Former WellPoint VP Liz Fowler to Implement Health Care Oversight

Remember Liz Fowler? The former WellPoint VP whom William Ockham noted was the literal author of the health care reform bill?

I’m sure you’ll be thrilled to learn that WellPoint’s former VP will be in charge of consumer issues and oversight as our country implements the WellPoint/Liz Fowler health insurance bill. (h/t Glenn Greenwald)

Liz Fowler, a key staffer for U.S. Sen. Max Baucus who helped draft the federal health reform bill enacted in March, is joining the Obama administration to help implement the new law.Fowler, chief health counsel for the Senate Finance Committee, which Baucus chairs, will become deputy director of the Office of Consumer Information and Oversight at the U.S. Department of Health and Human Services.

“Liz Fowler is an extremely knowledgeable and dedicated adviser, and while I’m very proud of her new position, she will certainly be missed at the committee,” Baucus said in a statement Tuesday.

[snip]

Obama and fellow Democrats have been promoting what they say are positive aspects of the reform bill, while the Health and Human Services Department is drafting many rules to implement to complex measure.

So Liz Fowler, WellPoint’s gal, will be writing the rules implementing the law (the rules that will determine whether this is a worthless bill or a decent one), particularly those designed to protect (cough) consumers and oversee companies like…WellPoint.

This is the kind of “oversight” that resulted in the BP disaster.

And remember Obama’s lobbyist restrictions? The ones that prevent someone from working in the Executive Branch on an issue that they’ve lobbied Congress on for two years? Fowler was not a registered lobbyist; rather, she was the VP of Public Policy and External Affairs. But in any case, it appears that Fowler returned to MaxTax Baucus’ staff on March 4, 2008, so nothing prevents the former VP of WellPoint from writing the “consumer and oversight” rules that are the only thing protecting Americans from policies — like WellPoint’s — that screw consumers.

It’s a nice trick: send your VP to write a law mandating that the middle class buy shitty products like yours, then watch that VP move into the executive branch to “oversee” the implementation of the law. What could go wrong?!?!

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  1. Teddy Partridge says:

    I give her 22 months at this new gig, tops. Then back to Wellpoint.

    Liz Fowler should be in prison.

    • djfourmoney says:

      This only happens because only about 1/4 of the population is even paying attention. Fowler wrote the f’in Senate bill and nobody knows she’s apart of the power structure at Wellpoint.

      Complete comedy and completely SAD.

  2. PJEvans says:

    I suppose they think we should be happy that someone from the health insurance lobby is going to run the program.

    Why do I have the feeling that this maladministration sold its intelligence and whatever good sense it had, in return for power?

  3. earlofhuntingdon says:

    Unfuckingbelievable. Mr. Obama is fast already becoming a caricature of his own, misguided, conflict-avoiding, corporatist self.

  4. Frank33 says:

    David Sirota wrote a decent story about the shill Fowler. Some stories with content are not allowed , at DK, unless flattering to the Administration. Seems familiar. But some of those Kossacks do love Liz Fowler because she is so…well informed.

    But there is a lot of HR abusing as usual. And they have to bring in FDL, who had nothing to do with this appointment by the President. At DK Noun, Verb, FDL

    If Sirota writes it, you can pretty much (4+ / 3-)
    guarantee it’s false.
      And again with the self-promotion meme! (5+ / 0-)
    Like clockwork.
    ▪  Sirota and Cenk have developed it into an (3+ / 0-)
art form.
    ▪ ———
    ▪  I’m asking MB what he thinks. (0+ / 0-)
Sirota is a public figure. Or at least he tries to be.
Your HR is complete bullshit.
    ▪  go right ahead (1+ / 0-)
I’ll be making some popcorn.
    ▪  i’m afraid that it violates the rules (3+ / 1-)
Sirota is a public figure. Maybe you need to stay at FDL where this point of view is not criticized if it hurts you so much.
    ▪  I’ve never posted at FDL (1+ / 0-)
Maybe somebody needs to hr you for that little ad hom you just used against me.

        • onitgoes says:

          Glad to hear that the “entire veal pen” is “unhappy” with FDL. If that’s true, then we’re getting noticed. Hooray for that. I’m all for making as much “noise” as possible and pushing from this point of view, which is marginalized constantly.

          People are entitled to disagree with the viewpoints espoused here, but this is one of the few places where such views are expressed. Viva la difference!

      • PJEvans says:

        Well, there are several people here who think that doing anything at Kos is a slur.

        So I would like to suggest forgetting that entire line of thought, because it’s extremely non-productive and does nothing for the reputation of the commenters who insist on bringing it.

  5. Peterr says:

    It’s a nice trick: send your VP to write a law mandating that the middle class buy shitty products like yours, then watch that VP move into the executive branch to “oversee” the implementation of the law. What could go wrong?!?!

    This is the PhRMA version of “The Aristocrats,” right?

    • emptywheel says:

      Millions of members of the middle class forced to pay for health INSURANCE rather than health care, instead of saving to send their kids to college?

      That’s my biggest fear. THough that’s already done, Liz FOwler can only fuck with things like Medical Loss RAtio (the percentage people have to use on actual health care, rather than health care).

  6. GulfCoastPirate says:

    It’s really quite sad to watch Obama and the Democrats do this to themselves. At some point you have to come to the conclusion that they are simply incompetent.

    • seaglass says:

      No, this is not incompetence friend. This is corruption pure and simple. These Corps. don’t pay millions to just have lunch with Barry and the boyz. So much for Mr. Hope and Change. The only thing we can Hope for is some small change to maybe trickle down the legs of the BIG PEOPLE to the rest of us “small people.”

  7. Sara says:

    For those going to Netroots Nation, bring the matter up there with Al Franken — he is the author of the profit/overhead/administrative costs lanugage, and he is also on the right Senate Committee, and I believe wants to protect his contribution to the bill as a whole. Find out who is his staffer dealing with this, with whom communications can be established. I assume Fowler has to be confirmed, and over the next few years will have to testify during oversight hearings. I think Franken can easily be recruited as a watch-dog on this Lizzy. I expect to be at an event with Franken during the August Recess — and will independently ask him about the matter.

  8. fatster says:

    O/T

    Emergent set to announce anthrax vaccine contract

    “The Department of Health and Human Services’ Office of the Biomedical Advanced Research and Development Authority (BARDA) awarded the contract, which funds two years for a total of nearly $55 million and includes three additional, optional years.
    . . .
    “The award is based on an Emergent proposal that says the company can produce 26 million doses annually . . . further expanded to produce 50 million to 60 million doses annually.”

    LINK.

    • montanamaven says:

      Discovered naturally occurring anthrax on a young buffalo at Ted Turner’s ranch in Montana.Bison Dies of Anthrax on Turner Ranch

      I was reading the news article on Liz Fowler in “The Billings Gazette” because David Sirota had quoted it and noticed how the story had been dumped in an obscure paper. So I chastised myself for not reading my local paper for news stories that should get national attention.

      Liz Fowler was the keynote speaker at a Montana Health Care Forum last week.
      Fowler Hawks Health Insurance Reform

      “Health care is complicated; it’s confusing and it’s personal,” said Liz Fowler, chief health counsel to U.S. Sen. Max Baucus, D-Mont. “It’s really easy for (opponents of reform) to start poking holes in it. I hope over time that people will understand it, but it takes a lot of work to try to explain all this stuff.”

      I enjoy commercials who make fun of using the word “stuff”. I use it for comedy also. But I really resent public figures using “all this stuff” that is too complicated for we mere mortals. And I hate when presidents use the word “folks” and drop all their “g’s” at the end of “ing”.

      Guess I should pay more attention to local news and show up at events that have these miscreants speaking.

      • Synoia says:

        1. It’s really not hard to understand that Heath Insurance cost an order=of-magnitude more than Canada.
        2. It’s only complicated when you effort is to protect all the profiteers in the system while attempting reform.

        Medicare for all? Really quite simple.
        Medicare buy in? Very simple.

        • montanamaven says:

          Yes, Fowler, like her boss Baucus, uses the weasel excuse that it is “just too complicated”. It’s not. Medicare for all or some sort of universal health plan can be implemented immediately. Medicare itself was up and running within 3 months back in 1965? when it was passed. And they had big old main frame computers then. No desktops or laptops. Of course, they also got a man on the moon back then.

          I run into people who defend people like Baucus, Fowler, Salazar. They always know them personally. They are always well meaning people. Oh and they are always “smart” implying that I’m might not be as “smart”. I met a woman lawyer last week that chastised me for my condemnation of the Obama administration. She would only agree about Geithner, but praised Salazar. “He’s very smart. And you are not being rational.” She used “rational more than 5 times. For me “rational” is a word used often by fascists.

          No Salazar is not “smart”. Or Fowler or most of DC. Cunning, yes. Intelligent? Not so much. And compassion and a sense of justice? Not at all.

  9. prostratedragon says:

    —An old tango for new South Americans—

    One of the classics is “El Choclo (The Ear of Corn)” by Angel Villoldo; believe me, almost everyone has heard this tune.

    Many choice versions are listed here at youtube, of which faves of mine include the Canaro and Firpo for Argentine versions (selected by some of the dancers), and the Armstrong and Nat Cole versions to illustrate the nature of premature, or perhaps prototypical, new South Americanism.

    This poster has English and Spanish lyrics for the song; that perplexity is expressed as to the meaning of the title might suggest that the poster is more genteel than I, who have a notion that is consistent with both our new, dubious social order and its model.

    If that notion does not suit you, then another that fits the Discepolo lyrics stems from the 19th century street vendors of NYC, and probably Baires too, among many cities. As described in accounts such as, iirc, Gangs of New York, Luc Sante’s book whose title escapes me, or City of Eros, different standard snacks or trinkets were sold by different categories of people (who shared desperate poverty, however). This arrangement could make it easy for a lout with money, etc., burning a hole in his pocket gentleman about town to know who to approach for what ancillary service …

    Or, maybe corn was just Villoldo’s favorite snack.

  10. BayStateLibrul says:

    The coattail effect…

    Has the bearded Greek God of Medicine Asclepius’s serpent slivered from his staff?

    Wonder what Governor Dean is up to?

  11. RevDeb says:

    It is becoming increasingly clear that it really doesn’t matter who is in the WH—the corpos own the government and us. The Reagan Revolution is complete.

    • fatster says:

      and seaglass @ 22.

      Companies pile up cash but remain hesitant to add jobs

      “Corporate America is hoarding a massive pile of cash. It just doesn’t want to spend it hiring anyone.”

      LINK.

      JPMorgan profit leaps nearly 80%

      LINK.

  12. harpie says:

    O/T [probably has been noted before in comments, but I’m way behind! Sorry]

    UK Sought Rendition of British Nationals to Guantánamo; Tony Blair Directly Involved; Andy Worthington; 7/15/10

    http://www.andyworthington.co.uk/2010/07/15/uk-sought-rendition-of-british-nationals-to-guantanamo-tony-blair-directly-involved/

    UK on U.S. Rendition: “Is it clear that detention, rather than killing, is the objective of the operation?”; Jeff Kaye; 7/14/10

    http://seminal.firedoglake.com/diary/59918

  13. jparker says:

    All of this is misguided incrimination of a good public sservant. Has anyone taken the time to research the fact that Liz Fowler spent the overwhelming majority of her career NOT working at WellPoint? Has anyone taken the time to ask whether Liz Fowler, during her time at WellPoint worked to change the company’s practices that you find so terrible?

    I can take the same set of facts you use to persecute Liz Fowler and argue that she used her brief time away from public service working for WellPoint to get an insider’s perspective on how to drive change.

    You are allowing your disappointment with health care reform to color your judgment about a person you’ve never met. Would you appreciate this treatment if you were in her shoes?

    • OldFatGuy says:

      I think under normal circumstances, you make fair points.

      But I think given this set of circumstances, in which we’ve already seen her views in this area since she basically WROTE the HCR bill, then we have a legitimate basis for concern. It was a bad bill written entirely for the benefit of the insurance industry. If that was her priority while working for Max Baucus, why should we think her priority would change working for BO?

        • OldFatGuy says:

          Yep, except I guess when he’s working for the banksters. Or the oil companies…..

          Wow, that dood is gifted! He’s a multitasker!

    • fatster says:

      I’m sure open to learning how Liz worked so hard at WellPoint to change their policies. Could you provide some documentation for that? And for all she’s done in the public sector that benefits the public? Thnx.

      • TalkingStick says:

        It is appropriate to apply disappointment in the legislation. Judge the tree by its fruit. She wrote the health care bill.

    • spanishinquisition says:

      So you’re defending Dick Cheney because he spent the majority of his career not working for Haliburton?

    • alan1tx says:

      That’s what we do around here. Go back to listening to Rush or Glen Beck if you want to peddle those unpopular views.

    • Joe Steel says:

      You are allowing your disappointment with health care reform to color your judgment about a person you’ve never met. Would you appreciate this treatment if you were in her shoes?

      I am in her shoes…sort of.

      I’m an accountant working for a health insurance company. I defy anyone to prove he wants the public option more than I do.

      Fowler’s critics should prove their case before they assume every health insurance industry employee is just a lackey for predatory capitalism.

      • TalkingStick says:

        She wrote the bill. what more proof do you want? To hold her accountable is not necessarily painting all insurance industry workers with the same brush. It is evidence based..

      • spanishinquisition says:

        So you are criticizing what Candidate Obama campaigned on regarding the revolving door. You for instance have no problem with the former CEO of an oil company being VP. BTW it was Fowler who worked on Bush Medicare Part D, which Candidate Obama campaigned as being both a waste and an example of what was wrong in Washington.

      • Synoia says:

        “I was just following orders”….

        Is not a defense.

        You are a lackey, trapped in a ugly system.

      • montanamaven says:

        This diary is specifically about Liz Fowler and not “every health insurance industry employee”. Liz Fowler wrote a bad bill that keeps insurance company in control of people’s health. She is not Wendell Potter who blew the whistle on the predatory practices of Well point. He does not have a position in the Obama administration.

        This is not about the average worker in the health insurance business. This is about a well placed operative that moves smoothly from government to private business. Another example is Sylvia Baca who moved seamlessly from the Clinton administration in the Minerals Management Service to BP and then back now into MMS. I sure she’s a nice person. But oil drilling in the Gulf increased tenfold in the Clinton administration. And now she’s baaaakkkk! (From Jeffrey St. Clair’s report in the new “Counterpunch” print and online magazine. Subscription needed for some stories.)

        This is about corruption. Not whether somebody is a good dinner companion. We voted to get rid of this system of revolving door. Didn’t happen.

      • tanbark says:

        How much more of a case do we need to prove, when Obama picks the former VP of one of the largest of the robber barons to deal with consumer issues and oversight in the HCR bill that she practically wrote?

        I mean, she’s not going to be skewering small children and throwing them out the back door of the office of Consumer Information and Oversight; she’s just going to be filtering every decision she makes through the sieve of her connections to the health-insurance industry, and all of the money she made, and is still making, while she was there.

        BTW, we all know; these people NEVER cut their connections to their cushy jobs nor the ethic of them.

      • bmull says:

        The problem is not that Fowler worked for an insurance company. It’s the perception that she is not a strong advocate for consumers.

        • earlofhuntingdon says:

          It’s a bit more than that she is a lukewarm consumerist; it is that she appears to be such a strong advocate for the health “care” industry that makes her the wrong choice to implement Obama’s pretend health insurance industry reforms. We and open governance would be better off if she joined Jamie Gorelick’s “law” firm and started pimping outright, rather than pretend to be a concierge at the Mayflower.

    • oldhippiejan says:

      If I were in her shoes, I bet I’d have healthcare, something I don’t have now or won’t have for the foreseeable future.

    • bmaz says:

      Exactly what is misguided oh sage interloper? As you have presented no evidence to how what a citizen crusader Fowler was at Wellpoint, I will assume you have none. Your comment is totally worthless diversion and mindless pablum, but thanks for showing up for the first time ever to give us that. Thanks for playing.

  14. Bilbo says:

    Seems to me that candidate Obama had something to say about “Closing the Revolving Door” during his presidential campaign. What could it have been? Oh yeah,

    (1) CLOSING THE REVOLVING DOOR ON FORMER EMPLOYERS: Obama will eliminate
    incentives that could be provided to newly-hired public employees to favor their former
    employers. No political appointees in an Obama Administration will be permitted to
    work on regulations or contracts directly and substantially related to their prior employer
    for two years.

  15. VADEM says:

    And the hits just keep on comin…………

    I sure hope Obama is enjoying his one term, because between the unemployed, the progressives and real democrats, where does he think he’s going to get any votes from???? I believe I will be staying home in 2012.

    Of course, then we have

    Gibbs out there running his mouth about losing the House in November. Hell of a job WH. I think they are brain dead.

  16. onitgoes says:

    Plus ça change, plus c’est la même chose.

    Yet another example of Bush’s 3rd Admin. Thanks for nothing, Barack.

    This is not BHO’s “design flaw” (as in: he needs to grow a spine), this is BHO’s feature. He’s the corporation’s main dude, and BHO’s only out for the “big” people. Us “small” folk? Fahgeddaboudit.

    • spanishinquisition says:

      The rhetoric has changed under Obama, but it’s still the same thing that’s been wrecking our country for decades – having industries write their own regulations. Yes, we’ve gotten “reform,” but it’s been the type of reform that is harmful to us.

  17. medicinecat says:

    I turn to FDL daily to see what Obama’s insult de jour will be. I mean, in reference to the Liz Fowler saga, I couldn’t make this stuff up if I tried. Every day, Obama provides a good, swift kick-in-the-teeth to his once loyal followers.

    Now, the “why don’t you like me” shit is beginning to start in a big way. See David Dayen’s blog “There’s No Crying in the Oval Office”, above.

    I have a job that requires a great deal of driving, so I listen to “Progressive” talk radio for much of the day. Lately, both guests and callers have been crossing the line and hinting that those of us who no longer support Obama do so because, you know, there are winners and losers in every economy, and the people complaining are the losers.

    This ugly rationalization is just so Republican, and not shockingly, so Obama.

  18. oldhippiejan says:

    Yet another knife in the back.

    They can mandate to hell and back. I’m not buying their shitty insurance. So fine me. Put me in jail. I don’t really care.

  19. BearCountry says:

    The defenders of obamarahma, whether here or elsewhere, are just hoping that they can throw enough dust in our eyes to keep us and themselves from seeing the reality. Joe Steel and jparker seem a little confused. All in all, obamarahma proves day after day that he is a total corporatist. He has proven to be an excellent leader for them because he has beguiled quite a few people and they won’t give up their “facts.”

  20. tanbark says:

    Good thread, Marcy.

    It points out that, just now, the real threat to us has nothing to do with the 28% mouthbreathers; it’s coming from Mr. Centrist.

  21. temptingfate says:

    Slightly OT: Senate bill clears hurdle 60 to 38

    Dodd said his Senate Banking Committee may hold hearings later this year on regulators’ plans for implementing the bill.

    “It will be incumbent now on the present administration and those that follow it to nominate good people to head up these operations,” he said on the Senate floor. “I can’t legislate that. I can merely create the opportunity for that kind of protection to occur.”

    Ignoring how bad the Financial bill is, the appointment of Fowler to fix what she authored shows where the few useful parts of that bill are headed.

    WellPoint stock should jump as Fowler sets to her task.

  22. ChicagoTodd says:

    I would be interested to know if she still has stock options/holding with Wellpoint. My guess is yes — just like they let Cheney hold his Halliburton shares.

    In the end, nothing got changed — Obama and the Democrats just made this type of corruption more institutionalized. Out right depressing . . .

  23. xargaw says:

    I wonder if all the BRILLIANT men sitting around Obama have figured out just who is going vote for him in ’12?

  24. earlofhuntingdon says:

    Karoli at C&L writes this:

    Liz Fowler didn’t take out the public option. She didn’t kill it. And she didn’t lobby against it. Is it possible that she simply has a different policy opinion from others? Or that she actually doesn’t have a different opinion but made a calculation about what was possible with this Senate Finance Committee?

    Health care, whether it’s government-run single payer or covered by private insurers, is one of the most complex areas of public policy there is. Implementation of the Affordable Care Act needs policy wonks at the helm. If Liz Fowler is anything at all, she is a policy wonk, one who has earned a doctorate and a law degree, and who has spent her entire career in the policy area of health care….Seems like a natural choice to me.

    Shorter Karoli: the issues are complex and we need a “policy wonk”; Ms. Fowler might well have worked toward the possible rather than dream the impossible dream. (Cue your favorite rendition of Man of La Mancha’s title song here.)

    I suggest Karoli reread Marcy’s post and click on its links, then reread Glenn Greenwald for why work with Sen. Baucus and Wellpoint might readily trump a couple of junior years with Pete Stark. (Elena Kagan, for example, once clerked for Thurgood Marshall, but she has vastly different experience from his and is unlikely to mimic his priorities, passion or advocacy on the Supreme Court.) It is Fowler’s career trajectory that suggests conflict with the public interest, not that she once worked for a liberal or, conversely, that she spent her junior years in the trenches at Hogan & Hartson, Chief Justice Roberts’ old firm.

    The issues include why she worked for a liberal then, where has she worked since, what have been her contributions to the process, and who rewarded her for them. Most of all, it is Fowler’s de facto control over drafting the legislation. It’s the delight, as Jane says here, that drugs companies and health “insurers” generously displayed when they got “their” legislation, whose drafting – if not all its political contents – Ms. Fowler controlled.

    Ms. Fowler, no doubt, is talented; but her career path suggests she has more ambitions than being the neutral policy wonk implied by Karoli. (Frankly, that description seems David Brooksish.) The question is do Fowler’s priorities enhance or detract from the public purpose of constructive health care reform.

    I agree with Marcy and Glenn: Ms. Fowler seems more likely to be another Bush fox in the regulatory henhouse, advocating for corporate interests, than she is to work for constructive, public-centered health care reform.

    • bmaz says:

      I do not know Karoli in the least, but this is diversionary BS. Focus on the public option is an illusionary red herring. What we KNOW Fowler did write is the issue and it is a complex and hole riddled pile of shit that does not just maintain the status quo of the healthcare industry, but enhances their position exponentially while mandating consumers buy their shitty product.

      And Fowler’s boss Baucus, without any hint of objection by Fowler that I recall, watered down and or removed key provisions intended to protect consumers (as an example, specific protections that had been proposed for section 2712 regarding ability of carriers to rescind and/or terminate coverage were removed and instead the very same practices that carriers have relied on substantially to screw customers were codified into law where they were simply common law based previously). So, the glittering generalities bandied about by cheerleaders such as Karoli seems to do from your quote are just pitching bunk. To assert that Fowler did not pen the very desire of the healthcare industry is to blithely ignore the obvious.

      • earlofhuntingdon says:

        That’s why I posted it here. Karoli’s piece came out rather late in the day, specifically took aim at EW, and read like a ready-made, pulled-from-the-shelf, pro-Obama, MSM product untypical of C&L.

      • earlofhuntingdon says:

        Having crafted into statutory language Obama’s backroom deals, the industry’s wish lists, the Baucusian must-haves, Ms. Fowler would be the perfect choice to turn those deals into regulatory fait accompli, rather than leave it up to a health care Elizabeth Warren, whose implementation might derail them.

        Karoli’s post and golly gee whiz kids analysis is as underwhelming as the comments to it. Those comments run the gamut from suspend disbelief, I don’t see the problem to innocent until proven guilty and only a 2-year stint in the private sector. I guess none of them bothered to read what Ms. Fowler drafted and whose bread she buttered in doing it.

        One commentator did note the obvious: Ms. Fowler didn’t just take a job in the industry whose arcana she mastered as an underpaid public servant. That would be hard to criticize. She became one of the heaviest hitters in the industry’s vice president and top spokesperson in DC on this legislation and on health care reform generally.

        Two years of that, in the time period we’re dealing with, is plenty of time. As I said above, it’s not the individual stints, which are often short in the revolving door world, but the trajectory of those jobs that counts. Ms. Fowler is clearly working in the mold of Jamie Gorelick (presently representing BP), not Ralph Nader.

  25. mrwebster says:

    One note the apologists make is that the head of her division is a guy name Jay Angoff who has done very righteous work, and that he will keep her in line. I even wonder if he knew that Liz Fowler would be appointed to a deputy position. Given Angoff’s strong creditials my speculation is that the insurance industry paniced and got Obama to put Fowler on as a counter-weight and check on him. She could hold the ultimate power of the implementation by power of her veto over details. If Angoff resigns before the work is done, you can bet he was fed up with his deputy calling the shots and whining to Rahm.

    • earlofhuntingdon says:

      Good points. It’s not the formal position of authority that counts in DC so much as what political backing you have and from whom. That was already a fact of life before Dick Cheney etched it in stone. He accomplished what he did owing to that dynamic and because those who mattered understood that he was the de facto president, in part because the elected president’s attitude was “Sure, fine, ok by me.”

      Fowler might be someone’s deputy, but if she has a line to the top and is able to undercut her nominal superior(s), then her views and priorities and those of her patrons prevail. Those who play this game in Washington know that.