there is money, C5A-fulls of it transported to Afghan, Syrian, Pakistani or Iraqi collaborators in neat pallets of $100 bills straight from the U.S. mint that is supposedly so burdened by DEBT that research into the Ebola virus had to be sequestered and cut back. No sums shall be deemed too great to toss into the bottomless pit of the next military maneuver, weapons program, or booted mission, and ignominious failure of one sure-fire idea will lead directly to the next. Contractors will thrive, and congressional districts heavy with arms manufacturers will hum with activity. Legislators will sell themselves as brazenly as the seductresses of Amsterdam and for substantially less.

And what is the reward for this decades-long enabling of the Saudi meddlers sitting atop their pyramids of cash and propagating medieval phallic worship? They are now permitted to undermine the entire world economy by driving down the price of oil just when a little price inflation is what billions of people urgently need.

It’s remarkable that given the ease with which our propaganda apparatus cranks up enemies to suit the discourse of the moment, the Saudis remain untouched, almost beyond criticism. The Taliban and the Iranians are hateful to women, Isis publicly beheads people, enemies here and there fund terrorists and all get shellacked in our media. But the Saudis, who have been doing all these things for decades and much more effectively, remain completely off the hook.

Saturday, 11 October 2014

Ebola screw-up and big data health capitalism

Entirely without premeditation, I find I have taken a break from commenting on our biped species’ determined rush toward oblivion. I did take a two-week vacation and then commented on it for another week afterward, which was very restorative and felt self-indulgent—lingering Calvinism, no doubt. It is a bit surprising, though, to see how long it has taken me to refocus on the many ways in which humanity drives forward unrelentingly toward the multiple precipices of its/our own creation. I now feel sufficiently retoxified to resume.

Incidentally, however, I must express, albeit in the form of cliché, an observation: our disappearing world contains many marvels, which remain a source of delight.

The latest episode in biped self-immolation is the dysfunctional response to the first Ebola patient, a Mr. Duncan, and the continuing attempts to ignore the lessons that could have been learned by those mistakes. This careful review from Health Care Renewal points out several aspects that drew my attention. As many have noticed, the patient’s recent visit to West Africa was not communicated to other medical staff, and he was discharged despite having a high fever.

So far this is not rocket science: the man was black, uninsured and in Texas. What facts might be missing here? Is there some reason why he would NOT be promptly discharged onto the street given that the hospital could not make any money off him by ordering more tests or keeping him overnight as a mere sick human being? What minimally educated MBA hospital administrator would not applaud a nurse for getting this useless element out of their pristine medical facility toot sweet?

Now obviously there is a special circumstance here in that the fact of a dangerous infectious disease epidemic outbreak is hardly a secret and should have alerted anyone in the health field, especially including ER staffs. Although Texas might not care much about a penniless African immigrant, his microbes could have infected prosperous white people. Why didn’t the information about his travels get passed on?

Here we run into the modern fetish of electronic everything: the nurses might well have overlooked entering his crucial travel data into their computerized medical records. The article linked to above quotes an interview with the hospital corporation’s Chief Operating Officer, Jeffrey Canose. (The company is called Texas Health Resources, which I find a curious choice: “health resources “could mean things like gauze and doctors, of course, but I suspect they mean something more like a vein of ore to be mined.)

The biggest challenge is to continue on our journey to increase our capabilities as a fully integrated health system; to develop the competency to be a high-performing system in the realm of population health management; to shift our focus from sick care to actually managing well-being. . . .

Aside from the unctuous, business-school prose (“continue on our journey”), this bland rhetoric masks a ruthless business plan: how to collect premiums while not paying for people to be cured (“sick care”).

Now, “managing well-being” sounds innocuous enough. It could mean more attention to preventive health actions—who could object to that? On the other hand, it could (spoiler alert: does) mean figuring out who may need expensive services down the road and figuring out how to avoid paying for them.

How do they plan to go about doing that? Mr Canose tells us:

. . . people in IT are mission-critical partners in hearing what kinds of problems we’re trying to solve and in helping us to figure out how to drive clinical transformation and care design, and how to drive efficiency. . . . the electronic health record is a huge enabler to all this; the next challenge will be to enable things further, including through data mining, working with big data and clinical and operational support.

Why all the attention to IT and “big data”—meaning amassing huge numbers of medical files on all of us to detect patterns? (“Why do you have such long teeth, Grandma?”) Why, to better extract rent (“resources”) from the health care apparatus, my dear.

Anyone even marginally close to primary or emergency care as currently practiced, as I am, will immediately recognize what Canose is referring to: the requirements imposed on all providers from the moment a patient walks in the door to gather a slew of data on that person, which is fed into the maw of hospital computer servers. Ostensibly, it is designed to improve patient care, and it may have that effect in some cases. But we have all become bits in a database, dependent upon the carefully pre-pacakaged and pre-priced services to which we are entitled according our place in the system (and contribution to it). The hospital needed Mr. Duncan’s vitals and data on his health history and personal habits to beef up the statistical power wielded by its analysts so that Mr. Canose can sit in his office and calculate the health, illness and cost probabilities of a million future patients.

But in the rush to nail down what the system needed to “continue on its journey” toward greater shareholder profits, salient facts about Mr. Duncan were either ignored or not flagged because “recent travel to West Africa” does not appear in any of the complex algorithms related to extracting rent from health care. Given that the lesson of this major goof, if acknowledged and digested, would complicate the economics of our entire system, we can be fairly confident that it will NOT be learned. Ebola-specific errors may now be corrected as long as the attention remains high. But the broader indictment of how profit-making is undermining health outcomes will be studiously ignored.