Saturday, August 01, 2009

More Health Care Stuff

Timothy Noah has a good column at Slate today on the health care finance legislation making its agonized way through Congress. He correctly points out that the legislative process is essentially a swamp of gatekeepers who control legislation, always in someone's interest but that someone is not always the public. Usually, the someone is someone with a lot of money and is willing to share it with the members of Congress. Since so few members control so much, it's easy to use large sums of money strategically and effectively.

Which is why I do not have much faith that the Great Health Care Debate and Legislative Medicine Show of 2009 will change much. The large profits will remain for the medical-financial complex and millions of Americans will remain uninsured. We had this debate 16 years ago. I'm pretty sure 2009 will not be the last time. Nor do I think we'll be waiting 16 years.

Back to Timothy Noah, he is writing some of the most informative, intelligent work on the health care debate. You can read them here. Bad Tux, the Snarky Penguin is also writing well on the topic.


Wednesday, July 29, 2009

How Can You Be Sovereign Under a Foreign Army?

Dahr Jamail tells what Iraqi sovereignty under the Status of Forces Agreementreally means:

Yet Maj. Gen. Daniel P. Bolger, a US military commander in Baghdad who is clearly taken aback by the new restrictions on US forces outlined in the SOFA, wrote in an email obtained by The Washington Post that the Iraqi order to sharply restrict the movement and activities of US forces runs "contrary to the spirit and practice of our last several months of operations." He then added, "Maybe something was 'lost in translation.' We are not going to hide our support role in the city. I'm sorry the Iraqi politicians lied/dissembled/spun, but we are not invisible nor should we be." Bolger said US troops intend to engage in combat operations in urban areas to avert or respond to threats, with or without help from the Iraqis, and wrote, "This is a broad right and it demands that we patrol, raid and secure routes as necessary to keep our forces safe. We'll do that, preferably partnered."


No Doubt It's the Heat

It's 104 degrees in Olympia today. Maybe that's why this makes sense. Hell, even in normal temperatures, it makes about as much sense as anything I hear from the birthers.


Monday, July 27, 2009

Death Taxes for Health Care

Not wanting to pass the cost of my health care on to future generations, I suggest that the estate tax be retained and perhaps even raised to fund health care in the coming years. It seems fair to me. The Baby Boom generation is heir to the largest transfer of wealth in history as their parents, children of the Great Depression who prospered and saved during America's golden years after WWII, leave substantial assets to a generation that has always prospered but saved little. So why not use that inheritance to fund our medical dotage? It seems like a just an elegant solution.

Of course, even a pot of gold like the largest transfer of health in history will do little good if poured into the wasteful, inefficient health care system we now have. But at least it would relieve the burden we now seem so eager to pass on to future generations.

And remember, there's still plenty of money to be carved out of the national security budget. As they said during WWII, "We can do it." I would add, "If we want to."


Sunday, July 26, 2009

Anti Sun Velo Paddling

Despite the shortage of velo news posts, I have been riding steadily lately. These days that means staying out of the heat of some very hot days. Olympia has been experiencing stretches of high 80 and low 90 degree heat. So I have returned to my Arizona summer cycling mode of early morning rides, which are very pleasant. Even with the hot weather, mornings are still tolerable; I certainly don't have to avoid the sun altogether like I did in Arizona. So far this year I have averaged over 27 miles per week. That's higher than my goal of 20 miles per week but I've been banking extra miles against the weekends I plan to be on the road doing other things.

Yesterday, Maggie and I joined party with the Capitol Land Trust kayaking to Hope Island State Park. We put in around and paddled for about an hour or so to the island where we picnicked and walked the beach with a biologist who turned over lots of rocks to reveal much local fauna. It was a pretty leisurely trip although I was tired enough when I got back. I stayed slathered in sunscreen and avoided any unpleasant excess of sunlight despite the almost 90 degree heat and lots of reflected sunlight.

All those years in Arizona gave me a real appreciation for shade and dark places, a predilection apparently not shared by too many others. It seems I am always able to find shady spots to park, something impossible in Arizona pretty much anytime year, much less summer. Better yet, I just stay put after about noon.

Today is even noon


The Hope of Health Care Reform

If I seem to be spending all my blogging energy on health care finance these days, the reason is that the issue is important and immediate. My view of blogging is participating in public debate, so it makes sense to write about the issue while it’s on the public radar. War and foreign policy, another key obsession in this space, are certainly way down on the priority discourse, so if I want to engage the moment, health care will be the topic. Which brings me to today’s variation on how to pay the costs of this vital public good: Infrastructure. That’s right, infrastructure--roads, bridges, power grids, water and sewage systems—the things that make life possible in a mass society. Like infrastructure, health care is a vital public service.

In the United States these days this health care is largely directed by private sector interests under the guise of a competitive market place that claims to offer consumer choice. Thinking infrastructure again, we would not accept a highway system designed by multiple parties, coordinated--if at all--in a complicated and time consuming manner. We would find it even more unacceptable if we saw our neighbors with a more effective system.

So why do we put up with private interests from large corporations controlling and directing important public service? I’m pretty sure it’s because we don’t trust the government either, so we are willing to tolerate the devil we know rather than an uncertain change. A better reason is that competition and innovation among private interests can also contribute to the public weal. Somewhere between private parties maximizing their interests and socialized medicine lies the sweet spot of the proper balance.

American health care these days is anything but balanced. Certainly not when corporate health care interests earn profits that enable them to spend hundreds of millions in lobbying, lavish money on Congressional campaigns, fund mergers that remove decisions even farther from the doctor-patient relationship we supposedly values highly and pay huge salaries and bonuses. Every one of those dollars is a health care dollar that is not buying any health care. On the other end—patients, their employers and governments—are spending vast sums on a system that leaves even the insured vulnerable and produces modest overall outcomes even as it creates the world’s most advanced medical technology.

Obama has ruled out a government “takeover” of one-sixth of the nation’s economy, a sentiment I can agree with. But that should hardly mean a withdrawal or even a minor role in shaping the nation’s health care system. The public interest requires a strong regulatory presence that ensures open competition and fairness—you know, government as umpire. We had something like that in place for seven decades in financial services after the Crash of 1929 and it worked pretty well until dismantled by a Republican Congress and Democratic President in 1999. We do the same with the national power grid, operated by private entities but with a strong regulatory eye (we claim) on the public interest. A strong governmental presence in an important economic sector does not frighten me. Hell, as an individual with no real money and limited power, I want someone representing the broad public interest in this marketplace of capitalist sharks. The gravest danger to a society, as the Constitution’s Framers well knew, was concentrated power. In their world, the Executive posed the greatest threat of concentrated power and the Framers took great pains to circumscribe and limit that power. The tremendous economic and political power of the modern corporation, no doubt, would trouble the Framers.

So I want to see Obama stressing a strong public interest in two areas. One is universal access; everyone must have access to health care. The second is that we learn how to pay for what we want. My interest in universal access is humanitarian; I want for everyone else what I want for myself. Staying healthy and finding care when I need it gives me a security and independence that I value highly. I extend that right to all others since I want them to do the same for me. Universal access is also practical. If everyone can obtain medical care, they are less susceptible to pandemics; healthy people are more able to work and live independently.

Paying for health care and who gets how much profit out of the system is the touchstone issue in the current reform. Here I agree with the Blue Dogs and other conservatives that carp about fiscal reform. I strongly believe in sustainable finance. Health care is far from free and someone will need to pay for it. If I am using it then that someone should be me, either directly or through the premiums and taxes I pay to insurance companies and government that will help meliorate the costs. I should not be paying with someone else’s (say, future generations’) money. That, to me, is simply driving headlong toward the cliff with our kids and grandkids in the back seat. So I am right on with the Blue Dogs on that.

Where we part company is on how to pay the costs. They say “no new taxes” and I say “no more wars”. They refuse to look beyond their infatuation with private markets and consider alternate models of health care delivery. I say look at structural and transformative change. Health care is a public good, essential to the general welfare. Americans, through their elected representatives, have every right to create a system that provides the necessary public services.

Hell, we do it for highways. Nothing tells me that we cannot do the same for health care.