c3's blog

Yesterday VP Biden announced an "agreement" between the administration and major hospital groups to trim payments by $155 billion as part of over all health care reform. Details were scant and it wasn't clear if that over one year of ten years.

This is one of a serious of public "agreements" between the Obama Administration and major healthcare "players" In March we learned of an agreement in principle between the Administration and major health care organizations representing physicians, insurers and others to save $634 billion. Its not clear how much of this $634 b includes the later specific "agreement" with hospitals and drug makers and others.

We've also heard of an agreement between the administration and Big Pharma to reduce costs by $80 billion over ten years.

Now to be clear we have heard of additional costs in this Herculean effort. The President has already stated it will take at least $630 billion over 10 years to get universal coverage accomplished.

He's also promised to fix the payment adjustment methodology, Sustainable Growth Rate (SGR),that Medicare has in place. This formula has anually triggered lowered payments to physicians. Each year after much lobbying from physicians, this adjustment has been "adjusted" to ease or eliminate the pain.

OK, so lets do some back of the envelope math. First we'll make some big assumptions. 1) The announcement of $634 billion from doctors, hospitals etc announced in March doesn't include the later announced reductions AND that it will be an ANNUAL reduction 2)any announcement of savings over ten years will be assumed to save one tenth of that amount annually.

And the final BIG assumption/statement is that we AT A MINIMUM spend 50% more per capita than the next highest spending country with no additional health benefits BUT WITH universal coverage (I'm referring to Switzerland). So our target is an over 33% reduction in health care expenditures.

READY?
In 2006 the US spent a little over $2.1 TRILLION dollars on healthcare. So we'd need to save about $700 billion annually. The Obama administration has announced savings of $155 b from hospitals, $8 billion annually from Big Pharma and $634 b from doctors, hospitals etc. That all totals $797 billion. Hey We're there!.... but wait a minute. We're going to spend $63 b annually to expand coverage and some other undefined amount to "fix' physician payments.

SO If all these come to pass and there are no other additional costs we might be getting somewhere. I know you all may be a bit skeptical that the Obama administration can actually get this done. And your skepticism might be reinforced by this statement from Rep. Waxman,chairman of the House Energy and Commerce Committee regarding the agreement with hospitals

We're certainly not bound by that agreement. The White House was involved, and we were not

And also if we'd like to examine a recent state example of such a large effort, lessons from Massachusetts might give one pause. These include incomplete success at "universal coverage", runaway costs,and coverage and benefits cuts to reduce the deficit.

I thought I saw you lurking in those details!

With last Tuesday's Health Care Summit, President Obama begin the search for the Holy Grail of new Democratic programs, comprehensive Health Care Reform. As a “down payment” in that effort the President committed over $600 billion toward health care reform. That number only begged a greater question, “How much will it cost?”

So that we’re all on the same page lets be clear about what it costs right now. Here’s an excellent group of charts demonstrating what we spend on health care in America.

Key points:
1) We spend 50% more per capita on health care than the next highest country (Norway)
2) Dollars for health come about equally from government, business and private households
3) Those dollars funnel through payers with 40% paid out by governmental programs (Medicare, Medicaid and others), 34% by private payers/insurers and 12+ % out of pocket
4) Those dollars are spent on: 31% hospital care, 21% physician services, 10% on pharmaceuticals and a variety of other costs. NOTE: 7% goes to administrative costs including insurance profit. That's ALL administrative costs.

Two other key basic realities of American Healthcare:
1) About 43 million Americans or nearly 15% American are insured
2) In spite of our extraordinary spending we Americans have not improved our health to a coincident degree as compared to other western nations

So we already spend far more than any other country and yet we can’t provide basic coverage for 1 in 7 of our citizens and though our health has improved over the years it hasn’t improved as much as other countries who have spent much less.

So how will spending at least $600 billion more (25% of what we already spend on an annual basis) lead to better coverage and/or better health?

We're fortunate in Arizona to have two thoughtful Republican senators, John McCain and Jon Kyl. Kyl's been getting more face time recently as a frequent spokesman for the loyal opposition. Here's a recent local interview regarding his impressions regarding both the stimulus package and the mortgage deal.

To me Kyl does a good job simply explaining conservative views/issues with the proposals.

My wife and I periodically ask each other, when will VP Joe Biden pipe down. Isn't his main job to wait, hopefully unsuccessfully, for the President to die. Does he really have to outdo Dick Cheney as an "activist" Veep.

Anyway,(as reported in the Times) Joe's done it again.

Visiting the Central Intelligence Agency to swear in Leon E. Panetta as the agency’s 19th director, Vice President Joseph R. Biden Jr. said Thursday that the Bush administration’s detention and interrogation policies “gave Al Qaeda a powerful recruiting tool.” Considering the setting — the C.I.A. lobby where several hundred agency employees greeted the vice president with cheers — Mr. Biden’s remarks implied a tough judgment on parts of the agency’s record under the previous administration.

I'm wondering if Joe himself is the "30%" that this administration will get wrong.

This article from the Boston Globe has so much to love.

The long and short of it: Partners Healthcare (the state's largest health care provider including Boston's two great giants: Mass General and Bringham) made a "handshake" agreement with Blue Cross (the state's largest insurer) to:

give Partners doctors and hospitals the biggest insurance payment increase since Massachusetts General and Brigham and Women's hospitals agreed to join forces in 1993.

In return, (Partner's) would protect Blue Cross from (their) biggest fear: that Partners would allow other insurers to pay less. Those who helped broker the deal say CEO Thier promised he would push for the same or bigger payment increases for everything from X-rays to brain surgery from Van Faasen's (Blue's CEO)competition, ensuring that all major insurers would face tens of millions in cost increases. Blue Cross called it a "market covenant."

There's just so many good quotes in here. The "duh" quote addresses concerns for the merger of Mass General and Brigham, thus creating Partners:

Though many analysts saw the merger as a smart way to reduce costs, three Boston University School of Public Health researchers warned at the time that it "actually may increase the cost of care," adding a layer of bureaucracy while boosting the market power of the combined institution.

And that it did. And all in the name of "higher quality" of care (which of course was not delivered)

This is REQUIRED READING

HT: Health Care Policy and Marketplace Review

Sarah Palin
- age 46
- Daughter of a HS Science Teacher + track coach
- Grew up in small town Alaska
- Undergrad Univ of Idaho (after some community college)
- Initially worked as a sports reporter for local TV station
- Married Todd Palin, oil field operator and commercial fisherman
- Five children: ages 19, 18, 13, 7 + 1
- Religion: Christian, non-denom., pentacostal
- Net worth $1.2 million
- Present Occupation: Gov. Alaska
- Previous occupation: Mayor of Wasilla, pop. 6,300
- Recently ran as VP candidate on Republican ticket: questions of experience

Caroline Kennedy
-age 51
- Daughter of assassinated Democratic President. Family, longstanding Democratic politicians
- Grew up in the upper East side of Manhattan
- Undergrad at Radcliffe, law degree from Columbia
- Initially worked at Metropolitan Museum of Art
- Married Edwin Schlossberg, exhibit designer at MOMA
- Three children: ages 20, 18 and 15
- Religion: Catholic
- Net worth $100 million +
- Present occupation: vice chair of the board of the Fund for Public Schools, a public-
private Partnership
- Previous occupation: Director of the Office of Strategic Partnerships for the NYC
Depart. of Education
- Presently “running” for appointment as US Senator for NY: questions of experience

As I predicted long ago, Governor Napolitano will be in the new Obama administration

This is a good choice. I voted for Janet. She's pragmatic and a centrist. She has the lawyer skills, if needed, (former US Attorney and AZ AG) and she's done a decent job of staking out a moderate position on immigration. I wonder if DHS will focus more on immigration?

Its also smart timing for her since she'd be facing her most difficult challenge as a governor: how to fix the bleeding budget.

And for those who are wondering, her successor will be Jan Brewer, Republican Secretary of State.

PS For those who really like the politics one could wager on whether she'll do this for a year then begin her run for the Senate seat that John McCain will likely retire from.

PPS This would be "conservative" Arizona's third female governor in a row (and four of the last five!)

Step 1: Identify key industry sector that employs illegal immigrants.

Step 2: Build financial "house of cards" that will lead to that industry collapse

Step 3: Watch as inflow of immigrants drops by nearly 40%

wasn't this bad when they said McCain didn't "do it"?

Here's a nice summary of a survey (yes Tully I know it probably wasn't terribly scientific) done by BeliefNet regarding the Evangelicals that voted for Sen. Obama. He doubled his support among young Evangelicals (18 to 29)from Kerry's numbers of 2004. For those interested in what motivates these younger Evangelicals there's some interesting stuff in here.

They Emphasize Completely Different Values Issues. Obama's evangelicals ranked their priorities like this:

* The economy
* Iraq war
* Reducing poverty
* Character
* The environment
* Cleaning up government
* Access to health care
* The Vice presidential selection
* Gay marriage
* Abortion
* Fighting Islamic radicalism
* Illegal immigration
* The candidate's experience

McCain Evangelicals listed priorities in a very different order:

* Abortion
* Character
* Cleaning up government
* Fighting Islamic radicalism
* Gay marriage
* The economy
* Experience
* Iraq war
* Illegal immigration
* Access to health care
* Running mates
* Reducing poverty
* The environment

More stuff regarding differences in the religious and political worldviews of those who voted for Obama and those who voted for McCain. As I read this I was torn between the assumption that we're seeing a significant change in the Evangelical approach to politics and the assumption that it was "just kids" who will change when they get married, settle down and have kids of their own.

Well now we know the 2008 election was not about turnout. So 2008 was about shifts. Clearly a major shift was the Hispanic vote.

Hispanics voted for Sens. Barack Obama and Joe Biden over Sen. John McCain and Gov. Sarah Palin by a margin of more than two-to-one in the 2008 presidential election, 66% versus 32%

And that result reversed a building trend since 1996

Nationwide, the Latino vote was significantly more Democratic this year than in 2004, when President Bush captured an estimated 40% of the Hispanic vote, a modern high for a Republican presidential candidate.

But even though McCain’s Latino vote fell well below that of President’s Bush’s in 2004, it was still much higher than the 21% share of the Hispanic vote that Sen. Robert Dole received as the GOP presidential nominee in 1996.

So what happened and what does it mean for the future?

First lets look at 2004, the Republican highwater mark. Here's a post-election review from 2004 by the National Review.

So did Republicans make progress among Latinos in 2004? A closer examination of the NEP numbers shows that Bush’s gains among Hispanics, although lower than initially estimated, were both real and significant. Specifically, the GOP’s increased Latino vote share offset the potential Democrat advantage from a hefty increase in Hispanic registration and voting....

In 2000, roughly 6 million Hispanic votes were cast. At 62-to-35 percent, this gave Gore a 1,620,000-vote victory over Bush among Latinos nationwide.

In 2004, Hispanic turnout rose by roughly 25 percent, to 7.5 million voters. Had the Democrats held their 2000 margin, their national advantage among Hispanics would have grown by 405,000, to 2,025,000. The improved Bush percentage in 2004 nullified this gain completely, holding the Democrat advantage in the Hispanic community to the same 1,620,000 as in 2000. The impact of a massive and successful Democratic voter registration drive was nullified.

Article author Richard Nadler has one key conclusion from this analysis

In other words, when Republicans have aggressively courted Hispanic votes, they have won them. And when we haven’t, GOP Latino vote-share numbers have barely budged.

So after 2004? (The Pew Hispanic Center is rich with research data.) This report before the election painted a bleak picture.

Latino registered voters rank education, the cost of living, jobs and health care as the most important issues in the fall campaign, with crime lagging a bit behind those four and the war in Iraq and immigration still farther behind. On each of these seven issues, Obama is strongly favored over McCain--by lopsided ratios ranging from about three-to-one on education, jobs, health care, the cost of living and immigration, to about two-to-one on Iraq and crime.

And don't let this fool you, the "Hispanic" issue that seemed do dominate the Republican Party over the past four years, was not ignored:

Half (50%) of all Latinos say that the situation of Latinos in this country is worse now than it was a year ago, according to a new nationwide survey of 2,015 Hispanic adults conducted by the Pew Hispanic Center.

This pessimism is especially prevalent among immigrants, who account for 54% of all Hispanic adults in the United States. Fully 63% of these Latino immigrants say that the situation of Latinos has worsened over the past year. In 2007, just 42% of all adult Hispanic immigrants--and just 33% of all Hispanic adults--said the same thing…. On the question of immigration enforcement, Latinos disapprove of all five enforcement measures asked about in this survey--and generally do so by lopsided margins

Now McCain came into this election with an advantage over other Republicans. As this Arizona Central Republic article points out

a spokesman for the McCain campaign said the Arizona senator's support among Hispanics in his home state, where he won 70 percent of Hispanic votes in his 2004 Senate race, shows he is in a strong position to compete nationally for the key voting bloc.

Charles Black, a senior adviser to the McCain campaign, said he believes Hispanics will credit McCain for his willingness "to sacrifice politically" in behalf of illegal immigrants, whom McCain often describes as "God's children," worthy of compassion and respect.

But the advantage seemed to fade in 2008. From Politico

McCain seems to have wound up with the worst of both worlds: He appears to be getting no credit from Latino voters for his past support for immigration reform, while carrying the baggage of other Republicans' hostility to illegal immigration.

So at present the Republican brand is badly tarnished among hispanics. And what about the future? Well the numbers noted here are NOT reassuring (if this voting trend continues).

Since 2000 Hispanics have accounted for more than half (50.5%) of the overall population growth in the United States… As of mid-2007, Hispanics accounted for 15.1% of the total U.S. population.

And those numbers will continue to grow.

And where's the way out for Republicans. Well clearly a new message on immigration or a new way to "sell" the old message on immigration will be key. And if that obstacle can be overcome we can see real possibilities for the Republican Party. This 2007 piece from the Hoover Institute shows the way forward

Other factors suggest Republican growth potential. A 2006 survey by the nonpartisan Latino Coalition found that 34.2 percent of registered Hispanic voters consider themselves conservative, compared with 25.8 percent who call themselves liberals.

That trend is reflected in Hispanics’ positions on a range of issues. A sizable majority—53.6 percent—of registered Hispanic voters believe that the Hispanic community should emphasize becoming a part of American society over retaining its own culture. Given a choice between cutting taxes or raising government spending as the best strategy to grow the economy, 61.2 percent favor lower taxes whereas only 25.5 percent support increased spending. More than 60 percent say they would be less likely to support a candidate who supports gay marriage. A majority (52.8 percent) consider themselves pro-life rather than pro-choice (39.8 percent).

Or as Reagan said it

Latinos are Republican. They just don't know it yet.

This will seem like a post typical of this past summer but I couldn't help feeding my
continued fascination with Senator now President-elect Obama's past associations. I was reminded of these by a couple of items.

First, this from Christianity Today's Political Blog. It is a full transcript of an interview by Chicago Sun-Times columnist Cathleen Falsani in 2004 early in his US Senate campaign. I find it most interesting in its insights into Mr. Obama's faith. Many will see what they want to see in this (and isn't that so typical of Obama) I see a man who has clearly had a religious experience but seems to still be searching for a focus. Right from the "get go" one sees that:

OBAMA:
I am a Christian.

So, I have a deep faith. So I draw from the Christian faith.

On the other hand, I was born in Hawaii where obviously there are a lot of Eastern influences.

I lived in Indonesia, the largest Muslim country in the world, between the ages of six and 10.

My father was from Kenya, and although he was probably most accurately labeled an agnostic, his father was Muslim.

And I'd say, probably, intellectually I've drawn as much from Judaism as any other faith.

So, I'm rooted in the Christian tradition. I believe that there are many paths to the same place, and that is a belief that there is a higher power, a belief that we are connected as a people. That there are values that transcend race or culture, that move us forward, and there's an obligation for all of us individually as well as collectively to take responsibility to make those values lived.

There's so much more in here that fascinates. Does it make any difference in who he will be as a President? Well, for me, character matters a lot. There's a lot I like in this interview; there's a lot that I hope has "developed" since 2004. I hope he finds a good church in Washington.

Now for the politically minded this catches one's eye:

FALSANI:
Do you still attend Trinity?

OBAMA:
Yep. Every week. 11 oclock service.

Ever been there? Good service.....

(later in interview)
FALSANI:
Do you have people in your life that you look to for guidance?

OBAMA:
Well, my pastor [Jeremiah Wright] is certainly someone who I have an enormous amount of respect for.

I have a number of friends who are ministers. Reverend Meeks is a close friend and colleague of mine in the state Senate. Father Michael Pfleger is a dear friend, and somebody I interact with closely.

So now in hindsight I still struggle to understand how state Senator Obama and then US Senator Obama could attend service "every Sunday" and not hear some of Rev. Wright's (and Rev. Pfluger's) now "infamous" words and say to himself "Hey wait a minute..."

Second, last week we finally heard from Mr. Ayers. As I assumed there's wasn't any "paling around" going on:

Ayers said that he and Obama also served together on a Chicago school reform board and a foundation board, but that their discussions were limited to issues before those boards...

"The truth is we came together in Chicago in a civic community around issues of school improvement, around issues of fighting for the rights of poor neighborhoods to have jobs, housing and so forth," Ayers said.

It's also clear why the Obama campaign (and apparently Mr. Ayers) didn't want any public pronouncements or interviews by Mr. Ayers during the campaign.

Ayers also defended his own actions during the Vietnam War.

"Let's remember that what you call a violent past that was at a time when thousands of people were being murdered by our government every month, and those of us who fought to end the war were actually on the right side," he said.

So why rehash all this? As we move into the Obama administration, I wonder if his past "liberal sensibilities" that apparently shielded him from that small voice that might say "Hey wait a minute..." will continue to speak to him?
-OR-
Will he be the man who has clearly moved and "progressed" on a path that started from the distinct political perspective of the south side of Chicago and now ends up in the much broader mix of political viewpoints that is the United States? (Or as some have put it,"moved to the center")

I'll be the first to admit, as a physician, I have a hard time understanding how "market forces" can ultimately "fix" health care in the US. I say this because 1) the costs are so high 2) the knowledge required to make an informed decision is immense 3) the consequences of a "bad" decision can be severe. Now having said all that I'm convinced the biggest issue in the US healthcare system is cost. We "buy" so much more healthcare than any other country. And its not because we're sicker.

Much of the discussion lately has been ACCESS. However, costs drive access. Put succinctly, in an employer-based healthcare system, as premium costs rise fewer employers offer health care benefits and more employees decline the higher premium costs when offered.

So with that in mind, I appreciated Sen. McCain's health care proposals that were really quite radical. In essence they would have "decoupled" health insurance from the employment and "re-injected" market forces into the system. Any effects on covering the uninsured would have been indirect. Well that's all a moot point now.

Enter The Galen Institute. They're a conservative, market-oriented health policy institute. With this article they've thrown down the gauntlet to fiscal conservatives regarding health care policy.

A group of people interested in advancing a liberal agenda was recently asked to "name the single most important policy step progressives could take to solidify a long-term grip on the government -- the kind of extended run we had from 1932 through to the Age of Reagan."

Sara Robinson of the Campaign for America's Future answered:

"I settled on 'provide universal health care -- preferably single-payer' as my final answer. I chose this not just because health care is an important public good (though it is), but because I'm convinced that this single step will do more to rapidly and permanently undermine the conservative worldview than anything else we could possibly do."

They go on to outline key "pressure points". Are conservatives up to this challenge?

ADDENDUM And if you're wondering why do we spend so much on healthcare, the Robert Wood Johnson Foundation would suggest its the same reason we just "gotta have that new iPod touch". (kinda)

Hat tip InsureBlog

In Arizona. In the last three months we’ve seen a dramatic rise in unemployment, up 1.1% from June to September, with job losses across almost all sectors. Retail sales are down by over 5% and, of course, we all know about the “free-fall” in the Arizona housing market. And so that should translate into a positive election year for Democrats, right?

Apparently not in Arizona. As outlined here, both houses of the AZ state government grew their Republican majorities. This was not what local Republican activist and consultant Stan Barnes expected.

With very few exceptions, the whole chattering class was sure that it was going to be a night for the Democrats,” Barnes said. “Someone forgot to give voters the memo that it was supposed to be a Democratic night.

The Democratic party spent huge sums of money in AZ to influence statewide and local races with little to show from it. What went wrong? Some suspect it may have been a McCain “coattail effect”. Others suggest the general tenor of the Democratic campaign message may have turned local AZ voters off.

GOP consultant Baker said the message the Democrats repeated over and over in their communications with voters was that the Republicans were bad. In hindsight, that may not have been wise, he said.

“They seemed very fixated on the idea that Republicans are nuts and they’re crazy. Pushing that idea in Republican districts may not have been a good idea,” he said.

The anger many voters felt with Republicans, said pollster Mike O’Neil, was because of the actions of those in power at the federal level. Legislative Republicans seemed to be insulated from that dissatisfaction, he said, largely because they hadn’t disappointed voters the way their federal counterparts had.

“Republicans in Arizona have not been guilty of the betrayal of their principles like those in Congress,” O’Neil said.”

For myself, I can certainly attest to the incessant Bob Lord ads that pushed the “John Shadegg equals George Bush” message. The election results were not what was expected.

So are there greater lessons to learn from this for both parties? Is the AZ Republican experience applicable to the nation as a whole? How about Massachusetts?

This nice little article from Out of Ur, a blog from Christianity Today, published yesterday reminds us of the visceral reactions to the 2004 results.

The view north of Chicago in Evanston, Illinois, was even more ominous. Northwestern University adjunct history professor Garry Wills declared November 2, 2004, "the day the enlightenment went out." No longer did America take after France, Britain, Germany, Italy or Spain. No, Bush's America harbored "fundamentalist zeal, a rage at secularity, religious intolerance, fear of and hatred for modernity." In short, the new America shared more in common with Al Qaeda and Saddam Hussein's Sunni loyalists.

And even before yesterday's election results the Christian Right (in this case Focus on the Family) began the "wailing and gnashing of teeth".

Indeed, Focus's hypothetical "Christian from 2012" writes, "Personally, I don't know how we are going to get through tomorrow, for these are difficult times."

Thankfully, there's a bit of wise advice from the author:

This election will affect how Christians live among their neighbors for decades to come, for better and worse. But faith must at least lead Christians to leave the scare tactics to the skeptics.

Chime in on how it went. For me it was the first time I could walk across the street to vote (in our community center). Polls opened at 6 am but I was there at 5:30 and at that I was about 15th in line. By 6 am already 60 in line. A long ballot (we have to retain all of our judges) including several ballot initiatives. Two pieces of ID confounded a few. Hey we're a mobile society and given our's is a new development, wouldn't you expect many people with incorrect addresses on their Driver's license.

Recently we've seen a significant drop in Gov. Palin's popularity among voters nationwide. And in fact we now see news stories of her popularity dropping in Alaska. Both of these items point back to a poorly covered area in this year's Presidential race. "Why was Gov. Palin so popular in Alaska?" Why is this an important question? Because I would contend that elections are more often about popularity than policy (now there's a surprise) and Sarah Palin's Alaskan popularity pre-nomination seems to be a decidedly uncovered item.

First of all, to remind us, here's a post from Alaskan blog, Alaskan Abroad a year ago describing her popularity.

After almost one year in the governor's office, and currently embroiled in a special session in Juneau over oil taxes, Sarah Palin continues to maintain extraordinarily high poll ratings.

But the rating remains quite unprecedented in the recent history of Alaska politics – only Ted Stevens in his heyday could really match this kind of public approval.

When first nominated for VP Gov. Palin received a lost of buzz. "Moose hunter", "beauty queen", "five kids" were some of the initial coverage items that described this unique national candidate. And of course we heard "over 90% approval rating". So I expected large national media to dig down to get to the source of this high popularity. After a not-so exhaustive search I struggled to find in-depth analysis of why she was so popular in Alaska.

From the New York Times the keys stories were Once Elected, Palin Hired Friends and Lashed Foes

Throughout her political career, she has pursued vendettas, fired officials who crossed her and sometimes blurred the line between government and personal grievance, according to a review of public records and interviews with 60 Republican and Democratic legislators and local officials

and Active Role for Palin’s Husband in Alaska Government

It is not necessarily clear whether Mr. Palin is helping shape his wife’s agenda or simply advocating for it, nor whether he ever put pressure on lawmakers, but his role has not been the customary one of a governor’s spouse in Alaska.
That has made many people in government uncomfortable and often confused over how to react.

Now the strange thing is on the NYT's "Timestopic" section that includes brief snippets of key newsworthy figures we see this:

In a state dominated by the same party – and in many cases the same people – virtually since its inception, Sarah Palin is at the vanguard of a new generation of Alaska Republicans with a reformist bent.

Gosh, now there's something that also seems worthy of in depth review. What happened?

From the Washington Post we heard that Palin Was a Director of Embattled Sen. Stevens's 527 Group.

Palin's name is listed on 2003 incorporation papers of the "Ted Stevens Excellence in Public Service, Inc.," a 527 group that could raise unlimited funds from corporate donors. The group was designed to serve as a political boot camp for Republican women in the state. She served as one of three directors until June 2005, when her name was replaced on state filings.

And in a bit more in-depth review of her past (but not her present popularity as a Governor) we came to understand that Palin's Strengths Rooted in Alaska Still no discussion about the source of her popularity.

It took columnist Howard Kurtz to allude, in a round about way, why this might not be happening.

Sarah Palin's coverage ricocheted from quite positive to very negative to more mixed, the study says. Overall, 39 percent of the Palin stories were negative, 28 percent were positive and 33 percent neutral. Only 5 percent of the coverage was about her personal life. The most negative element of the Palin coverage involved scrutiny of her record as Alaska governor, with 64 percent of the stories carrying a negative tone and just 7 percent positive.

How could just 7 percent of coverage regarding her record as governor be positive when she had a 90% approval rating?

Fortunately for me, I did find McClatchy suggesting one source of the mixed picture by pointing out that In Alaska, Palin's GOP critics suddenly become cheerleaders. I imagine it would be hard in today's election climate to get Alaskan Democrats who've been key supporters for Palin to push the positve aspects of her administration.

So at this point I can only conclude that the lack of in-depth analysis of the reasons for her Alaskan popularity are that we (that's us in the lower 48) can't understand why she would be popular and don't have the time to figure it out. Instead it's easier to focus on "strident pro-lifer", "former beauty queen", "Down's son", "unmarried daughter's pregnancy" etc.

And finally this cute blog post suggests how things might have gone if the shoe was on the other foot:

"When I said I wanted a reformer, I meant it," said Obama, who threw caution to the wind with his selection of Palin. The Obama campaign was impressed with the former PTA mom who took on Big Oil and dethroned the old boys' club that ran Alaska politics for more than a generation. "As The New York Times and Washington Post have frequently pointed out, Gov. Palin is the only candidate on either ticket with executive experience," Obama said. "And more importantly, she has experience fighting the powerful on behalf of the people — and winning."

UPDATE: (not that anyone is watching anymore) this article from Howard Kurtz puts it well. In essence the horse race (i.e. who's in the lead) colors the story. A campaign move is smart if you're now in the lead, and stupid if you're now behind, regardless of cause and effect.

When a candidate is winning, the media treat his tactical decisions as sheer brilliance. When a candidate is faltering, not so much.

My favorite weekly news magazine, The Economist printed this back in June.

Both candidates have their flaws and their admirable points; the doughty but sometimes cranky old warrior makes a fine contrast with the inspirational but sometimes vaporous young visionary. Voters now have those five months to study them before making up their minds (and The Economist will be doing the same). But, on the face of it, this is the most impressive choice America has had for a very long time.

Does familiarity breed contempt or has our prolonged and controversy-driven style of campaigning and campaign coverage wrung any sense of "America at its best" out of us?

Today we noted this report from the Pew Center for Excellence in Journalism.

But coverage of McCain has been heavily unfavorable—and has become more so over time. In the six weeks following the conventions through the final debate, unfavorable stories about McCain outweighed favorable ones by a factor of more than three to one—the most unfavorable of all four candidates

I would encourage everyone to read this summary. Among the interesting findings:
-Obama's positive coverage post-coverage centered on his lead in the polls (i.e. "everyone loves a winner)
-McCain's negative coverage accelerated after the financial crisis. As he took increasingly bolder steps to try and reverse the direction of the polls, the coverage only worsened.(i.e. "when the sh*t's flying everywhere the best thing is to duck")
-Obama's positive coverage began dramatically in '07.
-attacks hinder positive press coverage
-The economy played in Obama's favor.

And the most revealing quote:

What the findings also reveal is the reinforcing—rather than press-generated—effects of media. We see a repeating pattern here in which the press first offers a stenographic account of candidate rhetoric and behavior, while also on the watch for misstatements and gaffes. Then, in a secondary reaction, it measures the political impact of what it has reported. This is magnified in particular during presidential races by the prevalence of polling and especially daily tracking. While this echo effect exists in all press coverage, it is far more intense in presidential elections

IMHO this is similar to press coverage of the financial crisis. If the coverage is dominated with words like "crisis", "depression", etc then the coverage hurts confidence and then drives the market down further leading to further negative coverage. (However this could be my attempt at high-minded understanding. It may just be that reaction to public reaction is going after stories that will gain more reader/viewership.)

Hopefully, there will be some post-election introspection to get a handle on this (or am I being naive?) Why won't it happen now. I would cite this as a reason why there will be no self-examiniation till after Nov. 4. I mean when you're getting assaulted you tend not to ask yourself if maybe you should have locked the car door, you tend to want to fight back. (And hence more negative coverage!!)

Hawaii stepped back from universal coverage for children less than a year after the program started.

Gov. Linda Lingle's administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.

Over 2,000 children had enrolled in the "Keiki Care Plan" since it began last April. The stated paid a Blue Cross/Blue Shield company $25.50 per child enrolled. The Health Plan picked up the other half. Enrollees had some co-payments ($7 office visit co-pay) but no premiums.

So what happened?

many other government services are facing cuts as the state deals with a projected $900 million general fund shortfall by 2011.

OK but aren't those dollars worth it?

State health officials argued that most of the children enrolled in the universal child care program previously had private health insurance, indicating that it was helping those who didn't need it.

And so now what are the alternatives?

Families with children currently enrolled in the universal system are being encouraged to seek more comprehensive Medicaid coverage, which may be available to children in a family of four earning up to $73,000 annually....These children also could sign up for the HMSA Children's Plan, which costs about $55 a month.

So a little math: Is $1320 per year (or less than 2% of gross income) too much for a family of four to pay to cover their two children under the HMSA Children's Plan?

ADDENDUM Go hereand you can compare by City. It looks like Honolulu is an expensive city to live in.