30. August 2009 by admin.

 When Europeans – the British included – contemplate the battles president Obama must fight to reform our health system, their first response tends to be disbelief. How can it be that so obvious a social good as universal health insurance, so humane a solution to common vulnerability, is not sewn deep into the fabric of the United States? How can one of the biggest, richest and most advanced countries in the world tolerate a situation where, at any one time, one in six of the population has to pay for their treatment item by item, or resort to hospital casualty wards?

Their second response, as automatic as the first, is to blame heartless and ignorant Republicans. To Europeans, a universal health system is so basic to a civilised society that only the loony right could possibly oppose it: the people who cling to their guns, picket abortion clinics and block funding for birth control in the third world. All right, Europeans are saying to themselves, there are Americans who think like this, but they are out on an ideological limb.

If only this were true. The reason why the president is finding health reform such a struggle – even though it was central to his election platform – is not because an extreme wing of the Republican Party, mobilised by media shock-jocks, is foaming at the mouth, or because Republicans have more money than Democrats to buy lobbying and advertising power. Nor is it only because so many influential groups have lucrative interests to defend – although this is a big part of it.

It is because very many Americans simply do not agree that it is a good idea. And they include not only mainstream Republicans, but Democrats, too. Indeed, Obama’s chief problem in seeking to extend health cover to most Americans is not Republican opposition: he thrashed John McCain to win his presidential mandate; he has majorities in both Houses of Congress. If Democrats were solidly behind reform, victory would abide.

The unpalatable fact for Europeans who incline to think that Americans are just like them is that Democrats are not solidly behind Obama on this issue. Even many in the party’s mainstream must be wooed, cajoled and even – yes – frightened, if they are ever going to agree to change the status quo. Universal healthcare is an article of faith in the U.S. only at what mainstream America would regard as the bleeding- heart liberal end of the spectrum.

As some of Obama’s enemies warned through the campaign – and I mean warned, not promised – this is the philosophical terrain where, his voting record suggests, this President is most at home. But many more are not. The absence from the Senate of Edward Kennedy and Hillary Clinton has left his pro-reform advocacy in the legislature sorely depleted.

But there is something else at work here, too, beyond defective advocacy, and it lays bare a profound misunderstanding. Europe hailed president Obama’s landslide election victory as evidence that America had reclaimed its better self, turned to the left and bade farewell to ingrained racial divisions as well. That was a benevolent, but ultimately idealistic, gloss.

Barack Obama’s victory can indeed be seen as a reaction to eight years of conservative Republicanism under George Bush and a turn by U.S. voters to the left. But that left is still quite a bit further right than in most of Europe. Nor was it just a leftward turn that cost John McCain the White House; it was also a rejection of the weaker candidate. Obama’s great asset was that he came across as more competent on the economy, at a time of global financial meltdown. From the other side of the Atlantic, they convinced themselves that Americans had voted with their hearts, but there was a considerable element of the wallet as well.

That wallet element helps explain the deep-seated misgivings that have surfaced about president Obama’s plans for health reform. *A majority of Americans believe they have adequate health cover.*{see side bar below} Their choice of job may be limited by their insurance requirements (and labor mobility reduced). And their calculations may be upset – sometimes disastrously – by accident or illness.

But with most pensioners protected by Medicare, an “I’m all right” attitude prevails. It coexists with the fear that extending the pool of the insured, to the poorer and more illness-prone, will raise premiums for the healthy and bring queuing, or rationing, of care. The principle that no one should be penalised financially by illness is trumped by the self-interest of the majority, then rationalised by the argument that health is a matter of personal responsibility.

The point is that, when on “normal”, the needle of the U.S. barometer is not only quite a way to the political right of where it would be in Europe, but showing a very different atmospheric level, too. FOR THERE IS A MEAN AND MERCILESS STREAK IN MAINSTREAM U.S. ATTITUDES, which tolerates much more in the way of inequality, deprivation and suffering than is acceptable there, while incorporating here a large and often sanctimonious quotient of blame. (Some put this divergence down to the ideological rigidity that led Puritans and others to flee to America in the first place; others to the ruthless struggle for survival that marked the early settlement years and the conquest of the West. Still others see it as the price the U.S. pays for its material success.)

FOR EXAMPLE, Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, does not own a television, so it took him several days in late July to discover he had been singled out by opponents of health-care reform as a “deadly doctor,” who, according to an opinion column in the New York Post, wanted to limit medical care for “a grandmother with Parkinson’s or a child with cerebral palsy.”

Within days, the Post article, with selective and misleading quotes from Emanuel’s 200 or so published academic papers, went viral. Minnesota Representative Michelle Bachmann, a fierce opponent of Obama’s reform plans, read large portions of it on the House floor. “Watch out if you are disabled!” she warned. Days later, in an online posting, former Alaska Governor Sarah Palin attacked Emanuel’s “Orwellian thinking,” which she suggested would lead to a “downright evil” system that would employ a “death panel” to decide who gets lifesaving health care. By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel’s plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. “Every American needs to read this,” he declared.

The attacks on Emanuel are a reminder that there is a fair sized slice of unconscious Americans who not only don’t trust government, but also have come to regard it as a dark conspirator in their lives. This peculiar brand of distrust helps create the conditions for fast-moving fear-mongering, especially on complex and emotionally charged topics like the life and death of the elderly and infirm. Prairie fires of that kind are hard to douse when the Administration’s own plan for health care remains vague, weeks away from being ready for a public rollout. The health-care bill that recently passed the House does not contain, as some have suggested, any provisions that would deny treatment to the elderly, infirm or disabled like Sola’s son. One provision allows doctors to be reimbursed for voluntary discussions of so-called living wills with patients, but does not in any way threaten to deny treatment to dying patients against their will. The legislation anticipates saving hundreds of billions of dollars by reforming the health-care system itself, a process that would try to increase the efficiency of medical care by better connecting payments to health outcomes and discouraging doctors from unnecessary tests and procedures. The Obama Administration hopes that many of these reforms will be made in the coming years by independent panels of scientists, who will be appointed by the President and overseen by Congress.
 
This is where the criticism of Emanuel enters the picture, since he is just the sort of scientist who might be appointed to one of those panels. For decades, Emanuel has studied the ethics of medical care, especially in situations where a scarcity of resources requires hard decisions to be made. His work sometimes deals with the hardest possible decisions, like how to choose who gets a single kidney if there are three patients in need, or the reasons that doctors order tests with little medical value. Emanuel’s reputation ranks him among the top members of his field. He is published often in the best journals; he has been given multiple awards for work to improve end-of-life care. At the White House, he has taken a free-floating role at the Office of Management and Budget, advising on a wide range of health issues.

But in the United States, where citizen consciousness is in short supply, Emanuel has become a proxy for all the worst fears of government efforts to rein in costs by denying care. It would require a collective unconscious to believe this, and indeed, most of this country (and the world) are unconscious.

In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources. She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy. She notes that he has criticized medical culture for trying to do everything for a patient, “regardless of the cost or effects on others,” without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value. “No one who has read what I have done for 25 years would come to the conclusions that have been put out there,” says Emanuel. “My quotes were just being taken out of context.” And I, for one, totally believe him, and in him, as well.

For Emanuel, the entire experience has been a painful education in the sometimes brutal ways of politics, something his brother has long endured and dolled out. But that appreciation does not solve the question raised by the controversy. There is universal understanding that the nation’s fiscal course is doomed without major changes to health care. Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out.

{*}I just can not stress strongly enough how important it is that citizens make their voices heard on the issue of creating a real health care system in the United States. Democracy is about compromise until that becomes impossible and it transmutes into a zero sum game determined by a vote. That is the way it is supposed to work. But there are powerful institutional forces that oppose this and have vast buckets of your money — collected from you, or your employer, as monthly fees — and a deep commitment not to see their rice bowls broken or diminished. We must stand up as the majority and take time and go to a townhll meeting, and contact our Representatives and Senators, and the White House. We want national health care, like every other First World Country.

If we fail to reform our health care system this year, a major reason will be that a majority of Americans are satisfied with their health coverage and believe that reform could hurt them. According to a recent (unscientific) Consumer Reports survey, 64 percent of readers are satisfied with their plans — down from 67 percent in 2007, but still a clear majority. A recent New York Times poll found that 59 percent of Americans do not think that health-care reform will benefit them personally; 69 percent are concerned that reform could harm the quality of their own care and 68 percent are concerned that it could limit their access to treatment.

This is deeply misleading, for two reasons. First, what does it mean to say that you are satisfied with your health insurance? Consider homeowner’s insurance. Until you need it — your house burns down — you have no way of judging its quality. The same goes for health coverage; until you have a serious illness, the kind where your plan’s limits and exclusions may kick in, how do you know if your health coverage is any good?

For one thing, as the House Energy and Commerce Committee uncovered, some insurers go out of their way to revoke coverage for people with serious health problems by looking for mistakes on their original applications. For another, you could be underinsured, like 29 percent of all people with health insurance, according to Consumer Reports. It is politically relevant that two-thirds of Americans seem to like their health coverage, but whether they should like it is another question.

The second problem is that the health coverage that most satisfied Americans have — employer-based coverage — is less secure than they think. In America today, we have three main health insurance systems. At one end we have Medicare and the Veterans Health Administration, which (although many anti-reform protesters don’t realize it) are government-funded and government-run programs, and generally popular ones. At the other end we have the individual market, in which individuals buy insurance policies directly from health insurers. The individual market is completely broken; according to a recent Commonwealth Fund study, 73 percent of people who tried to buy individual coverage in the last three years did not end up buying a plan.

In the middle we have the employer-based system, which according to the U.S. Census Bureau covered 59 percent of the population in 2007. The employer-based system is good and bad. On the plus side, it solves the fundamental problem of the individual market. Again, think about homeowner’s insurance. The insurance company figures out how much your house is worth, estimates the chances of it burning down, multiplies those numbers together, and charges you that much (plus a little to cover expenses and profit) in premiums. That is, the cost of a policy should be related to the expected costs of that policy to the insurer.

Now translate this to health insurance and you’ll see why the individual market is broken. If you have a serious illness, like cancer, your expected annual costs could easily be $60,000. The insurer has to charge you at least $60,000 for coverage, or else it will lose money. You can’t afford that, so you go without insurance. According to the Commonwealth Fund, 70 percent of people with health problems found it impossible or very difficult to find affordable coverage in the individual market. In short, a “market” for health insurance works only if you prevent insurers from doing what insurers naturally do — discriminate among people according to how risky they are.

The employer-based system solves this problem. Employers can spread the cost of health insurance across their workforces, so that all employees are treated equally, regardless of their medical history. Furthermore, the tax rules governing employer-provided health care require that employers offer plans that treat all employees equally. The result is that if your employer provides health coverage, you can probably get it.

However, the employer-based system has two major weaknesses. First, and most obviously, it means keeping your health insurance is dependent on keeping your job. That means that your health is only insured to the extent that your job is insured — and your job isn’t insured. If you lose your job, or get a divorce from the spouse whose employer covers you, you have to find a new employer who offers a health plan, or you will be stuck in the individual market. Alternatively, if you get sick, you may be stuck in your job, no matter how much you may want or need to leave it.

Second, employers are dropping their health plans; the percentage of people covered through an employer has dropped from 64 percent in 2000 to 59 percent in 2007, and that decline is likely to accelerate. Why? Because, according to a Kaiser Family Foundation survey, the average annual premium for family coverage has already increased from $5,791 in 1999 to $12,680 in 2008 — a 9 percent annual increase — and a study published in Health Affairs forecasts that national health spending will grow at an average annual rate of 6.7 percent until 2017. Arithmetically, with each year that passes, it becomes harder for companies to keep their health plans without reducing benefits, reducing wages or increasing employee contributions to health plans.

The bottom line is that your current health plan may not be as good as you think it is, and there is a good chance that it will not be around when you need it.

Health-care reform comes in several different flavors these days, but the basic minimum is that it allows all people to buy health insurance regardless of medical history, and it provides subsidies to help poor and middle-income families buy health insurance. That means that if you get sick and lose your job, you will still be able to get health care. That is something that everyone should be in favor of — because everyone can get sick and lose his or her job.

JA

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13. August 2009 by admin.

President Obama has recently said the nation’s future depends on “investing in the research and development that will produce the technologies of the future — which in turn will help create the industries and jobs of the future.” In another nod to the value of basic science and technology research, President Obama said long–term investments in innovation are needed to ensure the country’s long-term economic growth.

“That means once again having the best-educated, highest skilled workforce in the world,” Obama said. “That means a health care system that makes it possible for entrepreneurs to innovate and businesses to compete without being saddled with skyrocketing insurance costs. That means leading the world in building a new clean energy economy with the potential to unleash a wave of innovation – and economic growth – while ending our dependence on foreign oil. And that means investing in the research and development that will produce the technologies of the future — which in turn will help create the industries and jobs of the future.
 
We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost,” he said during his inauguration. “We will harness the sun and the winds and the soil to fuel our cars and run our factories. And we will transform our schools and colleges and universities to meet the demands of a new age. All this we can do. And all this we will do.”

The question is whether this nation’s mostly unconscious Congress, along with its mostly unconscious citizens, will hear, let alone heed, his advice when it’s most needed, before the nation loses its role as the world leader in innovation. Or will they make the mistake of turning their backs, as they did on another U.S. president several decades ago, who tried in vain to warn his country’s unconscious citizens of their need to develop inovated energy conservation techniques, and innovative alternative energy research and development technology, to combat the ever looming energy crisis war.

I think it’s important to look at that…………shall we?

President Carter could barely make it past page four. The drafted speech delivered to him at Camp David read like a laundry list of vague energy plans. Carter placed a call from Camp David to the White House. “Cancel it”, the president said. “There’s more to it than energy,” Carter explained.

And then the president seemed to disappear. He stayed at Camp David for ten days. He invited a string of visitors from different walks of life. Details were mysterious; the press was locked out. The president had vanished to search his soul - and the nation’s soul - on his mountaintop retreat.

Bill Clinton was then a young thirty-two-year old governor of Arkansas, having severed the state as attorney general. So he was invited to Camp David. When Clinton sat in the Laurel Lodge conference room on July 11, he listened to the president decry the nation’s spiritual state and then told Carter to be more relaxed when he gave his next speech. The boy governor also suggested the president find a bridge between executive action and citizen participation, between a top-down and bottom-up approach. “I strongly urged,” Clinton explained, to show how the “federal government” could help develop “alternative sources of energy” and promote “conversation.” But at the same time, “this is not a problem which government alone can solve. Every individual citizen in this country has a role to play.” Invite ordinary citizens into the public realm, for sure, the governor implored, but expect something back from them. Clinton hammered the message home: “What the people are looking for is someone who will” endorse a “war of independence” in which “everybody has some role and mission to play.”

This wouldn’t be pandering or allowing citizens off the hook. This had to be a national conversation, a back and forth between leader and citizen. Then the president came out of hiding on July 15, 1979, a Sunday, and went in front of the television cameras.

Carter sat at his desk, leaned toward the cameras, pounded his fist, grinned his grin, and let big words and ideas fly. He condemned the American way of life. We as a people, Carter explained, “worship self-indulgence and consumption” and are mired in “fragmentation and self-interest.” “Our people are losing” faith in “the ability as citizens to serve as the ultimate rulers and shapers of our democracy.” He didn’t have to say it but he did anyway: ‘This is not a message of happiness or reassurance, but it is the truth and it is a warning.” he spoke openly of the nation’s wounds - of King’s and Kennedy’s assassinations, “the agony of Vietnam,” and the “shock of Watergate.” He recognized his own weaknesses as a leader and the fact that “all the legislation in the world can’t fix what’s wrong with America.” “I realize that more than ever as president I need your help,” he intoned. It was a speech of humility and honesty and more.

“Good evening. This is a special night for me. Exactly 3 years ago, on July 15, 1976, I accepted the nomination of my party to run for President of the United States. I promised you a President who is not isolated from the people, who feels your pain, and who shares your dreams and who draws his strength and his wisdom from you.

During the past 3 years I’ve spoken to you on many occasions about national concerns, the energy crisis, reorganizing the Government, our Nation’s economy, and issues of war and especially peace. But over those years the subjects of the speeches, the talks, and the press conferences have become increasingly narrow, focused more and more on what the isolated world of Washington thinks is important. Gradually, you’ve heard more and more about what the Government thinks or what the Government should be doing and less and less about our Nation’s hopes, our dreams, and our vision of the future.

Ten days ago I had planned to speak to you again about a very important subject—energy. For the fifth time I would have described the urgency of the problem and laid out a series of legislative recommendations to the Congress. But as I was preparing to speak, I began to ask myself the same question that I now know has been troubling many of you. Why have we not been able to get together as a nation to resolve our serious energy problem?

…………..It’s clear that the true problems of our Nation are much deeper—deeper than gasoline lines or energy shortages, deeper even than inflation or recession.

…………..We have learned that more is not necessarily better, that even our great nation has its recognized limits, and that we can neither answer all questions nor solve all problems. We cannot afford to do everything, nor can we afford to lack boldness as we meet the future. So together, in a spirt of individual sacrifice for the common good, we must simply do our best.”

…………..I will continue to travel this country, to hear the people of America. You can help me to develop a national agenda for the 1980s. I will listen and I will act. We will act together. These were the promises I made 3 years ago, and I intend to keep them.

Little by little we can and we must rebuild our confidence. We can spend until we empty our treasuries, and we may summon all the wonders of science. But we can succeed only if we tap our greatest resources—America’s people, America’s values, and America’s confidence.

I have seen the strength of America in the inexhaustible resources of our people. In the days to come, let us renew that strength in the struggle for an energy secure nation.

In closing, let me say this: I will do my best, but I will not do it alone. Let your voice be heard. Whenever you have a chance, say something good about our country. With God’s help and for the sake of our Nation, it is time for us to join hands in America. Let us commit ourselves together to a rebirth of the American spirit. Working together with our common faith we cannot fail. Thank You and Good Night.”
 
George Bush Jr., several years ago,  suggested that the nation’s “problem” with high gasoline prices was caused by the lack of a national energy policy, and tried to blame it all on Bill Clinton. First, Junior said, “This is a problem that’s been a long time in coming. We haven’t had an energy policy in this country.”

This was followed by, “That’s exactly what I’ve been saying to the American people — 10 years ago if we’d had an energy strategy, we would be able to diversify away from foreign dependence. But we haven’t done that. And now we find ourselves in the fix we’re in.” 

Consider President Jimmy Carter’s April 18, 1977 speech. It was the speech that established the strategic petroleum reserve, birthed the modern solar power industry, led to the insulation of millions of American homes, and established America’s first national energy policy. “With the exception of preventing war,” said Jimmy Carter, a man of peace, “this is the greatest challenge our country will face during our lifetimes.”

He added: “It is a problem we will not solve in the next few years, and it is likely to get progressively worse through the rest of this century. “We must not be selfish or timid if we hope to have a decent world for our children and grandchildren.

“We simply must balance our demand for energy with our rapidly shrinking resources. By acting now, we can control our future instead of letting the future control us.” Carter bluntly pointed out that: “The most important thing about these proposals is that the alternative may be a national catastrophe. Further delay can affect our strength and our power as a nation.” He called the new energy policy he was proposing, “The ‘moral equivalent of war’ — except that we will be uniting our efforts to build and not destroy.”

When Carter had become president the nation was still recovering from the “oil shock” of the 1973 Arab oil embargo, and scientists were realizing our nation was just then hitting the point of domestic peak oil production predicted more than a decade earlier by scientist M. King Hubbert. (The rest of the world is hitting the Hubbert Peak right now.) As Carter noted in his speech, “The oil and natural gas we rely on for 75 percent of our energy are running out. In spite of increased effort, domestic production has been dropping steadily at about six percent a year. Imports have doubled in the last five years. Our nation’s independence of economic and political action is becoming increasingly constrained.” 

“The world has not prepared for the future,” said Jimmy Carter. “During the 1950s, people used twice as much oil as during the 1940s. During the 1960s, we used twice as much as during the 1950s. And in each of those decades, more oil was consumed than in all of mankind’s previous history.” Hubbert said we must begin to conserve. Carter agreed.

“Ours is the most wasteful nation on earth,” he said, a point that is still true. “We waste more energy than we import. With about the same standard of living, we use twice as much energy per person as do other countries like Germany, Japan and Sweden.” Carter directly challenged the fossil fuel and automobile industries. “One choice,” he said, “is to continue doing what we have been doing before. We can drift along for a few more years. “Our consumption of oil would keep going up every year. Our cars would continue to be too large and inefficient. Three-quarters of them would continue to carry only one person — the driver — while our public transportation system continues to decline. We can delay insulating our houses, and they will continue to lose about 50 percent of their heat in waste. “We can continue using scarce oil and natural gas to generate electricity, and continue wasting two-thirds of their fuel value in the process.”

The year 1977 was a turning point for America. If we didn’t make clear and rapid progress, we would face painful times ahead. The Saudis would have their fingers around our necks. We’d face war in the Middle East to secure future oil supplies. “Now we have a choice,” Carter said. “But if we wait, we will live in fear of embargoes. We could endanger our freedom as a sovereign nation to act in foreign affairs.”

Failure to act in the 1970s and 1980s would inevitably lead to a time when the only way to maintain our lifestyle would be to rape our planet and seize control of oil-rich nations in the Middle East. If we didn’t begin to develop alternatives like solar power, and dramatically reduce our consumption of fossil fuels, then, Carter said, even our cherished personal freedoms would be at risk. If we continued to simply follow past policies that enriched the oil industry and the Saudis, instead of becoming energy independent, Carter said, “We will feel mounting pressure to plunder the environment.”

Carter’s speech drew a strong reaction from the Saudis and the oil industry. Think tanks soon emerged - many whose names are today familiar - to suggest there was really no energy problem, and they led the charge to establish a permanent right-wing media in the US. Within two years, Saudi citizen and oil baron Salem bin Laden’s sole US representative, James Bath, would funnel cash into the failing business of the son of the CIA’s former director, political up-and-comer George H. W. Bush. With that money from the representative of Osama Bin Laden’s half-brother, George Bush Jr. was able to keep afloat his Arbusto (”shrub” in Spanish) Oil Company. And he would be in the pocket of the bin Laden and Saudi interests for the rest of his life. But Carter was incorruptible.

“We can be sure that all the special interest groups in the country will attack the part of this plan that affects them directly,” he said. “They will say that sacrifice is fine, as long as other people do it, but that their sacrifice is unreasonable, or unfair, or harmful to the country. If they succeed, then the burden on the ordinary citizen, who is not organized into an interest group, would be crushing.” But that would be wrong. It would be un-American. It would lead to future oil shocks, and the probable death of American soldiers in Middle Eastern oil wars. Instead of caving in to the Saudis and the oil industry, Carter said: “There should be only one test for this program: whether it will help our country.”

Two years later, as the bin Laden family’s sole US representative was bailing out George Bush Junior’s failing oil business, Jimmy Carter gave another speech on energy, further refining his national energy policy. He had already started the national strategic petroleum reserve, birthed the gasohol and solar power industries, and helped insulate millions of homes and offices. But he wanted to go a step further. “I am tonight setting a clear goal for the energy policy of the United States,” Carter said on July 15, 1979. “Beginning this moment, this nation will never use more foreign oil than we did in 1977 — never. From now on, every new addition to our demand for energy will be met from our own production and our own conservation. The generation-long growth in our dependence on foreign oil will be stopped dead in its tracks right now and then reversed as we move through the 1980s…” In addition, we needed to immediately begin to develop a long-range strategy to move beyond fossil fuel.

Therefore, Carter said, “I will soon submit legislation to Congress calling for the creation of this nation’s first solar bank, which will help us achieve the crucial goal of 20 percent of our energy coming from solar power by the year 2000.” But then came the Iran/Contra October Surprise, when the Reagan/Bush campaign allegedly promised the oil-rich mullahs of Iran that they’d sell them missiles and other weapons if only they’d keep our hostages until after the 1980 Carter/Reagan presidential election campaign was over. The result was that Carter, who had been leading in the polls over Reagan/Bush, steadily dropped in popularity as the hostage crisis dragged out, and lost the election. The hostages were released the very minute that Reagan put his hand on the Bible to take his oath of office. The hostages freed, the Reagan/Bush administration quickly began illegally delivering missiles to Iran.

And one of Ronald Reagan’s first official acts of office included removing Jimmy Carter’s solar panels from the roof of the White House, and reversing most of Carter’s conservation and alternative energy policies. And yet today, despite the best efforts of the Bushies, the bin Ladens, and the rest of the oil industry, president Carter’s few surviving initiatives have borne fruit.

It is now more economical to build power generating stations using wind than using coal, oil, gas, or nuclear. When amortized over the life of a typical mortgage, installing solar power in a house in most parts of the US is cheaper than drawing power from the grid. (Shell and British Petroleum are among the world’s largest manufacturers of solar photovoltaic panels, which can now even be used as roofing shingles.) And hybrid cars that get 50-70 miles to the gallon are increasingly commonplace on our nation’s highways.

Instead of taking a strong stand to make America energy independent, Bush kisses a Saudi crown prince, then holds hands with him as they walk into Bush’s hobby ranch in Texas.

In calling for a commitment larger than any in U.S. history, Barack Obama has made science and technology a central theme of his recovery plan for months now. He has declared investment in science research more essential than ever. Even though we are listening, are we hearing him? The unconscious one’s that is. Sadly, they are not. Sadly, most don’t even care.

JA

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5. August 2009 by admin.

It’s not just that many U.S. citizens don’t understand what President Obama is proposing; many of them don’t understand the way U.S. health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance.

And that government involvement is the only reason our system works at all.

The key thing to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.

Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.

And in their efforts to avoid “medical losses,” the industry term for paying medical bills, insurers spend much of the money taken in through premiums not on medical treatment, but on “underwriting” — screening out people likely to make insurance claims. In the individual insurance market, where people buy insurance directly rather than getting it through their employers, so much money goes into underwriting and other expenses that only around 70 cents of each premium dollar actually goes to care.

Still, most people do have health insurance, and are reasonably satisfied with it. How is that possible, when insurance markets work so badly? The answer is government intervention.

Most obviously, the government directly provides insurance via Medicare and other programs. Before Medicare was established, more than 40 percent of elderly citizens lacked any kind of health insurance. Today, Medicare — which is, by the way, one of those “single payer” systems conservatives love to demonize — covers everyone 65 and older. And surveys show that Medicare recipients are much more satisfied with their coverage than those with private insurance.

Still, most of those under 65 do have some form of private insurance. The vast majority, however, don’t buy it directly: they get it through their employers. There’s a big tax advantage to doing it that way, since employer contributions to health care aren’t considered taxable income. But to get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.

And it’s thanks to these rules that employment-based insurance more or less works, at least in the sense that horror stories are a lot less common than they are in the individual insurance market.

So here’s the bottom line: if you currently have decent health insurance, thank the government. It’s true that if you’re young and healthy, with nothing in your medical history that could possibly have raised red flags with corporate accountants, you might have been able to get insurance without government intervention. But time and chance happen to us all, and the only reason you have a reasonable prospect of still having insurance coverage when you need it is the large role the government already plays.

Which brings us to the current debate over reform.

Right-wing opponents of reform would have you believe that President Obama is a wild-eyed socialist, attacking the free market. But unregulated markets don’t work for health care — never have, never will. To the extent we have a working health care system at all right now it’s only because the government covers the elderly, while a combination of regulation and tax subsidies makes it possible for many, but not all, nonelderly citizens to get decent private coverage.

Now Mr. Obama basically proposes using additional regulation and subsidies to make decent insurance available to all of us. That’s not radical; it’s as American as, well, Medicare.

JA

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