Congress: Incapable of Handling Health Care Reform

A recent op ed in the NY Times by Donald L. Barlett and James Steele cite a World Health Organization statistic that ranks the U.S. as 29th in terms of life expectancy measured in healthy years. According to Barlett and Steele, the explanation for what they call our "abysmal record" is the profit driven nature of the system. While the market functions well in delivering consumer products it does not work well in providing health care, where the goal cannot, and should not, be the increased sale of heart bypass operations as if they were a new brand of breakfast cereal.

The money, however, is in treatment - not prevention - so the market and good health care are at odds. Just how at odds is seen in the current shortage of flu vaccine. Preventing a flu epidemic that could kill 1,000s is not nearly as profitable as the manufacture of viagra, which brings in more than 1 billion a year for Pfizer.

What type of remedy do Barlett and Steele recommend for our ailing system? An independent agency that would set national health care policy, collect fees, pay claims, reimburse doctors fairly and restrain runaway drug prices - in a word - a single payer system such as already exists for Medicare.

The chance of getting such a program passed by Congress? Absolutely nil.

As Daniel Lazare makes clear in The Frozen Republic: How The Constitution is Paralyzing Democracy, Congress entirely lacks the competence to take on a fundamental issue like health care. In the late 1940's, Britain's Labor government created the National Health Service with a handful of civil servants and occasional input from the British Medical Association. By contrast, in 1993, Clinton's point man on health care, Ira Magaziner, recruited more than 500 experts to examine everything from cost controls to ethics. A Canadian style single payer system would have been far simpler but also more disturbing to the status quo, which was why Clinton opposed it. Instead, he opted for a complex approach that Republicans and powerful health care "industry" interests found easy to ridicule into oblivion.

Democratic senators quickly began peeling away to formulate their own proposals so that before long there were half a dozen plans circulating on Capitol Hill, each more complicated and flawed than the next. In the end, the whole game collapsed due to general exhaustion.

In the 11 years since the 1993 health care debacle, the problem has only gotten worse. We are in another presidential campaign season and health care is again on the agenda. Kerry's plan, to allow the general citizenry to opt into the federal employees health care program harkens back to simplicity. But, will it be a simple matter to get his program through a Congress where one or both Houses will be controlled by the opposition? Can Kerry even count on a majority in his own party to support him?

Every advanced industrial nation managed to create a comprehensive health care system decades ago with far less fuss and bother. We need to begin to look at the structure of our political institutions for an answer as to why the U.S. has been unable to do the same.

The Faith-Based Republic

I overheard an incredible discussion on C-Span this morning. What were the burning issues of the day that were being explored? A war that has cost us over 1,000 lives and billions of dollars? The precarious state of the nation's finances? The inability of the government to insure an adequate supply of flu vaccine for those who are in need? No, this morning's topic on C-Span was "who does God support" in the upcoming presidential election?

Why is it that the question of religion so dominates our politics while barely registering in countries that rank with us economically and socially? The answer lies to a great degree in the structure of our polity.

The Constitution was handed down to us by the Founding Fathers like Moses coming down off Mt Sinai to deliver the law to the ancient Israelites. The Constitutional Convention of 1787 was a closed door meeting. The people were invited neither to participate or observe the deliberations. The law itself was riddled with contradictions. For example, the preamble states that "the People of the United States do ordain and establish" the Constitution which implicitly recognizes their power to toss it aside and ordain a new one if necessary. But then, Article V forbade those same people from altering so much as a comma in the Constitution without submitting to a tortuous amending process. The point is that in order for the Constitution to work, the people were required to suspend their powers of reason rely on faith instead.

Reliance on faith as the foundation for our political system encouraged and nurtured its growth as a cultural phenomenon as well. This is one reason, though certainly not the only, why religion continues to play such a great role in our politics while it has all but withered away as an issue in Great Britain and Western Europe.

The culmination of our system's reliance on faith is the faith-based presidency of George W. Bush. Bush not only functions as our chief political leader, he is also the acknowledged leader of the evangelical Christian movement in the United States. Despite the great influence of faith on our politics over the past 200 plus years, this is an unprecedented development in the nature of the presidency. According to a recent article in the New York Times magazine by Ron Suskind, Bush relies solely on "gut, instinct and prayer" to make decisions that will affect the lives of millions. He demands "unquestioning faith from his followers" (i.e. other members of the government). In a particularly shocking passage, Suskind relates how a senior Bush advisor told him that he was merely part of "the reality based community." The aide went on to say that the U.S. is "an empire now, and when we act, we create our own reality."

That sounds like something straight out of a novel by Alexander Solzhenitsyn. I'd love to hear somebody from the Bush administration explain this to the families of the 1,000 plus people who have lost their lives due to the reality visited upon them by the Iraqi insurgents.

Why Are Election Officials Praying Rather Than Acting?

Last Sunday's New York Times "Week In Review" section contained an article entitled Imagining The Danger Of 2000 Redux. In it we learn that "the likelihood of trouble at the nation's 200,000 polling places may be greater than in any year in memory. According to the Times "In every hamlet, city, county and state election officials are praying, Please don't let it be close here."

Why are these people praying rather than acting? Why haven't these issues been comprehensively resolved since the last election debacle?

The Times goes on to note that if either candidate wins without a majority of the popular vote, there could be renewed calls to abolish the Electoral College and make other fundamental changes in the structure of American democracy. That would certainly be the answer to this writer's prayers.

The essence of the trouble with our political system is brilliantly described by Daniel Lazare in The Velvet Coup: The Constitution, The Supreme Court and The Decline of American Democracy. Strictly speaking, the U.S. is not a democracy at all. It is an 18th century republic that has come to resemble a democracy but which at its core remains stubbornly pre-democratic. The individual citizen has no constitutional right to vote. Article II states clearly that the power to choose members of the Electoral College lies with state legislatures rather than with the people at large.

The problem with any attempt to reform or abolish the Electoral College is that it would require a constitutional amendment, a process that was made purposely difficult by the Founding Fathers. But, they were living in a relatively underpopulated, slow moving agrarian society that was largely isolated from the rest of the globe. We, on the other hand, are inextricably bound to a rapidly changing world confronted by economic and social problems that the Founders could never have dreamed of. It is imperative that we begin to rethink our governing institutions with an eye toward making them cleaner, more efficient and truly representative of the needs of the majority of U.S. citizens.

As Lazare point out in one of the concluding chapters of The Velvet Coup, "In the modern era, any government seeing itself as democratic necessarily sees the conduct of free and fair national elections as its highest responsibility. Yet rather than placing responsibility squarely in the hands of the national government, America's superannuated Constitution placed it in the hands of the states."

That is something that simply must be changed.

Kerry's Out Of The Mainstream? Bush Out Of His Mind?

This writer has his share of criticism of John Kerry and what's left of the once venerable Democratic Party. But, there's no denying that last night he proved once again to be the more intelligent, cogent, coherent and competent candidate. Ask yourself honestly, who would you rather have handing potentially explosive issues like relations with Iran and North Korea over the next 4 years? Is re-electing Bush worth risking war with one or both of these countries? Is it worth re-enactment of the draft? Worth risking 10's of thousands of lives on all sides?

How bout that first question? Bob Schieffer, who looks like he was around for Pearl Harbor asked if "our children will ever live in a world as safe and secure as we did." Excuse me Bob, didn't you live through three major wars that cost 100's of thousands of American lives and millions on the other sides? When I was a kid, way back in the 1970's, we used to have "air raid drills" in elementary school. The fear of an all out nuclear exchange between the U.S. and Soviet Union, ever stoked by our politicians, was all too real.

Bush said that we were going after the terrorists wherever they are being harbored. How about in Saudi Arabia? A recent episode of PBS's Wide Angle http://www.pbs.org/wnet/wideangle/shows/saudi/briefing.html documents how those disaffected with the incompetence of the royal family are increasingly turning to radical Islam. Al-Queda is apparently alive and well in the kingdom even receiving quiet cooperation from the conservative religious establishment. I haven't heard either Bush or Kerry even broach the subject during this campaign.

Bush alleged that Kerry was on the extreme "left bank" of the mainstream. If that's so, where exactly would Bush place himself? He has frightened and bullied this country into a totally unecessary war that has lost us over 1,000 young lives, maimed thousands more and cost billions that might have been spent, at least in theory, on improving health care, transportation, housing and environmental protection for all. He has run up the largest federal deficit in U.S. history and made us dangerously dependent on foreign creditors like China, whose own economy has been subject to severe instability from time to time. He has closed off access to public records from both his and previous presidential administrations. His E.P.A has failed to give local communities vital warnings about contaminants in their water and air.

Do the words dangerous, radical or unhinged come to mind? One of my favorite episodes of The Twilight Zone is the one where a child played by Billy Mumy acquires omnipotent power and destroys most of the world in the process. The climax occurs when one of the surviving adults implores the others to pick up something heavy, take it to the child's head and "end this now."

Now, I'm not asking you to do anything even remotely that extreme. All you have to do on November 2 is pull a lever, touch a glass screen or pop a neatly folded ballot into a box.