Sunday, December 27, 2009

Should We Support the Senate Health Care Bill?

So the Senate finally passed a health care reform bill the morning of Christmas Eve. While the president hailed it as a landmark event, for many others who voted for President Obama especially because of his support for health care reform it was a bittersweet moment. Those who were hoping for real reform in the form of a public option or even a Medicare buy-in for those 55-65 years of age were disappointed to see the proposed bill systematically taken apart by various senators such as Joe Lieberman and Ben Nelson in exchange for their votes to reach the magic number of 60 to defeat the Republican filibuster that would have killed the bill.

Indeed, noted liberal commentator Keith Olbermann offered one of his
Special Comments which in effect said that the Senate bill was ruined to the point of being unsupportable. Before that former Democratic National Committee chairman Howard Dean said the same thing although he has softened his stance since then and said that he now reluctantly supports the bill.

There is a lot not to like about the Senate bill that was passed. For one thing, those of us without insurance coverage from employers would be required to buy health insurance from the private insurance industry under threat of a fine. Even worse, without any public insurance plan to compete, it is unclear what if any constraints there will be on premiums or if they will even be affordable to everybody. In an attempt to make the insurance affordable, federal subsidies will be available which in effect will amount to a massive transfer of tax dollars to the already wealthy insurance industry.

While the House which has a larger Democratic majority approved a bill that includes a public option and is much more reform-minded, the Senate cannot effectively pass anything with less than the 60 votes needed to avert a filibuster. And with the Republicans not offering a single vote in favor of the bill, the 58 Democrats and 2 Independents must all vote in unison or be defeated.

As NYT columnist Thomas Friedman has suggested, in the Senate we now have what can effectively called one party rule (the Democrats) in a two party system (with the Republicans serving as obstructionists) which makes passing needed legislation most difficult. Without any bipartisan support from the Republicans, the Democrats need absolutely all of their votes to prevail which means that tremendous compromises (which water down the bill) are needed to get the few stragglers such as Liebermann and Nelson to come on board.

The next step will be to reconcile the House and Senate bills to provide a single bill for both houses to vote on. While there are some who still think they can fight to reform the Senate bill into one more to their liking, the Senate stragglers out of the 60 who voted for the bill before have pledged that any changes would result in losing their support for the final bill.

So like it or not, we will most likely have to choose between the Senate version of the bill or no reform bill at all. For all of its warts, getting millions of people finally insured is better than no reform at all. Eliminating refusals to insure people for pre-existing conditions will be a major step forward for these individuals.

But how will this all work out? Will the insurance industry still be able to game the system to get the upper hand while too many people will still be unable to obtain affordable health insurance? The answer is probably yes. But if that happens, there is always the opportunity to pass legislation later on to try and correct those inequities. And it is true that Social Security and later Medicare first had gaps in their coverage that were fixed by later legislation.

While making these mid-stream corrections might well be difficult in this extremely polarized Congress, it’s a whole lot easier to work with an existing program later on than with no program at all which is what we have now. Especially considering that this is the best we can hope for with the Senate rules the way they are, the pragmatists amongst us who support health care reform have little real choice but to hold our noses and support this bill.

Sunday, December 13, 2009

Why Did Tiger Stray?

The announcement by Tiger Woods that he is taking an indefinite leave from golf is the latest chapter of a story about a man so universally admired before he crashed and burned among the accusations and now his admitting of having affairs with perhaps many other women. But the question remains: How could this have happened? This was a man who truly had it all — a fabulous career, incredible wealth, a beautiful wife and two beautiful children.

Before going further, I need to stress that this is not an attempt to justify Tiger’s behavior but is instead to try and explain why it may have happened. Granted, we do not know about the nature of the relationship with his wife, Elin since Tiger has so zealously protected their privacy. But Tiger does have a lot in common with other rich and powerful people who have been part of sexual scandals. And that gives us some clues.

So how did Tiger get to the pinnacle of the golf world? Of course talent has a lot to do with it but that by itself is not enough. To reach the pinnacle of any field whether it’s golf, or politics, or any other endeavor requires an incredible amount of drive and ego. People like this are certainly not like you and me. These people have an insatiable appetite for success and new conquests.

For Tiger, it was not just about becoming a pro golfer. It was about becoming the greatest golfer of all time. Unlike even most other PGA Tour golfers, it wasn’t about trying to win a major tournament or two sometime during their careers. It was about surpassing the all-time majors record of Jack Nicklaus. And despite all of his wins, his hunger for victory remains undiminished. Despite his wealth which may now be close to a billion dollars, he is still a money generating machine with not only his golf winnings and overseas appearance fees but also through his many lucrative endorsements. So when is it all enough? For many such people, there is no such thing as enough.

Presumably, Tiger when he was one of the world’s most eligible bachelors did just fine on the dating scene. But for many of us, that is not enough so we seek something more lasting in the form of a permanent partner and perhaps some children which is what Tiger chose when he married Elin. And for most of us, that is enough. Yes we have to choose one partner but we get something in return in the form of a loving and stabile relationship.

But for those who have this almost superhuman drive, is settling for one partner always enough? Why not try to have what they see as the best of both worlds which is to have the stability of a wife and children and also prowl for women on the side? Here for most of us, common sense gets the better of our egos. Important moral issues aside, for most of us, we know that if we cheat we will likely get caught sooner or later and suffer the consequences.

Surely the famous should know that they are far more likely to get caught getting into trouble in this age when a famous face can now be caught even on a cell phone camera. This is what happened to Olympic swimmer Michael Phelps when he inhaled from a marijuana bong at a party. And then there is the inevitable trail of E-mails, cell phone records along with text and voice messages to satisfy the hunger of the 24/7 news operations and gossip tabloids.

Making it even worse is that a wealthy public figure who engages in sexual escapades is especially vulnerable to blackmail or extortion threats as David Letterman found out. Anybody with a normal ego would know their limitations. But for those with such powerful egos, they can somehow assure themselves that even though most others sooner or later get caught, it won’t happen to them.

But no matter how much a man like Tiger wishes to stray, he can’t do it without willing accomplices. While there is understandable outrage at Tiger’s behavior, there appears to be considerably less outrage at the endless parade of women who are proudly boasting to the world about their alleged affairs with a man they most certainly knew was married.

Interestingly enough, instead of a married man being a turn-off for many women, a NYT blog by John Tierney,
Do Single Women Seek Attached Men? offers evidence to the contrary.

Now there’s experimental evidence that single women are particularly drawn to other people’s partners, according to a report in the Journal of Experimental Social Psychology by two social psychologists, Melissa Burkley and Jessica Parker of Oklahoma State University.

Noting that single women often complain that “all the good men are taken,” the psychologists wondered if “this perception is really based on the fact that taken men are perceived as good.”
But more to the point…

To the men in the experiment, and to the women who were already in relationships, it didn’t make a significant difference whether their match was single or attached. But single women showed a distinct preference for mate poaching. When the man was described as unattached, 59 percent of the single women were interested in pursuing him. When that same man was described as being in a committed relationship, 90 percent were interested.

Again, this is not meant to justify Tiger’s behavior. But if true, this all goes a long way towards explaining how it could happen.

So now that Tiger has been caught, he now knows that he has to make a choice between philandering and keeping his marriage intact (assuming Elin doesn’t leave him). While leaving golf for a while to sort out their relationship may well be the best thing for them, Tiger’s insatiable drive to be the best golfer ever will never go away. Hopefully, Elin realizes this and won’t make it a choice between her and golf for too long.

Sunday, November 29, 2009

Let the Health Care Debate Begin

So the debate in Congress by the Senate over health care reform is finally about to begin. For those in favor of reform, it has been terribly frustrating to put up with the same tired arguments of “socialized medicine” and “government takeover of health care” from those opposing the Democrats’ proposed bills. It’s one thing to criticize; but the problems faced by those who are unable to obtain affordable health insurance are real. What is the Republican alternative to help these people?

A recent article by conservative columnist and physician Charles Krauthammer
Kill these bills, then do health reform right sounds promising because it at least suggests some alternatives. But do they really solve the problem of the uninsured or are they little more than right-wing talking points?

Of course the reader can read the entire commentary in the link above. But I would like to provide some excerpts with some commentary of my own.
The United States has the best health care in the world -- but because of its inefficiencies, also the most expensive.
The quality of health care in the US is not in question. But it doesn’t matter how good health care is if one cannot get access to it due to lack of insurance. There is no question that we spend far more per capita than other countries that do provide true universal health care. Most importantly, it is only in the US where people die or go bankrupt for lack of coverage. Instead of pretending that the US is the best at everything, we should look to adopt what works in other countries.
The bill is irredeemable. It should not only be defeated. It should be immolated, its ashes scattered over the Senate swimming pool.
The bill even in the eyes of supporters has many flaws. But it least it would end the practice of people being denied coverage for pre-existing conditions or dropped because they got sick and had to file a claim. Do any Republican alternatives even address this?

Then do health care the right way -- one reform at a time, each simple and simplifying, aimed at reducing complexity, arbitrariness and inefficiency.

First, tort reform. This is money -- the low-end estimate is about half a trillion per decade -- wasted in two ways. Part is simply hemorrhaged into the legal system to benefit a few jackpot lawsuit winners and an army of extravagantly rich malpractice lawyers such as John Edwards.
The idea behind tort reform is that if we limit damages that patients can sue for, the cost of malpractice insurance would then go down which would help to make health care more affordable.

But in a paper by Americans for Insurance Reform,
Stable Losses/Unstable Rates they come up with this conclusion:

Specifically, AIR has consistently found that total payouts (by insurance companies) have been stable, tracking the rate of medical inflation, but premiums have not. Rather, premiums that doctors pay rise and fall in sync with the state of the economy, reflecting profitability of the insurance industry, including gains or losses experienced by the insurance industry’s bond and stock market investments.

They explain further:

Insurers make most of their profits from investment income. During years of high interest rates and/or excellent insurer profits, insurance companies engage in fierce competition for premium dollars to invest for maximum return. Insurers severely underprice their policies and insure very poor risks just to get premium dollars to invest. This is known as the “soft” insurance market.

But when investment income decreases — because interest rates drop or the stock market plummets or the cumulative price cuts make profits become unbearably low — the industry responds by sharply increasing premiums and reducing coverage, creating a “hard” insurance market usually degenerating into a “liability insurance crisis.”
So the assertion is that the low interest rates and poorly performing stock market of this last decade has been the main driver of higher malpractice premiums and not an increase in claims. If so, then the main beneficiary of tort reform will be none other than the insurance industry which has been vigorously lobbying for and financing the opposition to health care reform.

Second, even more simple and simplifying, abolish the prohibition against buying health insurance across state lines.

Some states have very few health insurers. Rates are high. So why not allow interstate competition? After all, you can buy oranges across state lines. If you couldn't, oranges would be extremely expensive in Wisconsin, especially in winter.
But health insurance is an extremely complex product that is subject to regulations that each state has established. As explained by in their paper Across State Lines Explained:

Allowing the state laws chosen by the insurance company, rather than the laws of the state where the consumer lives to govern health insurance regulation is what makes this policy so controversial.
But if some states do indeed have high rates because of very few competitors, why don’t other companies become licensed in those states to provide some competition and lower prices now? Maybe it’s at least in part because of the
McCarran-Ferguson Act passed by Congress in 1945 which has granted the health insurance industry an exemption from federal anti-trust laws and captive markets with no curbs on price fixing and other anti-competitive practices. In addition, critcs feel that allowing this competition across state lines may provide for better prices for the young and healthy but would still not address the needs of those who cannot get insurance because of pre-existing conditions.

Third, tax employer-provided health insurance. This is an accrued inefficiency of 65 years, an accident of World War II wage controls. It creates a $250 billion annual loss of federal revenues -- the largest tax break for individuals in the entire federal budget.
My, what would the Tea Partiers who watch Krauthammer on Fox News have to say about this idea to raise taxes? In any event, Krauthammer overstates the amount of savings compared to the
White House Office of Management and Budget which predicts an estimated $155 billion loss in 2010. Even so, it does raise an issue of fairness. Should people who get their health insurance from an employer get a tax subsidy when those who buy insurance on the open market have to use after-tax dollars? (A similar argument can be made for home owners who can write off mortgage interest compared to renters who get no tax break.)

Even so, this would be a tough sell since it would mean a tax increase for the middle class when many of them are already struggling. Repealing the Bush tax cuts for the wealthy who are not struggling would be a better way to help pay for all of this.

Insuring the uninsured is a moral imperative. The problem is that the Democrats have chosen the worst possible method -- a $1 trillion new entitlement of stupefying arbitrariness and inefficiency.

The better choice is targeted measures that attack the inefficiencies of the current system one by one -- tort reform, interstate purchasing and taxing employee benefits. It would take 20 pages to write such a bill, not 2,000 -- and provide the funds to cover the uninsured without wrecking both U.S. health care and the U.S. Treasury.
Insuring the uninsured is a moral imperative. The proposed bill does reek of stupefying arbitrariness and inefficiency. But with the simpler option of single-payer (Medicare for all) not politically feasible, this bill is probably the best we can hope for. Since the Clintons’ attempt at health care reform back in 1993 was blocked, the number of uninsured has skyrocketed during the years of subsequent Republican control of the presidency and Congress. Now that the Democrats are again in the majority and trying to pass health care reform, we again get Republican cries that they can do health care reform better.

So do the Republicans have a better way to do health care reform or are they little more than obstructionists working on behalf of the health care industry as many have charged? For a start, why doesn’t Krauthammer write up his proposed bill so we can all examine and debate its merits or faults? Certainly 20 pages is not a lot to ask of a professional writer. Would the proposed bill truly insure the uninsured (including those with pre-existing conditions) or would it mostly just ignore their existence? Let the debate begin!

Monday, November 23, 2009

The High Cost of Dying

This Sunday, the 60 Minutes story The Cost of Dying raised some crucial issues on the containment of health expenses for Medicare, the single payer health insurance for US citizens over 65.

Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives - that's more than the budget of the Department of Homeland Security or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked.

This is entirely different from the horror stories of private insurers denying procedures that have cut short the lives of people who were otherwise young and vital. In this case, we have a government insurance plan whose leniency allows doctors and hospitals to pad the bill by ordering endless procedures on patients without any real benefit in the way of life extension.

Here is one example from the story.

Meredith Snedeker's 85-year-old mother spent her last two months shuttling between a nursing home and community hospital in New Jersey, suffering from advanced heart and liver disease.

Dorothy Glas was a former nurse who had signed a living will expressing her wishes that no extraordinary measures be taken to keep her alive. But that didn't stop a legion of doctors from conducting batteries of tests. "I can't tell you all the tests they took. But I do know that she saw over 13 specialists," Snedeker told Kroft. Asked what kind of specialists, Snedeker said, "Neurological, gastroenterologists. She even saw a psychiatrist because they said she was depressed. And she told the psychiatrist, 'Of course, I'm depressed. I'm dying.'"

When (60 Minutes) reviewed the medical records, (they) discovered that there weren't 13 specialists who attended to her mother: there were 25, each of whom billed Medicare separately. The hospital told 60 Minutes that all the tests were appropriate, and an independent physician said this case was fairly typical. "You think they were running up the bill to make money? Or running up the bill or giving her all these tests because they really thought it might help her? Or to cover their…rear?" Kroft asked.

"Yeah, to cover their rear," Snedeker replied.

Among the tests conducted was a pap smear, which is generally only recommended for much younger women, not an octogenarian who was already dying of liver and heart disease.

Maybe it was both to run up the bill and cover their rears.

I have a personal experience to share here.

It was almost 30 years ago that my father was dying. We planned to have him spend his last days at home but some complications arose that required us to have him taken back to the hospital. Although he was in a coma by then, neither I or my mother wanted him to die alone so we took turns staying by his hospital bed, she during the day and me at night.

For someone who was obviously only a few days away from dying, it was curious to see the parade of doctors who came by all though the night to visit and sign the chart in front of his bed. I didn’t pay it much mind until I saw the bills from the doctors and hospital a month or so later. There was the list of visits and charges from each of those doctors — an incredible number of them who listed visits in the last few days of his life. And to add insult to injury, there were doctor visits listed for one and two days after his death!

When critics of Medicare bring up its financial difficulties, they overlook that since most people don’t die before reaching age 65, the private insurers in effect pass off almost all of the end of life care issues to Medicare. It would certainly make sense to have a discussion about limiting testing and procedures to where a patient can realistically be made better instead of prolonging an inevitable death with no quality of life. But then we would surely get the demagoguery in the form of “death panels” and “pulling the plug on Grandma” that is presently practiced by those demonstrating against health care reform.

Whether we like it or not, to make Medicare financially solvent over the long run, we do have to exert better control over what is being paid out to stop the abuses of those providers who are taking advantage of the present system to pad their profits through either unnecessary procedures or just outright fraud which alone is estimated at about $60 billion a year.

Finally doing something about all of this waste and fraud would go a long way toward our being able to afford health insurance for those millions in the US who have had to go without it.

Tuesday, November 17, 2009

Health Reform Is About People

For all too many of us, discussions on health reform are about how much it will cost along with arguments over political ideology. It’s all too easy to forget about the human suffering that is happening under our noses.

Recently, Rich Stockwell, Senior Producer for the MSNBC show Countdown came up with an idea to set up some free clinics in the states that are the home of conservative Democratic senators who have been opposing health care reform. The idea was to demonstrate how much of a need there was to help the people in these states and perhaps shame these senators into finally supporting health care reform.

Thanks to Countdown along with donations from viewers across the country, the first free clinic was held this Saturday in New Orleans. Senator Mary Landrieu (D-LA) among those opposing reform was invited to attend the clinic but declined.

But Mr. Stockwell did attend and wrote this account of what he saw,
Health Reform's Human Stories which Countdown host Keith Olbermann reads during a video shown of the event. Please check out the compelling video in this link.

It is hard to sum it up better than Stockwell when he wrote of his experience:

Health reform is not about Democrats or Republicans or who can score political points for the next election, it's about people. It's about fairness and justice in a system that knows none. I'd defy even the most hardened capitalist-loving-conservative to do what I did on Saturday and continue to pretend that the system in place right now is working.

I am left with one overwhelming question: what does it say about us as a nation of people who can live in a country so rich and yet allow this to continue?

Sunday, November 8, 2009

Why Baseball Needs More Competitive Balance

This last Wednesday, the New York Yankees won their record 27th World Series championship. For a franchise that has been in existence for 108 years, this means that they have won the World Series, on average once every 4 years. Just as impressive is their total of 40 World Series appearances which averages out to appearing in the World Series on average, 3 out of every 8 years.

Since I didn’t have a rooting interest, I watched the Yankees’ celebration seeing the look of ecstasy on the players’ faces along with their adoring fans. It was living vicariously since I knew that my hometown Pittsburgh Pirates would never likely get to the World Series in my lifetime ever again — certainly not under the present system used in baseball that mostly rewards the teams that are willing and able to spend the most for players. In Pittsburgh, a successful baseball season is now defined as finishing over .500 — which the Pirates have now failed to do over the last 17 seasons with no apparent end in sight.

In any one season, only one team can win it all. But there was always that hope for the losers who say “Wait Till Next Year” when the season starts anew and offers a fresh chance for everybody.

But especially for fans in smaller markets, that hope has vanished. They know that occasionally teams from small markets can get lucky and make the post-season playoffs. But even if they do, that means that the best emerging players will soon be attracted to the teams with the most money to spend so the joy will be short-lived. This happened twice after a pair of improbable World Series victories by the Florida Marlins which were followed by the dismantling of the teams for financial reasons. In effect, we have a system where the small market teams function as a farm team for the larger market teams with deeper pockets.

The Yankees have been notorious for their payrolls that dwarf those of most other teams. So after their victory, there is always the question of whether they won because of things like “character” or whether they are just simply
The best team money could buy.

The Yankees are not a big-market team. They DWARF big-market teams. They are quantitatively different from every other team in baseball and every other team in American sports. They don't just spend more money than every other team. They spend A LOT more money than every other team. The Boston Red Sox spend $50 million more than the Kansas City Royals? Who cares? The Yankees spend $80 million more than the Boston Red Sox.

Because of the more unpredictable nature of baseball games and their short playoff series, the teams with the largest payrolls don’t always win championships. But even so, the fans of smaller market teams know that the best stars will be playing elsewhere since that is where the money is.

In the National Football League which has a salary cap to equalize payrolls, teams succeed because they have better coaching and talent evaluation. And with more competitive balance, more fans in more cities stay interested in their teams throughout the season. In comparison, July in Pittsburgh is not important for the beginning of the baseball pennant race but rather for the start of Steelers’ training camp.

Baseball is the only major sport in America not to have a salary cap and if the powerful Major League Baseball Players Association has their way, there will NEVER be one. They obviously do not want to compromise the earning power of their marquee players. But in taking this stance, the union may well be doing a disservice to the players who play on the smaller market teams. Just like the fans who want to win a championship, these players would also like to have a chance to win a championship one day. There isn’t room for everybody to play for the Yankees and other large market teams.

The larger question is whether this has caused overall interest in the sport to decline. Several generations ago, baseball certainly earned its title in America as The National Pastime and the World Series was one of the most watched TV events of the year. Examining World Series television ratings over the last 25 years however, the percentage share of households watching TV who are tuned in has declined from in the 40s in the 1980s down to the 20s in the 1990s and in this decade mostly in the high teens. In contrast, National Football League Super Bowl television ratings through the years boast share ratings of at least 60% and sometimes 70%. In addition, NBC who presented the latest Super Bowl was able to command a cool $3 million for a 30 second ad.

The MLB All-Star Game has suffered a similar decline over the years and has now has to resort to the pathetic gimmick that the league that wins the All-Star Game gets home field advantage in the upcoming World Series to try and make it compelling enough to watch.

We have seen real life examples of what benefits those on the top of the food chain, e.g. Wall Street, doesn’t do much to benefit those on Main Street who are struggling. A similar case can be made that what benefits the top of the food chain in Major League Baseball, e.g. the Yankees, doesn’t do much to benefit the smaller market franchises that are struggling — which is hurting the overall popularity and health of the game. Of course, there are other issues such as steroid scandals that are turning off fans.

But if Major League Baseball wants to try and recapture the popularity it has lost in recent decades to football, they have to show that if they indeed want to operate 30 franchises, they need to work on offering a quality product with much more competitive balance. It is competitive balance that creates compelling interest in the games. The NFL knows this and has used it to expand its popularity over the years. In many cities, come September, it means the difference between baseball fans following a hot pennant race with their favorite teams — or instead turning to football because their team is hopelessly out of it!

Sunday, November 1, 2009

Can We Talk About Medical Marijuana?

Recently, the controversy around medical marijuana came to the fore again as detailed in U.S. Won't Prosecute in States That Allow Medical Marijuana.

People who use marijuana for medical purposes and those who distribute it to them should not face federal prosecution, provided they act according to state law, the Justice Department said Monday in a directive with far-reaching political and legal implications.

In a
memorandum to federal prosecutors in the 14 states that make some allowance for the use of marijuana for medical purposes, the department said that it was committed to the “efficient and rational use” of its resources and that prosecuting patients and distributors who are in “clear and unambiguous compliance” with state laws did not meet that standard.

The significance of this is that up until now, despite these states legalizing medical marijuana, the federal government still had the right to arrest people for consuming marijuana for any purpose — and did under previous administrations. This reversal under the Obama administration allows these medical users to breathe a sigh of relief.

But despite ample evidence that marijuana has been helpful in easing the suffering of cancer and AIDS patients, the US government continues to include marijuana as a
Schedule I controlled substance which declares that it has no accepted medical use. In keeping with this, the Food and Drug Administration has issued statements that "no sound scientific studies" support the use of marijuana.

What further compounds the aggravation for those supporting the use of medical marijuana is that the federal government is the nation’s
only legal grower of marijuana for medical research. Critics have charged that the government issue marijuana is of too low a quality to conduct serious research and have sought permission to grow their own medical grade marijuana for research purposes but without success.

So basically we have the government taking the position that there are no sound studies to support medical use of marijuana while at the same time doing what they can to restrict any research that may prove them wrong. But what else can we expect from a government that still stubbornly chooses to conduct a “War on Drugs”? In a way, it presents a dilemma for them. Taking a drug away from people who rely on it to relieve their suffering is cruel. But allowing it for medical purposes then opens the door for those who want to use and grow marijuana for recreational purposes which the War on Drugs people obviously don’t want to happen.

A New York Times video,
The Marijuana State shows how twelve years after California voters legalized medical marijuana, it is being exploited as a cash crop and for recreational use so it is felt by many that California has achieved de facto legalization or at least decriminalization of pot. Just to make sure, there are initiatives in California on legislation that would formally legalize pot.

This is why the medical marijuana controversy is inextricably linked with the controversy around its legalization. As long as marijuana remains illegal, it will remain a lucrative crop to grow whether it is by the Mexican drug cartels, or by those in Afghanistan where
eradicated poppy fields have been replaced by marijuana. The legalization and taxing of marijuana could bring a sizable windfall in government revenue at a time when we desperately need it to continue to provide vital services.

Drug Policy Alliance Network sums it all up this way:

Few public policies have compromised public health and undermined our fundamental civil liberties for so long and to such a degree as the war on drugs. The United States is now the world's largest jailer, imprisoning nearly half a million people for drug offenses alone. That's more people than Western Europe, with a bigger population, incarcerates for all offenses. Roughly 1.5 million people are arrested each year for drug law violations - 40% of them just for marijuana possession.

(And in the 36 states that still prohibit medical marijuana) People suffering from cancer, AIDS and other debilitating illnesses are regularly denied access to their medicine or even arrested and prosecuted for using medical marijuana. We can do better.

Sunday, October 25, 2009

President Obama vs. Fox News

Back in September, President Obama took the unprecedented step of appearing on 5 Sunday talk shows to try and sell his health plan.

Mr. Obama is going to appear on This Week with George Stephanopoulos on ABC. And Meet the Press on NBC. And Face the Nation on CBS. In between, he is going to sit down for interviews on CNN and Univision. (Fox News didn’t make the cut).

I personally found the choice not to include Fox News to be puzzling. Of course the viewers of Fox are strongly Republican but getting bipartisan support for his plan also requires him to try and convince his critics in addition to just his supporters.
More recently, the Obama administration spelled out its opposition to Fox News based on the belief that Fox is a political arm of the Republican Party and Is Not Really News.

It's really not news. It's pushing a point of view. And the bigger thing is that other news organizations like yours ought not to treat them that way, and we're not going to treat them that way. We're going to appear on their shows. We're going to participate but understanding that they represent a point of view."

Many in the liberal media have weighed in on whether this critcism of Fox is valid. For example in Newsweek, Jacob Weisberg writes on Why Fox News Is Un-American.

There is no need to get bogged down in this phony debate, which itself constitutes an abuse of the fair-mindedness of the rest of the media. One glance at Fox's Web site or five minutes' random viewing of the channel at any hour of the day demonstrates its all-pervasive slant. The lefty documentary Outfoxed spent a lot of time mustering evidence that Fox managers order reporters to take the Republican side. But after 13 years under Roger Ailes, Fox employees skew news right as instinctively as fish swim.

Rather than in any way maturing, Fox has in recent months become more boisterous and demagogic. Fox sponsored as much as it covered the anti-Obama "tea parties" this summer. Its "fact checking" about the president's health-care proposal is provided by Karl Rove. And weepy Glenn Beck has begun to exhibit a Strangelovean concern about government invading our bloodstream by vaccinating people for swine flu. With this misinformation campaign, Fox stands to become the first network to actively try to kill its viewers.

This sponsoring of organized protests against the Obama administration is the cornerstone of MSNBC’s Rachel Maddow’s argument on Why Fox News Isn't News.

So in essence, we have two questions. Are the criticisms of Fox true? and What should the Obama administration do about Fox?

The argument that Fox discredits itself as a serious news organization by itself organizing protest groups is a creditable one. And the Obama administration thus far is fighting back by boycotting and asking others to ignore Fox News.

But some of this strategy is backfiring. Recently, the White House made Executive Compensation Czar Kenneth Feinberg available for interviewing by all of the networks except Fox. The other networks then came to the defense of Fox by saying that they would not agree to interview Feinberg if Fox was excluded. The Obama administration gave in and allowed Fox in. So in effect, Fox News was made into a sympathetic figure by these tactics.

Whether some like it or not, the large audience that Fox has compared to the other cable news outlets such as CNN and MSNBC is simply too large to ignore or hope it goes away
And criticizing Fox for being conservatively biased overlooks liberally biased media outlets such as MSNBC making it appear that the Obama administration only dislikes bias when coming from the other side. Instead of complaining about bias which is a no-win strategy, it would be much more effective to stick to calling out Fox on any factual inaccuracies they spread which may well work to keep them more honest.

So instead of trying to ignore Fox, I would like to advocate a contrarian strategy. Perhaps it would do President Obama more good if he actually made an occasional appearance on a Fox interview show. Sure they are the “enemy” but Obama advocates that we need to talk to our foreign enemies — so why not Fox? Instead of conservative pundits with no liberal voices to provide any counterbalance, Obama himself can appear (along with other top officials) and defend his policies in the faces of the naysayers themselves and truly allow the audience to decide issues based on a more balanced presentation once in a while. Granted, the more hard-line Republican conservatives would likely never be convinced. But surely there are others watching Fox who might. It may well be worth a try if Obama wants any hope of getting bipartisan support of his policies.

Sunday, October 18, 2009

Is Playing Football Hazardous to Your Brain?

Malcolm Gladwell in a recent appearance on ESPN’s Pardon The Interruption had some sobering comments on how an accumulation of seemingly minor head collisions over an NFL football career can inflict damage to players that resembles that from Alzheimer’s disease. To listen to the interview, check out this podcast starting at the 9:15 mark where Gladwell stated that some percentage of football players would wind up in dementia wards by the time they reached their 50s.

Gladwell was there to promote his article in The New Yorker that asks the question
How different are dogfighting and football? The introductory video to the article, This Is Your Brain on Football is quite compelling and thought provoking.

He starts by saying that both football and dogfighting both inflict enduring injury on its participants. Then he details how autopsies of many retired NFL football players have brain injuries that result in dementia but are not caused by disease like Alzheimer’s but are from a condition called C.T.E.

Chronic traumatic encephalopathy (C.T.E.), which is a progressive neurological disorder found in people who have suffered some kind of brain trauma. C.T.E. has many of the same manifestations as Alzheimer’s: it begins with behavioral and personality changes, followed by disinhibition and irritability, before moving on to dementia. And C.T.E. appears later in life as well, because it takes a long time for the initial trauma to give rise to nerve-cell breakdown and death. But C.T.E. isn’t the result of an endogenous disease. It’s the result of injury.

Neuropathologist Bennet Omalu diagnosed the first known case of C.T.E. in an ex-N.F.L. player back in September of 2002, when he autopsied the former Pittsburgh Steelers center Mike Webster. He also found C.T.E. in the former Philadelphia Eagles defensive back Andre Waters, and in the former Steelers linemen Terry Long and Justin Strzelczyk, the latter of whom was killed when he drove the wrong way down a freeway and crashed his car, at ninety miles per hour, into a tank truck. Omalu has only once failed to find C.T.E. in a professional football player, and that was a twenty-four-year-old running back who had played in the N.F.L. for only two years.

When we think of head injuries in football, we think of the major hits that cause concussions. The effects of these major hits are pretty closely monitored to try and make sure that permanent injury doesn’t occur.

But a football player’s real issue isn’t simply with repetitive concussive trauma. It is, as the concussion specialist Robert Cantu argues, with repetitive subconcussive trauma. It’s not just the handful of big hits that matter. It’s lots of little hits, too.

That’s why, Cantu says, so many of the ex-players who have been given a diagnosis of C.T.E. were linemen: line play lends itself to lots of little hits. The HITS data suggest that, in an average football season, a lineman could get struck in the head a thousand times, which means that a ten-year N.F.L. veteran, when you bring in his college and high-school playing days, could well have been hit in the head eighteen thousand times: that’s thousands of jarring blows that shake the brain from front to back and side to side, stretching and weakening and tearing the connections among nerve cells, and making the brain increasingly vulnerable to long-term damage. People with C.T.E., Cantu says, “aren’t necessarily people with a high, recognized concussion history. But they are individuals who collided heads on every play—repetitively doing this, year after year, under levels that were tolerable for them to continue to play.”

This raises a major question as to whether brain damage may indeed be an inherent danger of the sport, especially for these linemen who endure head collisions on just about every play. As Gladwell points out, hitting is an integral part of the sport and it is unclear how helmets can be improved much to provide any further protection. Maybe the larger question is whether we can do anything without dramatically changing the game and perhaps taking much of the appeal from it. Football has long overtaken baseball as America’s national pastime and for many of us, we couldn’t imagine our autumn weekends without it whether it is high school, college or the NFL. But having said all of that, if you are a parent who has seen the evidence of permanent brain damage in these retired football players, would you really want your sons to become football players?

Post-Script: October 21, 2009
Brain damage commonly associated with boxers and recently found in deceased NFL players has been identified in a former college athlete who never played professionally, representing new evidence about the possible safety risks of college and perhaps high school football.

Sunday, October 11, 2009

Let's Not Give Up on Capitalism

After watching what I thought was Michael Moore’s best effort in Sicko which exposed needless suffering and death in America due to health insurance industry practices, I was curious to see if how he could do with a broader subject in his latest documentary Capitalism: A Love Story. The story he tells is most certainly compelling.

A sequence near the beginning of the movie was especially difficult for me to watch. It showed a family about to have their house repossessed. But to make it especially poignant, it was filmed inside the house by the family awaiting their fate while the doors were slowly but surely smashed in. As they explained, they weren’t going to resist being evicted once the people broke inside — but they weren’t going to help them by opening the door. It was a last symbolic gesture in a helpless situation.

With home foreclosures having skyrocketed in recent years and many of us losing our jobs, it is all too easy for some of us to imagine ourselves perhaps someday suffering the same fate. How did things go so terribly wrong?

A related scene shows a speculator who gleefully makes a killing on buying foreclosed properties with scarcely a thought about those who had been put out on the street in the process. Is it all about making money at any human cost? Is this what capitalism is all about?

As Moore relates from his middle class childhood, capitalism did quite well for everybody back then. Companies made lots of money, but workers often thanks to unions were also able to earn comfortable livings to support their families. The rich did well as they always do, but there was a strong middle class that used their earnings to consume goods and keep the economy chugging along. But since then, the rich have done fabulously well and much of the middle class has taken a beating. Is this an inherent flaw of capitalism as Moore seems to infer?

I think not. I still believe capitalism is the best economic system. For those who favor socialism, they should be reminded of the differences between the vibrant economy of West Germany compared to the sickly economy of East Germany when the wall between them was finally torn down.

I feel the fault is not in capitalism per se, but in the political climate in America over the last several decades that has given tacit approval for corporations to seek profits even when the human cost was high. For example, in Moore’s seminal work
Roger & Me, General Motors despite making healthy profits, still decided to close down their operations in Flint, MI turning much of it into a ghost town. Today’s most prominent example is the health insurance companies making huge profits while many needlessly suffer or die because they can’t get insured.

But in neither example did anybody do anything illegal. You can argue that they didn’t have a conscience but how does a government legislate that companies have compassion for their fellow man?

So while Sicko not only told a compelling story, it also gave a straightforward solution in the form of universal healthcare coverage just like the rest of the industrialized world already has. Capitalism tells an equally compelling story but offers no real solutions other than what Moore calls a return to democracy. While he encourages people to run for office, money is so indispensable to wage effective campaigns that candidates who are not already wealthy have to raise campaign cash from special interest groups which then robs them of their independence.

Perhaps the most fascinating part of the film was the showing of a recently discovered 1944 film showing Franklin D. Roosevelt arguing for a
Second Bill of Rights which would guarantee among other things:

A job with a living wage
Freedom from unfair competition and monopolies
A home
Medical care

But how do we for example guarantee everybody a job along with a home? Moore doesn’t say in his film. Just providing everybody with medical care is proving to be a formidable obstacle.

I still think capitalism is the best economic system but it only works well when we recognize some of its shortcomings. Free enterprise is about equal opportunity but we know that the more affluent will always have more opportunities at least in part because they have the better public school systems and better access to the best colleges. And it has been said that you need to spend money to make money. While we may all dream of being millionaires someday, who do you think has a better chance of making a million — someone who already has a million or someone with nothing? It’s no contest.

The policies under George W. Bush and before him Ronald Reagan who gave tax cuts to the rich have done little more than widen the gap between the rich and everybody else. Instead, government has to do what it can to level the playing field for those in the middle and lower classes along with providing a safety net for those who get into financial trouble for reasons beyond their control. And in this bleak economy where there are few jobs to be had, the government has to jump start the economy and create them. While this may sound a bit socialist, the fact is that without enough jobs to employ those who want and need work, capitalism — or just about any system — doesn’t work.

When done right, capitalism does work. We just need to make sure we do it right so it works for everybody!

Sunday, October 4, 2009

Letting Those 44,000 People Die

Perhaps the most controversial event of the last week was the feisty speech made on the Congressional floor by Rep. Alan Grayson D-FL arguing that the Republican health care plan can be outlined as follows:

2. And if you do get sick…


That’s right; the Republicans want you to die quickly if you get sick.
If the idea was to get attention, it worked. Grayson subsequently has made a number of appearances on different news shows, most notably this one on CNN.

Saying that Republicans want sick people to die quickly is more than a bit over-the-top. But had Grayson given his speech without the hyperbole, would anyone have paid attention? For better or worse, the media wants provocative sound bites to put on the air. In his discussion on CNN, Grayson explained that he was thinking about the over 44,000 who die annually in the US
according to a recent study from lack of health insurance and wanted a way to convey the urgency of the situation.

More than 44,000 Americans die every year – 122 every day – due to lack of health insurance.

That’s the startling finding of a new study –
Health Insurance and Mortality in U.S. Adults – that appears in the current issue of the American Journal of Public Health.

The 44,000 dead a year estimate is about two-and-a-half times higher than an estimate from the Institute of Medicine in 2002.

The next day in his
"apology" speech he focused more on these estimated 44, 789 Americans.

…that is more than 10 times the number of Americans who died in Iraq. It’s more than 10 times the number of Americans who died in 9/11. But that was just once. This is every single year.
And in an obvious message to the pro-lifers he had this to say…

Let’s remember that we should care about people even after they are born.

Unwisely, he ended the "apology" speech by referring to the dying as a “holocaust” for which he later
apologized to the Jewish Community despite the fact that he himself is Jewish and had relatives who died in the Holocaust.

To top it off, in
a fundraising speech, he had this to say about the Republicans:

Just what do these people think health care means? It's not some abstract "issue", we're talking about life and death! And the Republicans, who ran the government in full or in part from 2001-2009, chose to let those 44,000 people die, every single year when they were in power. And George W. Bush, whom the Republicans somehow pretend was not President for the last eight years, just let them die. He even vetoed health care for poor children.
These are strong words. While it may be unfair to say that anybody made a conscious decision to let people die, actions do have consequences. If the study is correct (and the opposition has not questioned its validity, only Grayson’s choice of words), roughly 122 people will die every day in America until we finally pass a reform bill.

I can’t help but think of the
Miracle on the Hudson back in January where the pilot became a hero for saving the lives of 155 people. Had those people died, there would have been outrage over the air traffic safety system and memorials would have undoubtedly been erected to the dead. But the difference is that when 155 people die in one place on one day, it is a tragedy. When roughly 124 people scattered across the country die needlessly each day, they become little more than a statistic.

While I cannot agree with all of the words that Grayson chose, he did express the outrage that we need to have for these dying people. So when we see endless delay by Republicans and some conservative Democrats — many of whom are financially enriched by the same health insurance industry that opposes any real reform — we need to think about those people who are needlessly dying each and every day in America and ask — Where is the outrage?

Sunday, September 27, 2009

Some Reflections on Pittsburgh

As a lifelong Pittsburgh area resident, I was especially interested in the media coverage of a city that remains a curiosity to many who do not know it well. The NYT blog article Why Pittsburgh? attempts to answer the question on how Pittsburgh was selected for the recent G-20 Summit.
The White House has repeatedly cited the city’s transformation from a Rust Belt shell to one whose economy rebounded on the base of the health, education and perhaps technology industries. Granted, those employers have acted as a buffer against the higher unemployment rates experienced elsewhere during the current recession. And many have pointed out that Mr. Obama has become pals with the Rooneys, especially Dan Rooney, the owner of the Steelers and the new ambassador to Ireland. Pittsburgh also is situated in a conjoined region of swing states…
So while it’s nice to talk about the city’s transformation from a dirty steel town to a much cleaner town that has more white collar jobs, this ignores much of the pain that places like Pittsburgh have gone through and will continue to experience especially in this weak economy.

But overall, I can truthfully say that Pittsburgh has a lot of good things going for it and is a great place to live — especially for those who have a family and a job. This is verified not only by publications like
Places Rated Almanac but also by the many Pittsburgh sports celebrities who originally lived elsewhere but chose to stay in Pittsburgh after retiring despite being able to live just about anywhere.

More than anything else, I believe Pittsburgh gets its appeal from having just about everything that the largest cities have to offer but without some of their liabilities such as high crime and cost of living.

But although Pittsburgh is still called the Steel City by some, the loss of the steel industry in the 80s along with the loss of other manufacturers like Westinghouse to non-union locations dealt a crushing blow to its population numbers which have steadily declined with each census to this day. Our universities graduate lots of young workers into the economy but few stay here for lack of jobs. Forbes has often put Pittsburgh
at or near the bottom of their ratings for singles. And its population is the second oldest in the country which ensures that healthcare will remain one of the few vibrant industries here.

An interesting phenomenon is the large number of Pittsburgh sports fans one sees on TV who are cheering in the stands in surprising numbers for their teams’ away games. It almost doesn’t matter where in the country it is as long as the home team can’t sell out their games.
Pittsburgh Steeler fan clubs and bars exist around the nation and the world for their fans to make a mental escape back to Pittsburgh. So what gives? While there are some who just admire the Steelers and Penguins for their successes, I would guess that many if not most of these people are those who loved being in the ‘Burgh but had to move elsewhere to find a job.

So the question to be answered by those attending the recent G-20 Conference just held in Pittsburgh is what do we do for the so-called Rust Belt cities such as Pittsburgh, Detroit, Cleveland, Buffalo, Baltimore, etc?

People in these places have been used to working blue collar jobs for generations to support their families. But once the manufacturing jobs left, the bottom fell out. Along with all of the beautiful places that Pittsburgh showed off to the visiting G-20 heads of state are the areas of urban blight they didn't see that never recovered from losing their factories and steel mills.

It is not realistic to expect all of these manufacturing jobs to return. But on the other hand, it is equally unrealistic to expect us to thrive as simply being a white collar and service economy. Service jobs are among the lowest paying ones. And as our present economy is showing all too well, the supply of white collar jobs is not inexhaustible. Simply sending more and more people to college may indeed be trading blue collar unemployment for possible white collar unemployment which is not a long term solution.

I think the lesson to be learned from the plight of Pittsburgh and the other Rust Belt cities is that we cannot have a healthy economy without at least some semblance of a manufacturing base here at home. It may be difficult to bring manufacturing of the existing products we buy back home from other lands. But there are many other goods we will need for our conversion to greener forms of energy along with the rebuilding of our infrastructure. For a start, we will need to make solar cells and wind turbines along with
fixing the power grid to deliver all of the resulting renewable energy to where it is needed.

President Obama has called a new energy agenda "absolutely critical to our economic future," and his stimulus package directs more than $40 billion toward that goal—the largest single infusion of government capital to the energy sector in US history, more than half of which will go to grid-related projects.
The number of well paying manufacturing jobs that can be created is significant and can’t come soon enough. I can only hope that someday in the not too distant future, Pittsburgh will not only be a great place to live, but also a great place to find a job!

Sunday, September 20, 2009

The Politics of Hate

Back in July when all of the rhetoric around President Obama and his proposed healthcare reform was really starting to heat up, I wrote a previous posting How About Some Rational Discussion for a Change? and incredulously wondered how somebody could actually go as far as circulating an E-mail comparing Obama with Hitler.

Today, photos of public protests with signs calling Obama a Nazi along with posters of his likeness sporting a Hitler moustache are so common they no longer have any shock value. These protesters along with many who listen to conservative radio talk shows that egg them on have gotten to where they have so much more than just disagreements over political issues. It’s gotten personal. Many of these people obviously have a strong personal dislike if not an outright hate of the president along with others who may agree with his policies. Disagreement in a free country between people of differing views is always healthy. Hate between them is never healthy! At its worst, it can become a cancer that robs us of our capacities to feel compassion and empathy for others. And it also has the ability to grind a government to a total halt because when hate comes between two sides, compromise which is needed to make anything happen becomes impossible — an irony that is probably lost on so many of these same people who complain about how ineffective government can be.

Of course it doesn’t have to be this way. Those who saw the eulogies for Ted Kennedy were touched by the genuine and mutual respect that Republicans Orrin Hatch and John McCain had with Kennedy despite the fact that their conservative political philosophies could hardly be more different than Kennedy’s liberal ones. Despite their differences, Orrin Hatch proudly talked about the health insurance program for children that he and Kennedy worked on to become signed into law.

But many in the Republican leadership today are trying to have it both ways. On one hand, they are not actively participating in the name calling and are saying that they did not approve of Congressman Joe Wilson’s “You Lie!” outburst at Obama’s Congressional address. But on the other hand, they are not doing anything to condemn the hateful behavior that has taken place at many of these demonstrations and town hall meetings. In fact Minority Leader John Boehner’s comments this morning to moderator David Gregory on
Meet the Press calling the demonstrations “spirited” did little more than give his implicit approval of what has transpired.

MR. GREGORY: I want, I want to come back to some of the specifics about health care. But I want to, I want to stay with this tone of the debate right now and whether or not you agree that by some of the things the president said in the course of that interview, he is trying to cool off the debate, the tone of the debate. Do you see it that way?

REP. BOEHNER: Well, I don’t know that the tone of the debate has gotten out of control.

MR. GREGORY: You don’t think so?

REP. BOEHNER: It’s been spirited, because we’re talking about an issue that affects every single American. And because it affects every American in a very personal way, more Americans have been engaged in this debate than any issue in decades. And so there’s room to work together. But I first believe that we’ve got to just take this big government option, this big government plan and move it to the side. Now, let’s talk about what we can do to make our current system work better. Then we’ll have some grounds on which to build.

Then Gregory brought up the concern of House Speaker Nancy Pelosi about possible violence if things get too overheated to Senator Lindsey Graham.

MR. GREGORY: This question about the role of the government, and, and House Speaker Nancy Pelosi saying this week what she worries about in terms of the tone of debate is that it could lead to violence, as it did in the ‘70s; you know, there was anti-government violence in the ‘90s in Oklahoma City, as well. How much of a concern is that? Do you share it, or do you think that that was an overstatement on her part?

SEN. GRAHAM: Well, quite frankly, I mean, the whole idea of the role of government needs to be debated.
Graham then continued to spout off talking points before Gregory could finally pin them down to a response that neither Boehner nor Graham are concerned about any violence.

Again, honest dissent is fine. But it is obvious that neither of these Congressional leaders care about whether we are getting beyond simple dissent and into mean-spirited hyper partisanship that benefits no one.

To stir things up further, former President Jimmy Carter spoke his opinion that the overwhelming majority of the hate directed toward President Obama is racially motivated. Only the most naïve person would totally discount that racism plays some role in all of this. But even so, the racism question provides an unwelcome distraction. Yes we can label some of these people as racists which would in turn lead to denials of racism which leads us to an unproductive dead end since many of these people may well have hate that has nothing to do with racism.

So maybe the most appropriate question for these people — including those whose radio and TV talk shows feed on all of this — would not be to ask why or even if they are racists. But instead we must ask why they have such hate in their hearts!

Saturday, September 12, 2009

The Health Care Protests Go On

Few presidential speeches have been as anticipated as the recent one by President Obama on healthcare reform. For many observers, the speech did a wonderful job of outlining the major problems in the US healthcare system. More importantly, he conveyed that there was an urgent moral imperative for the government to help those people who were needlessly suffering and even dying for lack of health insurance.

But in listening to conservative commentators after the address, the questions usually centered not on whether we really need healthcare reform but on how much the president’s proposed healthcare reform would cost along with how it would be paid for.

These questions seem reasonable enough but can conceal an agenda to effectively kill healthcare reform if none of the answers are deemed to be acceptable. In this case, President Obama estimated that this program would cost about 900 billion dollars over the span of about 10 years.

But what is an acceptable way to pay for this that would satisfy the conservatives?

We certainly can’t raise taxes — even for the wealthy who have done so well thanks to the Bush tax cuts.

We certainly can’t just add it to the deficit — even though this is how we financed those same tax cuts (along with the Iraq War).

Instead, President Obama offered to pay for at least most of this by eliminating waste and fraud in Medicare. But the conservatives don’t believe he can do it.

Undoubtedly, many billions of dollars in savings can be realized by offering a so-called public option similar to Medicare to compete with the private health insurance industry which now siphons off as much as 20 percent of what it takes in for overhead and profit. But conservatives are against this because of their objections to "government controlled healthcare".

So the result of all of this is today’s story Thousands Protest Health Care Plan

Thousands of people marched to the U.S. Capitol on Saturday, carrying signs with slogans such as "Obamacare makes me sick" as they protested the president's health care plan and what they say is out-of-control spending.

The standard conservative argument is that we should solve these kinds of problems through charity instead of getting the government involved. But the massive size of this problem with tens of millions without insurance can only be addressed through government. And as President Obama said in his recent address to Congress:

That large-heartedness -- that concern and regard for the plight of others -- is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

So what we have in these protesters is a group of people who despite the moral imperative to relieve the needless suffering of those without access to health insurance have decided that they are going to turn a blind eye to the suffering if it involves even a possible increase in their taxes.

What is especially ironic is that most of these conservative protesters would identify themselves as having strong Christian values. But what part of any of this is Christian?

Wednesday, September 2, 2009

We Really Need the Public Option

As predicted, the Congressional recess over August was a bitter fight over healthcare reform. But instead of helping to settle things, it looks like the issue has become more polarized than ever. Before it was a question between Democrats and Republicans of whether a healthcare bill needed to be passed. Now there is an even bigger battle among the Democrats as to whether the so-called public option must be a part of the bill to win their support.

What complicates things is that there is confusion by some on what the public option really is which is an offering to provide government insurance coverage similar to Medicare for those who are unable to find satisfactory choices among the private insurers. President Obama himself said that this was a necessary part of healthcare reform to in his words “keep insurance companies honest.”

In contrast, we have this
whopper by Republican Senator Jon Kyl, one of many bought and paid for by the health insurance industry.

“The health insurance industry is one of the most regulated industries in America,” said Sen. Jon Kyl (R., Ariz.) on the Senate floor Monday. “They don’t need to be ‘kept honest’ by the government.”

But after President Obama first said how necessary the public option was, he then backed off by saying that it was only a “sliver” of the healthcare reform package. This enraged liberals which caused Obama to then clarify that he still favored the public option but would consider alternatives. All of this waffling has caused Obama’s approval ratings to fall, especially with the liberal wing of his party who worked so hard to get him elected.

An important point that needs to be made here is that the support for the public option is much stronger than many in media and government have led on.
This New York Times/CBS News poll from June shows that 72% overall favor a public option. But what is amazing is that 50% of Republicans also favor it! So one has to ask if the Republicans’ solidarity in opposing any reform in Congress really represents their rank and file constituency rather than the health insurance industry that financially supports many of them.

To be sure, there are some powerful advocates of the public option such as former presidential candidate and Democratic National Committee Chairman
Howard Dean who is also a physician.

Americans deserve the right to choose their own healthcare. Congress must act to give Americans more choices for their personal healthcare by allowing universal availability of a public healthcare option like Medicare. Limiting choice to for-profit insurance only is the same broken healthcare system we have right now.
Even more noteworthy is former Cigna executive and now whistleblower Wendell Potter who while with Cigna was part of their campaign to discredit any attempts at healthcare reform. Here is an excerpt of his interview with
Guernica Magazine.
Guernica: Do you think the public option is important?

Wendell Potter: It’s essential. Reform without the public option would be far less meaningful and effective. The public option may not go as far as people would like in some ways, but we need a mechanism that controls costs and makes healthcare more available to citizens. It would go a long way toward keeping the insurance industry more honest, as the president has said.
At this point, I have to put in a word about the so-called liberal media. If more people had a chance to read and hear what Wendell Potter has to say, surely there would be more voices in favor of reform. But while Potter has gotten some exposure on Bill Moyers Journal on PBS and on MSNBC shows that cater to an already liberal audience, he has gotten curiously little exposure on the mainstream networks. For example, why hasn’t 60 Minutes done a story on him? Could it be that they and others are afraid of incurring the wrath (and possible loss of advertising revenue) from the big insurance companies by putting him on their air?

I have opined in a previous posting that if the public option does not make it into the final version of the bill, the bill should be allowed to die. Without a public option, if all of the uninsured were then mandated to buy insurance from the private companies, it could well result in a windfall for the health insurance industry without any real control over the cost of coverage. Indeed, many of the more liberal Democrats in the House have drawn this line in the sand.

But others say that if the bill has other vitally needed reforms like the elimination of pre-existing conditions, it would be a disservice to the uninsured to allow the bill to die. And after all, half a loaf is said to better than none.

In effect, we now have a giant game of ‘chicken’. For those who want to hold out for a bill that includes the public option, there is a chance that if the bill is then defeated, the opportunity for healthcare reform would be lost for some time and the Democrats will again crash and burn just like when they lost the healthcare reform battle back in 1993 under the Clintons.

But this is not 1993. With the ever increasing number of uninsured people since then, the need for healthcare reform has stirred so much passion among US citizens that if a bill is not passed this time, it will surely not be long before enough of the voting public will demand another try to pass a bill to finally get some meaningful reform. So instead of negotiating out of fear and perhaps having to accept a bad bill just to get something passed, I hope that President Obama will have the courage to go after truly meaningful reform which includes a public option. In his upcoming address to Congress on healthcare next week, we will hopefully find out how much (if any) courage he really has!

Wednesday, August 26, 2009

Afghanistan - No Longer the Good War

With all that is going on domestically in the US with health care reform and a dismal economy commanding so much of our attention, it is easy to forget about the wars we are still fighting in Iraq and Afghanistan. But although Iraq is (hopefully) winding down with our troop withdrawals, there is still the war over in Afghanistan that is growing. But that was seen to be OK. After all the thinking goes, once the diversion of the Iraq War ends we can put more resources into fighting the good war in Afghanistan we should have concentrated on from the beginning.

But clearly as we get more involved in Afghanistan, many are starting to question whether we should still be there. Many now openly wonder
Could Afghanistan Become Obama's Vietnam?

(Mr. Obama) looks ahead to an uncertain future not only for his legislative agenda but for what has indisputably become his war. Last week’s elections in Afghanistan played out at the same time as the debate over health care heated up in Washington, producing one of those split-screen moments that could not help but remind some of Mr. Johnson’s struggles to build a Great Society while fighting in Vietnam.

But is Afghanistan still the good war? At one time, that was easy to decide. The Iraq War was the bad war. After all Iraq, didn’t attack us and didn’t have Weapons of Mass Destruction. On the other hand the Afghanistan War was the good war. After all, Osama bin Laden and Al Queda who did attack us were based in Afghanistan. All we had to do was find and kill bin Laden, wipe out Al Queda, and then come home.

However, it has turned out to be far more complicated than that. When we first invaded back in 2001 in response to 9/11, we not only had to deal with one Islamic fundamentalist group in Al Queda but also another one in the Taliban who at the time had control of the Afghan government. Our removing the Taliban from power was seen as a good thing because of their extreme
restrictions on personal freedom and abhorrent treatment of women.

But just like in Iraq when we toppled Saddam Hussein, there was no real government leadership to fill the void in Afghanistan when we toppled the Taliban. Just like in Iraq, the democratically elected government in Afghanistan has proven to be weak and corrupt. Many feel that Afghanistan with its history of tribal alliances instead of a strong central government may well be ungovernable. Even so, our principal mission there has now become nation building which has become a thankless if not a hopeless task. And Osama bin Laden is still at large.

Even worse, the Taliban has come back stronger than ever as an insurgency movement fighting not only the Afghan government but that of Pakistan too. And Pakistan has a nuclear arsenal to counter the one that their arch-rival India has. What if the Taliban or Al Queda ever got a hold of those weapons? It’s a terrifying thought!

Indeed the Taliban has become so effective that the
U.S. Military Says Its Force in Afghanistan is Insufficient.

American military commanders with the NATO mission in Afghanistan told President Obama’s chief envoy to the region this weekend that they did not have enough troops to do their job, pushed past their limit by Taliban rebels who operate across borders.

The possibility that more troops will be needed in Afghanistan presents the Obama administration with another problem in dealing with a nearly eight-year war that has lost popularity at home, compounded by new questions over the credibility of the Afghan government, which has just held an as-yet inconclusive presidential election beset by complaints of fraud.
This has all produced a most difficult dilemma for the Obama administration. On one hand, the president can make a case that staying in Afghanistan is necessary to keep the region from becoming dangerously unstable in the hands of the Taliban. But on the other hand, this war can drag on indefinitely with increasing casualties and no real progress or end in sight — a bad war by almost anybody’s definition.

In Afghanistan, the Choice is Ours by Richard N. Haass is an excellent op-ed article that outlines this dilemma facing the president. The following passage is especially noteworthy:

The risk of ending our military effort in Afghanistan is that Kabul could be overrun and the government might fall. The risk of the current approach (or even one that involves dispatching another 10,000 or 20,000 American soldiers, as the president appears likely to do) is that it might produce the same result in the end, but at a higher human, military and economic cost.
So the important question to ask is not whether withdrawing would be bad but whether staying would only delay the inevitable. We need to ask the hard questions as to whether this war is truly winnable. And if the answer as many of us suspect is no, then it may well be time to leave Afghanistan to its fate just like we did with South Vietnam when we finally accepted that it too was an unwinnable war. After eight years of war there, it is time to finally bring our troops home. Instead of getting bogged down with unsolvable problems abroad, we need to put our full efforts into solving the considerable problems we face right here at home!

Wednesday, August 19, 2009

Time to Talk About Single Payer Again

As someone who has been avidly following the health care reform issue, I was stunned and angry to hear about President Obama backing off from the Public Option that he previously said was so important.

In a previous posting
The Continuing Battle Over Health Insurance Reform, I concluded with these thoughts:

If indeed the promised health insurance reform turns out not to have a public option, we will then know that President Obama not only made a deal with the devil — but that the devil in the form of the health insurance industry came out the winner. Which would make losers of all the rest of us!

I still feel the same way today.

The ‘deal with the devil’ refers to a concession made by Obama where he agreed to take a single-payer plan off the table in exchange for cooperation from the health insurance industry in getting a public option passed. So when ‘the devil’ reneged on his deal and instead fought the public option, Obama then offered another concession to placate the insurance reform opponents? What was he thinking of?

Compromise is a necessary part of the political process but it has become obvious that the only way that President Obama is going to get real health care reform is to fight for it! A sign of real leadership is being willing and able to fight for a cause that deserves it. The story about the recent
visit by Remote Area Medical to Los Angeles should remind us all that health care reform is first and foremost a humanitarian issue that he needs to fight for.

So instead of President Obama offering another concession, he should have fought back by at least threatening to put single payer back on the table.

Of all the solutions to the health care crisis in this country, single payer is the simplest and most cost-effective because we will then no longer have the health insurance industry as a middleman to siphon off money for overhead and profits that could instead go towards actual medical care. We know that single payer works because it is used successfully in many countries around the world including here in the US as Medicare for those over 65.

It is important to point out that the objection by those Democrats who do not support single payer is usually based more on the belief that it is politically unfeasible rather than any belief that it is not a good idea. Then presidential candidate Barack Obama explained this in
an interview from last year.

A more recent example is Senator Max Baucus who as chairman of the Senate Finance Committee had the following exchange with NPR’s Julie Rovner.

JULIE ROVNER: The supporters of single payer health care point out that their plan is not on the table.

SEN. MAX BAUCUS: Well, just to be honest, it's not on the table - the only thing that's not - because it cannot pass. It just cannot pass. We can't squander this opportunity. We can't spend - we can't waste (political) capital on something that's just impossible.

Again, please note that Senator Baucus did not say anything negative about single payer itself except to say that it would be "impossible" to pass it.

The liberal Democrats in the House have now threatened to withdraw their support for any reform bill that does not include the public option. Along with them, I fear that any bill that is passed without a robust public option to provide competition for the private insurers will be worse than useless. The proposed public co-ops now being discussed may possibly work in theory but should we base our health care reform on something so untested?

Instead of accepting victory at any cost, perhaps it would be better to let this latest effort fail if we cannot at least get the public option included. If indeed the reform effort fails this time around, the stage will be set for the next round which will undoubtedly be about single payer. After all, if we have to start over, why not go with the best solution especially if it has been shown that all of the compromise solutions we have tried are no less “impossible”!