yay for hrothgar

Raise a glass with Garrison Keillor to "for a landmark bill, achieved through the messy, maddening processes of representative democracy."

"it's your money"...(but not mine)

The anti-tax, small government rhetoric, at least to this patriotic American's socialist-leaning ears, has always revolved around this basic message: it's your money, you earned it, you should decide how to spend it, period.

Unless, of course, it's health care legislation, in which case:

1) if you're an "illegal immigrant," you cannot spend your own (very) hard-earned money to buy health insurance.

2) if you're a woman, you cannot spend your own (very) hard-earned money on a procedure that remains (technically) legal.

But if you're one of those privileged few who really have constituted the referent of the phrase "we the people" since the time that phrase was originally coined, then don't worry, no one will tell you how to spend your hard-earned money.

bipartisan?

Politifact.org: "barely true."

text of Obama's speech, available for comment

 This is a great opportunity to use the Insight app you can see at the bottom of the page below. Highlight text you want to evaluate or comment on, and go for it.

Text of President Barack Obama's address to Congress on health care reform Wednesday, as prepared for delivery and provided by the White House.
___
Madam Speaker, Vice President Biden, members of Congress, and the American people:
When I spoke here last winter, this nation was facing the worst economic crisis since the Great Depression. We were losing an average of 700,000 jobs per month. Credit was frozen. And our financial system was on the verge of collapse.

As any American who is still looking for work or a way to pay their bills will tell you, we are by no means out of the woods. A full and vibrant recovery is many months away. And I will not let up until those Americans who seek jobs can find them; until those businesses that seek capital and credit can thrive; until all responsible homeowners can stay in their homes. That is our ultimate goal. But thanks to the bold and decisive action we have taken since January, I can stand here with confidence and say that we have pulled this economy back from the brink.

I want to thank the members of this body for your efforts and your support in these last several months, and especially those who have taken the difficult votes that have put us on a path to recovery. I also want to thank the American people for their patience and resolve during this trying time for our nation.

But we did not come here just to clean up crises. We came to build a future. So tonight, I return to speak to all of you about an issue that is central to that future — and that is the issue of health care.

I am not the first president to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform. And ever since, nearly every president and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way. A bill for comprehensive health reform was first introduced by John Dingell Sr. in 1943. Sixty-five years later, his son continues to introduce that same bill at the beginning of each session.

Our collective failure to meet this challenge — year after year, decade after decade — has led us to a breaking point. Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy. These are not primarily people on welfare. These are middle-class Americans. Some can't get insurance on the job. Others are self-employed, and can't afford it, since buying insurance on your own costs you three times as much as the coverage you get from your employer. Many other Americans who are willing and able to pay are still denied insurance due to previous illnesses or conditions that insurance companies decide are too risky or expensive to cover.

We are the only advanced democracy on Earth — the only wealthy nation — that allows such hardships for millions of its people. There are now more than 30 million American citizens who cannot get coverage. In just a two year period, one in every three Americans goes without health care coverage at some point. And every day, 14,000 Americans lose their coverage. In other words, it can happen to anyone.

But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. It happens every day.

One man from Illinois lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones that he didn't even know about. They delayed his treatment, and he died because of it. Another woman from Texas was about to get a double mastectomy when her insurance company canceled her policy because she forgot to declare a case of acne. By the time she had her insurance reinstated, her breast cancer more than doubled in size. That is heartbreaking, it is wrong, and no one should be treated that way in the United States of America.

Then there's the problem of rising costs. We spend one-and-a-half times more per person on health care than any other country, but we aren't any healthier for it. This is one of the reasons that insurance premiums have gone up three times faster than wages. It's why so many employers — especially small businesses — are forcing their employees to pay more for insurance, or are dropping their coverage entirely. It's why so many aspiring entrepreneurs cannot afford to open a business in the first place, and why American businesses that compete internationally — like our automakers — are at a huge disadvantage. And it's why those of us with health insurance are also paying a hidden and growing tax for those without it — about $1000 per year that pays for somebody else's emergency room and charitable care.

Finally, our health care system is placing an unsustainable burden on taxpayers. When health care costs grow at the rate they have, it puts greater pressure on programs like Medicare and Medicaid. If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined. Put simply, our health care problem is our deficit problem. Nothing else even comes close.

These are the facts. Nobody disputes them. We know we must reform this system. The question is how.
There are those on the left who believe that the only way to fix the system is through a single-payer system like Canada's, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own.

I have to say that there are arguments to be made for both approaches. But either one would represent a radical shift that would disrupt the health care most people currently have. Since health care represents one-sixth of our economy, I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch. And that is precisely what those of you in Congress have tried to do over the past several months.

During that time, we have seen Washington at its best and its worst.

We have seen many in this chamber work tirelessly for the better part of this year to offer thoughtful ideas about how to achieve reform. Of the five committees asked to develop bills, four have completed their work, and the Senate Finance Committee announced today that it will move forward next week. That has never happened before.

Our overall efforts have been supported by an unprecedented coalition of doctors and nurses; hospitals, seniors' groups and even drug companies — many of whom opposed reform in the past. And there is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to the goal of reform than we have ever been.

But what we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics. Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge. And out of this blizzard of charges and countercharges, confusion has reigned.
Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.

The plan I'm announcing tonight would meet three basic goals:
It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will slow the growth of health care costs for our families, our businesses, and our government. It's a plan that asks everyone to take responsibility for meeting this challenge — not just government and insurance companies, but employers and individuals. And it's a plan that incorporates ideas from Senators and Congressmen; from Democrats and Republicans — and yes, from some of my opponents in both the primary and general election.

Here are the details that every American needs to know about this plan:
First, if you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

What this plan will do is to make the insurance you have work better for you. Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most. They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies — because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

That's what Americans who have health insurance can expect from this plan — more security and stability.
Now, if you're one of the tens of millions of Americans who don't currently have health insurance, the second part of this plan will finally offer you quality, affordable choices. If you lose your job or change your job, you will be able to get coverage. If you strike out on your own and start a small business, you will be able to get coverage. We will do this by creating a new insurance exchange — a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage. This is how large companies and government employees get affordable insurance. It's how everyone in this Congress gets affordable insurance. And it's time to give every American the same opportunity that we've given ourselves.

For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. And all insurance companies that want access to this new marketplace will have to abide by the consumer protections I already mentioned. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.

Now, even if we provide these affordable options, there may be those — particularly the young and healthy — who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for those people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek — especially requiring insurance companies to cover pre-existing conditions — just can't be achieved.

That's why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

While there remain some significant details to be ironed out, I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole. Still, given all the misinformation that's been spread over the past few months, I realize that many Americans have grown nervous about reform. So tonight I'd like to address some of the key controversies that are still out there.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.
There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false — the reforms I'm proposing would not apply to those who are here illegally.

And one more misunderstanding I want to clear up — under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

My health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system. As proof, critics point to a provision in our plan that allows the uninsured and small businesses to choose a publicly sponsored insurance option, administered by the government just like Medicaid or Medicare.

So let me set the record straight. My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75 percent of the insurance market is controlled by five or fewer companies. In Alabama, almost 90 percent is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down. And it makes it easier for insurance companies to treat their customers badly — by cherry-picking the healthiest individuals and trying to drop the sickest; by overcharging small businesses who have no leverage; and by jacking up rates.

Insurance executives don't do this because they are bad people. They do it because it's profitable. As one former insurance executive testified before Congress, insurance companies are not only encouraged to find reasons to drop the seriously ill; they are rewarded for it. All of this is in service of meeting what this former executive called "Wall Street's relentless profit expectations."

Now, I have no interest in putting insurance companies out of business. They provide a legitimate service, and employ a lot of our friends and neighbors. I just want to hold them accountable. The insurance reforms that I've already mentioned would do just that. But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear — it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up.

Despite all this, the insurance companies and their allies don't like this idea. They argue that these private companies can't fairly compete with the government. And they'd be right if taxpayers were subsidizing this public insurance option. But they won't be. I have insisted that like any private insurance company, the public insurance option would have to be self-sufficient and rely on the premiums it collects. But by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers. It would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities.

It's worth noting that a strong majority of Americans still favor a public insurance option of the sort I've proposed tonight. But its impact shouldn't be exaggerated — by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles. To my progressive friends, I would remind you that for decades, the driving idea behind reform has been to end insurance company abuses and make coverage affordable for those without it. The public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

For example, some have suggested that that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others propose a co-op or another nonprofit entity to administer the plan. These are all constructive ideas worth exploring. But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice. And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need.

Finally, let me discuss an issue that is a great concern to me, to members of this chamber, and to the public — and that is how we pay for this plan.

Here's what you need to know. First, I will not sign a plan that adds one dime to our deficits — either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize. Part of the reason I faced a trillion dollar deficit when I walked in the door of the White House is because too many initiatives over the last decade were not paid for — from the Iraq War to tax breaks for the wealthy. I will not make that same mistake with health care.

Second, we've estimated that most of this plan can be paid for by finding savings within the existing health care system — a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment — it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid.

In fact, I want to speak directly to America's seniors for a moment, because Medicare is another issue that's been subjected to demagoguery and distortion during the course of this debate.

More than four decades ago, this nation stood up for the principle that after a lifetime of hard work, our seniors should not be left to struggle with a pile of medical bills in their later years. That is how Medicare was born. And it remains a sacred trust that must be passed down from one generation to the next. That is why not a dollar of the Medicare trust fund will be used to pay for this plan.

The only thing this plan would eliminate is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies — subsidies that do everything to pad their profits and nothing to improve your care. And we will also create an independent commission of doctors and medical experts charged with identifying more waste in the years ahead.

These steps will ensure that you — America's seniors — get the benefits you've been promised. They will ensure that Medicare is there for future generations. And we can use some of the savings to fill the gap in coverage that forces too many seniors to pay thousands of dollars a year out of their own pocket for prescription drugs. That's what this plan will do for you. So don't pay attention to those scary stories about how your benefits will be cut — especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past, and just this year supported a budget that would have essentially turned Medicare into a privatized voucher program. That will never happen on my watch. I will protect Medicare.

Now, because Medicare is such a big part of the health care system, making the program more efficient can help usher in changes in the way we deliver health care that can reduce costs for everybody. We have long known that some places, like the Intermountain Healthcare in Utah or the Geisinger Health System in rural Pennsylvania, offer high-quality care at costs below average. The commission can help encourage the adoption of these common sense best practices by doctors and medical professionals throughout the system — everything from reducing hospital infection rates to encouraging better coordination between teams of doctors.

Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan. Much of the rest would be paid for with revenues from the very same drug and insurance companies that stand to benefit from tens of millions of new customers. This reform will charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money — an idea which has the support of Democratic and Republican experts. And according to these same experts, this modest change could help hold down the cost of health care for all of us in the long-run.

Finally, many in this chamber — particularly on the Republican side of the aisle — have long insisted that reforming our medical malpractice laws can help bring down the cost of health care. I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush Administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today.

Add it all up, and the plan I'm proposing will cost around $900 billion over ten years — less than we have spent on the Iraq and Afghanistan wars, and less than the tax cuts for the wealthiest few Americans that Congress passed at the beginning of the previous administration. Most of these costs will be paid for with money already being spent — but spent badly — in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. And if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.

This is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight — Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.
But know this: I will not waste time with those who have made the calculation that it's better politics to kill this plan than improve it. I will not stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in the plan, we will call you out. And I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it most. And more will die as a result. We know these things to be true.

That is why we cannot fail. Because there are too many Americans counting on us to succeed — the ones who suffer silently, and the ones who shared their stories with us at town hall meetings, in e-mails, and in letters.

I received one of those letters a few days ago. It was from our beloved friend and colleague, Ted Kennedy. He had written it back in May, shortly after he was told that his illness was terminal. He asked that it be delivered upon his death.

In it, he spoke about what a happy time his last months were, thanks to the love and support of family and friends, his wife, Vicki, and his children, who are here tonight . And he expressed confidence that this would be the year that health care reform — "that great unfinished business of our society," he called it — would finally pass. He repeated the truth that health care is decisive for our future prosperity, but he also reminded me that "it concerns more than material things." "What we face," he wrote, "is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country."
I've thought about that phrase quite a bit in recent days — the character of our country. One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.

For some of Ted Kennedy's critics, his brand of liberalism represented an affront to American liberty. In their mind, his passion for universal health care was nothing more than a passion for big government.
But those of us who knew Teddy and worked with him here — people of both parties — know that what drove him was something more. His friend, Orrin Hatch, knows that. They worked together to provide children with health insurance. His friend John McCain knows that. They worked together on a Patient's Bill of Rights. His friend Chuck Grassley knows that. They worked together to provide health care to children with disabilities.

On issues like these, Ted Kennedy's passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick; and he was able to imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent — there is something that could make you better, but I just can't afford it.

That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom; and we can no longer even engage in a civil conversation with each other over the things that truly matter — that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.

What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road — to defer reform one more year, or one more election, or one more term.

But that's not what the moment calls for. That's not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.

Because that is who we are. That is our calling. That is our character. Thank you, God bless you, and may God bless the United States of America.

Betsy McCaughey on the Daily Show

Rachel Maddow has been saying for at least two weeks that Betsy McCaughey is the originator of what has become the death panel meme. Politifact.com rates her original statement with their flaming "pants-on-fire" rating--apparently there's a difference between a statement being just false, or flagrantly false, in their estimation.

Last night Jon Stewart's interview of Betsy McCaughey was equal parts maddening and enlightening. The Daily Show cut off the interview when they ran out of time, but the uncut version is below (in two parts).

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Exclusive - Betsy McCaughey Extended Interview Pt. 1
www.thedailyshow.com
Daily Show Full Episodes Political Humor Healthcare Protests

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Exclusive - Betsy McCaughey Extended Interview Pt. 2
www.thedailyshow.com
Daily Show Full Episodes Political Humor Healthcare Protests

Note that Jon makes my point about epistemic trust. The issue is less about the actual wording of the bill than it is about the presumptions that control the interpretation of the wording of the bill. At issue: do you assume that the people writing health care reform bills are trying to reform health care, i.e. extend and improve access to health care for the citizens of this country, or, do you assume, like Betsy McCaughey, that this health care bill is a "Trojan Horse" for the nefarious intent to deny access to health care for those who now have it?

Unfortunately, though Stewart did ask "do you really distrust doctors that much?" to which McCaughey answered, "I distrust politicians"--he didn't follow up much further. Cynicism about politics I get. But surely it's not in the self-interest of career politicians to make nefarious plans to kill off their constituents--so how, even in the twisted worldview of those who believe human beings only ever act in intelligent and ruthless self-interest--how does it make any sense at all to assume that the writers of HR 3200 want to kill old people?

Regardless, there are two points of McCaughey's regarding the content of the bill that I want to respond to. First, she indicates more than once that there is a long list of specified interventions that the bill mandates that your doctor try to talk you out of. Here is the part of section 1233 I think she is referring to:

‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

‘(iii) the use of antibiotics; and

‘(iv) the use of artificially administered nutrition and hydration.’

.

Of course, there are other issues about whether this is "mandated" (I don't see that it is, and her arguments regarding indirect financial incentivizing seem a little stretched to me), and whether or not your doc is asking what you want versus talking you out of interventions (again, that trust thing. If you're that scared of your doctor, I suggest you find a new one). But on the single point of whether a bullet list of four item introduced with the phrase "may include indications respecting, among other items" constitutes a long list of specified interventions your doc must address? I don't see it. "May" still, I believe, remains a modal auxiliary verb indicating, among other things, permissibility, but not obligation (that would be "must"). I suppose though, like the word "mandatory," someone who's got skillz in reading this stuff can see where those words are crammed into the invisible subtext even when they're not there. (Ah, but that's that trust thing again.)

The second point she makes that I want to take issue with is that doctors will somehow be financially penalized if their patients don't adhere to the advance directives they create in consultation with their doctor, thus creating a situation in which people can't change their minds later if they want to. Leaving aside the discussion about financial incentivizing--which Stewart challenges her on--if her concern truly is to provide for a situation in which someone might change their mind about their advance directive, the bill itself provides for this:

‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.'

So there's no sense in which you only get one shot at making an advance directive, after consultation with your doctor which you don't have to pay for out of your pocket--paragraph 1 provides you can revisit this in any case every five years, but the paragraph above specifies that you can revisit your advance directive, in consultation with your doctor, more often in the event of getting terminally ill. So the scenario she paints, of your doctor collaborating with the evil politicians to talk you out of life-sustaining measures which you then cannot change your mind about later, is the opposite of what this bill actually says. Further, if you buy her financial incentivizing bit, you might could even argue that doctors have an incentive to revisit this issue with you at least every five years, and more often in the case of your getting terminally ill in some way. (But, you might not want to argue that to Betsy McCaughey; she would probably take it as further evidence that your doctor's being bribed by your government to kill you.)



P.S. I really hate the way she mugs for the camera.

on the limits of discourse

Having a conversation at gunpoint is not exactly my ideal scenario for the free exchange of ideas.

And apparently it's not just liberal kooks like me who find gun-toting to be disruptive to discourse in the public square.

From Bernard Kerik, 40th police commissioner of the City of New York and Iraq’s interim minister of interior following the fall of Saddam Hussein:

Allowing armed protesters to show up where the president is speaking is irresponsible and could cause a catastrophic security nightmare for those charged with protecting him.

It endangers the protective agents, the protesters, the public, and the president. It creates an immediate distraction as each armed protester then becomes a focus of observation for the agents.

Although Arizona and other states may allow the possession of these weapons, who can tell that the person carrying them at the time is not a threat to the president or others? An unidentified man who had a rifle slung over his shoulder told a reporter for the Arizona Republic, that “I still have some freedoms,” and he may be right. But freedom to create alarm and a possible threat to the president is not one of them.

Use some common sense.

That man may have no ill intent and possess his weapon legally, but what if someone not so nice takes it away? Why create scenarios where the protective agents focus is instinctually aimed at the weapon’s carriers? What if there is an accidental discharge by someone who is not that proficient with his or her weapon that creates a stampede or serious distraction?

No responsible gun owner, law enforcement executive, or public official should endorse or allow these armed protests anywhere near the president.

The president and his staff should let the Secret Service do its job, regardless of political correctness, and Department of Homeland Security Secretary Janet Napolitano should ensure that the president is protected at all cost . . . and if that includes stepping on some protester’s toes, so be it.

I’m all for the Second Amendment and our right to bear arms, but not at the cost of endangering the president. This is a dangerous practice and it must be stopped.

a random complaint

Apparently other people have noticed the sperm penetrates vagina motif of this Omnaris commercial as well. I am really, really tired of seeing it.

One minor thing I personally hope for out of health care reform? No more sexist commercials for nasal spray on my TV. And maybe even no more ads for meds, period: depression meds, weight loss, aspirin regimens, erectile dysfunction pills, hormone replacement therapies, osteoporosis treatments, you name it, quit telling me to ask my doctor about whatever drug you want me to pay exorbitant amounts of money to put in my body that I probably don't need.

But especially, quit with the sexist commercials about how armies of masculine meds can fix my permanently out-of-whack female body. Vaginas, even analogical ones, ought to be off-limits for TV commercials.

getting it wrong to prove you're right

Here's why, no matter how much I agree with Frank's outrage, his reaction was the wrong one.

She's still "crazy," and even more convinced that 1) she's justified in her "crazy" and 2) she was not given a fair hearing by Frank (and by extension, Obama and his administration).

That Hitler-mustachioed Obama poster is more important to her than ever. She's more entrenched in her opinions than ever. She's more convinced that the gov't is fundamentally untrustworthy and indifferent to her opinion than ever. She's more afraid of her perceived encroaching disempowerment and marginalization than ever. So she, and everyone else who fits this description, will be shouting louder, about Nazis and death panels and abortion mandates and whatever, than ever.

It's just more dialectically and epistemologically complicated than people in favor of health care reform want to admit. Olbermann wants to ask "why are people believing these lies?" without delving into the fact that this is the wrong question, or at the very least, the wrong way to ask this question. It's an alienating question, and perceived alienation is precisely the problem! Why don't you just dump some lighter fluid on the conflagration of crazy, then, and act all outraged when what you get back is an out-of-control wildfire.

Rachel Maddow did a better job last night on this, putting together the fact that these wildly divergent perceptions on health care are demonstrably linked to which information sources are trusted. But all the way through the segment, it's "off-the-kook-end theories" and "it's wrong, it's just not true, they exist in their own mini-verse." And then, it's Bill Maher who's invited to comment on this phenomenon, who of course is not at all provocative, and is totally nuanced. (snort.)

AAAAARRRRRRRRGHHHHHH!!!!

Can we please, please, please stop giving people excuses--no, rational justifications--for remaining in their epistemic mini-universe? Don't we want them to come out of the mini-verse? Why should they, when at every opportunity, we mock them and call them crazy and insult their FoxNews and their trusted pundits? When we say to them, "what planet do you spend most of your time on?"

I'm not saying we shouldn't be challenging these demonstrable falsehoods. Of course that needs to happen. But it flat-out doesn't matter if that's the first and only thing that happens. It doesn't matter if someone you don't trust anyway tells you that the people you do trust are lying. It doesn't matter if someone you don't trust tells you your firm beliefs and perceptions are false and distorted. It doesn't matter. It gets tuned out. And when the frustration mounts and the people you don't trust call you crazy, well, that just goes to show that you shouldn't be trusting them anyhow.

So next time, when someone like Frank confronts someone like that woman in the video, and says, "I'm going to answer your question with a question," please, please let it be this question:

"What do YOU want out of health care reform? Because I'd like to know."

the 800lb gorilla says so

h/t to jonmower.com

Why I'm in favor of health care reform--Crunchy Con

The author of the article linked above quotes at length from an interview of Wendell Potter, the former Cigna exec who's been saying to everyone who will listen why he favors health care reform. From the interview:

Guernica: Shifting to President Obama's plan: critics often say that Obama's healthcare plan would be detrimental to care because it would take decisions away from doctors and patients and put them in the hands of a government bureaucrat. Is this a legitimate concern?

Wendell Potter: No. But it is one of those talking points the industry repeats every time we have a debate about reform. They said it in 1993. They say it whenever the industry is under threat of increased government involvement. What I'm telling people is that our current reality is far scarier than the fear-mongering. What people have now is a corporate bureaucrat who stands between a person and his or her doctor. That's much scarier than the specter of more government. In any event, there is nothing in any healthcare plan that is being proposed that would put a government bureaucrat between a person and his or her doctor.

Guernica: Why is a corporate bureaucrat scarier?

Wendell Potter: Because every person who works for a for-profit company knows that the company has to meet Wall Street's expectations. Every manager of the company has to pull his or her weight to make sure he and his team are doing all that they can to help the company meet that objective. That includes medical directors. Same with the nurses. They know what the company has to do to meet Wall Street's expectations and to stay in the good graces of investors.

Guernica: So in other words, corporate bureaucrats have a profit incentive to deny care to people who are enrolled in their plans.

Wendell Potter: Absolutely. It doesn't have to be stated directly to them that you will be paid a particular bonus if you deny X number of claims; it's known, and it's part of the culture.

***

It's also worth re-posting here a bit from factcheck.org:

We would note, as does Obama, that denials of coverage are routine among private health insurance companies and under Medicare in our current system, and we asked McClusky [of the Family Research Council] about that. Why would such decisions about care be more objectionable under a public plan, for instance, than they are when Aetna or UnitedHealthcare denies coverage? "We find it more troubling when the federal government is doing it," he said. "It’s the 800-lb gorilla."

Of course, the 800 lb. gorilla claims it wants to provide, not deny, access to insurance and health care coverage, but hell--who believes what the 800 lb. gorilla says? Oh, unless it's the unlikely spokes(notquite)person for an insurance company chatting you up in the sauna. That 800 lb. gorilla, you can trust. He's got a profit motive, after all.

about babies and healthcare

Objections to health care cover the spectrum of life-and-death concerns: that is to say, death panels to mandated abortions. Now that the death panel crap is being debunked by all sorts of information agencies, expressions of fears that health care reform will kill Grandma are being replaced by fears that health care reform will kill babies.

Well, if I were the one in charge of the secret lethal army of Metal Ones, I certainly would send them out for the babies and the old people first. That would leave all the angry able-bodied people around for a nice Terminator-style fight for the earth. It's good strategery.

All right, so I know that the sarcasm isn't really being very nice. There's a reason my sister gave me the secret super-hero name of "Sarcastro." I try to delete all such commentary when engaging in real dialogue with people who disagree--it's hard, and sometimes I miss my aim, but I do try. But this is my blog, which I began, after all, as a venue for saying whatever the hell I wanted in a desperate experimental attempt to really find my voice. Which, as it turns out, is really sarcastic. Who would've thunk.

Anyhow, I was reminded again today that US health care stats include a shamefully high infant mortality rate.

And I can't help but think of the awful, awful irony of people so completely convinced that it's reforming this health care system that's going to kill babies.

Get it straight. I love babies. I want to have more of them myself. I want to have more babies in the same serene, beautiful way that I gave birth to my first ridiculously healthy little girl. I want every woman who has a baby to be able to give birth in that same empowering way I did--that is to say, with her agency intact, with say-so over her environment and her body, celebrating the advent of life into the world. I want this for every woman regardless of the circumstances of conception. I want this for every woman regardless of whether or not she can pay for it or has insurance for it. I want every pregnancy and every birth to be the beautiful, spiritual, bodily experience it should be. I want every pregnancy to culminate in that. Every single one.

That's not how it is.

And, of course, that's not how it will be, no matter what kind of reform finally gets enacted, because that's my ideal. But I think we could be a helluva lot closer to that ideal than we currently are.

And the first step to moving closer to the ideal is simply recognizing how far we currently are from it, recognizing that having the highest mortality rate of any developed country means that babies are dying. And maybe that, in some undesired, unintended way, if we do nothing about it, if we refuse to recognize that, then we are all baby-killers.

Section 1233 of HR 3200

You can find the full text of this bill online here. The "death panel" section follows below.

SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

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(a) Medicare-

(1) IN GENERAL- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended--

(A) in subsection (s)(2)--

(i) by striking ‘and’ at the end of subparagraph (DD);

(ii) by adding ‘and’ at the end of subparagraph (EE); and

(iii) by adding at the end the following new subparagraph:

‘(FF) advance care planning consultation (as defined in subsection (hhh)(1));’; and

(B) by adding at the end the following new subsection:

‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy.

‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

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‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

‘(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include--

‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and

‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State--

‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and

‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that--

‘(I) ensures such orders are standardized and uniquely identifiable throughout the State;

‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

‘(III) provides training for health care professionals across the continuum of care about the goals and use of orders for life sustaining treatment; and

‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

‘(2) A practitioner described in this paragraph is--

‘(A) a physician (as defined in subsection (r)(1)); and

‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.

‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that--

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‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care;

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‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and

‘(iv) may incorporate any advance directive (as defined in section 1866(f)(3)) if executed by the individual.

‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—

‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;

‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting;

‘(iii) the use of antibiotics; and

‘(iv) the use of artificially administered nutrition and hydration.’.

(2) PAYMENT- Section 1848(j)(3) of such Act (42 U.S.C. 1395w-4(j)(3)) is amended by inserting ‘(2)(FF),’ after ‘(2)(EE),’.

(3) FREQUENCY LIMITATION- Section 1862(a) of such Act (42 U.S.C. 1395y(a)) is amended--

(A) in paragraph (1)--

(i) in subparagraph (N), by striking ‘and’ at the end;

(ii) in subparagraph (O) by striking the semicolon at the end and inserting ‘, and’; and

(iii) by adding at the end the following new subparagraph:

‘(P) in the case of advance care planning consultations (as defined in section 1861(hhh)(1)), which are performed more frequently than is covered under such section;’; and

(B) in paragraph (7), by striking ‘or (K)’ and inserting ‘(K), or (P)’.

(4) EFFECTIVE DATE- The amendments made by this subsection shall apply to consultations furnished on or after January 1, 2011.

(b) Expansion of Physician Quality Reporting Initiative for End of Life Care-

(1) Physician’S QUALITY REPORTING INITIATIVE- Section 1848(k)(2) of the Social Security Act (42 U.S.C. 1395w-4(k)(2)) is amended by adding at the end the following new paragraphs:

‘(3) Physician’S QUALITY REPORTING INITIATIVE-

‘(A) IN GENERAL- For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

‘(B) PROPOSED SET OF MEASURES- The Secretary shall publish in the Federal Register proposed quality measures on end of life care and advanced care planning that the Secretary determines are described in subparagraph (A) and would be appropriate for eligible professionals to use to submit data to the Secretary. The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.’.

(c) Inclusion of Information in Medicare & You Handbook-

(1) MEDICARE & YOU HANDBOOK-

(A) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall update the online version of the Medicare & You Handbook to include the following:

(i) An explanation of advance care planning and advance directives, including--

(I) living wills;

(II) durable power of attorney;

(III) orders of life-sustaining treatment; and

(IV) health care proxies.

(ii) A description of Federal and State resources available to assist individuals and their families with advance care planning and advance directives, including--

(I) available State legal service organizations to assist individuals with advance care planning, including those organizations that receive funding pursuant to the Older Americans Act of 1965 (42 U.S.C. 93001 et seq.);

(II) website links or addresses for State-specific advance directive forms; and

(III) any additional information, as determined by the Secretary.

(B) UPDATE OF PAPER AND SUBSEQUENT VERSIONS- The Secretary shall include the information described in subparagraph (A) in all paper and electronic versions of the Medicare & You Handbook that are published on or after the date that is 1 year after the date of the enactment of this Act.

Sarah Palin institutes Official Death Panel Day

um, I mean, official "Healthcare Decisions Day." But we all know what that means, don't we.

Don't forget: April 16, it's time to dust off that Grim reaper costume and go scare some old people.

Okay, joking aside. This is the kind of information that ought to make a difference. If you can get past the fact that I picked it up from Rachel Maddow, whom I consider to be the awesomest chick on TV, and have a little "trust, but verify" attitude with the following, maybe the whole death panel thing can finally, um, be laid to rest. (RIP.)


from: http://gov.state.ak.us/archive.php?id=1094&type=6

WHEREAS, Healthcare Decisions Day is designed to raise public awareness of the need to plan ahead for healthcare decisions, related to end of life care and medical decision-making whenever patients are unable to speak for themselves and to encourage the specific use of advance directives to communicate these important healthcare decisions.

WHEREAS, in Alaska, Alaska Statute 13.52 provides the specifics of the advance directives law and offers a model form for patient use.

WHEREAS, it is estimated that only about 20 percent of people in Alaska have executed an advance directive. Moreover, it is estimated that less than 50 percent of severely or terminally ill patients have an advance directive.

WHEREAS, it is likely that a significant reason for these low percentages is that there is both a lack of knowledge and considerable confusion in the public about Advance Directives.

WHEREAS, one of the principal goals of Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities, and hospices to participate in a statewide effort to provide clear and consistent information to the public about advance directives, as well as to encourage medical professionals and lawyers to volunteer their time and efforts to improve public knowledge and increase the number of Alaska’s citizens with advance directives.

WHEREAS, the Foundation for End of Life Care in Juneau, Alaska, and other organizations throughout the United States have endorsed this event and are committed to educating the public about the importance of discussing healthcare choices and executing advance directives.

WHEREAS, as a result of April 16, 2008, being recognized as Healthcare Decisions Day in Alaska, more citizens will have conversations about their healthcare decisions; more citizens will execute advance directives to make their wishes known; and fewer families and healthcare providers will have to struggle with making difficult healthcare decisions in the absence of guidance from the patient.

NOW, THEREFORE, I, Sarah Palin, Governor of the state of Alaska, do hereby proclaim April 16, 2008, as:

Healthcare Decisions Day in Alaska, and I call this observance to the attention of all our citizens.

Dated: April 16, 2008

communal discernment sucks (again)

As I'm writing my introductory material on interdisciplinary methodology and epistemology, I can't help but reflect on how basic the question of how we know what we know is. It sounds like one of those questions only total nerds would think about, because in real life, it doesn't matter, or there's no time to think about it. But the question is as pragmatic as it is philosophical. And it's the thing that's killing us right now in our health care "debate."

What do you know about the proposed health care reform? Where did you learn it from? What's your source, and how do you know they're trustworthy?

Because here's the thing, right. I'll visit www.healthreform.gov, and read there that

"President Obama is committed to working with Congress to pass comprehensive health reform this year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans. The Administration believes that comprehensive health reform should:

• Reduce long-term growth of health care costs for businesses and government
• Protect families from bankruptcy or debt because of health care costs
• Guarantee choice of doctors and health plans
• Invest in prevention and wellness
• Improve patient safety and quality of care
• Assure affordable, quality health coverage for all Americans
• Maintain coverage when you change or lose your job
• End barriers to coverage for people with pre-existing medical conditions."

The issue of whether or not I think these things are worthy goals is one thing, sure. Of course. But the real issue, the one that is killing our communal discernment process as a country, is that of epistemic trust, or rather, the lack of it. When I read this information on the government's website, I trust that it accurately reflects the actual goals of the President and his administration. And it's only if you have that basic level of epistemic trust that you can begin debate about whether the stated goals are desirable. That debate isn't actually happening yet, because it seems to me that the larger, invisible problem of lack of trust is getting in the way. If you don't trust that these stated goals are the actual goals, if you think that somehow even though everything sounds nice that it probably isn't, that even though it says right there that Obama wants to "guarantee choice of doctors and plans" that what he really wants is to take away your doctor and assign a bureaucrat to shadow you for the rest of your life and literally stand between you and your doctor until the death panel comes for you in the form of Obama's secret army of Metal Ones, well...if you can't trust that what's being said is an honest reflection of the goals of the administration, then there's no point in debating what they're actually saying. And so, generally, we're not. We're not debating these stated goals.

This issue of epistemic trust is huge. When it's present, honest, productive exchange of ideas really can occur, because even if there's disagreement there's a common sense that all participants are honest, that they are representing themselves truthfully, and that you can trust what they say is what they mean. And this is precisely what we do not have right now.

That's the diagnosis. What's the solution?

Frankly, I'm at a loss. I don't know what could possibly fix this. But here's my attempt. Let's stop the shouting for a minute and just ask ourselves: is there a reason to distrust each other?

Is there a reason to distrust each other?

Is there a reason to trust each other?

Here's mine: we all live here. We all live here, and the laws that the representatives we've elected and empowered enact affect all of us. We all have a stake in this, and when we're talking about something as personal and basic and life-and-death as health care, we all have a huge stake in it. This seems to me to be reason to trust. Reason to assume that everyone has an interest in seeing this come out well. Reason to trust that it benefits everyone to sit down and list out what currently doesn't work about our system, and that it benefits everyone to brainstorm ways to fix it, and then talk about it until the best one of those ideas surfaces through the process of collective discernment. Or, as it is also known, democracy.

real health care

Here's an article about the work that my sister and others at Mission Lazarus are doing to provide real health care for people who need it and don't have it. What they're doing is amazing.

I can't help but think of the difference between the Christian principles being lived out by Mission Lazarus folk and the outcry against healthcare reform in our own country--an outcry which, in its myopic focus on the bottom line (and that's skipping the idiocy of unfounded clinging to false rumors about ridiculous things like "death panels"--I mean, really? hey, did you know the Metal Ones are also coming for you? anytime now, and they'll be funded by Obama's health care death panel) forgets that the bottom line is not money, it's sick people. I can't help but wonder if some of the same people who support Mission Lazarus and efforts like it are protesting health care reform for the American poor, even while they applaud my sister and her coworkers for taking care of the poor and the sick--somewhere else. I can't help but wonder if pointing out the irony will force a reconsideration of the Christian principles at stake here.

But then, not that many people read this blog. And those that do probably aren't afraid of the Metal Ones anymore. :)