Pushback on health care reform, in Oregon and the country

Chris Lowe

On a windy afternoon in Portland, the wind seems to have refilled the sails or at least the hopes of those advocating for substantial health care reform, locally and nationally.

The weekend before last it looked like the health care reform debate was all over but the face-saving. President Obana in his speech before a joint session of Congress had indicated that he could accept a bill without a public plan option, and shortly thereafter Speaker of the House Nancy Pelosi, who only up until then had been insisting that a public plan option was needed for a bill to pass the House (never mind how strong), came out and lined up behind Obama's cave-in. It appeared that all that mattered to the president was that there be some bill rather than no bill.

Then Max Baucus published his draft bill from the Senate Finance Committee. It was so bad that it generated significant opposition from unexpected quarters. Representative Jan Schakowsky of illinois, a member of the Congressional Progressive Caucus went so far as to say the "the public option" was still alive because of the Baucus Bill.

Of couse pushback against the steady hollowing out of proposed reforms had been building anyway. Locally a "Big Insurance Makes Us Sick" rally and march planned for tomorrow, Tuesday September 22 in downtown Portland at lunchtime has been in the works for several weeks. What makes it interesting is that it's an "all-in" event involving both groups advocating single payer approaches, such as the Portland Jobs with Justice Healthcare Committee, and oublic option advocating groups including HCAN and some of that coalition's member groups including the Portland MoveOn Council. These groups are muting their debates for this event to focus on the destructive role of private insurance companies in people's lives and in the corruption of democracy in reform politics. But response to the idea suggests that the event may be benefiting from the backlash against Baucus.

Likewise the Portland Jobs with Justice Healthcare Committee's new single payer radio ad campaign on KPOJ AM 620 may benefit. The ads are intended as part of an ongoing effort to raise awareness of Improved and Expanded Medicare for All, the arguments for it, and to expand outreach, organizing and mobilization. The choice to pursue them at this time was partly driven by the fact that to resolve one hang-up in committee, Speaker Pelosi promised New York Democrat Anthony Weiner a floor vote on an amendment to substitute the text of H.R. 676, the main single payer bill in Congress, for the text of H.R. 3200, and because one version of the H.R. 3200, as marked up by committee, contains an amendment by Congressman Dennis Kucinich that would modify ERISA restrictions to allow for state level or regional single payer systems.

The likelihood that the Weiner amendment would actually pass is vanishingly small. Yet the very fact that the Weiner amendment is unlikely to pass creates an argument that congresspeople should vote for it who say they are for an improved and expanded Medicare for all single payer approach in principle, but feel they must work for something that they think can pass. They don't have to do any work to get the vote on the floor, it's been done for them. They can vote for it to express their support in principle, and still vote for whatever version of H.R. 3200 emerges subsequently.

For the Kucinich amendment the prospects are somewhat better that it could survive into a final bill. In the first instance this is up to the Rules Committee, which must reconcile the varying committee mark-ups of H.R. 3200, which means in essence persuading key top leaders to keep it in. Work in Oregon on these two items by single payer advocates has been proceeding apace, but the pushback atmosphere created by Baucus' egregious effort can only help energize them.

The same applies to the barnstorming Mad as Hell Doctors road show, making 26 stops in less than 3 weeks, culminating at the White House. These mostly Oregon docs are bringing the message that doctors support a universal national health insurance system that gets the insurance companies out from between them and their patients, that supports their ethical views about the right of all to quality health care and the better outcomes based on health promotion, prevention, primary care and early stage chronic disease management, and that will relieve them of the monetary expenses and time costs of the billing and claims bureaucracy mandated by the hugely inefficient private insurance industry, in favor of public sector efficiencies amply demonstrated in practice: favorable response has been growing as the Mad as Hell Docs move onward to their final destination in Washington, D.C. on September 30.

At the national level, the Baucus Backlash manifests itself partly in criticism. For instance, Baucus managed to come out to the right of Republican Finance Committee member Olympia Snowe on subsidies. Oregon's own Bipartisan Ron Wyden, also on the committee, has offered to improve the bill, according to his lights. Speaker Pelosi was critical and again advocating for a public option (never mind how strong). There are enough similar reactions that even before holding mark-up hearings that Chairman Max has begun to to make it marginally more friendly to people and less so to the profits of his corporate donors -- albeit only marginally.

But it is not only in the insider Congressional politicking that has been affected by the pushback. The intellectual quality of the debate has been significantly raised in at least one quarter, as the Congressional Progressive Caucus put forward a detailed description of what they would consider a truly robust public option.

It's the kind of thing we needed back in March or April, along with a less detailed level of the principles involved, in politics to engage the public, and included full honest discussion of single payer. But the likelihood that any reform will pass this session that will change the crisis-producing dynamics of the current non-system is nearly as small as that of the Weiner amendment passing. The crisis therefore only will grow worse, and we will be revisiting health care reform quite soon. It is to be hoped that when we do everyone will recognize that the politics need to begin in the public, and not with what's supposedly "realistic" in Congressional inside baseball.

Disclaimer: I am a member of the Portland Jobs with Justice Healthcare Committee. The opinions expressed here are influenced by that fact but are mine, and are not meant to speak for the committee. For a period I belonged to the MoveOn Portland Council; while I quit the national organization over their internal practices, I remain friends with persons in the local group.

Comments

  • sharon (unverified)
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    In Astoria on Friday, John Kitzhaber said that the debate over the public health option is a "sideshow."

    His remark seems dismissive and callous considering the thousands and thousands who are without insurance at all today, and considering the many thousands of people who strongly support adding a public health care option.

    We need a public option to provide competition with private insurers and lower costs, and to keep the private insurers honest. While Kitzhaber has some laudable and idealistic health care goals, I'm very disappointed in his attitude regarding the public health option. He should go to the rally Tuesday and do some listening.

  • marv (unverified)
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    Supporters of a government run health program sometimes called single payer had to face a brutal reality that is sure to doom a plan similar to that of France from ever being implemented in the good ole USA.

    That is of course the whopping twenty-five percent increase in the cost of a day in hospital. Yes, it has gone up from $23.50 to $29.80. Crushing!

    Of course 'critics' will be wondering why The House with a substantial majority of Democrats has not taken up the issue of change. As in changing Medicare so that bulk drug purchase prices are achieved. Guess they don't want to upset Doc Hastings. Or Barack Obama.

    Then too is the Gramm, Leach, Blyley bill which did away with banking regulations. So bad was this bill that it incuded a provision excempting an implementation of State gambling prohibitions for what was about to be unleashed on the public. Many Oregonians have fumed about a Casino in the Gorge. Could that anger have been redirected?

    Nope. We got change you can believe in. Quick. Check the cushions in your sofa. Cuz that is what you get.

  • (Show?)

    There's a recurring claim by the health insurance industry, unrefuted so far as I know by progressives, that "every survey shows a majority of respondents satisfied with their private health insurance." Having once enjoyed a fat Blue Cross/Blue Shield policy as an employee of Oregon Higher Ed, I can imagine, depending on the details, that this is factual. And status quo defenders brandish this "fact" as if it's the last word... If there were a simple, clear, logical,100-words-or-less construction for demolishing this argument, what would it be? Cuz i think we have to.

  • Bill Bodden (unverified)
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    Sharon: You may not have liked John Kitzhaber's opinion, but it appears to be realistic.

    This whole health care reform process has been an absolute farce that may very well have been arranged by the "health" insurance industry. What better way than to buy he president and several senators and representatives in Congress to offer differing plans to make sure that there is no reform? Can you imagine a football team with the head coach coming up with one game plan, the defensive coach with another, the offensive coach with a third, and the kicker's coach joining in with a fourth for good measure. If a plan does come out of this Congress we will be much worse off than before.

    It is now time for people who want a single-payer health plan to wake up, switch to NAV or independent, and work to get rid of politicians who are owned by the insurance-medical-pharmaceutical complex and have betrayed the people. That includes Wyden, Pelosi and others who are up for election next year.

    As for a large majority supposedly happy with their current plans many of them surely must not be aware that if they come down with the wrong illness they will be SOL and next in line to join the medically bankrupt.

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    Jeff,

    I'm not sure it can be refuted strictly speaking, since as far as I know the surveys still show that.

    There are a number of aspects that put the meaning into context.

    I don't have the exact statistics to hand, but a while ago when I took an MPH course in "Health Systems Organization" the class divided up a number of health systems (several countries including the U.S., plus Medicare and the V.A. system. ALL of the other systems had higher levels of satisfaction in similar polls than U.S. private insurance, including Medicare and the V.A. system. The number generally cited for U.S. private insurance is about 60%, most of the others were around 70% as I recall. Which means substantial minorities dissatisfied in any case.

    A second point is that most people who say they are satisfied have not had to use their insurance for anything serious. There is a strong pattern of stories, admittedly anecdotal as far as I know, about people who think they are insured until they find out that they are not -- either not at all, or more frequently, not adequately to their needs. The clearest statistic indicative of this is that 62% of personal bankruptcies in the U.S. derive from medical cost causes, and of those bankruptcies, 75% happened to people or families who were insured. While it is possible that all of those people fell into the 40% odd who say in polls that they're not satisfied or don't know, I think it's a good bet that a large minority at least were satisfied, until they found out that they shouldn't have been.

    A third context related to the second is the erosion of insurance. People are paying more simply because of the rapid inflation of premiums. In some cases employers try to deal with their part of that by shifting a higher proportion of the premium cost to employees. More often they try to control it by changing parameters of the policies -- higher deductibles, higher % co-pays, higher maximum out of pocket, lower maximum benefit. And even with those cuts in the actual benefits, people's premiums are still going up.

    There may be polling data on some of this out there about which I don't know, but we need to get more whether there is or not. It would also be interesting to look at those polls over time -- if there are polls on a four or five point scale (very satisfied, somewhat satisfied, somewhat dissatisfied, very dissatisfied or similar with an neutral point built in) I would be surprised if we didn't see a shift within the "satisfied" side to a lower degree of satisfaction.

    <hr/>

    A final point about this is: satisfied compared to what? A lot of people are deathly afraid, so to speak, of being out there without a net entirely. To such people "satisfied" may mean "better than nothing, than having none." It would be interesting to know how it stacks up to people's view of really good insurance. And it would be interesting to have questions that explicitly asked, if you were offered the chance to trade your private insurance for a public plan (or my preference, universal tax-funded social insurance, aka improved and expanded Medicare for all or single payer) with these characteristics, which would you prefer.

    Obviously this is not the straightforward clear answer you think we need, perhaps correctly.

    In April at the First Unitarian Church in Portland at a town hall forum Dr. Alan Bates, a state senator who is one of the leaders of in-state health care reform efforts, said something along the lines of "Today about 60% of people say they are satisfied with the insurance and care they've got. Right now a move to single payer, whatever one thinks of it, is not possible because of that. But the quality if eroding. If something does not happen probably in this session of Congress to stop that erosion, in five or six or ten years that proportion will drop to 40%. And then we'll have single payer, whatever one thinks of it."

    Doesn't look to me like we're apt to get the degree of change that would stop the erosion ...

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    Bill, I'm pretty sure Dr. K. would consider the opinion you just offered as part of the sideshow. He's all about how care is delivered and considers the question of the payment system (public vs. private, multiple vs. single payer) secondary to that. Personally I think it's a false opposition, but having spent a lot of time looking at & reading Archimedes Movement stuff, he just comes at the issues obliquely to the lines on which the debate mostly is constructed.

  • rw (unverified)
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    Heard on the radio today, "I know there are many many people out there suffering who have nothing for healthcare. And me and my family are in really good shape where we are at. But I don't want to give up any of this even if it means someone else can get what they need too".

    Therein lies the issues.

    1. Complete lack of "rubber hits the road" philosophical concern for anyone else's well-being;

    2. Unwillingness of the Cadillac class to make fucking do with a brand new Volvo so maybe others could at LEAST have a blow-up Pinto;

    3. Complete lack of trust that it can actually be done, has to be done and it's worth doing FOR THE FUTURE GENERATIONS.

    Amazing: all you "good parents" can't think past the pimply noses of your progeny. What about THEIR progeny? You will eventually get that picture. Hopefully.

    But it will be too late.

    We gotta do this now.

    For me, nowadays there is something to lose. But I'm still close enough to the other side of that to consider it a job worth doing. I'm not so entrenched in cozy, covered, clutching-on that I am unwilling to do this so my son's children will have something I did not. Something they should have. And that I can do something to make sure they do have.

    Ehhhhhhh.... this is worth sacrificing for. And so let's start discussing another version of that garden trading stuff you all were so on about, the local market stuff that's so chic. What about thoughts of a local economy, populist, viz wellness to get each other through the necessary and risky work of getting this done?

    :)... We can do this! I know we can. What a wonderful thing it would be if people would give up a little bit, all together, and make it happen.

  • rw (unverified)
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    Dr. K is up to his eyeballs behind the scenes on the radicalization of the care delivery model currently in vogue - the onerous treadmill driven by quarter hours and capitation. He's a key force in the drive towards the integrated medical home now being funded by federal dollars.

    He does not tell us everything he's into and how it's getting done. It's going on five or six years of legislative and policy initiative work - but not in a heavily-media-driven way.

    It's being accomplished via demonstration clinic projects, junkets around the world, academic and policy conferences.

    Maybe he'd be a good choice. I'm thinking it would be good for us. It's good stuff.

  • (Show?)

    rw, Maybe things have changed a bit due to the RW (not rw) campaign of lies & scare tactics but as recently as July polls were showing 60-65% of people saying they were willing to pay more taxes so that everyone could get health care, "I'm all right Jack" on the radio is in a minority.

    Wouldn't disagree about JK but I think it's unnecessary and possibly counterproductive to his goals to pose it in opposition to other kinds of reform. In particular a unified single payer system would make it a hell of a lot easier to implement what he's trying to do. Pilot & demonstration projects are all very well but a) they don't reach far and b) they tend to be time limited. Even if they are as big as Kaiser-P, which you could see as a giant demo project in a way. I'm not against what he's doing, I wish Archimedes wouldn't dis what others are doing. Although I was against his approach to Medicare and would remain so, his self-imposed rule of "only working with existing public dollars" is nonsense. N.B. that part isn't about how we deliver care but the financing part.

  • Bill Bodden (unverified)
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    Obamacare and the $13 rule

    Excerpt: "In the capitalist haven of Hong Kong, anybody who can scrape together the equivalent of US$13 receives timely and usually first-rate health care in an emergency ward. By contrast, hospitals in the United States are turning away the sick, the injured and the dying."

    But Hong Kong and other nations are not afflicted with the disease of blatant hypocrisy as badly as the United States.

  • (Show?)

    "2. Unwillingness of the Cadillac class to make fucking do with a brand new Volvo so maybe others could at LEAST have a blow-up Pinto;"

    Let's understand that in many cases, unions collectively bargained in a fair manner for those benefits, often at the cost of salary or job security. Taxing those benefits now is of suspect fairness, IMO. And let's not forget that benefits have NEVER been taxable to this point, no matter how "luxurious."

  • rw (unverified)
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    I did not say Unions.

    There's more than one model of Cadillac out there, TJ.

  • rw (unverified)
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    Also, TJ, hate to say this since I support unions.... anytime I worked in a union shop, I had better wages, better everything than if not. So....... they have it better than everyone else, dear.

    Even when I was a clerical person, with crap wages at OHSU, jealously eyeing what the whining nurses had with the benefit of their stronger union, still, it was better than what I could get without in a similar setting.

    So I'm just not sure if folks believe their own words. Nobody is willing to put it on the line for what they believe. We are living in the age where nobody any longer has idealistic FAITH in a changed outcome if they step up. We want the different outcome and believe it SHOULD occur, but we no longer believe that our personal sacrifice will CAUSE it to occur.

    The closest I've come, even here, to hearing about personal sacrifice is those earning plenty chiding those who don't quite earn enough for being unwilling to pay even more for basics to improve the environment. Yet I honestly have not noticed where the same folks will say they are willing to go a little more naked so that others may be clothed. Not the same thing at all. Give a little more of your plenty, or have a little less, period.

    Different levels of commitment. Different belief structures too.

    I think we've seen too many whistle blowers screwed, too many idealists go crass...

  • rw (unverified)
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    We espouse, but maybe we do not believe.

  • rw (unverified)
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    SO, Chris, back to the topic. It's exciting to see that folks will mute their static and join forces to address a primary point: the negative and outdated role of the insurance industry.

    I just keep thinking this could be the start of a revolution in America. People taking to the streets and talking philosophy seriously, truly understanding that this IS life.

  • Bill Bodden (unverified)
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    The Federal Employees Health Benefit Plan (FEHBP) is not a Cadillac plan. I have the Blue Cross/Blue Shield option. While it is better than no plan, it is no Cadillac. Maybe a Chevy or a Ford. Given what I have paid in premiums, co-pays and charges not covered by this plan, I would have been better with no plan at all, except for the fact that it is difficult to get a doctor to treat if you don't have insurance. Then there is the prospect of some serious illness over the horizon, which in the present circumstances is one of the few reasons for having a health insurance policy.

  • (Show?)

    TJ and Bill, I read rw as referring to literal automobiles, & the income groups that own them, possibly because of having spent time considering cappucino and Cadillac conservatives in rejoinder to latte & limousine liberals. (Cappucino works, Cadillac doesn't quite).

    The rhetoric of "cadillac plans" is just conservatives practicing the kind of rhetoric of resentment of which they so often accuse people on the left.

    As for that piece of Rebecca's ruminations, I'm going to need to come back to it.

  • Nurse Wretched (unverified)
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    Dr. Don McCanne (http://two.pairlist.net/mailman/listinfo/quote-of-the-day):

    Frankly, I'm sick and tired of listening to those who say that PNHP needs to get on board and support the public option, which is really saying that we need to support an individual mandate to purchase unaffordable plans. Those of you who were duped into supporting this model that can't possibly work need to abandon that ship and get on board with us and our colleagues who will accept nothing less than health care justice for all.

  • rw (unverified)
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    Well Chris, much as you sought not to skewer me, you may have. I do confess that I was conflating a little, as is my wont. I was NOT, hopefully, following the classist demarcations and false categorizations of the current rhetoric. And, to me, interpretation is everything.

    Writership up here are behaving as if "good coverage" means one thing to all folks. Hell, it ain't so.

    I am pretty annoyed that I have to pay a forty dollar copay for any visit, and pay a stiff premium. But it's considered good coverage.

    And I was pretty irritated that I, on half of his mate's salary, had to pay twice as much for my Kaiser Perm as a close friend whose wife is a lifer at County Health. And they get better benefits for less, too!

    So to me a Cadillac plan means you are well off, it is NOT a choice between your tooth being fixed or your son's (our current choice in my house - wisdom teeth won out and will trump everything till the one thousand is paid off); and you are cared for when you need it. And a Volvo means maybe you sometimes have to push and shove to get what you need, but if you have balls you will still get care.

    The blow up Pinto is the best I've ever had. That and a three wheeled Radio Flyer. :)... so to me, the interpretation of access and pretty good access are different from others.

    I see one of our own up here wailing (as do I) about the incredible amount of income that goes every month to buy access that is metered and meted out. So does that make it not good care that is accessed? Or poor access to that care?

    Standards and interpretations.

    I was definitely talking about versions of health access and whether anyone out there is actually willing to give something more for what they've got so someone else can have ANYTHING of some of what they've got!

  • rw (unverified)
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    Heck Chris: I bubble and fume with resentment. Heheheh.

  • rw (unverified)
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    And, yes: I was not indulging in the dreadful crap the R's are putting out with "cadillac plan". Bunch of crap, that. I did mean real cars as a rhetorical device of how to interpret what you are getting.

    I think. Ack.

  • Dan (unverified)
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    Standard Insurance co. is right downtown on SW 5th and Main. Will there be any protests there? Just seems like this huge corp is right in our backyard - maybe something should be done?

    peace out, Dan

  • (Show?)

    "The rhetoric of "cadillac plans" is just conservatives practicing the kind of rhetoric of resentment of which they so often accuse people on the left."

    Before you go pinning it on conservatives, it's a favorite phrase of Ron Wyden's--because taxing "Cadillac plans" is exactly what his HAA plan does. In that context, it refers to high-dollar insurance plans, in many cases those negotiated through collective bargaining with unions. They are generously benefitted by design, as a tradeoff for job security and salary considerations. In other words, the way labor sees it, Wyden and Baucus might as well be saying they'll cut everybody's wages by $2 an hour if they have high-dollar plans.

    It may be a talking point, but it's wholly bipartisan.

  • (Show?)

    Rebecca, the difference between your Kaiser and your acquaintance's is not based on what each of you have. If your County Health friend got less, the County would keep the money, not Kaiser, and it wouldn't get redistributed to you. That's why we need single payer. It does away with all the nonsensical inequality that is purely based on bargaining, including historical bargaining that may have occurred long ago but set patterns.

    The polls I cited before do show that people are willing to give something up so that someone else can have more or something closer to what they need.

    Generally speaking when people have come together in social solidarity it hasn't been based on making some people less secure so others can be more secure, but on making everyone more secure compared to on their own. So if you look at early trade unions often one of the first things they did was form a burial fund. The German "sicknes funds" (something like non-profit insurers) were originally union institutions that got expanded and employers were made to contribute to and the government collects the contributions in a way that looks a lot like a payroll tax.

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    Nurse W., fwiw I think the logic of things moves in the other direction than what pisses off Don McCanne, for several reasons.

    1. There are lots of people who say they are pro-single payer but are willing / feel they have to take half a loaf or incremental steps or whatever through public option, but virtually none who say "I'm really for public option but I'm supporting single payer." As it becomes clearer and clearer that the anti-any-reform forces don't distinguish the two, and are fighting public option as hard as they would single payer, the reasons not to support single payer weaken.

    2. Conversely if PNHP were to come out for public option is would make zero, zip, nada, bupkis, nil, izé difference in the Congressional politics, except to strengthen the pressure to compromise right.

    3. Meanwhile at an event like today's demonstration the common theme was that "Big Insurance Makes Us Sick." It is single payer that ultimately removes the features of private insurance that cause it to do that. The more people identify private insurance as the problem, the clearer the solution is that gets rid of it.

    4. A lot of us can see now the unaffordability issue Dr. McCanne raises, partly because we've followed individual mandates at the state level. Others who can't or won't see it now will be forced to face it as a public option, particularly a weak one which is all we're going to get if that, fails to solve the affordability problems.

  • Bill Bodden (unverified)
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    "There are lots of people who say they are pro-single payer but are willing / feel they have to take half a loaf or incremental steps or whatever through public option, but virtually none who say 'I'm really for public option but I'm supporting single payer.'"

    At the present time it is much too early to compromise. Those of us who believe in single-payer need to continue to demand it. If we come to a stand-off that means nothing or something short of single-payer then talk of a compromise might be appropriate.

  • rw (unverified)
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    Chris - yes, I know how it works. But it maddened me that people making so much more than I, better benefits than I paid less for their care at the same institution, got better ratios of care than I. And I worked for a reasonably-sized company to boot, that espouses all we speak of up here, and disburses M/M funds to the disenfranchised too! :).... nonsensical is exactly right. It is all about contracts.

    I work in that realm right now. Tiny provider clinics ONLY stand a chance if they take membership in physician associations who then negotiate terms. One provider gets this dollar sum from Careoregon, and the exact same kind of provider doing the exact same procedure is getting a different contract rate.

    It is all on the insurance contractor model. All of it. Breeds discontent, disgruntlement and the species of entitlement that emerges from disadvantage by dint of... the nonsensical!

  • rw (unverified)
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    I am staunchly pro union. But that does not stop me from seeing the lack of real commitment to non-brothers in the arms on the part of some unionists.

    I was recruited by the AFL-CIO for organizing some years back. But I'd seen too much of life to go for those frenzied cheerleader sessions they ran. FLAT anti-intellectual. Not for me.

    We'd have nothing without the unions, such as they are anymore... but that does not stop people from simply espousing but not really stepping up.

  • rw (unverified)
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    chris, i just wonder if those polls will translate into action, sustained action?

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    Bill, you've got me backward. I'm not proposing that any single payer advocates compromise. I'm suggesting reasons why those who say they are or could be in principle favorable to single payer eventually should and I think will increasingly come to join us who advocate it directly now.

    Take the AFL-CIO. As a federation they've favored public option and the principle of single payer. At their recent convention they had 70 different labor organizations bring single payer resolutions and they unanimously passed one specifically endorsing H.R. 676. They also unanimously voted to continue to work for strong public option in the immediate context. But the specific endorsement of 676 is much stronger than anything to date and support for single payer from the local level up is building. I think there is or will be more of that kind of movement because what's likely to pass at this point is going to be so piss poor that it is going to require re-evaluation of what is "political realism." Some of the pols will want to run away from the issue entirely but the continuing collapse of the system won't let them do it long.

    rw, the sentiment expressed in the polls is not able to be put into action at present in part because President Obama promised he wouldn't let it (no new taxes on individuals below $125,000 / yr or couples below $250,000 / yr). I also think the number may have gone down after the lies of August, haven't seen new polling on that. And I'm sure if you framed the question differently, like, would you be willing to give up some of your security about getting health care so that other people could have more security, you wouldn't get the same results at all. But I don't read that as direly as you seem to do, I guess, because that's not what's needed or the best or even the not best but o.k. that could happen. And I'm not sure I see it as a reasonable ethical thing to ask, actually, nor one that would in past societies have met much favor either, except in tightly known circles of people. We can get into the atomization of all of us, but I don't see it as a spiritual failing of individuals, it's a degradation of the kind of society we have and the kinds of relationships it facilitates and obstructs. And I know you are no romanticist, unquestioningly of "tradition" as well, you know the kinds of abuses it can cover.

  • Brian C. (unverified)
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    Gotta concur with Kitz on the sideshow remark. Seems like a spot-on assessment of the so-called health care debate at the moment. Apart from a lot of noise and political positioning where is the real plan? You know, the realistic, pragmatic one that pencils out and has a chance in hell of passing. I'd like to think that most single payer advocates know that doesn't stand a chance in hell of going anywhere and it should be obvious that the other extreme appears to favor the status quo. So, what's the correct course of action in this moment? If real change is in fact the primary goal that is.

  • rw (unverified)
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    Yah, Chris, I have agreement with you as to the power of semantics. And as to the foolishness of speculative atomization of the person. LIfe's Chances (anthropology term, actually) and the Moment will change a fixed element in a breath.

    However, I feel I'm a realist: given what America is, built upon the belief that one must lose and one must win, our pathology is going to express itself for a good long time in what it is we do end up with.

    A realist, I wonder just how many of the well-meaning have the grit to get it done if they MUST have less to force the line upwards for all? Honest.

    But I am also not so arrogant as to deny the limitations of my frame of reference, skewing more towards acceptance, gratitude and also fullness literally by the day, but still and yet fundamentally bedrocked upon scarcity. This can only skew my perceptions, expectations, rationales and hopes. Not to mention jaundice my opinions, eh....

  • rw (unverified)
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    And, Chris, extremist wench that I am, I would probably pose the question as "Are you willing to do with a little less so that those with NONE may have something?"

    That IS the reality I know about that I refuse to pretend is not reality.

    My first night standing to pray on the Hill, the edema that dogs me since that wreck ten years ago leapt upon me and swelled both lower legs to nearly the size of the upper. I made a decision to not allow this to distract me from what I'd traveled a lifetime and thousands of rugged miles to do: pray in the place made for that prayer. And accept whatever it is came.

    So I conferred myself into wakan tanka's hands (as if I can take myself out of them? hah!) and went on with it. Three nights later I got my first easing from the burning and tightness that should have had me afraid.

    This sequelae that I live with should not have been mine. But utter dispassionate lack of caring as well as lack of care have made it so.

    And so that is the truth of America's healthcare system. As much as they want to be healers, they are also taught to deploy a helpless and elegant shrug.

    I love them, I love working with them, I love this niche I am in for all of my professional life. But as you say, I am not a romanticist even as I am its first Poetess when given a chance.

    I hold the knowledge and can't renege: it's not so some could have a little more Chris. IT is so millions in desperate need can have ANY.

    Do we truly have the grace and the grit to do it? And how in the world are we gonna hold Obama accountable for what he's doing now? This isn't right. It is not courageous.

  • rw (unverified)
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    ps, how exciting: we are getting pet insurance and viagra banners. Hahahahha. Even the advert logarithms get it what "wench" really means. Do I have to relinquish my favorite word?

  • robert s (unverified)
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    Solve immigration and a huge part of the cost of healthcare goes with it ...don't believe me ? Go into the ER at St. V's on any saturday night but I warn you ...better bring a translator. Other problems helped out dramatically by enforcing the current immigration laws are the Meth epidemic and school funding and overcrowding, the need for more jail space and the over burdening of all of our social services programs

  • rw (unverified)
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    I smell the smell of ogre!

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    rw,

    It's funny, I see something like the question you're posing in the issue of consumer culture as it relates to ecological sustainability and survival, but not really in health care.

    The question you are posing has no real referent. No one is being asked to give up a little so everyone can have some. A bunch of people have been scared into thinking that they might be asked to give up everything or a lot. Meanwhile the president has centered his entire rhetoric around the claim that no one who likes what they have will have to change anything. And in the background all of this is lies because the insurers and employers are gradually taking away or radically changing the terms and conditions of what is available.

    If the movement for unified national health insurance continues to get more traction and if the current reform efforts fail to deliver as they are likely to do, it may be that a form of your question will become a challenge to pose to people in response to right wing whining about "government takeover" and lies about what it means. But it would be an odd form, because single payer actually would not require material sacrifice from the huge majority. What people who have to give up in some cases would be ideological bugbears about government.

    Your way of posing the question makes me despair. If I entered into the terms you use I would give up.

    Part of my reaction is that I don't know the answer to your question but that in this case it is the wrong question, and an unnecessary, unhelpful and disspiriting one. If you want me to be a campaigner for people to have the grit to give something up, I won't. I'll be a campaigner to change the system so that everyone can have something better than what we've got now, because I believe that's possible and preferable to what you seem to be asking me to want and to try to get.

    Maybe that's just living up to your low expectations, i don't know. But maybe it's saying you're setting the bar too low. It feels to me like you are asking me to accept a corrupt and degenerated system and then work to spread the inadequate results around a little more equally (which in a somewhat different way would describe what I think Congress and the president are trying to do.)

    I have spent approaching 40 years, really since my first glimmerings of adult consciousness, taking adolescent in its most literal sense, resisting generalizations about populations. This makes me resist yours too.

    In a way I guess a lot of other people who also claim to be realists agree with you. That may be why President Obama uses the mendacious rhetoric and misdefinition of choice he uses, and refuses really to go into the challenge of the moral imperative of providing a broad solid floor of health care security and talking about the several sources of health insecurity and health care insecurity.

    As I step back from it, on different issues I recognize that I think things not so far in the shape of consequences from what you're saying. That is, I think it has become characteristic of U.S. politics since the Reagan era to have a tyranny of the majority centered around the relatively better off, though with a penumbra of people who hope to join them and of people who fear to fall. It's a more economistic variant of older politics that more formally relied on racial exclusions and color bars and ethno-racial mobilizations -- the recent version has some of that still of course, but its role has changed.

    But how different my language is from yours. I'm not sure we even can communicate. If we met in person I'd talk more with you about it, but I don't want to do so on line.

    BTW when I spoke of atomization i did not mean of souls, but of social ties -- new forms of isolation and attenuated (though sometimes multiplied) created by car and t.v. and latterly computer culture.

  • Nurse Wretched (unverified)
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    If the "common theme was that 'Big Insurance Makes Us Sick', then how could anyone attending your rally support a "public option"?

    No. That may have been your theme, but the majority of Democrats who have been led to the edge of the cliff believe foolishly that individual mandates for buying unaffordable and inefficient private insurance is a worthwhile project, just like expanding the war into Pashtunistan or torturing by proxy are worthwhile projects.

    <h2>A huge majority of Democrat rank-and-file have wanted the equivalent of Medicare for All for decades, but the Democrat leadership will not let them have it.</h2>

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