Tuesday, May 19, 2009

5 Things You Should Know About Obama's Health Care Policy

The choice of a public health insurance plan is crucial to real health care reform. But right now, it's being smeared by conservatives and insurance-industry front groups. Don't let them swiftboat healthcare reform. I've lived and had surgery in a country with national (universal) healthcare, and it was great. Here, thanks to moveon.org, is what you really need to know:

1. Choice, choice, choice. If the public health insurance option passes, Americans will be able to choose between their current insurance and a high-quality, government-run plan similar to Medicare. If you like your current care, you can keep it. If you don't—or don't have any—you can get the public insurance plan.

2. It will be high-quality coverage with a choice of doctors. Government-run plans have a track record of innovating to improve quality, because they're not just focused on short-term profits. And if you choose the public plan, you'll still get to choose your doctor and hospital.

3. We'll all save a bunch of money. The public health insurance option won't have to spend money on things like CEO bonuses, shareholder dividends, or excessive advertising, so it'll cost a lot less. Plus, the private plans will have to lower their rates and provide better value to compete, so people who keep their current insurance will save, too.

4. It will always be there for you and your family. A for-profit insurer can close, move out of the area, or just kick you off their insurance rolls. The public health insurance option will always be available to provide you with the health security you need.

5. And it's a key part of universal health care. No longer will sick people or folks in rural communities, or low-income Americans be forced to go without coverage. The public health insurance plan will be available and accessible to everyone. And for those struggling to make ends meet, the premiums will be subsidized by the government.

Read more on "The Case for Public Plan Choice in National Health Reform," by the Institute for America's Future.


Wednesday, May 6, 2009

The Road Less Understood

The title to this blog alludes to one of America's most well-known and most misunderstood poems. Contrary to popular belief, the poem is not a paean to counter-culture and non-conformity, to alternate lifestyles and to getting off the beaten path. Not that those are bad things. Karpe Diem, I say, and I think Robert Frost would agree with me; getting out into nature, stopping and smelling the roses and all that hippie love stuff, or jesus love stuff if you want go back to the source, is a good thing. It's just not what the poem is about, and giving the text a careful reading and lexical analysis will show you what I mean...

In the first stanza we meet the poem's protagonist, a primal projection of the young poet, the everyman, standing in a yellow wood and faced with a choice between two paths.

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

The first thing to note is that the traveler is already in a yellow wood. So we are already talking about a walk through the woods, not a decision to leave some urban or other lifestyle in preference for the "green" way of the backwoods.

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,

In this second stanza, the traveler decides to take the other path, describing it as "just as fair" and "perhaps" having a better claim because it is "grassy and wanted wear". Aha, you say. I told you so. It's all about taking the road less traveled, forging through uncharted territory, being different etc. etc. But the very next couplet belies this attempt to differentiate the two paths telling us that they were worn "really about the same".

At this point, the two paths have been described as "just as fair" and "about the same" with one of them "perhaps" having a "better claim". Not quite the rallying cry of the non-conformist that you'd expect, right? Well if you aren't convinced yet, the next stanza pretty much puts the metaphorical nail in the biodegradable coffin with the unequivocal description "equally lay".

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

So far we've got a poem about a traveler standing in the woods trying to pick between to almost equally trodden paths. The traveler tries to look down the road and presumably picks the "nicer" or "better" path, but readily admits that there isn't really a discernible difference. Then the traveler sort of reluctantly chooses one, knowing that they will more than likely never go back and try the other.

At this point, the poem is starting to look a bit more nihilistic. What's the point of picking if we can't see the ends, if we can't distinguish the difference? The key comes in the final stanza, when the traveler is looking back in retrospect on their life.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.

We now envision the traveler in some smokey and nostalgic roadside inn, no doubt with a wooden sign hanging askew over the door and an old-fashioned "Olde" in the title. The traveler is perhaps sitting in a rocking chair by the hearth, tamping out his aromatic pipe. What we know is that he or she is addressing an unseen audience. Who are they? Perhaps fellow travelers? Perhaps a circle of knock-kneed and wide-eyed children?

And what is the traveler saying? That that one decision, that one small decision between two nearly identical paths in a yellow wood has made all the difference. Basically the traveler is attributing a great importance to a decision that at the time was almost a flip of a coin. And this is what the poem is really about, the unreliability of memory and man's helplessness in the events of life.

The traveler believes that a choice between two indistinguishable paths was a key turning point in their life. The way they remember it, that one choice made all the difference. Maybe they don't really remember how the paths were basically the same, or maybe they have an elevated opinion of their abilities and believe that even in this minutest of moments they were charging towards self-made greatness.

It kind of depends on how you read the "sigh". Is it a sigh of regret and loss or puritanical pride in a job well done? Has the traveler become a prince or a pauper in the years following that fateful frolick in the forest? We are clearly in the presence of nostalgia, but is it a nostalgia born of myopia or hubris? Is man to believe that he is the master of his fate and that decisions, even admittedly haphazard ones like the choice between following two equally trodden paths, make a difference? Or is this a lesson on the unreliability of memory and man's tendency, or perhaps need, to attribute agency and meaning to the chaos and randomness of life?

Whether you believe in pulling yourself up by your bootstraps or the inexorable wheel of fate winding out your life, the song remains the same. Frost is reminding us that each moment is precious and rarely can be saved for another day. And that as the shadows lengthen and fall upon us, we will perforce look back at the rise and fall of our days and know with certainty that our lives are precisely as they are and could be no other way. Otherwise they would not be ours to remember. We will have the choice to look back and sigh with joy or regret for the paths we chose and never chose to take, and together these will be the paths of our life lying just so, diverging in the woods of our soul. And we can be sure that the paths we trod have made all the difference, because our dusty and fading footprints are no doubt the legacy we leave behind to those who follow...

One final point about how memory diverges from life (like two roads in a wood) and how, willfully or not, this leads us to misunderstand: the Robert Frost poem is titled The Road Not Taken, not as most people will remember The Road Less Traveled. And that, to paraphrase Robert Frost, not only makes all the difference, but is exactly what he's talking about.


Monday, May 4, 2009

Babies don't vote, babies don't pay

How can we be the "greatest" and "richest" country in the world when we don't guarantee basic health care to all of our citizens?

The cost of health care, in both moral and economic terms, is bankrupting our country. There is no reason why everyone shouldn't receive quality, affordable health care. A healthy workforce makes good sense, but we are really talking about caring for people, the sick--a simple mitzvah, the kind of thing your grandmother would want you to do, but taken to a national level.

But that's the easy part. It's not just who we care for, but how we care for them. Serious reforms are also necessary in how we research new drugs and treatments, and how we make choices about what procedures, particularly at the end of life, are offered to an individual.

I believe these type of complicated decisions regarding public health, preventative care and use of limited resources need to be made by scientific and non-profit oriented (i.e. non insurance and non pharmaceutical) groups like the NIH.

One of the reasons that the United States has the highest infant mortality rate in the so-called "civilized" world, that is to say compared to other places like Western Europe, Japan etc. is that babies don't vote and babies don't pay. So we spend more time and money on finding viagra and cures for social anxiety disorders. This same market logic drives research away from world wide killers like malaria or improving preventative medicine. Screening and teaching better diet and exercise to avoid diabetes just aren't as profitable as insulin.

The system will spend tens of thousands of dollars, however, to extend someone's life by a week or two. If you can call lying in an intensive care unit with failing organs and an artificial respirator down your throat as well as being extremely sedated because your body responds to the respirator as if you are drowning or suffocating as living...

This is why research and health guidelines need to be free of industrial and market bias. Health care providers and individuals need access to good information. Smart national guidelines will help doctors sort out increasingly complicated health choices (drug interactions, comparisons of generic to brand drugs, comparisons of treatment combinations). National guidelines will not tie your doctor's hands, but empower them with information rather than marketing and advertisements. It's a non-issue really, because hands are already being tied and manipulated by decisions about which procedures are reimbursed and for how much.

The next step is encouraging individuals and families to think and talk about critical care and end of life issues such as when and how much invasive care should be given, and under what circumstances. Every adult as part of their electronic and accessible health records should fill out organ donor plans, do not ressucitate orders, file health proxies etc. Schools should have a mandatory health and diet class that teaches proper hygiene, eating and exercise habits and how to become well informed participants in a national health care system.

And participation is the key. Now is the time to speak out and let your elected official know how you see the future of health care in America.