Long-Term Care vs. Medical Costs

Nicholas Kristof relates the story of a friend who divorced her husband in order to avoid having to contribute to his long-term care costs.

If M.’s husband required long-term care, the costs would be catastrophic even for a middle-class family with savings.

Eventually, after the expenses whittled away their combined assets, her husband could go on Medicaid — but by then their children’s nest egg would be gone, along with her 401(k) plan. She would face a bleak retirement with neither her husband nor her savings.

A complicating factor was that this was a second marriage. M.’s first husband had died, leaving an inheritance that he had intended for their children. She and her second husband had a prenuptial agreement, but that would not protect her assets from his medical expenses.

It should be noted that although we treat long-term care costs in many ways as medical costs, they're a somewhat different creature. Absent Medicare or Medicaid coverage, long-term care is generally not covered by even the goldest of gold-plated health insurance. Instead, it's separately insured as (surprise!) "long-term care insurance".

My wife was recently offered the opportunity to buy long-term care coverage as a benefit at work. The price was reasonable, due to her age, but coverage was not available for anybody else in the family. The limits on raising premiums were big enough to drive a truck through - with the cost of insurance also jumping considerably at various age thresholds. It was nice of her employer to make the effort, but it wasn't a good deal for her. As with any choice not to carry insurance, we're playing the odds.

Kristof's friend and her husband made two mistakes, the first of which may have been consistent with the odds at the time the decision was made: they chose not to obtain long-term care insurance, and they chose not to engage in estate planning that would have involved both protecting separate assets and intended inheritances, as well as preparing for possible disability and Medicaid eligibility. Kristof is arguing that, as a rule, society should pick up the cost of long-term care. And that can be part of the current debate - whether long-term care should be included as a basic benefit in health insurance plans. But as it stands, if you don't insure for long-term care, you can expect to pay for a good portion of it - and the trend is for states to be more aggressive in pursuing the assets of people receiving Medicaid benefits, not less so.

But let's not forget, somebody is paying for long-term care. If it's not the recipient of the care, or that person's family, then it's the taxpayer. It's not at all unreasonable as a public policy for the taxpayers to say, "You need to contribute significantly to your own costs of care before we step in." It's possible to increase the exemptions for long-term care, such that the effect on somebody like M. is less pronounced, but why should a taxpayer in effect subsidize her children's inheritance - paying for her husband's care so that her kids can inherit more money?

It should also be remembered that we're talking about more than long-term care for the elderly. We're talking about any recipient of Medicaid or government disability benefits, at any age. There are young people who don't marry because, as one or both of them are disabled, they would have their benefits cut as a result of their combined marital income. There are parents who either don't leave money to disabled children, or who construct special needs trusts that control how the money can be used, in order to keep the inheritance from being taken by the state as reimbursement for the cost of Medicaid. An argument can be made in each of these contexts that the care or benefits should be provided without respect for need, but again there's a countervailing argument that people who can afford to pay for their own care should do so before asking the taxpayer to take over.

The current situation does create absurd outcomes. People do marry in a church but without getting a marriage license, while others live together as spouses, living lives every bit as committed as those in "real" marriage but flying under the government radar. Some, like M., are divorced "in name only", continuing to live with and care for their spouse. But here's something to remember - as long as we impose any income or asset threshold on government benefits, the same "unfairness" will continue to exist. If we raise the threshold we reduce the number of people who are asked to pay for part or all of their own care, or to experience a reduction in their benefits due to their total household income, but we increase the burden on the taxpayer.

If Kristof is trying to make the argument that 100% of long-term care costs should be paid out of tax revenues, it's a perfectly legitimate argument to make - but he doesn't quite come out and say that. I suspect he would concede that some people are wealthy enough that they should pay at least part of that cost. I don't personally see any way to provide universal long-term care insurance, with no means testing, without a significant increase in tax revenues or deficit spending.

If your goal is to stay with the spouse you love, while still protecting your separate assets and preserving inheritances you intended for children from a prior marriage, consult a good estate planning lawyer. (Kristof's tale suggests that when M. married her husband she had considerably more money than him, hence the prenuptial agreement that protects her in divorce but not in his illness. A prenuptial agreement is not an estate plan.)

It's Important To Be Pro-Life....

Except when it counts? Or is that when it's most important that the state dictate your (lack of) choice?

Ross Douthat ploddingly repeats a tired old argument on abortion rights and Down syndrome:

For abortion opponents, cruel ironies abounded in this sibling disagreement. Because of Eunice Shriver’s work with the developmentally disabled, a group of Americans who had once been marginalized and hidden away - or lobotomized, like her sister Rosemary - was ushered closer to full participation in ordinary human life. But because of laws that her brother unstintingly supported, that same group was ushered out again: the abortion rate for fetuses diagnosed with Down syndrome, for instance, is estimated to be as high as 90 percent.

Now we could start by looking at facts. You know, Kennedy's support for universal healthcare and SCHIP. By helping families afford to care for their developmentally disabled children through programs largely opposed and restricted by Republicans, liberals like Kennedy made it easier for families to "choose life". But lets run with Douthat's "facts be damned" approach. When Michael Gerson trotted out that same statistic, I responded with what should be obvious to even a mediocre thinker:

Do you suppose he has evidence that parents who self-classify as conservatives don't choose abortion when they learn that they are expecting a Down syndrome child? Well, he says, "In America, the lives of about nine of 10 children with Down syndrome are ended before birth." So either Gerson has to admit that American conservatives are a big part of what he describes as the problem, or argue that significantly less than 10% of Americans are "conservative."

I guess there's one more possibility: He could be arguing that while liberals fret over the conflict between humanitarianism and egalitarianism, conservatives are skipping the debate and heading straight to Planned Parenthood.

Seriously, that statistic can mean only one thing: When confronted with a very tough choice - one that Gerson and Douthat would strip away from them - the overwhelming majority of pro-life parents suddenly find that they prefer to live in a pro-choice world.

Now remember, the abortion issue is one of Douthat's favorite topics, if not his absolute favorite. If he understands anything, it's this issue. As much as he complains that Kennedy was firmly pro-choice, Douthat's an embodiment of pro-life absolutism. Thus, it's fair to take him to task for this:

[I]n Planned Parenthood v. Casey, the Supreme Court upheld a near-absolute right to terminate a pregnancy - a decision made possible by her brother’s demagogic assault on Robert Bork five years earlier, which helped doom Bork’s nomination to the court.

Did you follow that? Douthat, a supposed conservative Republican (and yes, he expressly declared himself a Republican on Bill Maher's show just a couple of weeks ago), whining that his party wasn't able to stack the Supreme Court and legislate from the bench.

First we have the illogic of his "for want of a nail" argument. Apparently, Douthat takes great umbrage that Kennedy said of Bork, "Robert Bork's America is a land in which women would be forced into back-alley abortions", because but for such "demagogy" abortion might now be illegal.

Douthat also flat-out lies about the holding of Casey, which largely upheld state law restrictions on access to abortion. Other than spousal notification laws, what common restriction on access to abortion has been found to constitute an "undue burden" under Casey?

Douthat closes with yet another distortion, one that suggests that he's succumbing to the temptation of regurgitating his party's weekly memo instead of providing actual (or factual) analysis:

And it’s entirely fitting, given his record, that Kennedy’s immediate legacy is a draft of health-care legislation that pursues an eminently Catholic goal - expanding access to medical care - through a system that seems likely, in its present design, to subsidize abortion.

Nothing in the current healthcare proposals would have any effect on the Hyde Amendment or its prohibition on using federal funds to pay for abortions.

Update: Dana Goldstein points out yet another piece of legislation Kennedy sponsored:

In 2005, Kennedy co-sponsored a bill - the Prenatally and Postnatally Diagnosed Conditions Awareness Act -- that expanded federal financing for support programs for expectant and new parents who receive a Down syndrome diagnosis. Research shows that doctors delivering such a diagnosis often share very little information about living with the disease, and presume that the patient would prefer to terminate her pregnancy. Indeed, about 90 percent of couples who receive a prenatal Down syndrome diagnosis do choose abortion. But enriched by his sister Rosemary's life, Kennedy sought to link expectant and new parents with mentor families already raising a child with Down syndrome, as well as create a national registry of families willing to adopt disabled infants.

Once again, the opposite of what Douthat was implying.

Update II: Ruth Marcus addresses the abortion factor, noting how the issue has historically been treated, and (without naming names) how people (like Douthat?) are distorting the issue in an effort to derail healthcare reform.

The Perils of Gold-Plated Health Insurance

Bill Moyers, commenting on the failure of Democrats to back their President, observed,

"too many Democrats have had their spines surgically removed."

Ironically, I understand that spine removal is a covered benefit under the health plans offered by the federal government. Had Democratic Members of Congress, for example, been struggling under the inadequate coverage given to tens of millions of Americans, or had they been uninsured and had to cough up their own money to pay for their spine removal surgeries, the reform debate would probably be over by now.

Silver Spoons, Together....

Glenn Greenwald on our meritocracy, with G.W.'s daughter Jenna being hired on as a "Today" correspondent:

They should convene a panel for the next Meet the Press with Jenna Bush Hager, Luke Russert, Liz Cheney, Megan McCain and Jonah Goldberg, and they should have Chris Wallace moderate it. They can all bash affirmative action and talk about how vitally important it is that the U.S. remain a Great Meritocracy because it's really unfair for anything other than merit to determine position and employment. They can interview Lisa Murkowski, Evan Bayh, Jeb Bush, Bob Casey, Mark Pryor, Jay Rockefeller, Dan Lipinksi, and Harold Ford, Jr. about personal responsibility and the virtues of self-sufficiency. Bill Kristol, Tucker Carlson and John Podhoretz can provide moving commentary on how America is so special because all that matters is merit, not who you know or where you come from. There's a virtually endless list of politically well-placed guests equally qualified to talk on such matters.

If you're looking for that list, at least in terms of political legacies and dynasties, here's a good start.

Because A Commission Would Satisfy Everybody

Fred Hiatt lectures Obama that if he doesn't intervene in the Justice Department and stop the possibility of the prosecution of CIA agents whose abuse of detainees exceeded what even Dick Cheney deemed allowable, there will be

a series of debilitating revelations, prosecutions and arguments that could drip-drip-drip through the full length of his presidency.

Yeah. Sure. Whatever. So what does Hiatt propose as an alternative?

But a fair-minded commission -- co-chaired by, say, former Supreme Court justices Sandra Day O'Connor and David Souter - could help the nation come to grips with its past and show the world that America is serious about doing so. It could help Americans understand how this country came to engage in what many regard as vile and un-American practices. It might help the country respond better the next time it is frightened.

Right. Because after the appointment of a commission led by a former Supreme Court Justice or two, lengthy hearings and, no doubt, an extremely long report summarizing their findings, everybody will be happy, there will be no accusations of cover-up or a conspiracy, and no further accusations or calls for investigation. No movies years later rehashing the cover-up and conspiracies. Nope, couldn't happen.

But I'm being unfair to Fred. This solution will make him happy, and that should be good enough for everybody else.

Destroying Fine Art

Rob Zombie is saving us from the possibility of inferior sequels to last year's Halloween remake....

In summer 2007, just weeks before the big-screen arrival of his "Halloween" reboot, director Rob Zombie said he was done with the franchise....

Then a couple of things happened: The movie became the #1 movie of the Labor Day weekend, and Zombie found out what other filmmakers were planning to do with the series he'd pulled off the horror-franchise scrap heap.

"I just got protective of the series, because I had spent so much time trying to revive the whole thing that it looked like they were just going to go back in and destroy it," he told MTV News recently.

Yes, heaven forbid another director might come along and make a sequel to a horror movie retread that, unlike Zombie's film, is actually scary.

And The Missing Letter Is....

"Y"? Kind of... Mikey Mouse, if you ask me.

I think even Mr. Potatoe Head could have spelled that one.

Google Land

Last night, as we tucked her into bed, our four-year-old daughter started to tell us about "Google Land".

Google land is full of smart people.

There are no lines in Google Land.

Everything is free in Google land. They have free food, and free pop and free chocolate.

There are dumb people in Google Land, but they have to pay.

Pretty close.¹
__________

1. I suspect that if I ask her teacher, I'll find out that either one of her classmates' parents works for Google, or they had a visitor come in from Google's local office. I would ask at Google's local office, but now I'm afraid they would charge me for the information. ;-)

Honest Politicians?

It's a shame that it's seen as a surprise, rather than something to be expected:

As a presidential candidate, Barack Obama pledged to right the wrongs he said bogged down efforts to rebuild the Gulf Coast after Hurricane Katrina. Seven months into the job, he's earning high praise from some unlikely places.

Gov. Bobby Jindal, R-La., says Obama's team has brought a more practical and flexible approach. Many local officials offer similar reviews. Even Doug O'Dell, former President George W. Bush's recovery coordinator, says the Obama administration's "new vision" appears to be turning things around.

Not too long ago, Jindal said in a telephone interview, Louisiana governors didn't have "very many positive things" to say about the Federal Emergency Management Agency.

But Jindal said he had a lot of respect for the current FEMA chief, Craig Fugate, and his team. "There is a sense of momentum and a desire to get things done," the governor said.

Added O'Dell: "I think the results are self-evident."

Kudos to Jindal and O'Dell for giving credit where credit is due. Politicians on both sides of the aisle, please take note.

"Meretricious"

The Non Sequitur takes on George Will's Kennedy eulogy. The quote at issue,

Kennedy's second-most memorable speech, a remarkably meretricious denunciation of Robert Bork, demonstrated the merely contingent connection between truth and rhetorical potency.

The use of a term like "meretricious" is, I think, intended by Will to disguise the true meaning of his statement. If you read older case law, particularly family law cases, you'll see references to "meretricious relationships". If you don't know what the word means, you could glide right past it, or even think it's a compliment... "He said something about Kennedy's speech having merit".

Whatever excuses the Post throws up from time to time about not editing its columnists, do you think the editorial would have gone to print in that form had Will described Kennedy's speech as "whore-like", rather than hiding behind an equivalent but less obvious term?

Never Mind What, Again?

David Ignatius, who I believe to be a sincere defender of the U.S. intelligence community, instructs us,

CIA officers aren't idiots. They knew they were heading into deep water - legally and morally - when they signed up for the interrogation program. That's part of the agency's ethos - doing the hard jobs that other departments prudently avoid. They hoped their government would protect them from future reprisals, but the graybeards were always dubious about the politicians' promises of support.

Not that I'm questioning the core assertions - CIA officers aren't idiots, and they had good reason to disbelieve any promises of the party in power that no abuses would be investigated or prosecuted - but Ignatius fails to inform us exactly which politicians promised them that acts of torture would be immune from legal scrutiny. I'm not sure if Ignatius is telling us that it would have been stupid for a CIA officer to believe a circular, self-serving argument that "anything the executive authorizes is okay," or if he's telling us that it would be stupid for them to believe a politician's promise of immunity in any context. But it's interesting that he seems to simultaneously argue that the CIA never relied upon the Bush era promises, yet that those promises should nonetheless restrict successor administrations.

It's sad, I think, that Ignatius doesn't understand that it would be terrible public policy to allow politicians to immunize government workers of any sort from immunity with a mere promise, even a promise that was not believed, that "your actions are legal" or "you'll never be prosecuted even if a judge disagrees with me." Even if the politician also offered them a legal memo from one of his underlings. The CIA agents at issue swore to defend the Constitution, not to bend to the will of the President or Vice President. If their own opinion was "this is not legal", why would they take a politician's word for anything?

And why does Ignatius believe their deference, particularly in the face of the strong doubts he identifies, should justify immunity? I know that there's always a double-standard when armed conflicts are involved, but in the past we of the United States have unapologetically prosecuted people for war crimes with a deaf ear to the defense, "I was just following orders." Whatever compelling arguments may be made against prosecution, you won't find them in Ignatius's column.

As so often happens in our country, the cynics were proved right: Despite President Obama's fine talk about looking forward, not backward, Attorney General Eric Holder decided this week that the CIA interrogators will face yet another criminal review of conduct that they were assured by the Bush administration was legal. No matter that the same evidence was provided five years ago to career prosecutors, who decided against bringing cases.

Which "career prosecutors" declined to bring charges? What was the substance of their determination - its basis in law? If Ignatius can't answer the first question he has no business trying to buttress their credibility - maybe the decision was made by somebody like Monica Goodling. If he can't answer the second, he's flying blind. Maybe we're back in the same circle of reasoning advanced by Ignatius, with the depth of the review amounting to "If the President says it's legal, it's legal":

Looking back, it's easy to say the CIA officers should have refused the assignments they suspected would come back to haunt them. But questioning presidential orders isn't really their job, especially when those orders are backed by Justice Department legal opinions.

But let's accept that and pretend, like Ignatius, that CIA officers swear to defer to the President instead of upholding the Constitution. If prosecutions result from the current process it will be of people whose actions went beyond what even the Bush Administration authorized. So the only objection Ignatius has raised which could be relevant is that a "career prosecutors" who may not in fact be either plural in number or have any actual experience as prosecutors, but were employed in the most politicized Justice Department in living history, chose not to authorize charges that would have severely embarrassed the Bush Administration? Well, you have to admit, it's a compelling argument. [cough]

What will happen the next time the White House wants the CIA to do something that's potentially controversial? Well, you know the answer. The CIA officers will want to talk to their lawyers, and maybe then to lawyers from the party out of power. That's not the ideal mind-set for a modern intelligence service. But the republic will survive.

Overlooking his hyperbole for the moment, who, other than Ignatius, Rush Limbaugh, Glenn Beck, Dick Cheney, and possibly the CIA officers who felt too constrained by the Bush Administration's torture authorization and now may face prosecution, wouldn't add, "And may well be stronger for it."¹ Why is it less than ideal for the CIA to say, "Our lawyers disagree that torture is legal, so maybe they can meet with your lawyers and hash out something that everybody is comfortable with."

Perhaps the biggest lesson here could be drawn from Ignatius's declaration that the CIA wasn't in the interrogation business at the start of this process, had "zero internal expertise" and lacked both the skills or manpower to develop an interrogation program in-house, and had serious concerns about the legality of the program and of the possibility of future prosecutions. Sometimes when you're heading toward a traffic light that by all appearances is a very late yellow, maybe an early red, you should defer to your better judgment and put your foot on the brake.
__________

1. It's a rhetorical question and yes, I know I can add Michelle Malkin, Sarah Palin, John Boehner, Ann Coulter, and similarly strong thinkers to the list.

Who Did This Guy Used To Work For, Again?

After repeatedly succumbing to the childish temptation to label healthcare reform "Obamacare", Michael Gerson lectures,

A party-line, Democratic transformation of American health care in this environment - in the midst of decisively losing a public argument - would smack of power-hungry radicalism, more the liberalism of Robespierre than Jefferson.

Even ignoring Gerson's self-serving presumptions about a "public argument" inflamed by the deliberate lies of his friends and peers, it seems fair to ask: Is he truly that offended that the Democrats might act like Bush-era Republicans?

Back when Bush was in office, Gerson would surely have been telling us that ignoring public sentiments and Democratic opposition while forging ahead with a legislative or war agenda represented "leadership". Filibusters or the threats thereof would likely have been deemed obstructionist. But as they say, now that his ox may be getting gored....

You know what else? Sometimes, forging ahead with your agenda despite the obstacles actually is leadership. It's fine for Gerson to simultaneously smirk that the failure to pass healthcare reform and its passage would both represent failures by Obama - after all, that's what his party memo tells him to say. But enough of this world of make-believe with death panels, the end of Medicare, and everything Obama does or doesn't do pre-defined as failure.

Having a Volunteer Military

I'll give Bob Herbert his due, as he was drafted into military service and served in Korea. But when he speaks of the modern, volunteer military, I disagree with some of his contentions. He's completely right, in my opinion, that many members of the public don't appreciate what's involved in military service (and arguably you can't fully appreciate what's involved unless you've served in combat), but that's in no small part a matter of design - a political convenience advanced by the Bush Administration and continued under Obama.

As long as media coverage of casualties remains low, there's little pressure to change present policies. No doubt, the book Herbert mentions contains chilling pictures of the casualties of war, but if you're shocked by them it's because the mainstream media has decided it's distasteful, exploitive, or [insert excuse of the day] to run them.

America’s young fighting men and women have to make these multiple tours because the overwhelming majority of the American people want no part of the nation’s wars. They don’t want to serve, they don’t want to make any sacrifices here on the home front — they don’t even want to pay the taxes that would be needed to raise the money to pay for the wars. We just add the trillions to deficits that stretch as far as the eye can see.

It's hard to argue with that. Again, that's the fruit of deliberate political policy. The Bush Administration's response when asked about sacrifice on the home front? It boiled down to "Ignore the war and keep on spending." If you took the Republican Members of Congress who were the strongest advocates of the Iraq War they would still howl like banshees at the notion of raising taxes to pay for the war, even as they use the cost of the war as an excuse for opposing healthcare reform, stimulus bills, or similar initiatives.

But Herbert continues,

A clear idea of the pathetic unwillingness of the American people to share in the sacrifices of these wars can be gleaned from a comment that President Obama made in his address last week to the Veterans of Foreign Wars. “We are a country of more than 300 million Americans,” he said. “Less than 1 percent wears the uniform.”

The president was not chiding those who are not serving, he was only intending to praise those who are. But the idea that so few are willing to serve at a time when the nation is fighting two long wars is a profound indictment on the society.

Well, yes and no. It's an indictment of our present political culture that praises ever soldier as a hero while burying the most painful illustrations of sacrifice. For individual members of society, I think it's a fair indictment of the "fighting typists" - the faction of the Republican Party that expressed unbridled support for the war in word but not in deed. The Rush Limbaughs and Dick Cheneys of this world always have "other priorities".

Does it indict those who argued that the Iraq war was a war of choice, would put an undue burden on the military and jeopardize the mission in Afghanistan? Not so much. Had Bush not launched the war in Iraq, we wouldn't even be having this discussion. If Obama succeeds in significantly reducing troop levels in Iraq, we wouldn't need this discussion.

But even taken at face value, the argument has its limits. Yes, if we had more volunteers we would have a reduced need for "stop loss" and might even be able to eliminate it. But how many more volunteers do we actually need? If you raised the number of volunteers from "less than 1 percent" to 1%, you would likely exceed capacity. If you believe the need is to put 650,000 combat troops into Afghanistan and Iraq, you must have the capacity to train, support and supply those troops - you're talking about adding millions of people to the military. And in fairness to the American public, after 9/11 there was great interest in joining the military.

Five years after military recruiting hit the ceiling after the Sept. 11, 2001, terror attacks, recruiting remains solid, with every service meeting its active-duty recruiting goal for the 15th consecutive month.

To the extent that interest in joining the military has declined, it's less an indictment of society than it is of the Iraq war and the Bush Administration.

Herbert continues,

If we had a draft — or merely the threat of a draft — we would not be in Iraq or Afghanistan. But we don’t have a draft so it’s safe for most of the nation to be mindless about waging war. Other people’s children are going to the slaughter.

I disagree with this, as well. I recognize the talking point that, with a draft, people will oppose entering wars of choice. but... let's take another look at Herbert's résumé:

He was drafted during the buildup to the Vietnam War, but was ultimately sent to Korea.

Which of those two wars was prevented by the fact that there was a draft? For that matter, what war in any country has ever been prevented by virtue of conscription? To put it another way, with conscription in place, was the country not largely supportive of the Vietnam War at its inception, as it was with Iraq?

If you want to learn about the sacrifice of soldiers, you have to work at it. It's not in the mainstream media. Beyond platitudinous expressions like "support our troops" it's not in the right-wing media. It may well be that our political leaders and media conglomerates are right - we don't want to hear about it - and if true that is an indictment of our society. But it's more of an indictment of our media and political system.

Jealous, Much?

I appreciate as much as anyone Joe Klein's ongoing effort to rehabilitate himself, having stumbled around on the job for quite a few years of the Bush Administration. But you don't need to read the last half of Primary Colors to know that when Klein has an axe to grind, he'll grind it right down to the handle. I mean, there have been plenty of times in my life where I could have been stuck with the label, "Doesn't play well with others," but by some reports Klein gives it new meaning.

Before today I had completely forgotten Dan Okrent, let alone the rant he posted when leaving his post at the New York Times. Klein? Not so much. After bragging,

Here's how it should work: I'm a columnist and I have a right to my opinions but, in the words of Daniel Patrick Moynihan, I don't have a right to my own facts. And so every column I write is checked assiduously by Time Magazine researchers.

He eagerly recounts Okrent's column:

Several years ago, the first New York Times ombudsman, Dan Okrent, created a stir by pointing out factual errors in the columns of Paul Krugman and Maureen Dowd.

Well, actually, the facts are a bit different. Okrent wrote:

Op-Ed columnist Paul Krugman has the disturbing habit of shaping, slicing and selectively citing numbers in a fashion that pleases his acolytes but leaves him open to substantive assaults. Maureen Dowd was still writing that Alberto R. Gonzales "called the Geneva Conventions 'quaint' " nearly two months after a correction in the news pages noted that Gonzales had specifically applied the term to Geneva provisions about commissary privileges, athletic uniforms and scientific instruments. Before his retirement in January, William Safire vexed me with his chronic assertion of clear links between Al Qaeda and Saddam Hussein, based on evidence only he seemed to possess.

No one deserves the personal vituperation that regularly comes Dowd's way, and some of Krugman's enemies are every bit as ideological (and consequently unfair) as he is. But that doesn't mean that their boss, publisher Arthur O. Sulzberger Jr., shouldn't hold his columnists to higher standards.

I didn't give Krugman, Dowd or Safire the chance to respond before writing the last two paragraphs. I decided to impersonate an opinion columnist.

I would say Okrent behaved like a child, but that would be to insult my four-year-old.

What's missing from Okrents ad hominem abusive against Krugman? Any substance. He calls Krugman names and insults his work, but fails to identify or even hint at any actual error, misstatement or misrepresentation. For Dowd, he at least identifies one instance where she took a quote out of context. So in relation to mistakes, when Klein says "We all make them, by the way - being human and all that" and admits that he himself has actually made one, after adopting by reference Okrent's missive in relation to Krugman he needs to double that count.

Also, it's important to note that Krugman does not claim infallibility, and runs corrections in his columns. I doubt that Krugman would object to more strenuous fact-checking by an editorial staff, were one available. Klein seems to bristle at any suggestion that he's less than perfect, or that he should take personal ownership of the one mistake he admits to having made.

Good grief, the point of the editorial is to argue that editorials need to be factually accurate, and that newspapers should take responsibility for their inaccuracies. Klein and Time could have at least done themselves the favor of fact-checking what really does come across as a jealous, mean spirited opening. I wonder, has the Okrent column been sitting on Klein's desk for going on five years, just in case the opportunity arose to take a potshot at Krugman?

Giving Liars a Platform

In what could be take as evidence that the Washington Post editorial page has an anti-reform agenda, today Fred Hiatt rolls out the red carpet for an editorial by Michael Steele. Steele has, of course, been a leading voice in the GOP effort to frighten seniors into thinking that their healthcare is jeopardized by the reform bill, and in suggesting that seniors will face death panels which will decide if they deserve additional medical care.

Steele is a liar, a coward and a hypocrite, which perhaps makes him a good representative of what's left of his party.

At a certain point, I do think that the media should call out liars - declare, either directly or by simply declining to print their latest set of lies and deceptions, that their tactics render them undeserving of a platform. And yes, that also means on the editorial pages - excuses such as "it's a widely held view, so we're giving it space" don't hold water. Perhaps Sarah Palin proves that if you push things far enough there's still a tipping point, as I suspect a month or two ago the same editorial (perhaps penned by the same author) might have been published under her byline. But Steele has embraced every single lie that Palin and others associated with the anti-reform movement have advanced. He should be held accountable. And I suspect that had Palin handed Hiatt an editorial he would have run it - that the shift in spokesperson comes from the party's recognition that Palin has lost her credibility, not the paper's.

But more than that, Steele's yammering about a "Seniors' Health Care Bill of Rights" - a law that would "protect" Medicare recipients from having their benefits reduced, or even having the government attempt to negotiate better price terms with doctors and hospitals. This, as a representative of a party that has attempted to kill Medicare from its inception. Talk about spitting in the face of Reagan's legacy. Yes, the same party that hates Medicare and only a few years ago attempted to gut Social Security is now the champion of senior citizens' rights to unlimited entitlement benefits. And a shockingly high number of seniors believe them!

There's something a bit sad, and a bit too American, about getting a faction of citizens riled up because they may (in theory) see change in their free, taxpayer funded benefit if a similar benefit is made available to others. (I quote Grandpa Simpson on this attitude, perhaps too often.... "I didn't earn it, I don't need it, but if they miss one payment I'll raise hell!") The Republican Party's mantra, "Ask what your country can do for you...."

Update: There he goes again....

Such Bravery....

The Washington Post's editorial page criticizes Yale University Press for declining to include illustrations in a forthcoming book:

The scholarly work in question is Jytte Klausen's "Cartoons that Shook the World," a book about the 12 cartoons of the prophet Muhammad whose 2005 appearance in a Danish paper ignited a worldwide controversy. Yale University Press is publishing it in the fall -- or some of it. Not just the picture of the newspaper's controversial page of cartoons but all of the book's illustrations, which include a historical range of artistic depictions of the prophet, will be omitted. Why? Because what the Press described as a group of "counterterrorism officials . . . U.S. diplomats . . . foreign ambassadors from Muslim countries . . . and senior scholars in Islamic studies" -- without so much as reading the book -- deemed them too inflammatory to publish.

The Post asks, rhetorically,

If one of the world's most respected scholarly publishers cannot print these images in context in an academic work, who can?

Sometimes, though, a rhetorical question deserves an answer. Who could publish those images? The Washington Post could. So let's travel back in time:

Hundreds of readers have asked why The Post hasn't reprinted the Danish cartoons of the prophet Muhammad that inflamed Muslims around the world, leading to deadly protests and the burning of embassies. Some readers questioned the Post's journalistic courage....

Executive Editor Len Downie made the decision, consulting with other top editors. The issue, he said, is one of journalistic judgment, not courage.

Downie said, "This newspaper vigorously exercises its freedom of expression every day. In doing so, we have standards for accuracy, fairness and taste that our readers have come to expect from The Post. We decided that publishing these cartoons would violate our standards. This has not prevented us from reporting about them and the controversy in great detail in many stories over several days."

Then-Ombudsman Deborah Howell provided further explanation,

The Post's news standards include a prohibition on gratuitous nudity, obscenity and violence. "Defamatory or prejudicial words and phrases that perpetuate racial, religious or ethnic stereotypes are impermissible," the paper's stylebook says. This also applies to photos and drawings.

But that only explains why they weren't run on the news pages. What about the editorial page?

Hiatt also could have chosen to run the cartoons depicting Muhammad. Downie oversees the news pages. And the wall of separation between editorial and news is high, very high.

But Hiatt said he would have made the same decision. "I would not have chosen to publish them, given that they were designed to provoke and did not, in my opinion, add much to any important debate. Should our calculation change once the story becomes big, because the cartoons are suddenly 'newsworthy'? If it was essential to see them in order to understand the story, then maybe. But in this case, the dispute isn't really about what the cartoons look like . . . it's about the fact that he was depicted at all. The cartoons were easily explainable in words. Why reprint something you know will offend many of your readers?"

What was that? Let's back up for a minute. So we have John Donatich, the director of Yale University Press, explaining that

the recommendation to withdraw the images, including the historical ones of Muhammad, was “overwhelming and unanimous.” The cartoons are freely available on the Internet and can be accurately described in words, Mr. Donatich said, so reprinting them could be interpreted easily as gratuitous.

We have Fred Hiatt, back in 2006, justifying his parallel decision not to run the cartoons because they did not "add much to any important debate" and "were easily explainable in words"... you know, essentially what Donatich is saying. And now he's running an unsigned editorial accusing Yale of "self-censorship" that "establishes a dangerous precedent" and allows "violent extremists to set the terms of free speech". Pot, kettle, and all that.

With all due respect to Fred Hiatt, the issue here in no small part results from decisions like his own, justified on pretty much the same grounds as those offered by Yale University Press, to not run the cartoons. Had he and others in similar positions of editorial discretion run the cartoons, the issue would likely be over. The cartoons would be everywhere, and nobody reproducing them would have to feel like they were painting a target on their own (or their author's) forehead.¹ There would be nothing special or newsworthy about their decision. Yale's decision may well be self-censorship that empowers extremists but, if so, the Post's decision not to run the cartoons when the issue was white hot was at least as culpable.
__________

1. I have seen some comments that suggest Donatich was worried about his own safety, but I very much doubt that. We have a historic parallel in The Satanic Verses by Salman Rushdie. Ayatollah Khomeini's fatwah was directed at Rushdie, not his editor, publishing house, or anybody associated with his publishing house.

Parents Behaving Badly

The Washington Post's ombudsman discusses reader comments, along with whether and when they should be deleted. In relation to this story, about people who pretend that they're still employed, despite having being laid off, negative comments were posted by people claiming to be one of the subjects' wife and daughter:

Cole said he was stunned by the comments. Before agreeing to cooperate for the story, he said, reporter Annie Gowen had told him The Post monitors abusive comments. He had been reassured after reading The Post's rules that forbid inappropriate comments.

"What level of responsibility does the Post have [for] what should be considered unacceptable comments?" he asked me last week.

Although not in a context as busy as the Post's website ("The Post's Web site can get more than 20,000 comments a week"), I run some "busy enough" web forums. Despite clear written policieis, I've often had to deal with demands to "delete my posts" or "stop people from being mean to me". But honestly, when people behave badly the source of the problem is rarely (dare I say "never') a site's comment moderation policy - it's that they're people, and sometimes people behave badly.

Let's first take a look at the wife's explanation for her posts about her husband:

Lori Cole insists [a correction of the story] is in order and faults The Post for not contacting her before publishing the story, especially since it identified her and the Coles' two adolescent children. [The article's author, Annie] Gowen said she asked Clinton Cole to introduce her to his wife, but that he dissuaded her because of stress in the family from his job loss.

The article does identify Lori Cole, and anybody who knows them is going to understand the reference to their children, but it's a bit strong to say the kids are "identified":

Meanwhile, the fortunes of the family, which includes his wife, Lori, and two children, ages 13 and 9, have spiraled downward. They are on food stamps. Dinner is sometimes cold cereal.

Don't get me wrong - if the publishing of the story was a surprise to the family, the father needs to take responsibility for that. He should have either said, "The story's about me, so please don't mention my family," or at least warned them that it was coming. Given that he instead said, "Don't talk to my wife," its easy to see how she would feel sandbagged.

But if we move to the comments under discussion, the mother has no room to complain about his putting their children into the story:

Cole's wife blasted her husband. Rather than being laid off, Lori Cole wrote in a comment, he was "fired for poor performance." She said their marriage is broken.

Then [E.] Cole, who identified herself as the couple's 13-year-old daughter, posted a comment saying her father had mental problems.

So dad brought his children into the story with reference to their age, then mom brought more personal, embarrassing details into the story. Shortly afterward, whether by invitation or by coincidence, the daughter posted using her full name, to post a personal attack on dad. The context, according to dad,

His wife is "conducting a smear campaign because, quite frankly, she's trying to win a large amount of money in a divorce court."

Well, if his prior story is to be believed, it's difficult to also believe that he has a large amount of money he could pay out in a divorce settlement. But it does, perhaps, explain why he didn't want his wife interviewed for the story.

The Post's ombudsman concludes,

I think [the comments] should have been removed when The Post received the initial abuse report. Further reporting could have been conducted before deciding whether they should appear. With such incendiary charges, it seems only fair.

I'll assume the Post's moderation software allows comments to be deleted from public view, while preserving them for the record in a manner that allows for their later restoration. Even if that's the case, for practical reasons I disagree with the idea that comments should be deleted, investigated, and considered for reinstatement. If a violation of the posting rules is not apparent from the comments on their face, it would put an incredible burden on the person responsible for moderating threads to be asked, "Delete the borderline ones, just in case, then investigate their truth." Further, as the article notes,

Legally, The Post isn't liable for comments. Under federal law, responsibility rests with the commenters.

Does he believe that immunity would continue even after the Post brands a previously removed comment as "true (or close enough to true)" and restores it to public view?

But lets go back to the comments for a moment. I disagree that mom's comment should have been deleted. She was stating her side of the story, and she's a grown-up. But I probably would not have left the daughter's comment in place, even if we assume that the comment was made, unprompted, by the daughter. It was the choices of the parents that brought the children into this, and I don't see that they belong in the middle.

Taxes and Mandates

The Washington Post offers an editorial arguing that the government cannot constitutionally impose a mandate that all uninsured persons obtain health insurance. Well, yes and no.

The otherwise uninsured would be required to buy coverage, not because they were even tangentially engaged in the "production, distribution or consumption of commodities," but for no other reason than that people without health insurance exist. The federal government does not have the power to regulate Americans simply because they are there....

This leaves mandate supporters with few palatable options. Congress could attempt to condition some federal benefit on the acquisition of insurance. States, for example, usually condition issuance of a car registration on proof of automobile insurance, or on a sizable payment into an uninsured motorist fund. Even this, however, cannot achieve universal health coverage. No federal program or entitlement applies to the entire population, and it is difficult to conceive of a "benefit" that some part of the population would not choose to eschew.

The first thing to consider is that, with a health insurance mandate directed at employers, most individuals are going to end up insured through their jobs. So how about we create a new payroll tax to cover health insurance but instantly credit back any deductions made for health insurance through the employer - both the employer's share and the employee's share. Employers who do not offer insurance will collect the payroll tax, implementing the same instant credit consistent with their employees' documentation of health insurance coverage.

The amount paid in premiums will be confirmed through end-of-year filings by health insurance companies. The self-employed will either insure so as to qualify for the tax credit, or pay the tax. So you could choose not to buy insurance, sure, but you would end up paying a tax in the approximate amount of what basic healthcare coverage would have cost. No mandate - just the choice between buying insurance or paying a roughly equivalent tax without getting insurance. Collected taxes can be used to help offset the cost of caring for the uninsured.

Why wouldn't that work?

Me? I'm off to start my new insurance company. Here's the business model: I charge a premium in the lowest permissible amount (the least expensive plan you can buy to avoid any penalty from the mandate), use that to obtain reinsurance for losses above, say, $50,000, and offer essentially no other coverage. Participants can fund HSA's, if they wish. If a participant gets through a year without making a claim, I refund... let's say 50% of their premiums. The rest goes to the cost of administering reinsurance, administering claims (something I would outsource), and profit. Coverage for pre-existing conditions? Not a problem. Unhealthy people will stay away in droves. Anybody want to invest?

Krugman on Obama

Paul Krugman offers up an editorial explaining how Obama's disappointing some of his biggest supporters. Krugman has always been skeptical of Obama, but that's no reason to dismiss his observations. It's a crazy time, in which the Republican Party panders to the most extreme, outrageous and misinformed factions of its base, while the Democratic Party marginalizes and alienates some of its most informed and dedicated members.

The best defense of the White House's moves, that there's no clear understanding of what a "public option" would entail, and thus the various people advocating for a public option may have different things in mind, fails as a defense. Why? Because the same criticism applies to any and every part of healthcare reform - and will continue to apply until the bill is in final form. And frankly, if the White House were to get proponents of a public option together and figure out what they had in mind, I believe that there would be broad consensus as to the basic concepts. "Town Hall" hysterics aside, it's really not that difficult to understand.

It appears in terms of reform that the White House viewed compromise as necessary and, having rejected single payer as politically infeasible, viewed the public option as a starting point for negotiations. And then they assumed that everybody would see the logic in this approach, and that negotiating away the public option was inevitable. Which is true if you start your negotiation by telegraphing your goal - "We'll drop the public option if you, more or less, agree to the rest." But it's only true if you let it be true.

Obama didn't understand that his supporters see a public option as more central to healthcare reform than a lot of the reforms he's pushing through. Oddly, he didn't recognize that the nation's insurance companies, in dropping their opposition to his basic set of reforms, feels the same way - a public option means real competition for them, but a mandate with no public option means immensely fattened profits and reduced competition.

Krugman notes that it's possible to have universal healthcare that's neither single payer nor inclusive of a public option, and observes that some of the proponents of a public option "might be willing to forgo it if they had confidence in the overall health care strategy". True, but more than what Krugman says, that "the president’s behavior in office has undermined that confidence," there's been no attempt to explain how we could achieve similar universality under the proposed reform legislation without a public option. I see a law mandating that everybody buy insurance as falling short of that - if the gist of "reform" becomes that everybody has to now buy crappy coverage from a for-profit insurer, reform will be a failure. An unpopular failure.

I think that Obama's problems come from a number of directions, even leaving aside the mess that he inherited. I think he overestimated the Democratic Party's ability to learn from its own mistakes, including the manner in which Congress undermined Clinton during his first two years in office contributed to a loss of the party's credibility and it's Congressional majorities. I think he also overestimated the party's willingness to stand up to corporate interests, put the needs of the country first, and unite behind legislative initiatives that could seriously improve life in this country. But that's a failure to learn from history, where you can take a room filled with several hundred smart men (and, unfortunately, considerably more than a smattering of dumb ones), were "debate" quickly reduces to the level of the lowest common denominator. (Is that a fair description of Congress?)

I am not so much convinced that he underestimated the Republican Party, as much as he overestimated the media. For many years, any time one or two Democrats supported a Republican proposal, the proposal was deemed "bipartisan". Suddenly the definition has shifted, and apparently means that if a majority of Republicans don't support Obama's proposals then they're not "bipartisan". And no matter how badly or outrageously the Republican Party behaves, the media always points the finger at Obama - "See, he promised bipartisanship, but he still can't come into a compromise with people who actively lie, intentionally distort the debate, and have stated that they want to cause him to fail for their own political benefit."

I think Krugman does highlight a very real strategic failure by the White House:

But there’s a point at which realism shades over into weakness, and progressives increasingly feel that the administration is on the wrong side of that line. It seems as if there is nothing Republicans can do that will draw an administration rebuke: Senator Charles E. Grassley feeds the death panel smear, warning that reform will “pull the plug on grandma,” and two days later the White House declares that it’s still committed to working with him.

How did that happen? I believe Obama thought it would be easier to woo enough of the (tiny number of) moderate Republicans to support his reform plan (which he would then call "bipartisan"), than in either cracking the whip on the "Blue Dogs" or giving them the concessions they were demanding. Thanks in no small part to their party's very effective disinformation campaign, those moderate Republicans are disinclined to support any reform bill, and the "Blue Dogs" haven't been brought any closer to supporting the reform package.

Those Blue Dogs? What do they bring to the table. They have no apparent party loyalty. Whatever their motivation - fear of alienating constituents, fear of alienating donors - if they cause Obama to falter it's very likely going to be their seats that switch back to the Republican column. Do they truly feel that they have more to gain here by advancing John Boehner's "make the President fail" agenda, than by working for a reform that will help their President and party, and improve the lives of their constituents? I digress, but if they do make choices that lead to their own marginalization or decimation at the polls, well, choices have consequences.

Meanwhile, while Obama may have underlearned the lessons of history on how his own party behaves when it's in the majority, perhaps he overlearned (or accurately learned) the lessons of G.W. Bush's "I've been reelected, so now I get to trash Social Security" victory tour. If Obama were truly to announce to the country, "Having give up single payer, I am resolute that the healthcare reform bill must include a public option," only to find that (as is presently the case) his own party won't stand behind him, he might experience a fate similar to Bush's. Which would be worse for his credibility? For those who believe he could make strong statements in support of a public option and have Congress fall in line, is that belief based upon anything more than faith? Wishful thinking?

An Apple Branded Television?

Dream on.

Apple will be adding an Apple-branded television set to its lineup by 2011, according to Piper Jaffray analyst Gene Munster. Such a device would have media-management features -- features currently found in the Apple TV settop box -- built into it, as well as a DVR and subscription-based content viewing, according to a research note to clients covered by AppleInsider....

"We see potential for Apple to offer best-in-class software and hardware and charge a premium," Mr. Munster wrote.

I can see Apple trying to partner with television producers to integrate iTunes, or rejuvenating its set-top box. But an actual Apple-branded television? I just can't see it. The "best-in-class" television hardware market is pretty narrow, and I have a hard time believing that consumers will happily jettison their, let's say, $2,500+ televisions every three or four years when the CPU's, RAM and hard drives prove inadequate for the next generation of TV operating systems, or when parts necessary to "Apple TV" but extraneous to the operation of the television start to fail.

I recently purchased a television, the first new television I've ever bought. I got a clearance model. It included a notice that it had built-in support for an online service that was no longer available. Brilliant, building that technology right into the TV and remote. Boy, that worked out. (I mean, in a sense it did - you don't really notice that the feature's missing, and its absence probably helped me get a really good discount, but you get my meaning.)

I do think it's likely that the world of televisions and the world of computers will continue to merge, with more streamed content and content purchased through sites like iTunes being watched on televisions. Apple's never been good at sharing, but perhaps they'll partner with some television manufacturers to offer an "Apple Inside"-type of feature - let the third party build the technology into its set, and let it display an Apple logo in the manner of the "Intel Inside" campaign. But if you're planning on keeping your television for a good many years, or if you're planning on using a variety of competing online services through your TV, I suspect you'll be much better served by a set-top box, or even hooking an inexpensive computer up to your television, rather than paying a premium for technology that is likely to be extinct long before your TV itself stops working.

Given my track record on anticipating Apple's moves, though, many will take this post as proof that Apple's going into the TV business. ;-)

What Is "Competition"?

The Washington Post is concerned that private health insurance companies wouldn't be able to compete with a public option. Their position is consistent with their historic defense of private insurance, but (as one might expect from an editorial page led by Fred Hiatt) falls far short of providing a sound, logical argument.

The Post presents what amounts to a three-part argument against the public plan.

First, the public plan will pay less than private insurers. Um... okay, let's assume that the government plan will be able to negotiate lower rates, still have adequate numbers of doctors and hospitals sign up to provide services, and pass those savings along to customers. This is "bad" because... of what? Why can't private insurers develop similar scale, or negotiate similar discounts? It's not about for-profit vs. non-profit - for-profit insurers survive and thrive despite the non-profit BC/BS networks. Why would doctors play ball, rather than dropping out of the government program in favor of the higher-paying private plans? Can a Medicaid patient walk into any hospital or clinic in the nation and obtain treatment? Why do many insurers base their reimbursement on Medicare reimbursement rates if those rates are so unreasonable - and why don't they publish their reimbursement rates so we can actually see for ourselves how much they pay for the same services?

Second, looking at the Medicare prescription drug benefit, "Insurers and private companies have been at least as innovative as the federal government in recent years in finding ways to provide quality care at lower costs". But isn't the argument supposed to be that they're better at finding efficiencies? If the "free market" struggles to keep up with the government as an innovator, what's its value again? And if we're supposed to be talking about "a level playing field", why is your only example one in which the government is handicapped and prohibited from negotiating discounts from pharmaceutical companies? If the defense of the free market is that, when not similarly hamstrung, private insurers are roughly equivalent in their coverage to the hobbled Medicare program, again, how's that an endorsement of the market? And why aren't we discussing Medicare Advantage, where private insurers required massive subsidies to provide the same level of care offered directly through Medicare? Why can private insurers compete effectively with the "public option" in a nation like Chile, when they would supposedly fall flat on their face, across the board, in the United States?

Third, mandating that insurers cover everybody without regard for pre-existing conditions takes away a leading justification for a public option. Really, what would that do other than create a sinecure for the existing insurance companies? How could a new competitor (other than the government) enter the market? In the presence of a public option, the mandate gives consumers a choice between insurers who have a history of bad behavior, who we are to trust wouldn't game the new rules, and a public option which would not game the system. A mandate without a public option provides a double windfall to private insurers - it requires that a lot of healthy people sign up for insurance, while pretty much ensuring that no new contenders will enter the marketplace such that there is... you know, such that there might actually be a healthy, competitive marketplace.

I don't really mind that Fred Hiatt and his crew shill for private insurance companies. The Post's editorial page is a big defender of corporate America and lemon capitalism. But I do wish they would be more honest about their agenda, and more careful (or is it an honesty thing, again) in their analysis.
__________

Update: In fairness to the Post, they ran an editorial on "5 Myths About Health Care Around the World, that more or less shreds the arguments raised in its many anti-reform editorials.

"Tips" for Driving Traffic to Legal Websites?

Law.com offers up a set of "tips" for generating traffic to law firm websites. I find myself questioning most of the suggestions.

The first thing I'll note is that I have no problem with telling lawyers that they need to hire an outside professional to develop and market their law firm's website, or that the professional should be paid for those services. In the alternative, a law firm may be able to identify a member of its staff (perhaps a lawyer, perhaps a non-lawyer) who has the skill and aptitude to do a lot of website development and marketing in-house, or to hire a full-time developer.

But let's admit up-front that, for most lawyers and firms, this isn't a do-it-yourself project. I don't think it's much of a favor to offer "tips" that either suggest otherwise, or which could not effectively be followed (or might be costly and perhaps even counter-productive) in the hands of a novice. Also, to the extent that tips include suggestions that should best be outsourced, it would be helpful to have at least one tip addressing how to select an outside professional. (Hint: If they approach you with the claim, "We'll put you at the top of Google" (i.e., "We'll buy some ads"), or "We'll deliver 10,000 'hits' to your site in 30 days", they're almost certainly not a firm you want to consider.)

In terms of offline ideas, I agree that a law firm's marketing materials should include URL of its website. I question the usefulness of a "stand-alone" business card simply touting a website. If you're handing out the card to people you are trying to recruit as clients, how is that better than a brochure or other, more complete marketing materials in which you market yourself and also direct them to your website? If you're not targeting the recipient of the card, what's the point? Stick the website information on the back of your card, which is probably blank anyway.

A business card has the advantage that somebody can take it out of his pocket, look at your URL, and type it into a computer, but for the most part conventional print marketing isn't very efficient at generating web traffic. If you do try special business cards, consider using (or having your expert use) analytics software to try to track the amount of traffic they generate. (You can use special tracking URLs as well, but when somebody's asked to type the URL into their computer that makes things more complicated for the recipient of the card.)

The article fails to distinguish between types of legal consumer, and how your target audience will affect your web marketing strategy. If you're making a presentation to a group that includes potential clients, and whose members will benefit from the information on your website, by all means mention it. If you're conducting free seminars for prospective clients (e.g., "How you will benefit from a living trust") you can promote your website to them as an adjunct to the seminar - a source of more information, and (if they don't sign a contact sheet) a means of drawing them back to you and your firm after they leave the room. If your practice depends upon people who have a special legal need arise - a personal injury claim, a divorce, etc. - marketing your website at live events is of limited value.

In terms of running a stand-alone print ad for your target audience, I again question how this is effective (or at least cost-effective) marketing. If, for example, you're a personal injury attorney and you run a special ad, "Go to the following address on my website where you can download and print out a list of things to do after a car accident", you're creating a barrier between yourself and your prospective client. They're supposed to go from the print ad to their computer, type in the URL you provide, download the document, print it on their own printer, then put it into their car? Here's an idea - include your list of things to do right in the ad - so they can cut it out and put the pre-printed list in their glove compartment. Or perhaps even better, use your print (and online) advertising to try to make sure that yours is the first name they think of after an accident, rather than expecting that they'll remember about your list, and find your list buried in their glove compartment and call you because your name's at the bottom.

Marketing your firm through microsites? Give me a break. If you want to have a URL devoted to a specific area of your practice, you can buy and use such a URL, but you're better served by having it redirect to content on your main site. Why? Because that way when people in the online world link to your "microsite" content, the links help boost your main site. And when your microsite is no longer useful (as can happen in a tort area, such as a defective drug case, or in the event of a change in the law) the links continue to bring traffic to your site rather than leading to a dead URL. Further, when you host the new content on your firm's website you benefit from the links and authority you've already created for that site. If you want to generate free traffic from search engines, that's what you should prefer over starting from scratch with a new site.

Also, after marketing and promoting your primary URL as a valuable resource to prospective clients, other lawyers, or whomever else you're trying to reach, it makes no sense to send your readers off to other websites to find the information they want, even if you own them. Would you do that with your physical offices - market multiple, neighboring office addresses for each area of your practice, or market a different phone number for each practice area or subspecialty? Or is it better to have a central reception area where all callers and visitors can be guided to the correct location?

I don't want to sound cynical, but let's say you have an existing website and your designer says "You need a five or ten page microsite on subspecialty X" - ask, "How much will the new site cost, and how much will it cost to simply add those pages to my existing site?" For that matter, "Why don't I have a CMS (content management system) that lets my lawyers quickly and easily add new pages to my current site without involving you?"

Entering contests? Many years ago, contests were all the rage. But most of them generated little traffic, while the "winners" proudly added icons and links back to the contest site to celebrate their awards. That's to say, most did far more for the promoters of the contest than for the winners. Not all contests work like that, and I'm not against entering website contests, but why am I skeptical that a highly effective but inexpensive design is going to win over a splashy site that cost five or six figures to develop, regardless of its performance? Whatever it's traffic, do you think your small firm site is going to beat the 2009 "Your Honor Awards" winning entries from Akin Gump, Wilmer Hale, and McMillan LLP?

As for the tip to "Send your extensive mailing list an e-blast" announcing your new site or "microsite", that's great if you have a huge, verified audience that has opted in to your mailing list and will be interested in your message. But do you have an "extensive mailing list" to eblast?

In general, I agree with the suggestion of trying to have a URL "that conveys what you do and is easily remembered", particularly for law firms directed at consumers. This, of course, is easier said than done. To get a URL that's reasonably related to your practice area you'll probably have to buy it, perhaps along with a website. If you're trying to buy URLs or websites you'll probably have to approach a great many sites before you find one that has both an acceptable URL and an acceptable price. In terms of a big firm that markets its primary URL through its firm name using communicative, easily remembered URLs for its microsites, again easier said than done. Of the examples given in the article, "eb5immigration.com" isn't that bad (although it's not very memorable, so it could blur into "Was that 'eb5lawfirm.com'? 'eb5laywers.com'? 'eb5visas.com'?), but "worksite-compliance.com" could be easily confused with "worksitecompliance.com", "workplace-compliance.com", etc. Incidentally, worksitecompliance is for sale at buydomains.com for $5,788. If I were developing the hyphenated version, depending on my budget, I would be making an offer or buying that URL before my competitor did.

The example provided in the article, trial.com, is a good URL. It's not great for branding, but it's a real word, short and memorable. If you find somebody with a similar URL and want to buy it, expect bidding to start in the six to seven figure range - plus, if it's a developed site, the value of its traffic. Obviously you need to carefully consider how well that work works for your business, and whether you're better off using the money to try to build a brand (Google, Yahoo and Amazon tell you nothing about what they sell, but they're powerful brands. "Trial" suggests that the site has something to do with... trials? Maybe it's a place where you order trial sized merchandise, or get free sample coupons from manufacturers?)

Of the articles online ideas, the first suggestion isn't really an online idea. Yes, writing in clear, understandable language, in plain English, also applies to the online world.

In terms of optimizing your website for search engines, yes, by all means. But any web designer should be developing your website to incorporate the basic concepts of search engine optimization. And if you're not attuned to SEO issues, all this tip is doing is reminding you of the importance of having some professional assistance in designing and implementing your website. Some of the tips are a bit dated - "Make sure most of the site's content is visible to the search engine crawlers, meaning the text is not stored in graphics or Flash technology" - although there are other reasons to object to flash pages or splash pages or regard them as interfering with SEO, a text layer can be included in a flash site, and flash can be used instead of graphics on an HTML site. No, you don't want to present your website's text in image files, but is anybody using graphics instead of text content these days? If you think that's a good idea and you don't recognize that you need help from an outside consultant, you probably didn't get this far in the article.

Also, in my opinion, out of date is this suggestion in relation to link-building:

How do you get a link on another site to point to yours? You ask the owner of the site to place your link on the Web site. The owner will probably ask for something in return, such as a fee or, more likely, a link back, called a reciprocal link. You can place the reciprocal link somewhere on your site, such as a resources page, but it is not necessary that the link be prominently displayed.

There are individuals and companies that offer link-building services. Google "link ninja". (Seriously.) If you hire a responsible person they'll work on getting you high-value links from good sites, and ideally your site will benefit both from traffic driven by those relevant links and eventually as search engines recognize your site as meriting those links.

Less ethical services will engage in spamming of forums and blog comments, spamming webmasters with link requests (you can also buy software to spam webmasters, not that I recommend it), or even engaging in dubious, sometimes criminal activities to inject your link onto other sites by exploiting weaknesses in their software. Some services principally work through their own network of sites - you pay, they add you; you stop paying, they delete you. I've also heard horror stories about firms that sabotaged former clients' link-building when their contracts weren't renewed, although I expect that's a very unusual outcome (and would never happen with a responsible, ethical service provider).

Link-building is time-consuming, and abuses of link-building have made it enormously more difficult. If I get a request for a link that is software-generated, I delete it - assuming it even makes it past my spam filter. If it's the usual "We can benefit each other if you link from your popular site to my invisible site" email, that's a joke - we both know that the primary benefit will flow to you, and you won't win links by treating me like I'm stupid. If it says "I've added a link but it will be deleted in two weeks if you don't link back and confirm the link to me," it goes in the trash. If it's an "I've added a link to your site, and would appreciate a link back," but the page with the link on it is buried, presents a garbage heap of poorly edited, poorly organized links, or the link to my site is nofollowed, the request again gets treated like the garbage that it is. And that eliminates close to 100% of requests.

What if you request a link, and the webmaster writes back with "As long as you link back to me"? That's not so bad, provided you're not just adding each other's links to a link page or, worse, you're giving the other site a quality link on a quality page and they're adding you to a link farm. But you still need to be cautious - if the search engines conclude that pretty much all of your links are reciprocal - that you're primarily or exclusively getting links by trading for them instead of 'earning' them with good content - you'll find the value of your links devalued in their algorithms.

What if the webmaster says, "Pay me, and I'll add your link"? The form of link building that involved secret deals to buy links from other sites is dying out. Why? Because (in simplified terms) Google decided that if you pay for a link it should be treated as an advertisement, and started both devaluing the link to the person who acquired it and in some cases imposing a penalty on the site that was secretly selling links. Google's Matt Cutts explains Google's rationale here - that was written almost two years ago. Any "tip" that suggests buying links that aren't clearly indicated as ads should be accompanied by a warning that the search engines disapprove of link-buying and, if they detect it, will devalue the links and may also punish one or both of the sites involved.

The final tip involves buying ads through Google AdWords or similar services. That, when done correctly, can be an excellent revenue-generator. You can track clicks, conversions (as you define them) and the amount of new business the ads generate. You can take advantage of highly granular data, to determine which keywords or ads return the most business and which should be dropped from your campaign. But this is advertising, not SEO - you can expect that the traffic you generate will last only as long as your ad campaign lasts.

Although these services offer tools that help people develop and manage their own campaigns, particularly if you're intending a large ad buy you need to consider bringing in a specialist to help you draft your ads and select keywords. It's easy to burn through a lot of money without much of a return if you target the wrong keywords, or assume that the most popular or expensive keywords will return the greatest amount of business or the best quality of customer. Beware anybody who promises to generate "traffic" for your site, without defining what that means - you want conversions, defined by a measure that includes the reasonable prospect that they'll become clients. (If a person from your state visits your site and completes the 'contact me' form, that may be adequate. If the person's in India, that's probably not something you would want to count unless you're an immigration law firm or it's an exceptional case (e.g., an international custody dispute) and those leads are actually generating clients.

If The Public Plan Is Stripped Out of Reform....

Then, for reasons Bob Herbert highlights, the side deal with the pharmaceutical industry should be flushed as well. And, also for reasons Herbert highlights, care needs to be exercised to ensure that people compelled to buy insurance are not only allowed to buy in without regard to pre-existing condition, but also at the group rate.

Herbert notes,

If the oldest and sickest are on Medicare, and the poorest are on Medicaid, and the young and the healthy are required to purchase private insurance without the option of a competing government-run plan — well, that’s reform the insurance companies can believe in.

More than that, it significantly raises the barrier to entry. Right now, at least in theory, a company that had a lot of money and a desire to enter the insurance business could do so - and could cherry-pick clients so as to protect its profits, just as the present group of for-profit insurers do. But post-reform, it would take a much larger investment, carrying much more risk, to start a new health insurance company.

Not that companies are leaping into the field, even under the status quo.

Losing the Public Option

Having a healthcare bill pass without a public option inspires a valid question, what's the point? Or, in more detail, how do you inspire the changes and efficiencies you need in the current health insurance market without introducing a robust competitor whose focus is on providing care and not on profit? But perhaps losing the public option, at least the hobbled option that would pass under the current reform bill, isn't as bad as you think.

The number of compromises that were being injected into the public option to keep it from being effective, or even competing on a level playing field with for-profit competitors, were worrying. It may in fact be more productive to walk away from those demands and side deals, passing a cleaner version of a public plan in future years. The public plan was to be entirely separate from Medicare (why?), was to be forbidden from negotiating drug prices (why?).... Rhetorical questions - to make it less effective, more costly, and less able to price compete with private insurers who don't face similar restrictions.

I acknowledge the retort that if it doesn't happen now, we can't count on it happening in the future. True. But we can count on the trends in private insurance continuing - the dropping of high cost patients (sometimes in flagrant violation of contract), rapidly increasing premiums, employers finding themselves unable to offer quality plans or perhaps any plan at all, people being made more and more responsible for their own medical expenses - whether or not they can afford them. Stripping out the public option is meant by the insurance companies and their captive congressmen to maintain the status quo - but the status quo is not sustainable.

Don't get me wrong. Killing the public option is cowardly and backward-thinking, the type of thing you would expect from a Member of Congress whose primary concern is the size of his campaign coffers. Those who stood in the way, or might stand in the way in the future, should be rewarded with primary challenges. But it may be more important to end the hysterics, let Obama move on to other parts of his agenda, and figure out how this issue can be more successfully addressed in the future.

If a public plan is postponed, the Democrats should evaluate what can be done through reconciliation. Can Medicare be expanded to let older workers buy in, at an unsubsidized rate, for a full or partial set of benefits? Could it be expanded to provide an administrative framework and national care provider network for insurance companies organized at the state level? Could it at least be rebranded with in-your-face tagline, such as "Medicare: Government Health Insurance That Works For You!"

Meanwhile, where's the Issa-Kingston "Federal Cafeteria Plan for Everyone" bill?

The Cure Is the Disease?

In terms of healthy (or should I say unhealthy) political discourse over healthcare reform, at MedRants, Dr. Centor diagnoses a problem:

So we have a debate similar to religion versus science. We have beliefs that no reasoned argument can address. We have an impasse in the debate, and thus we cannot reason our way to a solution.

He adopts the argument that it's a myth that the fight is won or lost over the quality of reason, and prescribes a solution,

The Democrats should change their strategy, because they cannot win on logical debating points.

He's far from the first who has made that claim, but happens to be the one I've most recently read. But really, if he were in an angry debate with another doctor who insisted that a gangrenous limb be treated with the mere application of a Band-Aid, would he truly abandon logic, fact and science? What's his proposal for winning debates on the merits without actually debating the merits? Punch the other guy in the nose?

Seriously, if the response to malicious distortion, lies, and dishonest "branding" of healthcare issues is for the other side to drop into the same gutter, how can you even begin to tell who has the better argument?

I think Rick Perlstein makes a much more sound observation In America, Crazy Is a Preexisting Condition,

The instigation is always the familiar litany: expansion of the commonweal to empower new communities, accommodation to internationalism, the heightened influence of cosmopolitans and the persecution complex of conservatives who can't stand losing an argument. My personal favorite? The federal government expanded mental health services in the Kennedy era, and one bill provided for a new facility in Alaska. One of the most widely listened-to right-wing radio programs in the country, hosted by a former FBI agent, had millions of Americans believing it was being built to intern political dissidents, just like in the Soviet Union.

He notes a kernel of truth behind Dr. Centor's point,

Liberals are right to be vigilant about manufactured outrage, and particularly about how the mainstream media can too easily become that outrage's entry into the political debate. For the tactic represented by those fake Nixon letters was a long-term success. Conservatives have become adept at playing the media for suckers, getting inside the heads of editors and reporters, haunting them with the thought that maybe they are out-of-touch cosmopolitans and that their duty as tribunes of the people's voices means they should treat Obama's creation of "death panels" as just another justiciable political claim. If 1963 were 2009, the woman who assaulted Adlai Stevenson¹ would be getting time on cable news to explain herself. That, not the paranoia itself, makes our present moment uniquely disturbing.

Not so long ago, "a more confident media unequivocally labeled the civic outrage represented by such discourse as 'extremist' - out of bounds"; now "it's being watered by misguided he-said-she-said reporting and taking over the forest". We have a failure of the Republican Party and a failure by the media - so who's to blame? Who needs to change? It must be the Democrats.

As usual, Seth Godin provides a good insight:

The screaming is a key part, because screaming is often a tool used to balance out the lazy ignorance of someone parroting opposition to an idea that they don't understand....

If you want to challenge the conventional wisdom of health care reform, please do! It'll make the final outcome better. But if you choose to do that, it's essential that you know more about it than everyone else, not less. Certainly not zero. Be skeptical, but be informed (about everything important, not just this issue, of course). Screaming ignorance gets attention, but it distracts us from the work at hand.

Godin suggests that the "screaming" approach to discourse " is ineffective, short-sighted and threatens the fabric of the tribe." He's right. And perhaps somebody comment that I needn't qualify this statement, but if we really follow Dr. Centor's advice and give in to the screamers, we're doomed at best to a future of bad policy and dysfunctional government.
________

1: He's alluding to an incident he previously described,

When Adlai Stevenson spoke at a 1963 United Nations Day observance in Dallas, the Indignation forces thronged the hall, sweating and furious, shrieking down the speaker for the television cameras. Then, when Stevenson was walked to his limousine, a grimacing and wild-eyed lady thwacked him with a picket sign. Stevenson was baffled. "What's the matter, madam?" he asked. "What can I do for you?" The woman responded with self-righteous fury: "Well, if you don't know I can't help you."