So we are now finding out the answers to some of our questions about which members of Congress actually represent We, the People…and which ones represent, Them, the Corporate Masters.

We have seen a Democratic Senator propose a policy that would put people in jail for not buying health insurance and a Democratic President who has taken numerous public beatings from those on the left side of the fence for his inability to ram something through a group of people…and yes, folks, the entendre was intentional.

But most of all, we’ve been asking ourselves: “why would Democratic Members of Congress who will eventually want us to vote for them vote against something that nearly all voting Democrats are inclined to vote for?”

Today’s conversation attempts to answer that question by looking at exactly how money and influence flow through a key politician, Montana’s Senator Max Baucus—and in doing so, we examine some ugly political realities that have to be resolved before we can hope to convince certain Members of Congress to vote for what their constituents actually want when it really counts.

“The idea of covering even the early stages of the cynical and increasingly retrograde campaign has already plunged me into a condition bordering on terminal despair, and if I thought I might have to stay with these people all the way to November I would change my name and seek work as a professional alligator poacher in the swamps around Lake Okeechobee.”

–Hunter S. Thompson, “Jimmy Carter and the Great Leap of Faith”

Now any normal person trying to analyze last year’s election would have said something like “the fact that Obama was promoting a new type of politics—and that a large majority of the public liked what they were seeing—should have meant that politicians would finally do what the public wanted”…and if you’re as cynical as I am, you might have thought that the fact that Obama is the most successful fundraiser in the history of politics would have made other candidates figure that supporting Obama, politically, would be the easy way to put more cheddar in their own pockets.

But here’s the thing: Senator Baucus has been in Washington, in the same job, since 1978, which is about three years short of half of his entire life (and he spent those three years in the House), and unless he wakes up dead one morning or Montana secedes from the Union he’s pretty much guaranteed to be there until at least January 2015.

In those three decades he’s been able to create, and then “outsource”, his own independent fundraising operation—and he’s been so good at doing this that he can donate money from his own Political Action Committee (Glacier PAC) to other Democrats, which is the Congressional version of acquiring really cool “Magic: The Gathering” cards now in an effort to both control votes today and become a more powerful player later on.

He did it by cultivating people in his own office who later went on to become lobbyists. At least 24 of ‘em. Since Baucus now runs the Senate Finance Committee and every bill in the Senate that needs money has to pass through his Committee for approval, all those hard working lobbyists now lobby…wait for it…their former boss.

This creates a fundraising “virtuous circle”: “Baucus-affiliated” lobbyists sell access to Baucus…and part of the price of that access is donating to Baucus…which, since “the fix is in”, creates legislative successes that lead to more people wanting more access for bigger favors…which makes the prices all go up, creating more power and influence for Baucus and his orbiting constellation of homegrown lobbyists.

And now that the enterprise has reached the point where the entourage has gone on to have their own entourages, Obama’s vision of “change you can believe in” is sounding more like a promise to screw up a perfectly good hustle than it is a way to run a country.

So how does all this influence the healthcare debate?

At the moment, Baucus could literally coach a basketball team of former staff members who now lobby Baucus on behalf of health care clients:

–David Castagnetti of Mehlman Vogel Castagnetti, Inc. is the vertically integrated busy beaver of the group, representing drug powerhouses Abbot, AstraZeneca, and Biogen, device manufacturers like GE Medical, service providers like Humana and the American Clinical Lab Association, and AHIP, the trade association of health insurers, among others.

–Jeff Forbes, who is currently self-employed, is representing drug maker Roche Group, Manor Care (who provides long-term care services in nursing homes and other environments), and the Advanced Medical Technology Association (AdvaMed), a group which includes many of the big players in the medical business.

–Roger Blauwet (he of DC’s Canfield and Associates), is representing Wyeth and Pfizer (two more major drug manufacturers), the Association of Financial Guaranty Insurers, who are the “reinsurers” who help carry risk for other insurers (in return for a piece of the action), and the Rx Benefits Coalition, which reports that it represents companies that support “market solutions” to make prescription drugs available.

Some clients feel that their needs require more than one “Baucus alumnus” on the payroll, which is why Scott Olsen and Jeff Forbes are working for biotech giant Amgen (along with about 150 other lobbyists), David Castagnetti and Angela Hofmann are slogging it out for Wal-Mart, and Roger Blauwet and Castagnetti are both hoofing it for the Pharmaceutical Research and Manufacturers of America (PhRMA), who is, literally, the “Big PhRMA” that everyone talks about.

Drug manufacturer Merck hired three of the anointed: Forbes, Blauwet and Castagnetti.

All of this effort is working—and working well. According to OpenSecrets.org, somewhere in the range of $4.5 million has been donated to Baucus during his career by insurance and healthcare interests.

It isn’t just health care, either. Because somewhere around two dozen former Baucus staffers turned lobbyists are “home on the Washington range”, no matter what is being debated in Congress, Baucus gets paid (two quick examples of his Committee’s jurisdiction: changes in tax policy and financial industry regulation—or the lack of it).

In truth, “Baucus gets paid” is probably a bit too cynical.

What I really should say is that Baucus has been exceptionally successful in listening to all points of view when considering ways to make the lives of every American all they can be, that the people who get listened to are exceptionally grateful for this attention, that millions and millions of dollars worth of gratitude have been funneled to Baucus over the years because he’s such a good listener, and that, from now until at least 2015, if you need a Senator to support “status quo you can believe in” you might want to try launching a great big brick of cheddar into the Senator’s constellation.

So the next time someone asks you how “change you can believe in” could have possibly morphed into “buy insurance or we’ll put you in jail”…well, now you know—and given the choice, wouldn’t you rather watch someone make sausage?

We are going to be talking a lot about swine flu over the next few weeks.

The conversation about the politics of the thing is already well underway, engulfing those who sought to remove funding for infectious disease control out of the “stimulus” bill.

We are lacking, however, an examination of the science of the thing, and that’s the point of today’s conversation.

How dangerous is this infection?
Why is it killing people in Mexico but not here?
Exactly what is a pandemic?
Do those facemasks really serve any purpose?
And what about closing the border?

They’re all good questions; and they are all questions we’ll try to answer today.

“I’ve always been a hypochondriac.
As a little boy, I’d eat my M & M’s one by one with a glass of water.”

–Richard Lewis

Why don’t we define a pandemic first, then move on to the “what we knows”?

A pandemic is a global event characterized by the emergence of a new virus that readily spreads from human to human. When humans are exposed to new viruses, the lack of previously developed antibodies means we lack biological defenses, making new viruses the most dangerous to human health.

(Vaccines are designed to safely expose humans to diseases. The body makes antibodies based on that exposure, making it better prepared for the next exposure.)

So here’s what we know: a swine flu outbreak that seems to have begun in Mexico has claimed more than 150 lives and sent more than 2000 to the hospital in that country as of Tuesday morning.

As of Wednesday, there are 91 laboratory-confirmed cases of swine flu in the United States, with 81 of them occurring in New York, California, and Texas. There has been one confirmed death in the US as of Wednesday, a child who had come to the US from Mexico to be treated for this infection.

In an ordinary year, the CDC reports, about 36,000 people die from influenza in the United States (during the 1990s, the number varied from 17,000 to 52,000).

There are a smaller number of infected individuals in numerous other countries.

The World Health Organization had, early this week, declared a Phase 4 alert, meaning that we have:

“…verified human-to-human transmission of an animal or human-animal influenza…virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic…Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.”

As of Wednesday that has been raised to a Phase 5 alert, which:

“…is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.”

We also have suspicions about a number of things.

We suspect that a pig farm near La Gloria, Mexico was the source of the outbreak.

We suspect (with very high confidence) that the number of confirmed infections will grow substantially as labs are able to complete the testing that changes probable and suspected cases to confirmed ones.

We suspect there will be additional deaths in the United States from this infection beyond the one that has already been confirmed.

Because at least 45 of the confirmed cases in the US are associated with a group of spring breakers just back from Cancún, we are suspicious that they might be the group responsible for introducing the virus into the country….however…the CDC reports that cases were first seen in San Antonio, Texas, and in Southern California in late March and early April.

Because the health authorities in Mexico might not have been tracking minor infections, it is suspected that the very high death rate currently associated with this infection in that country is overstated.

There is, as you might imagine, an entire list of things we cannot as yet explain.

The question of why young and presumably healthy Mexicans are dying at an alarming rate while citizens of other countries are not is first on that list. There are several possible explanations besides the potential statistical problems we note above, and one of those is the question of air quality in Mexico City.

The amazing level of air pollution in Mexico’s capitol city has created a childhood asthma problem of such long standing that it has now also become an adult asthma problem. It is known that people with compromised respiratory systems are predisposed to become victims of opportunistic respiratory infections, lending credence to this supposition.

It is possible that nutritionally compromised individuals in Mexico are becoming targets for more severe infections than individuals in the US who are getting sick but have more robust overall health due to better nutrition.

There is confusion due to an inability to accurately track the infection in Mexico. It is possible that new infections are still occurring, that the virus is in regression, that it is has mutated in new ways, or that another, as yet unidentified virus is now circulating; but due to a lack of reliable information it is impossible to tell which, if any, of these events are actually taking place.

The US public health authorities seem to be better able to respond to this health event than Mexican authorities have been. For example, there are reports, confirmed by Mexican Health Secretary Jose Angel Cordoba, that people who had close contact with individuals who have died from swine flu have not had access to medical or epidemiological follow-up…or access to antiviral drugs.

There have been questions as to whether border screening should be intensified to prevent infected persons entering from Mexico. In testimony before Congress Tuesday it was pointed out to Senator Kay Bailey Hutchison that infected persons might not show any symptoms while crossing the border, rendering such screening techniques as temperature monitoring ineffective.

Now let’s talk about this virus.

Dr. Anthony Fauci, in the same hearing room, gave us a lot to worry about. He points out that this is an almost unique virus, in that it has, within its structure, genes from bird, pig, and human influenza viruses (the process of these genes combining themselves in new ways is called “reassortment”); and seeing a “triple reassortment” is highly unusual.

The H1N1 virus that is the basis of this new virus is inherently capable of human-to-human transmission, he tells us, which is particularly problematic.

We will talk about what drugs might be effective in a moment…but first, a word or two on uncertainty.

There is no way to know if the virus we are dealing with today will mutate into new forms, nor can we predict if the virus will become relatively more dangerous if and when new populations are exposed. (It is also possible that the virus might mutate into a less harmful form).

We have no way to predict whether this virus will return, even stronger, in the fall, which would not be uncommon.

We cannot predict what other influenza viruses might appear, or if the two other currently circulating “seasonal” viruses might mutate in ways that cause greater concern.

We cannot predict the potential for further reassortment caused by the current seasonal flu viruses that had been circulating before the emergence of swine flu interacting with this new virus.

We cannot predict where the virus (and its antecedents) will crop up.

We cannot say for certain that the virus will not develop resistance to currently effective antiviral drugs.

These are problems associated with influenza management every flu season, and they are not particular to this virus.

“Excessive calm…may be a symptom of swine flu.”

–Stephen Colbert

Because things can change on literally a day-by-day basis, some of our comments on drugs will be correct as of today, but not necessarily correct in the future.

There are four antiviral drugs available, and two of them are rather ineffective in dealing with certain strains of influenza due to the fact that those strains have developed resistance to those drugs.

That leaves two useful drugs, Tamiflu and Relenza.

When deciding what drug to prescribe for someone who shows up at the doctor’s office, the doctor needs to have an idea what kind of flu you have. If you show up with swine flu, today, a doctor might be inclined to offer you Tamiflu…but if you showed up with an infection caused by the “seasonal” Type A H1N1 virus from 2007-2008, Tamiflu would be the wrong choice, as that virus is resistant to Tamiflu.

Why not just dose the entire US population with Tamiflu or Relenza right now, you might ask?

It’s partly a question of side effects and the damage they can cause, multiplied by 300,000,000 patients.

In the case of Relenza, there are significant side effects for those with respiratory diseases, and the drug is not normally recommended for those patients. The FDA recommends that patients who do use this drug have ready access to a fast-acting inhaled bronchodilator at the time it is administered. Some patients have experienced “transient neuropsychiatric events” (specifically self-injury or delirium) after using the drug.

Roughly 10% of Tamiflu users experience vomiting, and there are also patient reports of transient neuropsychiatric events with this drug (“confusion, paranoia, anxiety attack, nightmares” were among the listed symptoms). The use of this drug by children under one year of age is not normally advised, but on Wednesday an Emergency Use Authorization was issued for such use.

It’s also, to some extent, a question of uncertainty about this flu: will this virus turn out to be less harmful than the impact of those side effects? Will it, in other words, “just fade away”?

Beyond that, to try to prevent these viruses from developing resistance, we need to use these drugs as sparingly as possible; with that in mind, if we can avoid mass administration of these drugs it would be to our advantage.

The preferred approach would be to vaccinate…and it is hoped that by this fall a vaccine will be available…and it is hoped that the virus that is in circulation this fall will be roughly the same virus that was “designed into” the vaccine between now and summer.

Now a quick word on facemasks and respirators:

The CDC recommends facemasks for those in crowded settings…but they strongly suggest limiting the time in which you are in those settings more than they do the use of facemasks. They also strongly emphasize handwashing, covering your mouth when you cough, and washing hands after shaking hands.

It is also noted that airborne droplets can get around the edges of facemasks, rendering them fairly ineffective.

Respirators, on the other hand, can be effective, and are currently recommended for people who cannot avoid contact with infected persons. The “all-day” use of these respirators, however, is a challenge simply because of the increased effort involved in breathing while wearing such a device.

An artist asked the gallery owner if there had been any interest in his paintings on display at that time.

“I have good news and bad news” the owner replied. “The good news is that a gentleman inquired about your work and wondered if it would appreciate in value after your death. When I told him it would, he bought all 15 of your paintings.”

“That’s wonderful!” the artist exclaimed. “What’s the bad news?”

“The man was your doctor.”

–From Doctor Jokes at “Resources for Attorneys”

So what good news, if any, is there to tell?

As of right now we have no reason to believe that this flu is more likely to cause fatalities than the seasonal influenzas that we would normally see. (Keep in mind, however, that this could quickly change.)

If the pattern we have seen so far were to continue (and there is no particular reason to say it will or it won’t) we could end up with a virus that is widely transmitted but no more dangerous than what we are used to seeing in normal years.

Ironically, the virus’ wide dissemination would itself be good news; as it would expose more of us to this new virus, enabling us to develop antibodies to the infection even before a vaccine is developed for the fall.

We have covered a lot of ground today, so let’s wrap it up:

An influenza caused by a nearly unique virus is moving through the population of Mexico, that infection has spread to several other countries, and so far the number of fatalities worldwide has not exceeded 200. (We expect more than 35,000 deaths annually from influenza in the United States, by way of comparison.)

Because it is a virus to which humans have not been previously exposed, there is heightened concern among The Experts.

There is no reason, at this moment, to believe this influenza will be more lethal than the seasonal influenzas currently circulating among the US population.

This flu can currently be controlled by administration of either of two readily available antivirals. (By the way, don’t forget all that handwashing, covering your mouth when you cough…and handwashing….is pretty helpful as well.)

This type of virus (H1N1) is generically known for its ability to transmit readily from person to person, and not for its inherent lethality. (It is not yet certain, however, if this specific virus will follow that pattern.)

It is possible that a useful vaccine will be available for fall—and it is also possible that this virus will have morphed into a form that will be resistant to the newly developed vaccine.

Closing the borders isn’t logical, facemasks don’t really work, respirators do, but they’re not the sort of “all-day” accessory that a lot of us will enjoy…and avoiding crowded places is what the CDC today feels will work best.

There are a host of unknowns that could change all of this, and there are no predictive tools that can reliably give us reasons to be either sanguine…or scared to death.

All of this can and will change rapidly—sometimes on a day-to-day basis. In the time I spent putting all this together, the WHO raised the alert to Phase 4, then Phase 5, the number of US cases doubled, and the CDC has changed their recommendations for antiviral drug administration twice.

Put it all together, and at the moment things are nowhere near as bad as they could be, with a whole lot of uncertainty ahead.

Warning—commercial message ahead: I’m competing for a Netroots Nation scholarship, and I could use your support. Just head on over to the Democracy for America website, click on the “Add your support” link under “Grassroots Supporters”, and offer a word or two…and with that, thanks very much, and we return you to your regular programming.

OK, America, so I pulled a tiny prank tonight—and it was so classic that I have to tell you all about it.

It involves freedom of speech, a friendly message to one of those crazy Republicans we all know—and it forced that crazy Republican to get up at three in the morning because he could not handle the threat to his world view.

Wanna hear all about it?

Then come along and follow the story…because it’s worth it.

So here’s the deal: we have a neighbor who just has not been able to let go of the fact that McCain lost. If you drive past his one-home gated community, there on the giant steel gate is his giant McCain/Palin banner, flying proud…even to this day.

Well, driving past it every day started to give me an idea…

What if I made a banner of my own, and put it up across from his gate, so that the first thing he would see on Inauguration Day would be my special message?

Nothing mean…just something funny.

So I went out the other day, bought me a giant piece of posterboard and a big marker, and put the classic message “Na-Na-Na-Na…Na-Na-Na-Na…Hey-Hey-Hey…Good Bye!” in red letters big enough for all to see.

And tonight, at about 3AM…I put it up.

I had to drive a little way down from his property to pull over—and clad in my camouflage jacket, I surreptitiously crept up to the property across the street, which is a piece of uncleared forest.

My goal: the telephone pole just immediately across from the heavy metal security gate…and its giant banner.

There was almost no wind…and it was quiet.
Too quiet.

After about 50 feet of walking, I could hear the dogs beginning to stir.
Two, maybe three, starting to bark.

Only 25 feet to go now, and I could see my target, the telephone pole, approaching fast.

The dogs were starting to go nuts, but it’s likely the owners have to endure that several times a night as other people walk by, so I wasn’t too concerned.

So now I’ve made it to the pole—and just to show how polite I am about this kind of thing, I actually tied the sign to the pole with a string, so as not to damage the pole.

Then I set it down, facing his gate, and walked the 75 feet or so back to my car, hopped in, and drove away.

Mission Accomplished.

Two minutes later I’m back home, and The Girlfriend says: “let’s go back and see the sign”.

Chuckling, we hopped in the car for the two minute ride back.

Much to our surprise…it was gone!

Apparently the owners have been sitting up, awaiting The Apocalypse all night, and now they’re sitting around the living room looking at my sign and spitting and fuming at the desecration of…well, as it turns out, the only thing desecrated was their minds, I guess.

After all, the poster was not on their property—in fact, no one even crossed over onto their side of the street during the entire event. And nothing was damaged in any way…and the sign didn’t even desecrate Our Dear Sarah Palin.

(By the way, if you’re married and obsessed with Sarah Palin…how awkward do you think that must be?)

And apparently after spending the entire night waiting for the attack on his sign that never came…he’s now imported the infected sign…the Liberal Trojan Horse, if you will…onto his compound—right into the gated community of one home…where it is even now probably fueling his delusions of disaster.

So I guess I did what I set out to do. I sent a friendly message, it obviously affected the poor souls hiding behind the giant security gate…and even now, I suspect the thing they just can’t get out of their minds is that Barack Obama is going to be inaugurated, whether they like it or not, and all the denial and fear and paranoia in the world isn’t going to make the reality of it go away.

All in all…a pretty good start to a most excellent day.