Don’t forget about Medicare’s waiting period when reading about Arizona’s awful transplant policies

Arizona richly deserves the bad publicity for its draconian Medicaid transplant policies. Medicare deserves blame, too, for its draconian disability waiting period policies.

It’s gratifying to see New York Times reporters and columnists pick up the story of Arizona’s disgraceful Medicaid policies towards transplant patients. We’ve rightly hammered Arizona Republicans on this site for their death panel policies–policies which are linked with actual deaths and with at-best horribly callous treatment of very sick or dying patients.

One angle has not received sufficient attention. Many transplant patients profiled in these news stories have been deemed eligible for federal disability benefits. Yet they are stuck in the required waiting period to become eligible for Medicare. This issue reflects a complicated policy debate that has been invisible to all but a tiny fraction of the American public. Incidentally, issues such as this one illustrate why arcane policy details really matter for real people, and thus why complaints that the Affordable Care Act ran over 2,000 pages were so juvenile when there is such a need to get these details right.

Congress should modify Medicare’s terrible waiting period policies, particularly for patients who lack access to private coverage. Such policies were always problematic. These policies are particularly unjustified after the passage of health reform.

Arizona richly deserves the bad publicity it is getting. The federal government, too, could do much better.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

33 thoughts on “Don’t forget about Medicare’s waiting period when reading about Arizona’s awful transplant policies”

  1. If Dems ever learn how to play the game, this sounds like something that Dems might actually be able to embarrass Republicans into passing. If Dems don't learn how to play the game, I'm afraid any discussion of Federal legislation over the next 2 years is simply a waste of keystrokes.

  2. The government of a locality is the largest dealer in interpersonal violence in that locality (definition, after Weber). Why suppose that organized violence (the State) is the appropriate remedy for every social ill?

    A thought experiment. Compose answers to the following questions:…

    1. From State operation of what industries does society as a whole benefit? You may suppose either a dichotomous classification:

    A = unlikely candidate for State operation, B = likely candidate for State operation

    or a continuum:

    (highly unlikely) -1________.________+1 (highly likely).

    2. Now consider the further question: What criteria determine an industry's categorical assignment or position on the continuum?

    Does society benefit from a State presence in the medical treatment business? The education business? The nutrition business? Mail and parcel delivery business? Broadcast news business? Why not government shoe stores, etc?

    What general principals relate to a determination, for any industry, of its classification or position on the continuum, and how do these imply a State presence in the education industry?

    Combine enthusiasm for unlimited, tax-funded medical care with unrestricted immigration and anti-discrimination policies and you commit US taxpayers to provision of unlimited medical care to each and every one of the Earth's 7+ billion people who can afford a one-way ticket to the US. Do you really believe such a promise is sustainable?

    I expect ad hominem arguments in response. And strident denial of the obvious. Zzzzzzzzzzzzzz

  3. Congress should create a system of tax-financed, public, universal system of health insurance, and make the selling of private health insurance, a felony. What else is new?

    A system, which is predatory and destructive in general will be predatory and destructive in detail.

    Patching the leaks in a ship designed to leak ends with the ship sinking under the weight of its patches.

  4. Malcolm, the state's capacities to tax and prosecute crime makes it a uniquely efficient purveyor of insurance in many circumstances, because it can solve the problems of adverse selection and moral hazard, which often bedevil a private insurer. The government can also use a monopsony on the purchase of health services to manage the technical efficiency and price dynamics of those systems.

    Public provision of health insurance is an efficient design. That's all.

  5. Barry,

    I'm neither a libertarian nor a Libertarian.

    Bruce,

    1. What do you mean by "should"? You obviously place health "insurance" on the "likely" end of the continuum that I drew. Why?

    2. Do you imagine that "predatory and destructive" governments cannot exist?

    3. How does the State solve the problems of adverse selection and moral hazard? Seems to me, a State guarantee of treatment exacerbates the problem of moral hazard. "Adverse selection" is just another way to say "evaluation and prioritization", which must occur in any system.

    4. Insurance is risk management. The State cannot insure everybody, since there is no "risk" over the population as a whole, just certainty. State-guaranteed health "insurance" is a transparent cover for a particular sort of charity. Since corporate oversight is a public good and the State is a corporation, oversight of State functions is a public good which the State itself cannot provide. State provision of charity as a "public good" transforms the "free rider" problem at the root of public goods analysis but does not solve it.

  6. I had a client, worked hard all his life. His list of medical problems included: late on-set schizophrenia, one paralyzed lung, bad hips (need replacement), bad knees (needed replacement), bad wrists and hands (severe arthritis), bad back (needs spinal fusion surgery) and a number of organ issues involving his kidneys and liver. And there are more, I can't even remember all the things wrong with him.

    There was no way he shouldn't have been taken care of by the Social Security and Medicare benefits he paid into since he started working at 16. And yet he had to sue for social security disability and Medicare.

    The irony was, he really didn't want the money. The fact that his health insurance cost over $2,300 a month was the issue. He just wanted Medicare, that he paid into for forty years, and to be relieved of the nearly $28,000 in commercial insurance premiums he had to pay because his wife was self-employed.

    So much for public policy.

  7. I am fascinated by the depravity of "Malcom Kirkpatrick". He's a bonafide Bourbon. Forgotten nothing, and learned nothing. Well I'm hoping his inevitable future of having to relive a lot of cruel history doesn't include us in it.

  8. Malcolm, the fact that spreading costs over populations eliminates risk in the economic sense is precisely why we have insurance. The fact that government can eliminate adverse selection – the tendency of currently low-risk people to not insure – is precisely why that insurance needs to be provided under public auspices, either directly by the government or via a private insurance system regulated by the government.

    As to "charity," the current rule is that health providers must treat seriously ill people. If that's a bad idea, then say so. But that's where the "charity" is. Right now, the money comes, somehow, from those who pay for health insurance, either themselves or via private or government insurance. Under the Affordable Care Act, that will be regularized, and the providers will get paid for the work they deliver to people who can't pay for it. That's just a common-sense extension of the existing principle.

  9. Russell,

    After the fall of the Evil Empire the British poet and historian of the empire, Robert Conquest, wrote that the West had insufficiently learned two important lessons: the limits to the amount of good that can be accomplished through organized violence (the State), and the stultifying effects of bureaucracy, public or private.

    Mark,

    I accept that voluntary risk pools reduce individual risk, if one ignores moral hazard and outright fraud. That's a big "if". I'll have to think on "risk" over the whole population. It still smells fishy.

    (Mark): "The fact that government can eliminate adverse selection – the tendency of currently low-risk people to not insure – is precisely why that insurance needs to be provided under public auspices, either directly by the government or via a private insurance system regulated by the government."

    This is my basic text:…

    Eduardo Zambrano

    "Formal Models of Authority: Introduction and Political Economy Applications"

    Rationality and Society, May 1999; 11: 115 – 138.

    "Aside from the important issue of how it is that a ruler may economize on communication, contracting and coercion costs, this leads to an interpretation of the state that cannot be contractarian in nature: citizens would not empower a ruler to solve collective action problems in any of the models discussed, for the ruler would always be redundant and costly. The results support a view of the state that is eminently predatory, (the ? MK.) case in which whether the collective actions problems are solved by the state or not depends on upon whether this is consistent with the objectives and opportunities of those with the (natural) monopoly of violence in society. This conclusion is also reached in a model of a predatory state by Moselle and Polak (1997). How the theory of economic policy changes in light of this interpretation is an important question left for further work."

    (Mark): "As to 'charity', the current rule is that health providers must treat seriously ill people. If that’s a bad idea, then say so."

    So. If your family, friends, employers, church, etc. won't help you, there's probably a good reason.

  10. Malcolm,

    I am the guardian of a congenitally disabled man whose medical care, housing, and social service needs are far beyond what I could possibily finance through my rather nice salary as an chaired professor at the University of Chicago. There are hundreds of thousands of other Americans living with disabilities who require help. Our Social Security, Medicare, and Medicaid systems allow these men and women to live decently, and impose quite manageable burdens on the rest of us to accomplish this.

    The idea that charity or private insurance could carry this load alone strikes me as ridiculous. Indeed before the above programs existed, intellectually disabled people were commonly abandoned by their desperate families and/or treated horribly in under-funded state homes, poor houses, and charity institutions of Dickensian dimension. The only times and places where charity handles these problems well are those in which government makes very large implicit or explicit investments to financially support and regulate these activities. As Michael Walzer once wrote, the thousand points of light have always required a government power line.

    By acting together through social insurance, we can protect each other against risks that would crush any one of us if we had to face these risks alone. I'm not sure I can penetrate your thick layer of libertarian doctrine. I can just say that in my own life, "the stultifying effects of bureaucracy" is not the only or the most fearsome threat to my family's well-being.

  11. I'm not a libertarian or Libertarian. At least, my friends who call themselves "libertarian" don't apply that label to me.

    When do you pull the plug on some unresponsive lump of meat? This question occurs every day at the extreme ends of the life cycle. With tax funding of "universal" care (I did not know that the universe was sick) you will have "death panels" or you will bankrupt the country.

    The question "When do we pull the plug?" also occurs in young adults and the middle aged with severely injured people with poor prospects of recovery to anything like normal functioning. For every amount $X of medical resources and for every level of functioning d above "comatose" there is some individual A such that $X is insufficient to achieve d.

    No one has addressed the issue of immigration, and the related "moral hazard" of announcing to the Earth's entire human population: "Cope to the US with your health problems and receive free treatment, courtesy of the American taxpayer".

  12. Oh, good, now Malcolm is advocating Euthanasia of "the injured unlikely to be restored to normal function". Who gets to decide what normal function is? Are we going to equip ER residents with shotguns, like the cliche whem the horse has abroken keg?

    Terry Schiavo this ain't. End of life issues are difficult, even with the comatose or those with untreatable pain – but offing the inconvenient is a whole different kettle of fish.

  13. "Who gets to decide what normal function is?"

    That's the central issue, isn't it? Inevitably somebody or some body decides. It's either relatives and physicians or it's a "death panel". Take your pick. Just don't pretend that the State can give us eternal life and health.

  14. MK: "Inevitably somebody or some body decides. It’s either relatives and physicians or it’s a “death panel”. Take your pick. Just don’t pretend that the State can give us eternal life and health."

    Yes, someone decides. We organize and establish institutions in the hope of making "better" decisions.

    There will still be death, uncertainty and costs, in any system of social organization. There will be Type I errors and Type II errors in any binary choice. Economics isn't about making any choice cost-less or error-free; it is about static efficiency and dynamic progress, optimal control and material improvement.

    Of course, predatory and destructive governments can exist, have existed, do exist. But, this is not a problem on ontological evil. Governments can be useful and reasonably efficient, too, you know. I advocate for the latter. What do you advocate?

    Neither laissez-faire nor anarchy are good bets to deliver "give us eternal life and health" either, on the evidence.

    The state, and the economy, is almost entirely artifactual. The state is what we do; ditto for the economy. The insight that societies are, viewed from a certain level of abstraction, chaotically self-organizing shouldn't be mistaken for the assertion that any magic is involved, or that passivity on the ground is helpful. If we could work out in advance, from first principles, exactly how society should be organized, what functions the government should and should not have, and how those functions should be carried out, we would just hire masters of axiomatic algebra and geometry to be our politicians; the political economy would not be a never-ending, semi-chaotic experiment. Some Solon would gift us the architecture of our political economy, and that would be that. But, that's not how the world works. We figure some bits out as theory; we try, we fail, we learn, and, hopefully, we improve.

  15. Thanks for the reasonable responses.

    (Harold): "Malcolm, I believe you confuse brutality with analytic clarity."

    That's always a possibility, for our type. Clear-eyed, hard-nosed realism is often only a self-congratulatory pose.

    Bruce,

    That was a very thoughtful little essay. 10 on a scale from 1 to 10.

    "What do you advocate?"

    Constitutionally limited democratic republican government, term limits, separation of powers, federalism, and markets.

  16. Malcolm: Thank you for your humility, it was an unexpected turn and I like when people remind me of the need to allow them to exceed my negative expectations.

    Bruce: Very well said. In particular the last paragraph clearly expresses insights I've been working on for at least five years. I will be quoting you.

  17. Does Malcolm protest his libertarian-ness too much? The hallmark of the libertarian seems to be an obdurate insistance that the only rational argument or solution to any question of public policy is a resounding absolute. Subleties and nuanced judgement are viewed as a slippery slope, the well intention paved road to hell. I suspect that such reasoned argument by folks who seem so often to posess a high degree of intelligence and scholarship is a bit disingenuous since they seem quite aware that applying such unrealistic absolutes to any policy dooms it to failure and thus proclaim the public poicy enterprise a hopeless, dead on arrival waste. At the same time such limitations are never loaded on private enterprise because, well it's private and thus more sensible. And of course if the private sphere had to work under such silly constraints it could never function.

    The only absolute in the health insurance muddle is that the only rational sollution is the one that the entire civilized world has embrace save the USA. Some form of national health plan that assures all patients recieve the same standard of care. The citizens of all civilised countries have instituted and cling tenaciously to just that solution because it works. The only thing stopping USA from enjoying what the rest of humanity takes for granted is the mountain of money the insurance and pharmaceutic industries wield to pervert our democracy.

    The calculus is simple. If the the banker has to accept the same care that the carpenter does the banker will make damn sure the carpenter is cared for. And the electorate will make sure that the prices are kept at a sane level. Hence the neurosurgeon is a well paid respected member of the middle class who doesnt't expend his energies on wrestling with the moral delemas of sending away those who can't afford him or worrying about maximizing his profits or for that matter fighting an ongoig war with skinflint insurance beurocrats with a vested interest in nicking him and his clients for every penny.

    The hard choices of benefit versus the ultimate demise of us all will still be with us but those choices need to be made irrespective of wealth and power of the patient. Once we reach that point the debate will take on new meaning to the banker, the carpenter and the legislator who will view their votes as having the true life and death seriousness the subjct deserves.

  18. (Fred): "Does Malcolm protest his libertarian-ness too much?"

    How much is too much? I'm neither a libertarian nor Libertarian. I have addressed education and health care, so far, on this forum, and there I agree with libertarians. We have not discussed immigration, environmental protection, land use law, population control, or other areas where I disagree with many (most, probably) libertarians. Just ask Perry DeHaviland over at Samizdata.

    (Fred): "The hallmark of the libertarian seems to be an obdurate insistance that the only rational argument or solution to any question of public policy is a resounding absolute.

    I figure it's courtesy to make a stark, stripped-down argument for ease of comprehension. Details can be added later, if we get past name-calling. Insistence that these stripped-down arguments apply without adjustment to the real world is the mark of the fanatic of any stripe, seems to me.

    (Fred): The only absolute in the health insurance muddle is that the only rational sollution is the one that the entire civilized world has embrace save the USA. Some form of national health plan that assures all patients recieve the same standard of care. The citizens of all civilised countries have instituted and cling tenaciously to just that solution because it works.

    Speak of the devil…

    There's not a lot of daylight between Bruce Wilder's position and mine, as far as we've laid them out. I wrote earlier (2010-12-3-1055) "Watching the Trolls"…

    1. The government of a locality is the dominant dealer in interpersonal violence in that locality (definition, after Weber).

    2. A law is a threat by a government to kidnap (arrest), assault (subdue), and to forcibly infect with HIV (imprison) someone, under specified circumstances.

    3. Individual A has a right to do X in a locality if the government of that locality has promised not to interfere with A when A attempts to do X and, further, has promised to interfere with individuals B,C, etc. if they attempt to interfere with A when A attempts to do X.

    4. Individual A has title to a resource X if the government of the locality in which X exists recognizes a right by A to control X which includes the right to transfer control over X to unspecified individuals B,C, etc. (to sell the resource) on conditions mutually agreeable to A and B.

    5. The system of markets, (title and contract law) unites control over resources with the incentive to use those resources in socially beneficial ways, as Adam Smith explained.

    6. Democracy, separation of powers, federalism, and market-oriented policies institutionalize humility on the part of State actors. The alternative to the market is the command economy (there's really a multi-dimensional continuum).

    If a policy dispute turns on a matter of taste, federalism and markets allow for the expression of varied tastes, while the contest for control over a State-monopoly enterprise must inevitably create unhappy losers (who may constitute a vast majority; imagine a nation-wide vote on the size shoes we all must wear). If a policy dispute turns on a matter of fact, where “What works?” is an empirical question, numerous local policy regimes and competitive markets will generate more information than will a State-monopoly enterprise. A State-monopoly provider of goods and services is like an experiment with one treatment and no controls: a retarded experimental design.

    It's the people who are certain of themselves who would mandate one nationwide Final Solution to the Education Question or the Health Question.

  19. Ugh, can I invoke Goodwin's Law on the 'final solution' rhetoric?

    If we're talking about how to implement things like food safety rules, or pollution regulations, there are advantages in having a consistent set of laws as a baseline. Since many forms of pollution drift in the wind, flow downstream, or get shipped in products sold in different states, having country wide laws can be a good thing.

    Think of it as a product that the country, after due deliberation, has chosen to buy. Clean air is not free – there are compliance costs. But we have bought it just the same. It just can't be bought in state jurisdiction sized bits.

  20. I waited, because I couldn't quite believe that Malcom had begun the process of shifting to a facts based approach to the public/private questions under discussion. I'm glad I did, because unfortunately he remains purely ideological, and a Bourbon. Hence depravity ensues whenever his ideology intersects reality. As it did with Lenin and Stalin and Mao, and so on. It never ends.

    Let us divide the health care issue into its two components, economic and moral. Kevin Drum efficiently summarizes data on the modern experience with health care across the worlds developed countries here:

    http://motherjones.com/kevin-drum/2010/12/control

    The summary:

    "Every other advanced country in the world has a centralized healthcare system that largely controls costs via government mandates. And guess what? It demonstrably works. Every other advanced country in the world has significantly lower costs than ours and provides more readily available care, and nearly all of them provide healthcare that's at least as good or better than ours."

    Click the link for a graph that nicely summarizes one dimension, costs.

    Summarizing:

    "the big picture is clear: other countries had centralized systems that controlled costs and we didn't. And the centralized systems worked: they reined in costs while continuing to provide extremely high-quality healthcare. You might not like that from an ideological perspective, but from a practical one you can hardly deny that it worked pretty well."

    These facts are no longer in dispute. If the universal health care systems, of which there are a large variety, in fact generated the economic inefficiencies that so worry Malcom, then this would show up in either costs, or outcomes. They don't, on balance. In all those other countries universal health care is a budget strain, but it costs *less* than it does in the much more market driven US.

    Now to the morality aspects. Malcom is apparently concerned about the moral fibre of people who don't pay the full costs of their fate. I think John Holbo dissected these issues definitively in his classic post "Dead Right"

    http://examinedlife.typepad.com/johnbelle/2003/11

    Summary:

    "In short, Frum actually thinks that conservatism means forcing the poor and middle-class to sacrifice government programs whose existence is, or may be, in their economic interest. And why? Near as I can figure, for the sake of making over the poor and middle-class into more agreeable objects of aesthetic contemplation for (wealthy) conservatives, whose tastes run to: Donner party-like look-alike doughty leatherstocking hard-bitten frontier-type workers (respectful hats in hand.) And the word for this aesthetic transformation is: making people free. And somehow the economy is going to be OK."

    So what we're down to, which justifies the word "depraved", is that Malcom wants and needs unlucky people to suffer, and to die, needlessly, so that his idea of virtue in the world is satisfied. There needs to be enough of these less wealthy people suffering and dying so that it provides motivation for the others. Otherwise poor people will smoke and eat cheetos and get fat "too much".

    Am I right Malcom?

  21. Can I also bring up the "and to forcibly infect with HIV (imprison)" bit of, uh, text.

    Well run prisons are not rape factories.

    Nobody voluntarily gets HIV. (ok, maybe 1 / 1.0e7 would)

    Wow, still we have no common reference point to debate. I doubt we would agree on any facts to base reasoning upon.

  22. Mobius,

    Welcome to the Reality Based Community…

    Here

    "In prisons across the world, the HIV and AIDS epidemic presents a major challenge. HIV prevalence within prisons is often far higher than in the general community, and prisons are a high-risk environment for HIV transmission… Rape: The often violent nature of non-consensual sex can cause tearing and bleeding, which increases the risk of HIV transmission. Rape in prisons is rarely reported, but the WHO estimate that prevalence ranges from 0 to 16 percent.24 In 2003 in the United States it was estimated that over 1 million inmates had been sexually assaulted in the past 20 years."

  23. (Russell): "Am I right Malcom?

    No.

    1. It's "Malcolm", not "Malcom".

    2. On a condition-by-condition basis US medical care outperforms socialized care in terme of survival rates, post-diagnosis, according to what I read. The difference in aggregate longevity between the US and,say, Britain, is largely due to lifestyle choices like diet, exercise, and smoking and have nothing to do with differences in treatment.

    3. "Ideological" is an uncomplimentary way to say "systematic" and I try to be systematic. Antonyms are "scatter-brained" and "unscrupulous".

  24. Malcolm,

    "survival rates, post-diagnosis" can be misleading. To take one very famous example, if you're American, male, and fortunate to live long enough, you will probably be diagnosed with prostate cancer eventually; the same person would be less likely to be so diagnosed if they weren't American, and in either case the prostate cancer (real or suspected) is unlikely to kill them. There are conditions that we diagnose here much earlier than they are diagnosed elsewhere, or that we diagnose more broadly here than is done elsewhere. Either of these would mean that we would see greater survival times and higher survival rates even if the treatment were usually unnecessary or ineffective.

    My understanding is that our overall outcomes are not particularly different than the British get, though either country looks better in some areas of medicine – certainly not that, as you imply, we're really doing significantly better medicine here than there. And they're paying a fraction of what we are per GDP per capita (though they also have a long-term problem with medical inflation); they're a useful counter-example, but – for better or for worse- no plan with significant legislative support suggests we slash our spending to anything remotely like theirs, let alone that we go single payer.

    For what it's worth, according to my recollection the US (with its uniquely badly designed system) manages to pay as much tax money for healthcare as Britain spends on all of its healthcare, even though tx money is only about half of the health care spending in the US. So, assuming they're not dying off in droves over there in the UK, the real problem is that our system is designed to waste about half the money it consumes, at least if you take the British as an example of possible first-world medical expense for similar outcomes.

  25. Ah. I was right. Sorry about the "Malcom" Malcolm, I was in a hurry. I'm retiling the bathroom and the wall man had arrived. Sorry about all the other stuff, too; I wish it wasn't true, but it sure seems to be.

  26. And Malcolm, do rethink the holocaust references, ie "Final Solution". If you get huffy about misspelling your name, imagine how Jews feel about you belittling that event.

    Yours truly,

    me

  27. (Harold): “Malcolm, I believe you confuse brutality with analytic clarity.

    (Malcolm): "That’s always a possibility, for our type. Clear-eyed, hard-nosed realism is often only a self-congratulatory pose."

    I will add here that compassion is also often a self-congratulatory pose. There's a saying here in Hawaii: "The missionaries came to do good, and they did very well."

    All you need to know about the compassion of advocates for State provision of medicale care is this: Senator Edward Kennedy ($, Ma.) walked past lighted houses and did not report the accident for hours, while Miss Kopechne exhausted the air in the bubble trapped against the rear window of his car.

    (Mobius): "…do rethink the holocaust references, ie 'Final Solution.."

    (Bruce): "Congress should create a system of tax-financed, public, universal system of health insurance, and make the selling of private health insurance, a felony. What else is new?"

    One synonym for "comprehensive" is "totalitarian", seems to me.

    (Russell): "These facts are no longer in dispute."

    We disagree.

    (Russell): "…what we’re down to, which justifies the word “depraved”, is that Malcom wants and needs unlucky people to suffer, and to die, needlessly, so that his idea of virtue in the world is satisfied. There needs to be enough of these less wealthy people suffering and dying so that it provides motivation for the others."

    Thanks for demonstrating again the compassion of advocates for a State-monopoly health care system.

    Government-run health care: combining the efficiency of the Post Office with the compassion of the IRS.

  28. The argument which Joseph Priestley makes here against government-operated schools applies as well to government-operated medical facilities, seems to me.

    Two brief stories and I'm outta here for a month or so.

    I.

    After the 2004 election C-SPAN broadcast two panel discussions: one with campaign strategists for the major Presidential candidates and with pollsters, both independent and with the campaigns, and one with journalists who had covered the campaigns. The campaign people treated each other with respect. One pollster said had written an article for a professional journal in which he argued that gay marriage was likely to mirror the abortion issue in the generation of single-issue or deal-breaker voters, who would accept anything else from a candidate but that (one way or another). He said that after this article appeared he received an astonishing volume of hate mail. Another panelist asked "From the right or the left?" and he said "From the left". On the journalist panel a female writer from the New York Times remarked that, while she normally receives a drizzle of hostile criticism, in the current (2004) cycle the volume and fervor of the hostile criticism reached new heights. Another panelist asked "From the left or the right?" and she said "Oh, from the left."

    Question my compassion and I'll kill you.

    II.

    Years ago I was arguing politics with a friend, Muhammad, a PhD candidate in Soil Science from Somalia. He was a fan of the socialist dictator Siad Barre, and I upheld the free market side of the argument. Muhammad's friend, Jonathan, a grad student in Geology, an Ibo from Nigeria, observed and said nothing. I asked him what he thought of our discussion and he said: "If you really believed what you say, you wouldn't need to say it".

    See ya.

  29. And I even missed the old chestnut ad homenim regarding Teddy Kennedy. Wow, again. We've gone from Arizona letting people die who were on the brink of having transplants to how Democrats are the real killers.

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