Brain Injury Association of America Policy Corner E-Newsletter – October 3, 2008

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Posted on 5th October 2008 by Gordon Johnson in Uncategorized

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A weekly update on federal policy activity related to traumatic brain injury
__________________________________________________________________

Dear Advocates:

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This legislation was sent in an expedited fashion this afternoon to President Bush who signed the measure into law hours after its passage.

As the previous edition of Policy Corner noted, several important legislative developments occurred last week, and this week’s edition of Policy Corner includes additional details about these developments as they pertain to brain injury policy.

It remains unclear whether Congress will return for a lame duck session in November after the elections, although at least a short session appears likely for the Senate the week of November 17. BIAA will provide an update on the remainder of this year’s congressional schedule as soon as this information available.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/
__________________________________________________________________

Congress Passes Financial Bailout Legislation, Mental Health Parity

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This marks a tremendous victory for mental health advocates and others who have supported efforts to enact a parity bill for years. This legislation will require private health insurers to offer mental health and addiction benefits equal in cost and scope to traditional medical benefits.

Earlier this year, BIAA strongly endorsed the House version of this legislation. In a letter officially endorsing the bill in March, BIAA noted, “An intricate and intertwined relationship exists between substance abuse, mental health, and traumatic brain injury (TBI). Substance use and abuse is often both an antecedent to and a consequence of TBI.”

Upon its passage this afternoon, one of the bill’s sponsors and leading champions, Congressman Patrick J. Kennedy (D-RI), stated:

“This legislation is one more step in the long civil rights struggle to ensure that all Americans have the opportunity to reach their potential. For far too long, health insurance companies have used the stigma of mental illness and substance abuse as an excuse to deny coverage for those biological disorders. That ends today when this critical legislation outlaws the discrimination that is embedded in our laws and our policies.”

Other bill sponsors and leading supporters include Rep. Jim Ramstad (R-MN) in the House of Representatives, as well as Sen. Pete Domenici (R-NM) and Sen. Edward Kennedy (D-MA) in the Senate. Late Senator Paul Wellstone (D-Minn.) was also a leading champion of this legislation.

Appropriations Update

Last week, the House passed an omnibus continuing appropriations bill to fund most government programs – including TBI and trauma-related programs – at Fiscal 2008 (last year’s) levels until March 6, 2009.

Over the weekend, the Senate also passed this omnibus legislative package and forwarded it to President Bush, who signed it into law just hours before the beginning of the new fiscal year on October 1.

This massive year-end spending package includes a Continuing Resolution (CR) which funds programs covered by nine unfinished appropriations bills (including the Fiscal 2009 Labor-HHS-Education Appropriations bill, which contains funding for key federal TBI programs) at Fiscal 2008 levels until enactment of the bills or March 6, 2009 – whichever comes first. This essentially leaves final funding decisions on domestic programs to the next Congress and president.

Within this CR, all civilian health programs, including TBI and trauma-related programs, are funded at Fiscal 2008 levels. These Fiscal 2008 levels, and thus continuing funding levels through the beginning of next year, are as follows:

CDC TBI Programs (HHS): $5.709 million

HRSA TBI Programs (HHS) (HRSA TBI State Grant Program and Protection and Advocacy Systems): $8.754 million

TBI Model Systems of Care (NIDRR/Department of Education): $8.155 million

In addition to the CR to provide continuing appropriations for most federal programs, the omnibus bill also includes three Fiscal 2009 appropriations bills in their entirety. These three appropriations bills are those that fund Defense, Homeland Security and Military Construction-VA for all of FY 2009.

The Defense appropriations measure included in this legislative package contains $300 million in funding for Traumatic Brain Injury and Psychological Health initiatives within the Department of Defense.

The Military Construction-VA appropriations measure includes $41 billion in funding for the Veterans Health Administration (veterans medical care), representing $1.8 billion above the President’s budget request earlier this year and $4.1 billion above 2008 levels. This funding bill also provides $510 million in funding for Medical and Prosthetic Research, including cutting edge research into areas such as Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury, suicide prevention, and polytrauma. This funding level for research represents $30 million above 2008 levels, and rejects a $38 million cut proposed by President Bush.

The Military Construction-VA appropriations bill contained in this omnibus legislative package also included important report language (strongly supported by BIAA) urging the Department of Veterans Affairs to increase returning servicemembers’ access to TBI care and expertise in the civilian sector. Specifically, the Explanatory Statement accompanying this bill states:

“The Appropriations Committees strongly urge the Department to establish and expand cooperative agreements with public and private entities with neurobehavioral rehabilitation and recovery experience in the treatment of Traumatic Brain Injury (TBI) as recommended in section 1703 of Public Law 110-181” [FY 2008 National Defense Authorization Act].”

In addition, the bill provides $200 million for fee-based services intended to allow the VA to tap expertise in the public and private sector for health care that may not be readily available within VA medical centers.

Congress Authorizes VA Epilepsy Centers of Excellence

Last week, the House passed an omnibus veterans health care package (S. 2612), including key provisions of The Epilepsy Centers of Excellence Act (H.R. 2818/S. 2004), which BIAA has strongly endorsed.

Over the weekend, the Senate also passed this legislation and it is expected to be signed into law by the President imminently.

The legislation, championed by the American Academy of Neurology and endorsed by BIAA, anticipates an expected increase in the number of TBI-related epilepsy cases among veterans returning from service in Iraq and Afghanistan. The bill will create up to six Epilepsy Centers of Excellence (ECoE) at the Depart ment of Veterans’ Affairs (VA), and is aimed at restoring the VA as a national leader in epilepsy care and research.

The bill was sponsored by Rep. Ed Perlmutter (D-CO) in the House of Representatives and Sen. Patty Murray (D-WA) in the Senate.

Congress Clears FY 2009 Defense Authorization Bill For President’s Signature

Within the past few days, Congress also passed the FY 2009 defense authorization bill (S. 3001). This legislation contains a “Sense of Congress on TBI Research.” Specifically, the bill states in Sec. 725:

“It is the sense of Congress that the requirement under section 1621(c)(7) of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110–181; 122 Stat. 453; 10 U.S.C. 1071note) to conduct basic science and translational research on traumatic brain injury includes pilot programs designed to test the efficacy of clinical approaches, including the use of pharmacological agents. Congress urges continued studies of the efficacy of pharmacological agents for treatment of traumatic brain injury and supports continued joint research with the National Institutes of Health in this area.”

BIAA Signs on To Coalition Letter Opposing Proposed Medicaid Outpatient Regulation

BIAA recently signed on to a coalition letter urging Congress to enact a moratorium on a regulation proposed by the Centers for Medicare and Medicaid Services (CMS) to restrict Medicaid reimbursement for outpatient services. This regulation is termed the “Medicaid Outpatient Clinic and Hospital Services Rule,” and it would reduce federal Medicaid funding to states for freestanding health clinics and hospital outpatient departments.

This regulation, published on September 28, 2007 – and expected to be finalized in November of this year – would cut Medicaid reimbursement to many types of outpatient services, including services utilized by individuals with brain injury. [72 Federal Regulation 55158 to 55166 (to be codified at 42 C.F.R. 440, 447 and sometimes referred to as CMS 2213-P).]

To prevent finalization of this rule, BIAA has joined the Consortium for Citizens with Disabilities in urging Congress to enact a moratorium delaying implementation of this harmful regulation through April 2009.
In a heartening development, this week Members of Congress introduced legislation aimed at enacting such a moratorium.

Yesterday, Sen. Charles Schumer (D-NY) and Sen. Hillary Rodham Clinton (D-NY) introduced the “Preserving Access to Healthcare” (PATH) Act of 2008, which would, among other provisions, delay the proposed Medicaid outpatient regulation by six months.

In addition, earlier this week, Rep. John McHugh (R-NY) introduced H.R. 7219, the Protecting Hospital Outpatient and Community Clinic Services Act of 2008, which would provide a moratorium on the regulation.

BIAA strongly supports these legislative efforts.

BIAA Representatives Attend Trauma Spectrum Disorders Conference

Multiple BIAA representatives attended this week a scientific conference titled, “Trauma Spectrum Disorders: The Role of Gender, Race & Other Socioeconomic Factors.”

This conference – jointly sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the Department of Veterans Affairs, and the National Institutes of Health – focused on identifying and sharing knowledge and lessons learned about gender and race as they relate to psychological health and traumatic brain injury.

Presentations made at this conference are expected to soon be made publicly available on the Defense Center of Excellence’s website: http://www.dcoe.health.mil/.

Shopping and Choice – One of Brain Injured Person’s Biggest Challenge

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Posted on 13th August 2008 by Gordon Johnson in Uncategorized

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The below AP story approaches the issue of shopping from a completely different angle, but it does highlight one of the most pervasive frontal lobe deficits that brain injured people have: the difficulty in making decisions. Almost anyone who works with brain injury survivors can tell anecdotes of the horror of the super market aisle for those with brain damage.

If given a forced choice, like on most neuropsychological exams, brain injured people can do surprisingly well. But makes those choices open-ended, or as in the story below about beverages, provide an “explosion of choices” and the brain injured person will virtually shut down. Sometimes the act is to buy nothing. Other times it is to try to buy everything.

The point in the below story that really stood out for me was the point it makes that the more choices offered, the fewer beverages are purchased. Based upon that piece of information, it may be that we all have a vulnerability to being overwhelmed by too many choices, but in the brain injured, that vulnerability becomes a disability of decision making. That disability is not just about soda pop, but about almost every choice that a person has to deal with on a daily basis. Ultimately, that disability can virtually stall a human life.


Attorney Gordon Johnson

http://subtlebraininjury.com
http://tbilaw.com
https://waiting.com
http://fishtail.tv
http://vestibulardisorder.com
http://youtube.com/profile?user=braininjuryattorney
g@gordonjohnson.com
800-992-9447
©Attorney Gordon S. Johnson, Jr. 2008


Date: 8/11/2008 2:18 PM

BC-Measure of a Nation-Distracted Republic/2190
Eds: Also moved in advance. Multimedia: This story and all past installments of the Measure of a Nation series – which includes stories, videos and animations _ are packaged in an interactive in the _national/measure_nation folder. AP Video.
Distraction 2008: Freedom of choice _ or from it?
By TED ANTHONY

EDITOR’S NOTE — This latest chapter of “The Measure of a Nation,” a yearlong series of multimedia story packages about the presidency and the 2008 election as seen through the prism of the culture, assesses the absurd amount of choices the average American has today — and how a leader might cut through the clutter and capture the nation’s attention.
By TED ANTHONY
AP National Writer

LOS ANGELES (AP) — On blistering days in Los Angeles, drive northeast on the 110, exit at Highland Park and pull into a roadside grocery called Galco’s. Then walk in and say, “I’m thirsty. Can you point me to the soda-pop aisle?”

This question may get you laughed out of the place. Because at Galco’s, the soda pop is in most every aisle. The place is a soft-drink nirvana containing 500 varieties of fizzy beverage from all corners of the planet.

Root beer? They’ve got three dozen kinds. Perhaps your palate craves a bottle of Cheerwine or a cold Inca Cola. Choose between soda sweetened with high-fructose corn syrup or cane sugar, flavored artificially or naturally, colored pink or red or green or blue or purple. And that doesn’t include the 475 varieties of beer and the 60 kinds of bottled water.

The choice is yours, if you can handle it. The store, now known as Galco’s Soda Pop Stop, is an exuberant explosion of the vaunted notion of freedom of choice, one of the ideals that supposedly makes America what it is.

It is wonderful. It is also intimidating. And in an election year, it’s something the next president needs to understand.

The two-century focus on what America’s founding fathers called “the pursuit of happiness” — coupled with the Industrial Revolution in the 19th century and the rise of consumerism in the 20th — has birthed a landscape of options as dizzying as it is liberating. Bed and Bath, it turns out, aren’t nearly enough. These days, we’re much more concerned with Beyond.

A mere generation after the three broadcast networks ruled, a Comcast digital cable package hands you up to 250 channels of programming. Today’s average supermarket sells more than 45,000 items, the average Wal-Mart Supercenter more than four times that. On a single afternoon this month, eBay had 14.9 million auctions going, and Amazon was offering listings for 22.7 million books. By the end of last year, the Web had more than 108 million distinct pages to visit from the comfort of your lap.

John Nese, who built Galco’s into a promised land of sugary beverages, has thought a lot about choice in America. He offers two assessments.

The first: “People want choices. People want the opportunity to make their own decisions.”

The second: “They come in and they look and they go, ‘We’re overwhelmed. We don’t know what to buy.'”

The notion transcends simple consumerism. It also is the dilemma facing whoever wins November’s election. With options beyond our great-grandparents’ dreams, is freedom of unlimited choice really a freedom at all?

In a universe of unprecedented static, how can an American leader lead?

___

DRIVEN TO DISTRACTION

Mermaid Treasure looks just like Blue Jewel. Waterscape and Cool Dusk could be identical twins. And try distinguishing Seven Seas and Southern Evening from 10 paces away.

At the Home Depot in Gibsonia, Pa., no less than 372 shades of blue paint are available, not counting the many blue-greens and blue-purples also offered in a section of swatches nearly as long as the distance from the pitcher’s mound to home plate.

This cross-section of American choice illuminates the multiple levels of decision-making required to negotiate today’s consumer landscape, in this case before the painting even begins:

—Which store? There are four paint dealers within a mile of the Gibsonia Home Depot and at least 13 more within a 10-mile radius.

—Which brand? There are at least five to choose from.

—Which consistency? Pick from matte, eggshell, satin, semi-gloss and gloss.

—Which color group? Basic colors like blue, red and green are mere gateways to the real color choice.

—Which shade? Time to negotiate the hundreds of names that sound like either ice-cream flavors (Lavender Ice, Cloudberry) or small coastal communities (Little Pond, Wickford Bay).

That’s more than a million ways to paint a door. And as powerful as the human brain is, its bandwidth is ultimately limited. By focusing on smaller choices, by continuously sifting through the categories and subcategories of things like color preference and Google results and spam, could it be that our multiple options are controlling rather than liberating us?

“Since Reagan, the ideology in the United States has been that choice is good and more choice is better. And to the extent that you can give people more choice in every area of life, you are improving their well-being,” says Barry Schwartz, author of “The Paradox of Choice: Why More Is Less.”

But “nobody has the time or the expertise to make informed choices about everything,” Schwartz says. “When options are presented, people have a tough time just ignoring them.”

In 2000, according to the American Psychological Association, a study found that shoppers given the choice of picking a jam from smaller and larger assortments preferred choosing from the bigger assortment. Yet they were more likely to actually buy some jam if they had fewer options. Excessive choice, in effect, short-circuited them from engaging more deeply.

Now take that notion into the public realm. If too many choices drive us to distraction, how do es that affect how we perceive government?

“It’s wonderful that we can sit down in our living room and order 20,000 things. In a superficial way, we are more informed than people used to be. But it’s hard to get our attention, and I don’t see any way of turning that around,” says Edward C. Rosenthal, author of “The Era of Choice: The Ability to Choose and Its Transformation of Contemporary Life.”

His assessment is bleak. By 1900, people’s faith in established institutions like church and government began a slow wane, and Americans struggled to find their bearings. Thus did consumer choice gradually become fetish. Today, anyone who questions unfettered choice risks being accused of condescension and, worse, ignorance of market forces.

This is the landscape an American leader faces. The option becomes, “Follow me — unless you have something more interesting going on.”

And accurately or not, today’s citizens often think that they do.

___

LEADING THROUGH STATIC

“The only way we’re going to solve our problems in this country is if all of us come together,” Barack Obama said this month. Weeks earlier, John McCain said that “we are fellow Americans, and that shared distinction means more to me than any other association.”

Unity is big in 2008. It means more voters. But can we come together? These days, beyond 9/11 or Katrina or rising gas prices, what exactly is that “shared distinction” we like to think unites us?

To inspire voters, campaigns use strategies such as microtargeting — mining data and finding voters’ preferences, then customizing the message for each. But when candidate becomes president and prospective voter becomes mere citizen, those intricate techniques melt away.

What’s a leader to do? Christine Riordan, a leadership expert at the University of Denver, prescribes simplicity.

Just as paying attention to a leader is a consumer choice, Riordan says the leader can benefit from deploying marketing principles as well: An uncluttered message rings clearer, particularly when it’s accompanied by tight focus on content, packaging and image.

Debating whether there’s too much information out there, Riordan says, is beside the point.

“There’s no way we’re going back to the times of Zachary Taylor,” she says. “”It’s not, ‘Is too much information bad?’ It’s how do you manage within an environment that does provide all information and will continue to provide all information?”

Today, candidates and leaders must tailor core messages for the 75-year-old newspaper reader and the 19-year-old who communicates using blogs and Facebook. What’s more, to have any chance of cutting through the clutter, the leader has to seem sincere and authentic to both demographics, not to mention all the Gen-Xers and Boomers in between. He or she has to be all the flavors of root beer at once.

Consider House Speaker Nancy Pelosi. Like many politicians before her, she went on “The Daily Show” last month to match wits with Jon Stewart, be made fun of and maybe make a point to a coveted audience of hyper-aware, media-savvy Americans. She didn’t tank, but she appeared painfully overeager.

To neutralize the static, she needed the kind of banter that Stewart and NBC anchorman Brian Williams had a couple of nights later. It was amiably contentious and brimming with pop-culture cues. It was also just plain fun, a key element in capturing the “Daily Show” demographic’s attention.

“With more choices out there, if leaders want to bring issues to the attention of the public, they have to bring it into our venues and speak it on our terms,” says Adam Schiffer, a political scientist at Texas Christian University who studies voter behavior and the media’s role in politics.

“Institutions are breaking down and there are going to be new ways of doing things. But the cream can still rise. The signal can still make it through the noise in this new environment,” he says. “You don’t need 90 percent of the public informed on the issue and following it closely to get your policy passed.”

Exhibit A is Al Gore, who has been practically pleading Americans to pay attention to the environment for nearly a generation. He finally succeeded.

What helped him punch through the static? He made a movie.

___

SAME DIFFERENCE?

Across the continent from Galco’s and the dizzying choices of Los Angeles, another town struggles with its choices. But the options are different.

In this community, people are choosing their kitchenware, not from Pottery Barn or Crate & Barrel but silver or pewter. They’re choosing new clothes, not from Wal-Mart or Nordstrom but from the 40 or so fabrics at the local millinery. They’re choosing transportation, not Jeep or Toyota but feet or horse.

And they’re choosing sides: loyalist or rebel, status quo or treason.

Colonial Williamsburg is a city deliberately frozen in time, on the cusp of the American Revolution, when it was Virginia’s capital. Walking its 18th-century streets, seeing actor-interpreters bring revolutionary-era Virginians back to life, you could believe that the choices here were far fewer.

Yet for its era, Williamsburg was a cosmopolitan town, bustling with a merchant class and a spread of consumer goods that presaged modern America.

It also was crackling with revolutionary activity. Its citizens wrestled with their responsibilities and seizing their future. They confronted a lot of static and still managed to participate in the birthing of American democracy.

“Not everybody was running around yelling, ‘Yeah, yeah, liberty, death,'” says Dennis Watson, a Scottish-born American who portrays Williamsburg printer and newspaperman Alexander Purdie. “But,” he says, “this time they truly came together.”

There are lessons for us, and for our leaders, in the people of Colonial Williamsburg.

They, too, had choices far more abundant than their predecessors. They, too, struggled to manage their bandwidth and avoid letting distractions prevail. They may not have had XBoxes, but they had more options than most anyone outside of Boston or Philadelphia.

We are products of our age, too. If we can process 21st-century distractions and negotiate our lives, and most of us do, can’t we be active in our democracy, too? The ability to Twitter and to TiVo does not by itself preclude civic participation. Everyone has, well, a choice.

“This country is an experiment. And for it to have endured for this long, it requires the involvement of citizens — citizens making choices,” says Jim Bradley, who manages public affairs for Colonial Williamsburg.

It is tempting to imagine Williamsburg as a distillation of democracy, a representation of a time when leaders could be heard and citizens could be listened to, when a man could stand before a crowd, say “Give me liberty or give me death” and have it echo across the land.

That’s what Sherrie Bender of Houston, visiting Colonial Williamsburg on a recent day, means when she wonders, “Where are those conversations we had like Patrick Henry on the steps?”

They’re gone. In their place is something new and unprecedented but of the people nonetheless. To figure it out, we and our leaders are going to need a serious road map. More likely, we’ll just MapQuest it and go from there — if, that is, we don’t get distracted by everything we encounter along the way.

Copyright 2008 The Associated Press.
Summary
Date: 8/11/2008 2:18 PM
Slug: BC-Measure of a Nation-Distracted Republic
Headline: Distraction 2008: Freedom of choice _ or from it?
Byline: By TED ANTHONY
Byline Title:
Copyright Holder: AP
Priority: r (4)
With Photo:
Dateline:
Editors’ Note: Eds: Also moved in advance. Multimedia: This story and all past installments of the Measure of a Nation series – which includes stories, videos and animations _ are packaged in an interactive in the _national/measure_nation folder. AP Video.
Word Count: 2190
File Name (Transref): L0619
Editorial Type:
AP Category: a
Format: bx





Edit Mode : Cancel


EDITOR’S NOTE — This latest chapter of “The Measure of a Nation,” a yearlong series of multimedia story packages about the presidency and the 2008 election as seen through the prism of the culture, assesses the absurd amount of choices the average American has today — and how a leader might cut through the clutter and capture the nation’s attention.By TED ANTHONYAP National Writer LOS ANGELES (AP) — On blistering days in Los Angeles, drive northeast on the 110, exit at Highland Park and pull into a roadside grocery called Galco’s. Then walk in and say, “I’m thirsty. Can you point me to the soda-pop aisle?” This question may get you laughed out of the place. Because at Galco’s, the soda pop is in most every aisle. The place is a soft-drink nirvana containing 500 varieties of fizzy beverage from all corners of the planet. Root beer? They’ve got three dozen kinds. Perhaps your palate craves a bottle of Cheerwine or a cold Inca Cola. Choose between soda sweetened with high-fructose corn syrup or cane sugar, flavored artificially or naturally, colored pink or red or green or blue or purple. And that doesn’t include the 475 varieties of beer and the 60 kinds of bottled water. The choice is yours, if you can handle it. The store, now known as Galco’s Soda Pop Stop, is an exuberant explosion of the vaunted notion of freedom of choice, one of the ideals that supposedly makes America what it is. It is wonderful. It is also intimidating. And in an election year, it’s something the next president needs to understand. The two-century focus on what America’s founding fathers called “the pursuit of happiness” — coupled with the Industrial Revolution in the 19th century and the rise of consumerism in the 20th — has birthed a landscape of options as dizzying as it is liberating. Bed and Bath, it turns out, aren’t nearly enough. These days, we’re much more concerned with Beyond. A mere generation after the three broadcast networks ruled, a Comcast digital cable package hands you up to 250 channels of programming. Today’s average supermarket sells more than 45,000 items, the average Wal-Mart Supercenter more than four times that. On a single afternoon this month, eBay had 14.9 million auctions going, and Amazon was offering listings for 22.7 million books. By the end of last year, the Web had more than 108 million distinct pages to visit from the comfort of your lap. John Nese, who built Galco’s into a promised land of sugary beverages, has thought a lot about choice in America. He offers two assessments. The first: “People want choices. People want the opportunity to make their own decisions.” The second: “They come in and they look and they go, ‘We’re overwhelmed. We don’t know what to buy.'” The notion transcends simple consumerism. It also is the dilemma facing whoever wins November’s election. With options beyond our great-grandparents’ dreams, is freedom of unlimited choice really a freedom at all? In a universe of unprecedented static, how can an American leader lead? ___ DRIVEN TO DISTRACTION Mermaid Treasure looks just like Blue Jewel. Waterscape and Cool Dusk could be identical twins. And try distinguishing Seven Seas and Southern Evening from 10 paces away. At the Home Depot in Gibsonia, Pa., no less than 372 shades of blue paint are available, not counting the many blue-greens and blue-purples also offered in a section of swatches nearly as long as the distance from the pitcher’s mound to home plate. This cross-section of American choice illuminates the multiple levels of decision-making required to negotiate today’s consumer landscape, in this case before the painting even begins: —Which store? There are four paint dealers within a mile of the Gibsonia Home Depot and at least 13 more within a 10-mile radius. —Which brand? There are at least five to choose from. —Which consistency? Pick from matte, eggshell, satin, semi-gloss and gloss. —Which color group? Basic colors like blue, red and green are mere gateways to the real color choice. —Which shade? Time to negotiate the hundreds of names that sound like either ice-cream flavors (Lavender Ice, Cloudberry) or small coastal communities (Little Pond, Wickford Bay). That’s more than a million ways to paint a door. And as powerful as the human brain is, its bandwidth is ultimately limited. By focusing on smaller choices, by continuously sifting through the categories and subcategories of things like color preference and Google results and spam, could it be that our multiple options are controlling rather than liberating us? “Since Reagan, the ideology in the United States has been that choice is good and more choice is better. And to the extent that you can give people more choice in every area of life, you are improving their well-being,” says Barry Schwartz, author of “The Paradox of Choice: Why More Is Less.” But “nobody has the time or the expertise to make informed choices about everything,” Schwartz says. “When options are presented, people have a tough time just ignoring them.” In 2000, according to the American Psychological Association, a study found that shoppers given the choice of picking a jam from smaller and larger assortments preferred choosing from the bigger assortment. Yet they were more likely to actually buy some jam if they had fewer options. Excessive choice, in effect, short-circuited them from engaging more deeply. Now take that notion into the public realm. If too many choices drive us to distraction, how does that affect how we perceive government? “It’s wonderful that we can sit down in our living room and order 20,000 things. In a superficial way, we are more informed than people used to be. But it’s hard to get our attention, and I don’t see any way of turning that around,” says Edward C. Rosenthal, author of “The Era of Choice: The Ability to Choose and Its Transformation of Contemporary Life.” His assessment is bleak. By 1900, people’s faith in established institutions like church and government began a slow wane, and Americans struggled to find their bearings. Thus did consumer choice gradually become fetish. Today, anyone who questions unfettered choice risks being accused of condescension and, worse, ignorance of market forces. This is the landscape an American leader faces. The option becomes, “Follow me — unless you have something more interesting going on.” And accurately or not, today’s citizens often think that they do. ___ LEADING THROUGH STATIC “The only way we’re going to solve our problems in this country is if all of us come together,” Barack Obama said this month. Weeks earlier, John McCain said that “we are fellow Americans, and that shared distinction means more to me than any other association.” Unity is big in 2008. It means more voters. But can we come together? These days, beyond 9/11 or Katrina or rising gas prices, what exactly is that “shared distinction” we like to think unites us? To inspire voters, campaigns use strategies such as microtargeting — mining data and finding voters’ preferences, then customizing the message for each. But when candidate becomes president and prospective voter becomes mere citizen, those intricate techniques melt away. What’s a leader to do? Christine Riordan, a leadership expert at the University of Denver, prescribes simplicity. Just as paying attention to a leader is a consumer choice, Riordan says the leader can benefit from deploying marketing principles as well: An uncluttered message rings clearer, particularly when it’s accompanied by tight focus on content, packaging and image. Debating whether there’s too much information out there, Riordan says, is beside the point. “There’s no way we’re going back to the times of Zachary Taylor,” she says. “”It’s not, ‘Is too much information bad?’ It’s how do you manage within an environment that does provide all information and will continue to provide all informati on?” Today, candidates and leaders must tailor core messages for the 75-year-old newspaper reader and the 19-year-old who communicates using blogs and Facebook. What’s more, to have any chance of cutting through the clutter, the leader has to seem sincere and authentic to both demographics, not to mention all the Gen-Xers and Boomers in between. He or she has to be all the flavors of root beer at once. Consider House Speaker Nancy Pelosi. Like many politicians before her, she went on “The Daily Show” last month to match wits with Jon Stewart, be made fun of and maybe make a point to a coveted audience of hyper-aware, media-savvy Americans. She didn’t tank, but she appeared painfully overeager. To neutralize the static, she needed the kind of banter that Stewart and NBC anchorman Brian Williams had a couple of nights later. It was amiably contentious and brimming with pop-culture cues. It was also just plain fun, a key element in capturing the “Daily Show” demographic’s attention. “With more choices out there, if leaders want to bring issues to the attention of the public, they have to bring it into our venues and speak it on our terms,” says Adam Schiffer, a political scientist at Texas Christian University who studies voter behavior and the media’s role in politics. “Institutions are breaking down and there are going to be new ways of doing things. But the cream can still rise. The signal can still make it through the noise in this new environment,” he says. “You don’t need 90 percent of the public informed on the issue and following it closely to get your policy passed.” Exhibit A is Al Gore, who has been practically pleading Americans to pay attention to the environment for nearly a generation. He finally succeeded. What helped him punch through the static? He made a movie. ___ SAME DIFFERENCE? Across the continent from Galco’s and the dizzying choices of Los Angeles, another town struggles with its choices. But the options are different. In this community, people are choosing their kitchenware, not from Pottery Barn or Crate & Barrel but silver or pewter. They’re choosing new clothes, not from Wal-Mart or Nordstrom but from the 40 or so fabrics at the local millinery. They’re choosing transportation, not Jeep or Toyota but feet or horse. And they’re choosing sides: loyalist or rebel, status quo or treason. Colonial Williamsburg is a city deliberately frozen in time, on the cusp of the American Revolution, when it was Virginia’s capital. Walking its 18th-century streets, seeing actor-interpreters bring revolutionary-era Virginians back to life, you could believe that the choices here were far fewer. Yet for its era, Williamsburg was a cosmopolitan town, bustling with a merchant class and a spread of consumer goods that presaged modern America. It also was crackling with revolutionary activity. Its citizens wrestled with their responsibilities and seizing their future. They confronted a lot of static and still managed to participate in the birthing of American democracy. “Not everybody was running around yelling, ‘Yeah, yeah, liberty, death,'” says Dennis Watson, a Scottish-born American who portrays Williamsburg printer and newspaperman Alexander Purdie. “But,” he says, “this time they truly came together.” There are lessons for us, and for our leaders, in the people of Colonial Williamsburg. They, too, had choices far more abundant than their predecessors. They, too, struggled to manage their bandwidth and avoid letting distractions prevail. They may not have had XBoxes, but they had more options than most anyone outside of Boston or Philadelphia. We are products of our age, too. If we can process 21st-century distractions and negotiate our lives, and most of us do, can’t we be active in our democracy, too? The ability to Twitter and to TiVo does not by itself preclude civic participation. Everyone has, well, a choice. “This country is an experiment. And for it to have endured for this long, it requires the involvement of citizens — citizens making choices,” says Jim Bradley, who manages public affairs for Colonial Williamsburg. It is tempting to imagine Williamsburg as a distillation of democracy, a representation of a time when leaders could be heard and citizens could be listened to, when a man could stand before a crowd, say “Give me liberty or give me death” and have it echo across the land. That’s what Sherrie Bender of Houston, visiting Colonial Williamsburg on a recent day, means when she wonders, “Where are those conversations we had like Patrick Henry on the steps?” They’re gone. In their place is something new and unprecedented but of the people nonetheless. To figure it out, we and our leaders are going to need a serious road map. More likely, we’ll just MapQuest it and go from there — if, that is, we don’t get distracted by everything we encounter along the way.

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