The Politics of Health

One of the major issues in this year’s presidential election is about health care for Americans. Apparently all of the candidates are politically wise enough to agree that people who are sick should get medical attention. A few of those candidates are even wise enough to believe that preventing illness might be a better investment of health care resources than just treating the sick. But apparently that is about where agreement ends. HOW health care should be delivered seems to be a road traveled differently by each party and candidate.

It has been recommended that health care delivery should be evaluated against criteria of quality, access and coverage. Regarding quality, the US on the whole provides care backed with innovation and medical knowledge that is enviable throughout the world. But at the specific level, with individual doctors / hospitals / laboratories / support functions, it is clear that quality varies widely among geographic locations and among all sizes and types of facilities. We as individuals have minimal awareness of the quality and competency of medical services that we receive unless we go to a nationally recognized facility in the specialty of our illness. Part of that is because medical care is a closed industry. Failure rates, complaint histories, price, and comparative performance information is not available to the consumer/patient. Quality is a factor you only know about AFTER the work is done, which is often way too late. This inability to be “an informed consumer” of individual providers is the major flaw in those (particularly Republicans) who advocate “health care delivery by the free enterprise market.”

Which raises the access question: if quality is a variable and in fact often reflects a price tag, who is able to obtain medical care, much less has access to quality medical care? The estimate is that 48 million out of 300 million Americans have no health care. That should outrage each of us. Many of these are people who typically do not go for treatment except as a last resort. Even among those with coverage, day-to-day decisions are made about what care they can afford above the insurance reimbursement, or what life supports (food, shelter, heat, clothing) they must sacrifice to pay for medical expenses. So is quality care truly available to the public?

Regarding coverage, this is the quicksand beneath our feet. Whether or not you agree with his presentation tactics or his specific conclusions, Michael Moore’s “Sicko” movie correctly identified the very real and critical issue of insured Americans not adequately covered. Many of us walk around with our health insurance card in our pocket, believing we are protected from medical calamity. Until we find out otherwise, most often after we have received care. We face deductibles / copayments to be made, limitations on choices of doctors and/or treatments, disagreements of claims over “pre-existing conditions,” or ultimately the stamp of “Not Covered” on our claim form. Worse still are the people trapped in a bad job they cannot give up because they cannot transfer to a new job their employer-based insurance on which they depend.

It’s broken. And it is broken badly. And in this country of outlandish executive pay vis-à-vis worker pay, it is obscene that access to adequate medical care causes any debate at all. The Republicans raise the very old and tired bogeyman of “socialized medicine” when someone talks about government servicing all who need health services. They simply ignore the fact that government has been doing reasonably well (certainly no worse than the private sector) already servicing 8 million children, plus millions more senior citizens, millions of military veterans, and, oh yes, thousands of Congressmen and government officials. State and federal governments have long underwritten health care for a substantial portion of America, so let’s just give up on that scare phrase invented by the American Medical Association in the 1950s. Conversely, the Democrats see an expanded government role in health care, but they are so scared off by the Hillary Clinton reform disaster of the 1990s that they will only stick 1 or 2 toes in the water, keeping the rest of the leg high and dry. Could we please have some truly fresh “change” thinking here?

The two fatal flaws in our current concept of health care delivery are:
-Employer-Based Insurance: not everyone is an employee, so Bush’s tax credits are a nonsensical approach. Health care costs inflate business costs and reduce economic competition with the rest of the world. Employees now change jobs frequently but health coverage does not transcend the workplace.
-Health Insurance: buying insurance to cover your medical costs from someone for whom your needs are their costs and reduced profit is inherently a conflict of interest. You cannot reconcile these two differing objectives in a profit-based competitive marketplace. Especially if you offer insurance on a line-item, illness-by-illness basis. The resulting horror stories from this approach are legion. I insure my car against damage; I do not opt to insure my headlight versus door versus transmission versus motor. If medical insurance is going to be the approach, the industry should do its risk analysis and projections against aggregate total costs of the insured pool and parcel that out, like any other insurance. This is basic insurance 101.

We need to stop talking about how to make health insurance available to everyone. Because health insurance does not work and is not the answer. We need to start over and talk about how to make health SERVICES available to everyone. We need to get doctors and patients back together, while eliminating the incredible waste, inefficiencies and duplication that exist in today’s delivery systems. And you know what? This can be achieved if we focus on those two true objectives.

Primary Preview

After an excessive year of pre-election campaigning by our presidential candidates, we are now down to the beginning of primary voting. The first six weeks of 2008 will be telling, and all will look very different as early as mid-February. Even though it is all happening way too soon and for too long, it will be good to start sorting out the current playbill. Hence some observations below about where a year of 2007 campaigning has brought us:

The Republican field is shallow and un-inspires its own base; it still sounds like “more of the same,” with many aspirants but no one winning the “Reagan mantle.” The Democratic field is strong on credentials with enthusiastic supports; in the end they will galvanize around their final candidate.

The major issues are: Iraq; the emerging economic downturn; illegal (and legal?) immigration; and health care. People’s determining factors: fear of terrorism; desire for change of direction; end to government paralysis and polarization; need for competence in government. The person who connects on these wins. And the candidates:

- Biden: has been very impressive in his foreign affairs expertise and overall
manner, but just hasn’t caught on as a viable president.
- Clinton: not “inevitable,” and has stumbled, but has shown she would be a
formidable candidate; still unclear if she can win over her negatives and
demonstrate “change” versus her obvious intelligence and competency.
- Dodd: an effective Connecticut senator, but never viable nationally as president.
- Edwards: dead-on right about the corporate give-aways of this decade; but may be
too strident for those Americans looking for reconciliation in government.
- Gravel: Too harsh to be heard, regardless of message; disappearing from view.
- Guliani: Biden described him best --- “a noun, a verb, and ‘9/11” is all he can
speak to; the politics of fear needs to end.
- Huckabee: wins the Republican right platform with the least scary version of their
cause, and fulfills my early prediction of being “the sleeper” candidate; but is
there any substance under the good-humored folksiness?
- Kucinich: Don Quixote still lives, with ideas that still need to be voiced; could
still be the Secretary of Peace that he espouses in another’s administration.
- McCain: has thankfully rediscovered his integrity, but probably too late.
- Obama: clearly the freshest voice, very natural, confident and genuine; has not
fully answered “the experience question,” if that is ultimately deemed truly
relevant.
- Paul: following a unique path and message , showing surprising resonance and
strength with a specific constituency.
- Richardson: a good governor, a future cabinet member; has never found a
presidential personality.
- Romney: Joe Klein (Time magazine writer) said it best: “Mitt Romney seems
incapable of finding an issue where integrity trumps expediency”; the plastic man
is following an all-image / no substance path, and we have had 7 years too much of
that already.
- Thompson (Fred): the man riding the Republican right white horse has been a
complete bust; the pickup truck never got out of the garage.

GONE: Brownback, Hunter, Tancredo, (Tommy) Thompson.

On January 3, 2008, it’s all still very much a toss-up.

Happy Holidays

NEWS ITEM: “(New York) A group of people exchanging holiday greetings on a subway last week hurled anti-Semitic slurs and beat four Jewish riders who had wished them “Happy Hanukkah,” authorities said. The prosecutor’s office was investigating a possible hate crime.” (USA Today, 12/12/07)

In our country’s continuing need to create a controversy where there need not be one, we have now annualized this penchant. I refer to the great “Happy Holidays” versus “Merry Christmas” cloud that hangs over salesclerks everywhere. What does one say to a stranger in this season of joy and love for people of virtually all faiths over an extended calendar of celebration?

I guess there are some folks who feel it to be their First Amendment and unalienable right and spiritual obligation to wish everyone a Merry Christmas. Whether the recipient celebrates Christmas or not, or celebrates within a Christian or secular context, and usually without bothering to ask. Where companies have asked employees to use the Happy Holidays greeting (a meaningful wish applicable to virtually all peoples), employee groups and speeches from the pulpit decry once again “another assault on religion.” I think such outraged individuals have it backwards. If I may, I will use a personal story to illustrate.

When I left my native Arkansas at 21 to go to Boston, a more Wonder-bread kid from a homogeneous white Protestant environment could probably not be found. (What diversity existed in my town was out-of-sight/out-of-discussion, e.g. non-Protestants, Blacks.) Yet in Boston I found myself in a completely foreign melting-pot environment unlike any I had known. Religions, cultures, nationalities, with all their various Americanizations, were all there. Reflecting against all of these new experiences caused me to have to go back and understand where I had come from in my safe, all-the-same upbringing. It was a head-swirling multi-year process of change and assimilation, all for the far better I know.

On my return to Boston after a 2-year absence, I became dear friends with a couple whose history could not have been more different. Raised in New York City, in close knit Jewish communities, immersed in the performing arts, I seemingly had nothing in common with them at all. But over the years I learned so much from them and their family and friends. Not just about Jewish culture, but about many other cultures as well and the ability to all live together, given their broad exposure to such versus my nil.

For years, when the December holidays came around, I always sent them and his parents a Christmas card. Because Christmas cards is what I did every year. It was an unthinking reflex. Kind people that they are, they never pointed out to me my un-thoughtfulness, but just accepted the wish in good (and probably bemused) grace.

It was probably 15-20 years later when, out of the blue, it suddenly hit me how backwards I had been. Christmas is MY holiday, MY set of long memories. Their holiday, their memories, are of a different celebration and meaning --- in their case Hanukkah. I take joy when they wish me a Merry Christmas, their knowing that is a special time for me and my family. In my special feelings for them, I finally realized that my heart should wish them not my holiday but theirs: Happy Hanukkah, the holiday that brings similar seasonal warmth to them.

There are millions of non-Christians in this country, and many non-religious celebrators of Christmas. Many no longer live in isolated homogeneous communities, but increasingly we live intermixed all together. One can choose to “spread the Gospel” in the winter holiday time, or one can express true love and acceptance of each other and their respective celebrations. People who insist on the “right” to wish a Merry Christmas to people whose tradition of observance is different are in fact being very selfish. They make themselves feel better, but they are not truly spreading “joy and good will to others.”

Our country's diversity is one of our strengths. But say Happy Birthday to me on my birthday, not yours. Wish me a happy 4th of July, not a Happy Bastille Day. Wish people joy and peace in their own personal form. And if you don’t know, or haven’t tried to understand another’s culture, don’t assume; just know that “Happy Holidays” really does work just fine.

Happy Holidays to each of you, and to your friends and families, my readers.


Dedicated to Steve and Marilin, and honoring Steve’s recently deceased father.

We Do Not Torture

President Bush has declared to the world that “Americans don’t torture.” Therefore, since Americans don’t torture, the various things we do to extract information from the “civilian combatants” we are holding are – by his definition – not torture. Because we don’t torture. Because we are the good guys. Because …..

It is said that a paradox is the ability to hold two apparently contradictory opposite thoughts in your mind at the same time with no apparent discomfort. It often seems that George Bush has raised the concept of paradox to an unimaginable art form enveloping not just Americans but citizens of the world.

By any simple definition, torture is the act of inflicting pain or death on someone, or causing one to believe that such pain or death is an imminent outcome, in order to force one to commit an action. Much of our recent national discussion has been around the example of “waterboarding” as an interrogation technique. This involves submerging individuals in water, or pouring water over their heads, to the extent that an individual believes drowning is imminent. Well, if this is not torture, I just don’t know what else is. Most common-sense Americans can recognize it as just that. Stripped of any legalistic wordsmanship and political candidate rhetoric about who is more qualified to “keep America safe,” this is violence against others rationalized by the end [keep Americans safe at any price] justifying the means [torture].

We have given away so much of our better selves as a result of our venture into Iraq. So many human, philosophical, and ethical casualties. We are still working through 30 years of our legacy in Viet Nam; our Iraq experience will likely take us as long or more to recover. Americans are fundamentally a good and generous people. But in the name of personal security we have long ago surrendered the moral high ground. While we point to the bad guys and say that all we do is permissible because our cause is just and ethical, the bad guys are equally convinced in the rightness of their cause. A cause that is a mystery to us, perhaps, but very clear and rational to them. And they have the willingness to do whatever is necessary to advance that cause. We are left to wonder --- what version of America are we defending?

When we operate on the same level as our enemy, we thereby implicitly endorse their actions. We become what we say we despise. It matters not who started a cycle of violence; that becomes irrelevant history in favor of who did what last. So their actions begat our actions begat their actions, and the cycle never ends.

John McCain, himself a torture victim in Viet Nam, is the only Republican presidential candidate forthright enough to denounce this mentality for the danger that it is. The other Republicans are too busy out-racing each other to be the ultimate war hardliner. Meanwhile, most of the Democratic candidates speak out against the use of torture, but are still trying to figure out how to present themselves as both a peace candidate and war president at the same time.

McCain, for whom this question is not a hypothetical question, understands the simple truth of reciprocity: that what we do to others inherently gives permission to others to do the same to us. We are entitled to no better treatment than what we give. When we inflict torture, no matter how seemingly justified in the short term, we invite the same treatment to our soldiers and civilians in the field. When we give away our morality in favor of revenge, how do we subsequently explain the abused and distorted body of a tortured soldier to his or her parents and family? “He did not die in vain” and “she served her country proudly” somehow just doesn’t seem to be enough.

We Still Pray

In this age of personal statement by bumper sticker, I frequently see the message “We Still Pray” on the back of cars in front of me. Actually, I am glad that the folks in that car apparently do so. God has given us so many forms in which to engage in prayer, meditation, or just quiet contemplation, the more people engage in prayer in their own way is no doubt to our collective benefit.

The thing I don’t quite understand is why someone feels the need to tell me that they do so. Did someone tell them they could not pray anymore? If it is some form of “I do it, maybe you’d like to do the same,” perhaps God doesn’t mind a little recruitment on his/her behalf. But more often than not, I suspect it is offered more as a political statement than a spiritual one. In reaction to a perceived threat from the secular world that prayer, and those who do so, are under attack. This brings us to a political theme of the last 30-odd years of legal decisions against prayer in the public venues (e.g. public schools, government functions, and public-funded recreational activities).

I confess I am strongly on the side of very hard lines of separation regarding legally-sponsored spiritual and religious activities in publicly-funded venues. Certainly not because I am opposed to spiritual activity and expression by people. But when you do those activities in publicly-funded (secular) places, the problem is --- whose spirituality will you use? Whose religious ritual and dogma shall be used by a collective group of dissimilar taxpayers?

The U.S. is the most mixed cultured country in the world. It has been so since our beginnings ever since religious and economic pilgrims from a multitude of European countries and religions first encountered the Native Americans already here. We have certainly had our difficulties throughout our history in assimilating and respecting all of these forms and cultures, but in our own erratic way we’ve continued to generally do pretty well with it over time. Yet we also still have many pockets of isolated culturally homogeneous areas, such as in my current home here in western North Carolina.

Some groups today insist on trying to define America as a “Christian nation,” yet nowhere do I see that codified in any of our founding documents. And given all the different religious forms that claim the mantel of Christian, and the track record of argument (if not violence) that has occurred within that label, I can hardly see how that standard can provide a unifying framework for religious expression in America. As we also watch non-Christian religions growing in number in the U.S., the idea that one spiritual language, one religious practice, one faith can be made either universal or a yardstick implodes on its own improbability.

No, the founding fathers were, as usual, highly insightful in understanding what was needed for this country to truly be free, united and welcoming. Make every possible opportunity for people to find and express their faith, in the company of like-minded spiritual worshipers, in their homes and those places dedicated to worship. Given its abysmal track record, leave the state out of this.

In the secular world of tax-supported institutions, my dollars are equal to your dollars. So in an open and public setting, will your prayer be used, or mine? Will we say the Catholic Lord’s Prayer or the Protestant version? Will we bow in Christian prayer, meditate in Buddhist silence, close down the post office for Yom Kippur, or fast together in the school cafeteria for Ramadan? Prayer has not been forbidden; where one might pray, and your ability to tell me how to pray, has correctly been limited. The religious majority today could well be the religious minority of tomorrow. Then whose prayer will we use?

Freedom of Speech Defended

Columbia University recently invited Iran’s President Mahmoud Ahmadinejad to speak on its campus and submit to a Q/A session. For this, the University has taken a lot of flack in conservative quarters for giving Ahmadinejad a public forum from which to speak. I, however, was delighted that the invitation was extended. Certainly not because I am any fan of Ahmadinejad and his positions. Rather, I do think he is an ill-informed political ignorant given what he has said are his beliefs and his views of the world that surrounds him. (Then again, we fail to acknowledge that we are generally quite similarly ignorant of the world, belief systems and cultural history from which he comes.) But by extending this invitation, we demonstrated to him (and the citizens of Iran and the world) what freedom of speech really means in this country, versus in Iran; we created the opportunity to Q/A a national leader in an open, non-staged debate (something our U.S. President has shown no willingness to do), versus in Iran; and we allowed that national leader the opportunity to make his case for his beliefs, or to fail, through civil discourse, versus in Iran. And in this instance, Ahmadinejad managed to fail miserably to convince, almost to the point of the laughable.

It is a shame that this important example of democratic free speech was lessened by the self-serving, uncivil and rude introduction of Ahmadinejad given by Columbia University President Lee Bollinger. It was, nevertheless, an otherwise “America at its best” moment: our willingness and ability to let hate and ignorance fail on its own through the light of the spotlight rather than exist in isolated darkness. Hard as it may be at times, requiring the courage of our willingness to air that with which we disagree, it is still what we are to be about: the faith that extremes will ultimately be exposed for what they are, and that truth ultimately wins out. Or, as a quote stated that I read in an unlikely place, “If we don’t protect freedom of speech, we’ll never know who the idiots are.” The reality is that we are never able to create an effective dialog, or reach a negotiated conclusion, with another individual until we first at least understand what that person thinks, and why she/he thinks it, no matter how foreign those may be to our own background and thought process. We must first listen before we speak. Only from that basis can effective dialog begin.

Potpourri #1

Some short thoughts on various subjects passing by ….
***
Alberto Gonzales. Finally gone, finally resolved. Hopefully we can now get back to respecting the Constitution with apolitical justice. Have any lessons been learned?

***
The talk show commentators are continuing their goal to trivialize important issues in favor of ratings-producing hysterical rantings over distracting trivia. To wit:
- does Obama’s recent decision not to wear an American flag lapel pin really denote a non-patriot / un-American? (I personally have never been too fond of bumper stickers on my car or on my lapel.)
- Does MoveOn.org’s New York Times ad about “General Betrayus” really require a Congressional denunciation over not being respectful of our soldier(s), while concurrently skipping over denouncing the Iraqi killing fields fiasco which has created the problem in the first place? (And since when did any self-respecting right-winger start admitting that they read the New York Times?)
- When you have no case of substance, we need to beware the demagogue who moves to distracting sloganeering.

***
George Bush has apparently suddenly become our historian-in-residence. He now says that “we failed to learn the lesson of the Viet Nam War.” He said that lesson to be learned was “not to leave early, but to see the mission through.” (Even though I thought the Iraqi “Mission [was] Accomplished” a couple of years ago.) I would hardly call 10 years of a stalemate quagmire and 40,000+ American deaths in Viet Nam as “not seeing it through.” Like Iraq, an outsider cannot “save” a country that does not really want to be saved or does not want to achieve the outsider’s vision, while it seeks to pursue its own ideological aspirations. In the long run, you cannot prop up an unrepresentative and ineffective government through a military presence. You can only at best conquer a country, which we certainly have not achieved in Iraq nor did Russia achieve in Afghanistan in the eighties during their middle-east intervention fiasco. You cannot win a military objective by lying and covering up to the American public the realities occurring on the ground. And the body count of how many dissenters you have labeled “un-American” diminishes fighting strength, not enhances it. Those are the real lessons of Viet Nam that the mid-level military men of the mid-1960s-70s and the American people learned. George Bush apparently skipped class that day, and read a different history book than the rest of us.