Laid Up

I wonder what the criteria are these days for an overnight stay in the hospital. They must be high. Many years back my wife had a hysterectomy and to save money the HMO sent her home the same day. She gritted her teeth and wailed all the way home from her many jostling sutures. It seems just about everything is being done outpatient these days, but if it is helping to control health care costs, it is hard for me to tell.

My relatively minor surgery yesterday certainly did not qualify for a hospital stay, which is just as well. I am more comfortable at home anyhow and Georgetown University Hospital is so far away from where I live. It took close to two hours just to drive there from our house near Dulles Airport. Much of that time was wasted creeping onto the ramps for the Dulles Toll Road and then trying to merge onto the traffic. It’s insane but just to make it more annoying they upped the tolls with the start of the new year. The Silver Line is going in, Metro’s latest controversial extension that will go through Tyson’s Corner and eventually to Dulles Airport and beyond. Money has to come from somewhere, so it comes from commuters on the toll road that have no other alternative. I am grateful I have to navigate the traffic on it so infrequently.

Parking at Georgetown University Hospital is always a hassle, but fortunately, my surgery was not. They must have finished patients ahead of me early. I had barely walked in the door and they were moving me back. I had doctors and nurses competing for my attention. They even skipped the traditional gurney ride into the operating room. My surgeon, anxious to get the procedure done with, had me walk into the operating room where the anesthesiologist hurried with my IV. One moment I was looking at the bright lights on the ceiling and suddenly it was ninety minutes later and I was in recovery. Huge bandages now cover my right foot and leg. Somewhere under all that dressing is a three-inch scar near my ankle where the tarsal nerve repair was done. Somewhere on my leg are three other incisions that helped release the pressure on those nerves. By 2 p.m. I was in crutches and on my way home.

Given a choice in the future, I would definitely consider Georgetown University Hospital again. The whole experience felt much faster and more professional than other hospitals we have used. The staff was excellent from the moment I arrived until the moment I left. I could not have asked for more professionalism and courtesy. Some years back after some back surgery, Reston Hospital wanted to give my wife some crutches, for which they wanted to bill her $200. What an outrage! Reston Hospital is a for profit hospital partially owned by Senator Bill Frist, one of the major stockholder of HCA. Georgetown, as a non-profit Catholic hospital (as well as a teaching hospital) charged me $44 for the crutches with no markup. It will take a while to see what my net bill will be but I suspect it will be lower than if I had the procedure performed locally.

Anyhow, I am home, and home is where I will stay for three weeks or so. My leg is bandaged in such a way that driving is impossible. Fortunately, I am reasonably mobile. I use crutches but due to all the gauze covering it, I can put some weight on the right leg. Nor really is there any pain. Yesterday I felt only numbness. It is clear that the surgeon wants the sutures to stay in place because the foot is wrapped so tightly that the whole foot feels numb, and it was the numbness (and pain) that I was trying to get rid of. At least one is down.

Home is where you heart is supposed to be but in truth, I am not much of a homebody. This means that three weeks at home will be something of a minor trial for me. I dread retirement because I feel like I need a place to go to during the day. For as long as I can remember it was always work or school. Even if I was having a stay-cation, should I feel the need to escape there was always the car. As I heal, I may be able to hobble around in my crutches up and down the block. This will be the extent that I will be leaving home.

To fill up the time I will first keep the foot propped up most of the day. Long naps do not seem necessary. I have a stack of DVDs I can work my way through, and there are books to read. There is also the web to surf, but for me surfing the web is always more fun after I have dodged and parried with the real world the rest of the day. Thanks to 21st century technology, I can effectively do 90% of my work at home, at least for a few weeks. So I plan to resume working next week, although my kitchen table is a poor substitute for the office. It has no becalming view of the Shenandoah Mountains, nor the convenience of the cafeteria and snack bars, nor the social life one can find in the office.

Somewhat begrudgingly, I think what I will miss most of all these three weeks at home is my office social life. I am no social butterfly. There have been consecutive days when the only one I spoke to was the guy who removes my trash. Still, it is nice to interact with people other than my immediate family. Here I have my wife who for a while will have to cater to me and who is always nice to have around, but she is a well-known commodity. There is also my daughter who sleeps during the day and who generally ignores me anyhow. There is also one friendly cat. To the extent I have a social life these next few weeks, it will be with my cat.

There are still bills to pay and work for clients on the side to do. That will help. I best double my dosage of Vitamin D because it will be awhile before I will feel the sun shining on my skin again. Being laid up is a part of life, and one I should get used to. It is perhaps something to be welcomed rather than feared. As for being one of life’s trials, it will be a minor one. Come early February, I expect I will be sick of it and will look forward to returning to the office. Until then, I must be a homebody.

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.

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.

The end of Camelot also means the death of bipartisanship

I was born into the Camelot era. Yesterday, with the burial of the late Senator Edward M. Kennedy in Arlington National Cemetery, I saw its end.

For those of you who happen to be much younger than I am, “Camelot” refers to the mystique and perceived larger than life aspects of the extended Kennedy family. Back in the 1950s, particularly with the ascendancy of John, the extended and privileged Kennedy family became sort of like national rock stars, all larger than life. The Kennedys were a whole family of Barack Obamas, personable, stylish, accessible, passionate, outspoken, political by nature, but unlike Obama, rich. Yet, perhaps because of their Catholicism, they were sincerely interested in rectifying the inequities between the rich and the poor. When President John F. Kennedy asked us to give back to our country instead of take from it, we of the Camelot generation felt energized. Nationally we also embraced his ideas of American greatness by succeeding in quixotic national quests like putting a man on the moon by 1970. Moreover, we believed that through applied intelligence that were going to lead the world into a new, peaceful and utopian age.

The current sad and nasty debate over health insurance reform, the cause of Edward Kennedy’s life, shows how far we have come from the days of Camelot. For those of us still captivated by the Kennedy aura, there is nothing more natural or patriotic than to ensure social justice for all Americans. We believe this because only a few can meet their potential if they go through life economically and socially handicapped. No senator ever did more (or is likely to do more) to advance social justice than Edward M. Kennedy. Judging by Republicans in particular, the only socially acceptable way to “ask what you can do for your country” is to serve in the military. Otherwise, it is every man for himself, brother. The sanctioned game is no longer national unity or promoting the common welfare, but to see who can accumulate the most stuff and lord it over their less fortunate neighbors. To Republicans, government should not be redistributing wealth at all, except, of course, to farmers, small businessmen and very large corporations. To them, an important role for government is to make the rich richer at the expense of everyone else. Charity is okay only to the extent it is done by churches and non-profit organizations, even though such endeavors do not come close to meeting the need for services.

Bipartisanship, which was on critical support, also died with Senator Edward Kennedy. Kennedy was a consummate cross-the-aisle type of politician. He made friends with staunch conservatives like Senator Orrin Hatch and the late Senator Jesse Helms. The right is giving Orrin Hatch all sorts of grief for his having the audacity of even being a friend of Edward Kennedy, a liberal. How could he do this? How could he associate with one of them? How can anyone call someone a friend when they do not share the same political ideology? The mere idea!

Modern American politics is sadly resembling some lyrics from the musical Chess:

But we’re gonna smash their bastard
Make him wanna change his name
Take him to the cleaners and devastate him
Wipe him out, humiliate him
We don’t want the whole world saying
They can’t even win a game
We have never reckoned
On coming second
There’s no use in losing

Senator Kennedy, partisan though he was, was not vindictive. In short, he was civilized. With his passing, it appears that political discourse must henceforth be all coarse, all the time. Any compromise is now perceived to be a sign of weakness and a reason to be cast from your ideological tribe. Anything to give you the upper hand is okay, even if it is spewing nonsense like the government is out to kill grandma.

President Obama, usually a very perceptive guy, seems to think that bipartisanship is still possible. He assumes that at some fundamental level politicians can be reasonable people. Unfortunately, our politicians mirror the nation at large, which is full of dogmatic, uncompromising, my way or the highway, plain unreasonable people. As in the book 1984, today we perceive ignorance to be strength. In doing so we merely hasten the time when our country moves from a first-class country to a second-class country.

We are rapidly devolving into the Divided States of America. More agile countries, like Canada, address societal issues like national health care with pragmatism and evidence-based approaches. We try to solve problems through turning our ideology into law.

It is unclear to me if this can be changed. I do know that with Kennedy’s passing I am very worried about our country. If we cannot inculcate and foster an evidenced-based society, our nation is doomed. If extreme partisanship is more important than using our common sense to step forward and solve problems on behalf of all the people, rather than just our own ideological tribe, our nation is also doomed. We need politicians like Edward Kennedy brave enough to cross the aisle, listen and engage in give and take, and know the other side as people. Right now, the divides in our Congress seem more intractable than those between Israelis and Palestinians.

Perhaps education will eventually turn the tide. This is essentially what I told my students yesterday. I teach part time in a community college where the percentage of students who attain their associate’s degree is only about forty percent. This is not at all unusual for a community college, which welcomes all including lots of students who lose nerve on their path toward a degree.

The country does not need a nation of relatively unproductive citizens in low skill, low paying jobs for the rest of their lives. To retain our greatness, increase the common wealth and successfully complete in the 21st century, my students need to hang in there and complete their degrees. In addition to learning advanced skills in college, they also need broad liberal arts courses so they have a better appreciation for how the world actually works. Knowing why things are the way they are will help them as our future leaders pragmatically address the problems of the day.

Perhaps as part of acquiring their degree, they should also pass classes in negotiating and listening. Ideological wars solve nothing. All wars, whether real or ideological, are karmic in character; all are zero sum gains and merely sow the seeds for the next conflict. Bipartisanship is hard but it is a worthy goal, but it is impossible if neither side will negotiate honestly and in good faith. Both sides must be willing to compromise.

If peace can come to Northern Ireland, perhaps we can find political leaders brave enough to stand up to the flack within their own party and cross the aisle. With the end of Camelot, that day seems very far off. While it continues, I worry that our great nation is moving down a slippery slope toward national dysfunction.

Playing health care roulette

My two weeks out west on vacation were great. While I love the extra oxygen we have here in the lower altitudes on the East Coast, I do not particularly welcome the return of hazy, hot and humid, which passes for normal summer weather around here.

Nor did I particularly welcome the stack of unpaid bills, many of them large co-pays from various specialists for various procedures for my wife and I. My co-pay to have a varicose vein cauterized was $490.30. Still, at least I am insured. Anthem BC/BS paid the doctor another $3,268.71. The list price for the procedure was $4,843.00. Bear in mind the procedure was done out patient and including time in the waiting room took no more than two and a half hours. I was sedated but awake through the whole procedure.

Wednesday afternoon while I was still recuperating from the jet lag, I went in for a second procedure, this one taking about an hour longer. I expect I will pay at least another $490.30 co-pay for this procedure too. I hope that as a result the pressure will ease on the nerves in my right foot, although there is no guarantee.

While I sat in the waiting room, a working class man shuffled into the office. He did not have insurance and inquired on how much it would cost for a consultation. The fee was $475. Yes, it would cost $475 just to find out how bad his varicose vein problems were and to determine a treatment plan. If he requires surgery similar to mine, he can look forward to $10,000 or more of out of pocket costs to address them. As a self-employed individual, he is priced out of the health care market. His best hope is to work out a payment schedule with the doctor. Since he is not insured, it is likely that he is looking at years of payments to deal with his vein problems, assuming the doctor decides his credit is good enough to go ahead with the surgery, and assuming he can convince his wallet to go ahead with the work. With luck at age 39, this is his only major medical problem. What is clear is that like millions of uninsured Americans, he is playing health care roulette.

According to Republicans, he must be protected from socialized medicine at all costs. While he clearly cannot afford health insurance, according to Republicans he is better with no health insurance reform. In particular, Republicans, who are so much about “choice”, want to deny him the option of belonging to a public plan, perhaps similar to Medicare. For that would be “socialized” medicine, which must be bad, although would be perfectly acceptable if he were 65 instead of 39 and thus eligible for Medicare. We know the public option is bad because so many disgruntled Americans are shouting down speakers who say otherwise at community forums. According to Republicans, Americans will be better off, more solvent and presumably healthier if uninsured people like this man remain uninsured.

The disinformation campaign is working to some extent. P.T. Barnum famously told us a sucker is born every minute. Americans seem to revel in their ignorance.

About 11 percent of young citizens of the U.S. couldn’t even locate the U.S. on a map. The Pacific Ocean’s location was a mystery to 29 percent; Japan, to 58 percent; France, to 65 percent; and the United Kingdom, to 69 percent.

With such widespread geographic illiteracy, it is not surprising that well-funded campaigns financed primarily by insurance companies who are benefiting handsomely from the status quo are succeeding in convincing many Americans to act against their own interest. It is like we are living the novel 1984: Ignorance is Strength!

Republicans have proven adept at exploiting America’s ignorance and paranoid tendencies and seem to have no problem with bald-faced lying. The “problem” with Democrats is they seem incapable of the same disgusting behavior. Perhaps this is nowhere more evident than in shameless and bogus claims that health care reform will mean government-sanctioned “death panels” that will determine whether you live or die.

What one bill proposes is that Medicare will reimburse your doctor if you are in Medicare (i.e. age 65 and above) and choose to meet with him or her to discuss end of life care alternatives, such as whether you would like to be placed in a hospice toward the end of your life or should get a living will. This is certainly not a death panel, and such sessions are not even required. The patient chooses. If this is a government death panel then apparently our doctors are going to be secretly inducted into the civil service and given strict marching orders. It is such a mind-bogglingly false claim that it is amazing that anyone with two brain cells would believe it. Nevertheless, this is America, and our paranoia is always close to the surface. Thanks to Republicans, we are conditioned to believe the ridiculous. After all a plurality of Americans (45%) believe the earth was created by God no more than 10,000 years ago.

News flash: we already have medical death panels that effectively determine whether you live or die. We would be fortunate if the government was deciding, then we might have some say in it. Instead, the insurance companies often decide whether you live or die. If you don’t believe me and are insured, simply take the time to read the fine print of your health insurance contract to find out what conditions they will not cover. If your particular condition is not covered, assuming they do not unilaterally drop you as a client, you have two choices. If you are independently wealthy, you can pay for these other treatments out of your pocket. Alternatively, you can sell pretty much everything you own until you are nearly destitute and hope that the socialized medical system called Medicaid will cover the treatment you need.

It is legitimate to question the cost of a new national health insurance program. It is not legitimate to focus the debate on spurious and bogus claims that are simply boldfaced lies, like these imaginary government death panels. Other bogus claims: that illegal aliens will get health insurance, that federal dollars will be used to fund abortions, and that you will be required to sign up for a government health care plan. It’s a public option, not a public requirement.

What you will likely get from any bill that the president signs is the right to be insured by any insurance company licensed in your community, including a nationwide government plan if you prefer or if no insurance companies are available in your area, regardless of your preexisting conditions and with no fear of being dropped because your conditions have become too expensive. What you will also get is the ability to buy into any plan offered, including a government plan if you choose. If you are poor or have modest means, most bills would subsidize the cost of your insurance for a period. In short, you are much more likely to be able to be insured and more likely to stay insured. Logically, this should trickle down to those of us who are lucky enough to be insured now. For our premiums are already marked up to cover the cost of the uninsured clogging our emergency rooms.

I am sorry, but if you really believe that the government is getting ready to set up death panels for grandma, you are dumber than a box of rocks. Please send me your name and address so I can invite you to purchase some fine land that sits in the middle of Lake Okeechobee. Moreover, if by shouting down other voices at these rallies you succeed in stopping health insurance reform, you and millions of others who desperately need insurance will needlessly reap the foul results of your ignorance and rank stupidity. Instead of the government you need, you will get the government you deserve.

Demographics happen

There are few things more American than the right to make an ass of yourself. Perhaps it is the swine flu but lately it seems like the Republican Party is being gripped by a form of insanity. It must be a fever because what else could explain such delusional thinking of late? Substantial numbers of Republicans actually believe that Barack Obama is not a U.S. citizen, but was born in Kenya. Then there are these orchestrated protests at town halls being given by our congressional representatives and senators that seem to be attracting large numbers of orchestrated lunatics. It is one thing to be opposed to health care reform and to speak up in a civil manner. It is quite another thing to show up at these events, recite inanities if not outright falsehoods about health care reform and basically try to prohibit even a discussion on the topic from taking place. The National Republican Committee seems to be behind these protests, but they are also being whipped up by prominent conservatives like Rush Limbaugh and Glenn Beck too.

What is really going on here? What is happening is that America’s demographics are changing to the point where their impact is being acutely felt. What is really very scary to these protestors is that white privilege is losing its grip on America. For years the demographics of America have been trending less white and more multicultural. America witnessed a watershed moment with the election of Barack Obama. In the minds of most of these protestors, having an African American as president was insulting enough. It was just as insulting that Barack Obama would also try to rapidly enact the exact reforms on which he campaigned.

The opposition, as it always does, tries to push back. What is unique this time is the extraordinary lengths this group is going to in order to get attention. Obviously these people have been seething since the election. When a balloon pops, it pops at its weakest point. Today we see that when these feelings become overwhelming, they are articulated by their loosest cannons on the GOP ship of state.

Do not assume though that these loose cannons are rolling around the deck because their pins rusted out. The crew (in this case the National Republican Committee and prominent conservative commentators) has been actively working to pull out their pins. They do so deliberately because they know that talk has its limits and to effect change it must be followed by actions. These tactics seem to be working to some extent. People whose support for Obama was tentative to begin with might be persuaded to believe the incredible about him if sufficient numbers of their neighbors say so, particularly in a bad economy. Similarly, much of the disinformation about national health care reform feeds into general American paranoia about Washington and its surreptitious motives.

The general thrust of all these actions is arguably quite conservative. Conservatives by their nature do not welcome change. They resist change. Conservatives are used to a power structure where white men hold most of the political power. It is as American in their minds as George Washington and Thomas Jefferson. However, when you run out of convincing arguments and when the American people are generally not behind you, then in their mind some extreme tactics are required. Playing by the rules simply means they will become further marginalized. Go on the offensive using bizarre and unworldly tactics and at least you have attention and can attempt to direct the conversation. Trying to do so in gentlemanly conversations in Congress does not change the dynamics.

The attempt will likely prove futile. At best it may prove effective in the short term, but it will not prove effective in the long term. While there is an excitable minority that believes in conspiracy theories, most of us have brains that are more firmly attached to reality. For those of us who inhabit the real world, the silly belief that Barack Obama was born in Kenya, and is thus a “false” president, is laughable and ludicrous. It amazes us that anyone other than the tiniest fraction of the weirdoes could possibly believe something proven so demonstrably false.

Similarly, we wonder what these people are smoking when they worry about socialized medicine. We already have Medicare and Medicaid. Many of the people squawking the loudest are already receiving Medicare and would be unable to pay for their own medical care if it disappeared. Many of these same people choose to remain blissfully mindless that health insurance companies already effectively decide who lives and dies by deciding which treatments they will or will not cover. The only way to make sure that insurance companies will not deny necessary coverage is to have the law require universal coverage. In any event, America is a democracy. Who would you rather make this crucial decision, a representative democracy where at least you could petition for changes or an unelected insurance company accountable only to their stockholders?

America’s changing demographics is a trend that cannot be changed. America is already very multiracial. The biggest change is that changing is that the era of white male privilege is going away, and it is being noticed in the form of “scary” things like Hispanic Supreme Court justices, African American presidents and new policies that include audacious notions like health insurance companies shouldn’t be able to pick and choose who they cover. This is a privilege, by the way, that has been enjoyed by members of Congress and federal employees for decades with no complaints. No member of Congress, even the conservative Republican ones, is anxious to change their Federal Employees Health Benefits Plan so they could be excluded from coverage because of their preexisting conditions. Regardless of what happens to other Americans, they will give up their FEHBP coverage shortly after their cold dead fingers are pried off their guns.

The sad reality is that protestors trying to crash town hall meetings on health care or who push crazy ideas like Obama was not born in the United States are being manipulated by people who really do not have their best interest at heart. Except for the self made millionaires attending these rallies, attempts to avoid health insurance reform simply mean these very people are likely to be excluded for their own preconditions, if they have not been already. Moreover, they will likely soon be priced out of the health insurance market altogether as premiums continue to rise beyond their ability to pay for them.