First They Came for the Uninsured

When the Nazis came for the communists,
I remained silent;
I was not a communist.

Then they locked up the social democrats,
I remained silent;
I was not a social democrat.

Then they came for the trade unionists,
I did not protest;
I was not a trade unionist.

Then they came for the Jews,
I did not speak out;
I was not a Jew.

When they came for me,
there was no one left to speak out for me.

- Pastor Martin Niemöller

Overwrought to compare that to the U.S. healthcare crisis? Perhaps. It probably feels different if you haven't lost a loved one because of it.

Pastor Niemöller's point is that if a society doesn't value solidarity - even solidarity to protect those in disagreement with one another - then we allow predators to pick us off.

Solidarity is a value often mentioned in other industrialized nations. Not at all in the U.S., where it sounds subversive - doesn't it?

Death as a Rorschach Test

After a post at Slate I realize, once again, that Paul's death is a kind of Rorschach Test.

Usually people who are in favor of healthcare reform get it, immediately - how the U.S. healthcare system failed him in a far bigger way than misdiagnosing his appendicitis.

Physicians almost always get it immediately.

People who are afraid of change, and who don't understand that our health care system is a kind of ever widening net of dysfunction - not so much. For them it's all about misdiagnosis - if they've gotten past the point where it must have been Paul's fault, because the U.S. healthcare system is the best in the world (maybe needs a slight tune-up, but nothing major) - that being the case because we're the best.

And once a group starts thinking it's the best despite all evidence to the contrary, that's the beginning of the end, whether it's a sports team, an automaker, an army or an entire nation.

The United States does a lousy job of protecting what it claims is its most precious asset - its people.

Soft Support for Reform

Back when politicians thought all healthcare reform could be was adding a few more kids to the SCHIP program, just like every other single-payer supporter I know I liked to point to polls showing that a majority of Americans knew we needed to overhaul our system, that government needed to guarantee healthcare, that it was the dastardly insurance industry's grip on our politicians that was to blame and so on.

All along there were the Celinda Lakes warning that public support for healthcare reform has always been soft, and easily manipulated by fear-based campaigns.

Like this, you think?

RX FOR DISASTER
83 MILLION OF US WON'T KEEP OUR INSURANCE

And for those who do manage to keep their current insurance -- well, it won't cost $2,500 less, as Obama promised. Lewin estimates it will cost $460 a year more because of new cost-shifting from the government-run plan to private health plans.

That's right. The $1.3 trillion House health-care bill would cause millions of Americans to lose the insurance they have now -- while the rest of us would pay even more than we do now.

It's times like this when you truly appreciate the smart analysts out there, like Paul Krugman and Ezra Klein - who quoted Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

They say that people deserve the governments they endure - a pretty hardhearted assessment of, say the Cambodians under Pol Pot. But when it's a democracy, and when there's every opportunity to become educated, wouldn't it be true to say that a people deserves the health care system they're too afraid to change?

I'm feeling like picking fights about this - pretty unproductive I admit.

Flurry of Pundits on Healthcare Reform

Health Reform Can Pay for Itself, by Timothy Noah at Slate

Why Health Care Reform Will Pass, by Jonathan Chait, The New Republic

More Disapprove than Approve of Obama on Healthcare, Gallup Poll

Real Consequences of Inaction, at Healthcare NOW

Will Obama Wipe Out on Healthcare?, by Howard Fineman in Newsweek

Healthcare for Dummies, by Dana Milbank in the Washington Post

Americans: OK with Inequality

Jacob Weisberg has a nice piece at Slate on the reform package. What really caught my attention, however, was this commenter:

Weisberg writes: "[The British system] doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s..."

The PSA is more likely evidence of what's wrong with the US system, not what's wrong with the British. It has become a standard even though there is little, if any, evidence it saves lives. Yesterday's NY Times ran a story that pointed out, "the federal Centers for Disease Control makes it clear on its Web site: there is no medical proof yet that routine screening for lung, ovarian, prostate and skin cancer reduces deaths from those cancers." But many men will suffer wretched complications from treatments in response to the screening.

But that's my minor quibble with Weisberg. The major one is this: "Morally speaking, Americans are surely more accepting of economic inequality than their European brethren. But the random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the social conscience."

If only it were true that the bad health, disabilities and deaths that result from the lack of access to health care really offended Americans. Sure, there are some who are really outraged, some who are disturbed, and others who just can't be bothered to think about it. But there is also a group (large or not?) who are really satisfied knowing that there are winners and losers in American life and they are only too happy to be on the winning side. If we acted to create a more equitable system, how would they know who the winners and losers are and which side of that line they're on? Knowing that others are suffering, and believing that everyone in life pretty much gets what they deserve to get, they oppose any change that would bring relief to the suffering or make life "fairer."

Those who are passionate about universal care aren't large enough in numbers to bring about a change. Those who aren't passionate are too disturbed at the thought that reform may bring some change to what they already have to support it. And those who are happy with the way things are aren't going to support any change at all. If any reform bill passes it will have to be diluted too much to avoid imposing real change on health care providers or the currently insured. We're going to fall short again.

No doubt we'll fall short for just those reasons, although I sure hope that Obama gets us on track to a solution.

This comment makes me think about hearing some asinine Republican representative on C-Span last night pontificating on how every American has access to health care - it's just that not all of us have health insurance - two very different things, he wisely noted.

Right. Tell it to my brother. Tell it to all the American parents and children who've died because they did not have health insurance - and because they did not have health insurance they did not go to the doctor in time, and because they did not have health insurance the hospital treated them differently than had they been insured.

And I think about some commenter on a radio station saying that he sure did expect to have better health care - far better health care - because he was insured - otherwise what the hell was he paying for?

Full Court Press

It was all healthcare all the time on talk radio this morning. On the road this morning I heard some conservative literally spit into his microphone over how crazy it was for something that was supposedly free to actually cost a trillion dollars and how there's a long waiting list for programs - just as there would be once it was enacted for people to see their doctors. He also alluded to the idea that you wouldn't be able to get aspirin.

Pretty crazed stuff, but no doubt straight off the Republican talking points. Emphasize waiting, emphasize cost, emphasize a loss of personal control - all of which happen to be false, but still. Great talking points.

On to NPR where some WellPoint exec is claiming that Medicare is less efficient and innovative than private insurance companies.

Really.

On to the librul station where, without a skipped beat, Big Ed was glad that David Axelrod had finally made a shot over the bow to the Republicans that if they weren't willing to go along with the program then healthcare reform didn't need to be bipartisan.

He read this quote: "Ultimately, this is not about a process, it's about results," David Axelrod, Obama's senior political strategist, said during an interview yesterday in his White House office. "If we're going to get this thing done, obviously time is a- wasting." Both Axelrod and White House Chief of Staff Rahm Emanuel said taking a partisan route to enacting major health-care legislation isn't the president's preferred choice. Yet in separate interviews, each man left that option open.

"We'd like to do it with the votes of members of both parties," Axelrod said. "But the worst result would be to not get health-care reform done."

Paying for it will be the taxes on the wealthy - and it is curious how the Republicans can rail against that and at the same time denounce excessive bonuses - like the ones announced today at Goldman Sachs, where the average employee bonus is nearly $900,000 and top execs will see tens of millions.

Come on. You're not in favor of taxing that?

Public not so keen on the Public Option

People really do have an amazing font of ability when it comes to ignorance.

Once you understand something - like, for instance, that single-payer health care works, or that the U.S. is the only country in the world to allow private industry to act like racketeers in regard to citizens' health - there's often a sense of surprise that other people still don't get it.

Really? You don't get that? That the earth orbits the sun? That the moon orbits the earth? You weren't aware of that?

On the radio this morning comes a segment about Rep. Ed Perlmutter (D-CO), who is educating folks on the public option. (Thanks Ed - you're leading. It's appreciated.)

He invited some 5,000 of his Colorado constituents to chat with him about health care and the public option. He invited people who get his newsletter, presumably slanting Democratic, and then people randomly selected from his district. Questions at the chat included one guy noting that it's just common sense that if you cover everyone it must cost more, so how can single-payer proponents claim otherwise?

A poll on whether people were in favor of the public option found 54 percent against.

Defending the Indefensible

The case of a rejected potential mate came up in conversation with friends over the weekend. This loser's biggest fault? She was Catholic - which led everyone around the table to enthusiastically agree to hating the Catholic Church.

I was silent though I usually speak up at such moments. It's been infinitely more difficult to defend religion in general since Bush was elected... OK - it was always difficult to defend a group that raised the fetus to the point of idolatry, where abortion - rather than faith or personal sacrifice for justice - became the sine qua non for believers. At my weekend table I had to also wonder if the whole bit weren't some kind of passive-aggressive hostility aimed at me, since everyone there knew I'd worked for the Church for 16 years.

Instead of speaking up I was thinking of the editor at the Catholic Sentinel, my old boss, saying that Catholicism was the last bastion of respectable bigotry. It's no longer acceptable to hate African-Americans, Asians, gays, Islam, Judaism, or paganism, but it's OK to hate the Church.

Now that's a bit over the top, a bit Bill Donohue and Catholic Leagueish - after all, if someone vehemently disagrees with a powerful organization's policies because those policies do quantifiable harm, it's disingenuous to put that criticism down to prejudice. Eric Alterman and other critics of Israel's policy towards the Palestinians are not anti-Semitic. For crying out loud, Alterman is Jewish. As the Israeli state increasingly became identified with its wall and settlements, however, it became harder and harder to criticize those policies without sounding anti-Israel in general. Especially since Israel's defenders themselves evidently defined Israel by those policies. The same is true for Republicans, the anti-government, don't-believe-in-global-warming, Christianism party, and for the Catholic Church, the church of anti-contraception and no-abortions-even-to-save-the-life-of-the-mother faith.

Shouldn't Israel, Republicans, and the Church be more than that? It seems like they should do their part in helping those of us out here who would like to come to their defense in a fair-minded way.

Then there's the related problem of in so doing becoming aligned with frothers who insist that the entire Democratic Party is anti-Catholic. Right. Pelosi, Kennedy, et al.

Someone else over the weekend, in a completely different conversation (this one about the Church coming out strongly in favor of the coup that ousted Honduras's leftist president), said that they really didn't like this current pope's leadership.

Now that's a fair criticism.