Make it so

August 21st, 2009

Considering that these are the final lazy days of summer, the last few have seen me jumping around like a flea at the dog pound; I’ve landed for the moment, with apologies for ignoring you. You, and politics, were never far from my mind. I will compensate now with a big fat stuffed weekend collection.

Since I last posted, the public option has been put on the block — the Libs are demanding it, Pelosi is insisting on it, the Oval is supporting it in demurred fashion, the Blue Dogs are dismissing it, the Pundits are declaring it dead and the Pubs are rejecting it, as they planned to all along.

A Rasmussen poll shows the public against Obama’s ‘plan’ 53 to 42; despite the historically conservative slant in all that Rasmussen produces, Ted Rall jumped on that one to explain why health care reform is a goner. Meanwhile, A new WSJ/USA Today poll indicates that 77% of us want the public option; that would be WSJ as in Wall Street Journal. Conservative gold standard, that. What to believe?

I think they’re digging the grave a bit early; the Blue Dogs still won’t release their proposition, gnawing away at any healthy flesh they still find, so there’s been no gathering to fight over the bones and see if there’s any life in them. Obama seems set to take a harder line in September — he’d better, if he wants to get the Lefty cats back at the scratching post; I’d also like to see him put a cork in Emanuel. There’s a reason I much preferred Dean to Rahm.

It’s surreal to think that the Pubs winning message is that government can’t do anything right so we’d better keep what we’ve got now … when it’s the Pubs themselves that have proven that government can’t do anything right. Self-fulfilling prophecy for those deeply entrenched in profit-gathering politics. And once again they have mustered their minions … now down to the baffled and bewildered that do not see that they are arguing for corporate control of their lives rather than the “freedom” they so prize … to channel their anger and disappointment at having lost the election.

So, tired of batting down lies and obfuscations, Obama is shifting the message … which has been fiscal up to now … to a moral one. This is interesting. Sojourners and other moderate religious groups have been busy peppering my in-box with support opportunities. I would welcome … indeed, be THRILLED … seeing the Christocrats pitted against the compassion of the actual Christ message, allowing their holier-than-thou mean-spiritedness to become transparent to the public eye. And about damned time.

Me, I think that Obama has already changed the American landscape; some Libs aren’t so sure, but I take the broader view. It is, however, critical to perception that he get the health care reform in place — not solely insurance reform. In order to do that, he NEEDS … as do we … public option; NOT token co-op’s. And what have WE done to make all that happen?

Not much. We got on the wagon by the multi-millions to send him to the Oval and then disappeared back into the comfort of our personal lives, leaving change to him. Now that the road is bumpy, we’re picking at him like chickens at a bug. He can’t do this himself; and the reason the disinformation train pulled into the station was because the Pubs know how to rally their feisty base, making them visible and annoying [not to mention, lately, dangerous.]

Sigh. While we’re discussing the surreal, think about this … when Dub had us by the short hairs — Oval and House and Senate — we worked like crazy to shout down the influx of policy changes and corporate give-aways that put us into the tank today, to limited success and great frustration. Now, WITH the Oval and the House and the Senate, we’re letting a bunch of obstructionists and gun-toting Libertarian survivalists WIN THIS CONVERSATION? WTF??? Stand up and DO something, citizen!

I know … getting Dems to agree is like herding cats — we get lost in the particulars, losing the larger picture. For once, couldn’t we all just get in line to see this accomplished? I know party unity isn’t our cup of kibble, but we’re shooting ourselves in the … ummm … paw by scratching and hissing at each other rather than presenting a united front to the lemmings across the divide. And even though the leaders are testy, the public gets it; Progressives are beginning to gather in large numbers at town halls, not to attend but to counter the Pub pickets. That’s exactly right; that gets reported on television news, where opinion … tragically … is made.

Here in the land of riding mowers and deep fat fryers, Fishin’ Jim and I recently took a ride out to Amish country to shop; they’re as close to health food as you can come in the country. On a winding dirt road, in search of hand-made furniture — left at the barn, right at the gnarled tree — we came across a plain little building Jim identified as the school. The door was slightly ajar, a spray bottle in front of it, so I thought perhaps it hadn’t convened yet; then, at one of the high windows I saw a little face, from the bridge of the nose up — blue eyes, a shock of blond hair and a little straw hat … watching the world drive by. That brief moment was PERFECT in its simplicity; lovely to behold, and worth the entire trip.

It occurred to me that the Amish are about as close to Socialism … discounting Mormon’s … as we come in this country. And it’s interesting that at the base of all socialist movements, protecting themselves from infection by outsiders seems to be the only way to make their systems work. On the way back, driving through hamlet after hamlet, Jim said if it wasn’t for deep fat fryers, the few greasy spoons we encountered would blow away and we’d forget that the back country was even there. In the Midwest, seems to me, many a bypass surgery can be directly tracked to a love of deep-fried tenderloin and chicken and potatoes. With white gravy. It will prove all but impossible to change health care without addressing lifestyle.

This national hearth care push is only the beginning. Medical care in this nation is all about profit. It treats symptom rather than cause; it pushes procedural technique, rather than prevention. It burgeons with specialists while creating a shortage of GP’s. We got more problems than just this first shot, identifying that the medical model is broken. And by the time you add the auxiliary business that health care supports … equipment and rehabs and hospitals and sterile supplies and insurance billing, yadda ad infinitum … you can understand why health care is STILL the only stable profession, in constant search for a new hire. It’s as ingrained in our consciousness as the military-industrial complex, and as far-reaching.

The following health care reads are the best of the last few days — clarifying stuff, and I’m giving TIME’s Joe Klein a spot at the table for using one of my trigger-words … nihilist … referencing the Pubs. The last in the collection, describing a health team that should have been giving emergency care in some Third World country, instead helping out thousands in Los Angeles who waited overnight for a chance at being seen by a professional, is just an exclamation point on where we are today. Unbelievable, and moreover, unacceptable!

The bonus is in remembrance of the Prince of Darkness, whose brain tumor finally took him. Novak was quite a piece of work; but a talented one, spanning decades of print and television. I chose articles that explore his quirks as much as his career. He’s been out of the spotlight for a year; seems like a century. But time is doing that folding thing it does, lately — I spoke to that in the weekly, here — and if you really want a moments pause on infamous names remembered, consider that Tom ‘The Hammer’ DeLay is joining this season of Dancing With The Stars. Hell, obviously, just froze over.

To amuse, and make up for my short absence, I’m including some ‘toons and clips. Ann Telnaes takes on the crazy’s and the public option, here and here; Rachel Maddow goes after the quivering Dems here, and decries the leap in insurance stock as the Village decides the public option is dead. Go here to watch Jon Stewart enter the fantasy-world of the Death Panel Diva, last night. Finally, and improbably, even Wal-Mart is backing off of Glenn Beck, pulling its commercials along with a dozen other corporate sponsors that don’t want to be slimed by proximity — we can thank Jon for going after him on a regular basis, and THIS clip is the best of it!

If you want to tell Obama that you’re uninterested in any reform without a robust public option similar to Medicare, you can sign this Credo petition.

Go over to http://www.barackobama.com to sign up to host or attend health care related events.

Take every opportunity to let your leadership know you’re serious as a heart attack about REAL REFORM. Write and fax and call and sign and picket — talk to everyone about the reality of leaving our future in the hands of insurance companies. If we don’t start pushing by the hundreds of thousands, the nation will believe the handful of wingnuts who think Grama’s going into the Star Chamber … when, in actuality, an end-of-life discussion between patient and doctor [NOT decided, as now, FOR the patient BY the provider] is what grown-up’s do.

Have a splendid weekend, you grown-up, you; make it so.

Jude

Hey, Don’t Save Me From Government Health Care!
Jon Soltz, Co-Founder of VoteVets.org - HuffPo
August 20, 2009

The whole health care debate has been completely confusing to me and a lot of the veterans and troops I talk with every day. See, for us, most of us got free, government-run health care.

First, troops in the Active Duty component and their families get TRICARE, the largest component in the military health care system, which allows them to go to military hospitals and doctors, as needed, and reimburses them for medical costs at private doctors, if they have to go there. For all intents and purposes, it’s a mix of the British system (government provided health care) and the Canadian system (a single-payer government run system). The system is so good that virtually every veterans advocacy group has backed extending it fully to the National Guard and Reserve, since they are being deployed now more than ever.

Basically, it’s a force readiness issue — giving this kind of care to troops — and why support for extending it to the Guard and Reserve is so strong. With all the added pressures from wars and increasing natural disasters, it’s essential that all our service members are given preventative care, to ensure they’re ready when we need them. We’re simply a stronger nation when our troops are kept healthy.

For many, there’s also the Department of Veterans Affairs. This is almost exactly like the British system of care. The government builds the hospitals and clinics. The government pays doctors, nurses, administrators, and others a salary. For those with service-connected injuries and disabilities sustained in war, the VA is invaluable. So much so, in fact, that every veterans group has tried to expand eligibility for VA care.

Finally, there’s also what’s called TRICARE For Life; basically the opportunity for many veterans to reenter the TRICARE system later on. And after you reach the Federal retirement age, that old government-run TRICARE will supplement your government-run Medicare, so you have little or no out-of-pocket expense.

So what’s the point here?

Even at the worst of times, when the Bush administration underfunded the VA by billions, leading to backlogs and some real horror stories, the Veterans Health Administration, which administers care, consistently hovered at 80 percent approval among its patients, higher than those in the private system. With the funding improvements in the budget and new construction of hospitals and clinics through the stimulus program, those numbers will absolutely go higher.

TRICARE has been rated the insurance plan with the highest customer satisfaction — better than any private plan for six years running!

Those on the Right keep harping on how they’re looking to “save” the American people from the horrors and evils of government-run insurance and care. Well, troops and veterans don’t want to be saved! In fact, when completely fabricated and false rumors started spreading that health reform would mean troops and veterans being tossed back into the private system, the major Veteran Service Organizations freaked out and wrote a letter to Congress demanding that they NOT be thrown back to for-profit care.

A final point: If government-run insurance and care is so evil and so horrible, then why do conservatives keep supporting leaving America’s troops and veterans in that kind of system? Do conservatives hold America’s warriors in such low standing that they’d subject us to a “Nazi” system, us Rush Limbaugh has called it?

You can’t have it both ways. Either TRICARE and the VA are superior systems, worthy of our sacrifice, and thus a government-managed health system can be great. Or, they’re terrible, scary, and Communist-Nazi schemes that have to be eliminated, leaving troops and veterans to find their own care for their lost limbs, brain injuries, and other wounds.

America’s veterans and troops would say the former. It’s why for years they have fought to expand the government programs, not kill them. That’s why we find it so confusing that conservatives want to bar the doors and keep those Americans who want to be in a public system from even having that choice. ++

Health Care as a Civil Right
Obama needs to reframe the debate.
Jonathan Alter,NEWSWEEK
Aug 15, 2009 - from the magazine issue dated Aug 31, 2009

The United States has two parties now-the Obama Party and the Fox Party. The Obama Party is larger, but it is unfocused and its troops are whiny. The Fox Party, which shows up en masse to harass politicians, is noisy and practiced in the art of simplistic obstruction. As the health-care debate rages, it’s the Party of Sort-of-Maybe-Yes versus the Party of Hell No! The Yessers are more lackadaisical because they’ve forgotten the stakes-they’ve forgotten that this is the most important civil-rights bill in a generation, though it is rarely framed that way. The main reason that the bill isn’t sold as civil rights is that most Americans don’t believe there’s a “right” to health care. They see their rights as inalienable, and thus free, which health care isn’t. Serious illness is an abstraction (thankfully) for younger Americans. It’s something that happens to someone else, and if that someone else is older than 65, we know that Medicare will take care of it. Polls show that the 87 percent of Americans who have health insurance aren’t much interested in giving any new rights and entitlements to “them”-the uninsured.

But how about if you or someone you know loses a job and the them becomes “us”? The recession, which is thought to be harming the cause of reform, could be aiding it if the story were told with the proper sense of drama and fright. Since all versions of the pending bill ban discrimination by insurance companies against people with preexisting conditions, that provision isn’t controversial. Which means it gets little attention. Which means that the deep moral wrong that passage of this bill would remedy is somehow missing from the debate.

Sure, it’s important to fight for a public option (or a souped-up cooperative that can be made nearly as good). And we need to stand against a secret deal with Big Pharma, tighten insurance regulation, and assure that the bill includes language establishing clearly that doctors and patients-not bureaucrats, who are no better than insurers-make medical decisions. But these worthy goals have overshadowed the moral principle of nondiscrimination. The well-meaning woman who left a message at my office saying that she wouldn’t demonstrate in support of any bill without a public option has lost her perspective. The same goes for those who focus on cost ahead of principle. Whether we can “bend the cost curve” in five years or 10 years is fundamentally unknowable.

Washington’s elite policy mandarins obsess over “out-year” projections that never prove accurate. We must “pay” for the bill with new revenue streams, but let’s not pretend that any of the real costs (and incentivized cost savings) are discernible now. Look at “cash for clunkers.” The money that Congress set aside for a year lasted less than a week. The short-term projections were off by 99 percent. Any bill this big will be full of unintended consequences and will have to be fixed. The only way the system can’t be fixed is if the bill dies and no one tries reform again for many years.

History suggests that major social policy unfolds on a continuum. The Social Security Act of 1935 disappointed liberal New Dealers because what was called “old-age insurance” covered only about half the adult population. It excluded farmhands, domestics, employees of small businesses, and most blacks. That was because FDR needed the votes of Southern Democrats, the Blue Dogs of their day. (The bill cleared the House Ways and Means Committee with only one Republican vote.) Similarly, the Civil Rights Act of 1957, immortalized in Robert Caro’s Master of the Senate, was weak tea. It had to be strengthened by the Civil Rights Act of 1964 and the Voting Rights Act of 1965. In the later bills, Lyndon Johnson betrayed Southerners he had made deals with in 1957. If Nancy Pelosi can’t break Rahm Emanuel’s promise to Big Pharma’s Billy Tauzin this year, she can try to break it in the future. And Tauzin will lobby for more favors as the all-important new regulations are issued. Nothing in Washington is ever set in stone.

The only thing that should be unbreakable in a piece of legislation is the principle behind it. In the case of Social Security, it was the security and peace of mind that came with the knowledge of a guaranteed old-age benefit. (Ronald Reagan and George W. Bush got slam-dunked when they tried to mess with that.) In the civil-rights bills, the principle was no discrimination on the basis of an unavoidable, preexisting “condition” like race.

The core principle behind health-care reform is-or should be-a combination of Social Security insurance and civil rights. Passage would end the shameful era in our nation’s history when we discriminated against people for no other reason than that they were sick. A decade from now, we will look back in wonder that we once lived in a country where half of all personal bankruptcies were caused by illness, where Americans lacked the basic security of knowing that if they lost their jobs they wouldn’t have to sell the house to pay for the medical treatments to keep them alive. We’ll look back in wonder-that is, if we pass the bill. ++

The GOP Has Become a Party of Nihilists
Joe Klein, TIME magazine
Thursday, Aug. 20, 2009

In one of those awful collisions between public policy and real life, I was in the midst of an awkward conversation about end-of-life issues with my father when Sarah Palin raised the remarkable idea that the Obama Administration’s attempt to include such issues in its health-care-reform proposal would lead to “death panels.” Let me tell you something about my family situation, a common one these days, in order to illuminate the obscenity of Palin’s formulation and the cowardice of those, like Senator Charles Grassley of Iowa, the lead Republican negotiator on the Senate Finance Committee, who have refused to contest her claim.

Both my parents are 89 years old. They have been inseparable, with the exception of my father’s service in World War II, since kindergarten. My mother has lost her sight and is quite frail. My father takes care of her and my aunt Rose, lovingly, with some — but not enough — private help at their home in central Pennsylvania. One night in early August, I had a terrible scare. I called home and Aunt Rose was freaking out; she didn’t know where my father was. All the worst possibilities crossed my mind — it turned out he was just getting the mail — as well as a very difficult reality: if he’d had a stroke, I would have had no idea about what he’d want me to do. I had lunch with him the next day to discuss this.

It wasn’t easy. My dad is very proud and independent. He didn’t really want to talk about what came next. He was pretty sure, but not certain, that he’d signed a living will. He was very reluctant to sign an enduring power of attorney to empower me, or my brother, to make decisions about his care and my mom’s if he were incapacitated. I tried to convince him that it was important to make some plans, but I didn’t have the strategic experience that a professional would have — and, in his eyes, I didn’t have the standing. I may be a grandfather myself, but I’m still just a kid in my dad’s mind. Clearly, an independent, professional authority figure was needed. And this is what the “death panels” are all about: making end-of-life counseling free and available through Medicare. (I’d make it mandatory, based on recent experience, but hey, I’m not entirely clearheaded on the subject right now.)

Given the heinous dust that’s been raised, it seems likely that end-of-life counseling will be dropped from the health-reform legislation. But that’s a small point, compared with the larger issue that has clouded this summer: How can you sustain a democracy if one of the two major political parties has been overrun by nihilists? And another question: How can you maintain the illusion of journalistic impartiality when one of the political parties has jumped the shark?

I’m not going to try. I’ve written countless “Democrats in Disarray” stories over the years and been critical of the left on numerous issues in the past. This year, the liberal insistence on a marginally relevant public option has been a tactical mistake that has enabled the right’s “government takeover” disinformation jihad. There have been times when Democrats have run demagogic scare campaigns on issues like Social Security and Medicare. There are more than a few Democrats who believe, in practice, that government should be run for the benefit of government employees’ unions. There are Democrats who are so solicitous of civil liberties that they would undermine legitimate covert intelligence collection. There are others who mistrust the use of military power under almost any circumstances. But these are policy differences, matters of substance. The most liberal members of the Democratic caucus — Senator Russ Feingold in the Senate, Representative Dennis Kucinich in the House, to name two — are honorable public servants who make their arguments based on facts. They don’t retail outright lies. Hyperbole and distortion certainly exist on the left, but they are a minor chord in the Democratic Party.

It is a very different story among Republicans. To be sure, there are honorable conservatives, trying to do the right thing. There is a legitimate, if wildly improbable, fear that Obama’s plan will start a process that will end with a health-care system entirely controlled by the government. There are conservatives — Senator Lamar Alexander, Representative Mike Pence, among many others — who make their arguments based on facts. But they have been overwhelmed by nihilists and hypocrites more interested in destroying the opposition and gaining power than in the public weal. The philosophically supple party that existed as recently as George H.W. Bush’s presidency has been obliterated. The party’s putative intellectuals — people like the Weekly Standard’s William Kristol — are prosaic tacticians who make precious few substantive arguments but oppose health-care reform mostly because passage would help Barack Obama’s political prospects. In 1993, when the Clintons tried health-care reform, the Republican John Chafee offered a creative (in fact, superior) alternative — which Kristol quashed with his famous “Don’t Help Clinton” fax to the troops.

There is no Republican health-care alternative in 2009. The same people who rail against a government takeover of health care tried to enforce a government takeover of Terri Schiavo’s end-of-life decisions. And when Palin floated the “death panel” canard, the number of prominent Republicans who rose up to call her out could be counted on one hand.

A striking example of the prevailing cravenness was Senator Johnny Isakson of Georgia, who has authored end-of-life counseling provisions and told the Washington Post that comparing such counseling to euthanasia was nuts — but then quickly retreated when he realized that he had sided with the reality-based community against his Rush Limbaugh-led party. Mitt Romney, the Republican front-runner for President according to most polls, actually created a universal-health-care plan in Massachusetts that looks very much like the proposed Obamacare, but he spends much of his time trying to fudge the similarities and was AWOL on the “death panels.” Why are these men so reluctant to be rational in public?

An argument can be made that this is nothing new. Dwight Eisenhower tiptoed around Joe McCarthy. Obama reminded an audience in Colorado that opponents of Social Security in the 1930s “said that everybody was going to have to wear dog tags and that this was a plot for the government to keep track of everybody … These struggles have always boiled down to a contest between hope and fear.” True enough. There was McCarthyism in the 1950s, the John Birch Society in the 1960s. But there was a difference in those times: the crazies were a faction — often a powerful faction — of the Republican Party, but they didn’t run it. The neofascist Father Coughlin had a huge radio audience in the 1930s, but he didn’t have the power to control and silence the elected leaders of the party that Limbaugh — who, if not the party’s leader, is certainly the most powerful Republican extant — does now. Until recently, the Republican Party contained a strong moderate wing. It was a Republican, the lawyer Joseph Welch, who delivered the coup de grâce to Senator McCarthy when he said, “Have you no sense of decency, sir, at long last?” Where is the Republican who would dare say that to Rush Limbaugh, who has compared the President of the United States to Adolf Hitler?

This is a difficult situation for the President. Cynicism about government is always easy, even if it now seems apparent that it was government action — by both Obama and, yes, George W. Bush — that prevented a reprise of the Great Depression. I watched Obama as he traveled the Rocky Mountain West, holding health-care forums, trying to lance the boil by eliciting questions from the irrational minority that had pulverized the public forums held by lesser pols. He would search the crowds for a first-class nutter who might challenge him on “death panels,” but he was constantly disappointed. In Colorado, he locked in on an angry-looking fellow in a teal T shirt — but the guy’s fury was directed at the right-wing disinformation campaign. Obama seemed to sag. He had to bring up the “death panels” himself.

This may tell us something about the actual state of play on health care: the nutters are a tiny minority; the Republicans are curling themselves into a tight, white, extremist bubble — but there may be enough of them raising dust to render creative public policy impossible. Some righteous anger seems called for, but that’s not Obama’s style. He will have to come up with something, though — and he will have to do it without the tiniest scintilla of help from the Republican Party. ++

Health Care’s Generation Gap
RICHARD DOOLING, NYT
August 16, 2009

IN the 1980s, I worked as a respiratory therapist in intensive-care units in the Midwest, taking care of elderly, dying patients on ventilators. I remember marveling, along with the young doctors and nurses I worked with, over how many millions of dollars were spent performing insanely expensive procedures, scans and tests on patients who would never regain consciousness or leave the hospital.

When the insurance ran out, or Medicare stopped paying, patients and their families gave the hospital liens on their homes to pay for this care. Families spent their entire savings so Grandma could make yet another trip to the surgical suite on the slim-to-none chance that bypass surgery, a thoracotomy, an endoscopy or kidney dialysis might get her off the ventilator and out of the hospital in time for her 88th birthday.

That was back in the mid-’80s, when the nation was spending around 8 percent of its gross domestic product on health care. I and other health care workers solemnly agreed that the spending spree could not continue. Taxpayers and insurance companies would eventually revolt and refuse to pay for such end-of-life care.

Somebody would surely expose the ruse for what it was: an enormous transfer of wealth based on the pretense that getting old and dying is a medical emergency requiring high-tech intensive-care intervention and armies of specialists, which could cost $10,000 or more per day. (Europeans have so far resisted this delusion, one reason they spend much less than we do on health care, with far better results.)

But we were wrong. Health care spending has since doubled, to around 16 percent of our gross domestic product, and in the next 25 years or so is projected to reach 31 percent of G.D.P. Despite having those figures in hand, Congress might still pass legislation calling for spending more, not less, on health care, even though we’ve been told for decades that what we spend has almost nothing to do with the quality of care we receive.

In fact, expensive care is often worse care, because it snowballs into what some are calling an “epidemic of overtreatment,” in which unnecessary procedures, tests and medications all spawn more tests, more meds (to treat the side effects of the first batch) and more follow-up scans and procedures (in stand-alone clinics owned by the same doctors prescribing the tests, scans and procedures).

With so much evidence of wasteful and even harmful treatment, shouldn’t we instantly cut some of the money spent on exorbitant intensive-care medicine for dying, elderly people and redirect it to pediatricians and obstetricians offering preventive care for children and mothers? Sadly, we are very far from this goal. A cynic would argue that this can’t happen because children can’t vote (even if their parents can), whereas members of AARP and the American Medical Association not only vote but can also hire lobbyists to keep the money flowing.

One thing’s for sure: Our health care system has failed. Generational spending wars loom on the horizon. Rationing of health care is imminent. But given the political inertia, we could soon find ourselves in a triage situation in which there is no time or money to create medical-review boards to ponder cost-containment issues or rationing schemes. We’ll be forced to implement quick-and-dirty rules based on something simple, sensible and easily verifiable. Like age. As in: No federal funds to be spent on intensive-care medicine for anyone over 85.

I am not, of course, talking about euthanasia. I’m just wondering why the nation continues incurring enormous debt to pay for bypass surgery and titanium-knee replacements for octogenarians and nonagenarians, when for just a small fraction of those costs we could provide children with preventive health care and nutrition. Eight million children have no health insurance, but their parents pay 3 percent of their salaries to Medicare to make sure that seniors get the very best money can buy in prescription drugs for everything from restless leg syndrome to erectile dysfunction, scooters and end-of-life intensive care.

Sir William Osler, widely revered as the father of modern medicine, said, “One of the first duties of the physician is to educate the masses not to take medicine.” Perhaps the second duty should be to administer an ounce of prevention instead of a pound of cure. ++

Want to Lower The Healthcare Price Tag? The Insurance Debate is Just the Beginning
Zack Cooper, HuffPo
August 21, 2009

All the brouhaha over insurance co-operatives, the public plan, and Sarah Palin’s fictitious death panel creates the false impression that our healthcare system is the sole determinant of our health. It’s not. Our individual behavior — how much we smoke, drink, and exercise — rather than the way our healthcare system is structured, is what is really going to determine whether our healthcare system is financially sustainable over the next 50 years.

It turns out that about 40% of deaths in the US are caused by some of our less than perfect behaviors like eating foods that are high in trans fats, smoking too much, having unprotected sex or not exercising enough. By contrast, shortcomings in medical care and limited access to healthcare are only responsible for about 10% of our deaths. As a result, trying to reduce healthcare spending by focusing exclusively on insurance coverage and healthcare provision is like trying to halve the murder rate by chasing after bullets once they’ve already left the gun.
It is abhorrent that not everyone in the US has access to quality, affordable medical care, but that is not why we’re spending more money on healthcare than any other industrialized nation. We spend more on healthcare because of our bad habits. While proving universal healthcare coverage is a moral imperative, we need to realize that it is not a silver bullet for reducing costs.

This reality was made crystal clear last week when Britain’s National Health Service entered the US healthcare debate. When it came to quality, the American system was clearly better. According to the most recent OECD data, five-year breast cancer survival in Britain was 77.8% compared to 90.1% in the US. Five year-prostate cancer survival in Britain was 51.1%, compared with 91.1% survival in the US. Likewise, the death rate for heart attacks in the US was significantly lower too. Nevertheless, the British have a higher life expectancy, a lower rate of coronary heart disease, spent less money on healthcare and were in better overall health.

So why aren’t we talking more about ways to improve our underlying health? Politics, of course. Addressing our underlying health means spending extra money and altering our behavior now, which will result in health benefits in the future. If you thought the debate over the public plan got rough, wait until you see town hall meetings over a federal ban on deep fryers. Tackling the behaviors that lead to poor health and high spending also means developing policies that tread very close to our individual choices, values and culture. It raises what they refer to in Britain as the nanny-state issue. Do we really want to see the federal government telling us we can’t eat certain foods, need to exercise more and shouldn’t smoke?

While we’re uncomfortable with the nanny-state, we’ve already started to see some laws that tackle the causes of ill health. A number of states have banned smoking in restaurants. Connecticut has recently passed a law that requires chain restaurants to publish the calories in the items on their menus. And New York City has passed a law banning trans fats from being used in restaurants. This trend teaches us an important lesson - many of the legislative steps necessary to improve our underlying health and slow health spending are probably going to need to start locally.

We’ve also seen healthcare providers and the business community begin to focus on health improvement. At the Henry Ford Medical Center, staff are teaching patients how to cook healthier foods alongside providing medical care. At the Cleveland Clinic, the CEO has banned trans fats from their cafeteria, eliminated sugared beverages from their vending machines and he has gone so far as to refuse to hire smokers. These steps aren’t just the result of the goodwill of employers; instead they stem from strong business savvy. Research by Kevin Volpp and his colleagues has shown that when private companies financially reward employees for staying healthy, it’s good for the employees and the employers.

These types of health improving policies are ultimately going to have a bigger impact on bringing down the costs of healthcare than what is being proposed in the current reforms. That’s not to say that we shouldn’t seek universal coverage and make the insurance market more competitive, but it does suggest the Federal government needs to be more proactive creating incentives for states, local governments, private companies and insurers to offer these types of health-improving programs.

As the healthcare debate rages on, it is important to keep in mind the limits of what our healthcare system can accomplish. Right now, 95% of American healthcare dollars go towards paying for medical care and only about 5% go towards proactive measures to improve public health. If we really want to see a significant change in how much we spend on healthcare per year, that 95% to 5% ratio will have to change dramatically. ++

Brutal truth about US healthcare
An extraordinary report from Guy Adams in Los Angeles at the music arena that has been turned into a makeshift medical centre
Guy Adams, Belfast Telegraph
Saturday, 15 August 2009

They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury.

Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunisations that could end up saving their life.

In the week that Britain’s National Health Service was held aloft by Republicans as an “evil and Orwellian” example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.

The LA Forum, the arena that once hosted sell-out Madonna concerts, has been transformed – for eight days only – into a vast field hospital. In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.

In the first two days, more than 1,500 men, women and children received free treatments worth $503,000 (£304,000). Thirty dentists pulled 471 teeth; 320 people were given standard issue spectacles; 80 had mammograms; dozens more had acupuncture, or saw kidney specialists. By the time the makeshift medical centre leaves town on Tuesday, staff expect to have dispensed $2m worth of treatments to 10,000 patients.

The gritty district of Inglewood lies just a few miles from the palm-lined streets of Beverly Hills and the bright lights of Hollywood, but is a world away. And the residents who had flocked for the free medical care, courtesy of mobile charity Remote Area Medical, bore testament to the human cost of the healthcare mess that President Obama is attempting to fix.

Christine Smith arrived at 3am in the hope of seeing a dentist for the first time since she turned 18. That was almost eight years ago. Her need is obvious and pressing: 17 of her teeth are rotten; some have large visible holes in them. She is living in constant pain and has been unable to eat solid food for several years.

“I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,” she told The Independent. “I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.”

Along the hall, Liz Cruise was one of scores of people waiting for a free eye exam. She works for a major supermarket chain but can’t afford the $200 a month that would be deducted from her salary for insurance. “It’s a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?” she asked. “I’m one of the working poor: people who do work but can’t afford healthcare and are ineligible for any free healthcare or assistance. I can’t remember the last time I saw a doctor.”

Although the Americans spend more on medicine than any nation on earth, there are an estimated 50 million with no health insurance at all. Many of those who have jobs can’t afford coverage, and even those with standard policies often find it doesn’t cover commonplace procedures. California’s unemployed – who rely on Medicaid – had their dental care axed last month.

Julie Shay was one of the many, waiting to slide into a dentist’s chair where teeth were being drilled in full view of passers-by. For years, she has been crossing over the Mexican border to get her teeth done on the cheap in Tijuana. But recently, the US started requiring citizens returning home from Mexico to produce a passport (previously all you needed was a driver’s license), and so that route is now closed. Today she has two abscesses and is in so much pain she can barely sleep. “I don’t have a passport, and I can’t afford one. So my husband and I slept in the car to make sure we got seen by a dentist. It sounds pathetic, but I really am that desperate.”

“You’d think, with the money in this country, that we’d be able to look after people’s health properly,” she said. “But the truth is that the rich, and the insurance firms, just don’t realise what we are going through, or simply don’t care. Look around this room and tell me that America’s healthcare don’t need fixing.”

President Obama’s healthcare plans had been a central plank of his first-term programme, but his reform package has taken a battering at the hands of Republican opponents in recent weeks. As the Democrats have failed to coalesce around a single, straightforward proposal, their rivals have seized on public hesitancy over “socialised medicine” and now the chance of far-reaching reform is in doubt.

Most damaging of all has been the tide of vociferous right-wing opponents whipping up scepticism at town hall meetings that were supposed to soothe doubts. In Pennsylvania this week, Senator Arlen Specter was greeted by a crowd of 1,000 at a venue designed to accommodate only 250, and of the 30 selected speakers at the event, almost all were hostile.

The packed bleachers in the LA Forum tell a different story. The mobile clinic has been organised by the remarkable Remote Area Medical. The charity usually focuses on the rural poor, although they worked in New Orleans after Hurricane Katrina. Now they are moving into more urban venues, this week’s event in Los Angeles is believed to be the largest free healthcare operation in the country.

Doctors, dentists and therapists volunteer their time, and resources to the organisation. To many US medical professionals, it offers a rare opportunity to plug into the public service ethos on which their trade was supposedly founded. “People come here who haven’t seen a doctor for years. And we’re able to say ‘Hey, you have this, you have this, you have this’,” said Dr Vincent Anthony, a kidney specialist volunteering five days of his team’s time. “It’s hard work, but incredibly rewarding. Healthcare needs reform, obviously. There are so many people falling through the cracks, who don’t get care. That’s why so many are here.”

Ironically, given this week’s transatlantic spat over the NHS, Remote Area Medical was founded by an Englishman: Stan Brock. The 72-year-old former public schoolboy, Taekwondo black belt, and one-time presenter of Wild Kingdom, one of America’s most popular animal TV shows, left the celebrity gravy train in 1985 to, as he puts it, “make people better”.

Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.

Though anxious not to interfere in the potent healthcare debate, Mr Brock said yesterday that he, and many other professionals, believes the NHS should provide a benchmark for the future of US healthcare.

“Back in 1944, the UK government knew there was a serious problem with lack of healthcare for 49.7 million British citizens, of which I was one, so they said ‘Hey Mr Nye Bevan, you’re the Minister for Health… go fix it’. And so came the NHS. Well, fast forward now 66 years, and we’ve got about the same number of people, about 49 million people, here in the US, who don’t have access to healthcare.”

“I’ve been very conservative in my outlook for the whole of my life. I’ve been described as being about 90,000 miles to the right of Attila the Hun. But I think one reaches the reality that something doesn’t work… In this country something has to be done. And as a proud member of the US community but a loyal British subject to the core, I would say that if Britain could fix it in 1944, surely we could fix it here in America.”

Healthcare compared -

Health spending as a share of GDP
US 16%
UK 8.4%

Public spending on healthcare (% of total spending on healthcare)
US 45%
UK 82%

Health spending per head
US $7,290
UK $2,992

Practising physicians (per 1,000 people)
US 2.4
UK 2.5

Nurses (per 1,000 people)
US 10.6
UK 10.0

Acute care hospital beds (per 1,000 people)
US 2.7
UK 2.6

Life expectancy:
US 78
UK 80

Infant mortality (per 1,000 live births)
US 6.7
UK 4.8

Source: WHO/OECD Health Data 2009 ++

bonus

My Interview With Robert Novak
Conor Clarke, Daily Dish
18 Aug 2009

Columnist Robert Novak is dead, from a malignant brain tumor, which by most accounts was a pretty terrible way to go. Just about everyone in Washington has a Novak story — being a Washington institution will do that to you — and I’m no exception. Almost exactly two years ago, I wrote a profile of Robert Novak for the Guardian newspaper. This, naturally, called for interviewing him, so I did.

Novak was, to be perfectly honest about it, the least pleasant person I’ve ever interviewed. He didn’t shake my hand upon entering or leaving his office, and expressed fairly open contempt when I asked him a question about the Valerie Plame affair. His response was: “You can’t imagine how tired I am of answering those questions.” And then he proceeded not to answer the question.

I don’t mean to rag on the guy. It wasn’t his job to be pleasant — certainly not to the kind of nervous and uppity young reporter he ate for breakfast — and I didn’t get the sense he tried to give anyone an impression to the contrary. I hope it’s fair to say that he embraced the reputation that preceded him, and that the face grew to fit the mask. You don’t call your memoir “The Prince of Darkness” if you’re hoping to make new friends. (And on the day that I sat down with him I remember, distinctly, that he was wearing the same suit and tie that he wore glowering on the cover of his new book.)

There are many people who think, for good reason, that his career was spotted by ethical lapses — like trading access for protection (you were, famously, a “source or a target”), or outing sources after they died. Novak was unapologetic about all of that. About his conduct in the Plame affair, he told me: “It’s an irrelevant question to ask what I would do if I could do it all over again, because I don’t have the chance to do it all over again. It’s done.”

So he was perhaps a bit of a jerk, but an admirably fatalistic one. The first thing he said to me was this: “I don’t watch my words very closely. I’m 76 years old, and I don’t have that much time on this earth. There’s very little people can do to hurt me, and so I say what I want to say.” And, to his credit or not, he did just that. ++

My friend Bob Novak
Paul Begala, CNN
8/18/09

Editor’s note: Paul Begala, a Democratic strategist and CNN politicalcontributor, was a political consultant for Bill Clinton’s presidentialcampaign in 1992 and was counselor to Clinton in the White House. He was aco-host of “Crossfire” on CNN with Robert Novak from 2002 to 2005. Paul Begala says he admired Robert Novak for his skepticism about authority,work ethic and faith in his beliefs.

In our innumerable debates, I delighted in calling Bob Novak “the finest mind of the 12th century.” One time, though, he scowled and growled, “I prefer the 15th century. Spanish Inquisition. Those were the days.”

Novak left this world on Tuesday, but he also left his mark. Needless to say I disagreed with Bob about virtually every political issue, and sometimes our on-air debates continued as profanity-laced shouting matches after the show ended. Despite our profound differences, though, we were friends. Here’s why:

Bob was an iconoclast. He loved poking conventional wisdom in the eye. If all the media elite were perched on the same wire, Bob would land on the opposite wire and gleefully squawk at them.

Bob was an ideologue more than a partisan. One of the many sources of tension between us was the fact that I am a partisan Democrat who believes that, from time to time, my personal ideological agenda must take a backseat to advancing a broader progressive agenda carried by my party. Not Bob. He was a conservative first, last and always, and when he felt the Republican Party had strayed from his hard-core anti-tax, anti-government ideology he would hammer the GOP with the same withering ridicule he usually dispensed to Democrats.

Bob was deeply skeptical of authority. He was a lowly lieutenant in the United States Army, and he instinctively distrusted big shots — a rarity in a town that is often dazzled by rank. For a guy who said he preferred business to government, he was not afraid to show his contempt for network executives with whom he disagreed.

Bob had a remarkable work ethic. In the predawn hours after the 2004 presidential debate in Miami, Bob slipped in the shower, breaking his hip. The injury was terribly painful, and Bob was rushed to the hospital. Within 24 hours he was propped up in bed, working the phones and banging out a column on his laptop.

Bob was an old-school reporter. Most pundits (your humble author included) devour the reporting of others and regurgitate our opinions. While strongly opinionated, Bob also reported. His sources, especially in the GOP, were wide and deep.

When I was a White House official, one of my most dreaded responsibilities was dealing with Bob. He didn’t support much of anything we were trying to do, but he never lied to me, never broke his word, and tried his hardest to get things right. Accuracy mattered enormously.

Bob could be civil. This will astonish some, because Bob could also be rude. But he taught me at least one lesson in civility. On “Crossfire,” I carried a debate over into the commercial break.

I badgered and hectored and attacked the guest who was on the right. I was angry and I let him have it. “Wait just a #*& $@#^ minute,” Bob screamed at me. “You’re out of line. You’re being rude. Get off his back. He’s come here on our show to make his case and you’re abusing him. We call them ‘guests’ for a reason, Paul.” He was right.

Bob loved sports. One tiny island of common ground Bob and I could share was a love of sports. When James Carville and I joined “Crossfire” in 2002, CNN had a much-hyped debut planned for April 1. Bob didn’t care. Maryland was playing for the NCAA basketball championship and he was going to be there. Producers pleaded, but Bob was unmoved. He did the show via satellite from Atlanta, Georgia, and when Coach Gary Williams cut down the net for the Terps, Bob was courtside.

Bob became a Catholic. My brand of Catholicism and Bob’s were as different as our brands of politics, but as a cradle Catholic I admire anyone who, at age 67, is still seeking the divine, still questioning, still open to a new faith. We spoke about faith often, and I’m sure his Catholic faith gave him great comfort as he battled the disease that claimed his life. Requiem in pace, friend.

Or, as Bob might prefer: Goodnight, sweet Prince of Darkness. ++

Robert Novak, the Prince of Darkness for better or worse…
Phil Bronstein, San Francisco Chronicle via HuffPo
August 18, 2009

Criticizing the recently deceased is as rude as punking the Queen of England at an official event: it’s bad form both in terms of timing and reasonable respect.

As a journalist, I know I should revere Bob Novak, whose death from brain cancer was announced this morning, almost as much as the genuflecting and genuinely saddened colleagues are now doing on his alma mater, CNN. I doubt this mourning will reach Cronkite proportions, but Mr. Novak did have lots of influence over many years, was seemingly fearless in his views, straddled print and broadcast reporting successfully and made it nearly fashionable for TV guys to have combovers (see: David Gergen.)

[open link for YouTube]

Someone noted in one of the black-bordered eulogy TV segments this morning that he was called “The Prince of Darkness,” not by his enemies but by his friends because of his contacts and his power to move the D.C. discussion. I remember once being at dinner in a capital steak house when Bob Novak came in. He had that invisible wake around him that surrounds celebrities, that sense that the molecules in the room bend when someone famous arrives.

There was a line-up to shake his hand, adulation he accepted graciously but that seemed to make him grow larger and more luminescent with each fawning comment.

But the Darkness thing reminds me of a very different Novak moment.

I was covering the bloody conflict in El Salvador in the late ’80s. I’m not an either/or person, generally, and I had good relations with colonels on the right and guerrillas on the left. As in most of real life, the situation was more complicated than slogans or sound bites.

So I go to a disinterment of a couple of murder victims on the dusty outskirts of town. The grave re-diggers were, as they mostly were for these things, drunk, so it took a painfully long time. The few of us who were witnesses had to put some kind of cloth over our noses and mouths because there’s nothing as horribly ripe as a decomposing human body.

The two dead men had been buried hastily in a shallow grave. Their thumbs were tied together behind their backs and there were other infamous signatures of a Salvadoran death squad hit that are too gruesome to describe even for this blog. The fact that the victims were seen being hustled into a Cherokee Chief with smoked windows, the signature Death Squad vehicle of choice, and that they were leftist labor organizers made it clear what was up. (The guerrillas had their own killing apparatus, but it was mostly aimed at mayors in rural villages.)

Once they were dug up and carted off for more examination, I left, the stench of the grim, hazy afternoon event still in my nostrils. I was sure it was also on my clothes and in my pores. How could such a vital and vile thing not be?

I went to my rented house in the Escalon district of Salvador and slumped in a chair in front of an old TV set with rabbit ears. At certain times in the late afternoon, if the weather was just right and you fiddled with the antennae, we could get a few minutes of CNN.

There was Robert Novak, screaming at someone — probably Michael Kinsley on “Crossfire” — like an enraged health care town hall meeting participant: “Death squads in El Salvador is a liberal MYTH!”

I haven’t been accused of being a liberal all that much, and, as Christiane Amanpour said so wonderfully in Iraq, “Wolf, I can only tell you what I can see,” but I can tell you reliably that Salvadoran death squads were as real as Scooter Libby and Evans and Novak.

At the time, I wanted to reach through the TV screen and strangle the guy into sensibility. Or have the two tragic dead men delivered, without benefit of makeup, on his front lawn.
It wasn’t a liberal-conservative thing. Death squads were a fact.

Whatever else Bob Novak did well, even superbly in his professional life — a great deal, I don’t doubt — at that moment he did a huge disservice to the truth and to the memory of thousands of people who died violently, painfully and without justification in El Salvador.

Now, please let’s return to our ritual of respectful remembrance. ++

“I’m asking you to believe. Not just in my ability to bring about real change in Washington … I’m asking you to believe in yours.”
~ Barack Obama

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Entry Filed under: Political Waves