Then there's the most recent lie, where McCain lied about what he said on videotape less than a week earlier. -- Unless you want to say he forgot. I'm not sure which is the more charitable interpretation.

But it's worth pointing out, that this Katrina lie isn't a fluke or an aberration. McCain lies a lot.

Now, why would he or any other politician imagine that the MSM wouldn't notice this discrepancy and ask him about it? What events in the past few years could ever have given him the idea that he'd never be questioned on stuff findeable by fifteen minutes with Google? It's almost like the guy has no respect for the journalists covering him, like he suspects them all of being too lazy and ignorant to bother minimially checking up on his stories.

It's hard to imagine what could have given him that idea.

Back in 2000, I went to a McCain event at the Colebrook Country Club, where Mr. McCain served me barbecue chicken with his own hands.

Before the event, his staffers passed out a whole bunch of papers about him. One of them said that Mr. McCain never brought up his experiences as a POW, but talks about them when asked.

I timed him. He brought up his experiences as a POW four minutes into his remarks. No one had asked him.

In that same set of remarks he advocated banning all "R" rated movies. Later, continuing his remarks, he said that he wanted to have Saving Private Ryan and Schlindler's List shown in school to all American high school students. I asked him if he was aware that both of those films were rated "R". No, he wasn't aware.

When McCain momentarily released his medical records, the reporters managed to note that he took "simvastatin to control his cholesterol levels; hydrochlorothiazide for kidney stone prevention; aspirin for blood clot prevention; Zyrtec, an antihistamine, as necessary for nasal allergies; Ambien CR, as necessary for sleep when traveling; and a multiple vitamin tablet."

Ambien and Zyrtec together can cause confusion, amnesia, and all sorts of other mental side effects.

So, it's possible he lied and he's senile.

#2: If I may be cynical for a moment...
I wonder how the press will cover this election campaign. They love both McCain and Obama. How are they going to predetermine the winner, then skew the coverage that person's favor?

In any case, wrt to McCain, it's not that there is someone out there who never lies. It's that McCain's actions are wildly at odds with his reputation. He gets a lot of mileage out of his reputation as a maverick who bucks the Republican establishment. However, for a maverick, he falls into the party line a lot. (I mean, he campaigned for Bush in 2004. What a maverick move for a Republican!) So far, he's done a good job of disguising how conservative he actually is.

OTOH, the press keeps forgetting that Obama is a moderate. I like Obama. I will certainly vote for him. However, he's not liberal.

Nina, I'm wary of Ambien at all. My grandmother takes it and has been developing Alzheimer's-like symptoms since she began. Everyone is assuming that she is developing Alzheimer's and there is nothing we can do, but I wish her doctor would at least try getting her off the Ambien. (Especially since she drinks alcohol, usually 3 glasses of wine a night. She waits a couple hours before taking the Ambien, but I still suspect interaction.)

I talked to her and suggested that she talk to her doctor about tapering off the Ambien and perhaps switching to melatonin as a sleep aid. (I wish she'd taper off the alcohol too, but I think that's a losing battle.) Although she wrote it down and remembered it when she spoke to my mother a week later, I don't think she's mentioned it to her doctor. My mother is going to go with her to her next appointment and remind her.

So, yes. I'm very wary of Ambien.

Apologies -- it's probably "Nina Katarina" and not just "Nina," right?

He has no principles at all. I summed up some of the evidence here.

Heh. Ambien.

On Saturday night -- actually Sunday morning -- my dog woke me up for an urgent walk of the "throw up or the runs" type. I walked maybe 1/2 mile along the main road and back, with frequent stops for grass-nibbling (dog, not me).

And the whole time I was expecting a cop car to pull up and treat me like an Ambien zombie. ("Sir? Do you know where you live? Do you know the time?")

John #6:

I suspect they'll continue their intellectually lazy surface-level coverage of both men. They don't love either one for anything deep or important about them--they love the images. Racial-division-healing young up-and-coming black rockstar vs. long-suffering-war-hero maverick straight-talker, what a dream match! The opposition research folks on both sides will, however, do a fair bit of the work to feed some tabloid-level scandal and smear stories. Maybe Obama once smoked a joint with some of his students at the University of Chicago, or McCain has a couple of impending bimbo eruptions, or Michelle had plastic surgery, or McCain is on camera some time ten years ago telling a racial joke, or....

None of this will have anything to do with which man will make the better president. Deciding that would involve lots of really boring discussions of international affairs, economics, energy policy, taxes, health care, and constitutional/legislative issues. That stuff doesn't keep enough viewers to pay the bills. It's much better to focus on the "serious" news story of the day--say, an out-of-context excerpted quote from Obama's old pastor, looped again and again with scary colors on the screen and the most inflamatory bits printed on the screen, and some mock-outrage voiceover "putting it in context."

Just as a nitpick, it's worth pointing out that "left/right" and "liberal/conservative" are relative, not absolute, scales. (They also are pretty fuzzy, and change meanings dramatically over time.) McCain is quite liberal on various issues, compared to the mainstream of his party. Obama is pretty conservative, compared to the average supporter of Kustinich. Trying to make this sort of judgement into an objective scale is pointless. This is one reason why most people not right at the midpoint of the Overton window in their views think the media is biased one direction or another, but they don't all agree on the direction.

My favorite example of the this is the cognitive-dissonance-inducing far-right anti-immigrant Dutch politician who was assassinated a few years back, Pim Fortuyn. An odd part of the story, at least to an American[1], is that this dangerously far-right character was also an openly gay sociology professor, who also (according to Wikipedia) self-described as a Catholic.

[1] ¿Gringo? ¿Estadounidense? ¿Norteamericano?

Jon at #9: Once upon a time I thought McCain was an okay guy for a politician. That vote for torture sure changed my mind and made me take a more critical look at him and what he said.

I will never believe another word he says.

I remember a quote from the Daily Show when they were explaining, IIRC, the Enron scandal.

At the end of a particularly dense paragraph, Jon Stewart said something like "Yes, I know this is really really boring. But that's how they get away with it."

And it's true. You can do the worst thing in the world and, provided the way you did it is dull as dishwater, you can pretty much skate because entertainment news doesn't want to talk about it.

Nowadays whenever any 'legitimate' news source does a little "tsk tsk, __% of people get their news from the daily show or late night monologues," I roll my eyes nearly out of my HEAD. There have been so many times that I've caught an important or controversial story because I watch the daily show and the other networks... barely covered it, or didn't cover it at all. Insanity.

Now I'll admit the Daily Show fell for McCaine's "Lol, ima maverik!" spiel in the past, and influenced a lot of young minds that way. However, they are very clearly sorry about that now, and are asking some tough questions poking some tough fun. There is a limit to how far they can go, and I think they're stopping just short of "this man will never agree to come on our show again." Which, as concessions to power go, seems pretty reasonable to me given what the purpose of TDS is meant to be.

I really don't understand how the daily show survives and yet no actual news network has decided to give half an hour or an hour to a cleverly-written, well-investigated daily news show that covers things internationally. Something that comes close to the daily show in punch and variety but without the extra comedy sketches that make them have to trot out their 'fake news' banner over and over again.

I think kids would watch it. And by kids, I mean anyone who isn't already dead inside.

Heh.

Caroline, you might be interested to know that "everybody here uses Ambien", according to Colin Powell in 2003.

When the canonical history of this debacular decade is written, there may be a chapter on prescription drug abuse.

But, but...Obama and wife exchanged a "fist bump!" That's far more damaging to him than McCain's lies are to him!

If you search for "McCain Lies" on Youtube, you get 933 hits. Mind you, one of the items in the first page is actually titled "Obama Lies Again On Today Show About McCain", but that turns out to be Obama mentioning the 100-years-in-Iraq thing, which is actually true. I sure do hope that politics in this country goes back to "conservative vs. liberal" sometime before I'm dead, as opposed to the current "liberal-in-scare-quotes vs. crazy batshit evil".

The real important issue is which candidate has the more patriotic MySpace page.

http://www.myspace.com/johnmccain
http://www.myspace.com/barackobama

Advantage? Barack Obama. By a landslide.

It's fun to read the comments, too, for both candidates.

Let the record show that not a single African, Asian, or Hispanic American appears in McCain's top friends. (Someone should tell his people about that, by the way.)

Obama's MySpace page has a white guy from Texas in his top friends. A Texas Democrat, no less! (We are a minority group.)

When will this terrorist salute fist bumping madness stop? Whatever happened to shaking hands with them, like in the old days?

Since it came up: does anyone have a link to reliable data about the mental effects of ambien? I'm also interested in whether those effects occur only after taking it, or persist, and if so, for how long.

Sighted yesterday... A beatup pickup truck being driven by a white guy sporting a crewcut, and an Obama windshield sticker - although not in the same place as his crewcut.

One of the problems McCain is facing is that he was trained for this sort of thing in the age before The Daily Show/Stephen Colbert, as well as Youtube and Crooks and Liars and plenty of other internet sites that will play the embarrassing videotape of you saying what you claim you didn't say over and over and over and over again. There was a point in the history of the world when candidates could only hope television cameras would show up for something, or that major news service reporters would be on hand. That was an age where there wouldn't be at least two or three ordinary people with videocameras of their own on hand, just because they wanted to get a shot of someone important to show their friends.

The sort of coverage they get now is not what a lot of them are used to, and it shows. Think how often Cheney got caught out, back when he was allowed out to talk in public.

The MSM will break down and cover it when McCain melts down in a fashion that can't be hidden. This will happen if he's pressured enough.

Albatross #11:

Pim Fortuyn was pretty much a extreme libertarian, which is an ideology that doesn't fit comfortably on the left-right scale.

Actually, I think left/right politics is obsolete - the real political divide is between authoritarianism and (small-l) libertarianism. And that tends to cut across traditional party lines.

Sadly No has done the hard work of compiling the right's reactions to the fist bump (aka dap).

Ladies and germs, your political discourse!

The absence of principles on the Straight Talk Express is noteworthy. What's even more noteworthy is that the conservative movement hasn't had anything resembling a principle, or, for that matter, an idea for the past twenty years. McCain attacked Obama for having 'old ideas' but his are positively antediluvian.

(Note to Jim Macdonald: I tracked down the elusive Gibson to one of its few remaining lairs.)

#22: I think left/right politics is obsolete

This is more complicated than it seems. There are a lot of arguments that it should be obsolete; and if you look at what people actually think, there's a lot of variation from the L-R spectrum.

But structural filters tend to turn those beliefs into L-R model-friendly outcomes on the political level. That is, despite the fact that there are a lot of people whose views don't fit in the L-R model, the voting pattern of actual politicians fits very well on an L-R model. If you know where a Congresscritter stands on the L-R spectrum, you can predict most of their votes. If memory serves, studies have gotten the same result for the Supreme Court, too. But it definitely holds for Congress.

Interestingly, the L-R is a lot more predictive than it used to be in American politics; in the 50's and 60's, racial issues, and the lingering ties of Southern politicians to the Democratic party, made the model fit less well. But now it actually works as far as actual politicians are concerned.

Tim Hall #22: Actually, I think left/right politics is obsolete - the real political divide is between authoritarianism and (small-l) libertarianism.

Tim, I'm all in favor of discarding the simplistic left/right model that most people use to describe politics, but your claim about the "real political divide" is even greater nonsense.

Pretty much everyone I know wants some kind of big government program for something, and government to stay out of something else. Even libertarians. Some of the most authoritarian people I know are self-described libertarians.

When it comes to actual consistent minarchism (or anarchism), I know people who advocate that, but they're a tiny minority.

Steven Frug #25:

I guess I was thinking more of British politics, where the gap between the public positions of New Labour and David Cameron's New Conservatives seems a lot less than the variation of views within each party. Certainly the Labour authoritarians (who come from a Marxist/Stalinist background which they try to hide) and the Tory authoritarians (who come from a background of traditional social conservatism) have more in common with each other than with the more liberal wings of their own parties. And with Labour sucking up to big business as much as the Tories used to, the big fault line is no longer economics.

Quite possible that a different one-dimensional divide than left/right, or some multidimensional divide, would be a better model for British politics. I don't know. But it is indeed true that a one-dimensional model explains the behavior of US politicians well. There may be no a priori reason why you should be able to predict a Representative's vote on capital gains tax or warrantless wiretapping based on their vote on birth control, but in fact you can, and your prediction will almost always be right.

And it's also true that, on the simplistic but very accurate one-dimensional left/right scale, McCain is solidly right. Back in the '00 Republican primaries, he ran to the right of Bush. At the time, nobody thought that was misrepresentation.

In my experience Zyrtek/Zirtek/cetirizine *on its own* can cause confusion, amnesia, and crippling exhaustion. At least it did for me. How McCain can do anything as strenous as campaigning, at his age, on medication like that, is quite beyond me.

On the other hand, Zirtec is the medication that allows my mother to function during the pollen-laden months, and she's sharp as the proverbial tack.

Drug reactions are very individual; multiple drug interaction reactions even more so, it seems. I suspect one of the things that makes a doctor's job harder these days, with people on so many different permanent medications, is distinguishing the drug side-effects from real problems not caused by the drugs. This has to be especially hard when treating older people who are on more drugs.

drug side-effects

Oh, that's one of my buttons being pushed..pardon me, while I gently rant about medical terminology.

When I studied toxicology I learned that there are no such animals as "side effects". There are "wanted effects" and "unwanted effects". The unwanted ones come in flavors like "benign" and "adverse".

Which kind of effects a patient may get depends on highly individual factors, so there's no telling what will happen -- we can tell you only that a large percentage of people taking this drug had these effects.

The definition of "wanted" versus "unwanted" also depends on the patient; after all, you don't want the platelet-dysfunction effect of aspirin when you have a headache, nor do you particularly need tinnitus, but you can get any one of those effects. However, if you're taking aspirin because you've had a heart attack, then the anti-headache effect may be a benefit that you weren't looking for.

The term "side effects" was a way of minimizing things that doctors didn't want to think about or didn't want their patients to worry about. It's sloppy thinking on the part of medical professionals to call it a "side effect", but it's pervasive. I still keep trying to educate folks, even if it's just a drop in the bucket.

Leah @ 13, re "no actual news network has decided to give half an hour or an hour to a cleverly-written, well-investigated daily news show that covers things internationally."

Fox news thought they tried. It was called The Half Hour News Hour. (http://www.foxnews.com/halfhournewshour/index.html)

It was not cleverly-written or well-investigated, nor did it cover things internationally (for whatever definition of "internationally" you want to apply to covering things... I like creme freche, myself), but Fox was certain they had the right-wing Daily Show-killer on their hands.

On another note, I had to get the meaning of "MSM" from context (mainstream media, perhaps?), but was at a loss to expand the acronym until I remembered Mechanically Separated Meat, a thing legitimized by, and I'm not making this up, a document wherein the USDA redefined meat. MSM is the result of forcing bones with a bit of meat left on through a sieve, which pretty much describes the network news process.

Albatross @ 11
McCain is quite liberal on various issues, compared to the mainstream of his party.

Hmm. How so? He has a lifetime rating of 82 from the American Conservative Union. Economically, he's pro-tax cuts, anti-business regulation and happy to spend more money on the military. Socially, he's pro overturning Roe and has said "I'll appoint more judges like Alito", and though he was against the FMA, he was for the Arizona state-wide ban on same-sex marriage in 2006. He admits that global warming is real (yahoo!), but he's still against actually doing anything about it.

The only thing I can see he's potentially liberal about is that he realizes that we can't just toss illegal immigrants back across the border. (I would call that sane, rather than liberal.) Oh, and he's embarrassed by the religious far-right wing of his own party. Good for him, but politically, it doesn't seem to have influenced his votes.

But, as we were just discussing, "liberal" means different things to different people, so how do you think of him as more liberal than the usual Repub these days?

Ginger, #31: Point taken, but I think what's defeating your efforts is a language issue. "Side effects" is a short phrase which immediately conveys "any unintended effect of the medication" to most people. "Unintended effects" itself is going to be resisted because it's too long. What you need is a synonym for "unintended" which is a common word of no more than 2 syllables, and right now my brain is refusing to suggest anything.

re Ambien, one of the ways I judge the safety of drugs is how many e-mails I see on my plaintiff attorney listservs about the drug. When there is steady traffic about "anyone handling these cases?" or "if you've deposed Dr. Expert in these cases, please drop me a line," I know it's probably a drug I want to steer clear of. Ambien is one of those drugs.

re McCain, I've noticed that politicians don't seem to have quite caught onto the whole Internet thing. They're not aware that a 'private talk' slanted toward one audience can be up on YouTube tomorrow morning, or that bloggers can instantly compare what they said five minutes ago with what they said five weeks ago.

mythago, would that we all had access to such stats!

It's possible that the media may find the Obama story so much more interesting, so much more fun, and oh so much more stylish and glamorous -- so much more NOW -- that they'll drop McCain and that faux, exhausted maverick thang. Coz the media goes with the action, though they also try to create the action.

Obama's starting to be called a brilliant politician, a once in a lifetime sort. Is that true? Or is he just where things are so bad that people are desperate for anything that isn't what it has essentially been for so many decades now?

Love, C.

Constance, I absolutely don't feel like I can judge whether Obama is truly brilliant. You're right -- I'm so burned out from Bush that I am ready to cry at any improvement. I heard Bill Clinton talking on the radio after Katrina, and nearly wept because he was saying things that were decent and sensible. I thought Clinton was a very good president, but I don't know that I'd ever have called him a Great President.

I know that I do actually feel hopeful about this country's future when I hear Obama speak. That hasn't happened, oh, ever in the time I've been paying attention to politics (approximately since Clinton was first elected, which I know isn't very long). I don't know if that makes him brilliant and once-in-a-lifetime, though. He may just be decent and seem brilliant by comparison.

Authoritarianism isn't a political ideology in the sense that most flavors of liberalism and conservatism are, and when self-identified libertarians say "I reject authoritarianism", this usually means in practice "I deny the existence of externalities I find it inconvenient to deal with". It's not just about money, either - accepting that every other industrialized nation has better approach to health care requires acknowledging the validity of definitions and techniques that get denied in most libertarian discourse, for instance, even though they end up saving money and often better preserving personal privacy rights. (And the defense of property and contracts can get awfully bloody and oppressive all on its own - there is an authoritarian style of libertarianism, too.)

Back at McCain: It's hard for me to tell how much he actually may be in decline just because it's harder to get the kind of hard solid proof of contradiction we've got here, from years gone by. I'm sure someone must be combing the archives, though.

Constance: It sure looks like Obama is one of the great campaigners of our time, and willing to listen to people pointing out the opportunities of the moment. Simply not listening to the party establishment conventional wisdom is...not brilliant, necessarily, but at least brave. My own take is that political infrastructure has gotten stupid and cruel in much the ways that management in general has, and that Obama is a throwback in some good ways. But I reserve the right to change my mind on all this, too.

Ginger @ 31: "When I studied toxicology I learned that there are no such animals as "side effects". There are "wanted effects" and "unwanted effects". The unwanted ones come in flavors like "benign" and "adverse"."

I have a hard time getting this across to people, especially the idea that this applies not just to drugs, but to everything. As some Brit engineer once said, things have no purpose, they just do what they do, and the purpose of engineering is to arrange things so that the results you like are maximised and the results you don't want are minimised, so far as is possible; these two goals sometimes being antagonistic and therefor requireing trade-offs. Not understanding this principle leads to ideas like "if one pill is good for you, two pills must be twice as good".

Bruce @ 39
"when self-identified libertarians say "I reject authoritarianism", this usually means in practice "I deny the existence of externalities I find it inconvenient to deal with"".

This is exactly my experience, captured in succinct beauty. Thanks.

albatross @ #11, the LA Times tried to persuade its editorial readers today that there wasn't much difference between McCain and Obama on the policy front. Paul Krugman got annoyed and fact-checked it, and I picked up on his remarks and amplified a little.

McCain was the eighth-most conservative Senator in the most recent session based on actual roll-call votes. Even Sam Brownback had a slightly less conservative voting record, and I don't think anyone would call Brownback a moderate.

#38 ::: Caroline :::

#40 ::: Bruce Baugh :::

I don't know either. But sometimes the time calls out greatness. It's been a long time since this nation had a great president -- there have been only 3, as far as I'm concerned: Washington, Lincoln and FDR (others may / will disagree).

With oil gone the way it has, with the economy the shambles it is, with air travel and any travel constricting as it is -- our entire society, the global society -- even campaigning -- is predicated on the availability of oil.

It's clear I need to learn particulars, which I do not know, of how, on what, and against who FDR campaigned against to get the nomination, and then how and on what he campaigned to get elected.

He hit the White House running. With plans in place. They were deep into what they needed to do to turn around something as behometh as our national economy, tanked. The inertia!

It's a trillion times more inert now, thanks to many issues, not least the Iraq invasion.

The thing that the Clintons did not do well was organize. For over a year into the first term essential offices, appointed by the president went unfilled, because they never bothered doing the searches, drawing up lists, making the phone calls, or even looking into the offices that needed to be filled. By other accounts that kind of blindness to planning ahead was part of Senator Clinton's campaign as well.

I'm hearing that Obama is making plans.

If anyone can recommend a good title that is about the FDR first campaign, I'd appreciate learning it.

Love, C.

Constance, try here and scroll to First Term. There's a brief discussion of the campaign. There was no Theodore H. White back then, unfortunately.

Constance Ash @ 37: "Obama's starting to be called a brilliant politician, a once in a lifetime sort. Is that true? Or is he just where things are so bad that people are desperate for anything that isn't what it has essentially been for so many decades now?"

I can't tell you how brilliant a politician he is, but I can say that he has built a political machine the likes of which have never been seen before. The way he has used social networking to raise money, disseminate information, and build passion is unprecedented. It is as far beyond traditional campaigning as the combine is beyond the scythe.

I don't know how well that will translate into being president, but it certainly makes me optimistic.

Ambien... I use it occasionally (as in once a week or less) for when the insomnia is at its worst, and all it's ever done for me is help me just a bit with getting to sleep. It doesn't even do that immediately, but generally once I've managed to fall asleep while on it, I can remain that way for up to seven or eight hours, something I find difficult otherwise. Ambien is what they gave me when I was in the hospital for six days back in February and I was concerned about my ability to sleep with the various disturbances common at night in hospitals. It works for me, and I've had no ill effects that I or anyone around me has noticed, even when I took it every night while hospitalized. I'd take it between 10 and midnight, fall asleep anywhere from 30 to 90 minutes later, sleep with minimal awakening through the night, and then wake up alert around 7 AM when they came to do the first blood draw of the day. *shrug*

The possibility that Zyrtec and Ambien interact is quite important to me, because Eva is taking both to deal with what appears now to be Fibromyalgia (even the doctors are starting to accept that). On top of which she's taking Lyrica to counteract nerve pain that was making one arm almost useless. The combination is working to make her mental state less confused, we think, but I'd like to find out as much as I can about the potential interactions, just in case. Can anyone point me at a site that has reliable information? (I've spent a lot of time trying to google drug information and had a lot of trouble figuring out what was reliable and what was possibly dodgey).

Oh dear....

Finding good info on the net....

There are British Medical Professionals who will dismiss everything on the net--Even the British Medical Journal. And they don't know who the FDA are.

Head>Desk

heresiarch, #46: The sort of thing you mention here is an example of what I see: that, while every other politician is still clinging to the ideas and methods of the 1980s, Obama is creating the campaign structure of the future. This, in turn, makes me inclined to think that he will look to the future in other ways, and that's one of the things I think we desperately need.

Bruce Cohen (StM) @48 -- have you looked around on Medscape? You may have to join/register, but it has a lot of information, plus a "drug interaction checker" feature (accessible at the top of the page when you've done a Drug Reference search).

Linkmeister #43:

Of course, "close" is relative. Obama and McCain will be constrained in the same way by our existing programs, arrangements, resources, etc., so many of their policies will be very similar. For example, rhetoric aside, pretty much all long-term fiscal policy is going to be dominated by issues of paying for medicare and social security in the future. Absent a politically impossible[1] return to the draft, we're not going to invade and occupy Iran[2]. There's probably no way to seriously reform the tax system, though doing so could be done in a way consistent with both mens' beliefs. And so on.

There will no doubt be differences in policy between the two, and many will be pretty critical. Often, those differences will be relatively subtle--appointing justices, restructuring bureaucracies, and subtleties of how visas for students and researchers are handled[3] all look terribly important, but are wrapped up in a blanket of boring C-Span coverage that protects them from any kind of close examination. Of course, these policies depend as much on the party as the president--the Clintons tried to get massive health care reform through, but couldn't accomplish it. With more Democrats in Congress, maybe they'd have succeeded.

It's genuinely hard to know how either man (and his advisors) will react to the next great crisis. A great deal of what we really need an executive for is reacting to crises intelligently. Will Obama deal well with an Islamic fundamentalist takeover of Turkey, or an earthquake that levels Los Angeles? Will McCain handle a global economic meltdown sensibly, or come up with a sensible response to a rapidly-spreading 50% lethal strain of bird flu? It's kind of hard to say.

And one really critical part of the president's job is PR--trying to set a kind of tone for the nation, politically. As a nation, we pay too much attention to that stuff, but it's still there and important. In some sense, this is the way in which the candidates differ the most. It's all cosmetic, but that's just the way image is.

[1] Thank God!

[2] Though we might bomb them.

[3] In my own field, I've seen a big impact here--a lot fewer of the brightest foreign students and researchers seem to be coming here now than pre-2001. I expect this is only partly due to US policy (the dot-com bubble also burst, and many more jobs are now available in China and India), but it's going to have a profound impact on our country in 30 years, perhaps as profound as the massive immigration by bottom-tier workers we've allowed.

Lee #50:

Dean tried this last time, and failed, for a variety of reasons. Assuming an Obama win in 2008, I'll bet his Republican opponent in 2012 will be roughly his age, and will be as adapted to the changes as he is.

The thing is, Obama looks like the future, in ways the older McCain simply doesn't. That's not just age, but age is a big part of it.

The thing is, Obama looks like the future, in ways the older McCain simply doesn't.

Of the two of them, McCain looks a lot more like a boot stomping on a human face.

Bruce @48

I'd think about a combination of the Drug Interaction Digest and additional searches on Pubmed... although Medscape is a good idea and possibly more complete.

#41, Don Simpson -

I started thinking of this as "every silver lining has a cloud." Whenever a new design comes out for something*, one of the questions I ask myself is, "Why haven't they been doing it this way all along, if it is so much better?" I seldom find myself choosing the old way instead of the new way - I mostly don't have enough information to do that. But it is an interesting mental exercise and makes me more cautious with regard to "new and improved."

Applying it to medicine and healthcare isn't something I'd thought of, but it certainly seems wise now that you've mentioned it.

*Particularly an expensive something I expect to be durable and last me a good long time, like a car or a washing machine.

Tim Hall #27- I was under the distinct impression that most of the labour big wigs, such as Blair, Straw, and others were in fact on the right of the Labour party all along.
OK, Brown was a bit marxist, allegedly, and Blunkett used to think that freedom was a good idea, but that was before he got into power.
Reid was and still appears to be a Stalinist, but then thats got nothing to do with Marxism anyway, except for using it as a useful tool to get into power.

Meanwhile, Blair was so far right wing it was amazing he could fool people.

Kathryn @ 55

Thanks for reminding me about Pubmed. If it were a physics or computer science question I'd immediately look on xarkiv, but medicine isn't my field so I don't automatically think of Pubmed. I'm an application packrat, and buried in my Application folder is something called iPaper2, a nice user interface to searching there. I'm running it now, trying to find a search string that reduces spurious hits without throwing away papers I want to see. Again, thanks for the suggestion.

albatross @ 52

it's going to have a profound impact on our country in 30 years, perhaps as profound as the massive immigration by bottom-tier workers we've allowed.

I'd say we'll probably see an effect in the next 5 years. Sonething like one third of all the slots in US medical schools, and positions for new graduates of same, are filled by foreign citizens. We already have a shortage of older, more experienced doctors, because of HMO and insurance carrier policies*, if the number of new doctors goes down significantly because the foreign students don't want to study or work here, we're going to see a health care problem that'll make the current one look tame.

And that's without talking about the nursing shortage. We've been there for ten years already, and the best solutions the industry has come up with were designed to reduce the number of nurses. Reminds me of that great business mantra of the 80's: "Growth through attrition!"

* I've lost 2 primary care physicians and a dentist in the last decade, 2 in part and one entirely because they weren't willing to work within the limitations the bean counters insist on.

Linkmeister #43
What do you mean by "conservative"?

George Will was on one of the local radio stations (WBUR playing NPR?) last night, I heard about 12 minutes of it; he was distancing himself bigtime from the neocon regime in DC and mosts of its actions and implying that the regime in DC aren't really "conservatives" in many ways. However,also, much of what he was saying was incredibly disingenuous and misleading, but delivered in a very unruffled, self-secure, calm, self-grounded manner, the sort where someone might be spouting dogma that they know or consider with the entirety of their being to be True, and nothing can or will shake them from their adamant Belief.

Oh, one of the things said last night that lit up my BS detection filter, was his ukase about how Medicare and Social Security are going to eat the entire US GNP in some number of decades... his basis for this excrement and pronouncement is solely looking at the numbers and trends of numbers, as opposed to looking UNDER arithmetic and multiplication and exponentiation on paper or a computer screen... he doesn't seem the least bit interested in what the numbers are abstracted from, or that those sorts of curves, do NOT continue off to infinity like parabolas or hyperbolas, eventually something -changes- in the underlying activities that the math is a math model REPRESENTATION of.

Math moron/ignoramus ideological jerks who analyze the EFFECTS of something without seeming to care that effects as consequences, not -causes-, and that there are CONDITIONS and EVENTS and activities which are the drivers, and that changes in THEM, make the effects/consequences/results/outcomes/MATH ABSTRACTIONS AND MODELS change....

Long ago Jeff Hecht, though he didn't actually get to see the material, decried the Fletcher Report as "extrapolation on log paper." He was quite correct (I did see much of the study....), though, it was indeed extrapolation on log paper, and used as assumption that the same conditions were going to persist... Mr Will, WITHOUT being science and higher math literate, unlike Jeff, doesn't have the clue about "extrapolation on log paper" and the pitfalls of it, and BELIEVES crap that is BAD MODELLING!!! Bad assumptions, bad analysis, and a technomoron who uncritically promotes it as Credo....

Bruce Cohen (48): I use Drug Digest to check drug interactions.

Paula #60:

God, I love that pattern. "Yes, our side had power during the latest clusterf--k, but they weren't *true* {liberals / conservatives / Marxists / etc.}." This falls in alongside "Yes, our side had power and implmented failed policy X, but it only failed because of the obstruction and sabotage of the {opposition party / media / bureaucrats / speculators / judges / Jews / foreigners}" as a universal excuse. If I can get you to swallow these excuses, there is simply no failure or horror I can't get you to forgive. By swallowing these excuses, you become immune to evidence that your ideas don't work. Neither lost wars, nor melted-down economies, nor gulags and engineered famines will raise serious questions about your ideas, because there's always an out--it's always someone else's fault. You didn't lose the war because you planned it poorly and carried it out incompetently, but because you were betrayed by the opposition party and the media; you didn't turn into a prison-state full of gulags and terrorized citizens because your ideas were evil, but because a bad man got into power; you didn't lose the election because you failed to appeal to the people, but instead because the media were out to get you and the other party didn't play fair.

Paula #61:

Actually, I think big issues surrounding medicare and SS projected future growth are taken pretty seriously by folks that examine the budget numbers in detail. The issue here, as I understand it, is the overlap of demographics (lots of folks hitting retirement age soon, relative to the numbers who are still in the workforce; generally aging population because of both demographics and better medical care) and rising medical costs/expenses, and how this relates to discretionary spending in the budget. Over time, we will have more and more of our budget going to these programs, unless something changes. Sooner or later, things will presumably change, but it's not clear when or how. So far, we've failed to get medical care expenditures to stop growing faster than inflation despite a fair number of attempts.

Is there some reason I'm missing why this isn't worth worrying about?

[1] I gather this is sort-of hard to address, since you often don't know that you're in the last year of your life until after you succumb to the cancer despite treatment or whatever. But a lot of doctors who blog point out that a lot of resources are wasted on futile care--stuff that more-or-less just holds death off for another month or two, at great cost in time, money, and suffering.

#45 Linkmeister

That's a good start. Much more digging to do.

Re the Wills and other neoCONS continued above-the-fray-smiling-down-indulgently-upon-the-idiots -- f*ck 'em. I've been hearing their blather for years. Why are they even allowed to talk, one wonders, since over and over and over they are proven wrong and even proven to be liars.

As for SS and Medicare etc. -- they'd be just fine if those who hate government haven't done everything they can to get their own hands on that public money and put it into their private pocketses. That's by many, many reports and studies drawn to my attention.

Love, C.

As a link on SS/medicare and future budget issues:

A fun Brad DeLong post from 2005.

Something along these lines by Alex Tabarrok at GMU.

Both of these point out that there are major long-term budget issues looming, of which Medicare is a big (but not the only) part. The second post gives links you can follow for more detail.

Joel 54: Of the two of them, McCain looks a lot more like a boot stomping on a human face.

I agree, though I mostly think he looks tired. Don't you think he looks tired?

I suppose it would be evil to start a rumor that McCain only survived being a POW by betraying his buddies (the original idea was by eating them, but probably not very many people would believe that). Evil, like those rotten swift boat liars.

No, no, mustn't become the thing you hate. Tempting, though, isn't it?

Xopher #67:

I gather the real experts in this sort of thing figured that a combination of "Manchurian candidate" rumors (he was driven into a permanently dangerous, angry mental state by his torture in Vietnam) and "black love child" (based on his adopted Bangladeshi kid) rumors worked best. Maybe there are other equally effective rumors, but I have to admit, I'm probably not as good at this sort of thing as Karl Rove.

The beauty of both of these is that they turned positive things about McCain into negatives. He's dangerous because he (unlike W) didn't use his family connections to stay out of danger, and so wound up as a POW. And as a work of evil, smearing someone for adopting an orphan from the third world, partly so she could get needed medical care in the US is a thing of beauty. Damn, how do you top that?

albatross, I agree that the thing about his kid is slime from the very bottom of the slime bucket.

But don't you think he looks tired?

From what I've read of the story, John McCain didn't adopt Bridget, Cindy did. She'd flown over to Bangladesh with her children's charity, and was flying back with two children who needed better medical care. She became so fond of the one girl that she started adoption proceedings while on the plane, and when she landed she told McCain that he'd just acquired a new kid, whether he liked it or not.

It's a great story, marred only by the fact that she was also stealing painkillers from that charity while all this was going on, to feed her addiction.

Xopher @67 - I see what you did - you slipped in the "tired" meme while distracting us by stating that you'd never stoop so low as to spread false sumours about his time a a POW.

I'm shocked - shocked! - that you'd spread such rumours about a politician, especilly such a tired-looking one as John McCain.

Bruce @58,
I've thought of another 'find someone else who has done this research' site.

If you go to the NIH's Clinical Trials site, and If they've had a trial of the medicines in question, the qualifications list may provide some "this isn't compatible with our trial" info. It is reverse engineering the data.

Also, if you do find a researcher via Pubmed, I've had luck writing to them to see if they know of updates / upcoming updates to their research. Especially but not limited to if you ask about pathways. ("why yes, we've found that Strongazine affects the MSC5 gene, and that the whole family of Hulkamorfine drugs may do the same...")

Albatross #64

My main point is that all the sturm und drang has a basis of assumption of no second derivative changes in -anything-
-- assumptions that:
- the population change curve doesn't/isn't changing,
- assumpting that outflow for Social Security and and Medicare for immigrants/emigrants won't change,
- assumptions that the inflation rates on health care and Social Security payments won't change
- assumptions that old folks in the last few months are going to stay at the same increasing level of expenses to Medicare that have been happening
- assumptions that there won't be any drops in the rate of increase of expenses
- assumptions that there isn't going to be any leveling off, much less drop, in increases and any drop in per capita medical expenses on Medicare
- assumptions that e.g. General Electric isn't going to get STOMPED on sometime in the future for changing in the thousands of dollars for a service call for changing a $0.50 panel light on an MRI unit,
- assumptions that the spending on medical equipment, drugs, etc., are going to indefinitely grow at an increasing rate of expense...

These are all assumptions, and many of them involve the current regime's greedy buddy-buddiness with greedy corporate interests in the for-profit healthcare and medical market.

Countervailing some of this claptrap credo are such things as:
- US citizens traveling overseas for major operations, which save their healthcare insurers 50% or more of the expenses charged for the same operations and treatments in the USA.
- demands that the income transfers from US taxpayers to drug company coffers for usuruously priced medications, priced at Monopoly rates in the US and a fraction of those rates outside the USA, cease and desist
- an eventual tailing off (it HAS to happen) in applying non-function highly expensive treatments to terminal patients.... also known as "there IS a limit to how high balloons can fly!" It happens at junctures of ability to pay, willing to pay, market saturation, and in actually rational markets with competitions, competition being ALLOWED to provide competing products... patents don't last forever, no matter how hard patent owners and corrupt misadministrators try to protect them....

This part is likely to come off as cold, but... Death rates for baby boomers I suspect are on the increase--note that in the past year plus, the deaths of Janet Kagan, Mike Ford, Bob Asprin, Robert Legault, and other Baby Boomers. Janet was a long-time smoker and not in great health/hadn't been well in a long long time. Mike Ford had Type I diabetes for most of his life, and a transplant. Bob Asprin was a smoker. Neither they nor Robert survived to Social Security retiree age.

The mortality rate projections are just that-projections, and assumptions. What the actual rates will be, are unknown.... breakthroughs in healthcare or merely changing in eating habits that cut the diabetes etc. rates, that cut down need for expensive treatments, or changes in mortality rates where people drop dead before expensive hospitalizations and medications kick it, would drastically change the financial expenditures equation.

There are all sorts of things which could change the values and parameters and the equations regarding cost and expenditure per person... the projections of expenses etc. 40 years forward to me are mostly pathetically laughable, because the assumptions are such garbage-as-regards-credible data.

It's an example of total misleading crap "analysis."

Paula:

What reason do you have for expecting any of those things to get better, instead of worse? For example, if better treatment of heart disease now ends up extending the average life expectancy two years further than the current estimates plan on, things get worse for Medicare and Social Security. We've seen continuing increases in health care costs across Democratic and Republican administrations and congresses, and in states with both parties in power, and despite a whole long list of cost-containment measures which basically don't seem to have worked. Why is that going to change now?

I can certainly see many ways these projections may be wrong, but what I don't see is why I should discount the problem predicted by them. How is this different w.r.t. Medicare and Social Security than w.r.t. global climate change models--which also do a lot of extrapolation along straight lines on the log charts, rough approximations of poorly understood variables, etc. ?

albatross @ 64

Oh, it's worth worrying about, for sure*. What nobody wants to talk about is how it got that way. Social security is basically an insurance system paying into an annuity: you pay such and such a percent of your monthly pay for your working life, and you get so much per month for the remainder of your life. This works reasonably well as long as the money paid in is kept working: invested at a good return over time (6 - 7 % / year over inflation is reasonable over the long haul with good fund managers, given the size of the fund). But Congress, in its infinitesimal wisdom, chose to pour the income into the general fund and spend it as it came in, so there was insufficient investment, because of course what was owed just became part of the National Debt, a fiscal black hole if ever there was one.

* I'm right on the leading edge of that wave of boomers who start retiring in 2011. In fact, I had planned to retire this year, hoping to avoid the rush, but the greed crisis in real estate put paid to that idea for at least another year. I've managed to save enough that I don't need SS to survive until I'm at least 98, based on reasonably conservative projections, but it would be nice to have the extra income.

Xopher @ 69

But don't you think he looks tired?

I think he looks like a zombie, which might explain why he walked into that airplane wing. Maybe we could start a rumor that some of his campaign volunteers have been found with their brains eaten?

Paula Lieberman @ 60

I doubt that George Will believes any of the crap he spouts, and certainly not any of the nonsense about not supporting Bush (he just wants us to forget that he did, now that Bush isn't one of the popular kids anymore). I doubt he believes the vitriol he's been spitting out about Hillary Clinton, either; it's just more of the party line, intended to keep her from taking back any power from him and his buddies.

Back before William FBuckley kicked the bucket, I was hoping one day to see him and Will in a no-rules cage match. It'd be a battle to the death between the killer lizard (Will) and the velociturkey (FBuckley). I'd bet on Will, cold blood wins every time.

Albatross #74

There's a diet that REVERSES the damage done by heart disease--most people though either haven't heard about it, or are reluctant to give up their French fries, hamburgers, refined white non-whole grain flour, ice cream, and got for a low fat lots of beans and vegetables nearly no meat and very little fish diet.

Much of the diabetes epidemic (not all diabetes, but most of it) is diet and lack of hard exercise related. Changing to a mostly vegetarian whole grains and vegetables and fruit and beans and such diet, portion control, and never getting addicted to cigarettes would prevent most of the Type II diabetes cases and most of the heart disease in the USA, and probably made a huge dent in the cancer rate, too (and another way to drop the cancer rate probably would be BANNING lawn chemicals....there was a recent study in Europe that pointed at stuff used against bugs and/or vegetation as a strong cancer agent, and there is indicting of lawn chemicals as the source of Newton, Massachusetts, having higher cancer rates than comparable except for propensity for paying Chem-Lawn and its ilk to create Greener Grass through Nasty Chemicals Application adjacent localities... ).

Regarding diabetes, also, there have been recent studies showing that a substantial percentage of Type II diabetes cases, the disease in effect goes into remission if the person was substantially overweight and then suddenly drops the overweight.

Note: my mother was obese and came down with Type II diabetes. One of her older sisters who was obese, was a Type II diabetic. Their mother who was overweight was a Type II diabetic. One of my mother's other sisters may have been an undiagnosed diabetic. My mother's sole surviving sister isn't, but she's wont to go on a walk of a mile or more most days. My mother went blind due to the diabetes. Her diabetic sister had to have toes and part of her foot amputated. Etc.... It's a miserable disease, and mostly preventable via diet, except that the culture doesn't promote diabetes-resisting diet, not really, not when conditioning people to consume diets full of high fructose corn syrup and refined sugers and flour made from grain that all the fiber and germ's been removed from leaving behind starch with manufactured enrichment chemicals added, full of grain-fed meat in large quantity (the FDA recently announced that people should eat mammal meat only twice a week, to be healthier....), ice cream and cream laden with fat and sugar, supersize French fry servings of starch drenched in often hydrogenated fats.....

Xopher: Tired, yeah.

You know, that's one guy whom I really don't want to have access to advanced alien weapons technology.

I bet he likes kittens, but not like most people.

Xopher @67, I have to agree with Neil Willcox @ 71 about your sneakily slipping in that argument all the while talking about how tired McCain looks. I mean, he should really start taking naps, he does look so tired. Maybe a nap on the veranda in the rockin' chair is just what he needs. Before going to the early-bird special at Denny's.

McCain is so tired...

how tired is he?

He's so tired, he spreads contagious yawning without having to yawn himself.

Now, if you'll excuse me, I've got to drink my prune juice and go read the funny papers in the throne room.

albatross @ 64: "Actually, I think big issues surrounding medicare and SS projected future growth are taken pretty seriously by folks that examine the budget numbers in detail."

First, every time you put Medicare/Medicaid, on one hand, and Social Security on the other, together you make baby Paul Krugman cry. Medicare and Medicaid's problems have very little to do with Social Security: as a growth factor, the aging population (which affects all three programs) pales in comparison with the explosion in healthcare costs (which affects only Medicare and Medicaid).

albatross @ 74: "What reason do you have for expecting any of those things to get better, instead of worse?"

Perhaps because of this chart. Notice how the Social security line goes up slightly, then declines? Not a big increase, huh? Notice the lines that shoot up really fast? That's Medicare and Medicaid, the real sources of scary budget growth. Social Security is doing fine. In fact, estimates of how long it will last have consistently gotten longer as time goes by. See also: The Social Security obsession, again

So why the fuss over Social Security, which is at best a secondary budgetary worry? In my humble, it's no more than another Team B boondoggle, designed to scare people into opening their life-savings to investment by the same people who brought us the SS&L scandal and the sub-prime mortgage crisis. The idea of billions of dollars kept out of the market and not earning them money drives these people crazy.

Lee @ 50: "The sort of thing you mention here is an example of what I see: that, while every other politician is still clinging to the ideas and methods of the 1980s, Obama is creating the campaign structure of the future. This, in turn, makes me inclined to think that he will look to the future in other ways, and that's one of the things I think we desperately need."

Yeah, Obama is in the process of building the political coalitions and institutions of the future, rather than exploiting the ones of the past.

albatross @ 53: "Assuming an Obama win in 2008, I'll bet his Republican opponent in 2012 will be roughly his age, and will be as adapted to the changes as he is."

It's about more than just the candidate, though: the voters have to adapt too, and I don't think Republicans can do it. They're richer, older and less comfortable with technology than Democrats, all things that will make adapting to the new politics that much harder.

Richer hurts them because with the new campaign finance laws, it's better to have more, poorer donors than a few richer donors. Obama's built his fund-raising machine on the backs of "bundlers," who work to raise relatively small amounts from a larger number of donors. Gone are the days of the $50,000 a plate fund-raisers. Poverty correlates pretty strongly with voting Democratic--increasing the power of small donors versus rich donors simply benefits Democrats more.

Older and less tech-savvy go hand in hand; the modern fundraising pattern relies heavily on technological mechanisms, which are going to skew heavily Democratic--not only are younger voters more likely to be Democrats, they're more likely to be comfortable using the web to coordinate everything from fund-raising to phone-banking to organizing rallies. Did I mention that they're poorer too?

So there are a number of factors that will hamstring Republicans in their attempts to follow the Democrat's lead. Even if they were to clone all the software behind My.BarackObama today and create a My.JohnMcCain, they still wouldn't have the same user-base as Obama does. And remember that Web 2.0 maxim: users are the most important component of any site.

There are Republicans who are comfortable with current technology - I'm thinking here of folks like Patrick Ruffini, people who are (or have been) staffers and advisors but may well become candidates in their own right. Their problem is that they pretty much all come across like latter-day P.J. O'Rourke on a bad day, full of contempt and meanness, which aren't selling as well as they used to. I agree that the biggest problems will be on the user/donor end.

Stories I hear, the American medical care system isn't interested in prevention.

One thing to remember: for a large population (it maybe doesn't work well for a school district) you can look at the most recent census figures and make a damn good estimate of how many new people will qualify for social security pensions each year, for the next several decades.

That's why there are fears about the baby boomers. We can see the population bulge ageing, and we can see how many people will be of working age.

Of course, if all the wealth-creating work has been exported, the relative number is pretty meaningless.

heresiarch #82: I don't disagree with much of this. The thing is, there are two issues involving SS, which get mixed together. (Disclaimer: I'm absolutely not an expert on any of this stuff.)

1 There's an issue with the number of retirees and the number of workers, having to do with demographics. This is a problem, but it's not an especially hard one to solve. I think Brad DeLong compared this to a slow tire leak--you really need to take care of it, but it's not all that hard to deal with.

2 There's a larger budget deficit issue, in which the general budget has been hiding part of its deficit in the surplus being run by social security. As that surplus switches over to a deficit around 2020, the deficit will start growing, even if spending and taxes stay the same. This ultimately constrains future budgets. In some sense, we've budgeted on the basis of this surplus for many years now, like a family that wins the lottery, gets a payout spread out over ten years, and promptly reorganizes the family budget so that it depends on that extra income that will go away in ten years.

Here's a quote from DeLong's post in 2005 that described these colorfully:

If our current General Fund deficit is like having an impaired driver who has just crashed us into a tree, and if the Medicare-Medicaid problems are like a melted transmission, and if the post-2020 General Fund is like having no brake pads left, then our long-run Social Security deficit is like a slow tire leak.

The critical thing to understand is that fixing (1) (say, getting rid of the maximum amount of income on which SS taxes are collected) is a good idea, but it doesn't fix (2)--we still won't have that surplus we used to have, and that will require either raising taxes, cutting spending, or accepting a way larger budget deficit. And fixing (1) will already raise taxes on a lot of people, and raising taxes is not usually a winning political strategy. Neither is cutting government spending, no matter how frivolous or downright harmful. Imagine trying to cut the bloated homeland security budget, and how many jobs, local economies, and lobbyist-employing firms will be hurt by that.

heresiarch #83: I don't know about that. ISTM that for quite some time now, the conservatives have been much more effective at adapting to new technology (talk radio, Fox News, televangelists, the whole massive project to turn K street into an endless source of money for the Republican party) than were liberals. I doubt very seriously that there's something inherent in being a conservative that makes you unable to adapt to changes in technology to win elections. (Honestly, that sounds like the kind of belief held by people who are set to get their clocks cleaned in future elections, by underestimating the opposition.)

Once again, projecting out demographics curves decades in advance is mostly an exercise in fantasy. I think that there are more kids in school today in the USA than there were at the height of the baby boom... baby boomers delayed reproducing and the cohort after didn't delay for so long, and thus there's a pig in the python cohort even bigger than the Baby Boomers that's alive and heading/will be heading into the labor force....

And the situation with Baby Boomers is such that a significant percentage will -never- retire, either because they drop dead before allowed retirement age, or because they can't afford to retire, or because they don't feel like retiring.

And, once again, as regards Medicare and Medicaid, there has to be -some- upper bound on it.

Constance, #65: Why are they even allowed to talk, one wonders, since over and over and over they are proven wrong and even proven to be liars.

And how many times has some religious figure prophesied that The Rapture Was Coming, that the world would come to an end on a specific date, and yet even though it never does, they never lose their adherents? I submit that these two phenomena are not unrelated.

Bruce, #75: And Social Security could be fixed with the stroke of a pen, just by removing the cap on eligible wages. Right now, anyone who makes less than $102,000 per year pays Social Security taxes on every penny of it... and there it stops. All those CEOs and CFOs making 7-figure salaries (before options and bonuses) -- they still only pay FICA on the first $102,000.

heresiarch, #83: There are poor Republicans too -- the whole connection to the Religious Reich is a way to get lower-income people to vote against their own best interests -- but the kind of poverty that goes with Republicanism also has a tendency toward Luddism. These are the people, for example, whose first question about a computer is, "Does it have internet?" because they don't understand that accessing the Internet requires more than just a computer.

Dave, #85: My partner just pointed out something: the US medical-care system is like a tech-support center with no Level 1 operators. Something like 85% of most people's medical issues don't actually require seeing a doctor; a nurse practitioner could handle them. But we insist on kicking everything up to Level 2 immediately, rather than only when it's beyond Level 1's ability to address. And there's a related issue that many people won't be happy until they've seen a "REAL doctor" -- because that's how they've been conditioned to think. But installing a real tiered system for dealing with the gazillion routine sprained ankles and UTIs and colds-that-become-bronchitis and the like would make basic medical care much more available and affordable for the people who need it the most.

albatross, #87: Radio and television are old technology.

Lee (#89): At various times at the same family practice office I've been seen by physician's assistants, nurse practitioners, and "real doctors". I've never asked to see a "real doctor", not least because I trust the doctor to hire folks who know when they need to ask her for her opinion and when they don't.

Radio and television are not just old technology, they're centralized technology, with a very one-way model (even for call-in shows on talk radio). I think that's an important aspect; one of the big differences in the Dean/Obama style of campaign approach is the much greater level of bottom-up or bottom-across activity, rather than the more traditional top-down model.

Lee, #89, I had a great nurse practitioner until I got sick. These days I mostly see specialists or communicate with them via email (if I think it's something that can be handled that way).

And not only do people who make more than $102K only pay SS taxes on the $102K, people like me, who have private disability or other income, have to pay income taxes on some/all of the Social Security we receive.

Christopher, #90: Note that I did say "many people", not "all people" or even "people" in the abstract. My mother was definitely one of those people, and I've heard it from other people as well, not all of them older than me. It may be diminishing, but it's far from gone yet.

Lee @ 89

The allergy clinic Eva gets her shots at has a phone number dedicated to questions for one of the clinic's nurses. It's intended to deal with issues like, "do these symptoms warrant a visit to the doctor?" or "is there an over-the-counter medication for X", precisely the sorts of questions that Level 1 support should be answering. I don't think it's a common sort of service; I don't know of any other clinic in the area that does it.

albatross @ 86: "The critical thing to understand is that fixing (1) (say, getting rid of the maximum amount of income on which SS taxes are collected) is a good idea, but it doesn't fix (2)--we still won't have that surplus we used to have, and that will require either raising taxes, cutting spending, or accepting a way larger budget deficit."

And the problem with this is that (2) isn't a problem with Social Security. The federal budget's overruns can't be solved by "fixing" SS; they can only be solved by fixing the federal budget. The slow leak, which does have to do with Social Security, is a relatively minor worry. Thus the dismay at the focus on Social Security: the family's problem isn't that they won the lottery. It's their stupid financial decisions that are causing the mess. Moaning about how the lottery money's about to run out is to miss the real problem entirely.

albatross @ 87: "ISTM that for quite some time now, the conservatives have been much more effective at adapting to new technology (talk radio, Fox News, televangelists, the whole massive project to turn K street into an endless source of money for the Republican party) than were liberals. I doubt very seriously that there's something inherent in being a conservative that makes you unable to adapt to changes in technology to win elections. (Honestly, that sounds like the kind of belief held by people who are set to get their clocks cleaned in future elections, by underestimating the opposition.)"

Most of my reply to this has already been covered by Lee @ 89 and Chistopher Davis @ 90: while their use of radio and television was innovative, it was built on the back of old, centralized technologies.

Your reply sounds to me like the kind of belief held by people who think that deep down, conservatives and liberals are just Red and Blue versions of what is essentially the same group. I think the differences are more than cosmetic--conservatives and liberals really are different coalitions, with different skills and methods, strengths and weaknesses. Some strategies favor liberals, and some favor conservatives. The advent of the internet (especially 2.0) opened up a bunch of new strategies that, in my humble, tend to favor liberals.

I think the opposite was true of TV. One-to-many communication rather suits conservatism's authoritarian tendencies. TV's emphasis on sound-biting favors quick, easy-to-understand arguments. Conservatism, which is by its nature what people already know, benefits from this whereas liberalism, whose arguments are more often new and unfamiliar, suffers. It's pretty easy to convince someone of what they already know; teaching them something new takes longer. TV doesn't have the time for that. TV and radio are also prone to conglomeration, leaving media in the hands of a small elite, which again favors conservatism--the elite never wants to change the status quo; it might threaten their power.

Anyway, /two cents

Lee @ 89: "There are poor Republicans too -- the whole connection to the Religious Reich is a way to get lower-income people to vote against their own best interests"

Yeah, and they've been remarkably successful at it too, given what a raw deal they offer. Nonetheless, poverty correlates with voting Democratic--the poorer you are, the more likely you are to be a Democrat. The point of inflection is around $50,000 a year, I think: any poorer than that, and you're probably a Democrat.

Bruce Cohen, STM @93:
The allergy clinic Eva gets her shots at has a phone number dedicated to questions for one of the clinic's nurses.

The NHS in Britain has a telephone service like that, staffed by qualified nurses. There is also a website, with a self help guide that is pretty much automated triage. Incredibly enough, these are relatively new services.

I don't know the Dutch system that well yet; Martin has been doing the interfacing. But dealing with each medical issue (broken finger, swallowed battery) has started with a phone call to an advice line, with either a callback or an answer right away.

From a patient's perspective, having a phone line means a faster response for minor problems, and less worry that one is overreacting. From a doctor's perspective, it means early triage and a chance to address problems before they escalate.

My employer has a nurse line as part of our health benefits. It's a good program.

abi #95: Yeah, if you read any ER doctors' blogs, one of their most consistent complaints is that people show up at the ER who don't belong there. We make a lot of use of our pediatricians' number--there are four or five doctors in the practice, and there's always someone who'll call you back if you call before 10PM. The whole point of this is to figure out if the situation needs a trip to the ER, a trip to an urgent-care clinic[1], or a trip to the doctor in a couple days (or in a couple days, unless it gets better on its own).

How does health care work in the Netherlands?

[1] The urgent care clinic we're most likely to use is basically like a small-town ER in the 60s. The main advantage is that you can be seen by a doctor reasonably quickly, since you have to pay to go there. By contrast, the ER will often have you waiting for a long time, if you're not obviously in immediate danger of dying, since they've become free clinics of last resort.

Bruce, STM, #93, Kaiser has Advice Nurses you can talk to 24/7 that are meant to handle level 1 issues. Of course, the one I talked to Thursday last week then talked to the Kaiser emergency doc and sent me off to the ER. It was good to know my phenobarb level is too low, but I kept telling them I haven't had another stroke, I just wanted to schedule some tests for that Friday so the neurologist will have some info. I could have done that without going to the ER. I see the neuro on the 24th; she'll probably want me to have another EEG.