Health Finance Ho-Hum

Today's Senate vote on the health finance bill leaves me completely ambivalent about the outcome. The massive lobbying, wholesale misinformation and political expediency have combined to produce legislation that that falls far short of universal access and meaningful cost control. The rough beast now slouching toward passage does nothing to reduce the overhead costs—profit and administration—of health care in the US. It adds complexity and perverse incentives to a system that already has plenty of both. The likely results offer little reason for enthusiasm.

What hope I do retain is that maybe this year’s legislation will be a step toward a better system. TR Reid, in Healing America, builds his model of the “best health care system in the world” on a unified system that leverages collective purchasing power bargaining. Something along those lines would be a considerable improvement over what is likely to emerge from Congress this year.

But that’s in the future. Maybe. For now all we have are HR 3962 and the blended Senate bill. Weak as these may be, they still face further compromise so that that final result may not differ greatly from the system that it will supposedly improve. It will certainly be no simpler, nor is it likely to relieve most Americans of the prospect of choosing between medical care and bankruptcy. Its lack of universal coverage leaves the costs of uncompensated care unresolved. This year’s effort leaves much to be desired.

Forty-plus years ago, Medicare was hailed as a first step toward universal care. Few would have predicted then that, well into the next century, America would have the most expensive and least effective health care model among developed nations. Yet, here we are, still waiting to take that next step, even with four decades’ experience with a single payer system that works. The performance of my congress and president do not give me much confidence that our political system can enact any truly effective reform that the moneyed classes do not like.

This is hardly a surprising conclusion. It’s not like this hasn’t happened before (health care ’93) or in other issues (perpetual war). Lack of surprise notwithstanding, I’m still disappointed. Maybe it’s because this kind of systemic failure shows how far America has moved from the idea of “the general Welfare” so prominently written into the US Constitution.

Reason enough to be disappointed.

Weather News Revisited

A few days ago, I published verbatim the NOAA forecast discussion for the Puget Sound area. That post was the 1,000th post for this humble blog and the choice of subject was no accident. You see, back in my co-blogging days at the now defunct Mockingbird's Medley I posted something very similar there just to be silly. Turns out I stole the 1,000th post from Jim Yeager, the head Mockingbird. That was an accident but it dawned on me that it would be altogether fitting to mark my own similar milestone in the same way. In the end, it's probably as intelligent or significant as anything else I've posted in this space in the 1,994 days since I started this blog.

It's been a long, strange trip and I don't expect it to be any less strange in the future.

postscript

In a recent comment,Jim opined that the grim possiblity of this year's elections might compel him back into the blogging fray. Turns out that he's back.

The political discourse is getting better already.

Dollars and Sense

I love it even more when someone talks like this.

Only professional liars could cite concern about debt as reason to oppose a health care bill reducing the debt -- and then vote for debt-expanding defense budgets. Unfortunately, professional liars are the norm in today's politics, not the exception -- and they're leading America off the fiscal cliff.

Weather News

I love it when they talk this way.

WARM FRONT TODAY AND STALLED BAROCLINIC ZONE OVER THE AREA TNGT THRU MON NITE. A PLUME OF WET +4C AIR IN SW FLOW ARND 50KT AT 850MB AIMED AT THE OLYMPICS...AND THE FLOW WILL BACK TO MORE SLY THRU MONDAY KEEPING HEAVY RAIN IN THE OLYMPICS. THE LOWLANDS MIGHT BE WETTER TODAY THAN ON MON...BUT THEN BECOMING WINDIER THRU MON. THE NAM FOR EXAMPLE HAS RAIN OVER THE REGION TODAY BUT CREATES LARGE DRY AREAS IN THE PRECIP FCST OVER THE LOWLANDS MONDAY...WHILE KEEPING THE HVY RAIN GOING IN THE OLYMPICS AND NORTH CASCADES. I THINK THE POPS ARE PROBABLY TOO HIGH MONDAY FOR THE LOWLANDS AND THERE IS A GOOD CHANCE OF BEING IN THE DRIER WARM SECTOR OF THE SYSTEM FOR A PERIOD. FAIRLY CERTAIN IS THAT THE WINDIEST SPOTS WILL BE THE COAST AND NORTH INTERIOR NORTH OF EVERETT...AND A WIND ADVISORY WILL BE ISSUED SHORTLY FOR THE NORTH INTERIOR/ISLANDS/ADMIRALTY INLET AREA. .

Rogue Justice

Normally, I would applaud the Obama administration's decision to try Khalid Sheik Mohammed in a New York federal court. Not only does that decision display confidence in the American legal system but it also changes the war on terrorism to a far more logical and sustainable criminal matter. Normally, all this would be a step in the right direction.

Except that it's not. Looking at the decision--decisions, actually, since multiple defendants and legal venues are in play--Glen Greenwald points out that Obama has abandoned the idea of equal justice under law in favor of adapting the legal system to ensure conviction based on differing levels of evidence. "Show trials," he calls them.

I learned all about show trials early in life. My elementary education in the 1950's lost few opportunities to remind that evil Communists staged show trials before executing anyone who challenged the Communist Party rule. America, we were told, was different, a place where all were protected by the rule of law and all Americans could live safe in the knowledge that we would never be hauled into a Kafkaesque darkness from which we would never emerge.

That belief was not entirely unfounded. America's founders experienced the arbitrary rule of a monarch above the law and wrote a Constitution that specifically barred those practices. At first, equal justice under law was for all practical purposes guaranteed only for white male property-owners but later expanded to encompass (in word if not deed) all Americans. As a nation we celebrate our commitment to the rule of law as a proud achievement.

Which is all the more reason to lament the nation's willingness to abandon that principle in times of danger. Hearing the hue and cry over the danger of prosecuting terror suspects in civilian courts leaves me wondering why America is so eternally afraid. Apparently we have no confidence in our domestic police, prosecutors and foreign intelligence to identify and disrupt plotters. We seem to believe that Terror (with a capital T for trouble) is beyond our capability as a free and open society.

This is the same so-called logic I've heard all my life; namely, that some threats are just so dangerous that extraordinary measures are necessary. From the "unitary executive" to show trials, our fears encourage us to discard the ideals that we thought we treasured.

postscript

A couple other articles that address the same subject but did not fit easily into my stream of thought for this post are also worth reading if you want to pursue this subject even further.

ProPublicadetails competition between civilian and military prosecutors over jurisdiction and procedure even as they bargain with defendants to find something that will create a guilty plea and verdict.

Dahlia Lithwick at Slate follows oral arguments before the Canadian Supreme Court in the case of Canadian citizen Omar Khadr, captured at age 15 in Afghanistan and now headed for trial before a military commission.

The Business of Higher Education

You have the right to go to the out-of-state college of your choice.

Veterans Day 2009

On this Veterans Day I am thinking of Pat Tillman and Barack Obama. Pat Tillman is prominent in my thoughts because I am reading Where Men Win Glory, John Krakauer’s story of Tillman’s life and death. Barack Obama looms large because he could possibly strike a blow for real change and real peace but probably will not.

Tillman’s story is well-known. He was the patriotic football player who left a lucrative career and died for his country. First hailed as a combat hero and brandished by the CheneyBush administration as a patriotic prop during an election year, the Army later admitted that Tillman’s died from “friendly fire”, he was killed by his own men in an ill-fated mission. Krakauer adds depth and detail to the story, drawn from Tillman’s t diaries and recollection of family and friends. Krakauer also details the Tillman’s final mission, which was also his first as a full-fledged ranger.

What emerges in Where Men Win Glory is an account of a thoughtful, determined and dedicated young man whose talent and sacrifice were wasted. Tillman is not perfect—at 18 he was charged with felonious assault, later reduced to misdemeanor assault, for severely beating another teenager and Krakauer doesn't ignore Tillman's other less edifying behaviors—but Tillman learns from his experiences, in life, on the playing field and in the Army. I particularly identify with the Specialist Pat Tillman who forgoes the opportunity to harass lower ranking soldiers.

Krakauer subtitles his book as “The Odyssey of Pat Tillman”. The subtitle is not an overreach. Tillman was on an odyssey. Not surprising--that’s what life is. Tillman’s odyssey just played out in a more public way. Like Homer’s Odyssey, Tillman’s offers lessons about the strength and power of determination. Tillman’s odyssey also reminds us of the irrelevance of honor and patriotism in the CheneyBush wars.

Which brings me to Barack Obama, inheritor of those wars, who must now decide what to do with them. All accounts suggest that he will send more troops and try to hold off the Taliban insurgency while he jump starts the Afghan army. Obama could take a different path, a path that would lessen the violence and allow Afghan society to rebuild on its own terms in concert with its neighbors and the international community. Robert Dreyfuss offers a cogent alternative in The Nation’s recent issue on Afghanistan. Dreyfuss’ plan is one of several less militarized courses of action that the US could pursue in Afghanistan. Unlike the military options, engagement and diplomacy are less costly (in oh so many ways), they are far less likely to provoke counter attack and are far more sustainable in the long run.

On this day for remembering the sacrifices of war, I hope for peace without expecting much.

postscript

Here's why America does not celebrate Remembrance Day on this date.

What Manner of Beast?

Dennis Kucinich (of course):

“Why is it we have finite resources for health care but unlimited money for war?.... Unlimited money to blow up things in Iraq and Afghanistan, and relatively little money to build things in the US.... Trillions for war and Wall Street, billions for insurance companies... When we were promised change, we weren't thinking that we give a dollar and get back two cents.”

More here.

Into the Breach

Reading accounts of the Fort Hood shootings, I am struck by the immediate and selfless behavior of the soldiers. One sentence particularly caught me attention:

Other unarmed soldiers in the area also began to sprint toward the gunfire.

They headed toward danger. Unarmed. No matter. They were ready to do what needed to be done. They would figure something out as the situation developed.

I call that bravery and professionalism. The normal person, upon hearing gunfire, would head the other way. Soldiers confront danger. That's the nature of the work.

Thursday at Fort Hood, the nation saw up close how good America's soldiers can be in difficult, dangerous circumstances. That's something to think about this coming Veterans Day.

Something else to think about is why America is squandering these soldiers in extended, foreign occupations. As has been often mentioned in the articles about the Fort Hood shootings, our soldiers and their families are bearing a disproportionate burden of America's "boots on the ground" around the world foreign policy.

Others are asking "What has America done in eight years?" Americans should ask the same question.