Transcript for The Rachel Maddow Show, January 4, 2010

Guests: Richard Wolffe, E.J. Dionne, Jonathan Cohn, Kent Jones

Transcript:

RACHEL MADDOW, HOST: Happy New Year to you, Keith. It‘s great to have you back. Thanks.

We begin tonight with some breaking news. On the White House investigation into exactly what happens with the Christmas Day botched terror attempt. MSNBC political analyst Richard Wolffe is actually joining us now by phone with that.

Richard, I know you just shared some reporting on COUNTDOWN about a potentially very inflammatory development in the Christmas Day terror plot investigation. What can you tell us about that reporting and what else you‘ve been able to learn?

RICHARD WOLFFE, MSNBC POLITICAL ANALYST: Well, Rachel, this investigation is still very much at the fact-finding stage where the White House is looking at still what happened. It‘s very preliminary. Obviously, the president has just got back from vacation and just started prepping for his big session tomorrow—which I‘m told is still going to focus on things like the screening processes that people face.

But the question here is whether or not the systemic failure that the president has talked about was anything more than human error. Was this some kind of failure because of the system‘s internal tensions? Or was there actually just a surplus of information that people didn‘t understand or report fully?

So, the question about how intelligence was shared is very much uppermost in the president‘s mind. He is still—I am told—very steamed about the whole affair and the failings that led to such a serious breach of security. But it‘s still very early in the phase of where this investigation is going.

MADDOW: Richard, I believe that the—I think the reason that you‘re reporting tonight has an exclamation point on it for many of us who saw your interview on COUNTDOWN, you were thinking about where this might led, is the prospect, not just that intelligence leads that should have been followed weren‘t followed, that intelligence dots that should have been connected weren‘t connected, that there isn‘t enough communication among the different parts of the American intelligence community. That‘s important analysis but not new analysis.

What‘s new and very worrying is the prospect that intelligence was deliberately withheld by one part of the American intelligence community from another either because of a grudge to make somebody look bad or for any other reason that put petty politics above national security.

Is that, in fact, the path that this White House inquiry is going down?

WOLFFE: That I think is 10 steps ahead of where the White House is right now.

MADDOW: OK.

WOLFFE: I just checked in with White House people again. And, look, there are—there‘s lots of finger-pointing going on in the intelligence community, where you have people who are in the center of it all, who are tasked with pulling these things together who say the information was there and it wasn‘t flagged up or it wasn‘t shared adequately. So, there is a line of inquiry that goes to the heart of why wasn‘t this stuff shared adequately?

I think the early suspicions from inside the White House are that this comes down to human error more than this is some willful withholding. But the questions are being asked and they‘re being asked because some people are saying this stuff wasn‘t shared adequately and they say it could have been.

MADDOW: MSNBC analyst Richard Wolffe joining us, helping us sort out what‘s turning out to be both a fascinating story and a deeply troubling story about America‘s response to the terror alert or the terror incident on Christmas Day, and what we could have pieced together ahead of time.

Richard, thanks very much for your time. We appreciate it.

WOLFFE: Thank you, Rachel.

MADDOW: All right. We begin our first show of 2010, now, with the death of a political truism that doesn‘t seem to have survived 2009. The truism is the conventional wisdom that Republicans sure know how to do terror politics. 2010 being an election year—right now, Republicans all over the country are busy waxing poetic about terrorism on campaign trails all around the country.

For example there‘s this gentleman in Minnesota.

(BEGIN VIDEO CLIP)

ALLEN QUIST (R-MN), HOUSE CANDIDATE: I, like you, have seen that our country is being destroyed. I mean, this is—every generation has had to fight the fight for freedom. This is our fight. And this is our time.

This is it. Terrorism, yes. But that‘s not the big battle. The big battle is in D.C. with the radicals. They‘re not liberals. They‘re radicals. They are destroying our country.

(END VIDEO CLIP)

MADDOW: House candidate Allen Quist of Minnesota. Terrorism isn‘t the big battle. The big battle is between us and the liberals.

That sort of political speech right there is what it looks like when something that used to work for you stops working. Someone obviously once told that Republican congressional candidate in Minnesota, “Hey, you should campaign on terrorism. That always works out great for Republicans.”

That is the common wisdom and it might have been true at one point, but it does actually matter how you do it. And if you‘re saying things like, “I hate Democrats more than I hate al Qaeda,” I‘m pretty sure you‘re not doing it right.

Now that the calendar has flipped to 2010 we‘re experiencing a little outbreak of Republicans blowing it. Republicans blowing something they used to be pretty good at, the politicization of terrorism.

The latest is Republican Senator Kit Bond of Missouri. In trying to attack President Obama‘s handling of the Christmas Day underpants bomber, Mr. Bond stepped on the same rake that a number of his colleagues have already recently stepped on.

(BEGIN VIDEO CLIP)

CHRIS WALLACE, FOX NEWS: Do you think it was a mistake to charge Abdulmutallab as a criminal defendant?

SEN. KIT BOND ®, MISSOURI: Clearly. As you said, in your interview, as soon as he got a lawyer, he lawyered up. We should have held him as an enemy combatant and tried him under the military commissions.

(END VIDEO CLIP)

MADDOW: We should have held him as an enemy combatant.

After facing questions about why he thinks President Obama is wrong to try the Christmas Day bomber in federal court, when President Bush made the exact same decision about the shoe bomber, Richard Reid, back in 2002, Senator Bond, after facing those questions, decided to double-down apparently without checking his own record. The senator is now seeking to go back in time to try to create the impression that he was against the shoe bomber being charged in federal court back in 2002, now, calling it a mistake—even though Senator Bond made not one peep of protest about that at the time.

In fact, at the time, the Justice Department, the Bush Justice Department was prosecuting Richard Reid—at that time, Senator Kit Bond was asked specifically if he had any criticism of the Bush Justice Department‘s role in fighting terrorism. Senator Bond said he had none.

(BEGIN AUDIO CLIP)

BOND: I believe that the Department of Justice is observing constitutional guidelines and safeguards, but they‘re going after people who come from areas of the world which might spawn terrorists, and I think that‘s appropriate.

(END AUDIO CLIP)

MADDOW: In 2002, he said what the Justice Department was doing was appropriate. Now looking back on it he says, back in 2002, that was a huge mistake—huge mistake to use the Justice Department for this sort of thing. How dare Obama do this now, this thing I said at the time was appropriate?

Then there‘s Republican Senator Jim DeMint of South Carolina. And after facing pressure for putting an indefinite hold on President Obama‘s nominee to run transportation security, Mr. DeMint has now, sort of, caved, saying that he‘ll allow a vote on the TSA nominee as long as he gets time to debate the nomination on the Senate floor. While caving on the TSA issue, Senator DeMint continues to embarrassing himself—embarrass himself by pressing another issue.

(BEGIN VIDEO CLIPS)

SEN. JIM DEMINT ®, SOUTH CAROLINA: A lot of us have been concerned over the last year that the president did seem to downplay the threat of terror. He doesn‘t use the word anymore.

GLORIA BORGER, CNN: Senator DeMint, how has he downplayed the risk of terror?

DEMINT: Well, it begins with not even being willing to use the word.

The concern that a lot of us have had over the last year is we‘ve even dropped the word “terror.”

(END VIDEO CLIPS)

MADDOW: You know, when you see Jim DeMint saying this sort of thing, it might be useful to remember that he‘s just making it up as he goes along. You should hear a little laugh track in your head when he does that, as evidenced by President Obama repeatedly on tape saying this word that Jim DeMint says he never says.

(BEGIN VIDEO CLIPS)

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Terror and extremism that threatens the world‘s stability.

Extremists sewing terror in pockets of the world.

Suffering and civil wars that breed instability and terror.

New acts of terror.

(END VIDEO CLIPS)

MADDOW: When Jim DeMint says that Barack Obama never uses the word “terror,” he‘s lying. It should probably be pointed out when that happens.

As we have noted here before the outbreak of people inexpertly trying to politicize terrorism, trying to politicize terrorism but blowing it, that effort sort of has a mascot in Republican Congressman Pete Hoekstra of Michigan. Mr. Hoekstra is now apparently unwilling to defend his decision to raise money off of the attempted murder of 300 Americans on Christmas Day.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: Are you proud of that, of fundraising off the national crisis like that?

REP. PETE HOEKSTRA ®, MICHIGAN: Well, I‘ve been leading on national security for the last nine years that I‘ve been on the intelligence committee. And over the last two to three months, I‘ve been very concerned about where this administration is taking us on national security issues, the refusal to acknowledge that the Fort Hood attack was a terrorist attack.

UNIDENTIFIED MALE: But I‘m asking about raising money off the attempted murder of 300 people three days after it occurred.

HOEKSTRA: I am proud of the role that I have played in making sure that America is safe.

(END VIDEO CLIP)

MADDOW: Mr. Hoekstra dodging that question not once but twice yesterday. And that‘s actually a big change from the way the Hoekstra camp had been talking about his raising money off a terrorist attack against American citizens.

Just last week, Mr. Hoekstra‘s campaign told us that Pete Hoekstra himself signed off on that fundraising letter and that we should expect more similar efforts from him. Just a few days later, Congressman Hoekstra has been forced to become embarrassed about this. Now, apparently, unwilling to defend the effort when he‘s personally called out on it.

Even as Mr. Hoekstra apparently realizes the step on the rake face plant that he has made here, trying to raise money off of the attempted murder of 300 Americans on Christmas Day, three days after it happened, even as Hoekstra finally starts to get embarrassed about that, the Republican Party seems to be following Mr. Hoekstra‘s lead.

The National Republican Senatorial Committee sending out a fundraising pitch that reads in part, quote, “This country was one faulty detonator away from an American airliner being blown out of the sky. When a foreigner tries to blow up an airliner, it is an attempted terrorist attack. Will you please give $5 or $10 by midnight tomorrow so we have the money necessary to fight the Obama machine?”

The National Republican Congressional Committee also sending out its own fundraising e-mail using the specter of terrorist attacks against Americans to cash in.

Republicans are doubling down on trying to raise money off of an attempted terrorist attack. And while some are trying to win the terror debate by actively attacking President Obama publicly, others are making the strategic decision to keep quiet.

Peter Baker of “The New York Times” reported this weekend, quote, “A half-dozen former senior Bush officials involved in counterterrorism told me before the Christmas Day incident that for the most part, they were comfortable with Obama‘s policies, although they were reluctant to say so on the record. Some worried they would draw the ire of Cheney‘s circle if they did. They generally resent Obama‘s anti-Bush rhetoric and are unwilling to give him political cover by defending him.”

Republicans are supposed to be good at politicizing terrorism, yet here are four former senior Bush administration officials actually telling a reporter that there are things they think are keeping the public safe that they will not publicly support because of partisan politics. They won‘t let anyone know they support these policies they actually support and think are good for the country because they‘re afraid of Dick Cheney being mad at them. They told that to a reporter.

You know, keeping your name off that quote is not going to be enough to help your cause if you‘re willing to admit to being that craven.

Joining us now is “Washington Post” columnist, E.J. Dionne.

E.J., it‘s great to see you. Thank you for being here tonight.

E.J. DIONNE, WASHINGTON POST COLUMNIST: Good to be with you. Happy New Year.

MADDOW: Happy New Year.

It seems to me like there have been a lot of political missteps as people have tried to sort of politicize and capitalize off of terrorism in the wake of this Christmas Day incident. Are the people who are supposed to be good at this getting bad at this, or has the political context changed?

DIONNE: Well, you know, it‘s like a team that uses one play and does really great one season, the 2002 election, and it works great. The next season, the 2004 election, and they figure they can use the same play over and over again and not adjust it.

And I think what they ran into in the last week is the first couple days, President Obama was trying to reassure people. A lot of folks thought he looked too laid-back, wasn‘t engaged. If they had just hit him a little then and moved on, they might have gotten some mileage out of it, but instead, they sort of pushed way farther. Part of it was just over-politicization. A lot of people objected to the fundraising letter.

Some of it was just pure mendacity, the notion that Obama doesn‘t use the word “terror.” And just part of it was hypocrisy. You know, many examples where policies that President Bush pursued that Obama is pursuing suddenly became bad because Obama is pursuing the same policies and that just didn‘t work.

And so, I think they took a situation where they might have gained a little ground and at the end of it all, I think they lost ground in the last week.

MADDOW: And I think if we‘re going to sort of maintain the pseudo sports metaphor here, in terms of playing.

DIONNE: Forgive me.

MADDOW: No, I think it‘s actually appropriate because what this sort of seems like is an own goal on behalf of the Republicans. It seems like they‘ve tried to turn this into an offensive maneuver—like they always have—and it has back fired on them. They‘ve ended up scoring a goal on themselves.

And I don‘t feel though, like Democrats have made political progress with this. Democrats have been able to turn this to any offensive advantage here for them politically.

Are Democrats playing this same game with Republicans? Or are they just letting Republicans hurt themselves?

DIONNE: Well, the old line that if your enemy is losing a battle, don‘t interfere. And I actually think that there was a moment when it turned and that moment was when Dick Cheney came out and said the things that he said that were untrue and there is, I don‘t think, anyone better at mobilizing the Democratic base than Dick Cheney.

You found all sorts of people who had been critical of President Obama on the health care plan or on Afghanistan suddenly wanting to say, hold on a minute. Dick Cheney is going after Obama on something in, you know, what was, clearly, an unfair way. And so, I think this helped Obama immensely with his own base. I‘m not sure it mattered to a lot of other people, but it sure mattered with his own side.

MADDOW: What‘s your reaction to these anonymous, former Bush senior officials telling “The New York Times” that they support President Obama‘s counterterrorism policies but they won‘t say so publicly? To me, that seems like a relatively craven admission.

DIONNE: Well, I also liked in that Peter Baker article that some of them said, “If we supported Obama, it would actually make his policies more unpopular. If they said they were like President Bush‘s policies.”

You know, some of it is about how tribal and divisive we‘ve gotten on these kind of issues. Professionals used to be professionals and Republicans and Democrats could support each other, you can‘t do that now. And it‘s bad for you in the next administration.

But there are Republicans who have spoken out. I was really struck on “Meet the Press” yesterday when General Michael Hayden, former head of the CIA, and also, Michael Chertoff, who can be a fairly partisan Republican, emphasized the continuity between certain Obama policies in terms of just stopping and catching terrorists and the Bush policies.

And so, when you have the Republican professionals in this field speaking out and saying, “Hold on, you know, some of this stuff, our own side is saying isn‘t true,” they didn‘t put it that way but that was the effect of it—when I saw that I said, this game is really over.

MADDOW: Yes. E.J. Dionne, columnist for “The Washington Post”—it‘s really good to have your insight on this. Thanks very much for your time tonight.

DIONNE: Good to be with you. Thank you.

MADDOW: As Republicans arguably start to blow it on politicizing terrorism, another man bites dog as Democrats seem to be officially out-maneuvering Republicans on health reform—out-maneuvering them in terms of legislative tactics. Yes, I know these are words that you thought you would never hear. It took almost a year but Democrats do appear to be pulling it off. We have that story coming up next.

(COMMERCIAL BREAK)

MADDOW: If man-made islands, an indoor skiing mountain in the middle of a desert, and a billion-dollar Tiger Woods golf course complete with palaces overlooking the greens—if all of those things weren‘t enough to spear Dubai into everyone‘s mind as a place that‘s clearly compensating for something, well today, the tiny kingdom unveiled the tallest structure in the world.

There it is, in all of its tallness. The Burj Khalifa is a 160-story, 2,717-foot high monument to height. The official news agency of Dubai is calling it, quote, “Another unique achievement by Dubai to be added to the pages of humanity‘s modern history.”

For extra credit, can you name the structure that was the world‘s tallest manmade thing before this? Before the Burj Khalifa was unveiled? What was the tallest manmade thing in the world? Can you even guess what country it was in?

If you guessed Warren Beatty‘s little black book, you have a keen sense of topical humor but you‘re wrong. Up until now, the tallest structure in the world was this television transmission tower three miles west of Blanchard, North Dakota. And it transmits the heck out of Channel 11 in Fargo. The KVLY-TV mast northwest of Fargo is now the second tallest manmade structure on earth. That is until Fargo figures out how to one up Dubai over this whole Burj Khalifa thing.

I‘m sure Fargo‘s got something in the works. I love rivalries like this. Fargo, Dubai, Fargo, Dubai.

(COMMERCIAL BREAK)

MADDOW: If you used whatever vacation time you had over the past few weeks to get away from the relentless debate in the Senate about health care reform, I‘m sorry to tell you vacation is over. The House and the Senate are gearing back up for yet another round on health reform. But according to new reporting today, the Democrats may have found a way to get this bill done, despite the full court press by the Republican Party to try to stop it.

On December 1st, you might remember that Republican Senator Judd Gregg wrote a memo laying out all of the procedural road blocks available to the Republican Party to try to stop health reform, a veritable arsenal of obstruction. TPM posted it all online.

Republicans, it turns out, have used a lot of these techniques.

There‘s this one, for example, from section one, the “new legislative day.” We asked a senior Democratic leadership aide about this today who confirmed to us that, yes, basically, every time you saw 92-year-old Senator Robert Byrd being wheeled into the Senate in the middle of the night, Republicans were using the “new legislative day” tactic as the reason for that.

Then in section two of Judd Gregg‘s how-to-obstruct memo, there was this one: reading of amendments and conference reports in entirety. Remember when Senator Tom Coburn of Oklahoma tried that one? He forced a tag team of Senate clerks to spend a whole bunch of hours reading an amendment before Bernie Sanders let rip a righteous howl on the Senate floor to put an end to that one?

Senator Gregg‘s obstruction instructions also suggested using Senate points of order to slow things down saying, quote, “A senator may make a point of order at any point he or she believes that a Senate procedure is being violated with or without cause.” We saw that trick pulled out of the bag a few times, including when Senator John Ensign of Nevada unwisely decided to deride health reform as unconstitutional by waxing eloquent about how solemnly he takes his oaths—which was awkward for a married man undergoing an ethics investigation for shtooping his campaign staffer.

Then there was the “motion to recommit” gambit. That‘s where you try to send a bill back to committee asking for changes or additions. That was a tactic the GOP used repeatedly.

But, of course, despite all of these tactics, health reform did pass the Senate. So now the fight‘s over, right? We can retire Senator Judd Gregg‘s version of “The Art of War”? It turns out, no. We can‘t.

Republicans have one last hope, one last arrow in the quiver, one last section in the obstruction memo. It‘s the conference committee process where the House and the Senate reconcile their two different versions of the bill. And according to Sun Tzu, obstruction master of the Republican Party, Senator Judd Gregg, that conference committee process provides yet more opportunities to stall this thing.

Did you know it takes three more votes just to send a bill to the conference committee? Just think what the minority party could do with three more votes. Three more chances to slow this thing down, to slow it down enough to try to kill it yet again.

Well, according to new reporting today, Republicans are not likely to get that chance. As my next guest was first to report today, Democrats are planning to skip the whole conference committee thing and work out the differences between the House and Senate bills informally, which—yes, means they‘ll be working them out without the Republicans.

Jonathan Cohn, senior editor of “The New Republic” and author of “Sick,” is the man who broke the story today.

Mr. Cohn, thank you very much for being here.

JONATHAN COHN, THE NEW REPUBLIC: It‘s good to be here. Thanks for having me.

MADDOW: In your reporting today, you wrote that a Senate staffer had told you it‘s time for a little ping pong. Ping pong being the legislative alternative to the conference committee.

What does it really mean?

COHN: Well, ping pong is basically a reference to the fact that instead of having a group of senators meet and work out a final version of the bill and then have each chamber vote on it, basically, you have—the House will now basically take the bill that the Senate passed, say, “All right, this is our starting template. Let‘s see what we like about this and let‘s modify it a little bit to make us so we can be happy with it.” They pass it. And then they send it back to the Senate and then the Senate does the same thing. Ping pong.

But, of course, as this is all happening, there is an informal negotiation going on. And in effect, the discussions that are taking the place of the conference committee and that‘ll be the Democratic leaders, will be, you know, Nancy Pelosi and Harry Reid and will be the main committee players and perhaps some other people, and they will be having the discussions how to work out, “OK, how do we come to agreement on this, so as you said we can finally be done with this and we can finally get a bill onto President Obama‘s desk?”

MADDOW: Is it true that by doing things this way, rather than through a formal conference committee, Democrats are effectively denying Republicans further opportunity to slow down, obstruct, or maybe even stop the bill?

COHN: Well, there will still be a few opportunities. There has to be a final vote by the Senate, and as we‘ve seen, the Republicans will take any opportunity they can in the Senate to try to gum up the works. But this greatly diminishes the opportunities.

As you said, if we were going to go through the formal conference process, there would have to be a whole set of votes and a whole set of debates, and this thing could drag out for much, much longer. And, you know, it‘s fine, you know, to have this process of a conference committee and go through this formality if you‘re working with a minority party that‘s sincerely interested in trying to negotiate and come up with a compromise that, you know, some of their members can like. But I think we‘ve seen by now that that‘s simply not what the Republican Party is interested in.

You know, the time to cooperate, the time to talk about how to find some compromise that everyone can live with, you know, we had that time. We had the entire year to do that. And the Republicans made very clear that they were not interested.

So, I think, the Democrats now have gotten that lesson and they‘re reacting accordingly saying, “All right. You don‘t want to be part of this? We‘ll just take care of business on our own and we‘ll get this done and we‘ll try to come up with the best bill that we can.”

MADDOW: I guess the opportunity cost here is the prospect that the conference committee could actually be a chance to make the bill better, that it could be a place to constructively work out any kinks in the bill, to try to smooth out any policy awkwardnesses before it‘s actually signed by the president. I guess by having to do things this way or by choosing to do things this way—depending how you look at it—you do miss the opportunity to actually, in conference, make the policy, a better policy for the country.

COHN: Well, sure. I mean, look, in an ideal world, I‘m sure there are some ideas from the Republican side that would be useful to have as part of this discussion. And, frankly, I think Democrats over the last few months, even with the Republicans being relatively obstructionist about this, have actually made a lot of efforts to accommodate Republican concerns.

But look, at the end of the day, you need two to tango here. And if the Republicans aren‘t going to make themselves available in a constructive way, there is really no alternative but to proceed without them. I do think there‘s probably some opportunity cost there but, you know, you have to weigh that against the benefit, which is we can finally get this done. And I think that‘s the most important goal here.

MADDOW: And I think that any argument about that, and we have seen Republicans—particularly Republicans like John McCain—complaining loudly about Republicans being kept out of the process. But when they go so far as to put in black and white, to put in writing all of the different ways they‘re going to try to procedurally obstruct any form of health reform from going through, it becomes hard to also argue that they want to have a constructive role in the process. I guess they‘ve sort of ceded that territory, politically.

COHN: Well, I think so. I mean, don‘t forget on Christmas Eve, when we had that final, you know, climactic vote in the Senate and everyone was so exhausted, the last thing we heard from the Republicans was Mitch McConnell giving a speech on the floor vowing to fight on. “We‘re not going to let this bill happen. We‘re going to keep resisting.”

You know, frankly I think if Democrats were still trying to get the Republicans to cooperate and still bending over backwards, there‘ll be something wrong with them.

I mean, look, the Republicans have made their point. They don‘t want to be part of this discussion. That‘s their right. Let‘s move on without them.

MADDOW: Jonathan Cohn, senior editor at “The New Republic” - all cross the country right now, people are shell-shocked by the concept that Democrats are just taking the ball and running with it and trying to score. This is a new idea for liberals. I think it‘s just starting to sink in.

Thanks a lot, Jonathan.

COHN: Thanks for having me.

MADDOW: There is news brewing in the political blogosphere tonight about a Palin, a Palin who is not Sarah Palin. We will get to the bottom of it next.

And stay tuned for a full-on review of the constitutional provision that Michele Bachmann says is surely out to get you. Or at least she used to say it was surely out to get you. Now, she‘s not so sure. It‘s an interesting, backsliding story. Stick around.

(COMMERCIAL BREAK)

MADDOW: Still ahead, if you are a Republican member of Congress who has a deep-seated fear of the census, but you also rely on the census for the very existence of your job, 2010 could be a very complicated year for you. TMI on Michele Bachmann and the census she fears, ahead.

But first, a few holy mackerel stories in today‘s news.

(BEGIN VIDEO CLIP)

HILLARY CLINTON, UNITED STATES SECRETARY OF STATE: The instability in Yemen is a threat to regional stability and even global stability.

(END VIDEO CLIP)

MADDOW: That was Secretary of State, Hillary Clinton, speaking earlier today. The head of Cent Com, Gen. David Petraeus, took a surprise visit to Yemen this weekend. It was his third trip to Yemen in the 14 months that he has been the head of Cent Com.

Gen. Petraeus met with Yemen‘s president for about an hour and a half on Saturday. And then, the very next day on Sunday, the United States shut down our embassy in Yemen citing security threats. So did the Brits.

Today, the French, the Germans, the Japanese and the Czechs all followed suit, all either closing their embassies in that country entirely or limiting access to them.

Meanwhile, Andrea Mitchell reported on “Nightly News” tonight that truck-fuls of explosives are said to have gone missing somewhere inside Yemen, which may of course be why everything just got so suddenly shut down. We will keep you posted.

While we are talking about things going wrong in important places, political instability remains the huge story of Iran, a vast, growing, and powerful protest movement that has continued long beyond the summer‘s botched election. Government crackdowns have led to mass arrests, violence, and censorship.

Politically speaking, it is therefore incumbent upon the Iranian regime to at least try to appear unfazed, unified, and gaff-free in the face of this strong and growing opposition.

Now, you can cue the inadvertently hilarious new year‘s related government face plant. It is standard operating procedure for Iran‘s soccer league to send out a new year‘s greeting to all the members of the International Soccer Federation, FIFA.

This year was no different. The message was E-mailed out to everyone including, accidentally, a country whose existence Iran does not officially recognize - Israel, a soccer team that refuses to play in competition. A country its president has made quite a name for himself by insulting, dismissing, and denouncing.

So the message was essentially, “Happy New Year to everybody including soccer team of the country we refuse to admit exists.”

For this grave crime of accidentally forgetting to exclude Israel from the generic international New Year‘s greeting, accidentally including Israel in the happy new year, a senior official from the Iranian Soccer Federation has already offered his resignation.

According to the BBC, for their part, Israel took it all in stride. Quote, “They decided to make the most of it and replied with similar good wishes to, in their words, ‘all the good people of Iran‘ and ending the message with an E-mail wink. So Israeli soccer winning this round of word war three with cunningly deployed emoticons.

And finally, a story that has been percolating on blogs and throughout the Internet today - it has all the trappings of a monumental blockbuster of an Internet scoop. So one of our producers spent all day today looking into it and I have some very important information to share with you about a Palin.

Now, back in September, someone in Alaska filed paperwork to establish themselves as the organizer of a new limited liability company, an LLC. That person was Bristol Palin - 19-year-old Bristol Palin, the daughter of Sarah and Todd Palin, the mother of Tripp, now in the news for something completely un-tabloid-y.

The particular type of LLC that Bristol Palin established uses the federal classification code 541820 which means that Ms. Palin the younger has just formed a company that intends to provide lobbying, public relations, and political consulting services.

This is why it seemed like the real deal. First the lawyer named as the registering agent of this LLC is Thomas Van Flein who practices law at the address listed here on this document that we‘ve blurred out for the sake of his privacy.

Mr. Van Flein‘s previous gig was representing Gov. Sarah Palin during the trooper-gate scandal. Also, this also seemed like it was real, right? The registered company is called BSMP - BSMP - ah, the initials of Bristol Sharon Marie Palin.

Also, and although this is not real evidence, but it is neat, the signature on the document and Levi Johnston‘s ring tattoo of Bristol Palin‘s signature look a lot alike.

So adding all of this up, it seems like what you‘ve ended up with here is Bristol Palin, political consultant, lobbyist and public relations executive at the age of 19. Go, Bristol, go, right?

Actually, no. Mr. Van Flein finally got back to us late this evening. He told us in an E-mail, quote, “The code for BSMP, LLC pertains to several areas but includes public relations. Bristol Palin provides public relations services and is currently an ambassador for the Candie‘s Foundation.

The Candie‘s Foundation is a pro-abstinence organization. Bristol Palin has essentially set herself up to be paid as an incorporated entity as opposed to being paid as an individual and that‘s sort of a common choice people make when they have money coming in from various sources like this.

So BSMP, LLC, may just be a pretty smart financial decision by a very astute 19-year-old, or Bristol Palin is about to launch a lobbying and consultancy firm to run her mom‘s 2012 presidential campaign. Theoretically possible, but probably not.

(COMMERCIAL BREAK)

MADDOW: As the Republican Party searches for meaning in the political minority, one of its newest members is of course Alabama Congressman Parker Griffith who announced last month he was leaving the Democratic Party and becoming a Republican.

When he made that announcement, Mr. Griffith‘s campaign consulting team announced right away that they would be dropping Mr. Griffith because of his defection to the Republican Party.

Today, saying that Congressman Griffith had made a mistake, his chief-of-staff resigned as well, as did his legislative director and his legislative assistant and his other legislative assistant and his press secretary and his staff assistant and his legislative correspondent and his other legislative correspondent and his congressional fellow and his other congressional fellow. And even his intern quit.

Shout out to you, Andrew Menafee(ph). The entire Parker Griffith staff even waited until after the winter break so they could come back to Washington and do this en masse resignation in person and to release their “you made a big mistake” statement about their former employer.

And Mr. Griffith may have many, many virtues as a congressman and employer. Who knows, but inspiring confidence in those closest to him does not appear to be one of those virtues.

(COMMERCIAL BREAK)

MADDOW: First, Michele Bachmann encouraged everyone not to participate in the census. It‘s a conspiracy. Now, Michele Bachmann has changed her tune. If anything requires TMI, this story does. It‘s next. Stay with us.

(COMMERCIAL BREAK)

MADDOW: The secretary of commerce, the mayor of New York, and the director of the United States Census were all together in Times Square today to kick off a big, nationwide ad campaign.

This ad campaign includes a 13-vehicle bus tour traveling more than 150,000 miles, stopping at the Super Bowl in Miami, Mardi Gras in New Orleans, and even, I guess, bus-boating it somehow to Puerto Rico. The goal is to persuade Americans to fill out the census form, the form that should arrive in a mail box near you in mid-March.

The government is planning on spending over $300 million this year to persuade us all to spend 10 minutes answering that questionnaire and sending it back. The patriotic case for participating in the census is being made slightly more difficult this year by conservative Fringy McFringersons among us deciding that this year - even though it happens every 10 years, this year, the census must be some sort of commu-bamanist plot. For help unraveling this we turn to Kent Jones and TMI.

(MUSIC)

Oh, a special report.

KENT JONES, MSNBC CORRESPONDENT: Oh.

MADDOW: Oh. Kent, so tell me, how is it that once in a decade - fill out the census campaign, happens every decade. This year, they have to cope with conspiracy theories about the census, too.

JONES: That‘s right. Two magic words - Michele Bachmann.

MADDOW: Oh, yes.

JONES: Have a look.

(BEGIN VIDEOTAPE)

(voice-over): The congresswoman from the sixth district of Minnesota is drawing a line about the 2010 census.

REP. MICHELE BACHMANN (R-MN): I‘m not encouraging Americans not to fill out the census. I‘m saying for myself and for my family, our comfort level is we will comply with the Constitution, Article I, Section 2, we will give the number of the people in our home, and that‘s where we‘re going to draw the line.

JONES: Don‘t tread on me with your counting the people in my household.

BACHMANN: How do we know that our information that‘s given to the government, personal information, will stay private? What guarantees do the American people have that hackers won‘t get into the system?

JONES: You know what TMI means? Too much information, and that goes for your snoopy neighbors too.

BACHMANN: They‘ll go to our neighbors on our left and on our right and ask our neighbors to give them information about our personal lives. This is very concerning.

JONES: Actually, this is the census, which happens every 10 years, at least until Michele Bachmann can stop it.

BACHMANN: Look at American history. Between 1942 and 1947 the data that was collected by the Census Bureau was handed over to the FBI and other organizations at the request of President Roosevelt.

And that‘s how the Japanese were rounded up and put into the internment camps. I‘m not saying that that‘s what the administration is planning to do. But I am saying that the private personal information that was given to the census bureau in the 1940s was used it against Americans to round them up.

JONES: Whew! So what kind of deranged extremists would want to do that to its own people? Who came up with this flagrant insult to the Constitution? The guys who wrote the Constitution.

Back in 1787, the United States became the first nation to make a census mandatory in its constitution, quote, “The actual enumeration of the population shall be made within three years after the first meeting of the Congress and within every subsequent term of 10 years.”

It‘s data from that 10-year census that‘s used to redraw congressional maps - congressional maps like in Minnesota, which is facing the possible loss of a congressional seat after the next census.

Maybe that‘s why we haven‘t heard Bachmann railing about hackers or snoopy neighbors or interment camps since at least last August. Because if Michele Bachmann doesn‘t fill out the census and her constituents don‘t fill out their census, then what happens to her district? I think she‘s figuring out.

BACHMANN: The census is the mother load of all data collection in the United States.

JONES: Moral? Be nice to your mother lode.

(END VIDEOTAPE)

MADDOW: Thank you, very much, Kent. I appreciate that. A brand-new segment is premiering on “COUNTDOWN” tonight. Keith‘s quick comment on Dick Cheney versus President Obama.

But first is to catch a senator. John Ensign on camera asked about the ethics investigation into him shtupping his staffer and paying her off and getting her husband hired as a lobbyist. That‘s next. Stay with us.

(COMMERCIAL BREAK)

MADDOW: Tonight‘s “Cocktail Moment” is all about the secretive religious organization known as The Family about which we‘ve reported quite a bit on this show.

First up, former C Street denizen and Family member, Sen. John Ensign of Nevada. Since his June 16th confessional, awkwardly in front of a public restroom sign, he has been particularly adept at avoiding the media when it comes to questions about his extramarital affair with a staffer and about the investigations into his professional relationship with her husband, former aide-turned-lobbyist, Doug Hampton.

In fact, the first time we remember seeing Sen. Ensign actually having to respond to anyone on camera about Mr. Hampton was when CNN‘s Dana Bash and a producer attached themselves to Sen. Ensign outside on Capitol Hill.

(BEGIN VIDEO CLIP)

DANA BASH, CNN CORRESPONDENT: Senator, why was it so important to get Doug Hampton those jobs?

SEN. JOHN ENSIGN (R-NV): Just look at our state. Just look at our state. He‘s very clear on that stuff.

BASH: Is there any chance that you - are you considering resigning?

ENSIGN: I am focused on doing my work, and I am going to continue to focus on doing my work.

(END VIDEO CLIP)

MADDOW: Since that, Mr. Hampton has said in interviews that Sen. Ensign knowingly violated ethics rules by helping him get lobbying clients and meetings less than a year after he left the senator‘s employ.

So when CNN‘s Rick Sanchez got the chance to interview Sen. Ensign at the end of the year, the anchor gamely tried to get some kind of explanation from Mr. Ensign, only to be evaded for a full six minutes.

(BEGIN VIDEO CLIP)

ENSIGN: You know, Rick, I‘ve been dealing with health care reform.

My state has over 12 percent unemployment rate. We have two wars going on.

RICK SANCHEZ, CNN ANCHOR: Right.

ENSIGN: These latest terrorist attacks - there are so many other bigger issues. I‘ve commented on all I needed to comment on those kinds of things. I‘ve commented on all I was going to comment on that.

I‘m not going to answer any of the questions because I‘m focused on doing my job right now. All that stuff will take care of itself over time. I‘ve spoken all that I need to speak on this.

And everything will take care of itself over time. I‘ve answered all of those questions. In the end, everything will be answered in its fullest. We will cooperate, and I think, you know, based on the facts, that the evidence committee would clear me, and I‘ll be able to go on being a senator. I‘ve answered the questions that I‘m going to answer, and I go back to my statements ...

SANCHEZ: All right.

ENSIGN: ... that I have done nothing ethically or illegal in this matter. And in the end, it‘s going to absolutely - we feel that we will be completely exonerated.

(END VIDEO CLIP)

MADDOW: What we, senator? You know, speaking of The Family, the “New York Times” today picked up on the reporting we‘ve done, for the last five weeks or so, on the kill-the-gays bill proposed in Uganda.

As we have reported, the legislator who introduced the kill-the-gays bill and the country‘s president whose government has supported it are members of The Family.

Three weeks ago, we finally found out what the extremely secretive and media-averse Family thinks of the bill in Uganda.

Bob Hunter, a former Ford and Carter administration official, who‘s also been one of the Family‘s key contacts with Uganda, told investigative reporter, Jeff Sharlet, that The Family is opposed to that bill.

And not only that, Mr. Hunter said he‘s actively working to get U.S. politicians to actively fight against the bill. For the first time since we started reporting on The Family many, many months ago, we finally have been able to schedule an interview with someone who is a part of the group.

Mr. Bob Hunter is the interview on THE RACHEL MADDOW Show right here tomorrow night which happens at our regular time, which is 9:00 p.m. Eastern. We are really, really, really looking forward to having him on the show. It is long overdue.

We will see you tomorrow for that. In the meantime, “COUNTDOWN” with Keith Olbermann starts right now. Have a great night.

Fresh Pain for the Uninsured

As doctors and hospitals turn to GE, Citi, and smaller rivals to finance patient care, the sick pay much more

BusinessWeek reports:

In a lucrative new form of fiscal alchemy, a growing number of hospitals, working with a range of financial companies, are squeezing revenue from patients with little or no health insurance. April Dial's dealings with Hot Spring County Medical Center in Malvern, Ark., illustrate how the transformation of medical bills into consumer debt means quicker cash for medical providers but tougher times for many patients of modest means.

Dial, a 23-year-old truck-stop waitress who earns $17,000 a year plus tips, suffers from Type 1 diabetes. Sudden drops in her blood sugar level have sent her to the emergency room four times in the past three years. In September she spent three days at Hot Spring, including two in intensive care, fighting complications from her ailment. The bills came to more than $14,000. Dial's job offers no health insurance.

Until recently her mother, Carolyn, who waits tables at the same roadside diner, sent Hot Spring $100 a month under the nonprofit hospital's longstanding zero-interest payment plan. Dial says she couldn't make payments herself because she spends more than $150 a month for other treatment and insulin. In October she learned that Hot

Spring had transferred her account to a company called CompleteCare, one of the many small firms fueling the little-known medical debt revolution. Enticed by the enormous potential market of uninsured and poorly insured patients, financial giants such as General Electric (GE ), U.S. Bancorp (USB ), Capital One, and Citigroup (C ) are rapidly expanding in the field or joining the fray for the first time.

CompleteCare informed Dial that under the complicated terms of her newly financed debt, her minimum monthly payment had shot up more than fourfold, to $455. Dial says she doesn't have anywhere close to that amount left over after rent, food, and other doctor visits: "Every extra dime I have goes to paying medical bills."

Sophisticated Help

Collecting from "self-pay" patients like Dial has long been the bane of medical administrators. When they don't get paid immediately, hospitals typically recover around 10 cents on the dollar owed, even when they hire collection specialists. So hospitals and clinics are bringing in more sophisticated help. They are transferring patient accounts wholesale to finance experts, banks, credit-card companies, and even private equity firms. Many of these third parties use credit scores and risk-analysis software to price the debt and impose interest rates as high as 27% on past-due bills.

Among hospitals, nonprofits like Hot Spring County Medical Center are more likely than for-profit rivals to join forces with finance firms. Fewer nonprofits have effective in-house collection departments, and in many regions a higher proportion of patients at nonprofits lack insurance. "Hospitals can't just be an interest-free finance vehicle," says Todd Cole, director of patient accounting at TriHealth, a $2 billion pair of nonprofit hospitals in Cincinnati. "The world of $5 sent to the hospital and they will never send me to collections, never sue me—that world has gone away," he adds. TriHealth sells patient accounts at a steep discount to firms that specialize in collecting delinquent consumer debt. "Hospitals need their cash," Cole says. "It is the lifeblood that supports the doctors, the nurses."

For hospitals and outside firms to obtain that cash, someone has to pay. The people most likely to feel the pain are often those least able to afford it—patients who lack private insurance but who are not poor enough to qualify for charity care or government benefit programs. The pool of self-pay patients is mammoth: Some are among the nation's 47 million uninsured; others among the 16 million whose plans offer scant coverage or have deductibles as high as $10,000. Several recent studies have shown that medical debt is a leading cause of personal bankruptcy filings.

A host of nimble firms like CompleteCare in North Little Rock, Ark., began exploring this terrain years ago. Bigger players have jumped in more recently, although the market remains fragmented and reliable market share information isn't available. U.S. Bank, a U.S. Bancorp unit, finances about $2 million in patient debt per month through a medical-benefit firm, charging most customers annual interest of 13.5%, and as much as 24% on late bills. General Electric's powerful financial arm markets its CareCredit card to dentists, plastic surgeons, and some hospitals, with loan volume expected to hit $5 billion this year, up 40% from 2006. Citigroup and Capital One now offer similar cards. "Everybody is saying [medical finance] is the next horizon—whether it is lines of credit or credit cards," says June St. John, a senior vice-president at Wachovia (WB ), which is exploring the business. Whetting all these appetites is the $250 billion consumers pay in medical expenses out of their pockets, an amount that doesn't include insurance premiums. That's an estimate for 2005 from the consulting firm McKinsey & Co. The figure could hit $420 billion by 2015.

BusinessWeek's investigation of the fast-expanding medical-finance field has uncovered hazards, however. Many patients say they don't realize their debts are being shifted to such interest-charging middlemen as GE Money Bank, the unit that issues the CareCredit card. That's what happened to Alice Diltz when she visited Hillside Dental Care in Queens, N.Y., in October, 2005. Diltz, a 68-year-old part-time hospital aide, needed implants for two rotting teeth and three missing ones. The Hillside staff told her she would have to pay $7,450. But her dental insurance, provided by her retiree husband's policy, offered only $200 for extractions. Diltz paid $250 from her pocket and signed up for what she says she thought was an installment plan directly with the clinic. In fact, she signed an application for CareCredit, which was labeled as such, but in small print. Diltz says neither Hillside dentist Ben Mokhtar nor his staff mentioned a credit card.

While having her teeth pulled, Diltz began to bleed heavily. She got scared and left the dental office after the extractions. Four days later she canceled the implants, assuming her dealings with Hillside were over. But several weeks later she received a bill from CareCredit for $7,000. Hillside had transferred that amount to the credit-card company, which in turn paid the clinic about $6,300 up front. Diltz says she called CareCredit to dispute the charge, but bills kept arriving. Several weeks later, she says she called again and objected in writing. But GE told her she had missed a 60-day deadline and couldn't reverse the charge.

The GE card typically comes with an introductory 0% interest rate, but after Diltz didn't make her initial payment, the rate leapt to 26.99% on an annual basis. In August, 2006, GE Money Bank sued her in state court in Queens. With the help of the nonprofit Elder Law Clinic at St. John's University School of Law, she contested the debt, which grew to $10,175. "It was horrible to get those letters from GE," says Diltz. She and her husband live on $18,000 a year from her part-time job and social security benefits. "It was so stressful from day to day."

Outside Scrutiny

A GE spokeswoman, Cristy F. Williams, said in an e-mail that the vast majority of CareCredit's 6 million customers are satisfied. In the Diltz case, "we provided her with a dispute form and discussed the dispute process with her a number of times," Williams added. "She did not respond for several months." However, on Nov. 12, after BusinessWeek inquired about the case, GE said it had changed its stance. Williams said the company would erase Diltz's debt and remove any reference to it on her credit report. The spokeswoman said GE had begun to reassess Diltz's account on its own initiative. "We could have and should have been more sensitive to Ms. Diltz," she said.

Diltz's lawyer, Gina Calabrese, said she was skeptical that GE would have reversed itself absent a reporter's asking questions. "They knew about all these facts almost a year ago," the attorney said. "Imagine what is happening to all the unrepresented people who have valid cases." Mokhtar and his staff declined to comment.

In another instance, BusinessWeek's questions prompted GE to acknowledge that a medical clinic had pressured uninsured patients into using the CareCredit card. Dawn Shelly, 33, visited the Christie Clinic in Urbana, Ill., in late 2003 for a sinus infection. She told a staff member she couldn't afford to pay the $90 bill in cash. At the time she earned $7.50 an hour as a part-time school bus monitor; the job didn't offer insurance. The clinic, Shelly says, told her the only option was to apply for CareCredit. She says she thought she was signing up for a program similar to insurance, under which she would owe only a modest co-payment. "I never would have signed up if I knew it was really a credit card," she says.

Her CareCredit balance mounted with several additional visits to the clinic and a local emergency room, where she was treated by a clinic doctor. Unable to keep up with payments, Shelly, now unemployed, owes $3,485 to CareCredit, according to an Oct. 24 collection letter. Much of that balance comes from late fees and finance charges of 26.99%.

Until recently, the Christie Clinic's Web site stated that patients who couldn't pay in full "must apply for CareCredit." After BusinessWeek asked GE about the clinic's policy, the company said it would correct the situation. "We are instructing the provider to remove the language and change their policy for soliciting applicants for CareCredit," said GE's Williams. She added that GE would drop all fees and finance charges from Shelly's bill. The company also will try to resolve the concerns of any other patients who were required to use CareCredit, she said.

In early November the Christie Clinic removed all references to payment policies from its Web site. Anni McClellan, the clinic's director of financial services, said it is reviewing the policies. Christie discusses a variety of payment options with patients, she said. "There are so many specific circumstances surrounding each patient's financial conditions."

The Fine Print

Early experiments with financing self-pay medical bills began in the 1980s, when consumer-credit executives saw an opportunity in soaring debt levels and inefficient hospital billing practices. Most patients think that "your doctor will probably see you again and the hospital will not turn you away if you don't pay the bill," says Richard L. Clarke, chief executive of the Healthcare Financial Management Assn., an industry group. "On the other hand, with the credit card or a loan [from] the bank, people will be more concerned about defaulting because that is almost certain to cut them off from credit."

That's precisely the strategy that drives CompleteCare, the small Arkansas firm, which says it works with 40 hospitals and more than 400 physician practices across the country. Addressing potential health-industry clients, the company boasts on its Web site that it "pioneered the concept that patients become consumers the minute they walk out of your facility." April Dial, the diabetic waitress, says she didn't realize she had been transformed in this manner until weeks after leaving Hot Spring Medical Center in September.

Dial says a hospital financial counselor told her mother by phone in October that Hot Spring had discounted her debt by roughly 50%, to $7,300, before transferring the balance to CompleteCare under a contract the company signed with the hospital in June. Although she was surprised to learn about the transfer, Dial in fact had signed an admission-consent form at Hot Spring that included a small-print section authorizing the hospital to turn over her account. In contrast to the hospital's former zero-interest payment plan, CompleteCare charged Dial 5.75% interest on the first $2,500 of her balance, with a minimum monthly payment of 10% of the outstanding debt. CompleteCare initially applied the 10% rate to only $4,545 of the total bill, and required that Dial pay $455 a month.

After BusinessWeek contacted CompleteCare in early November, and Dial asked to have her case reviewed, the company said it would lower her minimum payment to $125, interest-free. CompleteCare President Steven C. Owen said the company changed the terms because Dial's "situation is so dire in terms of the balance owed. Our whole philosophy is trying to make it easy to pay."

Hot Spring's chief financial officer, Sheila Williams, said the hospital switched to CompleteCare hoping that patients "would pay a little faster if they were charged interest. It would become like a credit card." CompleteCare ran an ad in a local newspaper this summer to announce the change. But in recent weeks, she said, the hospital has reconsidered the arrangement in response to a complaint from a patient other than Dial. Hot Spring decided that effective Nov. 9, patients using CompleteCare would no longer be charged interest. "We just rethought it and decided that maybe it is not in the best interest of our patients," the hospital executive said.

Dubious innovations in medical financing are beginning to gain attention in Washington. Lawmakers and the IRS are investigating more broadly whether nonprofit hospitals provide sufficient free care to the uninsured to warrant more than $50 billion in annual tax breaks. Senator Charles Grassley (R-Iowa), the ranking Republican on the Senate Finance Committee, says some new financing arrangements appear to undermine the justification for tax-exempt status enjoyed by more than half of the country's 5,700 hospitals. "I'm very troubled by what we're seeing with some nonprofit hospitals' cozying up to banks, debt buyers, and credit-card companies over patients' medical bills," Grassley said in a statement responding to questions from BusinessWeek. The American Hospital Association said it hasn't studied the financing in question, but the trade group has repeatedly asserted that nonprofits provide ample community service to justify their tax benefits.

One of the leaders in this new field, HELP Financial, says that it merely makes the health-care business run more smoothly. The privately held Plymouth (Mich.) firm, whose initials stand for Hospital Expense Loan Program, says it has financed close to $300 million in medical bills at 100 hospitals nationwide. HELP purchases the debt at a discount and then charges patients interest of 10% to 18% over periods of one to five years. "The motivation for the hospital is really to keep them in the health-care business and out of the banking business," says HELP Vice-President Steve Posa.

Mia and Jase Redick reluctantly became HELP customers earlier this year and then discovered that they owed the company a hefty 14.5% on a bill of $6,293. In January, Mia, 36, had been rushed to Satilla Regional Medical Center in Waycross, Ga., after suffering a mild stroke. Tests revealed a small hole in her heart, a congenital defect that eventually required surgery. Mia, a pharmacy worker, and Jase, a job trainer for the state of Georgia, earn a combined $90,000 a year and have two small children. They lost state-provided insurance when Jase became an independent contractor in 2005, and had chosen to save money by going without coverage at the time Mia had the stroke. The couple assumed they would be able to pay the $6,293 tab for emergency care and tests in monthly interest-free installments. For years that's how Mia's family, Waycross natives, had used Satilla's in-house payment program. "It's what we always did," she says.

But on the winter morning when Mia arrived at the emergency room, a hospital administrator informed the Redicks that Satilla no longer offered its old payment plan. Jase says he was distraught and refused to discuss money that day. At a meeting the next week, the Redicks say they were told they had two options: retire the debt within 90 days and receive a 15% discount, or finance through HELP. With insufficient cash in the bank, the Redicks chose HELP. Distracted by Mia's condition, they didn't ask about having to pay interest. The bill arrived in March with the 14.5% rate, which translates into a monthly payment of $148. On top of $24,000 they owe to another hospital where Mia had surgery in February, "the overall cost of the debt is a lot to handle," says Jase.

Discounted Debt

Officials at Satilla say they brought in HELP in 2002 to reduce bad debt levels among the large population of uninsured patients in the hospital's rural south Georgia region. Through October, HELP had acquired $718,000 in Satilla debts. HELP pays 92 cents per dollar owed to the hospital. Satilla could trim the firm's 14.5% interest rate by selling debts at a greater discount but has chosen not to, according to Brenda Williamson, the hospital's accounts-receivable supervisor.

Barbara G. Albert, Satilla's patient financial services manager, stressed that the Redicks turned down Satilla's discounted 90-day payment plan. With more uninsured patients failing to pay medical bills, she said Satilla has to rely on HELP. "When you go to the dentist or the vet, you know you have to pay. If you go to the hospital, why should it be different?" said Katrina Wheeler, Satilla's chief financial officer. HELP's Posa said that it's up to Satilla and other hospitals to decide on appropriate interest rates: "What is right in one market may not be right for another."

Melvin Johnson, 55, another Satilla patient, has insurance, but his low-cost policy with AARP, the retiree-advocacy group, didn't cover the colonoscopy his doctor ordered in September. Johnson turned out not to have cancer, but the visit produced a bill for $3,304. He and his wife, Dolores, earn about $35,000 a year from her work as an outreach coordinator at a community health center and his construction job. Satilla's cut-off for charity care is twice the federal poverty level, or $27,380 for a two-person household. Unable to pay in cash, the Johnsons chose HELP. The 14.5% interest rate means their monthly payment comes to $125. "It has caused us to rearrange our budget," says Dolores, 35. "We've had to cut other expenses and reduce our savings."

Satilla's Albert said the couple could have bought better private coverage. "They're saving money," the hospital manager said. HELP imposes a cost on the hospital, her colleague Williamson added, in that Satilla gives HELP an 8 cents-per-dollar discount on patient debt.

Some medical financing programs manage to turn a profit without charging patients conventional interest. Aequitas Capital Management, a Portland (Ore.) private equity firm, provides financing through its CarePayment card to 50,000 patients treated at two dozen hospitals. CarePayment charges no interest on debts repaid over 25 months. Aequitas Chief Executive Robert Jesenik says his firm makes money by buying patient debts for about 80 cents on the dollar and then seeking to recover the full amount.

But patients aren't necessarily better off with CarePayment because they sometimes forgo discounts hospitals offer to people who pay in cash. At Spectrum Health, a nonprofit group of seven hospitals in Grand Rapids, Mich., self-pay patients who can write a check within 30 days receive a 20% discount; those who pay within six months get 10% off. Patients who charge their debts to CarePayment get no discount. Referring to CarePayment, Kathleen Engel, an associate professor at Cleveland-Marshall College of Law, asserts: "This is a markup, not a markdown." Engel, a consumer law expert, says that because hospitals effectively charge more when patients use CarePayment, the hospitals should disclose the price difference as the equivalent of an interest rate under the federal Truth in Lending Act.

Joseph Fifer, Spectrum's vice-president of finance, said its disclosure is legally sufficient. Steven M. Wright, Aequitas' senior managing director for health markets, agreed. Wright said Aequitas complies with the law by disclosing its payment terms when it sends CarePayment charge cards to new customers.

From his position as chief financial officer of Methodist Le Bonheur Healthcare, a $1.2 billion nonprofit network in Memphis, Chris McLean has grown increasingly skeptical of all these developments. Five of his seven hospitals serve a large portion of Memphis' poor population. Instead of selling medical debt, Methodist gives self-pay patients a 50% discount. Many are then allowed to pay over five years, interest-free. The debts of many others are immediately written off. One of Methodist's facilities serves a wealthier clientele and another is the city's only children's hospital; those units subsidize the other five.

"We get a lot of tax breaks, and for that we should produce some community benefit," says McLean. "If we heal somebody medically, but we break them financially, have we really done what is in the best interest of the patient?"

House Falling Short on SCHIP Override

The Washington Post reports:

House Speaker Nancy Pelosi (D-Calif.) reversed her stance from a week earlier, appearing resigned Sunday that Democrats would not convince enough Republicans to pass an expansion of a children's health insurance program over President Bush's veto.

"Isn't that sad for America's children?" she asked on ABC's "This Week." Her second appearance on a Sunday talk show in as many weeks came days before the House is expected to vote again on the State Children's Health Insurance Program.

Last week, Pelosi was far more optimistic about the chances of overriding Bush's veto, saying on "Fox News Sunday" that the Democrats needed "about 14 Republican votes" to reach the required two-thirds majority.

This week, it was Pelosi's Republican counterpart, House Minority Leader John Boehner (Ohio), who was facing questions on Fox, and he said he was confident that "we will have the votes to sustain the president's veto."

The White House has signaled it wants to find a compromise with Democrats over the program, but any agreement seemed distant today.

Pelosi said she has never heard from Bush about the program and she reiterated a point she made last week, that she is unwilling to support legislation that would cover fewer children than the current bill's 10 million.

The Senate already has a sufficient majority to override the veto, and Senate Minority Leader Mitch McConnell (R-Ky.) predicted on ABC that the White House and congressional Democrats would strike a deal.

"Neither side is going to leave these kids uninsured. It's become kind of a political football, which is really unfortunate. But the coverage is going to be provided in some way," McConnell said.

States Decry Children's Insurance Policy

The Guardian reports:

State health officials are decrying new federal guidelines that require many children to be uninsured for a full year before they have access to government-subsidized coverage.

Waiting periods prevent families from dropping private insurance to get cheaper or better coverage for their kids through the State Children's Health Insurance Program, or SCHIP.

But the vast majority of states require much shorter waits - typically one month to six months - than the Bush administration will require. Only Alaska has a one-year wait; in 16 states, there is no waiting period.

State officials say the policy could prevent pregnant women from having health coverage during any portion of their pregnancy or it could keep children from obtaining insurance even if a parent has died or lost a job.

``It would actually increase the number of uninsured children,'' said Deborah Bachrach, deputy commissioner in New York's Office of Health Insurance Programs. ``We think it's bad policy.''

New York has applied to expand its program coverage to families with incomes up to 400 percent of the poverty level - a threshold that many say the program was not intended to serve. Under the New York policy, a family of three earning as much as $68,680 could participate.

In its request to expand eligibility, the state said it would enact a six-month waiting period. Currently, the state has none.

The one-year wait is ``simply unconscionable,'' Bachrach said. ``New York could not agree to that.''

Many of the state Medicaid directors who participated in a conference call Wednesday to discuss the guidelines were upset.

``Not having any coverage for a year flies in the face of the health care reform efforts the states have been undertaking,'' said Martha Roherty, director of the National Association of State Medicaid Directors.

The one-year minimum applies to states that extend program coverage to more moderate-income families - specifically, to families whose income exceeds 250 percent of the federal poverty level, or $43,925 for a family of three.

It is estimated that 18 states and the District of Columbia are in that category or have plans to expand coverage to at least that level.

Dennis Smith, who oversees the Medicaid program at the Centers for Medicare and Medicaid Services, spelled out in a letter last week several new requirements the administration planned for those particular states. The new requirements were first reported by The Associated Press.

Smith said states that use the children's insurance program to cover families above 250 percent of the poverty level must make some assurances to prevent the substituting of public insurance for private plans.

The program subsidizes the cost of health insurance for families whose incomes are too high to qualify for Medicaid but too low to afford private insurance. Both the Senate and the House passed bills this summer that would increase substantially the spending on the program. Bush has promised to a vet if they reach his desk in their current form.

Several states have lowered their waiting period since the program began a decade ago. Georgia and Florida are the only states to increase theirs. Both states require children to be uninsured for six months before they can enroll.

Connecticut dropped its waiting period from six months to two months. New Jersey has dropped its waiting period twice - it now is three months - and allows for exceptions.

``We think it's very bad public policy to prohibit children from coming onto our program,'' said Ann C. Kohler, deputy commissioner of the New Jersey Department of Human Services. ``There's absolutely no evidence that people are dropping their private coverage to go on SCHIP.''

The Congressional Budget Office said this year the program does result in some substitution of private insurance for public insurance. For every 100 children who enroll, there is a corresponding reduction in private coverage of between 25 and 50 children.

Other states that would be affected by the new guidelines include Maryland and Massachusetts, which have six-month waiting periods. In Minnesota and the state of Washington, children have to be uninsured for four months before they can participate. Vermont has a one-month wait. Rhode Island has none.

Vermont Gov. James Douglas, a Republican, was highly critical of the guidelines.

``I am disappointed and dismayed by the Bush Administration's recent actions regarding SCHIP and by the shortsightedness that seems to continually emanate from Washington,'' said Douglas.

A Heartless "Philosophy"

At CommonDreams.org, Robert Weissman writes:

After six-and-a-half miserable years, it is hard to tally up the worst abuses of the Bush administration.Narrow the field, and focus only on abuses related to the economy. That’s the universe of all the favors that the Bush-Cheney cabal has done for Big Business, so it is still a very competitive contest.

A case can be made that the administration’s effort to block expansion of the State Child Health Insurance Program (SCHIP) should top the list.

SCHIP is a complement to Medicaid, and provides health insurance to uninsured children from low-income families, typically those making up to 200 percent of the poverty line ($34,000). It has had enormous success in its 10 years of existence. Four million children receive health insurance through SCHIP. It has reduced the number of children in families at or slightly above the poverty line who are uninsured by about a quarter.

This has very real and concrete meaning. As the Center for Budget and Policy Priorities has shown, children with insurance get more preventative care, get better treatment for chronic conditions like asthma, have far fewer unmet medical needs, and get better dental treatment.

SCHIP is now up for reauthorization. Because of medical inflation, the program needs more money to provide insurance to the same number of kids. Because the program has been a clear winner, members of Congress from both parties want to provide this needed funding, and to expand the program further.

But President Bush says no.

He has a “philosophical” objection to expanding SCHIP.

“I believe government cannot provide affordable health care,” Bush said at a media event last week. “I believe it would cause the quality of care to diminish. I believe there would be lines and rationing over time. If Congress continues to insist upon expanding health care through the SCHIP program — which, by the way, would entail a huge tax increase for the American people — I’ll veto the bill.”

Here’s what is most remarkable about this philosophical objection from the White House: It isn’t shared by the for-profit insurance industry.

Last week, the Senate Finance Committee, by a 17-4 vote, approved a reauthorization of SCHIP that would enable the program to cover an additional 4 million children without insurance. Most of these children — 85 percent — would already be eligible under existing standards, but would not be covered for lack of funds. The Senate proposal is funded by a 61-cent-a-pack cigarette tax increase, which would have health benefits of its own: deterring almost two million children from taking up smoking, encouraging more than a million adult smokers to quit.

America’s Health Insurance Plans (AHIP), the trade association for the health insurance industry, “supports the Senate package,” says Mohit Ghose, AHIP Vice President of Public Affairs.

“Kids coverage come first” in the effort to get all Americans covered, he says.

Isn’t it strange that the administration is trying to protect the industry, but your position is supportive of the Senate approach?

It’s about a “philosophical point,” not protecting the industry, says Ghose.

“I defer to the White House on what is government-run healthcare.”

The Bush administration’s position is that an expansion of SCHIP will mean that some covered children otherwise would have received private insurance, and that the government program will therefore “crowd out” private insurance.

It is true that, under the Senate program, about a third of kids newly covered would otherwise have had private insurance. But as the Center for Budget and Policy Priorities emphasizes, this is unavoidable (if you are in fact trying to avoid it): the patchwork nature of U.S. private health insurance makes it impossible to cover any group outside of the very poorest and not also provide coverage to some who would otherwise have some private insurance. Moreover, says the group’s Matthew Broaddus, any parent switching their child from private insurance to a public program is doing so either because they have to pay too much out-of-pocket, or because they think they can get better care from the public program.

Where the private insurance industry does line up with the administration is in opposing a bolder plan moving forward in the House of Representatives. The House plan would cover more uninsured children, which does start to worry AHIP, and it would pay for the expansion both with a cigarette tax and by collecting excess payments to private insurers in the misnamed Medicare Advantage program. Medicare Advantage lets seniors opt for a private insurance plan in lieu of traditional Medicare. These private plans are collecting at least 12 percent more per covered person than it costs to treat a person under Medicare. The industry is adamantly opposed to efforts to stop these overpayments.

As against expanding SCHIP, the administration proposes a preposterous tax credit to help pay for individual insurance coverage. Because individual insurance coverage is both the least efficient component of the health insurance market and the one most rife with abuse, it is a certainty that the administration plan would be a failure.

One benefit of having already suffered through the long reign of President Bush is that he no longer commands the authority he once did. The vast majority of people in the United States oppose his position and — in a change — a strong majority in Congress oppose him, as well.

But will Bush veto SCHIP expansion? Will enough Republicans break from the administration to override (or prevent) a veto? That depends on how loudly the public insists its elected officials choose healthcare for kids over twisted philosophies.

Take action now via the Families USA website.

Robert Weissman is co-director of Essential Action, a corporate accountability group based in Washington, D.C. that focuses especially on international issues and has been very involved in the access to medicines campaign. He is also editor of Multinational Monitor magazine. With Russell Mokhiber, he is editor of a weekly column, Focus on the Corporation.

Who Decides?

The Real, Unspeakable Reason For Out-Of-Control Health Costs & The Growing Numbers Of Uninsured in America


Fight over baby's life support divides ethicists:


In Austin, Texas, when Emilio Gonzales lies in his mother's arms, sometimes he'll make a facial expression that his mother says is a smile.

But the nurse who's standing right next to her thinks he's grimacing in pain.

Which one it is -- an expression of happiness or of suffering -- is a crucial point in an ethical debate that has pitted the mother of a dying child against a children's hospital, and medical ethicists against each other.

Emilio is 17 months old and has a rare genetic disorder that's ravaging his central nervous system. He cannot see, speak, or eat. A ventilator breathes for him in the Pediatric Intensive Care Unit at Austin Children's Hospital, where he's been since December. Without the ventilator, Emilio would die within hours.

The hospital contends that keeping Emilio alive on a ventilator is painful for the toddler and useless against his illness -- Leigh's disease, a rare degenerative disorder that has no cure.

Under Texas law, Children's has the right to withdraw life support if medical experts deem it medically inappropriate.

Emilio's mother, Catarina Gonzales, on the other hand, is fighting to keep her son on the ventilator, allowing him to die "naturally, the way God intended."

The two sides have been in and out of courts, with the next hearing scheduled for May 8.

The case, and the Texas law, have divided medical ethicists. Art Caplan, an ethicist at the University of Pennsylvania, supports the Texas law giving the hospital the right to make life or death decisions even if the family disagrees. "There are occasions when family members just don't get it right," he said. "No parent should have the right to cause suffering to a kid in a futile situation."

But Dr. Lainie Ross, a pediatrician and medical ethicist at the University of Chicago, says she thinks Emilio's mother, not the doctors, should be able to decide whether Emilio's life is worth living. "Who am I to judge what's a good quality of life?" she said. "If this were my kid, I'd have pulled the ventilator months ago, but this isn't my kid."

The law, signed in 1999 by then-Gov. George W. Bush, gives Texas hospitals the authority to stop treatment if doctors say the treatment is "inappropriate" -- even if the family wants the medical care to continue. The statute was inspired by a growing debate in medical and legal communities over when to declare medical treatment futile.

Dr. Ross says that under the law, some dozen times hospitals have pulled the plug against the family's wishes. She says more often than not, the law is used against poor families. "The law is going to be used more commonly against poor, vulnerable populations. If this family could pay for a nurse to take care of the boy at home, we wouldn't be having this conversation," she said.

Emilio is on Medicaid, which usually doesn't pay for all hospital charges. The hospital's spokesman said that he doesn't know how much it's costing the hospital to keep Emilio alive, but that cost was not a consideration in the hospital's decision.

"[Our medical treatments] are inflicting suffering," said Michael Regier, senior vice president for legal affairs and general counsel for the Seton Family of Hospitals, of which Austin Children's is a member. "We are inflicting harm on this child. And it's harm that is without a corresponding medical benefit."

"It's one thing to harm a child and know this is something I can cure," he added. "But that's not the case here." Regier says Emilio is unaware of his surroundings, and grimaces in pain. He said the ventilator tube down his throat is painful, as is a therapy in which hospital staff beat on his chest to loosen thick secretions.

But Gonzales says her son is on heavy doses of morphine and not in pain. She said her son does react to her. "I put my finger in his hand, and I'm talking to him, and he'll squeeze it," she says. "Then he'll open his eyes and look at me."

Gonzales said she'll continue to fight for treatment for her son. "I love my kid so much, I have to fight for him," she said. "That's your job -- you fight for your son or your daughter. You don't let nobody push you around or make decisions for you."