Anonymous Liberal captures the frustration of the current political scene in a post called "An Army of Trumans."

In this Bubble World, it is an accepted truth that our President is a bumbling ignoramus who can only string together a coherent sentence if he uses a teleprompter (which, apparently, other politicians don't use). I can understand a world in which Obama's political opponents mock him as a being too professorial or out-of-touch or arrogant. But unintelligent? Inarticulate? I don't know how to deal with that. It's like mocking John Boehner for being pale. ...

In Bubble World, cutting taxes actually raises revenue. In Bubble World, "the market" will magically solve all of our health care problems and true "freedom" is defined by one's ability to be denied health coverage for pre-existing conditions. ...

Source: People's World

The grounds for cancellation are often flimsy at best. A 2007 California investigation of a WellPoint subsidiary looked at 90 randomly selected cases of dropped insurance. There wasn't a single case where the evidence indicated the applicant had intentionally omitted or misrepresented anything.

Source: About.com

Agencies such as the Department of Health and Human Services need to draft regulations that govern implementation. This is where lobbyists can exert their influence. There's a summary of this activity in an article today from The Associated Press.

Voters can participate in the action too. Conservatives are pushing for ballot initiatives that will block the individual mandate: the requirement that most people purchase health insurance in 2014. If conservative initiatives draw large numbers of supporters to the polls, the 2010 election may allow Republicans in Congress to scale back the impact of health care reform.

Nice summation of what makes sense and what doesn't about the Tea Party from Andrew Sullivan at The Daily Dish. His conclusion:

In my view, this confluence of feelings can work in shifting the public mood, as seems to have happened. When there is no internal pushback against crafted FNC [Fox News] propaganda, and when the Democrats seem unable to craft any coherent political message below the presidential level, you do indeed create a self-perpetuating fantasy that can indeed rally and roil people. But the abstract slogans against government, the childish reduction of necessary trade-offs as an apocalyptic battle between freedom and slavery, and the silly ranting at all things Washington: these are not a political movement. They are cultural vents, wrapped up with some ugly Dixie-like strands.

When they propose cuts in Medicare, means-testing Social Security, a raising of the retirement age and a cut in defense spending, I'll take them seriously and wish them well.

Until then, I'll treat them with the condescending contempt they have thus far deserved.

Related posts:
How socialist is the US?
Tony Judt: On the edge of a terrifying world
Obama on race and the Tea Party
Our only language is English
Reaction to health care: A step backwards
The Supreme Court and health care repeal politics
Olbermann on the damage done by "death panels"
Keith Olbermann & the Fight against Death
Health care: Reminding people of death triggers irrational emotions
Were "death panels" a teachable moment for palliative care?

Source: SFGate

Without this provision, health care reform falls apart. If we're going to require insurance companies to cover everyone, including those with preexisting conditions, then the pool of purchasers must include healthy as well as unhealthy people.

Frontline has put together a documentary on the passage of health care reform. It argues that Obama caved in to special interests at every step of the way and that this is bad news for Democrats.

Barack Obama promised change. Then he took on one of Washington's toughest issues: health care. During his first year in office, he found himself making one deal after another with Capitol Hill's powerful insiders--lobbyists and influential members of Congress. He angered his political base, watched his popularity sink, and nearly failed to pass the bill. In Obama's Deal, FRONTLINE follows the story of the president's historic victory and offers the first in-depth look at how the Obama administration operates. Veteran FRONTLINE producer Michael Kirk ... provides a sobering view inside Obama's deals and reveals the realities of American politics, the power of special interest groups, and the role of money in policy making.

Source: University of Virginia

Governors of 30 states were threatened ("resign within three days or face removal from office)" by Guardians of the Free Republics, a group that aspires to "restore the U.S. republic by peacefully dismantling parts of the government."

Someone sent this to me, and I can't find it on the web to give credit to the artist.

Source: The Washington Post

Senator Kennedy, in a letter delivered to President Obama by Vicki Kennedy after her husband's death, had written: "You will be the president who at long last signs into law the health care reform that is the great unfinished business of our society."

Kennedy is buried in Arlington National Cemetery. There were hundreds of visitors to his grave site this week, including family members and colleagues. David Bowen, who had been Kennedy's health director, had vowed at the senator's funeral that he would not visit the grave until health care reform was passed.

Source: The Economist

Attorneys general from 14 states (so far) are filing lawsuits to challenge the constitutionality of health care reform. Some have the support of their Republican governors. Others have incensed their Democratic governors. Orin Kerr, on the conservative/libertarian law professors' blog The Volokh Conspiracy, gives the odds of repealing the individual mandate as less than 1%. He believes the matter will be dismissed in the lower courts and never reach the Supreme Court.

Linda Greenhouse, a longtime observer of the Supreme Court, makes her own case for why the repeal efforts will be futile and a waste of taxpayers' money. Her argument is not based on the principle of federalism or the Constitution's "commerce cause," but on the personality and character of the Supreme Court justices.

Source: The Truth or the Fight

Karen Tumulty writes: "Keep in mind that it is not in the interest of the lawmakers who hold the key votes to show any flexibility at this point. The real movement comes at the very last minute. ... [U]ntil a vote has been scheduled, and we are within 48 hours of seeing it happen, take anything you hear from anyone on Capitol Hill with a full box of salt."

Last October, in a one-hour special commentary on health care reform, Keith Olbermann discussed his father's illness in personal and graphic detail. Last night he provided an update that began: "Last Friday night my father asked me to kill him."

Olbermann and his father have had conversations about end-of-life care. He's outraged at those who oppose this emotionally difficult but medically important event.

Source: Torontoist

Early in the twentieth century, industrialized nations - with the glaring exception of the US - acknowledged that national governments had a responsibility to protect the health of the poor. In practice, this took the form of health insurance, wholly or partially paid for by the state. The motivation was primarily self-interest. Contagious diseases don't distinguish between the rich and the poor. Also, there was a fear that poverty would provide a breeding ground for social revolution.

Source: Cheezburger

The lack of universal coverage is perhaps the most disturbing difference. There are clearly economic advantages to universal health care: Diseases cost less in the long run when they're prevented or caught early; insurance costs less when it draws from a pool that includes both the healthy and the less healthy.

Universal coverage is an ethical issue. The US claims to be a country that values equal opportunity. If you lack adequate health care from the time you're conceived, however, your opportunities will never be equal.

Source: The New York Times

Trafford describes an experience she had with supporters of Clinton's health reform. In 1994 she traveled with the Health Security Express, a busload of individuals who suffered from a variety of illnesses and who were willing to trek around the country making a case for universal health care.

The riders became a target for attacks against the Clintons. At each stop, small but vocal crowds were organized to protest "BillaryCare" and "socialized medicine." One protester yelled at a woman in a wheelchair: "Go back to Russia!" I was stunned by the vitriol and nastiness of protesters.

Source: Ohio Daily

Abigail Trafford, author and former Washington Post editor, has written an analysis of the failure that includes an historical perspective on the Clinton years.

It took too long and seemed too big

Although the Clinton and Obama strategies were polar opposites in many ways, one thing they had in common was how long it took to create legislation.

[B]oth strategies were undermined by fatal delays. Bill and Hillary Clinton waited almost a year to unveil their plan. With the Obama initiative, Congress has been the laggard. Administration lieutenants hoped to get something passed quickly; then they would sell the plan to the public. But the delay frittered away the public's post-election enthusiasm for reform while allowing opponents to mount a counterattack.

Source: The University of Minnesota

The BBC has a new radio series that addresses the question: Why turkeys vote for Christmas. David Runciman writes the first installment, in which he asks: Why is it Americans who would benefit the most from health care reform are the most opposed? One third of Texas residents have no health insurance, for example, but 87% oppose reform.

There are many opinions on why Obama's reform didn't pass, and pundits will be arguing this issue for months, if not more. Texans, for example, are likely to oppose government involvement in any aspect of their lives, and that opposition can easily outweigh the value they place on health insurance.

The body as machine

Source: The Daily Mail

"Inventor Le Trung spent Christmas Day with the most important woman in his life - his robot Aiko. ... Her touch sensitive body knows the difference between being stroked gently or tickled. ... 'Aiko is always helpful and never complains. She is the perfect woman to have around at Christmas.' "

Celebrity health advice

Source: PLoS Medicine

"Many doctors say they're troubled by stars who cross the line from sharing their stories to championing questionable or even dangerous medical advice. ... Actress Suzanne Somers-- already well-known for her diet books and ThighMaster products -- in October released her 18th book, Knockout, which experts describe as a catalogue of unproven or long-debunked alternative cancer 'cures.' ... [Celebrities] 'can spread misinformation much faster than the average person with a wacky theory. ... Correcting that misinformation -- even with a mountain of evidence -- can be a challenge. ... 'It's much easier to scare people than to unscare them.' "

There's a long article in Sunday's New York Times on palliative sedation. I've also listed some older stories on the subject and an educational site.

Aging, end-of-life, and death

Source: The Why Files

Hard Choice for a Comfortable Death: Sedation, (The New York Times)
"Among those [end-of-life] choices is terminal sedation, a treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm. Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone's life, but only to make the patient more comfortable."

Source: Moore's Lore

It's now abundantly clear that the legislative process is hopelessly inadequate when it comes to things like health care, climate change, and economic inequality.

New York Times editorialist Paul Krugman considers the Senate, with its filibuster, "ominously dysfunctional."

Consider what lies ahead. We need fundamental financial reform. We need to deal with climate change. We need to deal with our long-run budget deficit. What are the chances that we can do all that -- or, I'm tempted to say, any of it -- if doing anything requires 60 votes in a deeply polarized Senate?

Some people will say that it has always been this way, and that we've managed so far. But it wasn't always like this. Yes, there were filibusters in the past -- most notably by segregationists trying to block civil rights legislation. But the modern system, in which the minority party uses the threat of a filibuster to block every bill it doesn't like, is a recent creation.

Source: Washington Life Magazine

The New York Times reports on the Senator's most recent vote on health care reform:

"When the roll was called Thursday morning, the mood was solemn as senators called out 'aye' or 'no.' Senator Robert C. Byrd, the 92-year-old Democrat from West Virginia, deviated slightly from the protocol. 'This is for my friend Ted Kennedy,' Mr. Byrd said. 'Aye!' "

Source: Wunderground

Anyway, here's a flock of interesting stories I've come across recently.

Aging, end-of-life, and death

The Breadth of Hope, Selling Hope, and More on Quelling Thanatophobia, (Pallimed: A Hospice & Palliative Medicine Blog)
One unspoken message behind the "sell hope for a cure" ads is "we will not only cure your cancer so that you can avoid death, but we'll also make it so it's a non-issue in your life so that you can return to the way things were before. It'll kind of be like getting your car's air conditioner recharged."

Source: FoundMoney

Senator Dorgan's amendment to the health care reform bill went down to defeat on Tuesday, but on Sunday David Axelrod, senior political advisor to President Obama, told CNN that "the president is committed to moving forward" on this issue. "Let me be clear," he said. "The president supports re-importation ... safe re-importation of drugs into this country. ... There's no reason why Americans should pay a premium for the pharmaceuticals that other people in other countries pay less for."

Source: The Heartland Institute

At least once a year, some brave Senator proposes an amendment that would allow Americans to buy prescription drugs from other countries. Spokesmen for pharmaceutical companies, such as Glaxo and Merck, readily admit that the drugs they manufacture and sell in the US are the same as those they sell outside the US. Whenever the issue of importing drugs comes up, however, they cry: "Imported drugs aren't safe! We have to protect the public!"

Source: Infected Tube

Paul Starr was a senior advisor for health care reform under President Clinton, and he's the author of a celebrated history of the American health care system, The Social Transformation of American Medicine. He has weighed in on the current health care debate in a New York Times op-ed piece.

In addition to commenting on the public option (it would enroll too few people and cost too much) and letting states run health exchanges (too many states would resist), he points out the importance of accelerating the timetable for reform. His concerns are similar to those raised last week by Maggie Mahar (emphasis added).

For Congress to put off expanding coverage to 2014 would be asking for a lot of patience from voters. It would also give the opponents of reform two elections to undo it. President Obama would have to run for re-election in 2012 defending a program from which people would have seen little benefit.

To speed the process, the legislation ought to give states financial incentives to adopt the reforms on their own as early as mid-2011. ... The final deadline for the federal government's expansion of coverage should be no later than Jan. 1, 2012.

Source: About.com, Daniel Kurtzman

What if, in the 2012 elections, conservatives took control of both the White House and Congress? In the House version, they would have only a few months to overturn the legislation and prevent it from happening. But with the Senate version, they would have a whole year.

Sourch: On the dash

Health experts have proposed a tax on soft drinks of one cent per ounce. That's an extra 12 cents on a 12-ounce bottle of Pepsi, which may not sound like much, but it adds up. If a two-liter (67.6 ounces) bottle of Coke sells for $1.35, the price would go up 50 percent.

Health experts claim the tax could cut consumption by 10 percent and, they hope, reduce obesity. Even if the tax had no impact on weight gain, there's the appeal of generating $15 billion a year in revenues.

Congress likes the idea of a tax on soft drinks because they could use the money to finance health care. The Congressional Budget Office did an estimate last December on a less drastic federal excise tax -- three cents for every 12 ounces -- and came up with a projected income of $50 billion over ten years. Currently there's no amendment taxing soft drinks in either the House or Senate versions of the health care reform bill. But that battle isn't over yet.

Source: xplosive world

Dan Balz has a nice summary of this summer's health care struggle in The Washington Post. Eleanor Clift, a long time Washington veteran, puts the "tortured history" of reform in perspective at Newsweek, reminding us of Nixon, Kennedy, and Clinton.

Source: Palliative Care Foundation

Palin's emotionally manipulative Facebook post appeared on August 7. "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care. Such a system is downright evil."

A great deal of misinformation was bandied about, and unnecessary fears were purposely inflamed to gain political advantage. There may be a silver lining to this cloud, however.

Source: Bill Moyers Journal

As Mahar says in her post today, the director and field producer "did a brilliant job of finding doctors and patients who tell riveting stories, while simultaneously exposing many of the less-well-known facts about our broken health care system."

Here's the website where you can watch it. I tried, and it works fine. You can make the video full screen. Move backwards and forwards. Watch some now and watch more later. The entire film is 80 minutes long.

Raphael, The School of Athens

Source: Paula Muhlestein

I loved this post from the Widener Law Health Law Institute blog. It's both wise and entertaining. Here are a few excerpts, but I recommend reading the whole post.

The Nose on Your Face

Olbermann called his Special Commentary "Health Care Reform: The Fight Against Death." Over and over again he returned with a flourish to the word "death," the subtext being "Look how heroic and iconoclastic I am to be talking about this unmentionable subject." The inevitability of death was his scare tactic: "You are going to die. We are all going to die." Yet at the same time, he accused his opponents of exploiting that same fear: The reason misguided folks are opposed to reform are the "death panel" scare tactics of the other side.

Source: Banning and Low

The current health care debate in the US isn't about health. It's about money. Legislation is written to accommodate the financial interests of money-driven medicine, especially the insurance industry.

Is there something in our fabled "ruggedness" that perpetuates financial inequality? At some level of the American psyche lies the belief that those who fail financially deserve to suffer, while those who succeed shouldn't have to share. Does this strain of thought color the health care debate?

This post is a submission to the Hastings Center's Values and Health Reform Connection, a new group blog on American values and why they matter in health reform.

Source: Jordan Maxwell

They would agree with Peter Montague that "the growing gap between rich and poor has not been ordained by extraterrestrial beings. It has been created by the policies of government." And government should fix it.

Conservatives, on the other hand, believe in the unfettered hand of the free-market system. It's a system that may produce social and economic inequalities, but you can blame the individual for that, not government policies.

Can sarcastic humor make a convincing case for health care reform? Will Ferrell, the comedian, and MoveOn.org, the liberal political advocacy organization, are giving it a try. They've created a video that defends beleaguered insurance company executives.

The video is available on YouTube and features well known celebrities. The cast, the humor, and Internet-only availability suggest this pitch is meant to appeal to healthy young adults who may feel they don't need the expense of health insurance. Mandatory insurance coverage -- even for the young and healthy -- is one option that may end up in the final version of health care legislation.

Source: Tax Tea Party

If there are indeed 46.3 million Americans without health insurance; if 45,000 people die every year from preventable causes because they have no health insurance; if the US ranks 21st out of the 21 wealthiest nations on child well-being - these are all moral issues. It's when we try to do something about these issues that morality sprouts a price tag.

Those who oppose health care reform aren't necessarily heartless ghouls who want children to die and the sick to suffer. They're simply approaching health care from a financial point of view, which can be difficult to reconcile with a moral perspective.

Source: The Long-Term Care Company

What about those people who truly believe they've always been healthy? When it comes to insurance, health is in the eyes of the beholder -- in this case the eye's of the insurance underwriter.

Source: textually.org

Australia's National Preventative Health Taskforce has published a report that includes 174 recommendations for preventing disease. Among the measures that could be implemented:

• A 50% increase in the price of cigarettes
• Cigarette packaging that allows only a bland box with the brand name and a health warning
• A minimum unit price for alcohol and increased taxes
• The elimination of alcohol advertising during TV sports events
• The elimination of alcohol advertising before 9 PM, when more children and adolescents are viewing
• Tougher restrictions on where and when alcohol can be sold
• The elimination of TV advertising for "energy-dense", nutrient poor (i.e., high empty-calorie) foods before 9 PM
• Reduced taxes on health foods to make them more affordable
• Tax breaks for gym memberships and for parents who enroll their children in sports activities

Source: Amazon

The United States is the only industrialized democracy that does not guarantee health care to all its citizens. For some Americans, this is consistent with our Jeffersonian heritage of a limited and frugal government. The wealthy should not have to pay for the poor, even in matters of life and death.

For many Americans, however, our health care system is disturbing. 45,000 Americans die every year from treatable diseases because they lack health insurance. We're the only country with medical bankruptcies. This feels morally wrong, just as some wars seemed wrong and made it difficult to feel good about being an American.

Source: thepeoplesvoice

What throws off the numbers for the US -- the reason our overall statistics are 23 points behind Britain, Canada, France, Germany, and Japan on a scale of 100 -- is that there are pockets of the population who lack access to health care and its benefits. The statistics for this segment resemble those of a poor, unsuccessful Third World country. The US ranks 21st out of 21 wealthy countries on child well-being according to UNICEF.

Source: State of the Division

The one Congressional committee that has yet to agree on its legislative reform plan is Max Baucus' Senate Finance Committee. An 18-page summary (PDF) of what we can expect was revealed this week.

Insurance reform of policies sold to individuals - that is, to people who are not covered by their employer -- includes some of the things we've been hearing about. Insurance companies can't deny coverage due to a pre-existing condition. They can't impose lifetime limits on what they'll pay. Your policy can't be cancelled for no good reason.

What's new is a gift to the insurance industry in the form of rates that can be charged for insurance premiums.

Source: The Guardian

That certainly doesn't happen in the US. We have little knowledge of what other countries think of us. We get our news from American media outlets - Fox, MSNBC - that confirm our narrow point of view. It's in the interests of these outlets to magnify events and fan our emotions so we'll keep coming back for more. Their tactics include demeaning or demonizing those who hold a different point of view. Liberal and conservative media are equally guilty of this behavior.

Source: eHow

According to the Centers for Disease Control and Prevention, three-quarters of health care dollars are spent on preventable chronic diseases. Smoking is an obvious culprit, but many (if not most) chronic diseases - diabetes, heart disease, cancer - have a connection to poor diet. We eat too few fruits and vegetables and too much sugar, salt, refined carbohydrates, and saturated fat.

Rep. Joe Wilson of South Carolina

Source: The New York Times

In a town hall meeting on health care this summer, a woman confronted Rep. Norm Dicks of Washington: "If you are so keen to forcibly take from one person to give to another, who you deem as needier than me. ... If you believe that it is absolutely moral to take my money and give to someone else based on their supposed needs, then you come and take this $20 from me and use it as a down payment on this health care plan."

Source: Bill Moyers Journal

Is it possible for opponents and proponents to find common ground here? Are these issues that could unite concerned citizens of various political persuasions? Could we all agree there's something profoundly wrong with the existing health care system that needs to be addressed?

One of the most disturbing quotations comes near the end of this post: "The end product of all of this mess and confusion in [medical] technological innovation is going to be a system that cannot be sustained, because it will be so expensive that only the extremely well to do, the elite, will have access to it."

Source: Bill Moyers Journal

Bill Moyers: "Money-Driven Medicine is one of the strongest documentaries I have seen in years and could not be more timely. The more people who see and talk about it, the more likely we are to get serious and true health care reform."

Source: Bill Moyers Journal

My sympathies may lean towards one side of the health care reform argument, but I find it distressing to see good people on both sides insult, demean, and provoke one another. I know it's a dog-eat-dog world out there, but does it really have to be? When Rodney King said "Can we all just get along?" did that resonate with us and become unforgettable because it was so naïve?

I don't think so. I believe, deep down, the vast majority of Americans would prefer a kinder, gentler nation. What we have now is a spectacle with high entertainment value.

Source: Gearlog

That type of reconciliation - a kindly, all-is-forgiven meeting of the minds - would indeed be historic. Unfortunately, "too much to hope for" is right, I'm afraid. The Republican Party, having lost most of its moderates, is now dominated by its right wing. A Democratic strategy is already emerging that calls for playing a different sort of reconciliation card.

Source: Canadian Family Physician

And do it as soon as you can. It takes five years after a divorce before your assets are no longer subject to seizure. That's because the government knows couples get divorced in order to escape medical bills.

Nicholas Kristof has an excellent op-ed piece on this problem in today's New York Times. He describes the case of a woman whose husband had dementia. She knew he would eventually need to be institutionalized.

Source: Teachers.net

Sicko

Every country is unique, so it's unproductive to imagine the US duplicating another country's health care system. What the US has now is a very complicated arrangement for delivering health care and paying for it, a convoluted system that's been evolving for decades - ever since Marcus Welby-like family doctors stopped making house calls.

Source: The AV Club

So writes Jonathan Cohn in a New Republic article called "Hindsight."

In politics, it's much easier to be a Monday morning quarterback than a prophet, of course. Cohn doesn't blame Obama for focusing on costs. At the time, that approach made eminent sense. "[T[he evidence of unnecessary, even harmful medical care ... has simply become overwhelming. And the argument that health care is a threat to our long-term fiscal health ... has become impossible to ignore." Theoretically we can spend as much as we want on health care, but that's money that doesn't get spent on roads, schools, public housing, and wages.

Source: WTRF

Ezra Klein in The Washington Post:

"Year after year, decade after decade, he labored to pass health-care reform. He sought deals with Republican presidents, with Democratic presidents, and even pursued the office himself. He tried to cut out the health-care industry and bring them to the table, to move forward on a bipartisan fashion and on a Democratic platform, to pass single-payer and to promote incrementalist approaches. The process wasn't the point. Nor were the people. Nor, even, was Ted Kennedy. Universal health care was the point. Helping the excluded, and the endangered, was the point.

Source: The Washington Post

There are many commentators who argue that insurance co-ops are an inadequate alternative to a public option. For example, Nobel Prize winning economist Paul Krugman:

[T]he supposed alternative, nonprofit co-ops, is a sham. That's not just my opinion; it's what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers.

One reason it's so hard to make progress on health care reform is that it's an extremely complex problem. Although President Obama does an excellent job of articulating the issues simply and clearly, it appears his message is not getting through clearly enough.

Dan Roam, a business consultant and the author of The Back of the Napkin, believes in visual thinking as a way to understand and communicate complex ideas. His basic argument is that if you can identify the specifics of a problem and communicate them clearly, then you can get the response you need to fund the solution to that problem.

Source: The Christian Science Monitor

Here's what Dan Roam comes up with when he applies his visualization technique to the problem of health care reform.

Healthcare Napkins All

View more documents from Dan Roam.

Source: The Associated Press

I recommend reading the entire article. Here are some highlights.

The idea of death panels gains ... credibility, ... "because many people are vaguely aware that end-of-life care is bankrupting Medicare and that at some point we have to figure out how to deal with that." ...

The power of "death panels" as a phrase and a scare tactic also works because Americans are deeply uncomfortable with death. We don't like to think about it or talk about it. ... As a result of that discomfort, reminding people of death sends them off the deep end, into the part of the neuronal pool where reason cowers behind existential terror.

Source: The Insider

Forty years after Woodstock, it's clear that a major shift happened in that decade, politically, socially and psychologically. Despite the communal love fest, Americans had begun "bowling alone." Crime rates started to rise, as did divorce rates. Quite suddenly, in 1965, a vast majority of people stopped identifying themselves as Democrats or Republicans and became Independents.

Source: Defending the truth

The study was presented at the annual meeting of the American Sociological Association on August 10, 2009 by its author, Kristen Springer. The men who participated in the study were all 65 years old, and preventive care was defined as annual physicals, testing for prostate cancer, and getting a flu shot.

The men's "macho quotient" was determined from a questionnaire that asked things like "When a man is feeling pain, he should not let it show. Do you agree or disagree?" Other questions designed to identify traditional masculinity asked whether men should be the main bread winner, act confident even when they're not, or have the final say in the decision to buy a house.

Source: Telegraph

The shouting captured media attention and overshadowed debate on the complex details of Obama's top domestic priority, but the furor could limit the influence of the town hall meetings when lawmakers take up the issue again in September.

"A lot of this is the base of the two parties screaming at each other and I don't know if it's changing a lot of minds one way or the other," Republican consultant Dan Schnur said.

"It just turns people off," said Jim Kessler, vice president for policy at the moderate think tank Third Way. He said extreme elements on each side are battling and "for everyone else this is a revolting spectacle."

Source: Silive.com

Here's a typical complaint I found online: "The Government Loses Over $200 Billion A year To Medicare/Medicaid Fraud!!!! Should they be taxing us more to grow their control of the system??? Isn't it a bottomless pit???"

This individual continues:

The federal Health Care Financing Administration, which oversees Medicare & Medicaid ..., estimates that the government loses 30 cents to every dollar from fraudulent practices in the medical community. This is a huge problem that must not be ignored.

Source: Psychic Medium Rare

Dean and former Senate Majority Leader Bill Frist, both MDs, were interviewed last night on the Charlie Rose Show. Towards the end of the interview, Rose asked Dean about Democratic liberals in Congress. Would the Democratic left rebel against the President if there was no public option in health care legislation?

"I hope so," Dean replied.

Dean went on to make the argument that, without the public option, the legislation simply amounts to insurance reform. Certainly that's worth something. It would be great if insurance companies could no longer cancel a policy once someone got sick. Or refuse coverage for a pre-existing condition. But insurance reform, by itself, doesn't require any spending. And this is an $800 billion bill.

Source: The health care mess

As President Obama pointed out in his press conference on health care last week, his political opponents see the derailment of health care reform as a big political win for the Republicans. He quoted Republican Senator Jim DeMint: "If we're able to stop Obama on this, it will be his Waterloo. It will break him."

Why does Obama continue to pursue Republican votes?

The politics: Is bipartisanship worth it?

Adam Nagourney, veteran political journalist for The New York Times, has an excellent article that addresses this issue. Here are some points to consider:

Source: Nick Brandt

Click photo for larger view.

Despite our best efforts to control cost inflation -- research, legislation, corporate reform -- the rhinos keep coming. "They are ubiquitous, powerful, protean and inexorable."

They feed on fuel sources deep in our system: expensive technological progress, the self-interest of the millions of people who make their living off the system, the public's desire to get the best care for nothing, the fee-for-service payment system and so on.

The rhinos are closing off your future.

Source: Hogue News

According to the federal HIPAA law (Health Insurance Portability and Accountability Act), insurance companies cannot rescind (cancel) a policy unless there has been fraud or intentional misrepresentation. But insurance companies cancel health insurance even when policy holders have done something by accident or unintentionally. (See yesterday's post: Why health insurance isn't there when you need it most)

Source: National Public Radio

Robin couldn't have anticipated this. She didn't know her dermatologist had written a word on her medical record that was misinterpreted by Blue Cross. The doctor immediately tried to intervene with the insurance company, but they wouldn't budge. First they wanted a three-month review of the last five years of Robin's medical history, and then they decided just to cancel.

Source: Bill Moyers Journal

Sicko

The insurance industry was extremely nervous about the release of Moore's film. Their trade association prepared a document full of talking points and tactics for lobbyists and insurance industry staffers. The contents were highly confidential, but not any more. Moyers not only obtained a copy, but has posted the complete document online (PDF). It's as fascinating as one of those secret tobacco industry memos.

Source: Americais

The public insurance option might reduce the cost of insurance by competing with for-profit insurers. But this doesn't reduce the number of unnecessary procedures. As David Brooks points out in a NY Times column, the public option, as it's currently formulated, would have no effect on the fundamental incentives that lead to higher costs.

Artist: Robert Parada. Source: AARP

In the US, drug company lobbying is so powerful that it can convince Congress to prohibit the negotiation of discounts (the 2003 Medicare Prescription Drug Act). As if that weren't enough, it's illegal for Americans to order drugs from Canada. (You're allowed to carry a 90-day supply over the border.)

President Obama has, in the past, favored changing legislation that prohibits drug purchases from Canada. (Congress calls this drug reimportation.) John McCain was in favor of change. (It's a popular position when running for election.) Democrats have been advocating this change for years. Between 70 and 80 percent of Americans favor this option.

Source: Stop Barack Obama

Meanwhile, The Washington Post reports that the largest hospitals, medical groups, and insurers have hired more than 350 lobbyists who are either former government staff members or retired members of Congress. Three out of every four major health-care firms have at least one lobbyist on their payroll who's been recruited from inside the government. Nearly half of these come from either key Congressional committees that are currently debating health care legislation or from the staff of key lawmakers, such as Senators Max Baucus and Charles Grassley.

Source: Forbes

The insurance practices and medical cultures of France and the Netherlands have more in common with the situation in the US. They get less attention than Canada and the UK because, according to Cohn, they don't fit the negative stereotypes of what health care is like when the government is involved in medical care. Based on his extensive research, Cohn reports:

Source: The Negotiation Academy

1) Don't trust the insurance industry.

2) Don't trust the insurance industry.

In a NY Times editorial, Krugman recalls how conservative Bill Kristol, in 1993, urged Republicans to oppose any significant health care reform. He did, however, advocate simplifying insurance forms. Fifteen years later the insurance industry is finally proposing "administrative simplification." What took them so long? And why is a public health insurance option important?

Source: Courier Times Online

"Private health plans have a strong incentive to spend a dollar as long as the expected savings in payments is at least a dollar,' he said in that article, justifying the profit motive of private insurance companies. Yes, and we all know how insurance companies save dollars: By finding an excuse to cancel the insurance of patients who become ill and by exorbitantly raising the premiums for small businesses. (See Health insurance insider speaks out.)

Source: Center for Media

and Democracy

As a Public Relations professional, Potter was very aware that the industry used behind-the-scenes PR and lobbying. The insurance industry opposes any health care reform that might reduce their profits. He was also aware that industry practices were responsible for the growing number of uninsured.

What I saw happening over the past few years was a steady movement away from the concept of insurance and toward "individual responsibility" ... a continuous shifting of the financial burden of health care costs away from insurers and employers and onto the backs of individuals.

Source: Cheap health insurance services in India

Wendell Potter, a former executive at health insurance giant Cigna, was one of three health care specialists who testified today before the Senate Commerce Committee. You can read the entire transcript of his testimony at The New Republic.

Potter began by identifying himself as an insider who had witnessed for-profit insurance companies in pursuit of their primary goal: Satisfying investors. Their strategy for accomplishing this goal includes deliberately confusing customers and "dumping the sick."

Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand -- or even to obtain -- information we need.

Source: Marty Nemko

The site makes great use of the web as an interactive medium. You can select from seven different proposals for health care reform, such as the eight principles that President Obama outlined in February or the national health insurance program that Representative John Dingell has been proposing since 1957. You can simultaneously view as many proposals as you wish.

Among those opposing Obama's choice of Sanjay Gupta as the next Surgeon General is Adrian Campbell, a Michigan woman who appeared in Michael Moore's film Sicko. Gupta told his television audience:

In Canada, you can be waiting for a long time. A survey of six industrialized nations found that only Canada was worse than the United States when it came to waiting for a doctor's appointment for a medical problem.

In the film, Mrs. Campbell takes her daughter to Canada for an ear infection. She feels personally offended by Gupta's statement. "When Dr. Gupta said that Canada has longer waiting times, I felt like I was being made fun of."

Gupta, the chief medical correspondent for CNN, discussed the situation with his employer in mid-December. He no longer covers health policy stories for CNN, but he can still be seen on "House Call," his weekend health and wellness feature. When a plane crashed into the Hudson, CNN called on Gupta to discuss hypothermia, and when Senator Edward Kennedy collapsed at the post-inauguration luncheon, he was similarly "pressed into duty."

The majority of press coverage has been favorable. Ezra Klein, in a "Momma said wonk you out" column, says the 1993 Clinton healthcare reform failed because it didn't have a media strategy. The selection of Gupta signals that the Obama administration realizes it needs "a far more sophisticated media operation."

On the other hand, Fox News refers to Gupta as "the TV doctor," as if he were a cast member of General Hospital. Michigan Congressman John Conyers, a strong supporter of universal health care, opposes the nomination. He's promoting Dr. Herb Smitherman, a public health advocate from Detroit.

There's also support for Dr. George Lundberg as Surgeon General. Lundberg, a surgeon like Gupta, was the longest-running editor of JAMA, the Journal of the American Medical Association (17 years). He was abruptly fired by the AMA when he chose to publish the research article "Would you say you 'had sex' if...?", a survey on the definition of "having sex" among college students. The offense was not simply the subject, but the timing. The publication date of the article was January 20, 1999. The Monica-Lewinsky-inspired impeachment trial of President Clinton had begun on January 7. Lundberg was fired on January 15. The AMA, of course, did not cite this incident as the reason for firing Lundberg. (For those curious about the results of the survey, see the footnote below.)

Lundberg, the author of Severed Trust: Why American Medicine Hasn't Been Fixed, has a lot to recommend him. See the extensive commentary on the post "Dr. George Lundberg for Surgeon General" on The Health Care Blog (THCB). One thing I don't see mentioned at THCB is that Lundberg's appointment would be a slap in the face to the AMA, assuming 10 years isn't long enough to let bygones be bygones. Such lack of diplomacy would be highly uncharacteristic of Obama, who strikes me as a Nine on the Enneagram.

The Enneagram is a spiritually based personality typing system, associated with Gurdjieff, Oscar Ichazo, and Claudio Naranjo. Type Nine on the Enneagram is called the Peacemaker. Since I'm a Nine myself, my opinion on this is highly subjective.

Here's a cartoon about the nine Enneagram types that I think illustrates how we tend to see in Obama what we value in ourselves. That's a good quality in a leader. If Obama thinks Sanjay Gupta is the right choice for Surgeon General, I'm inclined to agree.

Barack Obama Supporters Come In All Types

Cartoons by Elizabeth Wagele

Footnote: Would you say you "had sex" if...?
The JAMA article doesn't say this, but one conclusion you could draw from the survey of college students is that they make a distinction between sexual activity that can lead to pregnancy and behavior that leaves one technically a virgin. The research survey was done in 1991 at a midwestern college and included students from 29 states. Close to 80% considered themselves moderate to conservative politically. Sixty percent reported that what happened between President Clinton and Ms. Lewinsky does not qualify as having "had sex."

The medical purpose of the survey was to ensure that public health officials are gathering accurate information relevant to disease transmission. The sexual activity with the greatest risk of transmitting an HIV infection did not qualify as having "had sex" for 20 percent of those surveyed. In a situation comparable to that alleged between Clinton and Lewinsky, 75 percent of students would not list the other party as a sexual partner. (This latter statistic is from a later (1996) survey.)

Bernard Madoff

Source: The Wall Street Journal

It was the Ponzi angle, with its image of collapse, that attracted me to an Eric Novack post on The Health Care Blog, The Medicare Ponzi Scheme. Novack argues that Medicare's "unfunded liabilities" - the promise to provide benefits in the future - are the equivalent of an $85 trillion Ponzi scheme.

This is not an argument I'd care to meet in a dark alley, but for balance I recommend the Century Foundation's paper The "Unfunded Liabilities" Ruse.

What I found highly valuable about the Novack post was a reply by Rob Oakley that was a refreshing mixture of honesty and compassion. (You can find the reply by searching for "Posted by: Rob" at this link.)

There's been plenty of coverage of the Obama and McCain health plans during the presidential election campaign. I debated whether to contribute my opinion and decided against it. I think everyone is exhausted with media coverage. There's a nice Time Magazine article this week on "The 24-Minute News Cycle." It was reassuring to read that I'm not alone in refreshing the Google News page.

I can recommend some sources on the health care debate that go deeper than the rivalry of two candidates. There is a page put together by The New England Journal of Medicine (NEJM) called Election 2008. I especially liked the article "Three 'Inconvenient Truths' about Health Care" by V. R. Fuchs. I may write about that article later. Health care is not an issue that's going to disappear simply because the election frenzy is over.