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.

Swallowing the Medicine to Cure What Ails Us

Some time ago a friend of mine sent me this ABC News article about a study on men and condom use, or rather the preference to not use condoms. Given that even the most dimwitted of 7th graders knows why guys would prefer not to use condoms, this study sounded exactly like the type of thing that the Bobby Jindals of the world would attack as wasteful spending. How, I wondered, could we keep with the theme proposed by the Kinsey Institute researchers and make it relevant enough to folks on the right that they wouldn’t deem the funding to be of questionable import? The answer was quite simple.

Instead of the National Institutes of Health funding the Kinsey Institute to study condom usage, they could fund a joint project between Kinsey and the National Institute of Mental Health to study the psychopathology inherent in the inability of the religious right/family values crowd, in particular, and the Republican/conservative moment, in general to properly grasp the concept of and actually engage in tea-bagging, maintain marital fidelity, or to find their homosexual tendencies to be just as healthy as their heterosexual urges (except when they're soliciting strange men in airport bathrooms, or paying prostitutes, or acquiring Argentine mistresses those are decidedly unhealthy activities) when the first two are so central to their core beliefs and the third seems to be a regular predilection. Such a study could have wide ranging implications for our political system and even the current health care reform debate. Imagine a Republican Party transformed. Imagine them no longer being the party of “No,” but a party that could say “Yes!” Imagine, this study leading to others that eventually leads to a proper categorization and diagnosis of the illness that is conservatism. Imagine finding the genetic markers that cause this illness and being able to stop it before it fully expresses itself. Imagine, the health insurance industry no longer being able to discriminate against them for having this pre-existing condition and finally being able to get the coverage they deserve. Wouldn’t that make this a better more equitable country? Isn’t that change we can believe in? I guarantee that no less a paragon of the right than John Boehner would stand up and say “Yes, We Can!” if the Democratic caucus added such a provision to the current health reform legislation. At least until it came time to fund a study to cure what ails Democrats.