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”!

Sunday, August 9, 2009

What Health Insurance Reform Is Really All About

I can hardly recall an issue that has emotionally affected me more than following The Continuing Battle Over Health Insurance Reform. In my previous posting I talked about the health insurance industry using “guerilla tactics” and waging a “proxy war” and even equating them to the devil. When I wrote that posting, I wondered to myself if I might have been a little too over-the-top in how I portrayed the health insurance industry.

After what has happened in the week since, it looks like I may have been too kind to the health insurance industry. When
seeing what is happening at these Town Hall meetings that are being sabotaged by protesters that often have been planted by those with ties to the health insurance industry, there can be no doubt that this is a war that is being waged against anybody who is a threat to bring reform to the health insurance industry which would put a damper on the huge profits they have been enjoying under the present system.

So what’s the big deal about people coming to a Town Hall meeting to voice their opinions and concerns? Nothing, if that is really their intent. But it is obvious that the intent of these protesters is not to promote public discussion on health care reform but to disrupt it! This is not about accommodating those of differing viewpoints but is instead about silencing them!

What so many observers including many in the media are missing is that this fight is really not about the protesters or even the others on the political right who are spreading the poisonous rhetoric. In fact, these people are little more than surrogate warriors on behalf of those in the health insurance industry who are truly pulling the strings in this war against health insurance reform.

The most important thing is to realize who is actually getting hurt the most by this war. No, it’s not the Democratic politicians taking the verbal abuse although their egos may have been bruised a bit in the process. The people who are truly getting hurt in this war are those who are struggling to get by without health insurance and sitting on a ticking time bomb hoping they do not get sick enough to require a hospital stay. While those who wish to obstruct health insurance reform try to stall for time and hopefully kill it, it is easy to forget about the roughly 14,000 people who are losing their health insurance each day along with the roughly 1,500 people on average who die each month in the US simply due to lack of health insurance. Is it any wonder that those who are really behind this war welcome all of these distractions?

I realize that my rantings about the health insurance industry may make me look like just as much of an extremist as those on the other side of the issue who rail against the evils of “socialized medicine”. But the case against the health insurance companies is quite compelling if not overwhelming.

Even though most conservatives hate Michael Moore on general principles, his documentary Sicko still does the best job of describing the serious problems inherent with the for-profit health insurance system in the US and how people literally die due to insurance company decisions based on maximizing profit. For those who have still never seen this movie and wish to, it is available for viewing online
in this link.

One of those who appeared in the movie,
Dr. Linda Peeno became a whistleblower against the abuses of the HMO system while testifying to Congress that one of her decisions while working for an HMO caused the death of a man.

Another more recent whistleblower is
Wendell Potter who made a recent appearance on Bill Moyers Journal. The complete interview is available for viewing online in this link. I urge those who wish to learn more about this issue to take the time to watch this roughly 35 minute interview. I have to admit that the more I listened to the interview, the more feelings of rage I had towards the health insurance industry as Potter confirmed most of the darkest suspicions many of us had about them.

Here are a few excerpts from the interview.

Despite at one time being part of an industry campaign to discredit Sicko, we have this stunning admission.

BILL MOYERS: So what did you think when you saw that film (Sicko)?

WENDELL POTTER: I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned.

BILL MOYERS: What were they afraid of?

WENDELL POTTER: They were afraid that people would believe Michael Moore.

And concerning the present pending legislation on a proposed public option…

BILL MOYERS: Why is public insurance, a public option, so fiercely opposed by the industry?

WENDELL POTTER: The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so.

BILL MOYERS: Compared to the industry's--

WENDELL POTTER: They spend about 20 cents of every premium dollar on overhead, which is administrative expense or profit. So they don't want to compete against a more efficient competitor.

So the next time you hear this issue being obscured by blowhards pontificating on the supposed horrors that health insurance reform is going to bring us, please remember what this issue is really all about — a health insurance industry that will stop at nothing to preserve its handsome profits even if it means that more sick people will suffer or maybe even die needlessly as a result. Only then will you know whom to support when you talk to or write to your senator or congressman!

Sunday, August 2, 2009

The Continuing Battle Over Health Insurance Reform

The battle over US health care reform enters a new stage while Congress takes its August recess to visit constituents to get their input. So this gives us a chance to pause and take stock of what has happened up to now.

For those who have not read it, I offer a previous posting,
The Continuing Fight Over Health Care Reform as an overview of this issue. It is interesting that President Obama is now starting to refer to this issue as Health Insurance Reform. Indeed there are some commentators such as in this blog from Time, Health Insurance Reform? by Karen Tumulty who speculates on this change in semantics.

The phrase "health insurance reform" is indeed an effort to tailor his message to the concerns of people who have coverage--who are, after all, the vast majority in this country. But one challenge there is that these people--86% of them in our latest poll--are satisfied with what they have. And while you might think that in the middle of a recession, a lot of people would be concerned about losing that coverage, because it is something they get along with their jobs. Our poll found that only a surprisingly low (at least to me) 33% are.

But using the magic of 20-20 hindsight, I now believe we should have called this health insurance reform from the very beginning because the problem we have in the US with health care is first and foremost a problem with our health insurance system. Despite all of the yammering about the fear of “government run health care”, those who want reform actually want the government to tackle the problems surrounding health insurance which is shutting people out of receiving needed healthcare.

The reason behind these problems is an inherent conflict of interest associated with private health insurers. On one hand they are there to serve their policyholders by making healthcare available when needed. But more importantly, they have an obligation to their shareholders to maximize profits. This creates an incentive to restrict or even deny healthcare whenever possible. The more healthcare they can deny, the more profit they make. This is why so much time and money is spent by private insurance companies to try and deny claims from the present policyholders as much as possible along with avoiding future policyholders with preexisting conditions who would be a drain on company profits. Not surprisingly, this has resulted in health insurance companies making huge profits while many sick people were being shut out of getting needed healthcare.

So why not solve the problem directly and replace the private insurers with a public insurer (a.k.a. 'single payer’) like what we presently do with Medicare for those over 65? The answer is that the private insurance companies are politically very powerful and would undoubtedly fight to the death to avoid their demise — a fight that few of our politicians have any stomach for.

But how do the Democrats try to make progress in health insurance reform without going to war with the insurance industry? Essentially, they had to make a deal with the devil. In exchange for keeping the health insurance companies intact in any proposed health insurance reform, the Democrats would get to propose an alternative “public option” to provide a way to keep the private insurers honest.

And indeed President Obama kept his part of the deal. When seeking input on health insurance reform, those who were for a public single payer insurance system that would eliminate the insurance companies were specifically excluded from the conversation.

But when you make a deal with the devil, you take the chance of getting burned! The insurance companies have apparently decided that they like the idea of not having public insurance competition and don’t want that gravy train to end. So instead of cooperating with the proposed public option, they are fighting it with a guerilla tactics like providing talking points for Republican opposition through a so-called "nonpartisan" source of information in the form of the Lewin Group.

The Lewin Group, exposed by the Washington Post as a subsidiary of an insurance company, has been widely cited as an objective, nonpartisan source of information by those opposed to the creation of a public health insurance option.
And while the health insurance companies can hardly admit that they want to squash any public option in order to keep their profits as high as possible, they can mobilize their political base to wage a proxy war on ideological grounds as in the following E-mail ad from the conservative group Americans for Prosperity.
After months of debate in Washington and the usual wheeling and dealing between the politicians and lobbyists, Senator Specter is coming home for a month. Now it’s your turn to talk with him. Don’t miss the chance.

Bring your own signs! Prepare to ask questions!

You can bet our big government opponents are gearing up to turn out their troops. They’ll be shouting for government to take over our health care. They’ll be pushing the job killing, tax increasing cap-and-trade scheme. Already, their turnout operation is in full swing.

It’s up to us to make sure Senator Specter sees and hears our side – the side of freedom, of lower taxes, less government, of making your own health care decisions.
Of course this conveniently ignores two vital facts. One is that nobody is advocating the government takeover of health care — they are only looking for reform in the way health insurance is offered to finally make it affordable and available to all. And as for people making their own health care decisions under the present system, we know that it is insurance companies that have been making the healthcare decisions for Americans — sometimes with tragic results.

Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage.

Although some Americans may indeed be satisfied with their insurance, others have learned the hard way after they got sick that their insurance really didn’t protect them from financial catastrophe. But by then it was too late.

One of the concerns raised about the public option is that it may put the private health insurers out of business if they were unable to compete with government run health insurance. But if that really were to happen, why would that be bad? Why is it that the same people who say that government shouldn’t keep companies like General Motors afloat will gladly fight to keep the same health insurance companies afloat who have been getting rich denying coverage to sick Americans?

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!