"I'm for gay rights but ..."

So for the past few years I've been jousting with my family and loved ones around the issue of same sex marriage and repeatedly found my argument falling on deaf ears. In fact what I most often heard was, "I am for gay rights but..." and what would follow would immediately sweep away any indication of actual support for the union of two people from the same sex. As a service to myself and those with whom I will soon have this discussion with, I'll provide some statements and my rebuttals. Instead of taking our 45 minutes on spinning wheels, let's work and see and if we can cover some different ground.

1) "I'm for gay rights but ... you can't compare being Black to being gay."

I feel you, I understand that being Black is different than being gay, but did you realize even in that statement you're implying that we don't have Black gay folk? No really, this is the part of the conversation where you keep on throwing out "they" which you might as well then say "those people." I know you don't like me bringing that up, because for so long and so often within the dominant White culture of America Black folks are referred to as "they", "those people" and even recently "that one." It's really a process of othering, trying to make a distinction of who is "in" and should receive privileges and who is "out" (pun intended).

2) No, you're not getting it, I didn't choose to be Black and I can't hide being Black.

Touche, you're probably don't remember when you chose to be Black, if you ever did. In fact, since we're talking - heterosexual to heterosexual, I don't remember when I choose to be straight, but that's besides the point. The point is that being "Black" and being "gay", as we sociologists say are both "socially constructed". Yeah, fancy academic words but definitely important. By socially constructed I mean that we create the boundaries and meanings for these categories. There is a great film that breaks this down and books, but let's be real, you ain't gonna pick up a book or watch a movie in the middle of this blog post, so let me do what I can to break it down now. While we've come to think of meaning of Blackness as something that can't be changed, avoided, and pretty much is like gravity, we've forgotten that was created. In fact, the dominant images and tropes of "What is Black", weren't even our creation. Think about it, how many people who identify as Black, would say "my skin is actually the color of Black." Very few, in fact, we respond by saying things like "I'm brown, caramel, dark chocolate, etc." all descriptors that side-step an imposed moniker. Also have we forgotten that for so many years, the oppression of being Black and not having access to rights made many of our ancestors pass? Yeah, that's right, not all of us are "definitively Black" and certainly what it means to be Black has carried consequences.

3) That's my point, almost exactly, you can tell when someone is Black usually, but you never know if they're gay! Well unless they're really flamboyant or something.

Ah, I get it, if you are gay you don't have to "look or act gay" and if you don't act gay, you'll be fine in society. Yeah, that's called passing ... well actually more appropriately covering. See, as a Black folks, I really hope we think deeply about oppression and how oppressive it must be to not be able to show your love for someone else. If I walk outside and decide to kiss a strange woman in the middle of the street I won't get many strange glares (other than folks saying "Dumi's a wild cat") but if I love someone of the same gender and walk arm-in-arm with them down the street I'm likely to get screw faces down the block. As a result, we, heterosexual folks often say stuff like, "I don't care what you do behind closed doors but I don't want to see it." Interesting... we live in a society were the physical expression of romantic love between people is common, but almost completely forbidden for certain groups. In order to be one's self we ask people not to express themselves and "pass" or "cover" for straight. That doesn't sound very equal or liberated to me. Can you imagine a community where love was the norm and hate was not what we used to regulate others behaviors? (that's rhetorical)

4) Okay, I get that, but doesn't it piss you off when they use the Civil Rights Movement for their movement?

Once again, what's up with the us and them type of thinking. Gay Black folks have been around for a long time, to act as if they are not us is to deny part of ourselves. In fact, the most prominent voice and architect of the Civil Rights Movement was Martin Luther King Jr. His work centered on non-violence which he derived from Gandhi but he learned from Bayard Rustin who was a queer Black man. Gay, Lesbian, Bi and Queer Black folks have been at the center of our movement for rights as well as our cultural and social uplift, why try to write them out of history now? Or rather why not acknowledge the central role they've played in the collective Black struggle which should include lgbtq brothers and sisters? We can only say gay folks are piggy-backing on the civil rights movement if we don't acknowledge the contribution of gay folks to the movement. Now has the equal rights movement around sexuality taken on some tropes that came along during the Civil Rights movement, absolutely! But all subsequent movements do that, in fact, a marker of a successful social movement is an adoption of some its techniques. But let's not forget what the Civil Rights Movement was about! It was fighting to make the 14th and 15th amendments real!!! Those amendments legally gave Black folks equal civil rights but when we looked at how Black people were treated and what they could do, it is seen that it's unequal. I think we can take a similar look at the Gay Rights movement which is simply fighting for the same rights that heterosexuals have, be it marriage, adequate healthcare, or to live freely in society.

5) I hear what you're saying but God made "Adam and Eve" not "Adam and Steve"! We're a Christian country and marriage is a bond before God between man and woman.

Ah, you got me with that one, I didn't realize a rhyme could break down an entire situation. Oh wait, no it can't. There is an entrenched myth in this country that marriage is exclusively a religious, often insinuated Christian, practice that the government sanctions. Not true at all, anthropologists have long observed and discussed marriage as beyond Christian and beyond the sanctioning of the state. It is true here that many associate the two, but that does not seem logical that it must also be seen as such. First, the mythos of the United States as Chrisitian nation is based on ignoring that colonies were founded out of the fleeing of religious oppression. How ironic is it that religion would then become the basis for oppression in 2009 and 1619 when non-Christian Africans arrived in captivity and quickly were proclaimed subhuman and savage. If you are going to invoke the credo of a nation, then I'd suggest you invoke the ones of equality and diversity, which means you are welcome to have your beliefs but your beliefs should not be the basis for impinging on other's rights.

Now I know by this point you likely still don't agree with me, but I do want you to see there is validity to a discussion about gay rights and the civil rights or more importantly gay rights as civil and human rights! I do want you to see that all to often we neglect and relegate a part of our people to inhumane and unjustified treatments through our active and passive condoning of covering. I do want us all to think about what MLK meant when he said, "Injustice anywhere is a threat to justice everywhere." I do want us to really grapple with the fact that if Huey Newton in the 1970s could see the connection, we should be able to see it in 2009. I wrote this because I worry about a people's ability to turn a blind eye to injustice in a world and nation that often has suggested the unjust is just the way it should be. For a people who have fought for existence and rights, it should only be natural to continue that fight with our brothers and sisters.

***this piece is designed to be a primer and conversation starter. there are many more things to say, but wanted to get the ball rolling and get some basic ideas out there***

On America's Moral Barometers...

So, Plaxico Burress just got a 2-year jail sentence for carrying a licensed gun into a nightclub and shooting himself in the leg, but nobody else. Michael Vick just got reinstated to the NFL after serving 2 years in jail for his role in financing a dog-fighting racket. In both cases, lots of people have voiced outrage as to the supposed leniency in their cases. I'm not saying they are necessarily wrong (though I really think Burress' sentence is kind of crazy), nor am I condoning their actions...but do these people follow the news????


I mean, seriously, is Michael Vick the guy we need to go after? I get it, he played a part in something horrible, especially if you are a dog-lover (I'm indifferent, but can sympathize), but understand that the harm he inflicted, while obviously bad, was limited...and he paid his dues by going to jail and losing his money. Same will happen to Plax, whose football career is essentially over - 2 years in jail for a wide receiver at Burress' age means nobody will sign him when he's out. Barry Bonds, the home-run king, has essentially been blacklisted by Major League Baseball, and the players in general have come under fire for their use of steroids, but nobody is talking about the owners who looked the other way in the 1990s when juice-induced homers were filling the seats and their pockets. Michael Phelps, Olympic hero (and University of Michigan grad - go Blue!), attracted so much criticism for his admission that he had smoked marijuana in the past.

I'm not sure what the hell happened to America, but since when were sports athletes our moral barometers? Seriously. I'm not condoning any of the actions mentioned above, but give me a break. I'd say, at the very least, we should hold our leaders more accountable than the guys we watch throw spirals, right? I get the outrage some people felt when Vick was let back into the league, but, again, he actually paid for his crimes. How many of our leaders have done no such thing? How many people in far more important positions involved in far more serious matters have gotten away with murder? Literally? Yet, America directs more of its outrage at NFL stars doing dumb and horrible things than Kellogg Brown and Root (KBR - a former Halliburton subsidiary), who got some sweet contracts from the US government (and who says having friends in high positions, like Dick Cheney, et. al., doesn't pay?) in Iraq, have misused a lot of the money, and most importantly, may have done such a shoddy job on electrical wiring that that this work killed 16 US soldiers due to electrocution this past year. In some of the cases, the Pentagon already announced no criminal charges will be filed. Well, of course not. Paying a company $80 million to wire facilities in Iraq, and then have a number of US soldiers die because they were electrocuted in showers in those facilities, doesn't seem to be a serious matter at all. Totally not linked, you know, wiring and multiple electrocution deaths in showers. Now, if you really want to talk about morality, let me tell you about Michael Vick...

Speculation is that Burress got a pretty harsh sentence because Mayor Bloomberg wanted to make an example out of him. Okay. So, let me see if I got this right. You want to make an example out of somebody for doing something bad. In New York city. Um...do you know Wall Street is in the area? Because, while Plax is a fool for carrying a gun into a club, and he definitely could have potentially done a lot of harm, he actually only shot himself, whereas our "great" business minds on Wall Street ran amuck and broke our economy with their recklessness, causing a hell of a lot of real harm to countless Americans. What some of them did was totally criminal. So...lets throw the book at Plax instead!

How many laws did the Bush administration break? It seems like we're still getting stories every few weeks about something insane and criminal they did to this day. What are the consequences? None, basically, because they were only the leaders of our country. John Yoo teaches at Berkeley. Dick Cheney seems ready for his own prime time television show. Alberto Gonzalez still can't remember a damn thing and will be teaching political science courses (why, god, why?) at Texas Tech. George W. Bush is putting together a think tank (no, that's not a joke). None of them are in jail. None of them went to trial to go to jail. And I doubt any of them will. While this is killing some progressives across the country (and people in general around the world), the general mood in America is, we shouldn't go after these guys. Awesome. We've got bigger fish to fry. Athletes. Rappers. Not guys who lie to Congress in sworn testimony - he totally doesn't deserve to go to jail.

Over time, it seems like the people we should be holding up to higher moral and civic standards in our country are acting in absolutely appalling ways. And, most importantly, they're getting away with it. Rachel Maddow shouldn't be one of the only people reporting on "the Family" at the C St. House, for instance, an institution that includes Congressional leaders who use taxpayer money to learn about coercion from some of the worst dictators around. Why hasn't there been wider coverage of Bobby Jindal using taxpayer dollars to fly to churches all over Louisiana to give communities checks with his name on it that came from the Obama stimulus bill that Jindal so openly deplored? How about really leaning heavily on Governor Sanford for being completely out of touch with everyone while he went down to Argentina to visit his mistress? Forget the affair, a governor of the state can't just leave town (and country) without telling anyone. By the way, he used taxpayer dollars for several of those trips before, and lots of taxpayer dollars in other inappropriate ways. Maybe he will be impeached (there seems to be some movement towards it), but political leaders sure seem to get away with a lot, so I'll believe he's held accountable when I see it. Now, if he was Michael Phelps, different story...

Charles Barkley famously quipped years ago that he wasn't a role model. Well, I think whether they want to be or not, athletes (and lots of other people in the public limelight, like musicians, actors, writers, etc.) have no choice but to be role models. That means acting responsibly, and paying the price when they don't. Oftentimes, they do get away with a lot. But sometimes they don't. On the other hand, there is no doubt our political, civic, and business leaders should be role models, far more than athletes, etc.. They are engaged in far more serious issues than entertaining us. Somewhere along the line, though, we shifted our moral barometers. Guys like Dick Cheney became untouchable, but guys like Barry Bonds became lightning rods for debates about "what was wrong in America." Well, I think the fact that the discussion has moved to that level might begin to tell us what is wrong in America.

Note: I realize I went after a lot of Republicans here...that's just because its easier, given the insane number of ridiculous scandals they've been involved with, but please don't think my point here is a partisan one. It's about the insanity of holding athletes, entertainers, etc., up to be the moral barometers of this country, while giving our actual leaders, in politics, in business, in civic life, a much easier pass.

Losing Wars We Already Won (Part I): Torture vs. WWII

Over the past century, our nation has triumphed over two sets of aspiring global tyrants: the axis powers in WWII, and the Soviet Union in the Cold War. Our victories over these foes were, in each case, world-historical in scale and importance. Yet within less than a century, we now flirt with losing the principles those successes established.

First, our recent record on torture, and more recent failure to prosecute all officials involved in enabling it, undermines the legacy of international human rights we established after the Second World War. Second, after vindicating freedom, liberty, and individual privacy in the Cold War, we now dutifully submit to a surveillance state more intrusive than any that has ever existed in human history.

In other words, Bush and Cheney succeeded in doing what neither Nazi Germany nor the Soviet Union could: eviscerate American values and undermine our grandest foreign policy accomplishments since the turn of the 20th century. And while President Obama's aim to “look forward, not backward,” may resemble a thoughtful political compromise, it is an illegal capitulation to illegitimate political interests carrying profound consequences for human rights and freedom both in the U.S. and around the world.

WWII and Human Rights...

The allied powers fought the Second World War largely in the name of human rights, which we enshrined in its wake with a series of international institutions. The United Nations was perhaps the most ambitious example; others include various treaties setting baseline standards for (among many other things) the treatment of detainees during wartime.

International institutions to ensure collective security represented a major leap forward for humankind, akin to the Apollo moon landing 20 years later. Not since the Treaty of Westphalia in 1648 had international relations undergone so fundamental a transformation. A core tenet of the post-WWII era, established by the Nuremberg Trials of former Nazi officials, held that individuals bear criminal liability for violating international human rights regardless of what domestic laws my authorize their conduct. The “following orders” defense was soundly rejected and officials up and down the chain of command faced justice for war crimes.

We Americans have been called upon to apply these principles to our own leaders only 60 years later. But our willingness to preserve our earlier achievements has proven lacking.

...vs. Torture with Impunity

Despite public pressure from voices across the political spectrum, the Obama administration continues to sweep torture under the rug. And while the Holder Justice Department has demonstrated welcome independence by recently announcing a limited investigation led by a special prosecutor, it could be worse than none at all if senior officials enjoy effective immunity.

First, investigating only junior level scapegoats would set a legal precedent that decisionmakers can violate human rights with impunity. Second, overlooking senior officials who set torture policies would confer artificial legitimacy on the range of offenses that were officially approved, despite their international illegality. While the current cover-up threatens the rule of law and real accountability is necessary, scapegoating could be even worse than doing nothing.

Failing to follow the key Nuremberg precedents--that “following orders” cannot justify war crimes and that liability transcends the chain of command--weakens them in the future. Mere omission vindicates lawlessness: sitting on our hands or prosecuting only some individuals involved will undermine the international legal framework we erected after defeating the Axis powers.

Immunity for any officials involved in torture will lead to an unfortunately predictable result: a global race to the bottom in human rights standards. Every two-bit despot the world over will claim a license to torture, maim and perhaps even kill at will.

Rather than stand accountable to the international community, any accused torturer need merely cite the Holder precedents (allowing perceived necessity to justify war crimes and resurrecting the lame “following orders” defense) to escape justice for whatever manner of abuse they might concoct. Even today, torture by U.S. officials reportedly continues at Guantanamo Bay, where Immediate Reaction Forces have killed at least one detainee while administering brutal force feedings lacking even sanitation, let alone anesthesia.

Moreover, by eroding a principle so fundamental as the prohibition on torture, underinclusive prosecution renders more palatable the full range of other international law violations. If even torture doesn't justify prosecuting everyone involved, why would, for instance, poaching endangered species or violating the ban on ozone-producing chlorofluorocarbons (CFCs)?

When attempting to justify their desire to sweep torture under the rug, apologists argue from both sides of their mouths. Accepting the “following orders” defense, they suggest that investigators ignore wrongdoing by interrogators who committed torture, yet conversely demand that senior officials who issued those orders should also escape investigation (despite their even greater culpability). Apologists wish to avoid “chilling current intelligence operations,” but given the dismal performance of our intelligence agencies, a little transparency and accountability is long overdue.

Examining other examples of prosecution offers even more reasons to pursue a robust and thorough--rather than artificially limited--investigation. Unless expanded from its initial contours, prosecutor John Durham's investigation will allow the architects of torture policy to remain free, while only other country's torturers face justice (or for that matter, while non-violent offenders in America receive prison sentences for less severe crimes). The resulting contrast and lack of proportionality could erode the legitimacy of both the international legal regime generally, and our own criminal justice system, in one fell swoop. Few discrete decisions--and even fewer omissions--could do so much damage so quickly to such vital institutions.

Our failure to apply the Nuremberg precedents threatens to sacrifice a civilizational advance as major as the printing press. Perhaps we should be less surprised, however, given that U.S. torture policy boasts a long, unapologetic history across a disappointing number of contexts. The result will ultimately turn on how much (and how sincerely) we honor the sacrifice of veterans who died in WWII--and whether everyday Americans committed to the legacy of human rights they established see fit to raise our voices.

This article was originally posted on Huffington Post.

Health Care Reform: Correcting the misinformation

For the past three years I’ve been doing health policy research with the hope of helping to inform our elected officials about both the issues in our health care system and potential solutions. With the all of the news coverage of townhalls, speeches and protests regarding health reform, it has occurred to me that many people are horribly misinformed about many of aspects of our current health care system and the reforms being debated. I am always open to discussing these and other potential policies, so let me know if you want to chat. But before a more in depth conversation, I think there are some key aspects of the debate that need to be addressed.

What is health care reform?

There are many different aspects to health care reform, which include reforming the way we use the doctor, how the doctor diagnoses and treats us, and how it is all paid for. The items being discussed in the Senate and House are less about reforming health care (the way we use the doctor and how he/she diagnoses and treats us) and more about reforming the health insurance industry and market (how is the doctor paid for the visit and how do we pay for insurance).

Why is health care reform even needed?

There are about 50 million Americans who don’t have health insurance and thus don’t have the ability to go to the doctor like you and I do. They are unable to make an appointment with a regular private physician and often either delay care or end up in the emergency room to receive care which could have easily been done by a regular doctor. This is important not just because I believe that everyone should have access to health care, but also because the emergency room costs more than going to visit a doctor in his or her office. These costs, if they are not covered by insurance or the government, are passed on to the rest of us in the form of higher health care costs.

While the costs of health care are high for each of us, they are even higher for the government. Medicare, which is the government run health insurance program for those over 65 years old (and certain other key groups), is a huge cost to our federal government. Medicare is one on the fastest growing costs to the federal government. We need to do something now to lower health care costs to ensure that Medicare is available for all of us when we retire. The longer we wait the higher health care costs will become.

What are the goals of health care reform?

The main goals are to insure those who currently lack health insurance and to reduce overall health care costs.

So what does a public health insurance option do?

The public health insurance option is a way to reign in health care costs by creating competition with the private health insurance companies. This will force the private health insurance companies to have competitive pricing and benefits for all of us, because if they don’t people will choose to purchase health insurance through the government.

This public health insurance option is a government takeover of health care, right? It means that we are going to have a system like the UK or Canada, right?

Absolutely not. Think of the public health insurance option as a Medicare type program that the rest of us can buy into, if we want to. So if I am 61 and want to retire, but am too young for Medicare but can’t buy health insurance from the private market, I’ll be able to choose to purchase it from the government. It does not mean that private health insurance companies are going to go away or out of business. Trust me, they are doing just fine. In fact, the CEO of United Health Group made more than $125 million last year. Not to mention a recent report by the nonpartisan Congressional Budget Office found that adding a public option will not force the private insurance companies out of business. For those of us with health insurance that we are happy with, we likely won’t see any changes, expect lower prices in the future.

I heard that the health insurance reforms will allow a bureaucrat decide who gets health care and who doesn’t, is this true?

No, that is exactly what these reforms are trying to stop. There are thousands of us, each day who receive a letter from the insurance company saying that the treatment or health care that was provided will not be covered and we are not required to pay tens of thousands of dollars for the care we received or our loved ones received. Not to mention, our doctors currently will only provide a treatment if they know it will be paid for by the insurance. These are examples of a bureaucrat between you and your doctor making treatment decisions. The government is trying to remove that bureaucrat with these reforms. Currently, health insurance companies can drop coverage when you get sick (after paying premiums for years) because of some undisclosed ailment you had when you signed up. The proposals being debated in the House and Senate are trying to stop this practice and trying to ensure that we all receive the health care that we need.

There have been several rumors about death panels and euthanasia in the recent days. These are completely false. They stem from an inclusion in one of the proposed bills stating that doctors can be reimbursed by Medicare for having discussions with their patients about living wills and other end of life decisions. So if you are enrolled in Medicare and you want to talk to your doctor about those decisions and seek his or her insight into the matters, the doctor will receive payment. This simply creates a financial incentive for doctors to encourage their patients to create living wills and have end of life conversations with our families. The government will not place a value on people’s lives and grant care accordingly.

Are these health care bills going to fix everything?

Unfortunately, no. The health care system in not an efficient system. Ultimately, we need to examine the way we reimburse doctors to ensure we are reimbursing quality and not simply the quantity of services provided. We need to provide financial incentives for doctors that provide high quality care at a lower cost, like the Mayo Clinic in Minnesota does. They provide amazing health care at a fraction of the cost of some doctors and hospitals around the country. In the United States we are paying about twice as much for health care than any other country in the world but receive far worse outcomes than most developed nations. This reform is not going to fix everything, but it is an important step in moving towards lower costs and higher quality care.

As always, feel free to spread the word.

Lies, Damn Lies, and the Health Reform Debate: Hello Insanity!

I personally would have preferred a "hello, Cleveland!", but alas, it is not to be. The health care debate has been absolutely absurd, our leaders in Washington have been absolutely moronic at times discussing it, and the media hasn't really done a great job reporting some basic facts about what is going on - though I give some of them some credit, because their showing the ignorance and straight-up gangsta behavior by people at these town hall meetings is illustrating just how looney some of these folks are. Anyway, we here at the "Spoon" decided to do a little PSA of sorts on health care reform. We hope to have a more detailed analysis up soon, but here's a quick read that we hope will be informative. (Note: this was supposed to be a quick-read piece, but damn it all, I couldn't stop writing!)

First of all, I want to address the town hall meetings and "widespread" public dissent about President Obama's health care reform. #1, a lot of these people that are disrupting these meetings are doing so on the bill of the health insurance industry. So, that tells you something. Rachel Maddow did a nice piece detailing the connections and ties behind this nonsense the other night. Straight-up Hessians, to some degree. #2, those who aren't are saying some of the most incredible things I've heard. So, even if they're actually angrily opposed to reform (as opposed to angry because a paycheck from the insurance industry tells them to be so), they have no clue what they're talking about. That's kind of the media's fault - I realize they're sort of helping by playing these incredibly ignorant comments, but maybe they could spend more time providing basic facts about parameters of the debate on a constat basis to help. "The government needs to keep its hands off my Medicare" is priceless (since Medicare is a government-run program), along with the GOP talking point that health care reform will include a provision that will essentially force euthanasia on seniors, another ridiculous statement. Craaaa-zeee. So, yeah, the "widespread" dissent is largely either being paid for, or is informed by ignorance. Oh, and while I am happy to see public discourse and dissent, "paid for by" and ignorant dissent is not good, particularly when it gets dangerous, especially in settings where the public is actually allowed to participate, as opposed to other boisterous protests where the opposition is loud particularly because it is not ever allowed anywhere near the discussion. A fight broke out at one of the town hall meetings in Tampa where cops had to calm things down, a Texas Democrat was shouted down by right-wingers who didn't even live in his district, a Maryland congressman had an effigy of him hung in opposition to reform (following the loud cheers Rep. Todd Akin received when he joked about Democrats getting lynched at these town hall meetings), and Rep. Brad Miller from North Carolina cancelled his town hall meetings after his office received a death threat. These are troubling signs, and very emblematic of where this debate has gone. Former Right-to Lifer Frank Schaeffer offers us some chilling words on what the reform debate has become.

Second, let's talk about the government role in all of this. Look, the "bureaucrat" in the system that is going to make decisions about your care isn't the government! We already have bureaucrats in the system, except they work for the insurance companies, are often called actuaries, are not health care or medical experts, and make decisions about what is and isn't covered. Again, private insurance...bureaucrat. The public option is the government part of the plan that many on the right are angry about, arguing its socialist and will destroy the private insurance industry. I've already written a little about that in an earlier post. Well, okay, so what is the public option? Its still a work in progress, but basically, it will function as a national health exchange of sorts, essentially being a plan organized and facilitated by the government, not necessarily run by them in the classic sense of the word. The various bills on the Hill right now basically put regulations on the public plan that will require the plan to meet the same benefits and cost requirements of private insurance companies. Obviously, there will be some differences, but no government bureaucrat will sit at a desk and decide what is covered.

Plus, this isn't a single payer system AT ALL! The government is not taking over health care IN ANY REAL WAY with this plan. I can't emphasize the fact that this point needs to be made clear every single time someone raises it. Again, like I said before, the public option involves more government involvement, certainly, but its primarily setting up particular regulations on the type and scope of coverage that can be offered, which is to be modeled on regulations for private insurance. There will most likely be some level of sliding scale subsidies for coverage, based on family income. So, yes, the government will be more involved. But this in no way is even remotely equivalent with government-run health care. And, by the way, I'm not sure whether government-run health care isn't better than private insurance. Medicaid, for instance, covers a substantially sicker population at relatively reasonable per-person rates. Yes, overall Medicaid spending certainly has increased over the past handful of years, but that is being driven primarily by more individuals being covered by Medicaid...largely because employer-based care has eroded. That is to say, public programs like Medicaid and SCHIP have come through to help prevent a larger increase in the uninsured than we've actually seen. Research shows that, when adjusting for health conditions and socioeconomic status, Medicaid is actually less expensive than private insurance. That is to say, if Medicaid patients were on private insurance, getting the same care, their care would cost quite a bit more. Conversely, if people on private insurance were on Medicaid getting the same care, their care would cost less. Again, the reform being postulated isn't the government-run socialist medicine "nightmare" that people are saying it is in any way, shape, or form, but if it was, that might actually not be a bad thing.

Third, about rationing...look, there is a finite supply of money and services, so care is going to probably be rationed to some extent. This is a very hard thing to deal with when the person it affects is someone you love, but understand that we already ration care. Of course, our rationing is primarily based on class. If you have money, you usually get a distinctly different type of health care than if you're not rich. So, the 55 year-old high executive at one of the major banks, who totally blew it and should have been fired on the spot, not only keeps his job, gets bailed out by the government, gets a ridiculous bonus, this person also has great health insurance coverage for the ulcers they got when they thought they were going to be fired because they completely screwed up. A hard-working twenty-something employee at said bank, who did everything right, was a model worker, got laid off, lost a lot due to all types of investments gone awry due to the economic problems partly caused by their own executives, and is now uninsured and is now facing some serious financial difficulties due to a few medical bills. So, what we have is a highly immoral type of rationing of care. I want to have a moral rationing of care, where things like medical conditions and projected health outcomes help determine who gets what. Its far more efficient and far more humane. Again, it makes it tough for those whose loved ones are on the losing end, but at least there is a method to the madness, and we're ultimately helping more people with our difficult calls. That is not the case at all right now.

Fourth, our health care system is not the best in the world. It is, in fact, a middle-of-the-pack health care system, at best. The WHO World Health Report had us at #37 in overall system performance, and #72 in overall health. Not exactly numbers to write home about. A more recent study compared us to six other major nations, and we rank last in pretty much every category. We also ranked last among 19 countries in a survey looking at preventable deaths. We do pretty poor on both issues of access to care and quality of care, and are going in the wrong direction. But, we are number 1 in one thing...spending. This tells you one thing...we are doing a terribly inefficient job. Tons of spending, mediocre (at best) results. Any argument that we need to stay away from reform because our system is already the best in the world...is crazy as hell.

Fifth (or fif...damn, do I miss Chappelle's Show), about choice. The proposed plan does not scrap the current system (which I think it should, but that's another story). If people feel their current employer-based insurance or whatever other form of health care coverage they have is good, they can stay on it. Nobody is being mandated to go onto government-facilitated (that is much more accurate than government-run) health care. Also...I'm sorry, choice is nice, but real coverage that is affordable, period, should be the main concern. I hate this line of arguing...I won't be able to see my normal doctor in this plan, blah blah blah. Yes, its valid to argue about that, but when you're looking at comparing that against not having real (i.e. no smoke and mirrors high-deductible plans, or other types of coverage that don't pay for much in the end, which, ultimately lead to patients foregoing necessary care) and affordable health care, I go with the latter as the most important point every time. And...again...if you like your current insurance, you can stay there!

Sixth, about costs and the problem of health care spending....we need to curtail our health care spending, no doubt about it. It will take up a greater and greater portion of our budget, but the problem with the system as it is is that we're not really going to get much for that spending. There are so many inefficiencies present - we need to alter incentives, financing mechanisms, etc., in order to really start seeing a true deceleration of costs, as opposed to just cutting back coverage (which, I'm sure the insurance industry would have no problem doing - I linked to it in my previous post, but please check out Wendell Potter's damning testimony against the insurance industry, which has not gotten nearly as much media play as it should have...Potter was a whistleblower from CIGNA who really spilled some beans on just what our insurance industry has been doing - here is a ton of info about him, his testimony, and a great interview he did with Bill Moyers. Because so many patients are underinsured or uninsured, health care providers often have to game the system to ensure that they don't lose money. This means they might perform a variety of tests that aren't quite necessary, but are expensive, for patients with good health insurance, in order to compensate for the care they provide to patients who don't have insurance, or whose insurance doesn't really cover much of anything. The incentives of the system, in general, are to do as many tests as possible, too. I'm not saying this is what providers necessarily do, but the way they are compensated, as well as how the system is financed overall, often doesn't help this issue. A major step in the right direction would be to alter the mechanisms by trying to lower the number of uninsured and underinsured. This would likely lead to a change in efforts to game the system. The public option, some other type of hybrid system that the Senate Finance Committee is looking at as an alternative to the public option, and expanded public coverage for the poor and low-income, would be ways to address this issue. Additionally, we do need to reconsider how we finance care overall. A real emphasis on prevention, with some money behind it, could help. But, keeping the disjointed system as-is, or simply providing "more choice" through tax credits, etc., will do nothing to lower costs. The tax credit argument has serious flaws in it, which research has clearly illustrated. We need a real change in the system in order to stave off major financial problems down the road. Yes, the bill isn't low - about $100-150 billion/year, or around $1 trillion over 10 years. This, of course, doesn't exclude cost savings that will occur from reform. Yes, it's still going to cost us money, but under 1% of a national income that grows at around 2.5% each year. That's not cheap, but that's not going to destroy the country's economy.

Finally, this is a point I abstractly discussed in my previous post, and intimated above, but here it is more bluntly: is an increased government role in health care a bad thing? Seriously, think about it. Again, the point of clarification (in case I didn't make it obvious enough yet), Obama's plan will NOT create government-run health care in any real sense of the word. According to the CBO report, the public option will NOT drive insurance companies out of business. However...maybe it should. Spend a few minutes going through the info Potter shells out in the link above. This is what private insurance is. Innovation? Hardly. Better prices and better services? No way in hell. I'd argue there is both correlation AND causation between our highly inefficient health care system and the private insurance industry. Look, I have no problem with profits. I'm generally cool with capitalism, in concept (not what we call capitalism, which is borderline socialism for corporations, in America - again, prior post!). But, here's the thing. These private insurance companies have clearly sacrificed the health of Americans to make money. I mean...that's the point, right? Its not exactly easy to regulate a lot of private insurance, due to ERISA preemption. For instance, many state efforts to require Wal-Mart to pay more of the costs of its health insurance for its employees (having done some research on this, I'll say that Wal-Mart health insurance plans were very expensive, which, combined with low pay, resulted in many employees not only not being able to afford insurance coverage, but then enrolling in Medicaid - California had a big fight over this, as did Maryland, and a bunch of other states) were attempted, but defeated due to ERISA preemption - its not easy to mess with employer-sponsored plans.

So, here's the thing...when we are dealing with people's lives, which we literally are with health insurance, is this really an instance where the private sector is appropriate if it is not easily regulated, and has not exactly been doing a good job up to this point? I mean, its one thing when we're talking about televisions, stereos, iPods, etc. It is entirely different when we are talking about lives. I'm not saying the private sector can't have a role in health care. I'm not even saying it can't have the major role. I'm saying that the private sector model of profit maximization is highly problematic in this area, because lives are at stake in a very direct way. Given the track record, I don't quite get why people are so dead-set on ensuring the health care industry survives intact in this debate. We can be a capitalist society (it would help if we actually were one, of course!) without every single thing being pure free market. Health care is an area where I'm not sure a free market is ideal. It could work, if we could get some real regulations in place that required certain conditions, such as ensuring people had access to real insurance at affordable prices that didn't discriminate against pre-existing conditions (or maybe even create a national high risk pool for people with pre-existing conditions). Let private insurance companies bid on big regional or national contracts for insurance, let them run things their way so long as they comply with a reasonable set of federal regulations, let them innovate and compete...they'll almost certainly still do quite well, simply because you're talking about an incredible number of people they get to enroll in their plans. But, if the industry is left as it is, where we don't have any real innovation or competition, but much more of an oligopoly, where it is hard to really regulate plans to ensure they are providing real coverage at reasonable rates and not discriminating, and where they profit more from cutting people off from coverage when they need it the most (this isn't some made-up highly-cynical scenario, this is what continuously happens)...why is this something to defend at all? Look, it is not the idea of private insurance, or the idea of a free market, that is problematic - this can certainly work if implemented correctly. However, what we have right now absolutely isn't working, so I don't understand why critics use terms like capitalism and the free market as abstract ideas that need to be defended against increased government involvement, when it is painfully obvious that the private insurance system we have in place has done a terrible job. We need a real debate about whether a real free market, or increased government involvement, in health care is the better option. This would be healthy and helpful to all. What we don't need is this nonsensical discussion where the government involvement is linked to the Soviet Union and fascism, and the current system we have is tied to Adam Smith. Neither is true.

And in the end, we get the insane debate that has happened thus far on health care reform. We're talking about nonsensical stuff, most of it based on pure lies and deception. We should be discussing far-more important issues, like what kind of delivery system works best, how do we best incentivize the incorporation of health IT and quality of care standards, what are the optimal levels of cost-sharing to ensure appropriate use of care, what are the best pooling options to maximize economies of scale, whether we can we find a way to regulate private insurance companies in a manner to ensure that they stay in check while maximizing their flexibility to capture the benefits of true capitalism in terms of competition...these are all really important discussions to be had by supporters and critics of the type of health care reform being proposed right now. There's plenty of factually-based dissent to be heard from all sides. I don't think Obama is going far enough, whereas some old-school Republicans (do they exist anymore?) might say we need to keep the government out, but stop protecting the insurance industry and make the system truly a free market. These are real and valuable discussions to be had. But, what do we get? Discussions about euthanasia, unfounded fears of a fall into autocratic socialism, and, of course, Senator Grassley talking about dragons and health care like a lunatic. I'd say shoot me now, but I might not be able to afford the co-pay for the hospitalization.