Monthly Archives: April 2008

Identity Crises

Posted on by

That Bill Kristol is as hilarious as ever today. He is comparing Barack Obama to Karl Marx:

But it’s one thing for a German thinker to assert that “religion is the sigh of the oppressed creature.” It’s another thing for an American presidential candidate to claim that we “cling to … religion” out of economic frustration.

Note the “we.” Another member of the elite who doesn’t get it.

Obama in San Francisco does no courtesy to his fellow Americans. Look at the other claims he makes about those small-town voters.

Obama ascribes their anti-trade sentiment to economic frustration — as if there are no respectable arguments against more free-trade agreements. This is particularly cynical, since he himself has been making those arguments, exploiting and fanning this sentiment that he decries. Aren’t we then entitled to assume Obama’s opposition to Nafta and the Colombian trade pact is merely cynical pandering to frustrated Americans?

In Kristol’s world, the unwashed masses who live in those anonymous small towns are too dim to notice where their jobs went (which, if true, would make them almost as dim as Kristol) and wouldn’t be against “free trade” if demagogues would just leave the subject alone.

IMO Kristol shows us how really out of touch he is here:

He’s [Obama] disdainful of small-town America — one might say, of bourgeois America.

Either Kristol has no clue whatsoever about the real working-class folks of small town America, or he doesn’t know what bourgeois means. Or both. Either way, there is a huge class of Americans who are utterly invisible to Kristol.

This goes beyond just looking down on the simple peasants. Kristol doesn’t even know they exist. (See also fubar at Needlenose.)

Meanwhile, Obama is fighting back. ABC News reports:

“Shame on her,” Obama said, echoing one of Clinton’s own atacks on him. “Shame on her, she knows better.”

Obama said he was disappointed with her for her response and then launched into a new criticism of Clinton over her recent admission of being a hunter, and compared her sarcastically to Annie Oakley.

“She’s running around talking about how this is an insult to sportsmen, how she values the Second Amendment, she’s talking like she’s Annie Oakley! Hillary Clinton’s out there like she’s on the duck blind every Sunday, she’s packin’ a six shooter! C’mon! She knows better. That’s some politics being played by Hillary Clinton. I want to see that picture of her out there in the duck blinds.”

Obama said he is amazed and surprised by this “dust-up” but admitted that his words were chosen badly. He said he deeply regretted … that his words were misinterpreted.

This is exactly the right response. He shouldn’t back down. I think it’s possible that, when the dust settles, this episode will have resolved in his favor. Senator Clinton is already having to answer questions about the last time she went to church or fired a gun.

Here’s what’s sad: If I had read this column by Carl Bernstein six months ago I would have said Carl had fallen victim to Clinton Derangement Syndrome. Now, I suspect it’s close to the truth.

Here are some really good “see alsos”: Kevin Hayden at American Street; Ron Beasley at Middle Earth Journal; RJ Eskow at Huffington Post; Oliver Willis.

Here’s a particularly excellent commentary by Gary Younge. And David Lightman of McClatchy Newspapers writes “A surge of new voters in Pennsylvania is likely to help Obama.”

Update: Robert Reich:

Bitter? You ain’t seen nothing yet. And as much as people like Russert, Carville, Matalin, Schrum, and Murphy want to divert our attention from what’s really happening; as much as HRC and McCain seek to make political hay out of choices of words that can be spun cynically by the mindless spinners of the old politics; as much as demagogues on the right and left continue to try to channel the cumulative frustrations of Americans into a politics of resentment — all these attempts will, I hope, prove futile. Eighty percent of Americans know the nation is on the wrong track. The old politics, and the old media that feeds it, are irrelevant now.

Read the whole thing.

Update 2: Quote du Jour from John Cole:

So, in case you are keeping score, yes, American voters are dumb enough to vote for Bush twice (and I include myself in that number, sadly). They are not, however, dumb enough to sit around and listen to an Ivy League educated lawyer who has spent all but two of the last 40 years living in a Governor’s mansion, the White House, and a NY mansion and who made 110 million over the past six years call someone else elitist.

Go figure.

Bittergate Backfire?

Posted on by

Don’t miss this post by Josh Marshall, which says the Clintons have said things in private about the unwashed masses of small towns that were far less charitable than what Obama said publicly.

The Clinton campaign tried to capitalize on Bittergate by handing out “I’m not bitter” stickers. MSNBC reports that the Clintons tried to claim that the stickers were a spontaneous grassroots phenomenon, but later admitted that they, um, had them printed and passed them out.

I like this bit from the MSNBC story:

But the issue doesn’t seem to be sticking. Clinton himself has been silent on the issue. But at the first two events of the day, the campaign has sent one of Carolina’s hometown boys out to push the issue before Clinton takes the stage. Tom Hendrickson, a Clinton supporter and former Democratic Party chairman, included a reading of Obama’s comments in his introduction of Clinton.

“Senator Obama, don’t pity us and think that we’re bitter and frustrated,” he said in Winterville this morning. “We are hard-working family folks who are smart, and we get it. We don’t need pundits to tell us what to think.”

Hendrickson repeated the sentiment at a later stop in Winston, but dropped the direct mention of Obama as the source of the quote.

In both instances, Hendrickson’s speech evidenced little reaction from the crowd, which had been waiting for the main event for over an hour, and appeared to have little tolerance for a parade of surrogates.

By the third stop of the day in Goldsboro, Hendrickson did not even take the stage.

Maybe folks don’t need pundits to tell them what to think, but I take it folks also don’t need Clinton surrogates to tell them what they feel.

Elitism for Elites

Posted on by

It always amuses me when upper-class people with power and privilege start screeching about “elitism.” Today all manner of political, media and blogging elites — people with advanced degrees who’ve never been to a tractor pull in their lives — are snorting about elitism because Barack Obama said something that anyone with a real redneck background knows to be true — working-class, small-town whites feel left behind, bitter and frustrated.

This remark allegedly is an insult to working-class, small-town whites in Pennsylvania. I have a different perspective. Granted, my background is southern Missouri small-town working-class white, rather than Pennsylvania small-town working-class white, and there are subtle cultural distinctions between the two. While I may have kinfolk in half the trailer parks in the Ozarks, I admit that doesn’t qualify me to speak for Pennsylvanians. But over the past forty or so years small-town, working-class white America has been living through the shared experience of diminishing opportunity combined with increasing financial instability.

In community after community, the old factory or mining jobs that sustained the local economy are gone. Forty years ago, young folks left high school, signed on to jobs that paid Union-obtained wages and benefits, and looked forward to all the trappings of American middle-class affluence — homes, new cars, trips to Disney World. Now the bright young people move away to cities, and those who remain in the small towns sustain themselves — barely — by flipping hamburgers or cashiering at Wal-Mart.

The only ones who aren’t bitter and frustrated are those too young or too dim to realize life was much better a couple of generations ago.

I concur with many of Obama’s critics that the place of guns and religion in American culture is older, deeper, and much more complex than Obama’s remarks reflected. But don’t tell me small-town, working-class white folks in America aren’t xenophobic. They are, deeply, and they have been going back generations. That’s just a plain fact. Believe me, you don’t know the half of it until you’ve lived among them.

What’s rich about the current flap is that the biggest reason small-town, working-class whites have tended to vote “conservative” in recent decades is that the Right has stoked that bitterness, frustration and xenophobia, election after election, and turned it on the Left. As Joe Bageant pointed out in his pretty-brilliant book Deer Hunting With Jesus, small-town, working-class whites learn everything they know about the outside world from highly paid media elites like the perpetually angry and xenophobic Rush Limbaugh and Bill O’Reilly. Fear and anger are the bread and butter of right-wing politics; it keeps the rubes compliant.

Limbaugh, btw, may be from southeast Missouri, but his family had tons of money. True Redneckland would have been a place Limbaugh visited growing up, but he never had to live there.

And today you’ve got people like John “Power Tool” Hinderaker (highly paid lawyer; graduate of Dartmouth and Harvard Law) discussing Obama’s “bigoted opinion, common among urban liberals, of people who live in ‘small towns.” I don’t know why Hinderaker put quotes about “small towns”; maybe he thinks there are no such things.

Quoting Oliver Willis:

Apparently Fox, Drudge, and Politico are just tired of a slow news week and are looking for something – anything – to whip up a frenzy over, and of course the go-to people for quotes on this are the elite of elite cons like Grover Norquist and Karl Rove. I mean, when is the last time those guys had a conversation with someone making less than six figures– besides the help?

I’ve long believed you aren’t a real American until you find yourself in some rural Kentucky roadhouse at 1 a.m. singing “Rocky Top” with the rest of the drunks. I dare say this is an experience not many of Obama’s critics have had. I admit that I’m far enough removed from my own roots that I no longer remember the words to “Rocky Top” beyond most of the first verse and the refrain, but I used to could sing it all the way through. I suspect, however, that the small-town, working-class world I grew up in would be utterly alien to the likes of Hinderaker.

From a working-class perspective, the three presidential candidates represent different slices of the elitist pie. You’ve got Senator Hillary Clinton, who grew up in an affluent suburb of Chicago and graduated from Yale law school; Senator John McCain, son of a four-star admiral and U.S. Naval Academy graduate; and Barack Obama, the biracial graduate of Columbia University and Harvard Law.

American politicians going back to Andrew Jackson have emphasized the more common aspects of their biographies to appeal to voters. Failing that, one might get away with affecting folksiness as George W. Bush does. But politicians need to be careful when they presume to speak for the folks.

“It’s being reported that my opponent said that the people of Pennsylvania who faced hard times are bitter; well, that’s not my experience,” Mrs. Clinton told an audience at Drexel University.

Does anyone besides me find that hysterically funny? Of course it’s not been her experience. The only time she speaks to small-town, working-class commoners is when they’re lined up to shake her hand at a photo cop. She’s never been one of them. Obama has never been one of them, either, but he’s not pretending to be. Senator Clinton may think she’s found a talking point that will help her keep the lead in Pennsylvania, but she might want to be careful about portraying those small-town, working-class folks as being happy and optimistic.

Oliver Willis makes another good point:

It’s intriguing that Dems are never supposed to voice any criticism of rural America (which isn’t what Sen. Obama did) but Republicans are allowed to insult San Francisco, Massachusetts, the coasts, etc. It’s like there’s a double standard or something.

It’s all part of the Right’s elitist program of selling snake-oil to the rubes.

Update: See also Ezra Klein and Marc Ambinder.

Update 2: See also Steve Benen, John Aravosis and John Cole.

Why Wingnuts Are Idiots, II

Posted on by

Because, you know, whenever one “lib” says Khalid Sheikh Mohammed should be set free, then (wingnuts figure) all “libs” must want Khalid Sheikh Mohammed to be set free.

Idiots.

Hawkins has a couple more brain cells than many of the rest of his tribe, which is frightening. One wonders how they manage to dress themselves.

The real issue in the years to come is not what’s to be done with KSM. At this point he’s probably not capable of doing much but huddle in corners, hugging his knees and talking to his imaginary friends.

No, the real issue is going to be separating fact from fiction. After four years of detention and torture, KSM confessed to personally decapitating Daniel Pearl. I understand he confessed also to masterminding the September 11th attacks, the Richard Reid shoe bombing attempt, the Bali nightclub bombing in Indonesia, the 1993 World Trade Center bombing and various other foiled attacks.

And maybe he did those things, or maybe he just said he did to stop the torture. We’ll probably never know, because cases grow colder as time marches on. And we’ll probably never be able to put KSM on trial.

Speaking as an eyewitness to the destruction of the World Trade Center, I would like to say that it is more important to me to find out who really was responsible than it was to pick a scapegoat that fits the Bush Administration’s propaganda du jour and torture him into confessing. KSM was a dangerous guy and (note this, Hawkins) I don’t advocate releasing him, but neither do I accept on faith anything the Bush Administration says.

ABC News reported yesterday that “enhanced” interrogation techniques were not just approved in the White House; they were choreographed in the White House.

Highly placed sources said a handful of top advisers signed off on how the CIA would interrogate top al Qaeda suspects — whether they would be slapped, pushed, deprived of sleep or subjected to simulated drowning, called waterboarding.

The high-level discussions about these “enhanced interrogation techniques” were so detailed, these sources said, some of the interrogation sessions were almost choreographed — down to the number of times CIA agents could use a specific tactic.

The advisers were members of the National Security Council’s Principals Committee, a select group of senior officials who met frequently to advise President Bush on issues of national security policy.

At the time, the Principals Committee included Vice President Cheney, former National Security Advisor Condoleezza Rice, Defense Secretary Donald Rumsfeld and Secretary of State Colin Powell, as well as CIA Director George Tenet and Attorney General John Ashcroft.

And anyone who doesn’t think Condi was keeping the President fully briefed on these meetings gets to sit in the corner wearing the dunce cap.

Rightie genius macsmind writes,

There is nothing inherently wrong with the President of the United States and his key advisors having such discussions on what to do with the tiny little fact the article misses that these were TERRORISTS that wanted to kill AMERICANS.

And we know that because the Bushies said so! Brilliant!

The phrase “war crimes” is being tossed about. I am skeptical the Gang of Six Plus One will ever be indicted in this country. However, their foreign travel opportunities may be severely limited in future.

Well, I’m sure the government of China can show them a good time. They have so much in common.

Scapegoats

Posted on by

Today the Olympic torch, having been extinguished and re-lit several times in France, is in San Francisco. I haven’t yet heard what’s going on with it today, but protests are expected, and the IOC is considering scrapping the torch relay in the future.

You probably know that the government of China blames His Holiness the Dalai Lama for causing unrest in Tibet. You probably know this is bullshit. However, the people of China hear only the Chinese government’s side of the story, and they tend to support their government.

Here in the U.S. , wingnuts and the crackpots who lead them continue to promote the idea that either Iran, or al Qaeda (the original one), or both conflated together in John McCain’s addled brain, are the chief culprits behind the violence in Iraq. You probably knew this is bullshit, and if you don’t, Dilip Hiro and John Juan Cole explain it for you.

Republican presidential candidate and war hero John McCain continues to be confused about connections (unlikely) between al Qaeda and Sh’ia Iran. Michael Goldfarb thinks we’re all being picky.

This is getting beyond ridiculous. Sometimes people make mistakes, even liberals–like when Arianna Huffington, in the midst of attacking McCain for just such a gaffe, confused Iran with Syria. Does she really not know the difference between the two? Of course not.

Memo to Goldfarb: Arianna Huffington ain’t runnin’ for President. And McCain keeps making the same mistake.

Clinton supporters believe the Clinton campaign is struggling because media are mean to Clinton. The fact that Senator Clinton’s campaign keeps making big, fat, newsworthy mistakes is not, of course, a factor behind the negative press. Yes, there is some piling on, but she’s giving them so much to pile on about. (See also “Why the Clintons Held Onto Mark Penn.” Interesting read.)

And, as I remember, until the Clinton campaign started losing, the same press had built the Senator and her campaign team into the Most Awesome and Absolutely Unbeatable Political Juggernaut of All Time.

Ezra Klein writes that conservatives have a creative scapegoat for recent economic meltdown — liberals caused the subprime mortgage crisis:

The new line we’re hearing is that the financial meltdown was really the product of the Community Reinvestment Act, a piece of legislation from the late-70s that required federally-insured banks to lend throughout the areas from which they take deposits, including poor neighborhoods, which were being systematically excluded from credit. The legislation, by all accounts, worked. Now, however, conservatives are trying to argue that it’s behind the crisis: If the CRA hadn’t been pushing these banks to make all these unsafe loans, then the birds would still sing and Alan Greenspan could still start each morning by being anointed with the oil of the purest, youngest, olives.

As Robert Gordon shows, however, this is crap.

Well, yes.

Anyway, is there anyone out there actually taking responsibility for something?

Penned

Posted on by

By now you’ve heard that the controversial Mark Penn is no longer the chief strategist of the Clinton campaign. It’s not clear whether Penn has left the Clinton campaign entirely, however.

The breakup, if indeed it is a breakup, occurred because Penn was caught working with Colombia on a free trade deal that the Clinton campaign opposes.

Penn has been behind one blunder or embarrassment after another in the Clinton campaign, and there have been no end of calls from Clinton supporters to get rid of Penn. Yet the Clintons won’t let him go. Why is that? Michael Tomasky has some answers:

[T]here are two people who appear ready to stand by Penn, hell or high water, and they are the two who matter: Bill and Hillary Clinton. Penn joined Bill Clinton in the mid-90s, after the early woes (gays in the military, healthcare), and he kept the president on the ideological middle ground. He did the same for Hillary while overseeing her 2000 Senate campaign. In the course of these experiences, both Clintons came to swear by Penn’s advice. They saw his gift for numbers and demographic analysis, but they failed to grasp his obvious weak point.

Pennism is a kind of Democratic politics that one could argue was right for an era of conservative dominance: take few risks, and move as far to the centre and even right as possible so you couldn’t be labelled soft on defence or wobbly on support for the free market.

But George Bush and Karl Rove have seen to it that, after Iraq and Katrina and the US attorneys scandal and now a real-life recession, we are no longer in an era of conservative dominance. We’re not in an era of liberal dominance either, of course, but we are in a place where, for the first time in a very long time, conservatism has discredited itself, and more Americans are open to progressive alternatives. This was apparent to anyone paying attention in September 2005, after the tragedy of New Orleans.

But it wasn’t apparent to Penn. And by extension we can conclude it wasn’t apparent to the Clintons either (revealing, considering Bill’s alleged political genius). Hillary’s refusal to renounce her vote in support of the Iraq war – a refusal that I have no doubt was based on Penn’s advice, on the grounds that she had to continue to show she could be “tough” on foreign policy – was a disaster for her, as was the vote itself. If, in a few weeks’ time, we’re writing Clinton campaign post-mortems, her handling of Iraq will be deservedly high on the list of errata, and it was classic Pennism.

Tomasky’s column sums up my biggest concern about Senator Clinton. If Clinton becomes president, I fear she will continue the famous “triangulation” pattern that assumes the Right still controls public opinion, and progressivism will have missed a huge opportunity. What progressives need right now is someone who can communicate our values and ideals and inspire a disenchanted America to embrace them. That person is not Senator Clinton.

Yesterday while I was looking for something else I came across an old Mahablog post from January 2006 in which I said netroots progressives would not support Hillary Clinton. Clearly I was wrong about how much support she would get, although I still find it baffling that any progressive would support her. In this I quote a post by Chris Bowers, also from January 2006, titled “Why The Blogosphere and the Netroots Do Not Like Hillary Clinton,” and one by Stirling Newberry from November 2005, no longer online, in which he said “Hillary Clinton as a disaster for progressives and ultimately for the Democratic Party.”

The Clinton campaign hasn’t shown me any reason to change my mind.

Update: See also Jonathan Chait.

Why Wingnuts Are Idiots

Posted on by

Yesterday I wrote a post about the way our health care system is no longer capable of providing basic, primary care and emergency services to everyone who needs it. There are several causes for this, but the primary cause is that the “system” has been skewed away from preventive and emergency care services (in which there is no profit) and toward the creation of treatments and health care products that do make a profit.

Yesterday’s post focused on a New York Times story about Massachusett, which initiated a “universal” health care program that currently is insuring 340,000 people who had no health insurance before. And now there are not enough primary care physicians to go around. One physician has a 13-month waiting list for basic physicals.

A few wingnuts commented on this same New York Times story. Their take? “See? Socialized medicine doesn’t work!”

Don Surber:

Question: Why isn’t universal health insurance working in Massachusetts?

Answer: Good intentions also lead to shortages in everything. What the New York Times calls “unintended consequences,” I call predictable.

If we didn’t have all these wimpy good intentions, there wouldn’t be a problem. Clearly, that millions of Americans have been cut off from basic health care services is not a problem.

Another rightie, Soccer Dad, concludes that the primary care physician shortage proves Mitt Romney (credited with the Massachusetts health care program) is incompetent. Romney may be incompetent, but the fact is whenever and however the U.S. finds a way to provide decent health care services to those currently uninsured, whether by public or private means, what’s happening in Massachusetts is going to be a nationwide phenomenon.

Put another way, the only reason the insured don’t have massive waiting lines for health care services (in most parts of the country) is that so many Americans have been kicked out of the line.

In other Right Wing news — Yes, Hugh, there were arm bands and book bags in 1968. I was there. Wearing arm bands in protest of the Vietnam War was pretty common, actually.

And why can’t we have civilized debates about important issues? Read this and be amazed — at the psychological projection.

Idiots.

Update: Another idiot speaks —

Why, it must be some kind of doctor shortage! … Could it be, oh I don’t know, lack of incentive?

No, brainless one, there is plenty of incentive. However, all the incentive tilts in the direction of what parts of medical practice that are very profitale (i.e., new technologies and drugs) and away from those parts that are much less profitable (i.e., preventive care) or tend to lose money (i.e., emergency rooms). Your market-driven health care system at work.

And, as Kevin Heyden says, Massachusetts has better health care resources than most other states. So “what will it be like in the Southern states that are mostly rural, or the vast wide open states that grow bigger, the wester you go?”

For years I’ve been hearing health-care experts saying that the nation’s ability to delivery basic medical services to its citizens has been deteriorating, even as we continue to excel at the development of new technologies and drugs for extremely serious illness.

The lack of basic services, however, is one of the factors that is driving up the cost of health care for everyone. It would be far more cost-effective if people got regular checkups and went to doctors at the first sign of illness. However, the millions of Americans who are uninsured or underinsured tend to wait until symptoms are more severe and the illness more difficult (and expensive) to treat.

Here’s just one example — the United States on the whole has world-class hospital neonatal care for infants born prematurely or unhealthy. However, we fall far behind most other industrialized nations in providing basic prenatal care for all pregnant women. Thus, a higher percentage of American babies are born prematurely or unhealthy and need intensive, and expensive, hospital care to survive.

This is what’s called “stupid.” Naturally, wingnuts are for it.

Someone asked in the comments if we have to choose between “unevenly distributed access to health care, and evenly distributed inaccess to health care?” No, we don’t have to choose that at all. Wingnut mythology aside, most industrialized nations provide access to perfectly good health care with no waiting lines to all its citizens. Some do a better job than others, but it can be done, and at a lower cost per capita than we’re paying now. But the longer we pretend that somehow “market forces” are going to solve our health care crisis the worse the inequality will grow, because “market forces” are causing the inequality.

When we do ever switch to universal health care, it will probably take several years to build the medical infrastructure needed to deliver good basic care.

Quick Comments

Posted on by

The insanity among the Clintonistas continues.

See Benjamin Wallace-Wells for more on how the death of Martin Luther King devastated liberalism.

Tibetans are not the only minority group facing brutal oppression by the government of China. Charles Cummings writes on the treatment of the mostly Muslim Uighur people of Xinjiang:

Uighurs have been jailed for reading newspapers sympathetic to the cause of independence. Others have been detained merely for listening to Radio Free Asia, an English-language station funded by the US Congress. Even to discuss separatism in public is to risk a lengthy jail sentence, with no prospect of habeas corpus, effective legal representation or a fair trial. About 100 Uighurs were arrested in Khotan recently after several hundred demonstrated in the marketplace of the town, which lies on the Silk Road.

And what happens to these innocent Uighur men and women once they land up in one of Xinjiang’s notorious “black prisons”? Amnesty International has reported numerous incidents of torture, from cigarette burns on the skin to submersion in water or raw sewage. Prisoners have had toenails extracted by pliers, been attacked by dogs and burned with electric batons, even
cattle prods.

In Typhoon, I relate the terrifying true story of a prisoner in Xinjiang who had horse hair inserted into the tip of his penis. Throughout this diabolical torture, the victim was forced to wear a metal helmet on his head. Why? Because a previous inmate had been so traumatised by his treatment in the prison that he had beaten his own head against a radiator in an attempt to take his own life.

This is the reality of life in modern Xinjiang. Quite what the Chinese hope to gain from their inhumane behaviour remains unclear. According to Corinna-Barbara Francis, a researcher with Amnesty’s East Asia team, “the intensified repression of Uighurs by the Chinese authorities is in danger of contributing to the very outcome that China claims it is warding against – the radicalisation of the population and the adoption of violent responses to the repression.”

The government of China commits hideous atrocities on anyone it decides it doesn’t like. Of course, we’re hardly in a position to claim the moral high ground any more.

But ethnic minorities in China’s outlying areas, like the Uighurs and the Tibetans, are treated particularly harshly. As I said in “Rebellion in Tibet,” the Chinese are making every mistake every imperial power ever made.

That’s why it stuns me when some online publication that claims to be for “peace and social justice” publishes apologies for China such as this. Unbelievable.

Marketing Health Care

Posted on by

Massachusetts instituted what’s called a universal health care program — about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage, — and now supply is no longer adequate to meet demand. Kevin Sack writes in today’s New York Times —

Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.

Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May — of 2009.

A 13-month line for a physical? But the wingnuts tell us only Canadians have to wait in line!

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

This is something I’ve written about before. The fact is that “market forces” have skewed the way health care is delivered in this country away from basic services like preventive care and emergency rooms. That’s because the real money is in providing boutique medical care products and services for those with means to pay for it. About a year ago, I wrote,

Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.

How did this come to pass? Certainly we Americans value creation and innovation. But it’s also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where there’s no chance of profit, forget it.

This is what the “magic of the marketplace” has given us. You know how markets work; where there’s a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And I’m not saying this is a scam; many of us have benefited from the drugs and gizmos. The problem is that some parts of the health care process just don’t make any money. And where it isn’t profitable, our system is falling apart. …

… Here’s what the “free market” people never seem to wrap their heads around: Unprofitable demands do not generate supply, even when those demands are desperately needed.

Put another way, not everything that’s worth having can generate enough profit to pay for itself. …

… By now “market forces” have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our system were built back up to where they should be.

Every now and then there will be a news story about our shameful infant mortality rates or our less-than-stellar life expectancy rates or that emergency rooms are closing or the number of hospital beds per capita is shrinking, and you can count on some wingnut to come out of the woodwork and declare that we are number one at delivering new drugs to colorectal cancer patients that increase their life expectancy by a whole 4.3 months, so take that.

One occasionally finds the claim that the U.S. has too many doctors, rather than a shortage of doctors. The problem is that the “oversupply” seems to fall short in primary care. Kevin Sack of the New York Times explains,

While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.

A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.

My understanding is that there are adequate numbers of medical students who graduate as general practice doctors, but since they carry an average of $120,000 debt for student loans they can’t afford to go into primary care.

This is unfortunate, because comprehensive health care reform requires better primary care so that health problems are prevented or treated at earlier stages. But in the U.S. “market forces” are better at creating and marketing expensive drugs and gizmos to hospitals to treat seriously ill patents. Ain’t no money to be made in preventive care. Money to be saved, yes, but not to be made. So emergency rooms rot, and people in Massachusetts wait 13 bleeping months for a bleeping checkup.

The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs. [emphasis added]

Of course he has. You can count on Bush to do exactly the wrong thing.

Anyway, just because real-world experience proves beyond a shadow of a doubt that “market forces” will not provide anything approaching halfway decent health care for all Americans doesn’t mean the wingnuts will lose faith in market forces. There’s no point even arguing with them. And because wingnuts dominate media, few Americans hear all sides of this argument. All they ever hear about are waiting lines in Canada.

Of course, the only reason we haven’t had worse waiting lines here is that so many people have been kicked out of the health care system altogether.

Be sure to read Paul Krugman’s most recent column, “Voodoo Health Economics.” GOP presidential candidate John McCain’s health care plan is, essentially, to allow the “magic of the marketplace” to provide inexpensive health care for everyone. Krugman explains in no uncertain terms why this is nonsense. The Boston Globe has more about McCain’s not-even-half-assed heath care proposals.

I’m not enthusiastic about either Hillary Clinton’s or Barack Obama’s health care proposals. They both fall under the heading of “better than nothing” in my book, McCain’s proposals being “nothing.”

The two Dems may not be beyond hope on health care, however. From an editorial in today’s Toledo Blade:

At one time or another, both Senator Clinton and Senator Obama have said they could support a single-payer national health insurance system, a kind of “Medicare for all,” as a solution to the health care crisis, but they have apparently calculated that it is not politically feasible to advocate it today.

The new survey of the nation’s doctors suggests otherwise.

These findings dovetail with those of an AP/Yahoo public opinion poll last December showing 65 percent of Americans favor a similar approach.

National health insurance is not only necessary, but increasingly popular.

Winston Churchill is remembered to have said of Americans that we always do the right thing, after we have exhausted all the other possibilities.

It is time for our political leaders to stand up for the health of the American people and implement a nonprofit, single-payer national health insurance system.

In part I blame news media for not presenting anything approaching a balanced, fact-based debate on health care. We get only the Right’s POV and more of the Right’s POV. I think if the American people understood the facts, we’d have national health care already.