The Pragmatic Idealist

The Daily Dish By Andrew Sullivan : Late empires are known for several things: a self-obsessed, self-serving governing class, small over-reaching wars that bankrupt the Treasury, debt that balloons until retreat from global power becomes not a choice but a necessity, and a polity unable to address reasonably any of these questions - or how the increasing corruption of the media enables them all. Obama is, in some ways, a test-case. He was elected on a clear platform of reform and change; and yet the only real achievement Washington has allowed him so far is a massive stimulus package to prevent a Second Great Depression (and even on that emergency measure, no Republicans would support him). On that he succeeded. But that wasn't reform; it was a crash landing after one of the worst administrations in America's history. Real reform - tackling health care costs and access, finding a way to head off massive changes in the world's climate, ending torture as the lynchpin of the w...

The State of Health Insurance in California: Findings from the 2007 California Health Interview Survey : "The report . . . found that nearly one in 13 Californians had some kind of medical debt and that those with debt were twice as likely as those without debt to report delays in getting needed medical care." The link is to a summary of an extensive report. The report expands on the medical debt issue to point out that two thirds of those with medical debt incurred it while insured, and that nearly 10% of those with medical debt, more than 200,000 people, had medical debt that exceeded $10,000. The concept of medical debt, or medical bankruptcy (a large proportion of personal bankruptcies in the United States are caused by medical bills), is completely foreign to people in countries with universal coverage. Laying aside the moral imperatives here -- and conceding that there are principled moral and ethical positions on both sides of the question of universal, guaranteed he...

How You Ask The Question Matters – Pre-Existing Conditions « Enabling Healthy Decisions : "All of those in the communications space realize that linguistics do matter especially in certain healthcare situations. I think this is a great example of how politics and healthcare are playing out. No one really understands everything. They understand and get excited (pro or con) based on the soundbite." This is a really stark example of this issue. It should come as no surprise really. If you ask people "Do you want people with cancer to have access to health services?" Most will say yes. If you ask people "Do you want to pay more for you health insurance so that others can be covered?" Most will say no. Neither of those things is surprising. If you remove the responsibility of balancing the competing interests, it is expected and natural that people will want everything . It takes political courage to tell people they can't have everything. When resources ar...

Editorial - Majority Rule on Health Care Reform - NYTimes.com : "In recent weeks, it has become inescapably clear that Republicans are unlikely to vote for substantial reform this year. Many seem bent on scuttling President Obama’s signature domestic issue no matter the cost. As Senator Jim DeMint, Republican of South Carolina, so infamously put it: “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”" I agree with this. Obama and the Democrats need to learn from two watershed events in the history of health policy in this country: (1) Bill and Hillary Clinton's failure to pass health reform after setting out to do it weakend Clinton's presidency immeasurably, and (2) the Democrats' passage of Medicare in the 60's over almost universal Republican opposition is to this day a major feather in their cap and a reliable talking point. The Republicans lost their chance to lead. They will not follow. They need to get out of the way.

Senior Groups Reject Health Care "Scare Tactics" : NPR : "At high noon on one of the hottest days of the summer, a small group of senior citizens sweated it out in front of state GOP headquarters in Raleigh, N.C., asking the Republican Party to stop using what they called 'scare tactics' to turn senior citizens against health care reform. It could be the start of a silver backlash against what some say is a misinformation campaign about health care reform." This is heartening. The more voices that can be raised against the misinformation and appeals to emotion in opposition to health care reform, the better it will be. The fundamental scare tactic being used against the "haves" in the health care world is this: "The reformers want to take away the health care you have and give it to [the poor][the unemployed][illegal immigrants][the gays][ al qaeda terrorists]". At base this is a false choice. None of us have the option of standing pat...

GOP Pushes Health 'Bill of Rights' - washingtonpost.com : "Having seized on the idea that Obama's reform plans represent a 'risky experiment,' Republicans have lately intensified their health-care message toward the elderly. The Republican National Committee's 'bill of rights' includes calls to 'protect Medicare,' 'prohibit efforts to ration health care based on age' and 'ensure seniors can keep their current coverage.' Taken together, the list does not represent an actual reform proposal -- congressional GOP leaders have so far failed to introduce a plan of their own -- but rather a series of things Republicans believe reform should not do." More evidence that the opponents of health reform are more interested in scoring a political victory than in actually helping anyone. Here's what factcheck.org has to say about it: RNC’s “Bill of Rights” FactCheck.org : "The Republican National Committee this week posted a...

In a poll earlier this month by Public Policy Polling, respondents were asked: "Do you think the government should stay out of Medicare?" 39% answered "Yes". Another 15% answered "Not Sure". So, 54% of the poll respondents (representative of voting age adults in the U.S.) do not understand that Medicare is a government program. This is a rich irony of opponents' attempts to demonize government-run health systems like those in Canada and the U.K. We ALREADY HAVE one of the largest government health care systems in the world. Medicare currently covers 46 million people; Medicaid covers approximately another 40 million. Add to that 86 million the roughly 27 million veterans covered by the Veterans Administration and you have the U.S. government directly providing health care for more than 110 million people The entire population of Canada is 33 million. The population of the United Kingdom is 61 million. There are more people in government ...

Joan Walsh - Salon.com : "I want to ask, respectfully, that liberals who insist Democrats must give up the public option in the health care debate before there's a single vote, please stop telling us they're channelling Teddy Kennedy. I want to call out those liberals – my friend Jonathan Alter; ABC's George Stephanopolous; the not-always-liberal (in his own self-concept) Chris Matthews – and say: Why give up now? Wouldn't Kennedy have continued to fight, at least until he had concrete proof that he couldn't find 60 votes for the public option?" Exactly. Without a public option, there will be no meaningful reform. We must have a public plan participating in the marketplace, at a minimum. If it is out competed by private options, that's great. If it wins, as I suspect it will, that reveals a lot about how we got to where we are today.

I am here because, for too long I have stood on the sidelines of the debate about an issue I care about, talking to whoever would listen, but not doing enough. Will blogging be enough? Probably not. It's more, however, than I have been doing. I represent myself as an idealist. That term, however, immediately takes most of us toward a picture of pie in the sky unreality. I am an idealist. I am not, however, a Utopian. Nor am I particularly a believer in the fundamental goodness of human beings. In short, my ideals are not those most commonly associate with the term idealist. I have some thoughts and ideas about health care in the United States. About where it should go and how we should change it. About why many who are currently engaged in the public discourse on the topic either (1) are actually fighting a different war on this battlefield, or (2) are simply arguing from such a place of unreality that we should ignore them. It's important, though, that if I am going to ask y...

I was moved to start this blog by the death of Ted Kennedy. Ted Kennedy was not my hero. I was fairly cynical about him and his presence on the national stage. I viewed him as a lesser scion of a regal, tragic, American family. Then he died, and I paid some attention to what he had done in his 47 years in the U.S. senate. There is almost no law having to do with social policy in the United States that has passed in the past half century without Ted Kennedy leaving his mark on it. And yet his most important, vital work remains undone. We must change, in a fundamental way, the health care system of this country. If we do not, then we will lose the elements of it that we so value - the access to doctors of our choosing and advanced technologies and drugs - and it will bankrupt the nation. Along the way, U.S. businesses will be ever more competitively disadvantaged to competing concerns based in nations where health care is provided by the government. In looking more closely at Ted...