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The end-of-life decision

I’m sure that everyone has heard the tape of the 911 call or read the transcript.  An unidentified nurse at an independent living facility refused to do CRP on a resident who had collapsed.  The resident. 87 year old, Lorraine Bayless, collapsed in a dining room.  The New York Times published the transcript of part of the call

“She’s going to die if we don’t get this started. Do you understand?” the 911 dispatcher asked.

“I understand,” the nurse said. “But I cannot have our other citizens who don’t know CPR do it.”

“Is there anyone that’s willing to help this lady and not let her die?” the exasperated dispatcher said a bit later.

“Um, not at this time,” the nurse replied.

For me the most shocking part of this story is not that no CPR was performed, but that the nurse in question evidently thought she was following company policy.  The Boston Globe story elaborates

During the dramatic 7-minute, 16-second call, dispatcher Tracey Halvorson urged the nurse, who has not been identified, to start CPR. The nurse declined, citing company policy.

‘‘I understand if your boss is telling you, you can’t do it,’’ the dispatcher said. ‘‘But . . . as a human being . . .  you know, is there anybody that’s willing to help this lady and not let her die?’’

‘‘Not at this time,’’ the nurse answered.

Halvorson assured the nurse that Glenwood couldn’t be sued if anything went wrong in attempts to resuscitate the resident, saying the local emergency medical system ‘‘takes the liability for this call.’’

Later in the call, Halvorson asked, ‘‘Is there a gardener? Any staff, anyone who doesn’t work for you? Anywhere? Can we flag someone down in the street and get them to help this lady? Can we flag a stranger down? I bet a stranger would help her.’’

Now comes the firestorm and many, many questions.  Did Ms. Bayless have a DNR on file and did staff know about it?  Even if the independent living facility was “just housing”, don’t people just have an ordinary responsibility to each other to help and not just let someone die?  What was the policy really?  And were there other residents there who saw all this happening?

Like many people of my age, I am very familiar with this type of facility since my mother lived in one for many years.  Yes, she owned her own unit for most of those years and had a kitchen but she also was required to pay for one meal a day in a common dining room.  This is a common practice to help prevent isolation.  The facility also provided recreational activities including exercise classes, trips, a bus to go shopping and a nurse on site.  My mother had a DNR, but I’m not sure who knew about it until she moved into the assisted living section of the facility.  There all the staff knew.  Somehow I cannot begin to imagine that one of the staff in the dining room would not have started CPR if someone collapsed and started breathing.  My mother once choked and a wait staff member did the Heimlich on her.  And I saw other medical emergencies in which staff intervened even while waiting for the EMT’s to arrive.

So what went wrong here?  The NYT article points out the CPR can hurt frail elders more than it can help them.

In one study conducted in King County, Wash., where a surveillance system tracks every out-of-hospital cardiac arrest, University of Washington researchers found that only 9.4 percent of octogenarians and 4.4 percent of nonagenarians survived after CPR, compared with 19.4 percent of younger patients.

In another study of 2,600 out-of-hospital cardiac arrests over four and a half years in Oakland County, Mich., only 3.3 percent of patients over age 80 who received CPR survived to discharge from the hospital.

Even when older people survive CPR, the consequences can be deleterious: broken ribs and fractured sternums, punctures of the lungs or liver, vomit in the lungs and significant pain. Those who argue for CPR in the elderly say these complications, while serious, are preferable to death. Others say quality of life can be, and often is, terribly degraded.

Ms. Bayless’ family has expressed peace of mind with the decision saying that their mother wanted to go quickly, without intervention and given the potential consequences, I can understand their point of view.  But given that fact, why was there no DNR order on file?

Meanwhile everyone is investigating the need for clearer policies, the need for possible legislation and even the possibility of a criminal case.  According to the Globe

…the case has alarmed police, lawmakers, and advocates for the elderly. The Assisted Living Federation of America, the nation’s largest trade group for such centers, said Tuesday that even if facilities have policies saying employees don’t perform CPR, they should cooperate if asked by 911 dispatchers.

‘‘It was a complete tragedy,’’ said Maribeth Bersani, senior vice president of the trade group. “Our members are now looking at their policies to make sure they are clear.’’

Bakersfield police were trying to determine whether a crime was committed when the nurse refused to assist the 911 dispatcher.

And lawmakers are pledging an investigation.

‘‘This is a wakeup call,’’ said Assemblywoman Mariko Yamada, chair of the California Assembly Aging and Long-term Care Committee. ‘‘I’m sorry it took a tragedy like this to bring it to our attention.’’

For me the bottom line is this from the New York Times

There is another lesson here as well, much broader in scope, about what people owe each other in emergencies of this kind. Whether or not we have medical training, “all of us have a duty to respond to people in life-threatening situations,” said Dale Jamieson, director of the Center for Bioethics at New York University. “This is a general ethical commitment we have to each other as part of living in society.”

The main gate of Glenwood Gardens, a retirement community in Bakersfield, Calif., where an elderly woman died after a nurse refused to perform CPR

The main gate of Glenwood Gardens, a retirement community in Bakersfield, Calif., where an elderly woman died after a nurse refused to perform CPR

What develops from this incident will impact all of us boomers as we age.  And for younger people, this might be your parent.

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Texas, the death penalty and science

Hard to know where the fault lies:  with Governor Perry who seems to like to execute people without seeming to inquire too much about the circumstances or with the anti-scientific cultural bias that seems to inhabit the state.  Both are at play with the pending execution of  Larry Swearingen for a murder he may not have committed.

Jordan Smith (a reporter for the Austin Chronicle) writes for the Nation

Just over a year ago, in January 2012, Texas Governor Rick Perry marked a gruesome milestone: with 239 executions under his belt, he had officially overseen half of all executions carried out in that state since the reinstatement of the death penalty. Since then, Texas has killed fourteen inmates, solidifying Perry’s position as the governor who has presided over the most executions in history. To date, 492 prisoners have been put to death since the state’s death chamber roared back to life in 1982. By the time this issue of The Nation hits newsstands, the number will likely be 493.

Amid so much state-sanctioned killing there is scant official acknowledgment that the state’s capital punishment system is fraught with problems. As the body count rises, nagging evidence points to the possibility that Texas has executed at least one innocent person, and may be poised to kill more. The arson-murder case of Cameron Todd Willingham, killed in 2004, is the best known, but there are many other cases that raise serious questions about the guilt of people on Texas’ death row.

As it moves down the roster of executions scheduled for this year, the state is perilously close to adding another name to its list of potential innocents: Larry Swearingen, whose case highlights a growing tension in Texas between science and the law. Add to that conflict the all-too-familiar problems of prosecutorial bias and tough-on-crime politics, and you’ve got a recipe for wrongful conviction that, when death is involved, can’t ever be remedied.

I’ve written twice about Cameron Todd Willingham, once in 2009 and again in 2010.  Most people who know about the Willingham case believe that this was a case where an man known to be innocent was executed.  According to Smith, it may well happen again.  Interestingly, both cases hinge on science.

In Swearingen’s case, the courts have demonstrated little tolerance for scientific questions that are not only central to his guilt or innocence, but that have implications for every single death investigation in the state. Until Texas courts— particularly the state’s highest criminal court, the Court of Criminal Appeals (CCA)—accept that understanding science is key to doing justice, the risk that innocent men and women will be locked up, or worse, is inevitable. And in the absence of such a eureka moment, Swearingen, whose latest execution date was February 27, will die despite serious unresolved questions about his guilt.

According to the story in the Texas Observer

When a dead body is discovered, investigators can work out the likely time of death in a number of ways. The first clue is the bugs. It can take no time at all for blowflies and house flies to home in, searching for open wounds and orifices in which to lay their eggs. Between 12 and 24 hours later, when the body is cold to the core, those eggs hatch and the larvae feed on the flesh. The insects offer important clues for forensic pathologists, but it’s also important that they note what the outside temperature was in the days and weeks preceding the body’s discovery. That’s because the higher the temperature, the faster the insects will develop and once entomologists have identified the species, they can determine when they hatched and therefore how long that body has been there.

By day four, bacteria have started to break down the tissues and cells, releasing fluids into the body cavities that produce gases and cause the body to bloat. In summer, a human cadaver in an exposed location can be reduced to bones in just nine days—particularly if there are wild animals around.

Decomposition science is morbid but it can help solve heinous crimes. And it could be the key to figuring out if a man sitting on Texas’ death row was the killer in the gruesome 1998 murder of 19-year-old Melissa Trotter.

In February, nine forensic experts took the stand at an evidentiary hearing for convicted murderer Larry Swearingen to explain that precisely because of this decomposition science, they were sure that Trotter hadn’t been dead very long when her body was discovered— as little as a day; as long as 14. Either way, Swearingen couldn’t have killed her, they said, because at the time of her death he was in jail.

Smith concludes his piece in the Nation

Had Melissa Trotter been killed today, it is hard to imagine that Swearingen would be facing execution without the alleged murder weapon or other evidence first being subjected to DNA testing. The use of science, and DNA in particular, in criminal cases has advanced greatly since 1999. “This is evidence that would routinely be tested if the case was investigated today, and any one of these pieces of evidence could produce a DNA profile that could lead to another perpetrator,” says Bryce Benjet, who is working with the Innocence Project on Swearingen’s behalf. “Regardless of where you stand on the death penalty, I think we can all agree that we should be absolutely certain of guilt before putting someone to death.”

Of course, Texas’ efficient death machinery doesn’t necessarily discriminate between the certainly guilty and the probably or even possibly so. Finality of conviction has long been the force driving justice in Texas, especially as practiced from the bench of the CCA. But DNA has already exonerated forty-seven inmates in Texas—one of them on death row—and inspired efforts to ensure better certainty in convictions, in the state and beyond. Whether the court will accept and apply such science in Swearingen’s case—or in the cases of any of the twelve other inmates scheduled for execution in 2013—remains an open question.

Larry Swearingen’s execution has been stayed until evidence can be reexamined.  Let’s hope this happens before the courts and the state get impatient.  Let’s hope the science is accepted before he is put to death, not after as with Willingham.

Larry Swearingen

Larry Swearingen

Photograph Alex Hannaford

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Rebuilding the Longfellow Bridge, Part 2

In 2010, I wrote about the potential redesign of the historic Longfellow Bridge between Boston and Cambridge to make it more pedestrian and bicycle friendly.  This week, the Massachusetts Department of Transportation announced they were ready to being rebuilding.  Renovation will begin this summer and take three years if all goes according to schedule.  According to the Boston Globe

Through the duration of the three-year construction project, the bridge will only accommodate cars traveling from Cambridge into Boston. Traffic headed north will be diverted to the Craigie Bridge, adjacent to the Museum of Science. The road leading to Cambridge will be narrowed to one lane to allow for bicycle traffic. David L. Ryan/Globe Staff/File 2010 The road leading to Cambridge will be narrowed to one lane to allow for bicycle traffic.

For 25 weekends, the Red Line will not traverse the bridge, and commuters will instead be shuttled via bus. The T will continue to run on weekdays, on temporary tracks on the road while workers perform maintenance on the permanent rails.

The traffic flow will look something like this.

Traffic flow from Summer 2013 to Winter 2015

Traffic flow from Summer 2013 to Winter 2014/2015

As you can see, no traffic will come over the bridge from Cambridge.  The alternate route will go over a drawbridge near the Museum of Science which should make for a lot of fun during rush hour.  At least one can take the train on weekdays.

Then some time during the winter of 2014/2015, the closed lane will move to the other side of the bridge, but traffic will still only go from Boston to Cambridge.  There will be more buses to shuttle passengers while the train is shutdown.

Will all of this be worth the disruption?  Something had to happen with the Longfellow – that was clear.  The bridge which was built in 1906 badly needs repairs.  Everyone wanted more accommodation for walkers and bikers.  And the unique salt and pepper shakers had to be preserved so there would be no widening. The towers will be dismantled and rebuilt around a new frame.  The compromise redesign looks like this.

Redesign with one lane traffic to Cambridge.

Redesign with one lane traffic to Cambridge.

No one is 100% happy with this, but as has been pointed out, traffic has dropped since the Zakim Bridge on the interstate opened.

According to the Boston Globe story from last February

The state pulled back on its Longfellow plans in 2010 and convened a 36-member task force that included bike, pedestrian, and environmental advocates, neighbors, and civic and business leaders, whose input contributed to the new design.

“One of the breakthroughs of the task force was to treat the inbound side of the bridge and the outbound side of the bridge differently,’’ said state Representative Martha M. Walz,  a Democrat whose district includes the bridge’s Boston approach and part of its Cambridge approach.

Fellow task force member Richard A. Dimino  said the plan addresses contemporary needs while respecting the history of the bridge. “They’ve made exceptional efforts to ensure that the historic character of the bridge will be preserved, and obviously it’s a landmark bridge,’’ said Dimino, president and chief executive of A Better City, which represents hospitals, universities, financial firms, and other major employers on regional transportation planning.

You can see some of the design proposals and read more about the history of the bridge on my original post.  I will be watching the Longfellow as construction begins.

The Museum of Science, Boston. On the Charles ...

The Museum of Science, Boston. On the Charles River with a view of the Leonard P. Zakim Bridge behind it (Photo credit: Wikipedia)

Design drawings  JAVIER ZARRACINA, PATRICK GARVIN/GLOBE STAFF
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OK. No one cares about the sequester

No one cares about the sequester.  Or maybe, no one knows about it.  Or maybe everyone is just tired of Congress.

Here is Mike Luckovich today with a history of our recent financial crises.

Gee. I don't know why you think all this is my fault.

Gee. I don’t know why you think all this is my fault.

No wonder the general public doesn’t care right now.  And they probably won’t care until cuts start to hurt them.  Let’s face it:  both sides are using those old techniques of  putting forward the arguments that make the best case for their point of view.  The Republicans are right in that it won’t hurt for a little while – maybe a month or so.  And the Democrats are right that this whole exercise is unnecessary and, in the long run not helpful to recovery.

Thomas Mann and Norman Ornstein who wrote the excellent book, “It’s Even Worse Than It Looks”, have an excellent piece in today’s Washington Post titled “Five myths about the sequester”.

1. Blame Obama — the sequester was his White House’s idea.

Identifying the origins of the sequester has become a major Washington fight. Bob Woodward weighed in recently with a Washington Post op-ed making the case that the idea began in the White House. He’s right in a narrow sense, mainly because he focuses on the middle of the 2011 negotiations between Obama and Republican lawmakers. If you look before and after, a different picture emerges.

In our view, what happened is quite straightforward: In 2011, House Republican leaders used their new majority to force their priorities on the Democratically controlled Senate and the president by holding the debt limit hostage to demands for deep and immediate spending cuts. After negotiations between Obama and House Speaker John A. Boehner failed (Eric Cantor recently took credit for scuttling a deal), the parties at the eleventh hour settled on a two-part solution: immediate discretionary spending caps that would result in cuts of almost $1 trillion over 10 years; and the creation of a “supercommittee” tasked with reducing the 2012-2021 deficit by another $1.2 trillion to $1.5 trillion. If the supercommittee didn’t broker a deal, automatic spending cuts of $1.2 trillion over the next decade — the sequester — would go into effect. The sequester was designed to be so potentially destructive that the supercommittee would surely reach a deal to avert it.

The sequester’s origins can’t be blamed on one person — or one party. Republicans insisted on a trigger for automatic cuts; Jack Lew, then the White House budget director, suggested the specifics, modeled after a sequester-like mechanism Congress used in the 1980s, but with automatic tax increases added. Republicans rejected the latter but, at the time, took credit for the rest. Obama took the deal to get a debt-ceiling increase. But the president never accepted the prospect that the sequester would occur, nor did he ever agree to take tax increases off the table.

And of course no deal has been reached yet.

2. At least the automatic cuts will reduce runaway spending and begin to control the deficit.

What runaway spending? The $787 billion stimulus was a one-time expenditure that has come and gone. Under current law not including the sequester, non-defense discretionary spending as a share of the economy will shrink to a level not seen in 50 years. Defense spending grew substantially over the past decade, but that pattern has slowed and will soon end. Additional reductions must be achieved intelligently, tied to legitimate national security needs.

…

The annual budget deficit is projected to fall by almost 50 percent in 2013 compared with the height of the recession. Reducing the deficit over the long term requires going where the money is — boosting economic growth, controlling health-care costs and increasing revenue to handle the expense of an aging population. Deeper discretionary-spending cuts are counterproductive; immediate cuts, as Europe has made recently, could lead to a recession and bigger deficits.

I guess the Republicans want us to be like Greece after all.

And finally, one for the Democrats.

4. The cuts are so large, they will be catastrophic.

The administration has released state-by-state estimates of the sequester and highlighted the cutbacks most likely to harm or inconvenience the public. The reality is not so immediate or dramatic. The damage will accumulate in less visible ways, as irrational reductions in public spending impede economic growth and job creation; reduce investments in education, infrastructure and scientific research; and further disrupt the routines of a modern democracy. The longer the sequester remains in place, the more harm is inflicted.

So it may take a while to feel the cuts.  Maybe long enough for the Obama Administration to submit a sensible budget that everyone can agree on.  And no, I’m not smoking anything.  Just counting on mayors and governors to continue to put the pressure on Congress.

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Are you affected by gun violence?

I had never thought much about the impact of gun violence on my own life until I read Alex Kotlowitz’s piece in the New York Times Sunday Review.  The story is about Chicago right now the worst urban area for gun violence, but what he describes could apply to anyone, any place. We talk a lot about the post traumatic stress of  those who were in the movie theater in Aurora or the citizens of Newtown, but we don’t talk about the victims of the violence that happens every day one or two or three people at a time. And we certainly don’t talk about what happens to the rest of us.

I live in a neighborhood that is considered to be highly desirable.  Rents have increased as houses have been renovated.  Three families have been condoed.  There are stories in the paper about the sales price of homes.  But 20 years ago, there was a gang gun fight in front of our house.  The bullet hole is still in one of the vestibule windows.  A couple of years ago, a boy playing on one of the basketball courts, 4 or 5 blocks down the hill from us was shot and killed.  I have friends who have lost children to violence.  One can’t escape.  All of this is somewhere in the back of my mind when I walk or drive in our relatively safe, desirable neighborhood.  If I stop for a moment to think about violence, I think about my own neighborhood.  And if I am affected in a relatively minor way, what about the children?  This is the question that Kotlowitz asks.

EVERY year, the Chicago Police Department issues a report with the macabre title “Chicago Murder Analysis.” It’s a short but eye-opening document. Do the calculations and you realize that in the past 15 years, 8,083 people have been killed, most of them in a concentrated part of the city. There’s one particularly startling revelation that gets little notice: in 2011, more than four-fifths of all murders happened in a public place, a park, an alleyway, on the street, in a restaurant or at a gas station.

When Hadiya Pendleton, the 15-year-old public school student and band majorette who just a week earlier had performed at President Obama’s inauguration, was killed on Jan. 29, she was standing under an awning in a park with a dozen friends. They all saw or heard it when she was shot in the back. One of them, in fact, was wounded by the gunfire. Which brings me to what’s not in the “Chicago Murder Analysis”: Over the past 15 years, according to the University of Chicago Crime Lab, an estimated 36,000 people were shot and wounded. It’s a staggering number.

We report on the killers and the killed, but we ignore those who have been wounded or who have witnessed the shootings. What is the effect on individuals — especially kids — who have been privy to the violence in our cities’ streets?

The answer:  post traumatic stress.  Kotlowitz continues

I ask this somewhat rhetorically because in many ways we know the answer. We’ve seen what exposure to the brutality of war does to combat veterans. It can lead to outbursts of rage, an inability to sleep, flashbacks, a profound sense of being alone, a growing distrust of everyone around you, a heightened state of vigilance, a debilitating sense of guilt. In an interview I heard recently on the radio, the novelist and Vietnam veteran Tim O’Brien talked about how the atrocities and nastiness of battle get in your bones. The same can be said for kids growing up in Hadiya’s neighborhood.

The ugliness and inexplicability of the violence in our cities comes to define you and everyone around you. With just one act of violence, the ground shifts beneath you, your knees buckle and all you can do is try the best you can to maintain your balance. But it’s hard.

…

In December, the Department of Justice released a little-noticed report that suggested that children exposed to community violence might turn to violence themselves as “a source of power, prestige, security, or even belongingness.” The report went on to recommend that these children should be treated by professionals. At Hadiya Pendleton’s school, the principal said that over the Christmas holidays two students were shot and injured. If their experiences were at all typical, they were undoubtedly treated at a hospital emergency room and then released without any referral for counseling.

In Philadelphia, there’s a remarkable, albeit small, program, Healing Hurt People, a collaboration of Drexel University’s College of Medicine and School of Public Health, which scours two emergency rooms in the city for young men and teens who have been shot and pulls them in for counseling. When the program’s founder, Ted Corbin, was an emergency room doctor in Washington, D.C., he saw how shooting victims were treated and then sent back out on the streets, where, if they didn’t do injury to themselves, they’d most likely injure someone else. “If you don’t peel back some of the layers,” Mr. Corbin told me, “you don’t know how to stop that recycling of people.”

When the NRA talks about increasing mental health services instead of measures which might begin to stem the flood of guns, legal and illegally owned, washing over us, I don’t think they mean poor inner city kids.  I don’t think they mean funding for more programs like Dr. Corbin’s.  If they do, now is the time to speak out.

The basketball court where Jaewan Martin died.

The basketball court where Jaewon Martin died.

The young boy who was shot on the basketball court down the hill from us was an honor student attending one of the best middle schools in Boston.  Jaewon Martin died in 2010.  According to the Boston Globe

A popular honor roll student, Martin would have graduated from the eighth grade at the James P. Timilty Middle School in Roxbury at the end of the school year.

Martin was well-liked and well-known by students and staff alike, and his family was very involved in the school, said Boston Public Schools spokesman Matthew Wilder.

“It’s a really tough day for the school community,” Wilder said.

Grief counselors will be on hand at the school to help students and faculty members cope with Martin’s death.

Was there any additional follow up after the initial counseling?  What has happened to the other students in Martin’s class at Timilty or to others who knew him?  Is there PTSD?  Do we care?

I think this is the point of Kotlowitz’s story.  We need to care.

As Tim O’Brien says, it gets in your bones. In the wake of Hadiya Pendleton’s shooting, we’ve talked about stiffer gun control laws, about better policing, about providing mentoring and after-school programs, all of which are essential. But missing from this conversation is any acknowledgment that the violence eats away at one’s soul — whether you’re a direct victim, a witness or, like Anita Stewart, simply a friend of the deceased. Most suffer silently. By themselves. Somewhere along the way, we need to focus on those left behind in our cities whose very character and sense of future have been altered by what they’ve experienced on the streets.

The answer to my title question is yes you are.  If you don’t live somewhere violence happens with regularity, you are still affected because your future will be in some measure determined by these victims of violence.

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Maybe we should increase the minimum wage

Massachusetts has a minimum wage of $8/hour.  This is fifth highest among states, sixth if you count the District of Columbia.  According to the Boston Globe

Five years have elapsed since the minimum wage in Massachusetts increased in January 2008 to $8 an hour, still one of the highest wage floors in the country.

The Legislature has not voted on a minimum wage increase since 2006, when it phased in the increase over two years and overrode a veto by Governor Mitt Romney to do so.

Since then, four states, includ­ing Connecticut and ­Vermont and the District of ­Columbia have surpassed Massa­chusetts. Nevada requires employers to pay workers $8.25 an hour if they do not receive health benefits, but if health insurance is provided the minimum wage rate falls to $7.25.

California continues to pay workers a minimum of $8 an hour, and Washington has the highest minimum wage in the country at $9.19. Businesses in Connecticut must pay at least $8.25 an hour, and Vermont workers earn at least $8.60 an hour.

If Congress increases the minimum wage to $9, Massachusetts will automatically go to $9.10.  Better, but not a livable wage if you live in Boston, where rents are high.

Even with an increase we will still need the Minimum Wage Awards.

Thank you Brian McFadden.

PS.  Did you happen to notice who vetoed the Massachusetts Minimum Wage increase?

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Still more on sequestration

This morning The Fix by Chris Cillizza included this interesting post by Aaron Blake.  Blake posted four great graphics explaining the impact of the sequester.  I am going to copy 2 of them here, but you should look at the entire post.

Blake explains

First up is Pew’s illustration of the year-by-year spending cuts that are included in the sequester. As you can see, the cuts start out relatively small — less than $75 billion in 2013 — but they grow to more than twice that size by 2021, for a total of more than $1 trillion.

The biggest growth in cuts over that time occurs in the interest payments, but everything except for mandatory spending cuts grow steadily over time.

And then there is this depressing news.  Sequester will not have that big of a positive impact.

There has to be a better way.  Maybe spend some money to put people back to work and let them pay taxes thus increasing revenue?  And we do have to fix the tax code so Facebook executives actually pay taxes.  And maybe we can cut programs and defense more selectively.  This won’t be as dramatic, and it might be slower, but it will hurt fewer people.

Meanwhile, members of Congress of both parties are doing their best to keep funding for their own districts.  Politico quotes Senator Lindsey Graham, an opponent of the sequester

I’m almost relishing the moment all these tough-talking guys say: ‘Can you  help me with my base?’” Sen. Lindsey Graham (R-S.C.), one of the most vocal  critics of the sequester, told POLITICO.

“When it’s somebody else’s base and district, it’s good government. When it’s  in your state or your backyard, it’s devastating,” he added.

Of course Graham’s solution is to do away with the Affordable Care Act or Obama care.  Is the momentum swinging toward a rational budget and solution?  Probably not.

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What’s up with sequestration? Or we should have issued war bonds.

When I looked up sequestration in Merriam Webster, the closest meaning I could find to what is going on with the federal budget is

2
a: a legal writ authorizing a sheriff or commissioner to take into custody the property of a defendant who is in contempt until the orders of a court are complied with
b: a deposit whereby a neutral depositary agrees to hold property in litigation and to restore it to the party to whom it is adjudged to belong
So our tax dollars are being put aside until we pay down the debt or is it cut the deficit?  Back in 2004, the Treasury Department explained the difference this way.

What is the difference between the public debt and the deficit?

The deficit is the difference between the money Government takes in, called receipts, and what the Government spends, called outlays, each year.  Receipts include the money the Government takes in from income, excise and social insurance taxes as well as fees and other income.  Outlays include all Federal spending including social security and Medicare benefits along with all other spending ranging from medical research to interest payments on the debt.  When there is a deficit, Treasury must borrow the money needed for the government to pay its bills.

We borrow the money by selling Treasury securities like T-bills, notes, Treasury Inflation-Protected securities and savings bonds to the public. Additionally, the Government Trust Funds are required by law to invest accumulated surpluses in Treasury securities. The Treasury securities issued to the public and to the Government Trust Funds (intragovernmental holdings) then become part of the total debt.

One way to think about the debt is as accumulated deficits.

So back when Bill Clinton balanced the budget, we did not run a deficit and did not accumulate more debt.

While some on the right would argue that Clinton really didn’t reduce the deficit and he ruined the economy by raising taxes, I seem to remember that things were going pretty well for the average person during the Clinton years.

When George W. came into office he said he wanted to give us taxpayers back our surplus which probably would have been OK if he hadn’t then started 2 wars which we didn’t raise taxes of any kind to pay for.  No war bonds, no special tax assessment (used by state and local governments to pay for things), no general tax increase.  Thus the red ink on the chart above.  Then came what everyone is now calling the Great Recession.  Barack Obama really had no choice but to spend money to get the economy moving again.  We can argue about some of the spending – like saving some of the banks – but much of it work out pretty well, I think.

So now we have the sequester.  This was a deal made in 2011 to keep everything from coming to a halt.  I don’t think that anyone thought at the time that there wouldn’t be another budget deal to keep the cuts from going into effect, but so far no dice.  The New York Times ran an editorial on Sunday which is the best explanation of what the cuts would mean that I have seen.  For example:

NATIONAL SECURITY Two-week furloughs for most law-enforcement personnel will reduce Coast Guard operations, including drug interdictions and aid to navigation, by 25 percent. Cutbacks in Customs agents and airport security checkpoints will “substantially increase passenger wait times,” the Homeland Security Department said, creating delays of as much as an hour at busy airports. The Border Patrol will have to reduce work hours by the equivalent of 5,000 agents a year.

…

AIR TRAFFIC About 10 percent of the Federal Aviation Administration’s work force of 47,000 employees will be on furlough each day, including air traffic controllers, to meet a $600 million cut. The agency says it will be forced to reduce air traffic across the country, resulting in delays and disruptions, particularly at peak travel times.

CRIMINAL JUSTICE Every F.B.I. employee will be furloughed for nearly three weeks over the course of the year, the equivalent of 7,000 employees not working each day. The cut to the F.B.I. of $550 million will reduce the number of background checks on gun buyers that the bureau can perform, and reduce response times on cyberintrusion and counterterrorism investigations.

…

A three-week furlough of all food safety employees will produce a shortage of meat, poultry and eggs, pushing prices higher and harming restaurants and grocers. The Agriculture Department warns that public health could be affected by the inevitable black-market sales of uninspected food.

RECREATION National parks will have shorter hours, and some will have to close camping and hiking areas. Firefighting and law enforcement will be cut back.

DEFENSE PERSONNEL Enlisted personnel are exempt from sequester reductions this year, but furloughs lasting up to 22 days will be imposed for civilian employees, who do jobs like guarding military bases, handle budgets and teach the children of service members. More than 40 percent of those employees are veterans.

The military’s health insurance program, Tricare, could have a shortfall of up to $3 billion, which could lead to denial of elective medical care for retirees and dependents of active-duty service members.

And the list goes on.

The editorial concludes

Last week, Senate Democrats produced a much better plan to replace these cuts with a mix of new tax revenues and targeted reductions. About $55 billion would be raised by imposing a minimum tax on incomes of $1 million or more and ending some business deductions, while an equal amount of spending would be reduced from targeted cuts to defense and farm subsidies.

Republicans immediately rejected the idea; the Senate minority leader, Mitch McConnell, called it “a political stunt.” Their proposal is to eliminate the defense cuts and double the ones on the domestic side, heedless of the suffering that even the existing reductions will inflict. Their refusal to consider new revenues means that on March 1, Americans will begin learning how austerity really feels.

Remember the definition of sequestration I began with?  It is a temporary thing.  The money is supposed to come back to us.  If the sequestration cuts really happen, I can bet you they won’t be temporary.  We are reaping the cost of wars most of us didn’t want and any rational solution will be held up by the same folks who did want to go to war.  We should have had war bonds.

THE VICTORY FUND COMMITTEE CAN HELP YOUR MONEY...

THE VICTORY FUND COMMITTEE CAN HELP YOUR MONEY WIN THIS WAR THROUGH INVESTMENT IN U.S. TREASURY SECURITIES SUITED TO… – NARA – 515674 (Photo credit: Wikipedia)

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Re-reading “The Daughter of Time” or was Richard III a murderer?

"The Princes in the Tower"

“The Princes in the Tower” (Photo credit: Wikipedia)

I am a re-reader.  If I like a book, particularly a mystery, I will read it again.  Josephine Tey is a writer I first read in high school when I was introduced by my mother.  I remember thinking at the time that ‘The Daughter of Time” was one of her least interesting stories.  After all, Alan Grant is in a hospital bed reading books about Richard III and sending researcher Brent Carradine to look for answers about someone who died 400 years before.  I believed in the Thomas More/William Shakespeare version of Richard.  I was probably fourteen.  But since then, I have re-read it several times and since the discovery of Richard’s bones have done so again.

It is a very carefully constructed guide to how to conduct an investigation.  Grant starts out with one of his nurses’ history books from school and moves on to more complete histories of Richard and England.  He finds out that Thomas More, although written as if he were a witness to the events surrounding the princes in the tower, was actually between 5 and 8 years old.  Grant and Carradine go to original sources for answers to the kinds of questions anyone conducting an investigation would ask.  Who benefits?  What were people saying at the time?  Where were the relevant people at the time of the alleged murders?  Who was still alive after Richard died?

There are many, like Winston Churchill, who are unconvinced by Tey.  Thomas B. Costain presented much the same evidence as Tey in his history, “The Last Plantagenets.”

Many who believe that Richard was guilty believe that Richard somehow stole the throne.  Edward IV had died, his oldest son was very young and Richard was to be Regent.  Instead, Richard learned that his brother’s marriage was, as they said, irregular.  Parliament declared a Titulus Regulus making Edward’s son ineligible for the throne and Richard became King.

There is no question that Richard had been an excellent administrator of north England, including York.  At the end of the book, Grant lays out his case.

In the matter of the presumed crime:

(a)  He did not stand to benefit; there were nine other heirs to the house of York, including three males;

(b)  There is no contemporary accusation.

(c)  The boys’ mother continued on friendly terms with him until his death, and her daughters attended Palace festivities.

(d)  He showed no fear of the other heirs of York, providing generously for their upkeep and granting all of them their royal state.

(e)  His own right to the crown was unassailable, approved by Act of Parliament and public acclamation; the boys were out of the succession and of no danger to him.

(f)  If he had been nervous about disaffection then the person to have got rid of was not the two boys, but the person who really was next in succession to him:  young Warwick.  Whom he publicly created his heir when his own son died.

And Grant’s case against Henry VII.

(a)  It was of great importance to him that the boys should not continue to live.  By repealing the Act [Titulus Regulus] acknowledging the children’s illegitimacy, he made the elder boy King of England and the youngest boy the next heir.

(b) In the Act which he brought before Parliament for the attainting of richard he accused Richard of the conventional tyranny and cruelty but made no mention of the two young Princes.  The conclusion is that at that time the two boys were alive and their whereabouts known.

(c)  The boys’ mother was deprived of her living and consigned to a nunnery eighteen months after his succession.

(d) He took immediate steps to secure the persons of all the other heirs to the crown, and kept them in close arrest until he could with the minimum of scandal get rid of them.

(e)  He had no right whatever to the throne.  Since the death of Richard, young Warwick was de jure King of England.

I can’t predict whether the discover of Richard’s bones will lead to his rehabilitation as a ruler, but Tey makes an interesting case in his favor.  If you like mysteries or history or both, I recomment “The Daughter of Time.”

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