Saturday, September 12, 2009

I'm with George

Like many Americans, I watched President Obama's speech Wednesday night. As always, I was impressed with his calm rationalism mixed with a stirring call to shape the future. Obama did an excellent job of selling a plan that is clearly within the realm of the Conventional Wisdom. What I would have preferred was leadership for real change.

That's why I am pleased to see George McGovern speaking out for Medicare for All in today's Washington Post. I'm pleased not because I want to see a government takeover of health care but because a single payer system is simple and it works. Look at the convoluted flow charts of the various plans now in play before Congress. They are complex, Rube Goldberg contrivances that leave me and most Americans bewildered. I did not like Bill and Hillary Clinton's proposal 16 years ago for the same reason. Obama's version is sounds little better. Simple works best but no one in Washington seems willing to understand this most basic principle.

From a practical point of view, I waffle back and forth between insisting on single payer and some compromise, which is what Obama's plan is. I don't know if it is better to move something this year or hold out for real change. I'm pretty sure the system will do the former but I am equally sure that the underlying problems will not go away and that the Obama will not be, despite his fervent wish, the last president to call for health care reform.

I hope I am wrong but I don't think another tinkering quick fix is the final answer. If we're lucky, the bill that passes Congress this year will offer a bridge to a better, more practical system. But as we've seen so far, significant change that would be to re-think the whole system from the ground up will require courage and leadership. That's hihgly unlikely in America these days, especially when government regulation or enterprise is a possible solution. The idea of effective government action in the interests of the broad community has been so demonized and dismissed in the past 30 yesrs that to even mention the idea is to be considered a "tax, spend and waste Liberal."

And that's why I am not disappointed in Obama; I didn't really expect him to bring that kind of change. I hoped he might. Certainly he is the first politician since Bill Clinton to offer me that hope. But like Clinton, Obama in office is part of the Prevailing Consensus. So far he has changed little and his health care plan looks very conventional. But maybe?

In the meantime, I'll stick with George. He was right in 1972. He is right again in 2009. I'm proud to say that I cast my fist ever presidential ballot for him.


Badtux the Snarky Penguin actually beat George into print (can I say that about a blog?)with this post about Medicare for All.


Sunday, September 06, 2009

The Best Damn Reason Ever to Get the Hell Out of Afghanistan

Via Politico:
Prominent conservative foreign policy thinkers and activists who backed the Iraq war are circulating a letter to President Obama supporting his engagement in Afghanistan against criticism from left and right, and urging him to stay the course.

At least they're not calling it a cakewalk.

Seriously, it's time for this nation to have a very serious, sane discussion of our intervention in Afghanistan. The conservatives challenge Obama to " Afghans from the chains of tyranny, and keep America fully resource this effort, do everything possible to minimize the risk of failure, and to devote the necessary time to explain, soberly and comprehensively, to the American people the stakes in Afghanistan, the route to success, and the cost of defeat."

I, too, challenge the president to explain, soberly, comprehensively and realistically what America gets for all that blood and treasure. Maybe he should read this book in preparing his explanation. He is indeed dealing with "the logic of human messiness" which is seldom amenable to change by force of arms.


Holy Contradiction!

Roman Catholic bishops are weighing in on the health care finance debate. Not surprisingly they want proscriptions on abortion funding and protection for conscientious objection to abortion among medical proviers. Some are also warning against "socialization" and "monopolizing" and big government. They assert the Catholic social teaching of "subsidiarity" - essentially, that decisions are best made at the lowest level possible.

It's a most attractive idea--very American--but certainly ironic in a religion that boasts an authoritarian heirarchy and rule by decree of a supposedly infallible bishop selected from a small coterie.

Just sayin'

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A Very Model Practice

Washington Post today has a story about Group Health Cooperative, the Washington State health care system that has served this area for the past 60 years. The cooperative, which is both insurer and provider, is often mentioned as an alternative to the public option in reforming health care finance. Group Health has a good reputation and the number of complaints is minuscule compared to other insurers. The description of care at Group Health reads much like the VA practice model:
Everything at Group Health's 26 clinics are integrated. So when a patient meets with their doctor, all their records with any other Group Health specialist is immediately available. Patients are encouraged to make appointments online, and e-mail or call their physicians with questions, keeping them from having to make frequent office visits for easily answered concerns. Group Health says that it saves more than $12 million a year by resolving routine patient questions through a 24-hour phone line that is staffed by nurses and doctors.

I don't know if the VA saves $12 million a year with its 24/7 phone line. I do know that I can speak with a nurse at any time if I have a concern.

What the Group Health and VA practice models tell me is that cost-effective health care is possible. What's best is that these models emphasize primary care, a service that is increasingly scarce in the contemporary fee-for-service model.

Neither may be a panacea but both are models should be strongly encouraged in the way we pay for health care.