Part 1 here -
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=132x2981345Obama tries to find people, both Democrats and Republicans, who actually care about a particular issue enough to try to get the policy right, and then he works with them. This does not involve compromising on principle. It does, however, involve preferring getting legislation passed to having a spectacular battle. (This is especially true when one is in the minority party, especially in this Senate: the chances that Obama's bills will actually become law increase dramatically when he has Republican co-sponsors.)
So my little data point is: while Obama has not proposed his Cosmic Plan for World Peace, he has proposed a lot of interesting legislation on important but undercovered topics. I can't remember another freshman Senator who so routinely pops up when I'm doing research on some non-sexy but important topic, and pops up because he has proposed something genuinely good. Since I think that American politics doesn't do nearly enough to reward people who take a patient, craftsmanlike attitude towards legislation, caring as much about fixing the parts that no one will notice until they go wrong as about the flashy parts, I wanted to say this.
Nonproliferation: the poster child for issues that people ought to care about, but don't. Here Obama has teamed up with Richard Lugar (R-IN). How did this happen?
Here's the Washington Monthly:
"By most accounts, Obama and Lugar's working relationship began with nukes. On the campaign trail in 2004, Obama spoke passionately about the dangers of loose nukes and the legacy of the Nunn-Lugar nonproliferation program, a framework created by a 1991 law to provide the former Soviet republics assistance in securing and deactivating nuclear weapons. Lugar took note, as “nonproliferation” is about as common a campaign sound-bite for aspiring senators as “exchange-rate policy” or “export-import bank oversight.”"
The way to a wonk's heart: campaign on securing Russian loose nukes. -- In any case, in addition to working on nuclear non-proliferation, Obama and Lugar co-sponsored legislation expanding the Nunn-Lugar framework (which basically allows the US to fund the destruction or securing of nuclear weapons in other countries) to deal with conventional arms. From an
op-ed Obama and Lugar wrote on their legislation:
"These vast numbers of unused conventional weapons, particularly shoulder-fired antiaircraft missiles that can hit civilian airliners, pose a major security risk to America and democracies everywhere. That's why we have introduced legislation to seek out and destroy surplus and unguarded stocks of conventional arms in Asia, Europe, Latin America, Africa and the Middle East.
Our bill would launch a major nonproliferation initiative by addressing the growing threat from unsecured conventional weapons and by bolstering a key line of defense against weapons of mass destruction. Modeled after the successful Nunn-Lugar program to dismantle former Soviet nuclear weapons, the Lugar-Obama bill would seek to build cooperative relationships with willing countries.
One part of our initiative would strengthen and energize the U.S. program against unsecured lightweight antiaircraft missiles and other conventional weapons, a program that has for years been woefully underfunded. There may be as many as 750,000 missiles, known formally as man-portable air defense systems, in arsenals worldwide. The State Department estimates that more than 40 civilian aircraft have been hit by such weapons since the 1970s. Three years ago terrorists fired missiles at -- and missed -- a jetliner full of Israeli tourists taking off from Mombasa, Kenya. In 2003 a civilian cargo plane taking off from Baghdad was struck but landed safely.
Loose stocks of small arms and other weapons also help fuel civil wars in Africa and elsewhere and, as we have seen repeatedly, provide ammunition for those who attack peacekeepers and aid workers seeking to stabilize and rebuild war-torn societies. The Lugar-Obama measure would also seek to get rid of artillery shells like those used in the improvised roadside bombs that have proved so deadly to U.S. forces in Iraq.
Some foreign governments have already sought U.S. help in eliminating their stocks of lightweight antiaircraft missiles and millions of tons of excess weapons and ammunition. But low budgets and insufficient leadership have hampered destruction. Our legislation would require the administration to develop a response commensurate with the threat, consolidating scattered programs at the State Department into a single Office of Conventional Weapons Threat Reduction. It also calls for a fivefold increase in spending in this area, to $25 million -- a relatively modest sum that would offer large benefits to U.S. security.
The other part of the legislation would strengthen the ability of America's friends and allies to detect and intercept illegal shipments of weapons of mass destruction or material that could be used in a nuclear, chemical or biological weapon. Stopping weapons of mass destruction in transit is an important complement to our first line of defense, the Nunn-Lugar program, which aims to eliminate weapons of mass destruction at their source."
Dealing with unsecured stocks of shoulder-fired missiles and other kinds of conventional weapons, stocks that might fall into anyone's hands, be sold on the black market, and end up being used against our troops or our citizens, or fueling civil wars that tear countries apart -- it seems to me that this is an excellent thing to spend one's time on.
Avian flu: Obama was one of the first Senators to speak out on avian flu, back in the spring of 2005, when it was a quintessentially wonky issue, not the subject of breathless news reports. There's a list of Democratic efforts on avian flu
here; Obama shows up early and often. He has sponsored legislation, including what I think is the first
bill dedicated to pandemic flu preparedness. It's a good bill, providing not just for vaccine research and antiviral stockpiles, but for the kinds of state and local planning and preparedness that will be crucial if a pandemic occurs. (I was also very interested to note that it requires the Secretary of HHS to contract with the Institute of Medicine for a study of "the legal, ethical, and social implications of, with respect to pandemic influenza". This is actually very important, and not everyone would have thought of it.)
He has also spoken out consistently on this topic, beginning long before it was hot.
Here, for instance, is another op-ed by Obama and Lugar:
"We recommend that this administration work with Congress, public health officials, the pharmaceutical industry, foreign governments and international organizations to create a permanent framework for curtailing the spread of future infectious diseases.
Among the parts of that framework could be these:
Increasing international disease surveillance, response capacity and public education and coordination, especially in Southeast Asia.
Stockpiling enough antiviral doses to cover high-risk populations and essential workers.
Ensuring that, here at home, Health and Human Services and state governments put in place plans that address issues of surveillance, medical care, drug and vaccine distribution, communication, protection of the work force and maintenance of core public functions in case of a pandemic.
Accelerating research into avian flu vaccines and antiviral drugs.
Establishing incentives to encourage nations to report flu outbreaks quickly and fully."
This is very good policy, especially the parts about increasing surveillance and response capacity here and abroad. (
Effect Measure approves too.)
Regulating Genetic Testing: It was while I was reading about this issue that I first thought: gosh, Barack Obama seems to turn up whenever I am reading about some insanely wonky yet important issue. And this one is not just off the radar; it and the radar are in different universes. Anyways:
You might be surprised to learn that there is very little quality control over genetic testing. I was. If I offer some genetic test, I can basically say what I like about what it will reveal, so long as I avoid violating the laws against fraud. And if you think about how easy it would be to avoid those laws just by talking about, say, a test for some gene that has been found to be slightly associated with increased IQ, you can see how many deceptive (but not legally fraudulent) claims this allows.
Moreover -- and more seriously -- there is very little oversight of the quality of labs that do tests -- that is, whether or not they tend to get the right answers when they do those tests. There is a law (passed in response to evidence that significant numbers of people were getting incorrect results on pap smears) that requires what's called proficiency testing for labs. But though the law requires that the government develop special proficiency tests for labs that do work requiring special kinds of knowledge, and though genetic testing plainly fits that bill, the government has not developed any proficiency tests for genetic testing labs.
This is serious, and bad. Suppose you are mistakenly informed that you are a carrier for some horrible disease: you might decide never to have kids. Suppose you have a fetus tested and you are told that it has, say, Downs' syndrome: you might abort. To do these things as the result of a lab error would be horrible.
Not nearly as horrible as the results of some false negatives, though. Consider this case (from a very good
report on the topic):
"A Florida couple both tested negative for the genetic mutation that causes Tay-Sachs, a fatal childhood disease. Two copies of the mutation are required to cause the disease. The couple learned that the test results were incorrect for both parents when their son began exhibiting symptoms of Tay-Sachs shortly after birth. He died eight years later"
Tay-Sachs is an unbelievably horrible disease:
"Infants with Tay-Sachs disease appear to develop normally for the first few months of life. Then, as nerve cells become distended with fatty material, a relentless deterioration of mental and physical abilities occurs. The child becomes blind, deaf, and unable to swallow. Muscles begin to atrophy and paralysis sets in. Other neurological symptoms include dementia, seizures, and an increased startle reflex to noise. (...)
Even with the best of care, children with Tay-Sachs disease usually die by age 4, from recurring infection."
So imagine this: you know that you and your spouse are at risk for carrying this disease. You both get tested; neither is a carrier. You give birth to an apparently healthy child. But after a few months, the child you love stops developing normally, and it turns out that both your test and your spouses were misinterpreted, or screwed up, or whatever, and as a result your child is going to die a horrible death by the age of four. Oops!
In your copious free time, you can think of more cases in which screwing up a genetic test would be disastrous. After you get through with the cases involving children and inherited diseases, consider the effects of misreading a genetic test and informing a man that he is not the father of his child when in fact he is. The possibilities are endless.
You can probably guess who has introduced
legislation that addresses this problem. The people who wrote the initial report (note: I know them; they're very good)
think it's good. So do I.
Reducing medical malpractice suits the right way: Contrary to popular belief, medical malpractice claims
do not do much to drive up
health care costs. Still, medical malpractice litigation is a problem. Tort reform would address this problem at the expense of people who have been the victims of real, serious medical malpractice, who would lose their right to sue, or have it curtailed. If you read the medical literature, however, it turns out that there's a much better way to minimize malpractice suits, namely: apologizing. Strange to say, it turns out that people are a lot less likely to sue when doctors and hospitals admit their mistakes up front, compensate the patients involved fairly, and generally treat people with respect. It certainly would have helped in
this case:
"A Sanford mother says she will never be able to hold her newborn because an Orlando hospital performed a life-altering surgery and, she claims, the hospital refuses to explain why they left her as a multiple amputee.
The woman filed a complaint against Orlando Regional Healthcare Systems, she said, because they won't tell her exactly what happened. The hospital maintains the woman wants to know information that would violate other patients' rights."
I'd want to know what happened too, if someone cut off all my arms and legs. And in a case like this, if it was malpractice, limiting the damages a person can collect doesn't seem like the right answer, somehow.
Barack Obama and Hillary Clinton teamed up to introduce legislation aimed at helping hospitals to develop programs for disclosure of medical errors. (They describe it in this
NEJM article.) Again, I think it's good policy: this really is what the evidence suggests is the best way to reduce malpractice claims, and it does it without curtailing the rights of people who have already been injured through no fault of their own. Moreover, when people feel free to discuss their errors, they are much more likely to figure out ways to avoid repeating them. (The legislation provides support for this.) And that's the best way of all to deal with malpractice claims: by addressing the causes of medical malpractice itself.
***
Those are some of the wonkier things he's done. (There are others: introducing
legislation to make it illegal for tax preparers to sell personal information, for instance, and legislation on
chemical plant security and
lead paint.) He has done other things that are more high-profile, including:
* His
"health care for hybrids" bill
* An
Energy Security Bill* Various
bills on relief for Hurricane Katrina, including
aid for kids and a
ban on no-bid contracts by FEMA
* A public
database of all federal spending and contracts
* Trying to
raise CAFE standards*
Veterans' health care* Making certain kinds of voter intimidation
illegal* A
lobbying reform bill (with Tom Coburn), which would do all sorts of good things, notably including one of my perennial favorites, requiring that bills be made available to members of Congress at least 72 hours before they have to vote on them.
* And a
proposal to revamp ethics oversight, replacing the present ethics Committee with a bipartisan commission of retired judges and members of Congress, and allowing any citizen to report ethics violations. This would have fixed one of the huge problems with the present system, namely: that the members have to police themselves.
But it's the wonky legislation that I love. That and the fact that, for a freshman Senator in the minority party, he has a decent record of getting his proposals enacted.
As I said earlier, I am not interested in getting on anyone's bandwagon at the moment, and I wish he'd spoken up earlier about the torture bill. (Though the speech he gave on the Senate floor was excellent.). But I read one too many pieces about his lack of a track record, and I thought: clearly, the people who are writing these haven't had the same "there he is again!" experience that I have had while researching arcana. So I thought: I should say so.
http://obsidianwings.blogs.com/obsidian_wings/2006/10/barack_obama.html
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