A Liberal Sensibility in an Election Year

Liberal this - liberal that.  The neocon pundits constantly equate being a liberal with all manner of evils.  In an election year these kinds of things become more important.  But what is a liberal?   I don't claim to know.  But I am considered a liberal (I consider it a complement) and this is what I believe.
I believe in the most fundamental of liberal precepts; 'Do unto others as you would have them do unto you'.

I believe that the preservation of liberty requires a strong defense; but the incestuous and ruinous feeding of the military industrial complex is not the same thing as security.

I believe that civic investment would be greatly aided by a term of national service.

I believe that being a just and fair people is a heavy burden that our enemies might exploit; but the far greater danger is from those among us who would exploit fear to erode our liberty from within.

I believe in the precepts of Life, Liberty, and the Pursuit of Happiness; but this does'nt guarantee contentment or success - merely that the law and opportunities should be fairly and equally applied.

I believe that a country as great as this must chose to aid those of its fellows who are in need through no fault of their own. The greatness of a nation is really measured by how it treats the least fortunate of its people.

I believe in accountability: personal, professional, financial, legal, corporate, governmental, journalistic and societal.

I believe that truth and honesty are more important than winning.

I believe that foreign debt brings foreign influence that isn't always supportive of the best interests of our people.

I believe that immigrants refresh the well of national ambition and hope and prevent the social stagnation that limits other nations.

I believe that accepting cultural difference does not mean tolerating abuses of human rights.

I believe that public education is crucial to the preservation of liberty by the elimination of ignorance and the expansion of opportunity for all citizens and as such deserves every resource we can muster.

I believe in being open-minded but that doesn't mean endless debate on fringe beliefs.

I accept that people should be free to believe as they will, but that it is reasonable and prudent to consider the effect of revealed beliefs on the critical thinking skills required of those who would govern.

I believe that government money should not support promote or sustain any organizations or activities based on any faith or creed.

I believe that if faiths wish to participate in the political process then they should no longer be afforded unfair benefits such as freedom from taxation.

I believe that the cold perspective of science and the application of the scientific method are our best hope for addressing social, moral and national needs both now and for our future.

I believe in living within our means both personally and nationally which means hard choices that should be shared equally by all.

I believe that neither unbridled capitalism nor socialism is a viable and stable long term economic model. There is a happy medium.  A just system must reward ambition, innovation and hard work while punishing greed, deception and predation.

I accept that wealth confers many advantages but having a disproportionate influence on public policy should not be one.

I believe that government is the least corrupt of our choices for providing for the common good. 

I believe that while a conservative wants his or her children to be better off than they, I believe a true liberal wants his or her children to be better people than we.


ScoobyDoo - The Greatest Moral of any Children's Cartoon?

The moral of every episode of ScoobyDoo: All mystical things are the work of some bozo in a mask or a costume trying to manipulate impressionable people for personal gain.

Try to come up with a better lesson than that!


America's Trinity

Of America's Trinity of obsessions, which one doesn't really fit with the other two?


The Agony and the Irony: Jersey Edition

The Agony?  - that in the 21st century people still flock to these kinds of things as evidence of the miraculous.  The Irony? - look at the picture and think for a second...


Innovation Challenged Grant

Part of the Accountable Care Act legislation established a new department within HHS' Center for Medicare and Medicaid Services (CMS) - the Center for Medicare and Medicaid Innovation (CMMI).  Ten billion dollars were earmarked for the funding of 'innovative solutions' to healthcare reform.  Many people (myself included) believed that CMMI was created to try out newer more high risk alternatives to reform while the band-aid solutions provided by other parts of the ACA bought time.   Allegedly thousands of experts and innovators were interviewed to get a sense of what was out there on the horizon. 
About half the money was spent on low hanging fruit projects that are not particularly innovative but at least had some successful precedent.  If you look over their website you can see the projects they funded.   If you can't quite figure how some of those projects would ultimately change the game all that much, well you aren't alone.
Nevertheless, the promise still remained.  CMMI announced a 1 billion dollar grant for the most innovative projects it could find - the widely anticipated Innovation Challenge Grant!  This was the announcement that a lot of people had been waiting for.  The program announcement was bold and it looked like they were finally looking for moonshots.  More than 3000 applications representing 10,000 or so organizations applied.  Some of the best and brightest people in the country were involved.

Applicants were  given 40 pages of double spaced text - to explain how they would change healthcare, save billions, train new kinds of clinical providers, and restructure the healthcare system - in 6 months or less.  CMMI promised to review all the applications in record time.  This left few people who weren't applying to review the submissions and little time to dive into the details. The first inclinations of trouble was when they announced that an NIH style of review would be used but with a turnaround of weeks not the usual months. 

About 700 applications were quickly rejected - probably because they messed up on some draconian formatting requirement that is often used on government grant applications.  The announcement date came and went.  CMMI announced that they would have to extend the review dates, a couple of days before it was scheduled.  Presumably it came as a surprise 2 days before the deadline that they weren't yet done. 

A lot of people defend and argue against the way NIH conducts its peer reviewed grant evaluations.  Some people claim its the best and most honest mechanism for identifying promising projects and others accuse it of being little more than anonymous academic cronyism.  The truth, like most things, is a little of both.  It does appear with some regularity that a lot of the same people seem to be getting grants to do a lot of the same things they did before.  Personally, I think the anonymity is a mistake.  Too often, success comes down to the luck of the draw - who gets assigned the initial review.  If they don't like it, well then you're toast.  I reviewed one submission before it went in.  When I was shown the terse and condescending review notes they got back, it was clear to me that at least two of the reviewers hadn't read the proposal very carefully.   Mitigators to their damning criticisms had been well described in the paper.  And in one instance they clearly had not studied the model at all.  Snark in peer review is poor form in my opinion, but particularly so when one does a slipshod job of review.  You won't hear much carping about this sort of thing usually.  People are afraid of ticking off the powers that be so that future grants are at risk.

But what about the innovation challenge?  CMMI announced the winners to great fanfare.  You should go look at their site and see what they thought were the most innovative projects of the 3000.  Most of my colleagues were disappointed.  One went so far as to say that he must have misread the original announcement - he said it must have really said Innovation challenged...

No doubt there are some good projects in there but none is a moonshot by a long shot.  None will control costs to the degree required for the long term.  Some of the claims for cost savings proposed by some of these projects are pure fantasy.  The most technically sophisticated project is using technology that was new 15 years ago.  Most of the money went to large academic centers and health systems - you know, the ones that spend all the money now ;)  I may be wrong but I suspect it will be a huge missed opportunity.    I can see spending most of the CMMI money on more easily obtainable goals, but wouldn't it have been nice if some part of it had been pointed at the moon?