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Monday, June 25, 2012

How Republicans made it possible for the Supreme Court to rule against the mandate

It wasn’t easy for Barack Obama to persuade David Axelrod to take him on as a client. It took years, actually. But there was a reason Obama wanted Axelord to be the one to run his campaigns. Axelrod knew how to get black candidates elected by white voters. In fact, he had a whole theory about it.
In a 2008 profile of Axelrod in the New Republic, Jason Zengerle quoted Ken Snyder, a Democratic consultant and Axelrod protege, on his mentor’s approach. “David felt there almost had to be a permission structure set up for certain white voters to consider a black candidate.” The “permission structure” relied heavily on “third-party authentication,” which is to say, endorsements from respected figures or institutions that the targeted voters admired.
If you think back to the 2008 campaign, you can see Axelrod slowly building this permission structure around Obama. Right before Super Tuesday, Axelrod rolled out the endorsements of Ted and Caroline Kennedy. Right before the election, he rolled out Colin Powell. The timing and nature of the endorsements were meant to make an African-American candidate with an international upbringing and the name Barack Hussein Obama into someone that Ohio steelworkers could feel comfortable voting for. If Ted Kennedy and Colin Powell can back this guy, so can you.
But permission structures aren’t just for elections. Over the past two years, the Republican Party has slowly been building a permission structure for the five Republicans on the Supreme Court to feel comfortable doing something nobody thought they could do: Violate the existing understanding of the Commerce Clause and, in perhaps the most significant moment of judicial activism since the New Deal, overturn either all or part of the Affordable Care Act.
The first step was, perhaps, the hardest: The Republican Party had to take an official and unanimous stand against the wisdom and constitutionality of the individual mandate. Typically, it’s not that difficult for the opposition party to oppose the least popular element in the majority party’s largest initiative. But the individual mandate was a policy idea Republicans had thought of in the late-1980s and supported for two decades. They had, in effect, to convince every Republican to say that the policy they had been supporting was an unconstitutional assault on liberty.
But they succeeded. In December 2009 every Senate Republican voted to call the individual mandate unconstitutional. They did this even though a number of them had their names on bills that included an individual mandate. (For more on the political history of the mandate, see this post.)
The unity among Senate Republicans reflected a unity among all the institutions associated with the Republican Party. Fox News and right-wing talk radio pushed the idea that the mandate was unconstitutional. Republican attorney generals began pushing the idea that the individual mandate was unconstitutional. Conservative think tanks — including the Heritage Foundation, which arguably brought the mandate to Washington and the Republican Party in 1989 — began releasing a steady stream of material arguing that the mandate was unconstitutional. Conservative legal scholars began developing arguments showing the individual mandate was unconstitutional. Within a matter of months, the fact that the individual mandate was unconstitutional was as much a part of Republican Party dogma as “no new taxes.”
All of this forced the controversy over the individual mandate into the mainstream media, too. After all, if one of America’s two major political parties thinks the most significant health reform since Medicare is unconstitutional, well, that’s a story! And, as most Americans are not constitutional law scholars, it made the individual mandate look like questionable policy. As Yale law professor Jack Balkin put it to me in the New Yorker, “If you’re reading articles in the Times describing the case against the mandate, you assume this is a live controversy.”
With the Republican Party on-board, the media interested, and the public confused, the next step was the legal system. Conservatives filed 26 separate cases against the Affordable Care Act, ensuring that they would get a hearing in dozens of different district courts. Judge Henry Hudson, a Republican appointee who was heavily invested in a Republican consulting firm called Campaign Solutions Inc., was the first to rule against the law. Judge Roger Vinson, another Republican appointee, backed him up. In a pattern that would be repeated over and again as the law proceeded through the court system, Vinson and Hudson’s rulings got vastly more media attention than the much larger number of instance where district judges ruled for the bill or threw the challenges out of court. The result? Polls began showing a majority of Americans thought the mandate was unconstitutional.
The effort had setbacks, too. On the appellate level, two of the brightest stars in the conservative legal firmament ruled in the law’s favor. Orin Kerr, a law professor at George Washington University and a former clerk for Justice Anthony Kennedy, told me, ” the two top choices for Supreme Court picks on the Republican side are probably Brett Kavanaugh and Jeff Sutton. Sutton voted to uphold the mandate on the merits and Kavanaugh voted to say it was not justifiable.” Judge Sutton, by the way, is a former clerk for Justice Antonin Scalia.
But those setbacks were nothing compared to the luck Republicans had during the oral arguments before the Supreme Court. Paul Clement, the talented lawyer prosecuting the case against the Affordable Care Act, gave what most everyone agreed was the performance of his career. Don Verrilli, the solicitor general of the United States, gave what most everyone agreed was one of the worst performances of his. He began by choking on water and seemed to never quite recover his composure. ”He was passive. He was stumbling. He was nervous,” CNN legal analyst Jeffrey Toobin told POLITICO. “I was just shocked.”
For all the Republican Party had done to make the mandate’s constitutionality a live issue, the oral arguments gave their cause a credibility that strategic positioning couldn’t buy. The two arguments had met in front of the Supreme Court and the argument against the mandate’s constitutionality had clearly won. Everything up till that point could have been written off as conservatives convincing conservatives of something conservatives already wanted to believe. But on that day, the argument against the individual mandate met the argument for the individual mandate, and the argument against the individual mandate won — even in the eyes of the mandate’s supporters.
After that, confidence that the mandate would survive the Court collapsed. A poll of former Supreme Court clerks taken before the oral arguments found only 35 percent thought the Court would overturn the mandate. After the oral arguments, that rocketed up to 57 percent. A poll of top constitutional law scholars found that 19 of 21 thought the mandate was constitutional, but only eight were confident the Supreme Court would uphold it. InTrade, a political betting market, puts a 67 percent chance on the mandate being overturned.
The collapse did not come because anyone changed their mind about the underlying constitutionality of the individual mandate. Polls, both of experts and the public, have been steady on that score. Rather, what the conservative movement had done — with a big assist from Verrilli — was build a permission structure that would permit the Republican-appointees to the Supreme Court to rule against the individual mandate. They had taken a legal campaign initially dismissed as a bitter and quixotic effort based on a radical and discredited reading of the Commerce Clause and given it sufficient third-party authentication to succeed. If the Supreme Court rules against the mandate, it will no longer be out on a ledge. It will be in lockstep with the entire Republican Party, many polls,  a number of judges, the impression the public has gotten from the media coverage, and the outcome of the oral arguments.
And that’s what’s changed from two years ago. When this campaign began, it was unthinkable that the Supreme Court would indulge it, even if some on the Supreme Court were sympathetic to its aims. “There is a less than one-per-cent chance that the courts will invalidate the individual mandate,” Kerr said at the time. Today, it’s entirely thinkable that the Supreme Court will indulge it, and that means that the members of the Supreme Court, who care deeply about protecting their institution’s legitimacy, are free to rule in whichever direction they want. We’ll find out what direction that is on Thursday.
Posted by Ezra Klein on

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A Flowchart for Choosing Your Religion

A Flowchart for Choosing Your Religion

Looking for a JOB - How to Be the Next Hire

Making You the Most Viable Next Hire
Being flexible, creative and adaptable in today’s economy is the cornerstone to survival. The job search is no different and, with unemployment rising, requires just as much vigilance. One way you can keep your options open and make yourself even more marketable is by considering Consulting in addition to your quest for full-time employment. Often perceived as an “either-or” scenario, Consulting offers you just as many benefits as it does your “would be” employer:

Track record of Fixing Problems?
Career wise, people typically fall into one of two categories: those who thrive on problem solving and the prospect of a new challenge –or- someone who is exceptionally good at steering the ship once it is on course. If the thought of fixing something that is broken appeals to you (versus has you thinking about reaching for the Tylenol), then Consulting might be an avenue to explore.

A More Flexible Interview
Quite often, what a company needs is someone to tackle a specific problem, not a new full-time employee. Identifying this in the interview and being able to present yourself as the solution to their problem (at a lower cost), can ultimately create a job tailor made for you and your skill set. No one can compete against that.

Dating Before Marriage
A consulting engagement can give you the opportunity to see if this company is a nice place to visit or a great place to live. The only thing worse than a prolonged job search, is ending up in a position that results in you being unemployed again in 6-12 months. Consulting lets you do more due diligence than you could ever accomplish in an interview.

“Consulting” on Your Resume
To many recruiters, seeing “consulting” as your current role without any clients/engagements is just a way to dress up being out of work. But, with a list of key accomplishments at those engagements, you show that you are in demand, have more control over your search and are broadening your experience. The latter is extremely important if you are looking to transition industries.

Change Agent
For companies looking to make some sort of change internally (and you should like this if you have a track record of fixing problems), consulting is a more preferred approach versus hiring a permanent employee. It is much easier to come in as a consultant, effect the course correction and then hand it off to the internal leadership.

Money
Besides the obvious benefit of having income during your search, it also gives you breathing room to be more objective in selecting your next job.

It’s Easier to Find a Job When You Already Have One
So much of what makes this true is that fact that when you are employed, you tend to be a bit more objective because you have a “bird in hand.” Consulting (in addition to easing that financial strain, which helps here) can provide the self-assurance that comes along with being employed, which can get whittled away while unemployed.

Presenting yourself as a viable consultant or full time employee isn’t mutually exclusive. Rather, they are simply two sides to the same coin. For the companies where you interview, this will only make you more viable and versatile in your eyes. For you, there is nothing to lose. The worst thing that happens here is you generate some income to inevitable financial strain of your job search. On the other hand, you might just find through this process that you discover your next career move.

Bağdat Caddesi

Gel de parmaklara hakim ol, yapma bir Caddebostan, Bağdat Caddesi nostaljisi şimdi!...diğer bir deyişle 'Karşı taraf' . Cok uzun seneler yazları gittiğim, son yıllarda ise her Türkiye'ye gittiğimde kaldığım Istanbul'un bir başka eşşiz köşesi.
1960'lı 70'li yıllarda köşkleriyle, bahçelerinden salkım salkım sarkan ortancalarıyla, billur gibi denizliyle, 'sayfiye' yeri olmasıyla meşhur Erenköy, Suadiye, Caddebostan.

Dükkanların az, ağaçların çok olduğu, bunca yıl geçmesine rağmen hala güzelliğini koruyan Bağdat Caddesi. On, onbir yaşımdan itibaren yazlarım geçti oralarda. Sokaklarda oynanırdı o zamanlar, öyle pek araba filan geçmezdi. Doyasıya bisiklete binilir, el birakarak gitmek büyük marifet sayılır Erenköy, Saskınbakkal, Göztepe bisikletle rahat rahat gidilir dönülürdü. Deniz için bazı sokakların denize vardıkları noktalarda bulunan kayıkhanelerden saatlik ücretle kayık kiralanır, kadın erkek kürek çekmeyi bilir, kayıktan denize girilirdi. Bazı gençler dalıp iskele ayaklarından midye toplar bazıları ise sığ kumda zıpkınla vatos avlarlardı. Sokaklardan dondurmacılar geçerdi o zamanlar. Simdiki gibi binbir çeşit ne gezer 'Dondurma, Kaymaaak' diye bağıran dondurmacının küçücük arabasında sadece kaymaklı ve limonlu dondurma olur, bazen ise çeşit olsun diye vişneli bulunurdu.

Caddebostan Plajı'nın yanı sıra bir de üyelikle girilebilen klüpler vardı. Marmara Yelken Klubü başta olmak üzere, Balıkadamlar, Caddebostan Yat Klübü ve İstanbul Yelken. Eğer bunlardan birine üyeyseniz veya üye bir arkadaşınız varsa bazı sporları yapma veya izleme olanağınız olur, voleybol, ping pong oynar, kıyıdan yelkenlilerin yarışlarını izlerdiniz. Denizin ortasında ise köfteciler vardı. Bunlardan aklımda kalanı ise mayomuzun kenarına sıkıştırdığımız parayla yüzdüğümüz, veya kayıkla yanaştığımız 'Fıştak'tı. Dönerken yüzülüyorsa demirlemiş kayıklara tutuna tutuna, dinlene dinlene yüzülürdü.

Akşamüstüne doğru herkesi bir 'piyasa' heyecanı alırdı. Saçlar yıkanır, bildiğımız ütüyle ütülenerek düzeltilir, ve (Bağdat) Cadde'ye binbir tur atmaya çıkılırdı. Bir aşağı, bir yukarı. Parkur ise genellikle Santral Durağı'ndan Saşkınbakkala kadardı. O zaman 'cafe' adeti bir elin parmaklarını geçmez, 'Borsa'da yer bulabilmek için hızlı davranmak gerekir, 'Divan' ise gençlere çok pahalı geldiğinden ancak hafif 'yaşı geçmiş'lerin duraklama mekanı olurdu. Hali varaba sahiakti oldukça yerinde olan birkaç genç ise bir aşağı bir yukarı arabayla giderek Mustang veya Corvette'leriyle gelene geçene hava atarlardı.

Geceleri ise açık hava sinemalarının keyfine doyulmazdı. Caddebostan'daki Ozan Sineması'nda genellikle Türk filmleri oynar, çıkınca biraz aşağıda, Caddebostan Maksim Gazino'sunun (MIGROS)yakınındaki büfe'de 'zümküfül' yenirdi (Bir çeşit sosisli sandoviç ) Yabancı filmlerin mekanı ise Budak Sineması'ydı (Şimdiki CKM). Yastıgını kapıp tahta iskemlelere yerleştirdikten sonra, çekirdeğini çıtlatarak izlenirdi filmler. Bazen bu sinemalarda Cem Karaca gibi o zamanın ünlü sesleri konserler verir, bazıları ağaç tepelerinden konser izlerdi.

Sonra sonra o köşkler birer birer yıkılmaya, yerlerin uzun uzun binalar dikilmeye, Cadde'deki evlerin yerlerini dükkanlar almaya, arabalar çoğalmaya, faytonlar yok olmaya, tekerlekli dondurmacıların yerini Algida'cılar almaya başladı. Ama ne mutlu ki tüm büyümeler, kalabalıklaşmalar rağmen 'Cadde'yi bozmayı başaramadı! O hala 'Cadde', İstanbul'un ,Türkiye'nin en güzide caddesi hala boydan boya yürümekten zevk aldığım, bir yerde oturup geleni geçeni izlemenin keyfini her yıl bir iki hafta yaşayabildiğim bir yer.

Galata' ya dogru...

Galata' ya dogru...

The best way to improve health care requires physicians and other stakeholders

My honest approach for how to improve the care is to support a methodology such as being self-serving. I would like to start a program to introduce a software-based point-of-care tool for obtaining patient feedback. This real time information can be used with clients to positively impact the patient experience, nurse engagement, physician (soft skills) competence and overall quality. In my perspective the criteria for fulfilling the demand for finding the best way to improve healthcare is that it need be simple to implement, impactful and cost effective. The most impact to healthcare improvement will come from process improvement and healthcare provider recruitment AND retention. The by-products will be reduced cost of care and improved patient satisfaction. This applies to hospitals and private practices. Based on current studies and the economy, supplying adequate healthcare to the community is already tough and is going to get more challenging. Recruiting sufficient healthcare coverage will boost revenue and provide some improvement to patient satisfaction (wait time and access). However, failure to retain the medical staff will significantly hurt the outcome. With high demand and low supply, it will be well worth the time and money to present "we have the greenest pastures here". The method mentioned above may be called such as point-of-care through successful implementations that may turn in to popular key parts of process improvement. You need to have some feedback from the patients and the physicians in order to measure the processes that should be or are currently being improved. In order to achieve this you have to create the acronym HOSPITAL to help those in Healthcare recall the numbers of different types of inefficiencies in any medical facility. Those who have been exposed to Six Sigma and Lean have an appreciation for improvement opportunities and generally view things through differently trained eyes that can see within all those facilities. Publishing the results of the similar programs online may offer a transparent access to the consumers to monitor these inefficiencies. Welcoming any feedback relative to this and encourage your staff to consider this method or similar training methods for their teams will be highly critical for the outcome. We have to understand that it is impossible to solve a problem that we are unaware of. By providing even the most basic tools at the lowest level possible, these problems have a way of surfacing. While everyone recognizes that healthcare systems and organizations need to improve, I think not enough time is spent on firstly identifying the key stakeholders, and secondly properly ENGAGING them. I strongly believe that not enough time is spent trying to engage physicians in this process. In my experience too many of these "improvement strategies" are top-down decisions by non-clinical managers who failed to conduct any research into what physicians might want or what stumbling blocks there are/were to get them to adopt the new technologies. EMR/EHR/CPOE are prime examples - all of these require a breakdown in the normal activity flow of providers, as it requires them to either find and log on to a terminal or carry a bulky instrument. Almost all clients and colleagues I have worked with resent and resist those methods. And look how few MDs are part of Healthcare consulting firm teams. IMHO, I believe more energy should be spent engaging rather than alienating MDs as a first step, then doing the same for patients in order to get buy in from the two key stakeholders as I see it. I've always found that engaging these stakeholders on projects from the beginning results in more buy-in and most importantly, better recommendations/outcomes (a better product).

ULTIMATE RESULTS

ULTIMATE RESULTS

Ilhan Arsel

Ilhan Arsel

BJK FOREVER

BJK FOREVER
Karga kartalların sırtına oturur ve boynunu ısırır. Kartal cevap vermez, kargayla savaşmaz; kargaya zaman veya enerji harcamaz, bunun yerine sadece kanatlarını açar ve göklerde yükselmeye başlar. Uçuş ne kadar yüksek olursa, karganın nefes alması o kadar zor olur ve sonunda karga oksijen eksikliği nedeniyle düşer. Kartaldan öğrenin ve kargalarla savaşmayın, sadece yükselmeye devam edin. Yolculuk için gelebilirler ama yakında düşecekler. Dikkat dağıtıcı şeylere yenik düşmenize izin vermeyin....yukarıdaki şeylere odaklanmaya devam edin ve yükselmeye devam edin!! Kartal ve Karga dersi