Like many progressives in the United States, I’m wondering what it was all about. “It”, in this case, being the election of a President who cared about people, who was committed to health reform, who believed that single payer was the best idea for health reform, and that government existed not only, as Rousseau and Thomas Jefferson said, by the consent of the governed, but for the interests of the governed. And, to help him out, we threw out bunches of no-nothing Bush supporters and gave him almost (now, with Specter and Franken, actually) 60 votes in the Senate and an overwhelming majority in the House. So, what has happened? Not much. The painful story is detailed by Matt Taibbi in Rolling Stone, "Sick and Wrong", September 3, 2009, http://www.rollingstone.com/politics/story/29988909/sick_and_wrong/. Sit down and keep your fist away from glass tables when you read it, but read it.
The President and the congressional Democrats we elected seem to have wasted the goodwill, enthusiasm, and hope for the future that we gave them, and mired it in a sea of legislative inertia, with the President not leading but watching, without apparent pain, as the rest of us face great pain. Taibbi writes: “The more the Republicans and Blue Dogs fidgeted and f****d around, the easier it would be for them to kill the public option. Democrats, who on the morning after Election Day could have passed a single-payer system without opposition, were now in a desperate hurry to make a deal.” He is of course, correct. The President and most of the “progressives” in Congress have moved away from the “left” and such “leftist” ideas as, first, single payer, and now probably the public option, and soon, it seems from even employer mandates or minimum requirements for what insurance companies have to offer us in the way of coverage. They have done this, ostensibly, to become more acceptable to Republicans, but without an ounce of chance of success. Every “compromise”, every give-back of a promise to actually provide the all the American people with the health care that they need at a price that they can afford and with a system that has at least some possibility of controlling costs has been given away with absolutely zero acceptance, gratitude or compromise from the MINORITY, the right-wing cabal currently called the Republican party. They and their supporters have had nothing at all positive to say. They continue to call the President a socialist or a communist, they object to his talking to students in school, and they get away with it.
The leadership of this movement, which seems to be mainly Rush Limbaugh and Bill O’Reilly and Glenn Beck (sorry, Sarah) is truly Neanderthal, truly anti-people. Many people have written about the why of this, of how all these White Men fear that they are becoming less than completely powerful, that the history that always gave preference to them and any old thing that they believe may have to be compromised with – well, everyone else – and that is the reason for their venom. The New York Times article on the proposed creation of a “day of special significance” on Harvey Milk’s birthday, http://www.nytimes.com/2009/09/05/us/05milk.html?_r=2&ref=us, quotes opponent Randy Thomassen of SaveCalifornia.com as saying “The bill is so broad it could encompass all kinds of things. Remembering the life of Harvey Milk could allow for gay pride parades on campus or mock gay weddings or cross-dressing. There is no prohibition of what the bill calls ‘suitable commemorative exercises.’ The sky’s the limit.”
Let’s look at that. Thomassen is worried that what? That other people might do things that he doesn’t like? Things that won’t (except I suppose psychically) hurt him. Those people won’t make him do any of those things, but he doesn’t want anyone else to be able to do them either. He could just say he is opposed to the bill, which of course doesn’t call for any of these things, without sounding like a finger-wagging scold. Does Thomassen, and do his friends, really think it is ok to make people do, or not do, things just because he doesn’t like it or it offends him? If so, maybe they could come here to Kansas and tell the other folks on the lake here to stop using their speedboats and jet-skis so I can have more quiet and be able to use my kayak without all that wake threatening to topple me. Hey, I am much more affected, limited in my choice of activities, by those power boats than he is by a Harvey Milk day or any of the bugbears he calls out. Why do people think they can – or should – tell other folks what they can do, as long as it doesn’t hurt them? How can we honestly condemn the fanatics in the Mideast who want to do the same thing?
But it is not funny. Thomassen may or may not be only a finger wagging scold, but these same ideas, these same limits, are often imposed on others, sometimes violently. And certainly this is not new, the reason Thomassen and his friends are worried. It is the same reason that it was in the 1920s and 30s. In his mystery novel “The Redbreast”, Norwegian writer Jo Nesbø has a character talk about the old men from Norway who volunteered to fight with the Nazis on the Eastern Front: “Oh yes, they’re still angry. At Third World aid, cuts in the defence budget, women priests, marriages for homosexuals, our new countrymen, all the things you would guess would upset these old boys. In their hearts, they’re still fascists.”  At least in the book the old men who believed these things had once been acknowledged fascists and Nazis. If you were to accuse the folks – the O’Reillys and Limbaughs and Becks and Thomassens who say these same things now, of being fascists, you would be attacked. But you’d be a whole lot closer to the truth than those who accuse Obama of communism are. George Bush is no longer President, and Dick Cheney is no longer – whatever he was – but the venom of the “we’re going to tell you – make you – do what we want” crowd is, probably as a result, more overt.
Meanwhile, regular people have a lot bigger issues; the Times (Sept 4, 2009) reports on the “Jobless recovery”, whatever that is. What I see is that people are still losing their jobs, just at a slower rate, but not getting jobs. So who is recovering? The bankers and Wall Street folks? If you can’t pay your mortgage and feed your family, if you don’t have a job, it is not a recovery. And let’s get this straight: Unless we’re going to go for big-time socialism and pay everybody a living wage even there is no work for them to do, the only purpose of the economy is to create jobs. This is actual people we’re talking about. They need work, and they need health coverage, and they need to know that they won’t lose their health coverage if they, again, lose their job.
The folks who are so worried about losing their coverage now are those who are, like the vast majority of Americans, not sick – yet. As Dr. Ferrer wrote as a guest in this blog on May 8, 2009 :
“The healthiest half of Americans accounts for only 3% of health care expenditures. Conversely, the sickest 5% account for 55% of expenditures and the sickest 10% for 70% of expenditures. So most health spending isn't folks with a cold or twisted ankle who run to the doctor. Most health spending is NICU babies and 20 year-olds with massive trauma from car accidents and cancer patients and old folks with congestive heart failure and 5 hospitalizations in the last year. None of those is engaging in discretionary spending or likely to 'value shop' for health care or to direct their own spending.”
Should they become seriously ill, it will be a sad time to find out what is NOT covered in their policies.
It may be too late for the President to do something. The Times doesn’t think so. Their very strong and atypically long editorial from September 4, 2009, “President Obama’s Health Choices” (http://www.nytimes.com/2009/09/06/opinion/06sun1.html?_r=1) gives very clear advice on what they think President Obama should say in his Wednesday talk to a Joint Session of Congress.
“Given the raucous, often ill-informed attacks on Democratic proposals over the past month, and the clear aim of most Republicans to oppose any bill, no matter how much he compromises, Mr. Obama now needs to spell out in some detail what he wants and how it would benefit both the uninsured and most other Americans as well.”
The Times takes on the Republicans and the “Blue Dog” Democrats, who are supposed to be deficit hawks but have distinguished themselves in this debate mostly by opposing any reform that will pour less government money into the pockets of insurance companies:
“The Bush administration and a Republican-controlled Congress enacted a Medicare prescription drug benefit that will cost the government almost $1 trillion over the next decade without raising or saving a penny to pay for it. They also passed tax cuts for wealthy Americans that will cost more than $1.7 trillion over 10 years, again without making provisions to offset the costs. Now they are complaining that $1 trillion for health care reform — fully paid for over the next 10 years — is too much to spend on a problem that has been festering for decades.”
And the Times has a suggestion for the President: “Rather than yield to Republican intransigence, the Democrats ought to resort to a parliamentary maneuver known as 'budget reconciliation,' which would allow them to push through most reforms by majority vote.” I don’t know about parliamentary process. Maybe President Obama can still say, “OK, this is the way it is going to go. We are going to have health care for the people,” and make it pass the Democratic majorities in Congress. I don’t know if he still can; worse, I don’t know whether, even if he can, he will. If he is going to really lead on making sure we get real, comprehensive, health reform, this is the time to do it. I hope he does, and hope it is not too late.
 Nesbø, Jo. The Redbreast. US paperback edition. Harper. New York. 2009. P. 257.
My book, "Health, Medicine and Justice: Designing a fair and equitable healthcare system", is out and and widely available! Medicine and Social Justice will have periodic postings of my comments on issues related to, well, Medicine, and Social Justice, and Medicine and Social Justice. It will also look at Health, Workforce, health systems, and some national and global priorities
Tuesday, September 8, 2009
Will the President turn the “health reform” discussion around to real reform? Can he?
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