Psychiatrists agree: Republicans are insane

A year ago, I wrote that Republicans were putting the “bye” in bipartisanship. A commenter told me I was being premature because President Obama had only been in office a month. A year later, I bet the same commenter would now agree with me. You cannot have bipartisanship unless both parties can come together on a preponderance of disparate issues. When one side refuses to play ball, well that is clearly not bipartisanship.

Watching the “bipartisan” health care reform meeting on Thursday at Blair House was an exercise in mental torture. Even the Supreme Court would have to agree that no Gitmo inmate should be forced to listen to all eight hours or so of this “dialogue”. Watching it was kind of like hitting your head repeatedly against a brick wall. Not that President Obama did not try to lead out Republicans or ask them pragmatic and civil follow up questions. It’s just that Republicans did not have a whole lot of viable suggestions. The script was very shopworn even before the first Republican opened his mouth: start from scratch on a new health care reform bill. The only aspects of health care reform they seem willing to agree to are malpractice reform (which would affect less than one percent of health care spending) and allowing citizens in one state to get health insurance from other states. Everything else: forget about it! Cover the uninsured? Not interested. Seriously reduce the number of uninsured Americans? Not interested. As business reporter Steven Pearlstein pointed out recently in The Washington Post, based on the “discussion” at the Blair House, Republicans don’t give a crap about those too poor to have health insurance and certainly don’t want one dime of taxpayer money spent on the uninsured. In their ideal world, the uninsured would not get into the emergency room until they first brought a statement from their bank that they are credit worthy.

One of the definitions of insanity is to not learn from the same mistake. By this measure, Republicans (and this includes Conservatives and Tea Baggers) are insane. We usually deal with the insane by getting them psychotherapy or, if a menace to others or themselves, putting them in a rubber room. A clinical case could be made that the vast majority of Republicans on Capitol Hill should be in a rubber room. Because although we have tried massive tax cuts for the wealthy not once but twice and the result has been to make the rich richer and the poor poorer, Republicans are still convinced that all we need are yet more tax cuts affecting primarily the wealthy to change the situation around. In short, they are insane.

Republicans are insane on so many levels it is hard to know where to begin. Most of them deny that climate change is happening and many of them also want to abolish the EPA. This could revert the United States back to the 1960s when we had no environmental laws and polluters could pollute without restraint. They want to reduce fuel efficiency standards for cars. They actually think we can solve our dependence on foreign oil by drilling off our coastlines. The effect will of course make us more dependent on foreign oil, which will come principally from overseas and at higher and higher prices by not weaning ourselves off oil. It is just insane!

Perhaps most insane of all is that Republicans have this dichotomy about wanting to take a meat cleaver to reduce the size of government then, when asked, find it hard to find something to cut. Take a look at this 2008 American National Election Survey where self identified conservatives try to find things they would cut in federal spending. The number one thing that conservatives would like to cut is foreign aid, which accounts for less than 1 percent of our budget. Even there conservatives could not muster a majority (only 49%). Well, that certainly won’t solve the budget deficit! The next thing they most want to abolish are welfare programs. This is essentially Medicaid and food stamps, but even here, only 35% of conservatives want to do this. Presumably, 65% do not. About twenty percent want to cut funding for the war on terrorism. I assume this is the Ron Paul wing. It is clear from the chart that while tax cuts are always in season, if they were back in charge cutting the size of government would be mostly lip service, as it was under Reagan and two Bush presidencies.

But of course now these same people are in a froth because we are doing all this deficit spending. Moreover, they are deeply upset at President Obama for deficit spending money on tangible goods that we need like new bridges and road surfaces which also help to get us out of a bad recession. They prefer tax cuts and fairy dust instead. (Actually, Obama accommodated Republicans and added plenty of tax cuts in his stimulus package, including tax cuts for small business, and they are still upset.) They are telling us the government should live within its means, even during a severe economic recession. Yet, it is clear that if they were back in charge, the first thing they would do is cut taxes some more, and thereby exacerbate the budget deficit!

So why do Americans keep putting these bozos back in power? It must be because the majority of us are even dumber than Republicans, or as a nation, we suffer from ADD and cannot even remember all the debt we piled up under the last administration. Actually though the polls do not give as much comfort to Republicans as they might hope for. Americans are pissed off that divided government means that things like health care reform are not being accomplished. (By the way, Americans still strongly support health care reform, including a public option.) What is driving voters insane is the inability of politicians to find common ground at a time when it is essential. They are paying the price in house foreclosures, rising health care costs and unemployment. As much as they dislike the way Democrats are using their majorities, they like Republicans even less. Voters have a lot of visceral anger but little way to express it. Moreover, who could blame them? Obama promised change you can believe in, but a progressive president cannot necessarily turn around a deeply partisan and recalcitrant Congress. This was borne out on Thursday at the Blair House.

One thing is clear: you won’t get bipartisanship by electing Republicans. If voters want to end gridlock by voting for Republicans, they might end up breaking the gridlock but it is unlikely they will get real solutions to the problems they care about. Put Republicans back in power and for sure, you can count on more tax cuts for the privileged. You can also count on deficits that will make today’s look small. Voters would be insane to do so. Unfortunately, when you are really, really angry you are not usually thinking clearly in the first place. You are letting your emotions take control of your faculties, instead of using your brain.

If voters want bipartisanship then they have to vote for people who are running on the platform of being bipartisan. These candidates should have a track record of moderation and crossing the aisle. You certainly won’t find that in a tea bagger! Unfortunately, you are unlikely to find any such a creature nominated by the Republican Party this time around, and the odds are not much better for the Democratic Party either. With the exception of the lunatic left wing though, you can at least rest assured that the Democrats running will at least be sane. At least we have one foot firmly in reality.

Half a loaf is still better than none

Polls indicate that most Americans are not happy with the health insurance reform plan emerging from Congress. Of course, most Americans are also not fully informed about the health care reform plan either. With the Senate bill alone consisting of thousands of pages, who has time to read it? We depend on the press and policy wonks to give us the bottom line. To say the least, there is disenchantment. It’s kind of like hoping for a Lexus and instead getting a Yugo. Who would not be disappointed?

I know I am. I am in line with the majority of Americans who wanted a public government administered health plan on the assumption that it would at least be fair, provide real competition and be always available when other private plans left the market. It doesn’t look like that will happen. While anything is possible in the upcoming conference committee, it is likely the House will kowtow and it will be the Senate’s version of the bill that will become law. There is no public option in there, in large measure thanks to Senator Joe Lieberman.

Many Americans are also disappointed in President Obama’s performance to date. After all, he promised change. Where is the delivery? Our disappointment is reflected in his sagging pole numbers. In reality, given polarized politics as they currently exist in Washington, Obama is doing remarkably well. Particularly when it comes to health care reform, our disappointment is because our hopes are colliding with this messy thing called reality.

We might have actually seen the massive change that we were hoping for had we had solved a few other major problems before electing Barack Obama. Specifically, we needed meaningful campaign finance reform and limits on the influence of lobbyists in Congress. The Supreme Court in its infinite wisdom says our current corruption-laden political system is entirely constitutional. This meant, as usual, that those with the money, such as the health insurance lobbies, had a massively disproportional influence on our legislators. To me it is remarkable that in spite of the hundreds of millions of dollars spent to defeat reform we got as much reform as we did.

What we are getting is largely health insurance reform and not quite health care reform. Still, getting even health insurance reform is a remarkable achievement, given the money spent to defeat any kind of reform. Every single Republican senator lined up against reform, which meant that 58 Democratic senators and 2 independent senators had to pull together. Only of course, they did not so much pull together as kept watering down the bill until health care reform became health insurance reform. Naturally, billions of dollars in tax breaks went to appease the more recalcitrant senators. The resulting bill is a lowest common denominator bill, which is what you get when the Senate chooses to allow 41 senators to block almost any legislation.

One can complain about Senate Majority Leader Harry Reid’s tactical approach. He could have placated people like me by using a budgetary rule called reconciliation that required only a simple majority to pass. This could well have delivered a more liberal bill with more actual health care reform in it. He chose not to go that route. While I think it was a mistake, perhaps he had sound reasons for it. For example, he might have decided that disenfranchising conservative Democrats on this issue would eventually prove counterproductive with a whole host of other matters on which Democrats need to remain united.

Any major changes by Congress are excruciatingly difficult because there are so many well moneyed interests aligned for the status quo. This leaves the rest of us who are much less moneyed largely disenfranchised. Yet despite these odds, meaningful health insurance reform looks likely to become law. In that sense, President Obama is right that this package is a big deal. History suggests that even this much was a long shot. Once we get used to it, we will take it for granted and wonder why Republicans were so foolish as to block it in the first place.

Half a loaf is not as good as a full loaf, but it is still half a loaf. I do not agree with Howard Dean that we are better off without this bill. While it does little to address exploding health care costs, at least thanks to generous subsidies 30 million Americans will be able to acquire health insurance, and no one can be denied coverage for preexisting conditions. This should make our premiums less than they would be without reform. Every hospital or emergency room visit by an uninsured or indigent person means that their costs are passed on to the rest of us in the form of higher premiums. Reduce the uninsured and more of our health insurance premiums will actually go to treat us.

Count me among those who are disgruntled but still grateful for the half a loaf we are getting. It was not foolish of me to hope for more than what we got. It would have been foolish of me to actually think we would get it this time around. I never did.

Joe Lieberman: the leading asshole in the Senate

Granted the competition is extraordinarily stiff but congratulations to “Independent Democrat” Joe Lieberman. In a U.S. Senate full of overstuffed egos, you have proven yourself exceptionally singular even in this “august” deliberative body for your continual vacillation, contradictory statements and your “my way or the highway” approach to almost every issue no matter what the cost or how high the stakes. Of course when push came to shove it would be you, the leading asshole in the Senate, who would have to make or break health care reform to conform to your vacillating views, which will probably change again tomorrow.

When I think about you, this scene from Blazing Saddles (1974) comes to mind . To my readers, if you want to know how I feel, jump to 1:12, and change the words slightly to: “The fact that you would keep those 55 or older from having affordable health insurance just goes to prove that you are the leading asshole in the Senate.” That’s how most of the country feels about you, Joe: Democrats, Republicans, Independents and especially the citizens of Connecticut who in the future will not even elect you to be dog catcher.

Act of conscience

Recently I went back and reread parts of the New Testament to make sure they were still correct. Yep, that part in there where Jesus says not to judge others lest you be judged is still in there. Also still in there is the parable of the Good Samaritan. There are many instances of Jesus talking about universal brotherhood.  Overall, Jesus comes across as a pretty inclusive guy, walking among the sinners and heathen alike and treating almost everyone with universal love, brotherhood and respect. As best I can tell, the only ones he ever really got upset with were the moneychangers at the temple in Jerusalem. He called them “broods of vipers” and other nasty terms. Even as he hung on the cross dying a miserable death, he asked God to forgive his enemies.

How then did the church that he founded some two millenniums later devolve into snippy episodes like this:

In an interview published Sunday, [Rep.] Patrick Kennedy told the Providence Journal that [Bishop Thomas J.] Tobin had barred him from receiving communion and instructed priests in the diocese not to administer the sacrament [to him] “because of the positions that I’ve taken as a public official.”

Bishop Tobin seems to have a personal vendetta against Representative Kennedy, because on October 23rd he publicly admonished Kennedy.

Rep. Patrick Kennedy (D-R.I.) “is irresponsible and ignorant of the facts” about the Catholic Church’s views on health care reform and “continues to be a disappointment to the Catholic Church and to the citizens of the State of Rhode Island,” said Bishop Thomas J. Tobin of the diocese of Providence in a statement released Friday in response to an interview conducted with Kennedy.

What drove such a high authority of the Catholic Church to deliver this sort of stinging public rebuke? Apparently, Kennedy sees a wee bit of inconsistency because the pro-life Catholic Church would rather see health care reform fail altogether than allow any health plan in it to cover abortion services. Mind you that neither the House nor the Senate envisions spending any federal dollars to cover abortion services. Proposed bills (at least prior to the Stupak-Pitts amendment in the House) merely allowed health insurance companies to cover abortion services with their own premiums, as many do now. The Catholic Church opposes any legislation that maintains the current compact. When asked by a CNS reporter of his response to the Catholic Church’s position, Kennedy apparently had the audacity to say:

I can’t understand for the life of me how the Catholic Church could be against the biggest social justice issue of our time where the very dignity of the human person is being respected by the fact that we’re caring and giving health care to the human person – that right now we have 50 million people who are uninsured.”

“You mean to tell me the Catholic Church is going to be denying those people life saving health care?” said Kennedy. “I thought they were pro-life. If the church is pro-life, then they ought to be for health care reform because it’s going to provide health care that are going to keep people alive. So this is an absolute red herring and I don’t think that it does anything but to fan the flames of dissent and discord and I don’t think it’s productive at all.”

For those who follow the ins and outs of the Catholic Church, the bishop’s position is nothing new. What is new is the vendetta Bishop Tobin appears to be waging publicly and personally against Patrick Kennedy. It’s like an episode of The Prisoner. Kennedy has become an “unmutual” so he must be shunned, or at least denied Holy Communion within his diocese, as well as publicly admonished. Mind you, Kennedy is not being denied communion because he is an abortion provider, but because his votes as a public official are at variance from Tobin’s interpretation of Catholic theology. Kennedy’s uncle, the late Senator Edward M. Kennedy, was also threatened periodically by his bishop for his liberal positions on abortion rights. At least in Senator Kennedy’s case, it appears that while there was a lot of saber rattling, at no time was Senator Kennedy publicly denied communion. It appears that on some level his Massachusetts diocese recognized that the good that Senator Kennedy did because of his position and influence somewhat mitigated positions he advocated that were at variance with current Catholic theology.

It’s unclear exactly what Bishop Tobin expects to accomplish with his actions. It is possible, although unlikely, that Patrick Kennedy will have a change of heart and advocate policies and positions fully in line with Catholic theology. If he does, they will likely not align with the values of the very progressive state of Rhode Island that he is supposed to represent. In fact, Kennedy might have to look for other employment next November, because it is unclear if he toed the Catholic political line whether he would survive reelection.

Certain Catholic bishops are more authoritative and outspoken than others, and Bishop Tobin appears to be one of the egregious cases. It is disturbing, but not surprising, that he would make a public case out of Kennedy. Kennedy makes an easy example that perhaps can be used to keep others in line, or at least mum, perhaps creating a deterrent effect.

I hope Kennedy remains true to his convictions. If there is an authority higher that the Catholic Church, it is the right of individual conscience. For most people raised Catholic, the idea of leaving the church is heart wrenching. If Tobin is going to continue to single out Kennedy in a vindictive way, I hope he has the courage to leave the Catholic Church for a religious community where his freedom of conscience is embraced, not debased. Actions after all should have consequences and it was Tobin who acted first with his edict prohibiting Kennedy from receiving communion. If I were in Kennedy’s shoes, I would not leave this one unchallenged.

If he does leave the church, Kennedy may discover, as I did, that it was an action long overdue. In my opinion, any church that requires you to violate your own conscience is unworthy of your time, money or participation. I am confident that if Jesus were present among us today he would agree wholeheartedly because that is the Jesus that I have found in the Bible.

Election 2009 postmortem: Much ado about nothing

One thing I know: CNN will not be calling me to be a talking head. I would not tell them what they want to hear. For the pundits and prognosticators trying to interpret the tealeaves from last Tuesday’s elections pretty much have it all wrong. The election says nothing about a resurgent Republican Party rising from the ashes. It also says nothing about an emboldened Democratic Party extending its majorities. Trying to read national trends into these few and widely scattered election results is, frankly, much ado about nothing. It’s pointless to even bother. There is no “there” there.

Pundits and prognosticators of course want the results from these scattered elections appear to be more than they are. That works for them. They make their livings through spin. If they wrote columns or got a spot on CNN as a talking head saying that the election really changed nothing and says nothing about how the public is really feeling about Democrats and Republicans, who would invite them back? As for politicians, what else did you expect them to say? Of course Michael Steele, chairman of the Republican National Committee is going to crow because the GOP picked up two governorships. Of course, Democratic National Committee Chairman (and my current governor) Tim Kaine is going to point that at the national level Democrats picked up two house seats, including a seat that has been in safe Republican hands since the 19th century. Both are going to claim their party has the momentum.

In Virginia, Governor Elect Bob McDonnell won by double digit margins over the Democratic nominee Creigh Deeds. It is true that when Virginians elect a Democrat for president they tend to pick a Republican for governor shortly thereafter, and visa versa. So what? This election had nothing to do with Virginia’s trends. McDonnell won because Creigh Deeds was a poor candidate and a terrible campaigner. We Virginian Democrats had to sift through three poor offerings and oddly enough, Deeds was the least objectionable. First, there was Terry McAuliffe, a former DNC chair who had zero experience in Virginia politics and whose only expertise was in schmoozing and raising money. Then there was Brian Moran, who stood so far to the left that even I could not vote for him. More importantly, with his stands on the issues there was no chance that he could win a statewide governor’s race in this purple state. Finally, there was Creigh Deeds, a middle of the road Democrat who turned out to be milquetoast and ran one of the worst campaigns in modern Virginia history. He hardly inspired Democrats like me to vote for him and I did so only grudgingly. After all, he spent the last few weeks of the campaign bashing a public health insurance option in the misguided belief this would woo independents, who happen to want a public option.

There was not much there for Democrats to like, so they hardly felt driven to the polls. On the other hand, there was the handsome Bob McDonnell who despite his very conservative leanings pragmatically steered toward the center where the Independents were. He connected with independents with a campaign driven by moderate promises and a no new taxes pledge. It is not surprising then that in my purple state many Democrats stayed home while Independents had every reason to vote for McDonnell. Nor is it surprising that his big win had coattails, and helped Republicans increase their majority in the House of Delegates. As for disgruntlement at Barack Obama, according recent polls, Obama’s approval is at 51% in the state, which is close to the vote he received a year ago from Virginians. In short, the election was about state-issues, not national ones and had nothing to do with feelings about Barack Obama.

In deep blue New Jersey, Republican Chris Christie won because the incumbent John Corazine did not keep his promises. In fact, he broke many of the ones that mattered most to voters. He was to use his Wall Street acumen to solve the state’s budget crisis. Instead, in part to address the economic crisis, he ended up raising taxes and the expected property tax cut never materialized. No wonder voters were pissed. Then there was the minor problem that he carried the stink of corruption wherever he went. Christie too seemed to be emblematic of corruption. However, when an incumbent has approval ratings in the thirties, even in a deep blue state his chances are poor, so Christie won.

The lesson for Democrats from these two gubernatorial races is that if you want to win, you should nominate compelling candidates like Mark Warner and Jim Webb who can appeal to both Democrats generally and Independents specifically. Whoever you nominate should have integrity and not carry the whiff of corruption. State Democratic parties need to do a better job of encouraging good candidates to run. In both New Jersey and Virginia, voters sensed what they were being offered was sweet smelling manure.

On the national level, one should also not read anything into the two pickups made by Democrats in special elections. The seat in California was a given for the Democrats because the district had an eighteen point Democratic registration advantage. The much talked about NY-23 special election was a one of a kind election with dynamics that changed constantly. Arguably, the Glenn Beck wing of the Republican Party shot themselves in the foot by backing a strong conservative in a three-way race. This led the moderate Republican to drop out and in a very unusual move endorse the Blue Dog Democrat instead. While it is true that a Democrat has not held this seat in more than a century, one cannot read that much into this election because of the unique dynamics of this race. After all, it is but one of 435 House seats.

The 2010 elections will likely result in some Republican House and Senate gains, as historically this has been the case when Democrats control the Congress and the White House. It is way too early to say how the election dynamics will unfold. Democrats in Congress can do much now to lessen the likelihood of losses a year from now by passing legislation that Americans want, like health care reform. To maintain their majority, Democratic voters need a reason to feel energized in 2010. Meaningful health care legislation, climate legislation that truly addresses the global climate crisis, and significant steps to reduce unemployment will probably help. The 2010 elections are no more likely to be a referendum on Barack Obama than the 2009 elections were. As is always the case, these races will reflect primarily local issues. When fielding new candidates, Democrats should promote and fund candidates that will speak to the needs of ordinary people. In 2008, voters voted for change. They still want change. They are just having a hard time generating enthusiasm for politicians wedded to special interests.

As for the 2009 elections, the sampling size was too small to draw any reasonable inferences about national trends. Those who do either have an agenda or they are deluding themselves.

My bipartisan health care solution

Buddhists steer toward the middle path. They are convinced that more harmony is found in the center than at the extremes. Today, particularly when it comes to the current health care debate, there is virtually no middle ground. Partisanship has reached such extremes that only a couple brave members of Congress will cross the aisle. Even within a party, there are ideological splits, such as between Blue Dog Democrats and The Progressive Caucus.

It may not be obvious, but I am a moderate, or at least what a moderate was before hyper-polarization began during the Gingrich revolution. Now my moderate stances are characterized as liberal. For example, I am a fiscal conservative. Lately a fiscal conservative is seen as someone in favor of restraining the size of government. I am less concerned about how big or small government should be (although I suspect we need big government because of the complexity of the problems that must be managed today), than we should fully fund the government that we have. To start, we should put our federal tax rates back to where they were in the mid 1990s. In case you forgot, our country enjoyed tremendous prosperity during those years. This was in part because we seemed to have found the right middle fiscal path. Lowering tax rates and cutting capital-gains taxes have resulted in less prosperity and huge budget deficits. Reverting to 1990s tax rates would not immediately close our deficit but it would be a step in the right direction. It was a moderate middle path, asking the rich to give proportionately more of their income, but not at the top tax rates of eighty or ninety percent that we had in the 1950s and 1960s. The rich got much richer, so they had little reason to complain but of course, they yowled anyhow.

Through all the smoke and haze on health care reform, there is a pragmatic middle ground if both sides would get off the high horses and act in the best interest of the country. (I know, what an idea!) Unfortunately, no one is really sincere about bipartisanship, including our president. All of Obama’s talk about bipartisanship is mostly for his political advantage. It’s important for him to be seen making the effort to be bipartisan because it improves his street credentials, particularly with independents. However, he knows at this moment that if meaningful health care reform is to happen it does not exist. There is bipartisan consensus on health insurance reform (for example, denying insurance companies the right to exclude people based on preexisting conditions) but this reform does nothing to solve the affordability issue or to restrain long term costs. If we don’t solve the latter real soon we could end up a second world country.

Unfortunately, we are up to our eyeballs with disinformation at this point. One example is that the claim that a “government run health care” plan to compete with private health plans will be subsidized, thus adding trillions to the deficit. As currently envisioned, this plan (which would only affect the uninsured middle class) would be deficit neutral. It would be funded through premiums and cuts/efficiencies in Medicare. Moreover, it would be required to remain deficit neutral. If costs go up then annually either premiums would rise, or benefits or payments would be changed to make sure it remains deficit neutral. On the surface, you would think that a “deficit neutral” plan would be acceptable to Republicans, who ironically now see themselves as fiscal conservatives. Yet currently all Republicans in Congress are planning to vote against it, because they say it is “socialism”. (It is curious that Medicare Part D was not considered socialism.) They also believe that some murky future Congress will lose nerve and start subsidizing the program in the order of trillions of dollars.

Republicans are correct that our government has a poor track record at controlling costs of our existing public health care plans. This lack of control is causing the deficit to explode. Granted, there are departments like Defense which are growing at very large rates. However, most of other federal agencies have been growing with inflation, if that. It’s lack of controls on entitlement problems that are driving deficits into the stratosphere. Medicaid (the health plan for the poor) was never designed to be self-solvent. After all, by definition you cannot expect poor people to pay their own health insurance premiums. So the federal government and the states jointly contribute monies, and states have some say on the services allowed in their states. Doctors already complain bitterly about inadequate reimbursement rates for both Medicare and Medicaid. In the case of Medicare, every year there is bipartisan agreement to postpone fiscal responsibility another year. In short, costs are going up in part of bipartisan Congressional spinelessness. You didn’t think all that money that AMA members contribute to their campaigns was going to buy nothing, did you?

Unquestionably, both Medicare and Medicaid are rife with abuse. Much of the abuse has to do with the fee for service model of both programs. Certainly some of the failure can be placed on administrators overseeing these systems, although in most cases it is federal contractors checking the paperwork, not federal employees. Who is committing the actual fraud? Clearly, those billing for services never rendered are breaking the law. Arguably, the whole fee for service model invites abuse because there are no constraints on doctors to limit tests, many of which are marginal value, and which are performed in their own office and push up their profits. These problems too are well documented but Congress seems loath to change it. This problem could be fixed if Medicare and Medicaid were to change and payment was based on successful outcomes for a given condition. Naturally doctors are not too happy with that approach either, as they have invested huge amounts of money in equipment on the assumption that a fee for service model will endure forever.

What I would like to see on this debate is a grand bipartisan compromise, essentially a middle path solution that, at least twenty years ago, would not have been the least bit controversial. Republicans are skeptical about the government’s ability to competently administer another health care plan. So make the government prove they can, by making approval conditional and by rolling out the program slowly. Essentially the government would have to demonstrate that it can administer a deficit-neutral health care plan that is affordable, outcome-based and that constrains costs on a small scale and then can successfully scale it up incrementally. It would be rolled out in stages over a period, say three to five years. The states picked to participate would be chosen by a lottery. Initially it would start with a handful of states, and then it would be assessed for effectiveness. If it were staying on track, it would be expanded to include more states. If not there would be opportunities to kill or fix it before it gets out of hand. A set of independent auditors would determine whether benchmarks and quality standards had been met or not. This would make us fiscal conservatives happy plus it would demonstrate the government can competently run a large and solvent health care plan that meets the needs of the insured. If the government cannot, at least we cut our losses.

In the interim, open up the Federal Employees Health Benefits Plan to those who would not qualify under the planned expansion of Medicaid. The FEHBP is definitely not socialized health care. Every member of Congress knows he can choose from a large exchange of health insurers and cannot be denied based on preexisting conditions. It won’t solve the long term cost problem of health care costs, but it could allow many more people who now need health insurance to get it while the longer cost issue gets addressed.

You and your kids need flu shots

According to recent polls, more than a third of parents say they are unlikely to have their children vaccinated against the H1N1 (Swine) flu, which is now raging across the United States. This news comes despite other polls where fully three quarters of Americans agree this flu is a serious national health problem.

As a parent, I have to shake my head. These parents are either wacked out, dreadfully misinformed or simply don’t give a damn about their children’s health. I will go with the assumption that most parents love their children, so I will assume most fall into the “dreadfully misinformed” category. Who knows what paranoid fantasies these parents are conjuring up about this shot? Perhaps they are thinking their kid will be like that 14-year old girl in England who died after getting vaccination for the HPV virus. They might have missed the evidence that her death was wholly unrelated to the vaccination. Or maybe these parents are just paranoid tea-baggers, convinced that the government is intent on killing their kids. This may be a sizeable crowd but I would still have to lump these into the “wacked out” category.

Some others may have heard that you can catch the flu from getting a flu shot. Now this is possible, though unlikely. You are only at risk if you opt for the nasal spray rather than an injection. To work, the nasal spray must use a live (but mutated) virus. It is unlikely you will notice anything, but if you do, you are most likely to get mild cold symptoms. On the other hand, it could also be that you just happened to contract some other flu or cold at the same time.

However, if you get the flu shot in your arm, you will be injected with a dead virus, which means there is no possible way it could give you the flu. Nor can it happen to your children. They may not like the momentary sting of the injection but that is a silly excuse not to get them a shot, and borders on child abuse.

What we do know is that H1N1 flu affects children and young adults disproportionately. They are much more likely to get it, and they are much more likely to have a more severe case than the rest of us. I have had two cases of it in the class I teach at a local community college, and in both cases, the student was out for more than a week. I know a few adults who have had H1N1 and they reported mild fevers and a quick recovery. It is believed that this is because the virus is similar to one that went around three decades ago, so they have a partial resistance. In any event, this flu is now definitely in the pandemic stage. It exists in most communities of any significant size. In many communities, hospitals are setting up triage tents outside the hospital to deal with the deluge of cases. It is expected to peak over the next month or so and then slowly taper off. The only real question is whether the flu will get to you before you can get the shot. That depends on your carefulness and how fast (or whether you choose) to avail yourself of a flu shot.

I have a good reason to delay getting a flu shot. Because I am middle aged, if I do contract it, it is likely to be mild for me. Although I hate the flu, I would be happy to let young adults, children, pregnant women and other highest-risk groups get their shot before me. (At 52, I have reached the age where I am at some risk of death from the flu, so an annual flu shot is recommended.) What I do know is that there is a shot available for every man, woman and child in the United States. It’s already paid for. If you get the shot from your local doctor or drug store they may charge you a small administrative fee, but it won’t be for the shot itself. They will receive it for free. If you are bothered by an administrative fee, assuming it is charged at all, make an appointment with a local public health clinic and get it free there instead.

There are other specious worries about this flu shot. For example, some worry that because it was manufactured outside the United States the quality control will be bad. This is not a problem. The FDA has a long established process of rigorously monitoring vaccine production. The vaccine is outsourced mainly because our drug companies say it’s not profitable enough for them to manufacture it. Frankly, you have a much higher likelihood of being hit by lightning than being the victim of a badly manufactured flu shot. I wish our food supply were as well regulated as our flu shots. We’d never have to worry about getting sick from E. coli or other nasty bugs.

Others simply trust to luck. They figure they won’t get it, so why get a shot? And if they are lucky, surely it must rub off on their kids too! The problem with this philosophy is that it is stupid. Just because you don’t get it this year doesn’t mean you won’t get it, or a variant of it, in the future. Moreover, flu shots help you build up a natural resistance to these and other common bugs. As I found out, the flu typically puts you out of commission for a week or so. In many cases, it also puts you in the hospital (and leaves you responsible for hefty hospital bills). In extreme cases, it can kill you. Ordinary influenzas kill about 20,000 Americans a year, or about 55 people a day. Through October 3rd, the Centers for Disease Control reports 147 pediatric deaths from the flu, most attributable to the H1N1 virus. Are you willing to let your child be another victim when you can prevent it at no or little cost?

I already have scheduled my annual flu shot for next Thursday. Fortunately, my employer provides it free of charge at our convenient clinic. It makes sense for them to do so; this way I am more likely to stay productive. As soon as I can get a H1N1 flu shot without impacting those who need it more, I will get it as well.

Once upon a time, I was childless and stupid too. I trusted to luck until the flu took me out of commission for a week. When it did, I vowed if I could get a flu shot once a year, I would. Not only was the experience humbling and scary, it had a huge impact on my life. Not only did my work suffer, but many others had to pick up my slack while I was down. Not all influenzas are preventable but many are. Prevention requires mindfulness that to a virus you are no one special, just another host to breed baby viruses. If you can get the shot, be proactive and schedule it every year. Also, do common sense things like wash your hands regularly.

Of course, our precious children should not be allowed to opt out of the shot. They are supposed to be guided by loving and responsible parents. If the polls are right, at least where it comes to their children’s health, more than a third of America’s parents are being irresponsible.

Don’t let your kids or yourself be one of the statistics, dead or suffering pain needlessly when it is cheap, convenient and wholly preventable to avoid it. Get the whole family immunized. Perhaps you can do it all at the same time, so when your children become adults they will see the flu shot as an ordinary and important part of raising a healthy family.

Republicans are a party of sadists

If Democrats are a bunch of bleeding heart, do-good tree huggers (which sadly, we are not), it is clear that modern Republicans are pretty much the opposite. They may put on great smiles, but underneath that plastic veneer are a whole lot of seriously hurting and angry people who basically are sadists.

In case you are not familiar with the term, sadists take pleasure in the infliction of mental and physical pain on others. Being sadistic is not considered a virtue; it is considered a mental illness. Strangely, particularly in our bizarre modern times, Republicans do consider sadism virtuous. It is witnessed by the preponderance of Republicans and conservatives who were all for waterboarding and other forms of torture in our War on Terror.

In fact, some of the leading sadists come out of the conservative Christian community. Have you noticed? Yeah, it puzzles me too. I always thought Christians were for the poor and oppressed and wanted to relieve misery. Just a few of the Christian dominated conservative organizations that are opposed to health care reform include the Southern Baptist Convention, the Family Research Council, Focus on the Family, the Freedom Federation and American Values. The consequences of no health care reform are inescapable: health care will become more and more unaffordable, putting more people into misery, poverty and early death, and principally those near the bottom of the income scale. When you advocate policies that hurt and make miserable people you do not know or like, you are being sadistic.

The thing is most sadists enjoy inflicting pain and misery only on people they know personally. Republicans are taking it national, to people they don’t really know and in many cases just imagine. Take ultra-conservative TV show host Glenn Beck. Before he joined Fox “News” he worked for a radio station, B104 in Baltimore. What is more, Beck admits he was a sadist.

Today, when Beck wants to illustrate the jerk he used to be, he tells the story of the time he fired an employee for bringing him the wrong pen during a promotional event. According to former colleagues in Baltimore, Beck didn’t just fire people in fits of rage — he fired them slowly and publicly. “He used to take people to a bar and sit them down and just humiliate them in public. He was a sadist, the kind of guy who rips wings off of flies,” remembers a colleague.

Now that his audience is national, he appears to be in remission. In case you missed it, among Beck’s latest sadistic antics was this one where at first he appeared to boil a live frog.

As I noted back in 2007, Fox “News” commentator Bill O’Reilly is a bully with sadistic tendencies. He also has an explosive temper, both on and off the air. Yet in conservative circles, sadistic tendencies are now a virtue which might get you into their Hall of Fame. Sadistic tendencies show you are serious, just like Hitler was dead serious about ridding the world of the Jews. Indeed, Beck is rising in the public spotlight based on his sadistic notoriety. It’s like conservatives on TV and radio are holding a contest to see who can be the most sadistic and outrageous.

Fueling the sadism of course is anger, anger that must be expressed. When it is expressed in creative ways, such as pretending to boil a live frog, it gets publicity and weird interviews with Katie Couric. Even people who are not sadistic by nature might be drawn to watch Bill O’Reilly or Glenn Beck just to see what crazy sadistic antics they try on a particular day. (I am betting most of these people also watch TV reality shows.) While they are watching, of course, they will get plenty of propaganda. Their hope is that these viewers will make a regular habit watching them and, perhaps in time, enter the black and white world of the Dittoheads.

Perhaps it was Ronald Reagan who most recently started the whole mess, although clearly the underpinnings of this movement go back well before the rise of the John Birch Society. When Reagan first ran for president in 1976, he railed against welfare queens who he was sure were living the high life on the public dole. There was virtually no basis in fact for these allegations, but it made for an easy piñata that conservatives could bash. Given how miserable the economy was doing at the time, alleged welfare queens also made an easy target to advance a larger power agenda.

What was really needed in 1976, and is needed today in our sour economy, was some perspective. In 1976, anger against welfare queens was not the real issue; it was our rampant inflation instead. Our country was rapidly changing for the worse in a new global economy that we were not ready for. Today, the welfare queen may have been replaced with illegal immigrants clogging our emergency rooms, or illusory death panels of government bureaucrats, but their anger is real enough. When you feel angry inside, at some point you have to express the anger, at least you do if you have a short fuse. Naturally, the last place you will look for the source are some defects inside yourself. I am sure this anger has nothing to do with the way their Dads were so liberal with the use of the belt on their backsides.

So just why are conservatives so angry with Democrats in general and Barack Obama in particular? Is it just racist feelings that explain their hatred of all things Obama? That is certainly part of the unstated animus, but only a small part of it. What really gets conservatives riled up is the unacknowledged fear that we have an administration and Congress that just might actually solve a couple of these chronic problems that people really care about. (As I pointed out in my last post, I am not particularly hopeful that Democrats will succeed.) After all, should Americans choose a government run plan over private insurance, and should it be fashioned like Medicare, they might like minor conveniences like not having to hassle with paperwork and knowing that they might be able to afford to be sick. Moreover, that might mean they would want more policies like these, and more Democrats voted into office. Eventually Republicans might devolve into a wholly inchoate bunch.

The truth is, Republicans today pretty much are an inchoate bunch but they are making a hell of a lot of noise. Hurricanes are very loud too and leave a lot of devastation in their wake. When you go from welfare queens, who just might possibly exist in some weird and exceptional case, to government sanctioned death panels trying to kill grandma, it is clear that people like Sarah Palin are not playing with a full deck. The best you can say for them is that their sense of rage has temporarily overtaken their ability to reason based on the known facts. The worst you can say is that they are loose cannons. The last thing you want to do is put one of these impulsive people on the deck of the ship of state. The next thing you know they will be worrying their next-door neighbors are Martians because their next-door neighbor looks like Uncle Martin Martin from My Favorite Martian. This would mean, of course, given their tortured logic, that America is covertly up to its armpits in Martians, and, by the way, Martians look upon us the same way we look upon a juicy steak.

Seriously, if anyone needs health care reform, Republicans need it, and make sure it includes mental health benefits. Many of these folks can no longer discern reality from fantasy. Their world is apparently one full of endless subterfuge where someone is always out to get them or some member of their clan. Perhaps if there is some intelligence behind their hatred of health care reform, it is their hope that by maintaining the status quo we will end up with a nation of paranoid village idiots, just like them. When everyone is pointlessly paranoid, just like them, then perhaps they can relax a bit. Somehow, I doubt that will calm their restless souls.

I know that if I were Glenn Beck’s physician, I would be writing him a prescription for Valium and when he is calm enough send him to a good head shrinker. Chances are he will in there a long time.

America: An Empire in Decline (Part Two)

President Obama may be our Great African American Hope, but it is hard to avoid the feeling that our great country’s best days are behind it. Politicians will not admit it, of course. From their lips, like it came from Ronald Reagan’s, it is always Morning in America. If you need more proof our best days may be behind us, look no further than the current health care “debate”. It is a sad political debacle in which “compromise” apparently means everyone’s needs will be satisfied except for the people who actually need and use health insurance in the first place.

Democrats, as usual, are busy imploding now they have returned to full power. There are few things that Democrats do better than control both Congress and the White House and then quickly splinter into disunity. We saw it happen to Bill Clinton’s Democratic Congress, and before that to Jimmy Carter’s. This time, it’s the Blue Dog Democrats (who represent conservative and southern districts) vs. the Congressional Progressive Caucus. House Blue Dogs, who consistently represent more underinsured constituents than elsewhere, nonetheless cannot seem to summon the will to vote for the mere option of a universal public health insurance plan. The House Congressional Progressive Caucus, a somewhat larger body of Democrats, won’t vote for a bill without a public option.

Meanwhile, over in the Senate, alleged “Democratic” Senator from Montana Max Baucus, who is also chairman of the Senate Finance Committee, and whose reelection campaign is largely funded by the health insurance lobby, tried mightily to create a “bipartisan” health care bill. He did so by systematically excluding input from all but a handful of personally selected senators on his committee. “Bipartisan” meant trying to be inclusive to three Republicans, only one of whom (Olympia Snowe) may actually vote for his “bipartisan” bill. Baucus hopes that taxes on “Cadillac” health insurance plans plus murky promises to reduce future waste and fraud in Medicare will help subsidize health insurance for the working poor and the middle class. Everyone will be required to have health insurance, but will have to buy their plans from the same insurance companies that keep raising their premiums and dropping them as customers for sins like not disclosing that they had acne. With premiums alone currently running $13,000 a year for a family, and with subsidies anticipated to pay for only a small part of the premium, it is unclear where these already stretched families will find the dough to buy health insurance, but they risk a fine if they do not. The sad reality is that if the Baucus bill becomes law, most families will opt to pay the fine because they still will not be able to afford health insurance.

The winners, naturally, will be health insurance companies who will get plenty of new customers, many of whom are younger and thus less likely to get sick. While insurance companies will not be allowed to deny people insurance based on preexisting conditions or kick them off the plan when their care gets too expensive, they can keep raising premiums as much as they want. No insurance commissioner will be policing their premium rate increases. An independent commission may make recommendations for providing more efficient health care, but these are likely only to apply to Medicare, Medicaid and maybe physicians. A public option may or may not survive. It is likely to pass the House, but the assumption is that the Senate won’t pass it and they hold the trump card.

This is as close to health care reform as we are likely to get. In short, if you have insurance you cannot be dropped. If you don’t have it, you cannot be denied it even though you may not able to afford to do so. In addition, nothing serious will be done to slow the escalating costs of health insurance, meaning that it will only become more unaffordable as time goes on.

When a nation cannot find a pragmatic way to solve a pressing national problem that a majority of Americans earnestly want solved, you know government is becoming dysfunctional. Yes, the seeds for the eventual unraveling of our country are being planted through myopic and reckless acts of self-interest like these. Rather than be the United States of America, we are becoming the Divided States of America. You can see it in the senior citizens attending health care rallies, determined to protect their Medicare benefits at all costs while somehow blissfully unaware they are using socialized medicine. For those younger than them who cannot afford health insurance, well, screw ‘em. They got their government bennies first and they’ll be damned if anyone else will get any at their expense.

What would real health insurance reform look like? For one thing, we would mercilessly tax the things that are driving up health care costs, like we have been doing with tobacco and alcohol. There would be a ten cent per can surtax on every sugary beverage sold, from Coca Cola to a Starbuck Carmel Frappuccino. This alone would pay for much of our health care costs, but we could also do the same with any food the Surgeon General determines is unhealthy. We would give premium discounts to people who maintained a healthy weight. We would offer subsidies so the overweight and obese can enroll in successful weight loss programs like Weight Watchers. We would provide these companies bonuses for keeping people at healthy weights and physically active. We could require employers provide gyms and basketball courts and make sure their white-collar workers get cardiovascular exercise during the day.

No doubt, Republicans would scream about more socialism and higher taxes, and the food industry would oppose any reforms. And of course, they would win because this is America. In America, the interest groups that can best influence Congress (and these amount to those who have the most money, which is generally corporations) tend to get their way. Moreover, based on arguments recently before the Supreme Court, it looks like conservatives on the court will give corporations permission to spend unlimited amounts of money on campaign related advertising and propaganda too. We can look forward to even more government of, by and for the corporation.

Most sensible governments like the rest of the first world came to a reasonable solution a long time ago. A good American model would look a lot like Switzerland’s, where everyone buys private health insurance but niggardly insurance regulators set all sorts of conditions on premium increases and quality of care standards. However, we could not do that here, you see, because that would be “socialism” and might affect health insurance company executives and their $500M a year salaries.

Sadly, America has a long tradition of capitalism triumphing over common sense. Moreover, many of us will gleefully applaud policies that will only make us unhealthier and kill us faster. It’s the American way! From our growing guts, to our obsession with drugs, to our addiction to SUVs we cannot get beyond our own short sighted interests and pragmatically deal with the longer term problems that are crippling not only ourselves but destroying our great country.

I get the sense that we are doomed. I doubt even our Great African American Hope can pervade over such entrenched, self destructive and selfish dynamics. Shame on us.

Two parties could play the disinformation game

I suspect that it was mostly us political junkies who watched President Obama’s speech before a joint session of Congress last night. My wife cares very much about health care reform, but not enough, apparently, to watch the speech with me. It was one of Obama’s better speeches, but it should have been delivered months ago. His administration has been floundering trying to master the health care reform debate and the speech was a belated attempt to regain control of the debate. For such an important initiative, it required better marketing effort than it has so far received.

Granted, Obama has had a few distractions to deal with, like fixing our tanking economy. It appears that our recession is over, but to the unemployed, whose ranks are likely to continue to swell in the months ahead, this is meaningless. Health care reform appears to be in part a victim of an administration trying to do too much at once. It is also the victim of learning too many lessons from the failure of health care reform during the Clinton Administration. Certain those dynamics are still in play, they appear to have floundered responding forcefully to the new dynamics of the debate. With luck, Obama’s speech at least changed the dynamics.

South Carolina Republican Congressman Joe Wilson certainly made a name of himself by heckling Obama during the speech. When Obama said accusations that reform would cover illegal immigrants was false, Wilson stood up in the middle of a joint session and called the president a liar. He has subsequently apologized for the incident, although it sounded halfhearted. While he agrees he acted disrespectfully, he still believes that health care reform proposals will indeed cover illegal immigrants, even though this is demonstrably false.

As Wilson demonstrates, Republicans seem to state as fact what could happen rather than what is actually being proposed. Using the “could” argument, of course, anything is possible. A subsequent Congress could explicitly decide to cover illegal immigrants so there you go, it must be true. In the minds of many Republicans, because anything is possible in the future, this means that Democrats are actively planning to make it so. There is a word for this sort of behavior: paranoia. Sometimes paranoia is justifiable. When paranoia extends to acts that are only imagined but have no basis in fact, one of two things is going on. In the case of Joe Wilson, it suggests a psychosis. Wilson could probably use some therapy, including anger management therapy. Most Republicans in Congress though are too smart to be psychotic. Which means that when they spew garbage like these imaginary death panels they are simply lying. Obama was correct to call those spewing these lies what they are: liars.

Wilson apparently transgressed the line of propriety by expressing his opinion during a joint session of Congress. However, being a politician means that you are free to lie the rest of the time, unless you are under oath. The only thing that really matters is whether voters will hold you accountable for your lies. The odds are stacked in an incumbent’s favor, but in the egregious case of Joe Wilson, perhaps not. His outburst spurred many contributions to his likely opposition candidate in 2010.

It may be late in the game, but maybe Democrats should to respond with a weapon similar to the one launched on them. Such a strategy may be hard to swallow, since it is so disingenuous, but it has proven remarkable effective for the Republicans. After all, if Republicans are going to charge as truth things that could happen, why should not Democrats and the Administration feel free to do the same? Of course, it would have the effect of burning bridges with the Republicans, but heck, Republicans have already burnt the bridges! What is the point of reconstructing the bridge of bipartisanship on the Democratic side if the Republicans are unwilling to also reconstruct their side? As I noted recently, bipartisanship is now perceived as for losers.

Perhaps it is time to marshal forces like in a deliberate disinformation campaign. What would it look like? Here are some lies that, like the Republican lies, could be true, if not now then in Democrats’ imaginations but based on not wholly unreasonable inferences:

  • The Republican Party has a master plan to destroy Medicare and Medicaid.
  • Republicans hate poor people and want them to die young. Their opposition to health care reform is all about killing these Democrats to create a new Republican majority.
  • Republicans also want to destroy the Social Security system because they see it as just more socialism.
  • Republicans hate all but wealthy senior citizens. They want to destroy Medicare so their access to high quality care is unrestrained. If this means that other seniors die prematurely, that’s okay.
  • Republicans are racists who want to deport African Americans back to Africa and send all Hispanics back to their native countries.

Like Republican lies such as the death panel lie, these lies sound a bit crazy, but not so crazy to not have a whiff of believability to them. For example, it is easy to find quotes by Glenn Beck or Pat Buchanan suggesting they are racists. It is also easy to find far-right members of Congress, like Ron Paul, who really are in favor of getting rid of Social Security, Medicare and Medicaid.  The reason a smear so often works is because you really only need one egregious example to infer the truth about an entire class. In this sense, these lies are more credible than those Republicans have uttered. Since Republican lies have proven good at putting Democrats on the defensive, it is likely these lies would stick like superglue to Republicans. After all, their recent stints in power have left them with little credibility and their approval numbers are in the gutter. Moreover, the lies would keep Republicans busy explaining why the lies are not true, essentially taking the wind from their sails, as their lies did to Democrats at many town halls this summer.

In reality, it is not Republicans whose votes are needed. They will be opposed to it, no matter how much Obama and Democrats try to sweeten it for them. It is Democrats, particularly those Democrats that represent rather conservative districts and states, who are scared. I see it here in Virginia, a purple state. Senator Jim Webb is calling for more time for discussion and debate on health care reform, as if the last fifteen years have not been enough. Senator Mark Warner is being cautious and hedgy, and in particular seems to be backing away from supporting a public option.

Outspoken citizens at town halls are disproportionately influencing both senators. Numerous polls, such as this New York Time poll, show that the public option is strongly supported by a majority of Americans. Democrats have to summon the nerve to vote the will of their constituents. If they do, they will be rewarded by reelection because they will be seen as working for their constituents for a change. However, capitulation to a loud minority will only help ensure that Democrats reenter minority party status far sooner than need be.