I was popular, but it was transitional

I was amused during the run-up to Obama's inauguration and shortly thereafter when his approval ratings were sky-high. Considering he won something like 53% of the popular vote, who were the other 30% of Americans that suddenly approved of the job he was doing? What, in particular, did they approve of? Picking Hillary Clinton for State? Being able to string words together? Wanting to buy a dog? What?

This obviously couldn't last. Part of it is, in my perpetually humble opinion, because some people had ludicrous expectations that the recession would magically disappear as soon as Obama took office, and that Republican and Democrat alike would all sit around in a circle talking about how great he is for the near futue. This obviously hasn't happened, and was never going to happen. Obama has presented a stimulus bill, and has gone to extraordinary lengths to build bipartisan support for it. It didn't take long for the GOP to show how interested they were in playing along, and people who expected the mellifluous tones of Obama's voice to somehow charm passage of a massive spending bill are now forced to recognize that he can only do so much.

Part of it is also because, frankly, there are a lot of jerks out there. It does the country no favors to undermine its brand new president, but Limbaugh has a lot of listeners and his own self-interest to consider. As my one-time band teacher once said, may the fleas of a thousand camels infest his armpits.

And finally, of course, some of it was Obama's own fault. He is responsible for the screw-ups of his team's vetting process. Blessedly, we now have a president that can admit he was wrong. It doesn't make it all better, but it does take the sting away.

In a nutshell, I agree with Megan. Governing is hard, particularly when dealing with something as complex and massive as the US economy. I think Obama is doing the best he can, and hope that he continues to do so. But let's give the man a little time to get things started.

Mix equal parts hilarity and horror. Frappe.

Via Washington Monthly, an item about stupidity so immense, it deserves a commemorative statue:

Wells Fargo & Co. abruptly reconsidered a pricey Las Vegas casino trip for employees Tuesday after a torrent of criticism that it was misusing $25 billion in taxpayer bailout money.

The company initially defended the trip after The Associated Press reported the company had booked 12 nights at the Wynn Las Vegas and its sister hotel, the Encore Las Vegas, beginning Friday. But within hours lawmakers on Capitol Hill had scorned the bank, and the company said it was reconsidering.

The conference is a Wells Fargo tradition. Previous years have included all-expense-paid helicopter rides, wine tasting, horseback riding in Puerto Rico and a private Jimmy Buffett concert in the Bahamas for more than 1,000 employees and guests.

Oh, a tradition you say?  Well, then everything is fine.

What I particularly like is that you can almost hear the indignation in the voices of the people who may not be able to go to Vegas after all.

"Recognition events are still part of our culture," spokeswoman Melissa Murray said Tuesday afternoon. "It's really important that our team members are still valued and recognized."

[snip]

Kevin Waetke, another spokesman for Wells Fargo, defended the trip. He said the company, which recently acquired Wachovia Corp., had a long-standing tradition of recognizing top employees.

"This year, we have the unique opportunity to bring together our Wells Fargo and new Wachovia mortgage consultants to focus on continuing to do all we can for U.S. homeowners," Waetke said.

You also had the unique opportunity to accept $25 billion in taxpayer money, Mr. Waetke.  And somehow I suspect your new happy Wells Fargo/Wachovia family will be able to focus better in their offices than in Vegas, with all the shiny and/or half-naked things festooned all over the place.  And Ms. Murray, may I suggest you help your employees feel valued and recognized by treating them to sundaes?  The fixin's are cheap, and it worked well for our office.

Suffice it to say that this is playing... poorly on Capitol Hill.

"Let's get this straight: These guys are going to Vegas to roll the dice on the taxpayer dime?" said U.S. Rep. Shelley Moore Capito, a Republican who sits on the House Financial Services Committee. "They're tone deaf. It's outrageous."

No, my father is tone deaf.  These people are "taste test the Drano" moronic.  Because my mother reads this blog, and the Better Half would not approve of my sharing my true, unadulterated feelings in such a public forum, I will avoid the various obscenities that spring to mind upon reading this article.  It's rare that I feel anything akin to Marxist leanings, but I'm fighting a sudden urge to wrap a bandanna around my head, sing "La Marseillaise" and storm the nearest ATM.

Update, of sorts:  OK, so technically the French Revolution wasn't Marxist.  What I know about history is mainly pieced together from sugar packets.  I still stand by my point, which is "boo, stupid banking industry"!

Patients as friends

I'd like to submit this article from today's USA Today into the Annals of Worthless Journalism. (Yes, I realize this is kind of like criticizing the McDonald's Dollar Menu for its lack of seasonal produce. Sue me.) From the headline "Ethicists debate doctors who keep it personal," you might expect documentation of an actual debate. Instead, you get a couple of token quotes from some randomly-chosen ethicists, and several soft-focus profiles of nice, caring doctors that stitch up the neighborhood kids during episodes of SpongeBob. (Seriously.)

For example:

Sometimes going beyond the bounds of normal practice standards isn't a matter of emotional choice but simply about saving a life, says Samuel Weinstein, director of pediatric cardio-thoracic surgery at the Children's Hospital at Montefiore Medical Center in the Bronx, N.Y.

While performing open-heart surgery on a boy in El Salvador two years ago, the child needed blood but had a rare type not in supply at the hospital. Weinstein, like the child, was B-negative. He says, "I scrubbed out, donated a unit of blood, then scrubbed back in and finished the surgery with my colleague."

Weinstein says he did not intend to be a hero. "It is just something you have to do," he says. "You do everything you know how to do to help you put your head on your pillow at night. If he'd had a bad outcome, I would never be able to stop thinking about it."

While I'm a wee bit curious why Weinstein didn't donate the blood before he scrubbed in in the first place, I have a hard time imagining an ethical question about this.

On the other hand, while I hate to crush all those pretty elf houses on Lollipop Lane, there are a couple of real, legitimate concerns with the Rockwellian docs the article eulogizes.

1) House calls sound great on paper, and we all lament their passing, right? Sure. Fine. But they are very, very time-consuming. Medicine is, let's all remind ourselves, a business. The money office visits generate pays for the staff, supplies and administrative costs of keeping the practice open. Unless the house calls are done on the doctor's own time, they cut into the revenue stream in a way that doesn't make sense when you look at the big picture. In the time it would take me to drive to a patient's house, see the patient, drive back, and document everything in the record, I could see half a dozen patients in the office. Plus, is it fair to the other five patients I could have seen that I went and saw the one in her home? Cold? Maybe. But I think people, on balance, would prefer we keep the office open.

2) Apparently one of the doctors does minor facial surgery for his patients in his living room, with his 11-year-old holding a flashlight. I don't think this is admirable, I think this is crazy. All it will take is one lousy outcome or one crazy, lawsuit-happy parent, and St. Surgeon will be back to 100% office-based care.

"Tell me, doctor," asks the malpractice lawyer. "Were you able to guarantee sterile conditions there on your coffee table? Did you notice the problems with those stitches in the poor lighting?"

Should we all don sackcloth as we mourn the passing of a less litigious time, when Donna Reed undressed babies in their home office for Carl Betz to examine? Fine. And we also miss the dodo. I guess when you're chief of pediatric plastic surgery at UCLA, you're confident enough not to have these concerns. Lesser mortals like yours truly? Not so much.

Now, with that being said, of course I take the time to answer friends' questions if they call. I did minor wound care for one of my nieces this summer when she cut her foot. I dispense free advice in church all the time. I do all of this gladly and without reservation. Being helpful is its own reward, and I imagine most of my colleagues feel the same. But any time there are actual medical management decisions in question, I counsel people to speak with their own doctors. This has less to do with boundary issues and more to do with not wanting to manage someone else's patient, which does neither the doctor nor the patient any favors.

All in all, an inane article. It's nice to be nice. But doctors practice medicine the way we do, by and large, because we have to given the legal and fiscal demands of contemporary medical care. You'd never know it from USA Today, however,

Best mental image ever

From a run-down of this year's Superbowl ads in Slate:

An ad for the Toyota Tundra shows the pickup driving through a tunnel of flames and emerging unscathed. I very much hope, for the sake of Tundra drivers, that this functionality never comes into play. Separately: I am puzzled by the announcer's contention that "truckers know towing 10,000 pounds up a steep grade ain't good for your tranny." I'm picturing a post-op sex change patient standing in the pickup's bed, hands on hips, displeased with the truck's towing power. What's that you say? He means transmission? Oh. I suppose that would make more sense.

The fusion of faux masculinity inherent in a truck ad with an inadvertent reference to the transgender community fills my heart with unbridled glee. "Ain't good for your tranny," indeed.

Exit Tom Daschle?

Remember when Eric Holder was going to be the Cabinet appointee that got the most heat? Wasn't that the plan when all this started? The GOP would make a stink about the Marc Rich pardon, and then he would get confirmed, and everyone would move on? *sigh* Those were the days.

It seems that Tom Daschle is in a wee bit more hot water than originally suspected. From this morning's Times (!):

Unfortunately, new facts have come to light — involving his failure to pay substantial taxes that were owed and his sizable income from health-related companies while he worked in the private sector — that call into question his suitability for the job. We believe that Mr. Daschle ought to step aside and let the president choose a less-blemished successor.

I think this is a pretty big deal, myself. Everyone knows that the New York Times is the favored mouthpiece of the elite liberal chattering class. (It makes lovely reading while we nibble our brie.) And not only is the Times going after Daschle, so (per Politico) are the the Chicago Tribune, the Boston Globe, the Philadelphia Inquirer, and the Pittsburgh Post-Gazette. However one chooses to interpret the various papers' objections to Daschle, the sudden opposition on some of the nation's premier opinion pages indicates that this story has legs.

Zachary Roth at TPM has gone through the various charges against Daschle, and many of them seem forgivable. Both the limo driver and the undeclared income for May 2007 are, if rather rarefied problems, at least plausible mistakes. More bothersome to me is this:

The issue that almost certainly has the greatest relevance for Daschle's desired new job as HHS Secretary is his work on behalf of healthcare-industry interests. In his financial disclosure statement, Daschle reported getting paid more than $390,000 for giving speeches to groups including America's Health Insurance Plans (AHIP), a trade organization representing health insurers. He also got nearly $100,000 from health-related companies affected by federal regulation, including more than $5000 (again, the exact figure wasn't reported) for giving "policy advice" to the insurer UnitedHealth [emphasis in original]

I find this troubling. Now, on the one hand, Obama has pledged to bring about universal healthcare, and one could assume that he wouldn't have chosen Daschle if the latter were truly in the pocket of the insurance industry. But, as someone who takes universal healthcare very seriously, I am worried about a lack of commitment to the issue. Having someone with close ties to the industry in question makes me uneasy about the chances for truly progressive change.

That being said, Jonathan Cohn at The New Republic is bullish on Daschle's chances, and is optimistic that he'll bring about the necessary change. Hopefully, these questions will be asked, and answered convincingly before Daschle is confirmed.

But we shouldn't overlook the #1 factor in Daschle's favor, if not fitness for the job. As former Senate majority leader, he knows a lot of the people who will be voting on whether he gets the job. As much as Obama has claimed to be a change agent, this particular nomination will rely in large part upon Washington political insiderism.

Update: to the above tally, let us now add The New Yorker.

Update #2: And he's gone. Good.

Winning isn't everything

With the election of Michael Steele as the Chair of the Republican National Committee, some within the party seem to be using this moment as a time to reconsider the direction of the party.

... Jennifer Massour, state chairman of the Massachussetts GOP, said that Steele's first concern should be "outreach to new voters - to youth, minorities, and women". She said Steele's election was a clear signal that "this is not your grandfather's Republican Party" and represents "the wave of the future" for a more inclusive GOP. David Johnson, a former Executive Director of the Florida GOP, also saw Steele's success as a potent symbol of inclusion: "Not to borrow a phrase, but this is change we can believe in."

Really? Color me skeptical, mainly because I don't think the party leadership has shared the news with the rank and file. Via TPM, results of a new poll are... discouraging:

Coming off a shellacking at the polls in November, the plurality of GOP voters (43%) say their party has been too moderate over the past eight years, and 55% think it should become more like Alaska Governor Sarah Palin in the future, according to a new Rasmussen Reports national telephone survey. Just 24% think failed presidential candidate John McCain is the best future model for the party, and 10% are undecided.

More like Sarah Palin, ladies and gentlemen. More like Sarah Palin. Because that worked out so well in the past election.

Good luck, Mr. Chairman. You'll need it.

Update: Steve Benen has more here.

Why I think the stimulus will pass the Senate

Mitch McConnell, who is in more of a position to know than I am, thinks the GOP will scuttle the current stimulus bill in the Senate. Via TPM:

Senate Republican leader Mitch McConnell said Sunday the massive stimulus bill backed by President Barack Obama and congressional Democrats could go down to defeat if it's not stripped of unnecessary spending and focused more on housing issues and tax cut.

We all know what happened to the bill in the House. Since the Democrats lack a filibuster-proof majority, at least two Republican Senators would need to cross party lines to vote with for the package.

Why do I think the package will pass? From later in the same article:

Under Obama's plan, strained state budgets would receive a cash infusion, projects for roads and other infrastructure would be funded, and "green jobs" in the energy sector would be created. In its centerpiece tax cut, single workers would gain $500 and couples $1,000, even if they don't earn enough to owe federal income taxes. [emphasis mine]

Democrats only need two votes for cloture, and as it happens two Republican Senators happen to be from a state that is stone broke. Add in the pressure that GOP governors are putting on their party members in the Senate, and I'm going to bet that the stimulus package passes.

Update: For back-up, the ever-reliable Nate Silver.