Time To Choose

President Obama’s major address on health care delivered on September 9, 2009 may have been about reform of our health care system, but more than that it symbolized the choice Americans face as a people.   Either we can continue on the same path we’ve been on, which has been one of gridlock and acceptance of the status quo, or we can move in a new direction.

To the Republicans, the choice is said to be between “big government” and “halting government growth.”  If they had not spent trillions on tax cuts not matched by spending cuts, or wars that cost both money and international standing, they might have some credibility.   If they hadn’t presided over the bubble economy’s most dramatic expansion only to be shocked when it burst, I could take them more seriously.  Instead, it appears that the GOP has been more about anger, partisanship and fear than real problem solving.  When a Congressman calls the President a liar, heckling him in the Capitol, it represents a party so caught up in fear and emotion that it’s hard to take them seriously.   It’s also telling that the issue involved coverage for illegal immigrants, a xenophobic hot button for many on the right.

Alas, the Democrats have not played fair all the time either.   They have often lacked the courage to stand up to special interest groups in order to get realistic change, and have got caught up in political games and power struggles as well.   Both parties have fiddled while US strength and prestige slowly burns away, and now both glare at each other without trust as the country faces crises of a magnitude many are only starting to sense.

Bouyed by angry ‘townhall’ protests in August, many Republicans believe Obama is on the ropes, his Presidency in danger, and thus have decided it’s best to stay on the attack.   This is rationalized by ideological jihad, any governmental effort to solve a problem is bad, and thus it is legitimate to bring up scary things like alleged ‘death panels’ and other disinformation to use fear to generate opposition.

Yet the country faces real challenges.  First is a health care system that is utterly unsustainable.   If the Republicans win and nothing gets done, it will be a pyhrric victory, as the system will continue to collapse until so many lose coverage and get denied claims that people will scream for an even stronger government plan.  Second are deficits and debt levels that create a danger of inflation and structural long term weaknesses for the US economy.  This debt is bi-partisan and full of pork.   It can be cut, but both sides have to compromise.   There is much the US can no longer afford, including a massive military engaged in distant wars, and entitlement programs that often support those who do not need support.

Most importantly, though, is a spiritual crisis, or the crisis of character that President Obama spoke of.   America has gone from being a country of noble ideas and faith in the future, to one focused on consumption and fear.   But this can quickly change.  When the economic crisis hit Americans found themselves able to start saving, and put off buying new stuff.   We haven’t yet been corrupted by consumerism, we simply gave into its temptation thanks to cheap credit and efforts to convince us that consumption gives life meaning.   The choice before us is a moral choice, and as the President noted, one that speaks to our national character.

Can we solve these problems working together pragmatically, or are we going to divide into ideological camps unwilling to compromise?

On the left, liberals and progressive push Obama to go for a large public option, and threaten to derail the bill if they don’t get it.   They want to fight both moderate Democrats and Republicans whose skepticism of these ideas they disdain.  On the right, conservatives want to simply derail the plan, and continue with the status quo.   Obama is to be defeated; cooperation only gives him a victory which in the zero sum world of hardball politics might strengthen him.   For them, partisan battles trump the public good.

In the middle stand people like Barack Obama, and Republican Senator Olympia Snowe.   Snowe has not signaled support for a plan yet, but she has also not screamed out paranoid fears or slammed the door.   She seems genuinely commited to the idea of reform, driven by the kinds of moral concerns that Obama talked about as he reflected on the letter he received from Ted Kennedy.    In short, people like Obama and Snowe can recognize they have different core beliefs on many issues, but a shared belief in solving the problems facing the country, and taking seriously the suffering many Americans have due to no fault of their own.  They recognize that “private charity” simply won’t fill the gap, and bankruptcy and health woes hit hard working Americans who may feel they were not at risk.

It is time to choose to make changes and truly reform and alter the path of the country.   Thoughtful Republicans should focus less on partisan ideology and more on practical concerns: taking the debt and deficit seriously, working against bureaucratic waste, trying to assure individual liberty is not sacrificed, and keeping government accountable.   The positive traits that draw many to conservatism can be maintained and promoted even while reform is undertaken.   Constructively, the President opened that door for them, they can make a difference.

Democrats should realize that the also have to compromise.   Obama reportedly is making the compromise on malpractice reform in response to a demand by Snowe that this issue be taken seriously.   That makes her potentially far more effective in promoting conservative goals than those who screech about death panels and who play the fear card.   Moreover, Democratic refusal to compromise has hindered reforms before.   In the 70s Nixon supported a plan that, had it received Democratic support, would have given us a national health care system long ago.   In the early Clinton years more compromise might have allowed at least a first step at reform.

Health care reform is only the first issue, we face others just as serious.  But it is an issue that will say a lot about the future.  If partisan bickering and ideological war cause this to disintegrate into simply a continuation of the status quo, it proves that our leaders — and by extension us as citizens — lack the character to truly address the problems at hand.  If we can solve this by both sides coming together, if Olympia Snowe ends up representing the Republican party more accurately than Rush Limbaugh, and if Obama can steer his party to real pragmatic compromise, then we will have come together at a difficult moment to move the country in the right direction.

It is time to choose.   Our future depends upon it.

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  1. #1 by John on September 10, 2009 - 13:36

    Hallelujah. Something is better than nothing, just get the ball rolling.
    Your line about it being a pyhrric victory resulting in a much more nationalized plan is the best framing of the issue I’ve seen.
    Great post.

  2. #2 by Mike Lovell on September 10, 2009 - 15:46

    It seems that, for the most part, the options our dear and old wisened friends who represent us in Washington, can only travel down one of two roads: The same road we’re on, or the road to eventual governmental takeover of the healthcare system. These two roads seem to be the only messages that get out into the open exposure of the public eye, and yet, no matter what smaller changes can be made to the existing system to improve it, without turning it into something completley foreign to us, they are not given the light of day.

    Politicians on both sides of the aisle have said that lack of competition is one of the biggest problems with our healthcare system as it exists now. Repealing mandates that prohibit portability issues is one way to A) increase the competition issue and B) make insurance much cheaper which at some point will intersect with those who stand on the line of not being able to afford coverage currently

    Secondly, look to cancel out issues concerning pre-existing conditions that exclude many people from insurance benefits (honestly, some people really get screwed over on some shaky grounds of explanantion from the insurance companies), but counter it with a bit of tort reform and caps on medical malpractice. (a waitress making minimum wage and some tips, has something botched during her surgery and sues. Whether it was willful negligence to the nth degree, or a mere mistake, common sense doesnt suddenly count this lady’s life- which total income over a lifetime might have hit $1.4 mil- worth $10mil with a $90mil bonus for her pain and suffering, but we’ll let a lawyer say that mistake was worht more than even the doctor can count on making in his lifetime?)

    I’m sure there are a variety of ways to change the system (I’m just not smart enough to have it all figured out) to cover more people, cost less money to the people, and all the while avoid not only the status quo, but a vague plan that is full of questionable holes.

    • #3 by classicliberal2 on September 10, 2009 - 17:20

      “counter it with a bit of tort reform and caps on medical malpractice. (a waitress making minimum wage and some tips, has something botched during her surgery and sues. Whether it was willful negligence to the nth degree, or a mere mistake, common sense doesnt suddenly count this lady’s life- which total income over a lifetime might have hit $1.4 mil- worth $10mil with a $90mil bonus for her pain and suffering, but we’ll let a lawyer say that mistake was worht more than even the doctor can count on making in his lifetime?)”

      It isn’t about her income–it’s usually about her being permanently crippled or even killed (over 64% of malpractice payments per year involved actual death or permanent debilitation). There’s no dollar amount that can make up for that. She hasn’t just lost wages–she has lost a life.

      Malpractice suits are NOT a significant factor in U.S. medical expenditures–their cost is between 0.46% and 2% of total health outlays, depending on the methodology used. The only problem with malpractice is that the medical profession won’t police itself, and doctors who cripple, maim, and kill repeatedly are allowed to continue practicing (malpractice awards are heavily concentrated in a relative handful of bad doctors). The Republican response to Obama’s speech offered a perfect example of this–the clown the GOP picked to offer their response is a former surgeon who had been sued repeatedly for malpractice, his patients/victims winning millions. And, of course, few of the people who have genuine cause to sue ever do. Efforts aimed at curbing our ability to sue would be fundamentally misguided if they had, as a goal, any sort of genuine health care reform. As it stands, though, they’re just another leg of the perpetual right-wing effort to create an overclass that is entirely impervious to any public accountability.

      • #4 by Mike Lovell on September 11, 2009 - 15:36

        “It isn’t about her income–it’s usually about her being permanently crippled or even killed (over 64% of malpractice payments per year involved actual death or permanent debilitation). There’s no dollar amount that can make up for that. She hasn’t just lost wages–she has lost a life.”

        I have no argument on the first half here, I trust your stats on this one. The last two sentences, I agree with it, but a caveat. Why aren’t all people given the same amount in a judgement. The varying settlements are all over the map.

        “Malpractice suits are NOT a significant factor in U.S. medical expenditures–their cost is between 0.46% and 2% of total health outlays, depending on the methodology used.”

        You also have to look at the economic impact not just of the suits, but the ongoing malpractice insurance costs as well, which go up by pretty hefty percentages annually. The doctors pay this coverage, and the costs have to be passed on, or the doctor ends up actually paying the patient for the privilege to treat them.

        “The only problem with malpractice is that the medical profession won’t police itself, and doctors who cripple, maim, and kill repeatedly are allowed to continue practicing (malpractice awards are heavily concentrated in a relative handful of bad doctors)”

        I’ll agree, and this is a point that also needs to be reformed, and provisions for oversight made, with REAL penalties. I’l be the first one to point out, I’m not totally on board with Republican policies, but I’m also not on board with Democratic policies either. Changes to the current system need to be made, from affordability to the acts of insurers actually covering claims. Removing certain mandates from states requirements would also help reduce costs, as compliance standards always end up costing money that is funneled right through to the patients pocketbooks. I’m not talking about unleashing insurers and the health industries powers, but removal of certain ridiculous mandates that have almost no bearing on actual patient care. In an effort to inundate us with legal jargon left and right, I think often times we forget that a lot of things could be solved by starting the process over and looking at things in a simpler manner.

        Ultimately I believe in everyone having affordable access to quality healthcare, I just don’t see the practicality (coupled with actual economic realities)being solely in the hands of the government.

      • #5 by classicliberal2 on September 11, 2009 - 18:10

        “Why aren’t all people given the same amount in a judgement. The varying settlements are all over the map.”

        Not all injuries and degrees of negligence are the same. It wouldn’t make any sense to award the same damages to someone who lost a toe as to the family of someone who was actually killed. Juries make these decisions based on the facts of the case before them, and, for the most part, do so rationally.

        “You also have to look at the economic impact not just of the suits, but the ongoing malpractice insurance costs as well, which go up by pretty hefty percentages annually.”

        Those costs have virtually nothing to do with malpractice suits either, though. Public Citizen just crunched the latest numbers, back in July:

        “For the third straight year, 2008 saw the lowest number of medical malpractice payments since the federal government’s National Practitioner Data Bank began tracking such data in 1990. The 11,037 payments in 2008 were 30.7 percent lower than the average number of payments recorded by the NPDB in all previous years. Ratios of payments per capita and per physician have fallen even lower compared to historical norms. There were 13.5 payments per million physicians in 2006 (the most recent year for which the number of physicians is available), which is 29.2 percent lower than the average in previous years. The value of payments in 2008 (as distinct from the number of payments) was the lowest or second lowest on record, depending on the method used to adjust for inflation.”

        The explosion in malpractice premiums have nothing to do with the suits, nor will making it more difficult for the public to sue help anything. A number of states have toyed with capping damages from malpractice suits. Back in 2003, Weiss Ratings issued a report covering the first 12 years of such experiments. Their results:

        “Physicians continued to suffer a rapid increase in med mal premiums despite caps: In 19 states that implemented caps during the 12-year period, physicians suffered a 48.2 percent jump in median premiums… However, surprisingly, in 32 states *without* caps, the pace of increase was actually somewhat *slower*, as premiums rose by only 35.9 percent… [A]mong the 19 states with caps, only two of the states, or 10.5 percent, experienced flat or declining med mal premiums. In contrast, states without caps were actually *better* able to contain premium rate increases, with six, or 18.7 percent, experiencing stable or declining trends.”

        …which is pretty much the conclusion of every serious study on the matter (most of them based on individual states).

        The spikes in malpractice insurance premiums don’t come from nowhere, of course. They’re a consequence of greed (the same thing driving up health care costs in general), economic downturn (such as the sustained miserable economic performance of the Bush administration, followed by this wretched recession), and are always tied to a lot of incredibly stupid financial decisions by the insurance companies. When times get hard, and when they put their money in things that go bust, they use their doctor clients to make up the difference.

        The current numbers on the total “medical malpractice liability system,” as crunched by Public Citizen in July:

        “The cost of the medical malpractice liability system–if measured broadly by adding all malpractice insurance premiums–fell to less than 0.6 percent of the $2.1 trillion in total national health care costs in 2006, the most recent year for which the necessary data to make such comparisons are available. The cost of actual malpractice payments fell to 0.18 percent–one-fifth of 1 percent–of all health care costs in 2006. Annual malpractice payments have subsequently fallen from $3.9 billion in 2006 to $3.6 billion in 2008, but comparative data on total health care costs are not available.”

        A SORT-OF CORRECTION: Earlier I quoted, from my notes, the figure of 64% of malpractice payments per year going to those who suffer death or significant permanent injury. That number is a few years old. PC, in the report I just referenced, says that number currently stands at “more than 80%” of payments.

        “I’ll agree, and this is a point that also needs to be reformed, and provisions for oversight made, with REAL penalties.”

        The NPDB was created in 1990. From then to 2005, 57.8% of malpractice payments were made by only 5.9% of doctors. By contrast, 82% of all doctors in that time had never had a malpractice payment at all. That doesn’t mean they’re all clean–few people with cause to sue ever do. It does, however, suggest that a handful of bad doctors are responsible for most of the abuse that leads to the suits used as propaganda for taking away our right to sue.

        A few years ago–this is an example I like to use when talking about this–a gaggle of doctors in West Virginia got a lot of press by staging a “strike”–18 of them walked off their jobs for a day to protest the malpractice system and demand “reform.” They got on the evening newscasts, CNN, etc. Raised a big stink. The part that didn’t make so big a ripple in the press is that the leader of this effort was a fellow who, in the previous 15 years, had been sued 14 times for malpractice by his patients, paying out an incredible $1.7 million. He also admitted to having been a drug addict, who operated on patients while under the influence, and even became a supplier of prescription drugs to local addicts. Nine of the 18 doctors involved in this “doctor’s strike” stunt had similar records–they’d had $6 million in judgments against them over the years, and they were still practicing medicine.

        “I’m not totally on board with Republican policies, but I’m also not on board with Democratic policies either.”

        I have what I regard as a healthy disdain for both. My views are liberal, and I suppose that more closely aligns me with Democratic politics, but I have little use for the party. The current mess of a health care debate is a perfect example of why.


        Left Hook! The Blog
        http://lefthooktheblog.blogspot.com/

  3. #6 by Nathaniel Burns on September 10, 2009 - 15:49

    Good comments Scott. Exactly my thoughts. Now that I am entering the health field (I am doing a post-baccalaureate premedical program at UVM), this health care reform has become personal for me (not that it wasn’t before, such as last year when I had no health insurance because I was too old for my parents insurance, but yet my job at the nursing home wouldn’t let me have it because I only worked 20 hours a week).

    -Nate

  4. #7 by classicliberal2 on September 10, 2009 - 16:27

    Can’t agree on this one being a great post, Scott, or even a very good one. I think it has the same problems as Obama’s speech last night, most of them stemming from simply ignoring the on-the-ground political reality. We can’t do that and expect to accomplish much of anything worth accomplishing.

    The conservative base position is opposition to any real health care reform, anything that curbs the prerogatives of their corporate paymasters. Multiply anything by zero, and you still end up with zero. You can’t “compromise” with people who will not compromise. Obama made a big, grand speech where he’s all about compromise, cooperation, bipartisanship, and the response of the other side was to sit on their hands and look absolutely disgusted when he called the “death panels” lie what it was, then to actually call him a liar for telling the truth about the health plan not applying to illegal immigrants. The Republican response was handled by a barely-articulate former surgeon who doesn’t even believe Obama is a U.S. citizen. Obama’s absolutely disgusting embrace of malpractice tort “reform” is particularly interesting given this choice–as a surgeon, this fellow was a butcher who was sued repeatedly for malpractice, his patients/victims winning millions.

    Obama began the health care debate with his usual massive concessions to the other side–in an attempt to curry favor with the conservatives, he threw out the single-payer approach favored by the liberals (and the sane) in favor of yet another byzantine plan that preserves a private insurance industry that doesn’t work, is doomed to collapse, and is bleeding the country dry as it dies. And after that HUGE concession, he comes to the liberals again and says “you have to compromise more.” The conservatives call him a liar, tell the public he wants to kill old people, don’t give up a damn thing, or even indicate that they’re willing to give up anything, and he’s telling the liberals “you have to give more,” and even engages in vile Clintonian triangulation in order to marginalize them, the very people who elected him.

    It’s a crock. Obama wasn’t elected to behave like this. The public didn’t elect a candidate on a liberal ticket and huge majorities for his party in both houses of congress so conservative Republicans could continue to run everything.

    It’s also worth noting–indeed, it’s a matter of critical importance to this discussion–that, if the goal of health care reform is to come up with something that works, the idea that this sort of continual compromise is what will produce that result (particularly when it’s only being done by one side) is an entirely fallacious assumption. All health care reform ideas are NOT equal. The status quo is unsustainable. That can be documented with hard numbers. The conservative preference for maintaining the status quo with very few real changes–their “reform” idea–merely continues an unsustainable course. Stitching bad ideas to good ones only makes the good ones less good.

    • #8 by John on September 10, 2009 - 18:16

      classicliberal, I frequently see your point of view. But as a political realist, I have to disagree with your “all or nothing” argument.

      After decades of trying to pass healthcare reform and failing, I think the country would be much better off if Obama’s plan passes.

      There’s the compromise. On the right, do nothing. On the left, a single payer system. A single payer system will not pass. You seem to forget he needs Congress to pass it before he can sign it into law. So how would you have him “act”? His plan is a compromise between nothing and single payer. At least we would have something to build on. Because if you keep insisting on single payer now, nothing is what you will get. And the Republicans will get what they want.

      I would love single payer healthcare. But it’s not going to happen right now.

      • #9 by classicliberal2 on September 10, 2009 - 22:03

        “classicliberal, I frequently see your point of view. But as a political realist, I have to disagree with your ‘all or nothing’ argument.”

        I’m not making an “all or nothing” argument. I am a realist when it comes to these matters. Since the moment he was elected, Obama has been aiming for “bipartisanship” as a goal, rather than as a method. If you are wise in politics, you start with a strong position, fight for it, then compromise at the end, offering the minority some concessions, but, reflective of your majority status, mostly getting your way. Obama, on the other hand, gives away the store right up front. “His” proposals end up looking, right out of the gate, like some mushy compromise worked out by some “bipartisan” committee. It’s 1/2 Republican right from the start, and Republicans, who do stand firm and fight (they have no motivation to behave any other way), just end up moving it closer and closer to what they’d prefer. The final product will much more closely reflect their views than those of Obama.

        If Obama had began the health care debate by coming out forcefully for single payer and had fought for it, he could have settled for something that, while less, still moved things in the right direction. Instead, he keeps going to the liberals and saying “give up more, give up more,” while the other side gives up absolutely nothing.

        “After decades of trying to pass healthcare reform and failing, I think the country would be much better off if Obama’s plan passes.”

        It isn’t going to pass, not in the form he proposed it. It’s going to have to be whittled down via the regular legislative process. The “public option” was the cornerstone of his plan, and he’s already virtually thrown it to the wolves. We’re going to get a bill that ends up requiring people to buy insurance, without offering a cheap, public alternative. That what will eventually pass will make things even worse isn’t just a possibility; it’s a likelihood.

        “There’s the compromise. On the right, do nothing. On the left, a single payer system. A single payer system will not pass. You seem to forget he needs Congress to pass it before he can sign it into law. So how would you have him ‘act’?”

        Before any debate had began, single payer had about 100 co-sponsors in the House at the beginning of every congress, and strong majorities of the public have voiced support for it in polls for years now. There is a very strong constituency for it, and Obama had a very high popularity rating. The way to work toward it is to start by proposing a full-scale single-payer plan, then, over time, as the ugly debate proceeds, to pare it back to a plan that uses a “public option”-style scheme to introduce it gradually, first covering everyone without insurance, then allowing whoever wants it to sign up for it. Combine this with some of the reforms Obama has also suggested, such as getting rid of pre-existing conditions as a means of denying coverage. Insurance companies are going to find ways around that, and all of the other reforms, and that would make the ranks of the “public option” scheme swell, which, in turn, makes it cheaper and even more attractive.

        All that’s needed are 50 votes and the will to get them–not a small thing, but hardly an impossibility. Democrats have a majority in both houses, a supermajority in the Senate. Obama could draw in any wobblers with a carrot, promising to do things like overlook their pork projects come budget time, then, with anyone who wants to get tough, he brings out the stick, and ensures them that, among other things, they’ll be facing hard and generously funded primary challengers next election cycle if they don’t get on board. All it takes is 50 votes.

  5. #10 by Scott Erb on September 10, 2009 - 19:10

    I think John and I agree on this. The political reality is there is no ability to pass a single payer system, and in fact right now there are questions about even getting enough Democrats in the House to pass the current House bill. Politics is the art of the possible. It’s an art because you have to measure what’s possible, and whether or not you expand the range of possibilities. There are powerful, wealthy forces against real health care reform. Right now the Democrats have majorities they hadn’t had before, and through reconciliation could even get around a Senate filibuster. They should pass the best possible within those constraints, taking into account the political benefits of bringing moderate Republicans on board.

    Then you have at least a start.

  6. #11 by Josh on September 11, 2009 - 02:43

    I just need to know what a “moderate” position is on this issue (how does one really be moderate in politics?). I don’t know too much about politics, but it seems most Democrats and Republicans nowadays are not extreme, they just don’t know how to get along with each other. Just because the majority of Republicans are totally against Obama’s plan doesn’t make them “extreme” does it? Just because most Democrats disagreed with Bush on a lot of issues doesn’t make them extreme.

    I find myself agreeing with most Republicans on this issue, but I don’t look down on those who prefer the public option.
    If the public option is voted in, I’ll go along with it.

    I loath politics nowadays because people in the Congress avoid logical debate. It doesn’t mean they are extreme, it just means they are refusing to be logical. Because, if they did debate logically, Democrats would have to admit that there are many problems with their healthcare plans. If the Republicans debated logically, they would have to admit that there are many problems with the status quo (and not automatically dismiss the idea of a government involved solution). Some politicians may admit to the problems, but not many do. They want to pretend that their ideas are flawless. I don’t think about “extreme” or “moderate”, I think about one’s willingness to be honest.

    Anyway, sorry if I changed the subject. These thoughts have been with me since I watched Obama’s speech.

    • #12 by Scott Erb on September 11, 2009 - 03:12

      Good points, Josh. I think a lot of people loath politics these days for the same reasons you do.

      • #13 by henitsirk on September 13, 2009 - 03:02

        “I don’t know too much about politics, but it seems most Democrats and Republicans nowadays are not extreme, they just don’t know how to get along with each other.”

        Here in Idaho we have recently been entertained by the minor scandal of Rex Rammell, a Republican candidate for the 2010 gubernatorial election, and his ill-advised “Obama tags? We’d buy some of those” comment in response to an equally ill-advised audience comment regarding our new state wolf hunting tags. It was a dumb thing to say, but he’s refusing to apologize, and people have written letters to the local paper saying that condemnation of the comment and the opinion that he should apologize are against freedom of speech.

        The thing is, nobody is saying he doesn’t have the right to say what he wants. We’re just saying that he said something pretty dumb, and inflammatory, and disrespectful of the president, and that is what requires an apology. It’s been turned into an idiotic partisan squabble, instead of people just trying to be honorable and reasonable. Rammell was even quoted as saying he’s glad for the free PR this has brought him!

        Feh — politicians!

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