What’s wrong with the House health reform
Wednesday, 07/22/2009 - 12:58 pm by Bo Cutter | 11 Comments
Shaping the future with today’s choices.
The House of Representative has produced a terrible health reform plan. Sometimes choices are hard. This one isn’t: Nothing is far, far better than this mess. It can’t be fixed, patched, reworked or adjusted: it should be thrown away. I know it sounds strange, but the right course for progressives is to reject this bill completely.
This bill does solve the access to health care problem: by the simple expedient of loading more costs on a health care system that already costs too much. It does not change the health care system in any substantial way. It does not change how private health care works, although with its public option it probably insures the end of private health insurance. It does not provide for improved consumer choice or a more competitive system; it does not acknowledge the changed circumstances of the American job market; and it does not change at all the unlimited give-away employer health care subsidy. On the other hand, it does finance its more than $1 trillion extra costs by an 8 percent job tax on small business – it’s a new theory, employers will hire more if employees cost more - and by a second whack at high income families, bringing their marginal tax rates to those of the more expensive European nations. I can certainly understand why crafting this legislation required so much time and work.
This bill creates two serious cost and budget problems, one finally acknowledged, one largely unmentioned. First, considered just by itself, the bill costs more than $1 trillion and raises rather than lowers the growth of health care costs. In what should have been the death knell for the bill, but wasn’t, the director of the non-partisan Congressional Budget Office (CBO) said, “[I]n the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs. “
More seriously, and never mentioned by the Congress, this bill loads all of these costs on a national budget we already cannot afford. In 10 years, even without this bill, federal debt will already rise from 40 percent to 90 percent of GDP; in 10 years we are headed toward a “normal” every day 7.4 percent of GDP deficit. This is a train wreck. If we actually come even close to these numbers, we will cause more damage to the economy, to low and middle income families, to low wage workers, and to everyone else than any possible new program could add benefits.
What could the Congress possibly have been thinking of? And when – if ever – will Congress recognize the reality of the cliff we are heading toward? So far as I can see, there is only one person on the stage today with the brains and political skills to acknowledge we are at a dead end, to demand a do-over, and to provide a positive direction – President Obama. Unless that happens, we are in deep trouble.
About 40 years ago, when I first heard the mantra “don’t let the best be the enemy of the good,” I thought it was original and wise. I now know that it is a hackneyed cliché, invariably the signal of an effort to rationalize another terrible idea. I guarantee we will hear it in this case. But don’t kid yourself: there is no “good” here.
Braintruster Bo Cutter is a managing partner of Warburg Pincus, a major global private equity firm. Recently, he served as the leader of President Obama’s Office of Management and Budget (OMB) transition team.
Do you advocate a single-payer system instead? HR 676 exists as the framework for a single-payer system. If you don’t support that, is there another healthcare bill out there that you think addresses the problems you listed?
Posted by Zach P | July 22nd, 2009 at 4:44 pm
While we agree on throwing away the current bill, we disagree as to why. You say because of the costs, but this is nonsense. These costs are going to be paid one way or another. The only option for not paying even some of these costs is to allow people to die. So paying is not an option; the only question is how. Everyone knows the answer to that: shut down the Empire.
Now why I would throw this bill away? Because it does ABSOLUTELY NOTHING to address the problem of medical bankruptcy. This is outrageously unfair considering it is ONLY the middle class that suffers medical bankruptcies (the poor have no reason), and it is the middle class which will end up paying for most of whatever we enact (the poor have no ability). And of course, the ONLY thing that can address medical bankruptcy is single payer.
But, we are told, America wants to keep their current plan. Imagine the rediculousness of this. Even if this is true (which it is not — why would the insurance companies fear the public option if it was), all that would say is that the corporatists have managed to convince the American middle class that they want to keep a coverage that will destroy their lives and their futures if they ever really need it.
Posted by Benedict@Large | July 22nd, 2009 at 11:02 pm
If the conclusions of this analysis is correct, then perhaps the Congressional committee “system” is broken: i.e., the division of labor between different committees with their chairmen acting as chief negotiators.
If it is true that the House is being asked to vote on a 1,000 page bill in which disparate parts have been stapled together to create a claptrap that no one has had time to read (let alone analyze), aren’t Democrats making the same mistakes that the Republican-led Congress made in rushing to pass the Patriot Act (John Conyers in Fahrenheit 9/11: “Sit down, my son. We don’t read most of the bills.”) and Medicare Part D (when the CBO, perhaps politically pressured, misled Congress on its cost)? If there is a “Waterloo” it should be the Congressional committee system: a failure of health care reform (this year) would force “process” reform (next session).
So how would I remedy this? First, as OIRA-nominee Cass Sunstein [1] has recently pointed out, what the Founding Fathers envisioned was what Penn President Amy Gutmann calls a ‘deliberative democracy’ [2]. Second, in the spirit of post-partisanship and patterned by the LMDC open design competition for the WTC site plan, Speaker Pelosi should form a speaker task force to conduct an open design competition between legislative entrepreneurs that would bring three or more health reform bills for floor vote (i.e., Democratic, Republican, “third way” bills voted in random order for fairness) with the congressional chairmen functioning like the LMDC as what James Madison characterized in his letter to George Washington (April 16, 1787) as “disinterested and dispassionate umpires.” (Centering the open design competition around legislative entrepreneurs would facilitate conceptual integrity to make sure that the all the pieces of a bill seamlessly fit together, thereby solving the “too many cooks in the kitchen syndrome.” So forget about President Obama saying that Republican ideas were incorporated; what’s need is *choice* from a large number of different “paths to Nirvana” whereby three or more bills are simultaneously brought to the floor for vote). Third, for openness and transparency, each bill should be marked up and posted on the Internet in near-real time (see, e.g., PublicMarkup.org) for the American people to review whereby Louis Brandeis’ “sunlight is the best disinfectant” along with Gutmann’s deliberative democracy norm of “reason giving” (e.g., systematically go through a bill and for each provision its sponsor in an online video clip answering the following questions: To what problem is this the solution? What are the other ways to solve it? And in all intellectual honesty, why was it the best way to solve it?–whereby other members could then debate in an online blog to improve, amend or replace the provision) could cure what Madison called the “mischiefs of faction” (and corruption) in Federalist #10.
The Founding Fathers envisioned a deliberative democracy in which the role of the House was to “refine and enlarge the public views” (Federalist #10), and the Senate, to gauge the “cool and deliberate sense of the community” (Federalist #63). If these are the criterions by which their institutions should be judged, House Speaker Pelosi and Senate Majority Leader Reid have utterly failed in their duties as constitutional officers.
President Obama has also utterly failed to in his campaign pledge to “change” the way Washington works. In terms of the Rahm Doctrine, the failure of health care reform this year would be a serious crisis but could provide an opportunity to fix our broken U.S. political system: replacing “kumbaya” bipartisanship, Obama could take the post-partisanship tack of restoring the deliberative democracy that America’s Founding Fathers had envisioned. So let’s break the monopolistic stranglehold of the current Congressional committee system (that Ron Brownstein [3] cites as the cause of Congress’ dysfunction) and replace it with open design competitions in which “third way” legislative entrepreneurs can be unleashed to bring forth imaginative, innovative and coherent policy proposals to solve our seemingly intractable yet most pressing societal problems.
———————————————
[1] Sunstein, Cass R., “The Enlarged Republic–Then and Now,” The New York Review of Books, Vol. 56, No. 5, March 26, 2009 [http://www.nybooks.com/articles/22453#fnr6 ].
[2] Gutmann, Amy and Dennis Thompson, Why Deliberative Democracy?, Princeton University Press, 2004 [http://press.princeton.edu/chapters/s7869.html ; see chapter excerpt that descibes reason-giving].
[3] Brownstein, Ronald, The Second Civil War: How Extreme Partisanship Has Paralyzed Washington and Polarized America, Penguin Press, 2007 (see esp. pp. 126, 144-45).
Posted by Mike A. | July 23rd, 2009 at 5:30 pm
thanks for these responses
(1) I absolutely do not support a single payer plan. The closest actual piece of legislation I support is the Widen-Bennet bill which is (a)actually costed out; (b) genuinely bipartisan; and (c) a fundamental change in the structure of health care.I co-chaired the CED a couple of years ago and we at the time published a proposal which is what I really support. Go to CED’s web page.
(2) I’ve already said that I oppose a single payer approach. To take that further, I think that medical bankruptcy is a result not a cause of the current set of problems. The bankruptcy I’m worried about most right now is the nation’s.
(3)I love the set of comments about deliberative democracy. I’m not sure I understand the recommendations but I like what drives them My own point of view is simpler right now - the Congress is incapable ever of doing real policy, what it tends to do is add up all of the various interests and just put them all together. Which is what we have in this terrible bill. The Obama Administration has made a real mistake in essentially outsourcing the stimulus package, climate legislation, and health reform to the Congress. What the administration should have done is draft poicy directivies, provide them to the Congress, and then spend some political capital to achieve them. We all would have been spared President Obama’s total disconnect last night when he argued in concept for a health reform direction that sounded about right while the only actual piece of legislation out there is a complete mess that achieves none of the goals he stated pretty well last night.
Posted by Bo Cutter | July 23rd, 2009 at 6:02 pm
<>
This is why I am advocating Congressional “process” reform: as Sunstein wrote in his article cited above, “Publius did not believe that politics should be conducted solely as a process of bargaining and trade-offs.”
Instead of one monstrous health reform bill working its way through the different Congressional committees there should be up to 435 + 100 different creative, inventive and innovative attempts by legislative entrepreneurs to forge consensus (actually less if you recuse the speaker and the task force committee members who are the “disinterested and dispassionate umpires” of the open design competition: like the LMDC their power would be agenda control for defining “the problem” and evaluating the proposals in the committee report as to whether they solved “the problem” and met say, President Obama’s bill-signing criteria).
The utility a legislative entrepreneur can be seen by Frederick P. Brooks, Jr.’s software engineering classic The Mythical Man Month, 2nd ed (Addison-Wesley, 1995; chapter 4) in which for large complex software systems the most important thing is conceptual integrity, which can only be provided by a single mind (or a small group of resonant minds). The reason why the House has produced a “terrible bill” is because the sausage-making process of design-by-committee is ill-suited for facilitating conceptual integrity.
Question: Are we witnessing Mancur Olson’s “The Rise and Decline on Nations” (Yale University Press, 1982) in which special interests that seek to preserve the status quo eventually brings a great nation to its knees?
<>
This sounds a lot like the British (err Bush-Republican) ruling-party parliamentary approach to democratic governance in which Congress is just a rubberstamp. The drawback is that someday the Democrats are going to lose control of a chamber and when that happens it will reignite Brownstein’s Second Civil War as the Republicans avenge the abuses inflicted on them under Democratic rule.
No, President Obama’s real mistake was naively believing in “kumbaya” bipartisanship when his real problem was a dysfunctional Congressional committee system in which a handful of committee chairmen have a monopolistic stranglehold on drafting legislation (and interest groups who have a stranglehold on them by funding their leadership PACs). [N.B. Decentralizing legislative drafting from the Congressional committees and banning leadership PACs could counter the undue influence of interest group.] Instead, he and the Congressional Democratic leadership need to take the post-partisanship approach of design competitions, political equality, fair play, openness and near-real time Internet transparency.
<>
I am not sure what you mean by policy directives but President Obama should have done what Sony co-founder Akio Morita did in the late 1970’s when he placed a very small block of wood before his engineers, telling them to design what became the Sony Walkman. (Actually Obama sort of did this but for the sake of political pride he has now loosened his bill-signing criteria and as you point out is willing to sign any claptrap at this point.)
I think that President Obama has faithfully respected the separation of powers as prescribed by the U.S. Constitution: at bottom the Congressional committee system is broken. If indeed as you suggest that we need a “do-over” on health care reform, the Democrats should scapegoat the Congressional committee “system” and try again next session in 2011 with an open design competition between legislative entrepreneurs.
Maybe the best thing that could happen to the Democrats (and the country) is to be given a thumpin’ in 2010, which would be a wakeup call to force Congress to fix our broken U.S. political system.
Posted by Mike A. | July 23rd, 2009 at 9:41 pm
Oops, your quotations did not come out. Let me try again.
Posted by Mike A. | July 23rd, 2009 at 9:42 pm
CUTTER: “The Congress is incapable ever of doing real policy, what it tends to do is add up all of the various interests and just put them all together. Which is what we have in this terrible bill.”
This is why I am advocating Congressional “process” reform: as Sunstein wrote in his article cited above, “Publius did not believe that politics should be conducted solely as a process of bargaining and trade-offs.”
Instead of one monstrous health reform bill working its way through the different Congressional committees there should be up to 435 + 100 different creative, inventive and innovative attempts by legislative entrepreneurs to forge consensus (actually less if you recuse the speaker and the task force committee members who are the “disinterested and dispassionate umpires” of the open design competition: like the LMDC their power would be agenda control for defining “the problem” and evaluating the proposals in the committee report as to whether they solved “the problem” and met say, President Obama’s bill-signing criteria).
The utility a legislative entrepreneur can be seen by Frederick P. Brooks, Jr.’s software engineering classic The Mythical Man Month, 2nd ed (Addison-Wesley, 1995; chapter 4) in which for large complex software systems the most important thing is conceptual integrity, which can only be provided by a single mind (or a small group of resonant minds). The reason why the House has produced a “terrible bill” is because the sausage-making process of design-by-committee is ill-suited for facilitating conceptual integrity.
Question: Are we witnessing Mancur Olson’s “The Rise and Decline on Nations” (Yale University Press, 1982) in which special interests that seek to preserve the status quo eventually brings a great nation to its knees?
* * *
CUTTER: “The Obama Administration has made a real mistake in essentially outsourcing the stimulus package, climate legislation, and health reform to the Congress.”
This sounds a lot like the British (err Bush-Republican) ruling-party parliamentary approach to democratic governance in which Congress is just a rubberstamp. The drawback is that someday the Democrats are going to lose control of a chamber and when that happens it will reignite Brownstein’s Second Civil War as the Republicans avenge the abuses inflicted on them under Democratic rule.
No, President Obama’s real mistake was naively believing in “kumbaya” bipartisanship when his real problem was a dysfunctional Congressional committee system in which a handful of committee chairmen have a monopolistic stranglehold on drafting legislation (and interest groups who have a stranglehold on them by funding their leadership PACs). [N.B. Decentralizing legislative drafting from the Congressional committees and banning leadership PACs could counter the undue influence of interest group.] Instead, he and the Congressional Democratic leadership need to take the post-partisanship approach of design competitions, political equality, fair play, openness and near-real time Internet transparency.
* * *
CUTTER: “What the administration should have done is draft policy directives, provide them to the Congress, and then spend some political capital to achieve them. … [T]he only actual piece of legislation out there is a complete mess that achieves none of the goals he stated pretty well last night.”
I am not sure what you mean by policy directives but President Obama should have done what Sony co-founder Akio Morita did in the late 1970’s when he placed a very small block of wood before his engineers, telling them to design what became the Sony Walkman. (Actually Obama sort of did this but for the sake of political pride he has now loosened his bill-signing criteria and as you point out is willing to sign any claptrap at this point.)
I think that President Obama has faithfully respected the separation of powers as prescribed by the U.S. Constitution: at bottom the Congressional committee system is broken. If indeed as you suggest that we need a “do-over” on health care reform, the Democrats should scapegoat the Congressional committee “system” and try again next session in 2011 with an open design competition between legislative entrepreneurs.
Maybe the best thing that could happen to the Democrats (and the country) is to be given a thumpin’ in 2010, which would be a wakeup call to force Congress to fix our broken U.S. political system.
Posted by Mike A. | July 23rd, 2009 at 9:44 pm
I won’t push on your notion of how congress ought to do it but I am very interested in how you might apply your notion to how we, here, could design a better health care reform. I’m familiar with a range of approaches like this in software design, and in some other areas but how could we do it here? What is a small doable idea?
I never wanted to spend all or most of my time on health care in this blog
Posted by bo cutter | July 25th, 2009 at 10:07 am
(this is a continuation) but i am very interested in how discourse can happen in new ways
Posted by bo cutter | July 25th, 2009 at 10:10 am
CUTTER: “I am very interested in how you might apply your notion to how we, here, could design a better health care reform. … I am very interested in how discourse can happen in new ways.”
Sorry for the delay in responding. I just stumbled on your posting today (July 30, 2009).
First of all, what you or I perceive as “a problem” is fundamentally a value judgment. Its implication is that cost-benefit analysis (“CBA”) is not “do-able” (as evidenced by the pervasive non-compliance of Executive Order 12866 by the regulatory agencies [1]).
Second, humans are fallible which means that in our dynamic human environment, new and novel problems can only be solved through the method of trial-and-error elimination. For large-scale complex systems, the best we can do is to try to not make a terribly serious blunder, which can best be avoided through critical discussion. (N.B. This is the systemic flaw of the DoD acquisition system that leads to billion dollar cost overruns–but that is another story.)
So HOW can we, here, design a better health care reform?
My answer is for New Deal 2.0 to sponsor a multi-round open design competition that facilitates what Nobel Laureate Friedrich Hayek [2] called “competition as discovery.”
Like the LMDC –and the problem-solving format of the U.S. Army staff study [3] though without CBA–what New Deal 2.0 needs to do first is to define “the problem(s)” to be solved (e.g., bending the cost curve downward), which would be formally articulated as a request for proposals (RFP). Maybe for ill-structured problems New Deal 2.0 could present a strawman design to stimulate critical discussion (much like what happened when the LMDC offered the Beyer Blinder Belle designs in July 2002). New Deal 2.0 should post the proposals online, preferably in a modular format (e.g., PowerPoint slides with facing page explanations along the lines of the deliberative democracy norm of what Penn President Gutmann calls reason-giving).
To facilitate critical discourse, I would break up the public comment section (forcibly using radio buttons?) into three buckets based on the selection criteria of what Donald Campbell & Julian Stanley [4] and more recently HBS Professor Chris Argyris [5] call: (1) external validity; (2) internal validity; and (3) implementable validity. External validity is a progressive constraint that asks whether “the problem” was solved (i.e., progress is made when new problems are solved). Internal validity is a conservative constraint that ensures that the “old” problems remain solved (i.e., backward compatibility). Implementable validity is a piecemeal constraint that asks whether a proposed solution is do-able (i.e., in Silicon Valley speak, no “vaporware”).
For health care reform, the debate seems centered around internal validity. Here proposals must be self-inconsistent when answering the following four who’s: Who benefits? Who pays? Who supplies? And as appropriate, who loses? [6]
For the second (and succeeding) round(s) of the competition, “the problem(s)” should be redefined based on how well the proposed solutions met these three selection criterions (e.g., one way to solve a difficult problem might be to expand it). In other words “the problem” itself can undergo an evolution.
Discarding one’s bad ideas and stealing good ideas from others should be encouraged to find a consensus solution.
So in a nutshell, enforcing the selection criteria of external validity, internal validity and implementable validity is how New Deal 2.0 can facilitate critical discussion: it is what Lotus-123 inventor Mitch Kapor [7] calls a “set of principles” for how, in your words, “discourse can happen in new ways.”
————————————————-
[1] See, e.g., Nicholas A. Ashford, “Alternatives To Cost-Benefit Analysis In Regulatory Decisions,” Annals of the New York Academy of Sciences (Vol. 363, pp. 129-137, April 30, 1981). Frank Ackerman and Lisa Heinzerling, “Pricing the Priceless: Cost-Benefit Analysis of Environmental Protection,” University of Pennsylvania Law Review (150 U. Pa. L. Rev. 1553, May, 2002). Frank Ackerman, Lisa Heinzerling & Rachel Massey, “Applying Cost-Benefit To Past Decisions: Was Environmental Protection Ever A Good Idea?,” Administrative Law Review (57 Admin. L. Rev. 155, 2005). David M. Driesen, “Is Cost-Benefit Analysis Neutral?,” University of Colorado Law Review (77 U. Colo. L. Rev. 335, Spring, 2006).
[2] Hayek, Friedrich A.: “Competition as Discovery Procedure” (1968) in New Studies in Philosophy, Politics, Economics and the History of Ideas, Routledge and Kegan, 1978.
[3] U.S. Army Field Manual FM 101-5: Staff Organization and Operations, Appendix D (ignore CBA)
http://www.dtic.mil/doctrine/jel/service_pubs/101_5.pdf
[4] Campbell, Donald and Julian Stanley: Experimental and Quasi-Experimental Design for Research, Rand-McNally, 1963. (In common law external/internal validity is the legal doctrine of stare decisis. In scientific discovery it is the revolutionary/conservative characteristic of scientific advancement [e.g., the backward compatibility of Einstein’s theory that explained everything that Newton’s did, and more to resolve what Thomas Kuhn called an “anomaly”].)
[5] Argris, Chris: “Double-Loop Learning and Implementable Validity” in Organisations as Knowledge Systems: Knowledge, Learning and Dynamic Capabilities, Hardimos Tsoukas and Nikolaos Mylonopoulos (eds.), Palgrave Macmillan, 2004 (In addition to Silicon Valley’s “vaporware” an example of what does NOT satisfy implementable validity is what Karl Popper called utopian social engineering [where “utopia” literally means nowhere]; as an alternative Popper advocates piecemeal social engineering.).
[6] Recthin, Eberthardt, Systems Architecting: Creating & Building Complex Systems, Prentice Hall, 1991, p. 248.
[7] Mitch Kapor, “Power to the (Wired) People,” San Francisco Chronicle Open Forum, October 17, 2004 (“The best open-source projects are based on practices that integrate a set of principles with a set of tools. … So, yes, technology can help in the form of decentralized tools, greater transparency and principle-based communities that use them. The challenges are to develop both the tools and the community practices in a synergistic way.”)
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/10/17/EDG8O98IQ01.DTL#ixzz0Mn3jujQc
Mitch Kapor, What’s Wrong With Politics and What Should Technology Do About It?, Presentation delivered at the Web 2.0 Conference in San Francisco, CA, October 5-7, 2004 (The example that Kapor cites of a “principle-based” community that provides “rules” for civil discourse is Wikipedia.) http://itc.conversationsnetwork.org/shows/detail323.html
Posted by Mike A. | July 31st, 2009 at 4:59 am
Forgive me for being out of scope but the following is my pet policy solution for health care reform: Phillip Longman’s VistA Health System [1].
If Congress conducted an open design competition it should have been one of the more viable alternatives, and at the very least should New Deal 2.0 sponsor an open design competition, like the Beyer Blinder Belle designs offered by the LMDC in July 2002, it should be the first-round strawman baseline to initiate critical discussion.
Longman proposes the “VA model of care” (p. 111) in which together with the “Massachusetts model” that solves the adverse selection problem of buying individual private insurance (p. 112) financially imperiled hospitals would “install the VA’s VistA health information management software, agree to adhere to the performance measures and protocols of evidence-based medicine used by the VA itself, and [thus] secure a contract to care for a guaranteed pool of people” (p. 113).
On the Daily Show (0/27/09) [2], although he didn’t specifically mention the VA system, conservative Bill Kristol admitted that the government has run a “first class” health care system for the military. (N.B. The Walter Reed neglect scandal [3] that was reported by the Washington Post in February 2007 suggests that VA hospitals are better run than DoD hospitals. In addition the Bush Administration reduced the budgetary priority of the VA during its tenure while Senator John Kerry punished VA Administrator Kenneth Kizer for trying to consolidate VA hospitals in Boston by killing his renomination in 1999.)
Longman points out that “VA’s cost per elderly patient is only about half to two-thirds that of Medicare. Moreover, the VA’s cost per patient is essentially unchanged over the last ten years, while the per capita costs elsewhere else in the rest of the U.S. health care system gallop ahead year after year” (p. 119). For the CBO there is a long track record and hard facts to score whether and how much the cost curve can be bent downward.
For controlling Medicare costs, Longman writes: “One can imagine a day coming when the federal government decrees that all Medicaid and Medicare patients receive their care through VistA-affiliated hospitals and clinics” (p. 118).
Question: Given that the VA model provides health care that is better, cheaper and faster (no long lines, greater patient satisfaction), why isn’t Longman’s idea being considered by Congress? Put differently, from the perspective of the deliberative democracy norm of reason-giving, what is wrong with Longman’s idea?
My point is that an open design competition would have brought this proposed solution for consideration b the Congress. With the exception of Howard Dean’s interview, this “better mousetrap” has been completely ignored.
[1] Longman, Phillip: Best Care Anywhere: Why VA Health Care Is Better Than Yours, PoliPointPress, 2007, Chapter 10. For video (05/24/07) see http://www.newamerica.net/events/2007/best_care_anywhere and Howard Dean’s interview on MSNBC Countdown (07/28/00) http://www.youtube.com/watch?v=vwA12AQpn98 .
[2] http://www.thedailyshow.com/watch/mon-july-27-2009/bill-kristol
[3] http://en.wikipedia.org/wiki/Walter_Reed_Army_Medical_Center_neglect_scandal
Posted by Mike A. | July 31st, 2009 at 5:00 am