The Health Care Overhaul

Dear Readers,

With the whole country focused on the health care crisis and what to do about it, many who profit under the present system are trying to confuse the issues and delay progress in the hope that the movement will lose momentum.

In a recent comment to one of my posts, Sue made the following remarks, which she has since expanded upon at my request. They represent such a clear, rational summary of the main points we need to keep in mind, that I they are well worth repeating here:

Changes need to be made in the American health-care system. First, it is unconscionable in today's world that health care is dependent on employment. That made some sense in the era when people (meaning men) went to work for a company right out of school, spent their entire careers there, and retired a few years before their probable deaths from old age (at between 65 and 72). There was an unwritten contract that employees would be loyal and that employers would take care of their workers. This generally included health coverage for spouses and children. Now, of course, neither employers nor employees expect a lifelong employment relationship. In fact, many former employers now contract for temporary workers and workers may hold several jobs simultaneously. In this environment, employer paid or employer sponsored health coverage just doesn't make sense--much less work. And, for this reason, any health care coverage needs to be for everyone, not just for those who currently lack coverage. In other words, we need to disconnect the employment--health insurance connection.

Second, premiums range from outrageously expensive to totally unaffordable: both for individuals and for employers (especially the small businesses that make up the bulk of the employers in this country). The small company where I work is being hit with a 26% increase for the coming year, which is typical. Individuals and families will easily pay two or three times as much as individuals as they would as members of even a small group. And yet, if we were a larger company, our premiums would be lower and our coverage better.

Third, medical providers tend to be paid on a "per service" basis, which encourages them to order expensive tests and treatments and to see more patients than they can easily accommodate. Paying medical providers salaries rather than on a service basis could go a long way towards controlling costs.

Fourth, (and this goes right along with point three) we need a good peer review system to assure that the tests and treatments ordered are consistent. This doesn't mean that research facilities would be precluded from developing new approaches or pharmaceutical companies new medications, but it would assure some level of consistency.

Fifth, health care needs to be structured to emphasize preventative care. HMOs have received a bad reputation, due in part to the poor business practices of a few, but there are good ones. Kaiser Permanente and Group Health Northwest manage to take good care of their patients/clients while controlling costs and providing a high level of service. They could be excellent models for programs throughout the country. Also in this area, any program needs to include dental, vision, and prescription coverage to address all areas of preventative health care.

Finally, health care doesn't need to be a "single" provider to be reasonably cost effective. Choice is a good thing, but the choices should be realistic. We can't afford to have people running from doctor to doctor to find an agreeable diagnosis/treatment. Sure, this means a few people will be unhappy, but the vast majority will find their options more than adequate. Medicare and good HMOs are a good example of this: you can choose your doctor/facility within pretty broad parameters.

The Preamble to the Constitution includes as its raison d'etre "esablish[ing] justice" and "promot[ing] the general welfare"--two things that a reasonably thought-out health care plan would accomplish.

As to cost: if the money now being invested in employee health care by governments and corporations were pooled into a national program, I think we might find that we could cover all the people in the country for very little more than is now being spent on health care. Seems like we should give it a try.

While we may never agree on every point, this issue--unlike the economy--is one on which every one of us has some expertise. Almost all of us have fears, risks, and limitations associated our lack of adequate coverage or the costs of insurance. It doesn't take an economist to know that the public system, if it's not fixed, will soon be bankrupt. We really have no alternative but to get on with it.

Illusions of Individual Liberty

A few days ago, I had the privilege of spending the afternoon with a group of Hutterites, one of several closely related religious groups that also include the Amish and the Mennonites. Collectively called Anabaptists (not to be confused with Baptists), these people live communally and adhere to strict social and religious rules and regulations.

Hutterites establish extensive, modern farms that support their communities, which may consist of a dozen or more families. When a community—or “colony”—reaches a certain population (generally about 150 to 250), the leaders buy land elsewhere and establish a “daughter” colony. The community is divided, and about half the families migrate to the new location. The community I visited was a “daughter” colony forty years ago, when the original members immigrated to the United States from Canada.

Like nuns before the Catholic reform movement, Hutterite women wear special long dresses and hair coverings that distinguish them from others. Men wear black trousers with suspenders, and married men wear beards. Great care is taken to ensure that the day-to-day activities of the community are not much influenced by the outside world: televisions and radios are forbidden, and any access to the Internet is strictly limited to those who may need it to conduct business.

While Hutterites do have commerce with the outside world (including conducting tours of the compound, such as the one I was on), they are not of the world. Their first language is German, and older children and adults speak English with a pronounced accent. Children are educated within the compound and do not attend college. They learn the practical skills required for life within the colony and no others. For example, none learn to play musical instruments. (Although music is an important part of daily life, it consists of songs sung a cappella, usually in German.)

Asked if anyone had ever left the community, Theresa, our guide, said, “No. Why would anyone want to leave? We have everything we need here, and we take care of each other from cradle to grave.”

A closely related question is this: How could anyone leave? How could a young person who’s never been allowed—much less encouraged—to “think outside the box” ever leave the only world he or she has known since birth? How would anyone find the courage to leave behind all friends and family for a world that’s been depicted as evil and dangerous? Lacking many social skills and even the concept of “finding a job,” how could such a person get by in what the rest of us think of as everyday life?

I’m reminded of The Odyssey (which I’m sure Hutterite children don’t study in school). When Ulysses’ men arrived in the Land of the Lotus Eaters and experienced the euphoria the food there produced, they lost all desire to reenter the outside world. Ulysses had to capture them and tie them down in the ships to get them to leave that land of gentle captivity.

There are questions worth exploring here. If parents have the right to raise children however they please, what about the rights of the children? Should education involve preparing children for change, even if in the minds of the parents, change is not desirable? Should citizens be taught about the history and government of their country—even if their families encourage them not to participate in that government? Is ignorance by design of current events a type of captivity? Do people have a right to develop any or all of their talents—even those not valued by their family or community?

Thoughts and comments would be most welcome.

Trusting the Government

Joe and Mary are intelligent, well-educated, and compassionate people. They find each other and fall in love. A furious development of new neurological connections takes place in each of their brains, as each obsessively absorbs every detail about the other. Hormones and neurotransmitters go to work to ensure that each has eyes only for the other.

They plan a life together—two kids, financial security, plenty of time for travel—and get married. Each has perfect confidence that the other will work for the best interests of the family and (being perfect) never make a mistake.

Six months later, Mary’s pregnant (a little earlier than they expected) and Joe’s job is in jeopardy. Doubts have begun to creep in on both sides. Joe wonders if Mary can love a child and him, too. Mary’s beginning to wonder if Joe will be able to provide the financial security they both assumed they would have. The doubts begin to multiply—as doubts do—and six months later one of them files for divorce.

Trust is an essential element in all human relationships—individual and familial, public and private. Where trust is lacking, little or no progress can be made toward solving problems and achieving mutual goals.

And trust is a choice we make. Both Mary and Joe could have decided to give the relationship more time, to be patient, to maintain credibility long enough to see whether their collective projects—the child, prosperity, and the growth of their relationship—would pan out in the real world. Instead, they chose to bail.

There are parallels worth exploring between a marriage and the relationship of responsible citizens of a democracy with their elected government. One revolves around the issue of trust: it always takes time to be sure who you can trust and in what areas.

In a comment on yesterday’s post, “Sisyphus” asked,

Did you feel this confident trusting the experts when Bush/Cheney were the experts?

No, because I didn’t vote for them and didn’t regard them as “experts” on any of the matters most important to me. I didn’t see Bush choosing people highly qualified for the posts to which he assigned them. However, I have to say that, even so, I gave the Bush administration the benefit of the doubt.

I’m not sorry I did, because I know that deep distrust without reason can be counterproductive and pathological. And in all fairness, few people at the time could have predicted just how disastrous the outcome would be.

In my ignorance, my biggest concern about Cheney at the time was his heart condition and the risk to stability if he ever became president. In the immediate aftermath of 9/11, I wanted to trust Bush—with his military background and familial connections—to do the right things to protect the country. The benefit of the doubt is one thing, however, and blind faith is quite another. I quickly lost faith in Bush/Cheney, as did we all, and it was all down hill from there.

Bush/Cheney had eight years to betray and lose the public trust. The evil fruits of their labor were, by that time, apparent for the world to see. The chief architects of the eventual Obama legacy are just now taking their chairs. In the interest of supporting those things the administration may do well, I think it’s right—maybe not easy, but right—to give it the benefit of the doubt.

The government, after all, is only people. And as we know from our own private lives, some are trustworthy, and others are not.

The Case for a Three-, Four-, or Five-Party System

There has been a gratifying influx of mail from Radley Balko readers in response to yesterday’s post, which discussed whether the average citizen is qualified to pass judgment on specific numbers associated with the economy. My point was that without extensive research and reasoning, few of us are qualified to comment intelligently on certain complex issues.

I say “gratifying” not because those readers agree with me (they don’t), but rather because they disagree for specific reasons and bring up a variety of points that would be well worth debating. I find this a refreshing change from the position of many conservative members of the GOP (General Opposition Party), whose entire argument often boils down to circular reasoning: “Obama is wrong because his policies are bad because Obama is wrong.”

While it seems unlikely that I will ever embrace the principles of Libertarianism, for a variety of reasons, I’m beginning to think that this toddler of a political party just might grow up to be the best hope for the country—not because Libertarians are “right” but rather because they may be capable of building a viable third party in America.

During the past six decades or so, politics in America has devolved to such an extent into a destructive, two-party war of words that it’s damn near impossible to get anything done any more. The government in Washington—that incredible, 230-year-old experiment—grinds away, eating up trillions of dollars and the lives of dedicated men and women. Due to obstructionism and partisan politics, it too often accomplishes very little. The waste of time and human resources is incalculable. The government is like a good furnace, working away in a house with all the doors and windows open.

Because of its two-party system, America has been increasingly been caught in the vice of either-or fallacies: government or the market, states’ rights or federalism, capitalism or socialism. Staking out a position for only one of each of these pairs is like deciding which type of person should inhabit the planet—men or women. If either side wins, once and for all, the result will never be fruitful.

Enter the Libertarian Party—which, if I understand correctly, places much greater emphasis than either of the other two parties on individual rights. From that perspective, it concerns itself with matters such as privacy, individual sovereignty, and minimal interference of government in the lives of its citizens. It seems to be generally opposed to legislating morality in matters like abortion and gay marriage. It appears to reject a relationship between government and its citizens that is either nurturing or controlling, paternal or maternal. My impression is that Libertarianism demands an adult-adult, businesslike relationship between what government is necessary and autonomous, responsible citizens.

Libertarians have staked out a territory that is neither big government nor big business. It’s not about who has the right to control the populace but whether anyone does—other than individuals themselves. Inserting this new perspective into the public discourse has the potential to completely change—and enrich—the tired, repetitive old rhetoric of “us-vs.-them.”

There are other territories, as yet uninhabited, on the political landscape. Perhaps it’s time for someone—Al Gore, for example—to found a Green Party in America, which could help focus attention on our nation’s relationship with Planet Earth. Personally, I’d be likely to vote often in favor of a party (perhaps it could be called the “Darwinian Party”) dedicated to promoting reason and scientific literacy.

Breaking out of the old two-party paradigm has the potential to free the entire nation to take a fresh look at our increasingly new world. Democrats and Republicans alike, we really must stop just repeating ourselves. So Libertarians, I may not agree with you about many things, but in all sincerity, I wish you well!

The Economy: "Feeling" Our Way

A Libertarian reader recently sent me a link to a blog post by FoxNews commentator Radley Balko in which he invites readers to state what their limits would be on “size, cost, and limits of government.” What specific number, Balko asks, should be the maximum allowed for tax rates, inflation, federal spending as percentage of GDP, and so on?

The question itself illustrates one of the biggest problems facing the Obama administration—or anyone else who tries to get things done in Washington: the ingrained American cultural habit of “thinking” emotionally.

Let’s use an analogy to illustrate why this is a ridiculous exercise. Suppose when they were building the first space shuttle, NASA asked the American public—who, after all, were footing the bill for the project—for similar input; for example, “What kind of fuel should we use in the boosters?” or “What materials should we use for the heat shields?” And most importantly, “What is the maximum number of dollars we should spend on the program before pulling the plug on it?”

Had such questions been asked of the general public, would NASA have received any meaningful answers? And if they had, should the progress of the human race have hinged on the collective opinions of a handful of ordinary citizens who know little or nothing about physics, materials science, or human anatomy?

Ah, you might say, but the economy isn’t rocket science.

In a way it is. Both physics and economics consist largely of nonlinear patterns of progression, which the human brain is not equipped to instinctively understand. This is why so many people get into trouble in terms of their own personal finances—they simply don’t feel the effects of compound interest rates, for example. The human brain needs sophisticated training in mathematics to account for the effects of time on numbers—and only specialists have that knowledge, just as only specialists know how to build a space shuttle.

How am I supposed to know how much is too much when it comes to, say, Medicare? As an individual citizen whose expertise is in psychology and education, I don’t even have a good feeling for what the price of bread should be. Like everything else in the world of economics, the price of bread—and of Medicare—can only be judged in terms of many other variables. Economics, in other words, is relative—and when it comes to the big-ticket items, prices are relative to economies in other countries, which fluctuate on a minute-to-minute basis. It takes sophisticated computer technologies and the experts to run them even to make educated guesses.

In response to Balko’s challenge, one reader commented that “106 trillion is a scary number.” Well, yeah—especially since the unaided human brain can’t begin to conceive of numbers in the trillions. That’s why we need to rely on specialists who have the mathematical skills, knowledge of history and economics, and access to computational tools to make informed decisions. In other words, we have to trust the experts.

Trust? Now there’s a scary concept. How do we know whom to trust?

The answer is, we don’t always know. But as a nation, we elected a well-educated man with good communication skills to assemble teams of experts capable of addressing particular problems. We elected a body of legislators with the collective responsibility of working with him to achieve our national goals. Now I suggest that we give them a little time to do their jobs without constantly having to respond to ignorant questions and objections from people who confuse thinking with feeling.

It’s one thing to try to make the intellectual effort to be informed. It’s another to assume that any one of us has the expertise to pass absolute judgment on matters of enormous complexity about which we have no specialized training. From the economy to education to global climate change, our national leaders are dealing with problems about which few of us have in-depth knowledge. A little humility would be in order here.

I suggest that, in matters about which we have no expertise, we withhold judgment and encourage others to do the same. Later, as we are doing with respect to the last president and his administration, we can analyze results. But for now, let's avoid pooling our ignorance and trying to micromanage what we don’t understand.

Let's Use Our Heads about Health Care

After months of talk, the debate is starting in earnest—if you want to call it “debate.” For the opponents of change, it’s more a process of pulling out the old bag of tricks and finding ways to manipulate the emotions of the public—at least that large percentage of the public that is easily and thoughtlessly swayed by slogans and TV ads.

An angry-looking Canadian woman claims that, in her own country, she was denied timely surgery for a brain tumor and “wouldn’t be alive today” if she hadn’t been able to get treatment in the U.S. Much more would have to be known about the situation to determine, from a rational perspective, whether that claim is true. Was the tumor really terminal? Was it untreatable? Were there better options, in the opinion of her doctors, than surgery? Is the woman wealthy? (That’s relevant, because in America, expensive life-saving procedures are often available only to the rich or well-insured.)

It’s likely true that, for whatever reasons, that one angry Canadian woman is dissatisfied with her country’s subsidized health care system. It’s also true that many, many people in Canada, England, France, Switzerland, and other countries are very satisfied with their health care. As someone who's been concerned about this subject for many years, I've talked with people in each of those countries, as well as with friends from other nations that have public health care systems. I have not personally met anyone who, like the woman in the TV ad, is bitter, dissatisfied, and convinced that the system in her country, as a whole, doesn’t work. (A recent article in the Denver Post, for example, expresses an entirely different view.)

Economists, doctors, small business owners, and almost everyone who’s ever been sick in America (or tried to stay well) knows the current system is untenable. It has to change. If business in Washington continues as it has lately, with some floating ideas and others shooting them down, the result will be much less satisfying than it could be with a spirit of cooperation and mutual support. And if we citizens demand such a spirit from our legislators, we're more likely to get it.

It’s always possible—and not very helpful—to track down a few nay-sayers and put them on television. What would be helpful is for interested citizens—regardless of political affiliations—to become informed about this complex issue and let lawmakers know specifically what they want and don’t want to see in the legislation currently being developed.

For example, there must be a public option to private insurance, in order to relieve the burden on small businesses and the self-employed (or those who would like to be self employed, if only they could get health insurance). There must be some way to control escalating pharmaceutical costs. People must be able to choose their own doctors. Whether you agree or not with these statements, they are the kinds of specific recommendations that could be helpful to legislators. Let's let them know what we want--not just what we don't want.

Change must happen, and the government must have a part in it. For too long, health insurance companies have called the shots—based on their natural desire for the biggest possible profits—when it comes to the health care of individuals. For too long, the divide has been growing between the rich and poor in terms of quality of life and the simple right to live.

It's much more difficult to learn, think, and make constructive recommendations than it is to simply say "no." In this case, "no" is not an option. Let's hope that as many Americans as possible will exercise their civic responsibility with a thoughtful, informed, and helpful kind of "yes."

Skepticism, A Citizen's Responsibility

A recent email informed me that Pepsi was producing a patriotic beverage can with the words “under God” omitted from the Pledge of Allegiance. Another claimed that while her husband was in Europe and Africa, Michelle Obama was using taxpayers’ money to flit around Europe on an extravagant spending spree. Still another warned that anyone using a cell phone while it’s charging is in serious danger of being burned or electrocuted.

The good people who forwarded these emails to me are all persons I know and believe to be essentially honest. They are also, like so many of us, extremely gullible. With all good intentions, they habitually pass on alarming reports, convinced by slick rhetoric, a tone of anger or outrage, or even (as in the case of the cell phone claims) provocative photographs. The trouble is that, intentionally or not, they are often spreading lies.

Such lies are not harmless. Free-floating anxiety is rampant enough in our highly credulous society. The emotions most commonly inspired by false claims and conspiracy theories—fear and anger—can easily derail logical thought and interfere with good decision making. Anonymous Internet slander can be used intentionally to harm the reputations of business competitors or rival political candidates.

I propose that, instead of hitting the Forward button, we all get in the habit of verifying the content of any emails that come our way. This can easily be done by checking current news reports or fact-checking web sites, such as Snopes.com or Factcheck.org. If you can’t verify it, delete it. Let’s stop wasting time and emotional energy on other people’s fantasies and anonymous lies.

Love Thy Country

I was alarmed to see a rather elderly man standing in 100-degree heat yesterday outside of my local Walmart. He was holding a sign that said, "Lower Taxes!" The Cons and Neo-cons are at it again, following up on their pointless tea party of April 15.

Nobody's going to stand out in the sun holding a sign that advocates for higher taxes. But let's face it--it takes money to run a government. And our governments--state, local, and federal--are what give us the American lifestyle we all so enjoy (and are rapidly exporting to the rest of the world). It seems to me that on the day we celebrate the founding of our nation, a little gratitude might be in order.

Events of the past few weeks have brought news of chaos in Iran following a sham election, suppression of free speech in China, and brutal persecution of gay people in several African nations. Wouldn't it be appropriate, just for today, to celebrate the fact that we have a right to protest? (And it requires money to, among other things, protect those rights.)

I'd be willing to bet that if we asked one of these addle-pated protesters exactly where they would economize without sacrificing benefits, they'd be hard pressed to give a specific example. Like the Republican Party to which many of them undoubtedly swear allegiance, they seem to be just generally against.

It's a shame that we acknowledge respectful rules of etiquette in casual conversations but discard them completely in our national discourse. A good rule of business communication is not to complain unless you can offer specific, constructive alternatives. Just once, I'd like to see anti-tax protesters try to wave signs that say what they really mean. "Lower Police Salaries" would go over well on a local level, for example. Or how about, at the national level, "Stop Funding Medical Research." Those might not be good ideas, but at least they are ideas--specific positions that can be proposed, discussed, attacked, defended.

Mark Sanford's Deepening Hole

Caught by a reporter last week, Jenny Sanford sniped that her husband’s career was the “least of her concerns.” The couple may be at odds with one another right now, but at least they seem to have that one thing in common.

As politicians go, Mark Sanford seems singularly disinterested in continuing his career. Anyone in the “real” world—that is, the world outside the alternate universes of entertainment and politics—would certainly have been invited by this time to clean out his desk and turn in his key. Sanford would do well to heed the advice of a fellow politician, a Brit named Denis Healey, who formulated the First Rule of Holes: “When you’re in one, stop digging.”

In a series of tell-all interviews, Sanford has admitted to enough improprieties and episodes of bad judgment to keep investigative reporters busy for months. From across the country, it appears that his political enemies within the state of South Carolina have so far been remarkably restrained in their comments—but why shouldn’t they be? Why interrupt the man when he’s so busy digging his own grave?

As the country watches this tragi-comic saga unfold, some commentators muse about how a man could be so indiscrete in a state that’s right in the middle of the “Bible belt,” home of the purest ideologues of social conservatism and the religious right.

My question is, where else could it happen? That “old-time religion,” which so many conservatives espouse (or at least flap their lips about), is all about emotion—pure, unadulterated (pardon the pun), raw emotion. There’s nothing rational about it.

According to the Pew Research Center, 33% of Americans believe that the Bible is literally true—that every word of it should be taken as historical fact or divine prophesy. Among those affiliated with Evangelical Christian churches, that figure rises to 60%. In South Carolina, where professed Christians comprise 92% of the population, it stands to reason that reason isn’t highly regarded as a decision-making tool, much less a moral compass.

Typically, Christians of the “Bible-is-the-literal-word-of-God” variety solve problems by praying a lot and then waiting for guidance from God, or inspiration—which is to say, they listen to their feelings, conveniently convinced that God will fill them with the right “spirit” and lead them to salvation. Well, the spirit that moved Mark Sanford led him to Buenos Aires—apparently not once but several times.

All this is, of course, embarrassing for the General Opposition Party (GOP), which spent so many years fostering an image of being the standard-bearer for family values. The Republicans had a good run, fueled in part by successfully channeling the emotionalism of Evangelical Christianity and beer-swilling, red-neck American patriotism—that is to say, as John McCain so eloquently put it, by “energizing the base.”

The very public behavior and maudlin suffering of Mark Sanford—not to mention the martyrdom of his wife, which is also getting its share of media attention—give a whole new meaning to the term “base.” Perhaps it’s time for the Republican Party to consider whether populism—relying as it does on the shifting sands of emotional commitment—is the best foundation on which to try to build government.