The Broad View

Broken record

In less than three days, Obama will be giving another of his make-or-break speeches. Once again, he'll be trying (and, I expect, failing) to redefine the health reform debate that has careened so far out of reason or control. On the Sunday gasbag shows, White House officials prepared the way -- for another round of insipid boilerplate and equivocation. From the NYTimes:

Three days before President Obama is to address a joint session of Congress about overhauling the health care system, administration officials on Sunday continued to characterize a new government program for the nation’s 50 million uninsured as worthwhile but not essential to legislation.

David Axelrod, a White House senior adviser, said on NBC’s “Meet the Press” that Mr. Obama “believes the public option is a good tool.” But Mr. Axelrod added: “It shouldn’t define the whole health-care debate.”

Oh no, the public option certainly doesn't define the whole debate. The right-wing whackjobs have taken care of that and now it's insane conspiracy theories about commie-fascist death panels and withholding health care from Republicans that drive the "debate".

The White House press secretary Robert Gibbs, who appeared on ABC’s “This Week with George Stephanopoulos,” sidestepped questions on whether Mr. Obama still regarded the so-called public option as a necessity for any bill he would back.

“We’re trying to provide choice and competition for individuals and small business owners,” Mr. Gibbs said when asked if the public option was “essential.”

“The president strongly believes we need to provide choice and competition,” he said. Pressed on whether Mr. Obama would demand that a government insurance program be included in legislation, Mr. Gibbs said that it could be a “valuable component” of any health plan. And asked whether the president would reject a plan that did not include government insurance, Mr. Gibbs responded: “We are not going to prejudge where the process will be.”

[...]

And The Associated Press reported that on a call with prominent liberal House members Friday, Mr. Obama refused to be pinned down.

In his talk-show appearance, Mr. Gibbs said, however, that Mr. Obama will clarify his position in his address to Congress and is considering broadly outlining his own legislation instead of letting Congress set the terms.

It's nauseating. Just fucking make up your mind, already. Stand for something, dammit. I have this nightmare vision of getting to 2012 with a president that has spent the last four years refusing to be "pinned down" about anything of importance.

The endless parroting -- "choice and competition," "competition and choice," blah, blah, blah. What does that mean, exactly? That's right: Nothing. There hasn't been one component of actual reform (versus insignificant tinkering at the edges) that Obama hasn't supported, then "indicated" he'd trade away, and back and forth, yes, no or maybe, ad infinitum.

Are we supposed to cheer that Obama might propose an actual plan? It beggars the imagination that this "clarification" will be any less nebulous than his statements thus far when the latest trial balloon is floated using words like "considering" and "broadly outlining." If he truly wants to "clarify" this clusterfuck, he'll ditch everything and start over by first reading the riot act to the Senate Democrats and then taking a tire iron to their future electoral ambitions.

That won't happen, though. We'll probably get another mealy-mouthed paean to bipartisanship, competition and choice along with heart-felt thanks for the cooperation of the insurance and pharmaceutical industries in fashioning this historic legislation. Feh.

An aside: Not only have I called and emailed the White House, I mailed an ink-and-paper letter to the president in which I promised that he will lose my vote if a fully competitive public option is not passed. Late last month, I received a reply. It's a canned response, brimming with bland boilerplate. The letter includes this line:

There are tough choices to be made, and I will bring businesses and workers, health care providers and patients, and Democrats and Republicans together to create a system that delivers better care and puts the Nation on a much sounder long-term fiscal path.

I am then urged to "learn more about [Obama's] agenda" online. The letter ends with this:

I share the sense of urgency that millions of Americans have voiced. I watched as my ailing mother struggled with stacks of insurance forms in the last moments of her life. This is not who we are as a Nation; together, we will fix it.

Sorry, but Obama's language and tone are so dispassionate, so dry, so brittle, that the merest gust of Teabagger bullshit can easily shatter his narrative -- and that's exactly what's been happening.

Americans are dying because they can't get or afford health insurance. Americans in the hundreds of thousands are facing medical bankruptcy even with insurance. Insurance and pharmaceutical companies are posting the biggest profits on record and they're lavishing millions in salaries and bonuses on their executives while children are denied life-saving treatments. How can these fuckers be winning?

I know Obama is a cool customer. However, if he wants to change the scorched landscape of American health care, he had better get angry --  very angry and very soon. This is a life-and-death debate and Obama's got to man up and fight. Get in touch with your lizard-brain, man.

[Cross-posted at The Followspot.]

The Reaper Chronicles

Every aspect of the health insurance "debate" makes me purple with rage. This morning's AP story quotes Sibelius' claim that the wretched Obama is willing to drop the public option in favor of the useless co-op nonsense.

There are no words to describe my complete disgust with Obama and the rest of the Washington Democrats. Their gutless incompetence has in all likelihood doomed real health insurance reform for another generation. Actually, a humane, civilized health care system is probably impossible in the U.S., given our hostility to doing anything to help our fellow citizens -- especially those who aren't white -- and the opposition of a loud, easily manipulated plurality of stupid Americans. Yes, there is a significant percentage of American citizens who are proudly ignorant, gullible dolts. These are the kind of people who give Democracy a bad name.

The Rabid Right's latest cri de coeur -- "Obama Death Panels" -- has been scooped up and amplified by an equally stupid and irresponsible media class. So far, Obama has been singularly ineffective in countering the hysteria. As Maureen Dowd writes in today's NYTimes:

Sarahcuda [Sarah Palin] knows, from her brush with Barry on the campaign trail, that he is vulnerable on matters that demand a visceral and muscular response rather than a logical and book-learned one.

Okay, here's a visceral response to the idiotic notion that Obama will pull the plug on Grandma. Here's the story of a real Grandma, my husband's Grandma.(All names have been changed.)

Louise had metastatic cancer. She had survived breast cancer many years earlier but now, in her eighties, the cancer had returned. One bout of chemotherapy was enough to convince her that she didn't want to spend what was left of her life enduring painful torture. I think it was the right decision. She lasted another two years and was relatively healthy until the last three or four months. The "cure" would probably have killed her far more quickly by weakening her with poison and pain. And it is those last three or four months that concern us now.

Harry, my husband's grandfather and Louise's husband, was in his mid-eighties. He was amazingly vigorous and sharp as a tack, but old age had amplified his peculiarities. He was a miser and a hoarder. And he was totally paranoid about having strangers come into his home. That, in itself, wasn't unreasonable. The elderly have good reason to feel vulnerable to strangers. As his wife's health deteriorated, however, he insisted on coping with caring for her by himself and then, when he could no longer lift her to change her soiled bedding, he enlisted his daughter Joanne's help. My husband's mother was well into her sixties and not in great shape herself.

The combination of ignorance and despair was determinative. Joanne called me one day to ask, amazingly, for my advice. She didn't know what to do, how to proceed, how to handle an increasingly untenable situation. Her stubborn, paranoid father refused to allow anyone into the house -- no nurses, no home health workers, not even Meals on Wheels.

I advised that she convince Harry that he must allow her to have professional help. At no point, I said, should she allow her father to hospitalize Louise. I told her that once her mother was in the hospital, her agony would be prolonged. She would have the tubes inserted, the machines hooked up, and she'd be kept alive as long as possible, in misery. I advised her to contact someone about home hospice care.

All Louise needed at that point was to be kept clean and comfortable. At home, she could spend her last days with family in familiar surroundings with a view of her lovely garden outside.

Harry was an autocrat and would have nothing of it. Joanne, even in her sixties, was still a cowed and impotent child when facing her father. So Louise was taken to the large hospital nearby. She was hooked up to a feeding tube, IVs and monitors. Her view out the window was of a brick wall.

Louise spent the last forty-two days of her life on her back in that hospital. No one asked about alternatives. Standard operating procedure was to prolong her life through any and all means.

There's also a dirty little secret that nobody in this health care "debate" talks about: Doctors are paid by the procedure and there's nothing like a helpless, elderly patient for the opportunity to pile on the tests and procedures. During a patient's last days in the hospital, doctors come out of the woodwork to peek in the door, glance at a chart, order an expensive test, and walk out to bill Medicare accordingly.

When Louise wasn't staring out the window in pain, she was being hauled all over the hospital for tests and x-rays for -- what, exactly? There was no question that she had terminal disease and that the end was very near. Did they think this blood test or that x-ray would tell them something they didn't already know? Did they expect to predict the exact day and hour of her death?

So for forty-two days, Louise was mindlessly kept alive while her body was being eaten to death by the cancer. Her bones had become so fragile that some time in the last week her hip broke merely from lying in the bed. Her guts had turned to putrid goo. Finally, she died.

The hospital bill was, of course, stratospheric. Miserly Harry didn't care, though. Medicare picked up most of it and what they didn't cover, supplemental insurance did. And it was all totally, utterly unnecessary. Harry was rich enough that he could have paid for round-the-clock nursing at home. There would have been no feeding tube, no monitors, no IVs. Louise would have died weeks sooner, in her own bedroom, and been spared what passes for "care" in America's modern hospital system.

But no one in a position of authority spoke up. Louise wasn't given the chance to choose her own fate. Every day in the hospital, she begged to go home. Instead, she had a husband more concerned with money and his own paranoia, a willfully ignorant man happy to have someone take the problem off of his hands for free. She was left to a system that has perverted its mandate for mercy into a soulless, hypocritical exercise in milking the helpless for every penny that can be squeezed from Medicare.

So don't talk to me about "Obama's Death Panels." Don't talk to me about "pulling the plug on Grandma." Don't pretend to care about people when all you care about is demagoguing and demonizing humane health care reform to score political points.

I'm in despair that any real reform will ever be enacted. I'm sick of a country informed by brutality and stupidity. I wonder what all those imbecilic "Town Hell" screamers would be screaming if they found themselves in Louise's hospital bed.

(Cross-posted at The Followspot.)

Whitewash and hogwash

As long as I'm talking about corporations, Republicans and branding, I'd like to segue to the related issue of image manipulation and control.

Corporations have learned to use image advertising to effectively change the public's perception of the corporation's business and reputation. (Since most corporate types are Republicans, the Party has naturally adopted the same techniques.)

There are two commercials currently being broadcast widely that I find galling. Every time I see one, I literally yell at the tv and whoever's in the room.

The first, and most infuriating, is the ad for the PPA -- the Partnership for Prescription Assistance. It opens with a string of ordinary slobs expressing their heartfelt thanks to the PPA for enabling them to get their prescriptions, i.e., to remain alive. Then we get spokesman Montel Williams cheerily informing us that through the goodness of America's pharmaceutical industry, poor people around the country who had difficulty affording their prescriptions are now getting free meds. Then we see the PPA Bus trundling over the countryside presumably dropping anti-depressants and statins off the back to the grateful groundlings.

This is image manipulation on a world class scale. The rapacious pharmaceutical companies know that news stories about poor people suffering and dying because they can't afford their meds -- anywhere from $155 to $398 for a month's supply of Advair or $31 to $82 for Lovastatin -- would be the end of their sweet deal. Not even their trained seal legislators would be able to withstand the public roar for draconian regulation. This must be avoided at all costs.

So even though the blood-sucking pharmaceuticals will get those extortionate prices from Americans who can somehow afford it, they manage to avoid the worst publicity by giving medicine away to the poor to shut them up. It's just good business for them, the same as buying friendly congressmen and senators or taking doctors on lavish junkets so they'll remember your pills and potions when they take out the Rx pad. And in the end, given the obscene profits the pharmaceuticals rake in, giving pills away and bribing people is small change.

Meanwhile, those of us with prescription insurance coverage rarely hear or see the actual list price for the drugs we buy. Sure, we know the co-pays have gone up precipitously and may be killing us at $35 a pop for brand names, but we can hardly fathom that some drugs cost a king's ransom. And many don't make the connection between outrageous drug costs and premiums rising at double-digit rates.

But hey -- we've got Montel Williams to soothe us with tales of pharmaceutical philanthropy.

The second ad is one of those commercials with lush photography, romantic images, intimate music and a sentimental, feel-good narrative -- all saying exactly nothing about the product. Behold "The Human Element":

Quite a stretch from the Dow Chemical of my youth, the loathed manufacturer of napalm. The despoiler of our nation's air and waterways. The negligent corporate parent of Union Carbide, the company responsible for the disaster of Bhopal, still toxic after more than twenty years.

It's so sad. "The Human Element" is a lovely series of images and sentiments. It's obscene that it's in the service of a transparent whitewash.

It's not that we don't understand that chemical manufacturing is an indispensible part of our lives. It's not that we don't appreciate the chemical products that make our lives better. But none of that excuses crimes against our planet and criminal neglect. To Dow Chemical though, it's easier to manipulate public opinion through a pretty ad than to clean up their act.

And there are others -- the ads for the extractive industries that tell us how much they care about the environment as if they did more than the bare minimum to comply with regulation. My favorite is BP with the sunny flower logo. We're supposed to applaud because they're researching alternative energy technologies now. Yay! It would be rude to remind them that they're also part of the global oil racket that is determined to keep pumping and selling at ever-higher prices until there's not a drop left. Bah.

"A sign of profound desperation"

The Times has a story up that should make us weep, or rage; I'm not sure which. One thing seems certain, though: This country has entered an economic and political landscape that is uncharted, and who the hell knows where we'll end up.

BEND, Ore. — Last month, right after he had the heart attack and then the heart surgery and then started receiving the medical bills that so far have topped $200,000, Melvin Tsosies joined the 91,000 other residents of Oregon who had signed up for a lottery that provides health insurance to people who lack it. [...]

Despite the great hopes of people like Mr. Tsosies, only a few thousand of Oregon’s 600,000 uninsured residents are likely to benefit from the lottery anytime soon. The program has only enough money to pay for about 24,000 people, and at least 17,000 slots are already filled.

Let's consider this for a moment: Health care by lottery. It sounds like the plot of a dystopian movie, perhaps "Mad Max: Beyond Medicaid."

“There’s so much need that there’s really no way you can meet it,” said Chris Coon, the outreach manager for the Community Clinic of Bend....

“Using a random process to decide who gets health care is a sign of profound desperation,” Mr. Coon said.

This is in the United States in 2008, a mere 63 years after we vanquished enemies in two hemispheres and strode the earth as the richest, most enlightened and most powerful nation the world had ever seen. How do we find this even remotely tolerable?

House votes today on overriding Bush's SCHIP veto

I'm listening now to the final two-minute speeches from the floor before the House votes on overriding Bush's heartless veto of the SCHIP expansion bill. The arguments, for the most part, are predictable -- and, as usual, are meant for the record and future campaign videos. It would be naive to think that any minds are going to be changed.

In spite of the fact that polls show an overwhelming majority of the public to be in favor of the policy, the punditocracy tells us that in the people's house there won't be enough votes to override.

We'll know soon enough. Sigh.

Aside: Listen (or read) between the lines. So many of the Republicans emphasize American children. In fact, there has even been bald mention of the exlusion of "illegal immigrant" children. This thread of nativism runs through the entire oppositional argument. It is essential, in fact, to the immoral whole.

State and local health care reform runs into a brick wall called ERISA

This is an example of why it is so important for citizens to understand something of process, before we go bitching off about legislators who can't always do what we want them to do. Get down into the weeds (be a wonk!) and find things like this, as explained by Ben Arnoldy of the Christian Science Monitor.

The biggest name in healthcare reform isn't Hillary, or Mitt, or Arnold - it's ERISA. That's the name of a federal law that could invalidate many of the budding efforts by states and cities to expand access to healthcare.

ERISA, which stands for the Employee Retirement Income Security Act, shields businesses from state and local regulation of the benefits they offer workers, including health insurance.

Mind you, ERISA is a law that goes back to 1974. It was good liberal legislation, intended to protect employees.

Supremely ironic, no?