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News, notes, and observations from the James River Valley in northern South Dakota with special attention to reviewing the performance of the media--old and new. E-Mail to

Wednesday, August 19, 2009

Reasoning with dining room tables

I suppose the forum sponsored by South Dakota Public Broadcasting and AARP-South Dakota at NSU last night was an attempt to circumvent the delusional scurrility that has subverted the discussion of health-care reform and to put the focus back on the issues that reform measures are intended to address. The fact is that it is probably impossible to have a reasoned fact-based discussion of health-care matters. The right wing is dedicated to avenging its loss of the election to Obama, not attending to the health-care needs of the country, and that makes any focused discussion of the issues impossible. Nevertheless, there were a few moments at the forum when some individuals tried.

Coverage of the event by both the traditional and Internet media demonstrate the level of distraction that detracts from any productive discussion. In the newspaper and television coverage, more space was given to the 20 or so protesters outside the Johnson Fine Arts than to the 250 or so inside. Tom Daschle is still an obsessive hate-object for the hate cult, and the media covered more of that than the substance of what is at issue.

Daschle repeated a statement of the problems that define the crucial issues with health-care:

  • Cost

  • Quality

  • The number of uninsured and under-insured.

Questions were submitted on cards, a usual and customary procedure in forums where moderators try to keep the discussion on track. It allows moderators to eliminate the redundant, the specious, and the merely malicious. In trying to summarize the nature of the individual questions, moderator Cara Hetland commented that to many people health-care has a very personal aspect. And that is why the inane demonstrations put on by the protesters are so frustrating and unproductive. For many months, Senator Johnson and Rep. Herseth Sandlin have held meetings with health-care providers and constituents throughout the state to gather specific instances of where health-care works and where it doesn't. The analysis of many specific situations is what provides the answers to the problems. But those individual stories, while anecdotal by themselves, collectively define what needs to be done.

The comments elicited by generalizing the questions submitted were in themselves too general and vaguely referential to provide clarity and specificity about proposed solutions and what they would address.

Perhaps the most clarifying moment came when Dr. Tom Huber, a family physician from Pierre who is president-elect of the South Dakota Medical Association, explained why he thinks the proposal that has led to the "death-panel" charges is so important. Both his mother and mother-in-law died recently of age-connected ailments. He pointed out that for people on Medicare, 30 percent of their medical costs are accrued during the last month of their lives. Expensive life-prolonging treatments might give them another month of intense pain and suffering, but can do nothing to stop the ineluctable advance of death. Dr. Huber stressed how necessary it is for people to have counseled thought about what provisions they wish to make for this eventuality.

None of the panelists at the forum, except for Tom Daschle and Dr. Huber, are supporters of current proposals for health-care reform. They consisted of representatives of the Chamber of Commerce, the Association of Healthcare Organizations, the insurance industry, a small business owner, and the AARP. The AARP is a strong advocate for reform but is very emphatic in saying that it endorses no proposals under current consideration. Tbe panelists indicated a need for some kind of changes, but were critical, at least by implication, of pending legislation. They offered no specifics on what could be improved, and many indicated they did not understand the House bill.

The insurance industry representative criticized the 1,000-pages and said it is unfair to the public to advance such a complex piece of legislation. Tom Daschle said that if the curren health-care system were translated into bill form, it would take thousands and thousands of pages.

The bill under consideration by the House is an example of convoluted bill writing. The falsehoods created about by opponents are not readily refutable by specific language because the bill contains a maze of cross-references that make it virtually unreadable on a computer screen.

A few of the panelists stayed behind after the televised part of the forum to take questions from people on the floor. The first quesitoner had an accusation concerning the AARP stance, and was quickly told he was factually wrong. We left at that point.

An essential fact of health-care insurance is that fewer and fewer people can afford. One question was whether there were really 48 million people without health-care insurance, or was it a matter of 20 million people who decided to buy a car instead. The question was snarky, but still gets at the problem. When people are faced with the need to make decisions between trnsportation, housing, and health-care, health-care probably gets deferred by a matter of economic necessity. The rising cost of health-care and the fact that it takes up such a huge percentage of the family budgets is the problem.

Little coherent information about health-care reform is availble. If anyone is really interested, they might took a look at this very interesting and incisive presentation posted on Behind Government Lines.

Tuesday, August 18, 2009

The fence post caucus makes itself heard

The word fascism is being hurled around. Well it should. We've lived under a regime of corporate fascism for the better part of a decade. What has happened to our country fits the definition of fascism perfectly. I don't mean the definition made up by the withered fruits on the tree of democracy that have still to negotiate a grade-school primer. Or those brighter lights who change the definition of fascism so that what they do doesn't fit what is globally recognized as what defines fascism.

The corporate fascism we've lived under finds tremendous profits in going to war. The fact that the war is one of the major driving forces behind our deficit does not matter. They get their money. The fact that 4,300 vital, young Americans have been killed in a totally fabricated and useless war in Iraq does not matter. The corporations who feed on that war get their money. Just look at Halliburton. If your blood pressure can stand it. Killing young people and making the machinery of war has huge profits. And huge profits are the stuff our country is built on. Put more of our soldiers in the line of fire, connive some bidless contracts, and watch your stocks soar. The corporations get their money. That's all that matters. Oh, and they call it patriotism.

When corporations lure our defense department into dangerous waters, hold it hostage, and dictate a price for trying to extract it, we call it enterprise. When teen-age Somalis do the same thing, we call it piracy.

And then there is this health-care business. Much money can be made from sickness and death. Not much money can be made from good health. We have a very significant number of people who cannot afford health care insurance. As Paul Krugman points out, "Every wealthy country other than the United States guarantees essential care to all its citizens. " But that's not the American way. It doesn't make corporations any money.

The proposal for a public option as a means to provide health-insurance coverage to everyone is called socialism and an intrusion by government into private business. It's okay if the government subsidizes insurance companies with $60 billion a year. "Leaving private insurance companies the job of controlling the costs of health care is like making a pyromaniac the fire chief," said Rep., Anthony Weiner, D-N.Y.

It's all okay as long as the corporations get their money. That has become the American way.

To preserve America, we need to leave people free to get sick and die and get killed in wars like Iraq and contribute to the economy. For the corporations. That's become the American way.

So, let us have no talk of a public option which would make it harder for corporations to compete for their money, subvert the corpoprate pursuit of happiness, and kill the profit potential of sickness, death, and dying.

Instead let us celebrate the great tradition of falsehood and ignorance that is so undeniably the American way. In god and corporations we trust.

Monday, August 17, 2009

A forum question for Sen. Daschle

Time has posted an article pointing out that while Sen. Daschle personally excoriates the health insurance industry while he is a leading advocate for the public option, in his role as a consultant he also advises one of the biggest opponents of health-care reform, United Health. The article asks why Meet The Press did not inform its viewers Sunday of this seeming conflict of interest. `

Saturday, August 15, 2009


You want some facts,some courtesy, and some intelligent talk?





Friday, August 14, 2009

When Did Americans Turn into a Bunch of Raving Lunatics?

That's the headline in a series of stories about the anti-Obama forces by Esquire's political columnist. He delves into the personalities driving the "birther" movement and other kinds of dementia that possess what seem to be otherwise nice folks.

Members of the main stream media are doing what journalists are supposed to do and are fact-checking the dreck being generated about health care and other issues that Obama has put on the agenda. As we've been claiming all along, the issues are just pretexts to give vent to deeper, more troubling moral pathologies that infect Americans.

The New York Times has an in-depth article about where the "death panel" lie got started and who is propagating it.

The Columbia Journalism review has started a column to track the misinformation created about health-care reform.

Even the White House has launched its own website to counteract the diarrhea pandemic among the dingbat caucus.

These efforts may give some succor to those who long for sanity, but does anyone think those who live in delusions want to go there?

Thursday, August 13, 2009

Les Paul: June 9, 1915 - August 13, 2009

Les Paul, the most influential maker of music and muscial instruments, died today at the age of 93 of complications of pneumonia.

Starting out at 13 playing in a country band, Les Paul played with and inspired the nation's top jazz and popular musicians, invented the solid- body guitar, and was the kind of musician that every other musician would like to play with. He just enjoyed playing his instrument.

For a full obituary, which includes a video link, click on this New York Times story.

Wednesday, August 12, 2009

Is it about health-care reform? No, it's about finally lynching Rosa Parks

People go to town halls to disrupt, insult, and abuse. Their defenders make the preposterous claim that they are simply voicing their protests over proposed legislation they don't like. But what they don't like is stated in fabricated lies that have no basis or relationship to what is being proposed in the health care reform.

There are many questions about reform proposals that can be asked and that need some answers. But those questions are not being asked by the protesters. In a lower key, you can hear some town hall participants asking them, but they are drowned out by the sound and the fury, and cable news and internet videos concentrate on the instances of conflict, insult, and abuse.

The most salient question is whether you want the insurance corporations, the right wing obstructionists, their lie fabricators, and their raging followers to set the direction and the agenda for the country? By comparison, rigid socialism takes on a benign aspect. When people base their words and actions on lies that are proven false over and over again, the country is in trouble.

Much accusation of Nazism, death panels, government-mandated euthanasia, is being directed at President Obama and those who see a need for health-care reform. But they are based upon falsehoods about what is being proposed, not any basis in fact.

When George W. Bush was accused of totalitarian tactics, the analogies were based on facts. He pushed us into a war in which 4,300 soldiers have been slaughtered with a lie about weapons of mass destruction and links of Iraq with Al Qaeda. He instituted warrantless wiretaps of American civilians. His henchman adopted torture as a tool of interrogation. And he instituted a concentration camp network that still has not been unsnarled.

The pretexts under which Nazism and government totalitarianism are being charged in the reform debate do not possess that degree of factuality. In fact, they are just another battle in the culture wars, a retaliatory action.

In the climate of falsehood and rage existing today, no critical dialogue that could come up with a reasonable compromise for making health-care accessible and affordable to everyone is possible. That is the point of the protests in the form that they have taken.

Not much has been said of the culture wars since the election of 2004, but they are raging. And the rage over health-care reform is clearly a rage over other matters. Paul Krugman says it is a result of "cultural and racial anxieties." Much of the dialogue is crypto-racism, although many other sources of bigotry and hatred are also involved. When people are raging in talk that has no basis in fact and reality, you know there are other sources for their outrage.

The best illustration of what is taking place occurred at a town hall meeting held by Sen. Claire McCaskill (D-MO). Cable news and some internet sources show an unruly black woman being shoved out of the meeting by police. What has not been shown is what really happened.

The woman had a poster of Rosa Parks, the woman who refused to give up her seat on a bus to white man and started the civil rights movement. She had the poster rolled up. When a journalist asked to see what the poster was, she started to unfurl it, when a white man jumped up, grabbed the poster, and ripped it up. The woman was ejected for trying to get her poster back.

Here is the story as reported on the Huffington Post.

Among the many eyebrow-raising clips aired on major news networks yesterday from Senator Claire McCaskill's health care town hall was one of a woman being half-escorted, half-dragged from the building.

What the clip failed to catch was that the woman was provoked. She and a few other women had brought posters to the town hall, but they rolled them up after being booed and berated by the crowd. When the woman unrolled one to show to a journalist, an angry man in the crowd rushed over and tore it up. A poster of what, you ask? Rosa Parks. When the woman moved to take her poster back, the police stepped in and escorted both parties from the building. But only the woman made national news.

Forget about health-care. America has some old battles to fight. If you think it's worth it.

Monday, August 10, 2009

Someone needs to talk to someone's mama outside

The Washington Post in an editorial titled "An Unhealthy Debate," makes an astute case about what the discussion of health-care has devolved into:

No one, liberal or conservative, Democrat or Republican, should be happy with the current system [of health-care], which spends too much to cover too few. Insurance is increasingly unaffordable. Even those with coverage are at risk of losing it, being denied needed care or being locked into jobs because of preexisting conditions. Rising health-care costs threaten the economy, while entitlement spending consumes a growing proportion of the federal budget.

The moment is ripe for a responsible fix, which is what makes the current eruption of smackdown politics all the more depressing.

The piece decries the fact that deliberate falsification of facts regarding the proposals have been projected into the public discussion. Thr falsehoods are what the alleged protesters keep shouting as they keep proponents of health-care reform from stating their side of the case. However, the Post editorial takes a very cavalier attitude toward the contrived and outright misrepresentations and the hate-libels contained in them. In its recent editorial decision to appease its regressive critics, the Post has shown a shift of late in the way it handles news. It couches its citation of Republican tactics in euphemistic terms:

Republican lawmakers and conservative activists have fanned the flames of uninformed opposition with familiar warnings about government-run health care and socialized medicine and irresponsible new twists, such as the suggestion that the proposals under discussion would strong-arm seniors into euthanasia.
The slogans chanted by opponents of health-care reform may be stupidly false, but there is nothing to profit by continuing the discussion. When people use falsehoods as pretexts for attack and resort to defamation, they are not interested in facts or solutions to problems. They are manufacturing justifications for their attitudes, not responding to factual issues. . The nature of the confrontations and the often unfounded accusations with which people try to justify their disruptive offenses make further discussion of health-care reform pointless. You simply can't reason with people who have chosen to believe in--or at least recite--lies.

Something not openly commented about is that the heated controversy has fanned the talk of investigating George W. Bush and Dick Cheney for war crimes. I have received Internet petitions for members of Congress to launch an investigation and make charges. President Obama has discouraged such an investigation in order to concentrate on his agenda, but many supporters of Obama think that the question of fraud, deception, and violations of the Constitution has to be settled before the nation is ready to deal with its current problems. One petition noted that the deaths of U.S. military in Iraq have reached 4,330 and are increasing daily. It made the case that it is absurd to indulge in fantasies about Obama death squads under a health care plan while our troops are being killed daily in a fraudulent war. The health-care debate may well force hearings on the Bush-Cheney legacy before any other work can be done.

Some of the more militant progressives think it is time to end any attempts at using the legislative process to gain reform. They have raised the issue of boycotts, emphasizing the fact that during a time of recession, well-organized boycotts can have immediate, direct effects that talk cannot produce. The progressives need to tap organization resources the way that health-care opponents have. Whether the advocates of reform can martial coordinated effort is dubious. However, boycott promoters point to how successful they were in the civil rights battles. When doing business becomes a partisan issue, people at least have the satisfaction of knowing that their money and support is not going to people who wish them ill.

People who want health-care reform will have to take direct action if they are to realize any significant improvements in services and cost controls.
But in the meantime, the debate moves toward violent confrontations, and the Washington Post editorial at least specifies some of the falsehoods fueling the anger. . Cory Heidelberger at Madville Times does the fact-checking on five of the absurdities taken up as rallying cries

  • Myth 1: Democrats want to kill your grandmother.
  • Myth 2: The government -- i.e., you -- will have to pay for abortions.
  • Myth 3: Obama will ban all private health insurance.
  • Myth 4: The government can't possibly run a healthcare program.
  • Myth 5: Unlike private insurance, government bureaucrats will ration care.
For those who actually want to address the reform issues, has also supplied an analysis of the falsehoods. It provides detailed factual analysis of claims promoted

  • CPR administers bad facts again
  • Surgery for seniors vs. abortions
  • :False euthanasia claims
  • Canadian straw man
And Factcheck offers this factoid: In 2008, U.S. health care spending is estimated to have been $2.4 trillion. It is projected to nearly double to $4.4 trillion in 2018.

For those who wish to address the real situation regarding health-care reform, the facts are readily accessible. For those who wish to feed their anger and malice, there is an abundance of falsehoods to stoke the fires of hate.

Saturday, August 8, 2009

Crypto-racism and the incitement of rage

Rep. Todd Akin (R-MO) captured the real attitude that possesses conservative America. He spoke of the protests taking place with his constituents in Missouri:

"Different people from Washington, DC, have come back to their districts and have town hall meetings, and they almost got lynched."

The audience then broke out into laughter and applause."I would assume you're not approving lynchings, because we don't want to do that," Akin said, putting his hand to his neck in imitation of choking, which got audience laughing some more. "

But the point is, people are really upset at some of this legislation, and with very good reason they were upset."
When Akin used the world "lynch," he expressed the motivating attitude behind the rage against Barack Obama. As demonstrated by the hanging of Rep. Frank Kratovil (D-MD) in effigy outside his Maryland office, lynching and all the violent attitudes and actions involved with it are what the alleged opponents of health care really have in mind. The language of one of the intended assassins last year at the Democratic convention in Denver identifies what the real problem is with them: "a nigger in the White House."

The Internet often reveals the true expressions and motives of what is surging through the political world, and the picture of Obama rendered as the Joker shows the racist intensity that explains much of the anger being vented in the so-called health care reform protests. One does not need to have a background in rhetorical analysis to get the real message that is moving so many Americans into violent confrontations. It is the same motive that inspired a Florida physician to circulate a picture of Obama as a witch doctor.

It may be true that in electing Barack Obama president, a majority of Americans moved dramatically beyond the old racist attitudes that held the nation in its grip and motivated America's own Holocaust-- slavery, Jim Crow, and the racial cleansing of much of Native America. But that doesn't mean that the people who long for segregation and the oppression of dark-skinned people have gone away. Their virulent hatred and desire to inflict violence on the objects of that hatred still festers and fumes and erupts into hate speech, as has typified the so-called health care protests.

Again one does not need to be educated in the fine points of true discourse to recognize the fact that the protests are designed to disrupt and prevent any discussion of the health care proposals in a manner that can provide legislators with informative and usable viewpoints. The shouting down of speakers and the chanting of charges that have been and can easily be proven to be totally untrue and without any merit in fact whatever show the true nature of what the alleged protests are all about. The most emphatic evidence is that the protests do not address any points in the reform proposals, but are expressed as personal defamation and denigrations of President Obama. It is hard not to hear the anger at there being a black man in the White House. While the language shouted in the confrontaitons does not, as yet, employ the N-word, it uses all the synonyms and attack tactics.

The accounts and videos of the disruptive incidents make the claims that these are merely people trying to be heard is absurd. The clear intention is not to be heard, but to prevent the people speaking for reform from being heard. And the racist expressions belie any claims to benign exchanges.

But racism is just another manifestation of a deeper cast of mind that resists and cannot keep pace with the progress of social justice that characterizes America's advance toward meeting its principles of freedom, equality, and justice for all. What the organizers and agitators of protests are using is an appeal to the reptilian cortex, that primitive remnant in the human brain that can trigger mindless, undiscerning rage when it feels threatened.

The appeal to the reptilian is what fear-mongering is.

Those who are controlled by the reptilian find anyone that differs from them, whether in color, culture, or thought, is a threat. Their response is to attack and try to vanquish anyone who seems to resist their efforts a dominance.

For some people, the reptilian cortex holds control over the neo-cortex, which is where the power to reason, discern, make decisions, and take voluntary action is situated. The field of advertising and public relations has long recognized the role that the reptilian plays in the behavior of some people and motivational researchers have recognized how to manipulate the reptilian as a part of marketing strategy. The appeal to the reptilian as a way of influencing their behavior has been examined by that part of the media that operates on the level of the neo-cortex.

Journalistic observers and political strategists are right when they say that the debate on health care reform has been obstructed and converted to a debate on President Obama. The people who are agitating against reform have successfully excited the reptilian with outrageous statements about government takeover, euthanasia, and Nazi pogroms. Those motivated by the reptilian do not think about whether these statements have any basis in fact or truth. They merely rage, as their pogrammers intended them to. The fact that the protests are quickly moving into violent confrontations is evidence that they are driven by the reptilian.

Racism is alive and raging. However, it is merely one aspect of the battle against those who follow higher callings. The conflict between conservatives and liberals has devolved into a struggle between the reptilian and the neo-cortex.

The debate is not so much over providing health care for all as it is over which forces will control the country. To the regressives, their reptilian sensibility tells them their territory has been invaded and their dominance is threatened. Nothing incites their rage against progress more than having a black family in the White House.

Friday, August 7, 2009

Republican lies and agitation get called out

A Washington Post business writer decides he can no longer tolerate the Republican perfidy and malice:

The recent attacks by Republican leaders and their ideological fellow-travelers on the effort to reform the health-care system have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage. By poisoning the political well, they've given up any pretense of being the loyal opposition. They've become political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems.

There are lots of valid criticisms that can be made against the health reform plans moving through Congress -- I've made a few myself. But there is no credible way to look at what has been proposed by the president or any congressional committee and conclude that these will result in a government takeover of the health-care system. That is a flat-out lie whose only purpose is to scare the public and stop political conversation.

Wednesday, August 5, 2009

Heidepriem: Born in Kenya and cross-dresses as a wise, Latina woman

Pukwana--It was narrowly reported in Mitchell today that South Dakota gubernatorial candidate Scott Heidepriem was born in Kenya and parades around South Dakota as a wise Latina woman who will say anything to legislate from the bench.

The reports were independently confirmed by the Northern State University Center for Illiteracy, Fabrication, and Prozac and by the Sibson Project for Excellence in the MSM. When contacted to comment on the report, Mr. Sibson said, "I can smell Russia from my house."

Prof. Blent Cantshard of the NSU Center said he could not talk further because he had this fusion thing to work on. (Hat tip to the South Dakota Wart Collage for the link technique.)

In addition to the dubious birth charges and having designs on making legislation (he's a state senator, also), he was charged with owning a BMW. He said he doesn't. He did once, but now owns a VW. The Sibson Project was working on this fascination for German-made cars and the Nazi tendencies it reveals. The NSU Center issued a statement that only the rightwing-ding chorus can sing about Nazis.

Heidepriem was also charged with selling his house. Then was called out for being a liar when he said he wasn't but was thinking about it. That is a violation of the wingding admonition never to think.

And then Heidepriem was charged with resigning from his country club. He said he reduced the level of membership. Again, the wingding conclave quickly termed this a lie, and found Heidepriem guilty of living his own life.

Heidepriem's attempts to legislate from the bench were supported by the charge that he is a successful trial lawyer. Sneaky devil.

Worst of all, Heidepriem is guilty of minding his own damned business.

The wingding conclave of the Sibson Project, the NSU Center, and South Dakota Wart Collage (all the ugly all the time) will hold a rally outside the offices of the Democratic legislators where they will hold hands and sign their anthem, "Jesus Wants Me for a Teabag."

Sunday, August 2, 2009

Swimming in the cess pool: fact-checking health care proposals

Charles Babington of the AP fact-checks the health care claims:

CLAIM: The House bill "may start us down a treacherous path toward government-encouraged euthanasia," House Republican Leader John Boehner of Ohio said July 23.

Former New York Lt. Gov. Betsy McCaughey said in a July 17 article: "One troubling provision of the House bill compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care."

THE FACTS: The bill would require Medicare to pay for advance directive consultations with health care professionals. But it would not require anyone to use the benefit.

Advance directives lay out a patient's wishes for life-extending measures under various scenarios involving terminal illness, severe brain damage and situations. Patients and their families would consult with health professionals, not government agents, if they used the proposed benefit.

CLAIM: Health care revisions would lead to government-funded abortions.

Tony Perkins of the Family Research Council says in a video, "Unless Congress states otherwise, under a government takeover of health care, taxpayers will be forced to fund abortions for the first time in over three decades."

THE FACTS: The proposed bills would not undo the Hyde Amendment, which bars paying for abortions through Medicaid, the government insurance program for the poor. But a health care overhaul could create a government-run insurance program, or insurance "exchanges," that would not involve Medicaid and whose abortion guidelines are not yet clear.

Obama recently told CBS that the nation should continue a tradition of "not financing abortions as part of government-funded health care."

The House Energy and Commerce Committee amended the House bill Thursday to state that health insurance plans have the option of covering abortion, but no public money can be used to fund abortions. The bill says health plans in a new purchasing exchange would not be required to cover abortion but that each region of the country should have at least one plan that does.

Congressional action this fall will determine whether such language is in the final bill.

CLAIM: Americans won't have to change doctors or insurance companies.

"If you like your plan and you like your doctor, you won't have to do a thing," Obama said on June 23. "You keep your plan; you keep your doctor."

THE FACTS: The proposed legislation would not require people to drop their doctor or insurer. But some tax provisions, depending on how they are written, might make it cheaper for some employers to pay a fee to end their health coverage. Their workers presumably would move to a public insurance plan that might not include their current doctors.

CLAIM: The Democrats' plans will lead to rationing, or the government determining which medical procedures a patient can have.

"Expanding government health programs will hasten the day that government rations medical care to seniors," conservative writer Michael Cannon said in the Washington Times.

THE FACTS: Millions of Americans already face rationing, as insurance companies rule on procedures they will cover.

Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions.

Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them. He recently told a forum: "We don't want to ration by dictating to somebody, 'OK, you know what? We don't think that this senior should get a hip replacement.' What we do want to be able to do is to provide information to that senior and to her doctor about, you know, this is the thing that is going to be most helpful to you in dealing with your condition."

CLAIM: Overhauling health care will not expand the federal deficit over the long term.

Obama has pledged that "health insurance reform will not add to our deficit over the next decade, and I mean it."

THE FACTS: Obama's pledge does not apply to proposed spending of about $245 billion over the next decade to increase Medicare fees for doctors. The White House says the extra payment, designed to prevent a scheduled cut of about 21 percent in doctor fees, already was part of the administration's policy.

Beyond that, the nonpartisan Congressional Budget Office said the House bill lacks mechanisms to bring health care costs under control. In response, the White House and Democratic lawmakers are talking about creating a powerful new board to root out waste in government health programs. But it's unclear how that would work.

Budget experts also warn of accounting gimmicks that can mask true burdens on the deficit. The bipartisan Committee for a Responsible Federal Budget says they include back-loading the heaviest costs at the end of the 10-year period and beyond.

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