Weiner has been destroying for a few weeks now. Here he is speaking at the Congressional Correspondents dinner.
His Fox New interviews are instant classics.
Every year when I arrive at the Final Four city, I try to get the flavor of the place on the bus ride from the airport to the hotel. One of my observations after arriving in Houston is that it's a good city to get sick in. There seems to be a hospital or medical center on every block. Maybe that's why there are so many gun and weapon stores: people feel that if they accidentally shoot themselves, it's no big deal. There's a gun wound specialist just around the corner.
I saw a great billboard on the way to the hotel. It was an ad for a lawyer whose phone number is 713 - WASN'T ME. I'm not kidding. After seeing this, I kept hoping the next billboard would be from the prosecutor's office with the phone number 1-800-OH YES IT WAS. Unfortunately, the second billboard didn't pop up. It shouldn't have surprised me. I mean, what are the odds that those two billboards would be on the same street? I can't do the math and answer that question, but I'm pretty sure the odds of that happening are a lot smaller than the odds of seeing these four teams play this weekend.
Deep reductions in a House committee's budget proposal would cost Texas hundreds of thousands of jobs through the next two years, according to an analysis released Thursday.
"I've been trying to say this for over a year. I've been trying to say how our economy was bad, and how our shortfall was going to be affecting Texas, and nobody seemed to believe me. But I think reality is probably setting in on that," said House Appropriations Committee Chairman Jim Pitts, R-Waxahachie. "I really didn't realize the extent of the total employment. It's pretty shocking."
The Legislative Budget Board's "dynamic economic impact" analysis of the Appropriations-approved budget proposal predicts 271,746 fewer jobs in 2012, and 335,244 fewer in 2013, compared to what total employment would be if revenues and spending remained stable. That includes government and private-sector jobs.
The analysis cautions that the estimate "does not imply the state will lose that many jobs from our current employment level upon enactment" of House Bill 1, as approved by the Appropriations Committee this week.
Instead, it shows Texas would have fewer jobs compared to a scenario in which state spending remained constant relative to the current budget.
Bad economy blamed
"Since available revenue for the 2012-13 biennium is predicted to fall well below that amount, in large part due to the national economic recession, many of these job losses can be attributed to the steep downturn of the Texas economy during the past several years," the LBB analysis said.
Senate Finance Committee Chairman Steve Ogden, R-Bryan, said the state needs to address the structural budget deficit caused by the 2006 school finance plan, but disputed the LBB's job loss estimates.
"We have a trillion-dollar economy in Texas. There's 9.5 million people employed in Texas. I don't think by any stretch of the imagination the budget that we pass is going to cost many - it may result in hundreds of job losses, but I would really doubt if it would be thousands," he said. "Most economic analysts would say that if you raise taxes to increase government spending, you'll cost jobs."
Travis Tullos, regional economist with Austin-based consulting firm TXP, described the LBB's prediction as a "worst-case scenario, generally speaking."
"If you were to increase taxes sufficient to cover that deficit - whatever that ends up being - that would be more deleterious to the economy than going ahead with a more conservative budget," Tullos said.
"I never planned to acquire a lot of jewels or a lot of husbands," ... "For me, life happened, just as it does for anyone else. I have been supremely lucky in my life in that I have known great love, and of course I am the temporary custodian of some incredible and beautiful things. But I have never felt more alive than when I watched my children delight in something, never more alive than when I have watched a great artist perform, and never richer than when I have scored a big check to fight AIDS."
A) Cash Gone. You have to write a big fat check for a downpayment. “But it's an investment,” you might say to me. Historically this isn’t true. Housing returned 0.4% per year from from 1890 to 2004. And that’s just housing prices. It forgets all the other stuff I’m going to mention below. Suffice to say, when you write that check, you’re never going to see that money again. Because even when you sell the house later you’re just going to take that money and put it into another downpayment. So if you buy a $400,000 home, just say goodbye to $100,000 that you worked hard for. You can put a little sign on the front lawn: “$100,000 R.I.P.”
B) Closing costs. I forget what they were the last two times I bought a house. But it was about another 2-3% out the window. Lawyers, title insurance, moving costs, antidepressant medicine. It adds up. 2-3%.
C) Maintenance. No matter what, you’re going to fix things. Lots of things. In the lifespan of your house, everything is going to break. Thrice. Get down on your hands and knees and fix it! And then open up your checkbook again. Spend some more money. I rent. My dishwasher doesn’t work. I call the landlord and he fixes it. Or I buy a new one and deduct it from my rent. And some guy from Sears comes and installs it. I do nothing. The Sears repairman and my landlord work for me.
D) Taxes. There’s this myth that you can deduct mortgage payment interest from your taxes. Whatever. That’s a microscopic dot on your tax returns. What's worse is the taxes you pay. So your kids can get a great education. Whatever.
E) You’re trapped. Let's spell out very clearly why the myth of home ownership became religion in the United States. It's because corporations didn’t want their employees to have many job choices. So they encouraged them to own homes. So they can’t move away and get new jobs. Job salaries are a function of supply and demand. If you can’t move, then your supply of jobs is low. You can’t argue the reverse, since new adults are always competing with you.
F) Ugly. Saying “my house is an investment” forgets the fact that a house has all the qualities of the ugliest type of investment:
Illiquidity. You can’t cash out whenever you want.
High leverage. You have to borrow a lot of money in most cases.
No diversification. For most people, a house is by far the largest part of their portfolio and greatly exceeds the 10% of net worth that any other investment should be.
I'm sure the government of Iran must be watching the events in Libya with particular interest. In December of 2003, Libya announced it had a nuclear weapons program and that it would get rid of it. The last of the nuclear weapons technology exited the country in 2009. Libya's repressive, dictatorial regime was welcomed back into the fold of the great Western powers and their friends (a.k.a., the "international community") and trade flourished. Now, just over seven years later, Libya is under military assault from those same powers, only now without the nuclear threat that keeps the West out of North Korea. For the power centers in Iran this must be particularly instructive. America will one day have another Republican president determined to go to war in the Middle East. Will the Iranian people rise up and find a government willing to crush dissent with brutal force? Will America decide that this cannot be tolerated and military action must occur? Will Iran have a "nuclear deterrent" or not? These are questions military leaders in Iran, and our folks in the Pentagon and intelligence community, must be considering. Military actions always have unpredictable repercussions.
An unlikely battlefield in Texas’ budget war is a hushed pink-and-blue hospital nursery, where 1- and 2-pound babies bleat like lambs under heating lamps and neonatal nurses use tiny rulers to measure limbs no bigger than fingers.
State health officials, searching for solutions to Texas’ multibillion-dollar budget shortfall, have set their sights on these neonatal intensive care units, or NICUs, which they fear are being overbuilt and overused by hospitals eager to profit from the high-cost care — and by doctors too quick to offer pregnant mothers elective inductions and Caesarean sections before their babies are full term.
The Texas Health and Human Services Commission (HHSC), under the gun to find cost savings in the state’s huge Medicaid program, suggested last month it could save $36.5 million over the next biennium by better managing which babies end up in NICUs, curbing so-called convenience C-sections and refusing to finance elective inductions before the 39th week of pregnancy.
“When we look at the data, it indicates that, yes, there is overutilization of NICUs — more babies are being put in NICUs than need to be in NICUs,” said HHSC Commissioner Tom Suehs, adding that two of his own grandchildren were put in Texas hospital NICUs in the last two years, even though they were healthy and their deliveries were uncomplicated.
Lawmakers are not ready to say with certainty that Texas has a NICU overutilization problem, though their comments suggest it. “We are seeing some trends that are a bit troubling,” said State Rep. Lois Kolkhorst, R-Brenham, who has filed legislation to create a commission to study NICU use. Added Sen. Jane Nelson, R-Flower Mound: “We don’t want to reduce services, but we need to combat inefficient, unnecessary use.”
Nor will most hospitals admit to a NICU problem. Couple Texas’ high birth rate, low health insurance coverage and limited prenatal care with the growth of in vitro fertilization, multiple-baby births and so-called geriatric — or past the age of 35 — pregnancies, hospital administrators say, and you have a full NICU. “The services exist because they fill a need,” said Amanda Engler, spokeswoman for the Texas Hospital Association.
The data suggests NICU beds may not be proliferating due to natural demand alone. Births in Texas are up nearly 18 percent since 1998, according to state health statistics. Meanwhile, the number of NICU beds in Texas hospitals has surged roughly 84 percent, to 2,510 in 2009 from 1,365 in 1998.
State health officials are not shy in suggesting there is a profit motive at play for hospitals. The average routine delivery costs Medicaid $2,500, according to state records; the average NICU stay costs $45,000.
Elective procedures like inducing labor prior to 39 weeks of gestation or delivering a baby via C-section at the mother’s request are only contributing to complications that send babies to the NICU, these health officials say. In 1998, C-sections made up 23.8 percent of Medicaid births, state data shows; more than a decade later, they made up 35 percent. In 2009 alone, 137 Medicaid-covered newborns suffered complications resulting from elective inductions, according to state health officials, costing the Texas Medicaid program $1.6 million.
Dr. Charles T. Hankins, a longtime neonatologist at Texas Children’s Hospital in Houston and an associate professor of pediatrics at the Baylor College of Medicine, suggested there is a far more nuanced motive than pure profit. Hospitals — hard hit by low reimbursement rates and high malpractice costs for routine obstetric care — are simply looking for ways to make up the difference. “A lot of facilities realize if they had a Level 3 nursery, they could help offset their costs,” he said.
He thinks the NICU boom is often driven less by hospitals than by obstetricians, who do their residency training in facilities with NICUs and cannot imagine not having one available for their patients. “The doctors want their patients to be happy, and the hospital administrators want to keep the doctors happy,” he said.
The problem is that diagnosing the need for neonatal care can be subjective, Hankins said. If a hospital wants to increase its NICU census, providers can admit more infants or lengthen their stays — and parents generally trust those assessments. And he said there is no state oversight, either of admission and discharge best practices, or of how NICUs advertise themselves. Some hospitals convert Level 2 NICU beds to Level 3 NICU beds with little to no increase in infrastructure or technology, he said, and no one challenges the designation.
State health officials acknowledge that the NICU designation is up to the hospital and is not reviewed by the state. “Hospitals are willing to work together to accomplish the optimal care for these babies,” Hankins said, but added that they need proper guidance to do so.
Some state lawmakers question what Texas’ Medicaid program has been doing, if not offering this guidance. The growth in NICU beds — much of it along the Texas-Mexico border, which has the youngest population in the state, and in suburban hospitals outside of Houston, Dallas and San Antonio — comes despite years of improvements in prenatal care for mothers on Medicaid, the joint state-federal health program that covers more than half of Texas births.
"One of the tenets of Medicaid has long been better prenatal care, and less babies needing NICUs,” said Sen. Bob Deuell, R-Greenville, a family practice doctor who, in a recent Senate hearing, suggested the cost savings health officials are looking for may not be ample in the delivery room.
But Dr. Frank Mazza, vice president and chief patient safety officer for the Seton Family of Hospitals, said state health officials are on the right path in considering birth inefficiencies. When Seton made the almost unheard-of move in 2005 of prohibiting elective inductions before 39 weeks — part of a system-wide effort to improve perinatal safety — the number of babies admitted to the NICU fell off dramatically. The hospital’s revenue from them also dropped by 95 percent, to $186,000 per year from roughly $4.5 million per year.
“We should have in Texas the safest health care and the most cost-effective health care,” Mazza said. “By keeping babies out of the NICU, you accomplish both.”
Still, even Mazza acknowledged that if his own wife were having a baby today, he would choose a hospital with all the bells and whistles. “Of course I’d want her in a hospital with a NICU,” he said, “with the latest and greatest technology.”