Of Licenses and Lizards

The headline at The Trail — “Spitzer Drops License Plan, But Damage to Democrats is Done” — has rekindled hope among the wingnuts. I just want to point out that Gov. Spitzer’s policy, although unpopular in New York, had little impact on the recent state and local elections here, even though Republicans campaigned on it heavily.

I agree with Taylor Marsh

It was clear to me after the debate that Clinton backing Spitzer was because she refused to push a fellow Democrat under a bus. I applauded that action, but knew this issue would evolve as it has. Equally clear was that backing Spitzer on driver’s licenses for illegal immigrants was going to cause her a lot of grief in the general election, but also in the primary because the press eats this subject up. It sells papers. Rumors are that some of Clinton’s team were furious with Spitzer for putting Clinton in this spot, so he pulled his immigration plans. It’s over, just in time for the CNN debate. …

… This is one of the most emotional issues there is and one easily opened to demagoguing. Democrats made Spitzer wake up, because those against his plan are the types who come out to vote. That’s the bottom line.

The emotional value of illegal immigration has two sides. It doesn’t matter which one is right during election season, because feelings are as they are and you can’t change an electorate who won’t listen. While intending to solve the challenge of undocumented or illegal immigrants, Spitzer finally acknowledged that you can’t move a country to follow your lead until you’ve convinced them you understand and respect their feelings. You also need a Democratic president to get it done.

Immigration is the number one right-wing red meat issue. The mere mention of the “I” word causes complete cerebral cortex failure in a wingnut, allowing the reptilian brain complex to take over. One might, then, forgive them for not understanding that a state’s driver’s license policy is not a matter to hang around the necks of candidates for national office. After all, lizards are not famous for their higher reasoning skills. I don’t let media off the hook, however.

Steve M:

Hillary Clinton is still not flip-flopping on drivers’ licenses for illegal immigrants. She was not for these licenses before she was against them, or against them before she was for them.

She has merely tried to say that the problem needs a federal solution (a comprehensive immigration reform law), while trying to weasel out of making a plain statement of support or opposition to the Spitzer plan. She never wanted to say she didn’t support it (which might have alienated certain blocs of voters), so she kept saying she understands it.

And her new statement is quite consistent with her old statements — including the evasion. …

… She says as president she won’t support licenses for the undocumented, but that’s not quite being categorically against them. She says she’ll fight for comprehensive reform. And she’s merely supporting Spitzer’s withdrawal of the plan — she’s not saying it was wrong and he never should have put it forth.

Way too nuanced for lizards, of course.

Jeralyn of TalkLeft has been blogging about this issue for a while. A post from 2004 gives good reasons to allow illegal aliens to obtain driver’s licenses. More here. But Taylor’s right when she says “It doesn’t matter which one is right during election season, because feelings are as they are and you can’t change an electorate who won’t listen.”

Even so, immigration is not the number one concern for citizens at large. This issue is not the Achilles’ heel for Dems the wingnuts believe it to be.

Update: David Broder says the immigration issue could sink the Democrats. This is solid proof the Dems need not worry too much about it, since Bwana is as clueless as they come.

Update: On the Unified Field Theory of Hillary Hatred

Why You Have To Be Brave To Live Here

Stephanie Strom writes for the New York Times:

In the genteel world of bridge, disputes are usually handled quietly and rarely involve issues of national policy. But in a fight reminiscent of the brouhaha over an anti-Bush statement by Natalie Maines of the Dixie Chicks in 2003, a team of women who represented the United States at the world bridge championships in Shanghai last month is facing sanctions, including a yearlong ban from competition, for a spur-of-the-moment protest.

At issue is a crudely lettered sign, scribbled on the back of a menu, that was held up at an awards dinner and read, “We did not vote for Bush.”

By e-mail, angry bridge players have accused the women of “treason” and “sedition.”

Judging by Memeorandum, this is the hottest news item on the blogosphere right now. The wingnuts are spewing about Bush Derangement Syndrome. “Shut up and play cards” is a common suggestion.

The players have been stunned by the reaction to what they saw as a spontaneous gesture, “a moment of levity,” said Gail Greenberg, the team’s nonplaying captain and winner of 11 world championships.

“What we were trying to say, not to Americans but to our friends from other countries, was that we understand that they are questioning and critical of what our country is doing these days, and we want you to know that we, too, are critical,” Ms. Greenberg said, stressing that she was speaking for herself and not her six teammates.

The controversy has gone global, with the French team offering support for its American counterparts.

“By trying to address these issues in a nonviolent, nonthreatening and lighthearted manner,” the French team wrote in by e-mail to the federation’s board and others, “you were doing only what women of the world have always tried to do when opposing the folly of men who have lost their perspective of reality.”

Jimmie at the Sundries Shack disagrees.

What these ladies should have done is reminded the Bush-haters that they were at a bridge tournament and not a political convention and that good manners prohibit the discussion of politics at a table where it is not welcome. I’m fairly sure that reminding your fellow bridge players of their manners would have solved the problem.

Then you beat the stuffing out of them and taunt them relentlessly from the winners’ podium. Maybe you even stack the losers up in a pyramid and have one of your team point at them and laugh while you take pictures.

I assume that last bit was another attempt at levity. But what this tells me is that wingnuts don’t get out much. These days, for Americans, to go abroad is to be treated with, at the very least, caution. We may look normal on the surface, but at the least provocation we may grow tusks and root up the shrubberies.

But these ladies appear to have run into some outright hostility, and they were trying to diffuse the situation. Any emotionally mature person might have done the same thing, which is why wingnuts don’t understand it.

Gateway Pundit writes,

Did they not notice they were playing cards in Communist China?

China- The same country that harvests prisoner’s body organs- The same country that jails Christians and people of faith- The same country that murdered 30-40 million of its own citizens less than 50 years ago.

Do these pampered loons have any perspective of history?

Standard wingnut moral relativism — whatever we do is OK, because China is worse. But in the real world, people who claim a higher standard had better live up to it or face the snarking.

The bridge lady might have written this on her menu instead:

It is not fair for bridge players to criticize GWB. He exemplifies something essential to playing every hand of bridge.

The dummy.

But what does it say about a nation that allows a dummy to be its head of state for eight years?

Nothing Is Inevitable

At MyDD, Jerome Armstrong analyzes the most recent polling numbers out of Iowa and New Hampshire. In brief: For the Dems, Iowa is up for grabs. Senator Clinton is ahead by a nose, but her support is soft. Her position in New Hampshire is stronger, but much of this support comes from her perceived electability. I agree with Jerome that if she loses Iowa, which is very possible, New Hampshire could slip away from her also.

But I admit that I have a terrible track record at predicting what voters will do.

Just for some perspective, see Democratic candidate rankings for the 2004 nomination, taken in November 2003:

Not Sure 34%
Howard Dean 15
Wesley Clark 10
Dick Gephardt 9
Joe Lieberman 9
John Kerry 7
Al Sharpton 4
John Edwards 3
Dennis Kucinich 2
Carol Moseley Braun 2
Other 6

(Zogby America Poll, 558 Likely Democrat Voters Nationwide, Conducted 11/3-5/03, Margin Of Error +/- 4.2%)

New Hampshire only, also November 2003:

Howard Dean 38%
John Kerry 24
Undecided 21
Wesley Clark 4
Joe Lieberman 4
John Edwards 4
Dick Gephardt 3
Carol Moseley Braun 1
Dennis Kucinich 1
Al Sharpton 0

(American Research Group Poll, 600 Registered Democrats And Undeclared Voters, Conducted 11/2-5/03, Margin Of Error +/- 4%)

Here are the final results for New Hampshire, 2004.

Kerry 39%
Dean 26%
Clark 13%
Edwards 12%
Lieberman 9%
Kucinich 1%
Sharpton 0%

And the moral is, pre-election poll results are like dust in the wind.

For the Republicans, Mitt Romney is ahead in both polls. In Iowa, Rudy Giuliani is only 4th (after Romney, Huckabee, and Undecided). In New Hampshire, he’s tied for second place with John McCain.

So tell me again why the bobbleheads keep talking about a Clinton-Giuliani race in 2008?

As I remember, all through 2003 many professional television pundits kept saying Dick Gephardt or Joe Lieberman would be the nominee. And now exactly the same crew, albeit a tad more wrinkled, are talking up Clinton and Giuliani. And they get paid for this. I make wrong predictions just as often, but I do it for free. Such a deal.

At the Washington Post, Michael Shear writes about the Hillary phenomenon among the GOP.

They mock her proposals, utter her name with a sneer and win standing ovations by ridiculing her ideas as un-American, even socialistic. She has become the one thing the Republican candidates for president can agree on.

Hillary Clinton.

Earlier this year, the senator from New York was the subject of an occasional laugh line from former New York mayor Rudolph W. Giuliani. Now, the trickle has become a torrent as the leading GOP candidates seek to one-up one another in a Clinton-bashing contest aimed at energizing their party faithful.

“The competition inside the GOP for who’s the most anti-Hillary is going to pay dividends,” said Greg Strimple, a GOP pollster and consultant who is not working with any presidential campaign. “Looking for that piece of anti-Hillary energy is what you’re seeing right now.”

I’m glad to see Republicans running an honest campaign for a change. But what will the eventual nominee campaign on if Senator Clinton is not his opponent? The poor dear will have to run on issues. Iraq, health care, the economy? God, guns, and gays?


Censure Senator Feinstein

Feinstein AshamedIf you’d like to vent your outrage over Senator Feinstein’s longstanding coddling of the Bush Administration, culminating in her support of Bush’s new Attorney General Mukasey, add your name to support a censure resolution, put forth by the progressive caucus of the California Democratic Party. They’re meeting this Friday in Anaheim, so time is a bit short. Obviously it’s more meaningful if you actually live in the Golden State, but I doubt if that’s a firm requirement.

Free Markets, Health Care, and Innovation

I waded into Jonathan Cohn’s “Creative Destruction: The Best Case Against Universal Health Care” with misgivings. But to my delight Cohn presents the “best case” and then demolishes it.

The “best case” is the argument that a free market health care system encourages innovation that leads to new treatments and cures. Yes, we devote 16 percent of our gross domestic product to health care, but our health care spending is driving innovation for the entire world. If the profit motive were removed from health care, say the “free market” advocates, innovative medical research would be squelched. And that’s a compelling argument.

However, there’s theory, and then there’s the real world. As Cohn says,

But it’s one thing to say that universal coverage could lead to less innovation or reduce the availability of high-tech care. It is quite another to say that it will do those things, which is the claim that opponents frequently make. That argument requires several leaps of logic, many of them highly suspect. The forces that produce innovation in medicine turn out to be a great deal more complicated than critics of universal coverage seem to grasp.

It turns out that in the real world the real innovations, the breakthroughs that take medical research into whole new directions, are generally not made by the private sector health care industry.

The great breakthroughs in the history of medicine, from the development of the polio vaccine to the identification of cancer-killing agents, did not take place because a for-profit company saw an opportunity and invested heavily in research. They happened because of scientists toiling in academic settings. “The nice thing about people like me in universities is that the great majority are not motivated by profit,” says Cynthia Kenyon, a renowned cancer researcher at the University of California at San Francisco. “If we were, we wouldn’t be here.” And, while the United States may be the world leader in this sort of research, that’s probably not–as critics of universal coverage frequently claim–because of our private insurance system. If anything, it’s because of the federal government.

The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year, it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities). The majority of that money pays for the kind of basic research that might someday unlock cures for killer diseases like Alzheimer’s, aids, and cancer. No other country has an institution that matches the NIH in scale. And that is probably the primary explanation for why so many of the intellectual breakthroughs in medical science happen here.

There is absolutely no reason why moving to a universal health care system would require cutting back on NIH research. In fact, since 2003 President Bush and his congressional allies have allowed NIH funding to stagnate. They needed room in the budget for other priorities, like tax cuts. “In this sense, the greatest threat to future medical breakthroughs may not be universal health care but the people who are trying so hard to fight it,” Cohn writes.

In fact, in the real world there are indications that the profit motive might be stifling innovation. Most of the private health care industry is focused on developing and marketing as many new, patented products as they can. As a result, much product and development research is focused on incremental improvements on those products that have made money in the past. Research that does not hold a promise of new product development, even if it might lead to cures, is shoved aside. For example, in this article in Genetic Engineering and Biotechnology News, the authors argue that cancer research needs to get away from tweaking products and move into areas that have clinical impact. Cohn writes,

As books like Marcia Angell’s The Truth About the Drug Companies and Merrill Goozner’s The $800 Million Pill point out, a lot of the alleged innovation we get from private industry just isn’t all that innovative. Rather than concentrating on developing true blockbusters, for the last decade or so the pharmaceutical industry has poured the lion’s share of its efforts into a parade of “me-too” drugs–close replicas of existing treatments that offer little in the way of new therapeutic advantages but generate enormous profits because they are patented and because companies have become exceedingly good at promoting their sales directly to consumers.

In some cases private industry has gone from creating products to cure diseases to tweaking diseases to sell more products. For example, the criteria for clinical depression have been so watered down that just about anyone having a bad hair day might fit the diagnosis. It seems obvious that Big Pharma is behind this — the better to sell large quantities of Zoloft and Paxil, my dears. This phenomenon, in turn, leads to misuse of drugs, more unfortunate side effects, clinical trials that show drugs have little effect on “depression” (because the trial subjects were not actually depressed), and the persistent notion that clinical depression isn’t a real disease and people who think they have it are just whiners. Those of us who really are clinically depressed may appreciate our Big Pharma meds, but we have major issues with the Big Pharma marketing departments.

Cohn writes of CT scanners, which are wonderful devices. However,

It’s the potential to sell many more such devices, at a very high cost, that has enticed companies like GE to invest so much money in them. In fact, compared to the rest of the developed world, the United States has a relatively high number of CT machines (although Japan has more). But experts have been warning for years of CT overuse, with physicians ordering up scans when old-fashioned examinations would do just fine. (Some experts even worry that over-reliance on scans may be leading to atrophied general exam skills among physicians.) Studies have shown that the mere presence of more CT scanners in a community tends to encourage more use of them–in part because the machine owners need to justify the cost of having invested in them. The more CT devices we buy, the less money we have for other kinds of medical care–including ones that would offer a lot more bang for the buck

And on and on. It’s an excellent article that I urge you to read and bookmark.

So far I’ve seen one reaction from a “free market” blogger, who simply ignores all of Cohn’s well-documented arguments and repeats the mantra:

The advantage of markets is that they foster innovation. They reward successful innovation. Moreover, they eliminate obsolete institutions and organizations.

Government is much more likely to protect incumbents. Regardless of whether it stifles innovative treatments, government will certainly stifle innovative ways to organize and deliver health care. Indeed, it already does so, with its restrictions on medical licensing and practice. A complete government takeover could only make things worse.

Wingnuts simply cannot process empirical evidence that their glorious theories don’t apply to the real world.

In other health care news, today Eugene Robinson discusses “socialized medicine” snake oil and a major study conducted this year by the Commonwealth Fund:

Respondents in the United States were less likely than those in the other countries to say their health-care system “works well” — and much more likely to see a need for “fundamental” change or a total overhaul. With 47 million Americans lacking health insurance, I suppose that shouldn’t be much of a surprise.

What did surprise me was the wealth of data refuting the general criticism that single-payer health-care systems are cold, impersonal and, well, uncaring. According to the survey, 80 percent of Americans have a regular doctor whom they usually see. That sounds pretty good, until you learn that 84 percent of Canadians, 88 percent of Australians, 89 percent of New Zealanders and Britons, 92 percent of Germans, and 100 percent of Dutch respondents surveyed said they had regular doctors. Marcus Welby, M.D., seems to have emigrated.

Okay, but what about the long waits for treatment under single-payer systems? The survey found that 49 percent of Americans said they could get a same-day or next-day doctor’s appointment when they were sick — as opposed to 75 percent of respondents in New Zealand, 65 percent in Germany, 58 percent in Britain and so on. Only in Canada was it more difficult to see a doctor within 48 hours.

It’s true that in the United States, the wait for elective surgery is likely to be shorter than in the other countries (except Germany, which has the shortest wait of all). But onerous delays of six months or more were significantly more common only in Australia, Canada and Britain.

And then there’s this:

The United States spends $6,697 per capita annually on health care, according to the survey — more than twice as much as any of the other countries surveyed. Americans were much more likely than any other national group to have spent at least $1,000 out of pocket on medical expenses over the past year. And, of course, 16 percent of Americans reported being uninsured, as opposed to essentially none in the other countries.

It makes sense, then, that far more Americans than respondents in the other countries reported that in the past year, they had failed to fill a prescription or skipped doses, experienced a medical problem but decided not to go to the doctor, or skipped a prescribed test, treatment or follow-up.

We may have a mess of a health care system, but I bet we beat the world at cooking up half-baked theories and clinging to them through thick and thin. Alas, disease and death are not theories.

Update: Andy Sullivan misses the point.

Ron Paul

The indispensable Dave Neiwert has a post up about Ron Paul’s legislative record. Those who have the mistaken impression that Paul is not so right wing because of his stand on Iraq should read this post and be corrected.

Update: See also “White Supremacists Rallying Around Ron Paul’s Presidential Campaign.” No surprise. States’ rights, you know.

Update: Patrick Nielsen Hayden writes,

If you think “the elitist, secular Left has managed to convince many in our nation that religion must be driven from public view,” that “the notion of a rigid separation between church and state has no basis in either the text of the Constitution or the writings of our Founding Fathers,” that “the collectivist Left hates religion,” and that “the secularists [are waging] an ongoing war against religion…Christmas itself may soon be a casualty of that war,” gosh do I have a Presidential candidate for you! His name is Ron Paul.

Folks, the man’s a five-alarm whackjob. He only looks good to some because he’s running in a field of six-alarm whackjobs.

Food v. Medical Care

According to the McKinsey Global Institute, the United States now spends more on health care than it does on food. Is that self-evidently screwy, or what?

I looked up McKinsey Global Institute because Paul Krugman mentioned it in his Friday column, “Health Care Excuses.”

Excuse No. 2: It’s the cheeseburgers.

Americans don’t have a bad health system, say the apologists, they just have bad habits. Overeating and teenage sex, not the huge overhead of America’s private health insurance companies — the United States spends almost six times as much on health care administration as other advanced countries — are the source of our problems.

There’s a grain of truth to this claim: Bad habits may partially explain America’s low life expectancy. But the big question isn’t why we have lower life expectancy than Britain, Canada or France, it’s why we spend far more on health care without getting better results. And lifestyle isn’t the explanation: the most definitive estimates, such as those of the McKinsey Global Institute, say that diseases that are associated with obesity and other lifestyle-related problems play, at most, a minor role in high U.S. health care costs.

In truth, American fast food circles the globe. And native cuisines of other nations are not necessarily health food. Have you ever been subjected to a full English breakfast? There’s probably less cholesterol in cheeseburgers.

The other excuses, btw, are (1) people without insurance get health care, anyway; (3) we get better medical care now than we did 50 years ago, so the money is well spent; and (4) socialized medicine! Krugman explains why these excuses are bogus.

On the same day this column was published, the Heritage Foundation released its own assessment of America’s health care:

The debate over government-run health care has roiled for decades. Today, we’re at the tipping point.

Incremental growth in public health programs has brought us to the brink. Today, almost half of America’s children — 45 percent — have their health care paid for by taxpayers. The children’s health bill (SCHIP) now before Congress would boost this to 55 percent. And that’s the tipping point.

Once most children are covered by taxpayers, the remaining children will shortly follow. Then their parents. Then those with no children at home. Eventually, the whole country would be under Washington-run health care, using tax dollars to pay the bills.

Even without a megabillion-dollar SCHIP expansion, taxpayers already pick up the tab for almost half the health care in America, via Medicare, Medicaid and the Veterans Administration. The SCHIP expansion could tip that, too, so the majority of all health care — not just kids’ care — is government-paid and therefore government-controlled.

If Congress overrides President Bush’s SCHIP expansion veto, the full and final federal government takeover of medicine in America becomes inevitable. With that would come lower quality health care, long waits and explicit government rationing of care. That’s the story wherever countries have nationalized their health systems.

That last part is a lie. It’s true the national health care systems of some countries, notably Britain and Canada, have hit some bumps. But most countries with national health care do not have “lower quality health care, long waits and explicit government rationing of care.” The fact is that, in measure after measure, the U.S. health care system is actually below average. It’s true that we still manage to lead the world in some aspects of health care, such as cancer survival rates. But I explained here why our glorious cancer survival rates are not really all that glorious.

And I bet no Brit or Canadian has to line up to get health care in old animal pens.

Heritage continues,

SCHIP expansion also distracts from efforts to make health care more affordable. That would require a reversal of the Washington-dictated bureaucracy that is pandemic in American medicine and drives up costs — as illustrated by 135,000 pages of federal regulations that hog-tie doctors and hospitals. Reduce the bloated bureaucracy, and you reduce the costs.

[Update: Turns out the 135,000 pages is a myth, and an old myth, at that. From the comments of Rep. Pete Stark, House Ways and Means Committee, hearing on Medicare Reform, March 15, 2001.

Mr. STARK. Don’t mention that to the good folks in the 13th District of California, please.

There is no business operation–and that is what HCFA is–that can’t stand improvement and doesn’t need constant revision to see that we are using current technology. In fact, we are offering you a buck off, I think, if you will file electronically. Maybe we should charge you a buck–you being your group and other participating doctors–if you don’t file electronically to urge you to get out and buy that laptop and help us be more efficient.

There are a lot of ways we can cooperate, but the MERFA may very well completely eliminate any ability to enforce our laws and regulations. It is not the way to go. And I would urge you to–which is unlike previously, 10 years ago with the AMA–continue to be in the tent with us as we write any improved legislation, and I think we can go a long way together.

But, please, you know, for a lot of the guys who work hard, this argument 135,000 pages of regulations is baloney. We have counted them. There are about 35,000, which is maybe too many, but it isn’t 135,000. That number came from Mayo, who have refused to send us any documentation of where it came from. But, believe me, I want to stay out of the Mayo Clinic if they can’t tell the difference between 135,000 and 35,000, or when they read my cholesterol level, I am going to have a real problem.

So thank you for your organization’s support to stop smoking, to get kids insured, to reform managed care. But remember that one of the complaints you have that are fixed in the Patients’ Bill of Rights is that you get paid by the private insurers on time. At least we do that. We may come back after you later, and maybe we have to change that. But be careful what you wish for. It could come to pass. And I look forward to working with you.

I take it the 135,000 pages is a kind of urban legend that’s been around for a while.]

I googled around for some concrete examples of how federal regulations “hog-tie doctors and hospitals” and run up costs. There are probably other examples, but all I found was this: The EPA has issued some regulations regarding disposal of “infectious waste,” defined as “microbiologic (stocks, cultures); blood products; pathology waste (tissue and organs); sharps, including needles and blades; animal carcasses, body parts, and bedding from infected animals; and bedding and waste from patients placed in health-related isolation.” Some of these regulations came about after health care residue such as bloody gauze and used hypodermics washed up on some beaches. But if you don’t mind the beaches, I suppose it would save a little money to let hospitals dump this stuff any way they want.

But I don’t see how relaxing pathology waste regulations is going to change the fact that the United States spends almost six times as much on health care administration as other advanced countries. I bet most of those other countries have regulations, too, since they’re all have socialized medicine.

I still say that if “market forces” could have found a way to solve the health care crisis, it would have done it by now.

But here’s something else alarming, picked up from Paul Krugman’s blog.

Two important articles co-authored by Peter Orszag, the director of the Congressional Budget Office.

The first emphasizes a point I’ve also tried to get at:

    The long-term fiscal condition of the United States has been largely misdiagnosed. Despite all the attention paid to demographic challenges, such as the coming retirement of the baby-boom generation, our country’s financial health will in fact be determined primarily by the growth rate of per capita health care costs.

In other words, Social Security is not the big problem (and it’s not in “crisis,” Sen. Obama); it’s Medicare and Medicaid, and their problems are wrapped up in a general health-care crisis.

In other words, if we don’t retire the bleeping “free market” health care system, we’re doomed.

The second has a lot to say about controlling costs, and also explains succinctly, albeit in slightly obscure terms, why “consumer-directed” care, which is at the core of all the Republican plans, won’t work:

    On the consumer side, higher deductibles would encourage patients to be more prudent in their use of services, but they also raise concerns about the financial burden on persons with major health problems. Furthermore, the concentration of health care spending among a relatively small percentage of the population with very high costs limits the effect on total spending of increased cost sharing for initial charges.

In short, making people pay more for things like doctors’ visits is going where the money isn’t. The big bucks go for big expenses like cardiac surgery — and either these things are paid for by insurance, or not at all.

Cutting-edge medical science of a mere century ago was nearly medieval compared to what we have now. My father used to claim that, in his youth, tonsillectomies were performed on a kitchen table, and the chief surgical instrument was a hot spoon. My dad used to embellish a tad, but the fact remains that most of the really expensive procedures and equipment didn’t exist until the 1940s or later. Before then, there was no open-heart surgery, no MRIs, no chemotherapy, no dialysis. Mass production of the first antibiotic, penicillin, didn’t begin until 1943.

Before the 1940s, “consumer-directed” medical care probably was as economically efficient as any other consumer service. But for the past few decades medical care has become so expensive that only the extremely wealthy can pay for it. So consumers were cut out of the system a long time ago. Now we have an insurance company-directed health care system, and the health care sector is eating all our other economic sectors.

Heritage claims “taxpayers already pick up the tab for almost half the health care in America.” Heritage is not famous for its factual accuracy, but let’s assume for a moment that’s true. What we’ve basically done over the years is patch together some government programs to take over some parts of the population the private insurance companies weren’t serving — to pick up the droppings from the private health insurance table, so to speak. Put another way, we’ve created a mess of government programs to help maintain the fiction that our “free market” health insurance system works just fine. As they say in Britain, brilliant.

Armistice Day

It’s Armistice Day. Click here for a Wilfred Owen retrospective. More here.

James Fallows has some observances on the day here.

Originally this was a moment for looking backwards, to honor those who had served in the Great War and mourn those who had died. Its retrospective purpose remains. But for Americans right now it should also be a moment to honor the men and women who continue to serve and sacrifice and be injured and die — and to reflect on the fact that, for the first time in our modern history, they do so with absolutely no shared sacrifice or service from the public at large. Everyone knows this and avoids thinking much about it. Today it’s worth at least remembering.

It’s also worth thinking about how warfare itself has changed. In 1918, several warring nations agreed that the war would stop on the eleventh hour of the eleventh day of the eleventh month. But it’s unlikely our current military actions will end with an armistice. Wars will just go on, and on, until changing circumstances cause people to lose interest.

For that reason, war can no longer be thought of as an extraordinary event of limited duration that will end on some day future generations will have to memorize for history tests. From now on, we must understand that when we choose to engage in a large military action there may not be an end to it for many years. Certainly, there can be exceptions to this. If a war has a narrow and sharply defined mission — running Saddam Hussein out of Kuwait, for example — then a war might still be of limited duration. When the mission is more grandiose and less specific — ending evil, spreading democracy, making the world safe from terrorism — then don’t expect to live long enough to see the end of it. Unless, of course, we just stop fighting it.

And for that reason, “we’re at war” can no longer be an excuse for playing fast and loose with the Constitution. It was controversial enough when Lincoln and Franklin Roosevelt assumed extraordinary “war powers” that would be relinquished when the wars ended. When President Bush expands the powers of the presidency, he is in effect changing the way powers are balanced and separated from now on. Because our wars will have no armistice, no formal conclusion dignified with treaties and ceremonies, war powers will not be relinquished unless some future President chooses to do so. Or, unless Congress and the Courts force the President to relinquish them.

On the other hand, without shared sacrifice on the part of civilians, war and the sacrifice of soldiers can too easily be put out of mind. For those not directly involved, perpetual war could become just another part of the constant drone of issues emanating from mass media. And that makes it too easy.

From an editorial in the Lufkin Daily News:

One in four of our nation’s homeless people is a veteran, according to a study released this past week, and soldiers returning from the current conflicts in Iraq and Afghanistan are becoming destitute more often and more quickly than veterans of past wars. …

… Part of the problem, a big part, is that war has become so commonplace for our country. The wars we are fighting now have no end in sight, and the daily news has hardly changed since they began: U.S. soldiers are dying at a slow but steady rate. Most the country is against the war, and the absence of a military draft means the people who are serving are doing so by choice. That, unfortunately, makes it easier for us to disregard the sacrifices they are making.

Another issue is that, while local organizations (namely, the Angelina County Veterans Day Committee and local school districts) do a great job of putting together ceremonies to recognize our veterans, it’s like pulling teeth to get members of the public to attend them. Then there are the other 364 days of the year on which we think, and do, very little about veterans’ needs.

Taking care of returning veterans should be a high priority for government, not a job delegated to volunteers or Veterans Day committees. Veterans should not have to ask for charity.

See also Vietnam Memorial Turns 25.

Update: See also John Nichols.

Update 2:
Commander Jeff Huber, U.S. Navy (Retired), quotes Kurt Vonnegut’s Breakfast of Champions:

I will come to a time in my backwards trip when November eleventh, accidentally my birthday, was a sacred day called Armistice Day. When I was a boy…all the people of all the nations which had fought in the First World War were silent during the eleventh minute of the eleventh hour of Armistice Day, which was the eleventh day of the eleventh month.

It was during that minute in nineteen hundred and eighteen, that millions upon millions of human beings stopped butchering one another. I have talked to old men who were on battlefields during that minute. They have told me in one way or another that the sudden silence was the Voice of God. So we still have among us some men who can remember when God spoke clearly to mankind.

Armistice Day has become Veterans’ Day. Armistice Day was sacred. Veterans’ Day is not.

Commander Huber continues,

I have this little veterans’ memorial along the edge of my yard. It’s where I put in some new plants early in the fall, so they’d be established when winter came and then bloom when spring rolls around. Puttering around the garage while I was in the middle of this yard project, I found a miniature U.S. flag on a small stick, one of those things you see real estate agents plant a million of in everybody’s yard on the Fourth of July. I’d saved this one from the Fourth, for some reason. Anyway, there it was on a shelf in my garage, and I picked it up and took it out where I’d just put all the new plants and stuck it in the ground, where it has stayed 24/7 ever since.

I think of this little plot as my memorial to everyone I personally knew who died in uniform. None of them died in combat. Most of them died in “training accidents,” mainly aviation related, things like disappearing into the side of a mountain or flying to the bottom of the ocean.

I keep thinking someone who thinks he’s really, really patriotic will come along someday when I’m in the yard playing with my dogs or something and tell me how I’m not treating the flag properly, that I should know better than to leave it outside day and night, rain or shine, what with me being a veteran and all.

I can’t wait to see the look on that person’s face when I say what I have to say in reply to that. It should be pretty comical, the look on the face of that person who thinks he’s so all fired patriotic.

That person might look like he just heard the Voice of God.