Health Care

There was a superb piece by Peter Singer in the New York Times on July 15 entitled Why We Must Ration Health Care.  For one thing, we already do it; we just don’t do it equitably.  A public plan with the ability to purchase supplemental insurance or to purchase private insurance would be preferable to what we have an not as onerous as a single payer system.  But we can’t lose sight, the author points out, that even in countries with single payer systems, people are far happier with their system than Americans are presently with what they have.  It is time to move forward on health care reform.  This article helps point us in the right direction and dispense with the argument that we can’t ration health care.  I strongly recommend it.

There’s an good column by Steven Pearlstein in the Washington Post this morning called Bloviation vs. Reality on Stimulus Health-Care Provision.  It explains an issue related to health care in the stimulus bill that in a sense tees up the upcoming health care debate in this country.  It’s worthwhile to read.  Count me on the Democrat side on this one.

I’ll try keep this relatively short as I didn’t find much of note in my reading of today’s Washington Post (WP) and New York Times (NYT).  I’ll reference five columns, two from the WP today, two from the WP yesterday and one from today’s NYT.  Two keep us informed on the two topics I’ve been following most closely of late, Gaza and the American economic stimulus package.  The other three begin my effort here to offer insights and perspectives into the American health care crisis and what we are all going to need to know to develop an informed opinion on the subject.  As we know, this will be a hot topic in the coming months.

On Gaza, take a look at Security First: The Path to Peace Starts with a Professional Palestinian Force by J.D. Crouch II, Montgomery Meigs and Walter B. Slocombe (WP).  They are co-authors of a study entitled “Security First: Priorities for U.S. Engagement in Israeli-Palestinian Peacemaking.”  It provides an additional useful perspective on the problem in Gaza and a potential path forward.

On the stimulus, Paul Krugman weighs in again with a piece entitled Ideas for Obama (NYT).  It’s useful but doesn’t resonate with me as have some of his previous columns on the subject.

As for health care, I offer three opinion pieces, all from the WP.  In yesterday’s WP there were two stories I found to be very interesting reading.  The first, by David Brown, a doctor and a health and science reporter for the WP, is entitled We All Want Longer, Healthier Lives.  But It’s Going to Cost Us.  The Second is by Craig Bowron, a practicing hospital-based internist, entitled The Drawn-Out Indignities of The American Way of Death.  The first gives us a useful overview, a primer in a sense, of the health care problem that faces America and most of the developing world.  How are we going to be able to afford it.  He closes the very informative piece with analogy to Thomas Malthus writings of two centuries ago suggesting then that the world was unlikely going to be able to continue to feed itself.  The commonality here, the author suggests, is that perhaps science or a “demographic transition” will change the equation that now seems as inevitable to us as concerns health care costs as the lack of food appeared to Malthus in 1798.

The second piece is a useful think-piece on death and dying.  I have thought a lot about this myself since experiencing my mother’s death 8 years ago.  Like families discussed in the piece, my family had to decide how aggressively to medically treat a loved one.  We decided that we would not aggressively treat a lung infection and to let my mother die sooner rather than later.  It was the most difficult decision I was ever a part of but I regard it as the only possible decision we could have made given that Parkinson’s disease had already robbed my mother of everything that had made her life worth living.  I also carried away from that experience a personal commitment that I will not die in an institutional setting with the sound of televisions sets from other rooms echoing into my room from a sterile linoleum hallway.  If I die conscious, I want to die looking out a big window at a lake with trees and birds.  I want to hear the sounds of nature and know that my death is but part of the eternal cycle of life in our universe.  I do not want to hear a successor to Oprah Winfrey (she is my same age and God willing we’ll both live to a ripe old age) talking about nothing important at all from a room next door.  The bottom line is that Mr. Bowron’s piece is a good one to get us thinking about how much we want to spend as a culture to extend our lives and to what end.

The third and final piece is by Robert J. Samuelson and is entitled Obama’s Health Care Headache.  He speculates that any solution to our present health care crisis will need somehow to make people share in the cost of medical care.  In other words, he suggests that we need mechanisms where the patient somehow shares in the cost of the health care so as to communicate in a personal way that health care is not free.   It brings to mind the statement I’ve seen quoted several times now.  I’m not sure of where it originated.  It’s to the effect that “if you think health care is expensive now, wait until it’s free.”  It’s true.   

Over the past week I’ve been making the case that the reason Barack Obama won the election, and won significantly, was that he offered in one clear package a presidency that offered to break completely with the Bush presidency of the last 8 years.  The principal components of this package: competence, temperament, hope, and policies that were generally acceptable to the electorate.  Put another way, Barack Obama was the antithesis of George Bush and that, more than anything else, was what the voters were looking for last week – CHANGE.  McCain couldn’t come close having chosen to abandon the center and keep his right wing happy, a right wing which still adores George Bush.  As I noted in my post yesterday —Weekend Roundup – Some Reagan-Obama Similarities, Obama’s challenge will be to steer a relatively middle-of-the-road course and not let the Democrat-dominated House and Senate pursue an overly liberal agenda.  I am not saying that Obama should give up on health care and certain other promised “liberal” reforms.  Especially on the high profile issue of health care reform, Obama promised it and he must follow through.  But what Obama must avoid is a Congress that passes every item on the liberal special interest wish list.  I also believe the selection of Rahm Emanuel was probably a very good choice to help insure this doesn’t happen. 

So in a sense what I’m arguing is that Barack Obama will be wise to govern as though he has a more divided government that he actually has.  Although not yet settled, it is looking like Obama will not have a filibuster-proof Senate (60 votes).  Let that be viewed as a blessing in disguise, a manifestation of divided government that will in the long run do Obama (and the country) more good than harm.  This is because the one thing Obama has to fear is a voter backlash in 2010 and 2012 that puts Republicans back in control of the House and/or Senate.

An overly “progressive” agenda that provides a check mark by every item on the liberal special-interest wish list could make this a reality.  Our country is clearly largely a center right nation and the electorate will be offended by an overly liberal agenda.  A very valuable piece to reference on this is contained on the weblog, Divided We Stand, United We Fall and is entitled 2010 and 2012 Election Prologue – The Road Back.  The author, a strong advocate for divided government, takes a thorough look at the next two election cycles and suggests that it is unlikely that Republicans can stage a comeback in 2010 but that it is quite possible in 2012.  The only point I’d add to his analysis is that this all depends on how Obama and the Democrats govern.  If they govern in relatively moderate fashion, I agree that 2010 is unlikely to see any change in Democratic control of the House and Senate.  2012 is any one’s guess.  However, anything is possible if Obama and the Democrats govern as liberals with a mandate. 

Also supporting my general theory on this is an Op-ed by Alan Ehrenhalt, the editor of Governing Magazine, in the New York Times today.  It is entitled Will Obama’s Congress Be Too Friendly?  It is a worthwhile-read.  Here’s an excerpt:

All of this suggests that, to escape the fate of Messrs. Carter and Clinton, Barack Obama needs to preserve the centrist image he cultivated during the campaign; to reinforce the personal good will that both parties genuinely seemed to feel for him on election night; to avoid letting impatient Democratic majorities tempt him into pushing initiatives that the electorate won’t support; and still somehow emerge with a record of accomplishment that bears some resemblance to the promises he made all over the country this fall.

I couldn’t agree more.  Stiving for bi-partisan support wherever possible and in essence governing as though there was a divided government will help insure that Obama’s legacy will be a successful one.  Of course there are a myriad of other factors with which Obama will have to successfully contend if he is to “succeed”.  I am hopeful, however, that if he charts a relatively centrist path Barack Obama otherwise possesses the skills to be a great leader and president.