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The phrase “Arizona shootings” will forever be associated with Congresswoman Gabrielle Giffords (D-AZ) and with young Jared Loughner, and with even younger Christina Taylor Green.

The gunfight at OK Corral is history.

“Cousin-in-law” and author of the Nelson Report, Chris Nelson, described the incident as the “deadly intersection of three horrible moral and political dilemmas which are a genuine cancer in this country”.  Chris is not the only one to cite the contributing causes:

1. The issue of access to effective treatment for mental disorders
2. The lack of willpower to enact meaningful and rational gun control laws.
3. The rising vitriol of US politics.

I will leave gun control to others and instead, focus on the intersection of the first and last.

Vitriol as culprit

Is the rising vitriol of US politics to blame?  I come down firmly in the camp of those who say yes?

Is civility the answer?   Maybe.  But so may agreement on access to effective treatment for mental disorders.  I don’t say that to impugn the mental state of those on the right for whom I would normally spare no vitriol.  But stick with me.

There are those for whom a black man in the office of President of the United States is their nightmare come true.  It is an even more haunting image than Black Panthers with guns.  It is Putney Swope in the White House.

But this is not 1960.  This is 2011.  Political correctness may be disparaged and ridiculed, but it has sway.  One treads lightly when being racist if one wants to garner the attention of the mainstream media.

So they attack the President’s key legislative initiative – health care.

Competing visions of America

But this is also a lot more than racism. Racism is just one stream feeding this river.  It is about two competing views of America, two competing views of freedom, two competing views of government and society.

I may take a broader view than Paul Krugman who is also exploring this idea.

One view of America sees it as a nation of individuals, where freedom of the individual is paramount, especially freedom of the corporate individual.  Government is perceived as an impediment to that freedom.

The competing view of America sees America as a community coming together to support each other.  Economic freedom is defined in terms of freedom from want and need, and access to equal opportunity.  Government is seen as an ally in that process, a power that can balance the accretion of power to private interests.

One camp falls back on the image of the supportive village community.  The other would borrow from Lucy in Peanuts to insist, “We love America, it’s Americans we can’t stand.”

Has America lost its way?

These are not new divisions; they underlay the very foundations of the United States Constitution.  I would argue that there are several things that distinguish the current environment.

First, I would argue that American capitalism has lost its sense of direction.  For roughly 150 years it was driven by scientific and engineering discovery.  By discovering and harnessing the laws of nature they were able to increase the abundance and support the needs of society.  America was the land that was the first to accept new ideas from Darwinism to Freudianism to Relativity.

I see that loss sense of direction in the Republican Party.

It was the Republican Party that saw the disconnect between slave labor and a free labor market.  As Marlon Brando said in the movie Burn, “Why own a slave, when you can rent one?”  Breaking down old barriers and old ideas was the key to modernizing the United States economy.

I am admittedly on thin ice here, but I think there is a connection between today’s resistance to ideas like global warming and even evolution to American capitalism’s lost sense of direction.  I toss that out for other minds to ruminate.   If Democrats want to gain the upper hand they should clarify a new enduring vision of the American economy.

Second, these fundamental differences used to be found within both parties. Southern Democrats had more in common with conservative Republicans and likewise northern Democrats allied themselves with progressive Republicans.   Bipartisanship was essential.

Today, these differences have been sifted into their respective parties.  Has this made notions of bi-partisanship obsolete?  After all, many modern democracies seem to succeed by allowing different parties to take turns governing.

Health care as the link

Third, health care is a fundamental challenge to these competing views of America.  It is such a fundamental challenge that conservatives dare not face the consequences of their own arguments.  The conservative view would argue that health care should only be available to those who can afford it.  It is obvious through decades of public policy decisions agreed to by both parties, that not all Americans can afford health care.  To argue otherwise is to also argue that doctors and hospitals should deny health care to those without money or insurance.  Have we sunk that low?

Can these views be reconciled through civil discourse? Perhaps not in the short run.  But our Civil War should be an example, first, of the death toll cost of hard line positions, and second, the long term seeds of discontent sown by “reconciliation” by military conquest.

Next week the Republicans will make their move to repeal health care. The Republicans will not be proposing that our fragmented and broken health care system be replaced with a more rational single payer model.

If the current legislation is flawed, it is because it is the best that could be agreed to in a political climate that allows a minority opposed to health care reform to impede progress.

Next week – uncivil content

Next week the Republicans will make their move to repeal the very legislation that might have given Jared Loughner access to some mental health benefits. Unfortunately for the six dead and 13 wounded, not soon enough.

They will be arguing that it is better to turn lose the Jared Loughners of the world rather than to extend them a helping hand by allowing them to gain health benefits through their parent’s plan.

They are not proposing a better idea; they are proposing nothing.

The idea that all Americans should have equal and continuous lifetime access to affordable high quality health care does not fit with their view of America.

They may moderate their tone.  They cannot and will not moderate the content.  And it is the content of their argument that is fundamentally uncivil.

Photo Credit: JL McGee

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The National Public Radio news program “All Things Considered” declared 2010 – The Year of Mean.

NPR, not a media outlet to go too far out on a limb, couched their declaration in a bit of tongue in cheek satire.

But even NPR couldn’t shy away from the question underlying the truth of their observation.

Brute

What kind of country are we becoming?

I toyed with a number of labels for this “mean” movement.  Evil-doers was already taken.  Tyrants or oppressors?  No, not yet.  Pigwidgeons had some appeal despite its association with Harry Potter.  A pigwidgeon is described as a stupid and contemptible elf.  But pigwidgeons are not normally nasty, just stupid; so pigwidgeon may work for a certain ex-half-governor but not for the broader movement.

Meanie is too wimpy.  The word caitiff has some appeal.  Webster describes it as a “base and despicable person, a mean and wicked man”.  To add to the word’s appeal, it also describes a certain kind of vampire.  But this blog is not likely to catapult the word “caitiff” into the popular lexicon.  So I continued my search.

Ruffians didn’t seem inclusive enough.  It may describe some of the gun-toting extremists in the movement, but not John Boehner.

So I settled on brutes.  I am open to other words, but for now, it’s brutes.

Brutes

2010 saw the brutes attack a variety of issues and concerns of working Americans, but my focus is health care.

Their cause gained some momentum in the first month of 2010 when the Democrats lost the seat held by the long time champion of universal health care, Ted Kennedy.  Scott Brown (R-MA), with support from the brutes, ambushed the Democrats by upending their  feckless candidate, Martha Coakley.

It is a sad commentary on American politics when a Senate majority of 59% is not considered a safe margin to pass anything.

Are we becoming a country of minority rule instead of majority rule?

The Brutes and health care reform

Health care reform ultimately did pass in 2010.  It was indeed an historic achievement.

It was not a great bill, but it does make an effort to expand access to care, contain costs and improve health care quality.  Given its poor foundation (the current health care and insurance industries), it should be no surprise that the result is less than ideal.

It was an important milestone in American politics.

One of the groups that stands to benefit significantly is young Americans.  Employers are now required to permit young adults to stay on their employer-sponsored plans to age 26.  Together with other significant reforms, the bill supporters claim that it will cut the number of uninsured in America by half.

The Brutes and working Americans

Almost all of these people are on the fringes of the working middle class.  They may work for an employer, sometimes several employers, but none of them offer health insurance.  They may be sick and trying to get back to work.  They may be young and trying to enter the work force.  They may be entrepreneurs who are not only drawing on their bank accounts to start new businesses, but also banking that their health will sustain them until their businesses can.

The brutes don’t like these Americans.  They prefer tax breaks for the rich.

Are we becoming a country that is turning its back on the people whose backs build this country?

The Affordable Care Act has a number of initiatives designed to make the market for health insurance more transparent and therefore more accessible.

The brutes don’t like government regulation.  Therefore they want to repeal the Affordable Care Act.

Are we becoming a nation that places ideology ahead of practical solutions?  Isn’t that what toppled the Soviet Union?

The future of America?

As a result of the 2010 Congressional elections the brutes will now be able to parade their disdain for working Americans and their bias for the rich and powerful on a more prominent stage.  I don’t expect 2011 to be less mean.

I can only hope that the true nature of the brutes will become exposed for all to see.

Maybe then we can cast the meanness and the brutes aside and move America forward.

Photo credit:   Lonnie Dunkin III

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Some recent bright spots did shine through among the depressing election results this past week.

In Massachusetts, voters and docs expressed support for a single payer solution to the continuing health care crisis.

Fall in New England

Massachusetts is the state that gave us the Connector – the model for the Affordable Care Act that is now the target of the anti-incumbent horde that is invading Washington DC.

I have noted here before that the Massachusetts model might have been an acceptable state model given the restrictions that federal law imposes on the ability of states to be truly innovative with health care reform.

An individual mandate might even work in a state with a high level of income and a low rate of uninsured.

Voters are also patients

As a model for federal reform, it is flawed.  To think it might work in Mississippi or Texas is disastrous.

Some Massachusetts voters had the opportunity to express a view in their own state.  A non-binding question appeared on the ballot in 14 Massachusetts state representative districts.

The question:

“Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?“

The question received overwhelming support, passing in all fourteen districts by an average of 63%.  Five of those districts voted for Scott Brown, whose election supposedly signaled an anti health care reform sentiment.  Even together with the ten districts that approved a similar measure in 2008 in Massachusetts, the measure has a long road to travel.

Docs too

Meanwhile doctors in Massachusetts were also asked their opinions about the state’s health care reform.  In their annual Workforce Survey the Massachusetts Medical Society asked physicians to choose among four health reform options.

The largest number, 34%, chose a single payer option; followed closely, 32%, by those who prefer a public-private mix with a “public option.

Two thirds of doctors in Massachusetts chose a health reform option that went beyond that proposed by the Affordable Care Act.  Only 14% chose their own state’s model, with the balance, 17%, opting for the status quo.

Those who criticize the President and the Democrats for not listening to their public are right.  These voices represent patients and doctors – the two constituencies that a health care system is supposed to serve.  When not encumbered by media distortions funded by the profit making centers of the health care industry – insurance companies and pharmaceutical manufacturers at the top of the list – patients and even doctors come down on the side of a rational and pragmatic approach to funding and delivering health care –single payer.

Physicians for a National Health Plan explored this distortion and misrepresentation of survey data in much more depth in a series of article on their web site.

And in Vermont

Another encouraging development on the healthcare front is the election of Peter Shumlin as governor of Vermont.  A single payer system in Vermont was one of the top issues in that gubernatorial campaign.  Curiously the debate focused more on the practicalities of implementing a single payer system in Vermont rather that the ideological bent that characterizes those discussions elsewhere.

Sanity can prevail.

Is Washington listening?

Photo Credit: FLICKR – Maggie-Me

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Retired Steelworkers and single payer advocates rest after a long day rallying and lobbying for health care on June 25, 2009.

The Senate and House are preparing to reconcile two modestly different approaches to health care reform.  Charges and counter charges continue to swirl around like New Year’s Eve confetti.  Are we on the verge of an historic breakthrough on health care reform?

What lessons have we learned about ourselves and our government?  Let me suggest six.

1.            America matters more to some than Americans.

The target of health care reform is Americans who are in the margins of our workforce.  They earn too much money to qualify for health care programs for the poor – state Medicaid and Children’s Health Insurance Programs (CHIP).  They work for small businesses who cannot or do not provide health insurance coverage.

As a society we have already agreed to provide health care to the poor, the old and those who work full time for profitable companies.  Why is it so difficult to fill the remaining cracks in the system?

Yet opponents of reform frame their arguments as a classic American struggle against big government.  The stories of very real Americans facing death by neglect or medical bankruptcy don’t seem to resonate as much as the conjured images of America challenged by fictional tyrannical death panels and giant government databases.

2.            I got mine – go get your own.

Very few people with health insurance pay anywhere close to the full cost of health insurance.  Less than 10% of adults under 65 obtain their health insurance in the individual market where they have to pay the full price.  73% of those who tried to buy individual insurance gave up either because it was not available to them or it was too expensive, according to a study by the Commonwealth Fund.  For the rest of us, our employer pays the majority share, or the government for those on Medicare and those on Medicaid.

Yet extending the same helping hand to those who may need health insurance to continue to participate in the workforce is tantamount to terrorism or tyranny, according to certain news commentators.  That may be an extreme view, but the noise it generates is dead weight that drags the center of political discourse away from constructive and meaningful reform.

3.            Money talks

Despite the clamor from the right, polls consistently show strong support for health care reform and even for the “controversial” public option.  Recently, I described how opinion pools show strong support for a single payer system.

So why are Democratic politicians having such a hard time getting “on board” with health care reform.  Countless stories have documented the amount of money the health care industry has spent on lobbying members of Congress.  One is reminded of my home town’s favorite son, Simon Cameron, Lincoln’s first Secretary of War, who once said, “An honest politician is one who when bought, stays bought.”  Only when some politicians began to realize that actual voters are behind those poll numbers did the public option begin to show renewed life.

Sadly, the Senate result reinforces the impression that money talks.

4.            Symbols matter

There is not a whole lot of evidence that the public option by itself will make a meaningful dent in the number of uninsured or in medical cost inflation.  But it is a powerful symbol reflecting one’s viewpoint about who should be the intermediary between the patient and the health care system – a government or quasi-governmental organization, or a private health insurance company.  There is clearly little appetite or political will to take on the insurance companies directly with the kind of strong and consistent regulation found in other countries.  The best that Democrats can offer is the threat of weak-kneed competition.

5.            Why do simple when complex is so – complex?

There is much ado about the nearly 2,000 pages of the health care bill.  When Congress tries to fix 1/6 of the American economy, it can’t be easy.  An analogy can be made to taking your tired old clunker to the repair shop.  It is too expensive.  It can’t haul nearly as many people as it was supposed to.  But you love it to death.  Your favorite repairman could hand you a ten-page estimate and tell you it will still be expensive and still won’t carry the all the passengers you would like.  Or he could hand you a one-page invoice for a new car.  HR 676, the “Medicare for All” legislation and beloved of single payer advocates, is 27 pages long.

6.            Who does Congress love most?  Not you and me.

Do you doubt the devotion of Congress to the insurance industry?  If so, the provision in both the House and Senate proposals to require an 85% medical loss ratio should say it all.  The law requires that at least 85% of premium income be used to pay for medical claims of covered participants.  Even the most conservative estimates put Medicare’s loss ration in excess of 90%, some argue in excess of 95%.  If the government can spend premium income more efficiently why let the private insurers in?

What next?

It’s no longer a safe bet that health insurance legislation will succeed (It does not deserve to be called health care legislation).  It is criticized from the right and from the left.

As feeble as it is, it will be a significant achievement given the long record of historical (and hysterical) opposition. Calling it reform will be the challenge of the spin-doctors.  Already there are estimates that it will leave a significant number of people still uninsured.  It doesn’t do enough to manage costs.  And there will undoubtedly be a backlash for a variety of reasons, some of them legitimate.  The question will be, how soon before Congress will have to revisit this issue?

Photo by JL McGee

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When a 2,000 page piece of legislation traverses the legislative sausage making process, it is a large target for those who want to take pot shots.

When you are trying to fix a system that is broken in lots of places, it is not an easy process.

Let’s remember what we are trying to fix.

The system does not cover everybody.  Estimates on the number of uninsured range from 30 million to 70 million depending on whom and how you are counting.

It’s expensive.  Our economy already sets aside more resources per person than any other country on the planet.  We pay more in taxes for health care than any other country on the planet.

We are not a healthy country.  Relative to other industrial countries, we don’t live long.  Our babies die before they reach their first birthday.  Our pregnant mothers die in child birth.

That’s a lot of fixes.

In fact, the 2,000 pages is a pretty mediocre start.  If either the House or the Senate version survives intact, it still will not cover everybody.  It still will be expensive.  And there isn’t much reason to believe that we will be any healthier as a result.

But it is a start.

And let’s not forget that simple in the form of single payer (HR 676) was taken off the table very early in the process.

The irony is that the easy fix, a government or quasi government operated health care system, was never a serious contender in the debate.  Congress instead has drafted a Rube Goldberg contraption designed to fix the current system.  It will allow the insurance industry and the rest of the health care industry to continue to pillage tax payer pockets for private profit.

And the working poor, those intended targets of reform, will be poorly served by the reforms.

And what is the criticism.

That it is a government run health care program!!?

Can you begin to comprehend the twisted logic of these nut cases, these nattering nabobs of negativism, these bobble headed pundits who put the interests of insurance companies ahead of poor working Americans struggling to stay in the work force.

I know facts and logic have very little to do with this debate, but let me tug on superman’s cape and examine two of the more outrageous claims.

Fascism and Socialism

I’m sure someone must have said that if you repeat something often enough it becomes true.  Was it Joseph Goebbels, Hitler’s Minister of Propaganda?  Why else would right wingers keep equating fascism with socialism.  The two are diametrically opposed.

Germany, under Chancellor Otto von Bismarck, institutionalized the world’s first system of health insurance.  It was part of a package of proposals that included bans and restrictions against the socialist parties of the day.  The health insurance system was intended to shift worker loyalty from the socialist parties to the state.  But even the “Iron Chancellor” had to compromise and the German system of health insurance funds,  called Krankenkassen (sickness funds), stayed under private control.  In fact, governance was not unlike that of today’s Taft-Hartley funds.  Employers and workers ran these very private and usually very local systems.

Forty years later another iron ruler, this time Hitler, was in power.  An essay in the book, Political Values and Health Care: The German Experience, describes how the Nazis tried to purge the sickness funds of Jews and Socialists.  They did have some limited “success”, but they also had to deal with the very real political reality that these were the experts who controlled this very private system.  Purging them threatened to dismantle health care delivery to the Nazi base.  After the war, governance of the sickness funds was restored to the more private structure that existed before Hitler.

So what is the lesson here?

Fascists like health care for the people they like and oppose it for the people they don’t.  Who does that sound like in the current debate?  A health care system cannot be both fascist and socialists.

Guns and health care

Gun owners seem to think that health care legislation will threaten gun ownership by imposing reporting requirements on gun shootings.  Don’t they know that there is already an elaborate coding system in place that allows emergency rooms to report all kinds of accidents, including shootings?

They also resort to the tactic of assuming that because the law doesn’t prohibit something it therefore permits it.  The legislation does not specifically define gun ownership as a healthy behavior and therefore gun owners want us to believe that the government can and will define gun ownership as an unhealthy behavior and therefore charge gun owners higher premiums.

While there might be a compelling idea there somewhere, there is no logical basis for this conclusion other than their own rabbit hole minds.  Isn’t there something in the Constitution that limits the power of the federal government to those specifically designated to it?  Do these people make any sense at all?

Remember the woman in Bridgeville, PA who was shot while at a health club and had no health insurance.  Gun owners could at least acknowledge that the system needs to be reformed to permit treatment of people like Heather Sherba.

If not, perhaps banning guns as a preventive health care measure might be an option if this legislation fails.

It would be logical and supported by facts.

Ooops!

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When reason fails shouting prevails.

From Senator Max Baucus, “We need more police.”

Voics from the back of the room

And more voices from behind the table.

Margaret Flowers, MD & Katie Robbins, Healthcare-NOW

Carol Paris, MD, PNHP

Adam Schneider from Health Care for the Homeless

Russell Mokhiber, Single Payer Action

Thanks to the brave organizers of this event!