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

Concussion Trauma Risk Seen in Amateur Athlete

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.

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
Education

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!

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:

1. DON’T GET SICK

2. And if you do get sick…

3. DIE QUICKLY

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?

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!

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!

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?

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!