What KIND of health care?

The raging health care debate "debate" is almost entirely devoid of facts, an issue on which I've previously posted. Instead of discussing fact, then, we tend hurl vague accusations, like calling the reformers "communists" (and you've GOT to see this). I "blame" Obama for this lack of specificity, but I realize that the vicious opposition mounted by huge self-interested insurance companies and health care providers might require that he not play all of his cards at this point. But isn't it odd that our politicians aren't at least clarifying the term "health care coverage" when they refer to national health care coverage? Defining this term would make a huge difference to the public reaction to any national plan. Here are two possibilities (though there are others): A) The national plan will offer gold-plated coverage much like the expensive United Health Care coverage I buy for my family through my employer. For the record, the pre-tax cost of this coverage is about $20,000 per year for my family. Is the Obama proposal to provide every citizen with this kind of coverage? If so, I can see why there is massive resentment to the proposal. Many working people can barely afford health insurance coverage at all, and the coverage many people do purchase is not nearly as comprehensive as the expensive coverage I purchase. Of course people who can can only afford to buy their own rudimentary policies will resent that the government might buy gold-plated policies for everyone else, including many highly irresponsible people. B) The national plan will offer a rudimentary coverage only. It will cover x-rays and casts for broken arms, but not heart transplants and expensive drugs that only marginally increase one's chances of surviving an illness. It wouldn't keep people suffering from terminal illness on life support when there is no reasonable chance that they would ever leave the hospital. It would cover only a small subset of the treatments covered by gold-plated policies. It might be akin to the Oregon Plan. I believe that there would be massive resistance to the national coverage described in A) but far less resistance to the coverage described in B). At least Oregon's legislators had the cajunas to specifically state what was covered under their plan and what was not (Oregon's prioritized list is available for all to see). Oregon had the fiscal responsibility to make certain that they could afford the level of health care to which they were committing. Oregon dealt head-on with the accusation that they were "rationing" health care; absolutely they were, just like private plans ration health care only to those who pay those high premiums. Both responsible and irresponsible health care plans "ration" health care. Therefore, it is not a criticism of any health care plan that it "rations" health care. Here are the guiding principles to the Oregon Plan:

In 1987, the Oregon Legislature realized that it had no method for allocating resources for health care that was both effective and accountable. Over the next two years, policy objectives were developed to guide the drafting of legislation to address this problem. These policy objectives included:

• Acknowledgment that the goal is health rather than health services or health insurance • Commitment to a public process with structured public input • Commitment to meet budget constraints by reducing benefits rather than cutting people from coverage or reducing payments to levels below the cost of care • Commitment to use available resources to fund clinically effective treatments of conditions important to Oregonians • Development of explicit health service priorities to guide resource allocation decisions.

Our national conversation regarding health care is so dysfunction on so many levels that it's hard to know where to begin. I'll make only one more point in this post, however. Opponents of current proposals often make accusations that there will be "death panels," indicating that some sick people will be allowed to die. As a nation, we need to grow up and deal with the fact that this happens every day in every hospital in the country: we shouldn't be allocating huge amounts of money to maintain pulses in people who have become living corpses. There are some families who "can't let go" no matter what (e.g., Terry Schiavo), and our national plan needs to have specific guidelines for these situations. In fact, every private insurance plan should have guidelines for determining when further treatment is likely to be futile and a provision for ending coverage at that point. The alternative is to make policies so horrifically expensive that many people can't afford policies that cover tratments likely to make an immediate positive impact on their lives. Only when we put these issues clearly on the table can we begin to have a real conversation.

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The Right is wrong

My 10 year old daughter came home from school last week, and while she sat with me eating her after-school snack asked me; “Is President Obama a racist?” she said. “No, honey, where’d you hear that?” I said. “Well, [so and so] said that in class to me today and I just wanted to know,” she said. “Did the person tell you where they had heard such a thing, honey?” I asked. “Yeah, [their] grandpa said it,” my daughter replied. “He heard it on TV.” My daughter and I had a discussion on what is racism, its source in ignorance, and how it’s just plain wrong. We also talked about the TV and radio shows which spread intolerance and bigotry for profit and political gain. My daughter’s eyes glazed over a little, and I said; “Thanks for letting me know what’s up with you! Go play with your friends!” Well, I never thought it could happen but, there is obviously no lowest depth of putrid vile chicanery that the far right wing racists will go to block anything that President Obama is up to keep his promise of change in America. Now they’re indoctrinating racism into 10 year old school children.

Continue ReadingThe Right is wrong

Russ Feingold seeks Afghanistan timetable

Russ Feingold has published an article in the Wall Street Journal calling for a flexible time line to bring home the U.S. troops in Afghanistan. Here's an excerpt:

We need to start discussing a flexible timetable to bring our brave troops out of Afghanistan. Proposing a timetable doesn't mean giving up our ability to go after al Qaeda and the Taliban in Afghanistan. Far from it: We should continue a more focused military mission that includes targeted strikes on Taliban and al Qaeda leaders, and we should step up our long-term civilian efforts to deal with the corruption in the Afghan government that has helped the Taliban to thrive. But we must recognize that our troop presence contributes to resentment in some quarters and hinders our ability to achieve our broader national security goals. Some may argue that if we leave now, the Taliban will expand its control over parts of Afghanistan and provide a wider safe haven for al Qaeda. But dedicating a disproportionate amount of our resources to the military occupation of one country is not the most effective way to combat the terrorist threat we face. Even if we invest billions more dollars annually for the next 10 years and sacrifice hundreds more American lives, we are unlikely to get a credible government capable of governing all Afghan territory.
I agree entirely. I'm not convinced that there is any widespread military mission remaining in Afghanistan. Why are we still there in great numbers? I agree that we should pull out most of our troops but monitor for real life threats to the U.S. I suspect that Obama is afraid to leave for fear of looking weak. That's not a good reason to keep thousands of troops anywhere.

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George Lakoff offers some framing tips to the Democrats re health care reform

Linguist George Lakoff is asking how a man who did such a marvelous job campaigning for President has stumbled so often on the issue of health care. Lakoff thus wrote an article offering some a list of language/framing advice to the Democrats. Here's the foundational concept:

The list of what needs reform makes sense under one conceptual umbrella. It is a public alternative that unifies the long list of needed reforms: coverage for the uninsured, cost control, no preconditions, no denial of care, keeping care when you change jobs or get sick, equal treatment for women, exorbitant deductibles, no lifetime caps, and on and on. It's a long list. But one idea, properly articulated, takes care of the list: An American Plan guarantees affordable care for all Americans. Simple. But not for policy wonks.

The policymakers focus on the list, not the unifying idea. So, Obama's and Axelrod's statements last Sunday were just the lists without the unifying institution. And without a powerful institution, the insurance companies will just whittle away at enforcement of any such list, and a future Republican administration will just get rid of the regulators, reassigning them or eliminating their jobs.

According to Lakoff, Obama needs to break out of his wonkish way of talking about health care. He is mistakenly operating on the principle of "policy speak":

If you just tell people the policy facts, they will reason to the right conclusion and support the policy wholeheartedly.

Lakoff argues that "policy speak" is a big mistake. Mere facts don't win arguments. Rather, the facts need to make sense to people, resonate with them and inspire them to act. Here's Lakoff's version of what should be Obama's basic message:

Insurance company plans have failed to care for our people. They profit from denying care. Americans care about one another. An American plan is both the moral and practical alternative to provide care for our people.

The insurance companies are doing their worst, spreading lies in an attempt to maintain their profits and keep Americans from getting the care they so desperately need. You, our citizens, must be the heroes. Stand up, and speak up, for an American plan.

Lakoff has lots of specifics. For instance, remind Americans that health care is a patriotic duty. Highlight the phrase "doctor-patient care." Deny that the insurance companies care; rather, they clearly communicate that insurance companies make money by depriving us of care. Hammer the phrase "insurance company bureaucrats." Tell Americans that their health care premiums are "private taxes" levied by insurers. Remind Americans that health insurers "govern our lives." Talk about the "failure" of insurance companies. The "villainizing of real insurance company villains should have begun from the beginning. George Lakoff is asking how a man who did such a marvelous job campaigning for President has stumbled so often on the issue of health care. Lakoff thus wrote an article offering some a list of language/framing advice to the Democrats. Here's the foundational concept:

The list of what needs reform makes sense under one conceptual umbrella. It is a public alternative that unifies the long list of needed reforms: coverage for the uninsured, cost control, no preconditions, no denial of care, keeping care when you change jobs or get sick, equal treatment for women, exorbitant deductibles, no lifetime caps, and on and on. It's a long list. But one idea, properly articulated, takes care of the list: An American Plan guarantees affordable care for all Americans. Simple. But not for policy wonks.

The policymakers focus on the list, not the unifying idea. So, Obama's and Axelrod's statements last Sunday were just the lists without the unifying institution. And without a powerful institution, the insurance companies will just whittle away at enforcement of any such list, and a future Republican administration will just get rid of the regulators, reassigning them or eliminating their jobs.

According to Lakoff, Obama needs to break out of his wonkish way of talking about health care. He is mistakenly operating on the principle of "policy speak":

If you just tell people the policy facts, they will reason to the right conclusion and support the policy wholeheartedly.

Lakoff argues that "policy speak" is a big mistake. Mere facts don't win arguments. Rather, the facts need to make sense to people, resonate with them and inspire them to act. Here's Lakoff's version of what should be Obama's basic message:

Insurance company plans have failed to care for our people. They profit from denying care. Americans care about one another. An American plan is both the moral and practical alternative to provide care for our people.

The insurance companies are doing their worst, spreading lies in an attempt to maintain their profits and keep Americans from getting the care they so desperately need. You, our citizens, must be the heroes. Stand up, and speak up, for an American plan.

Lakoff has lots of specifics. For instance, remind Americans that health care is a patriotic duty. Highlight the phrase "doctor-patient care." Deny that the insurance companies care; rather, they clearly communicate that insurance companies make money by depriving us of care. Hammer the phrase "insurance company bureaucrats." Tell Americans that their health care premiums are "private taxes" levied by insurers. Remind Americans that health insurers "govern our lives." Talk about the "failure" of insurance companies. The "villainizing of real insurance company villains should have begun from the beginning. I recommend reading Lakoff's entire article, which is detailed, and thoughtful."

Continue ReadingGeorge Lakoff offers some framing tips to the Democrats re health care reform