Adventures in Belarusian Health Care

I've taken a couple weeks away from blogging, but a nearly severed finger tends to obstruct even the most disciplined writing regimen. Here's the story: I was attending the May 9th Victory Day parade with Clark, Will, and Ace when I noticed that folks were climbing atop a mobile rocket launcher for photos. So I hoisted myself upward and did the typical tourist thing, taking silly "look at me" pix. As I began to navigate my way back to the ground, I remember thinking, "This is much higher than I expected. I'm gonna have to let myself drop a couple feet. The landing will hurt a bit, but not too much. I can handle it."

I dropped and felt the expected lightening bolt of pain upon impact, but not where I anticipated. Turns out, as I fell from the vehicle I caught my wedding ring onto a hunk of metal and damn near peeled my finger off. Steadying myself and spotting red splotches on the ground, I stared at the digit that now resembled a mushroom cap. The thin gold band was cut and corkscrewed in and out of my skin. I said to the ashen faced people nearby: "I can handle it. I can handle it." Then as the pain started to dial up, I told Clark, "I think I've got a real problem here. I think I need help." Clark jumped into action and flagged down a soldier who directed us to an ambulance across the parade route.

At first the medics drove at what seemed like a leisurely pace. "Great," I thought, "a frickin' tour of the city." But as my breathing grew more pronounced, the driver kicked on the siren. "спасибо," I whispered. "I can handle this." The driver sped up. Elena X. Karpovich met me at the hospital, wrangled the insurance paperwork, and got me seen by a doctor: a young guy - maybe thirty, possibly younger. I vividly remember how he laid out a piece of brown butcher paper and positioned a big scalpel next to my finger. I thought, "Well, shit. This is it." I was sure he'd amputate. Instead he snipped some chunks of flesh and unhooked the ring from inside my finger.

His priorities, naturally, were the mechanics of the job, not my feelings. Thus when he cut a piece out of the gold band to ease its removal, I felt like I should cheer him on: "Yeah, cut it, cut it." He stopped and stared at me strangely. Then he spoke; the words were English, but the sentiment was all Russian.

"Don't speak."

A few minutes later, as he was injecting the wound with jabs of anesthetic, I started to recite a mantra to help myself manage the pain.

"This is a good pain. This is a good pain…"

Once more, he stopped and stared into my eyes:

"Don't speak." 

So, yeah, at first I thought he was a jerk. But I gradually came to appreciate his no-nonsense style. He knitted together dozens of stitches where the ring had been and up both sides of my finger (I later asked him how many, but he'd lost count). The doctor also developed a long-term treatment plan that involved him going well beyond the call of duty to ensure that I received excellent follow-up care. And with two subsequent meetings, he grew kinder and more patient with me.

A few days later, Elena transitioned me to a local clinic. There another doctor and nurse changed the bandage every couple days, checking to see if infection had set in. That meant me donning surgical slippers, walking into a treatment room, and waiting for the inevitably sharp pain as the nurse would gingerly remove the old bandage. Afterward I would sign a form and pay at the desk. All communication at this point was in Russian.

Elena, always calm and almost impossibly nice, endured many phone calls when I needed the doctor to translate his instructions. And day by day my finger began to feel better. I wore a splint for more than a week, getting it removed only yesterday. Oh, and what about the cost? Well, that annoying insurance that folks must pay at the Minsk airport covered my emergency care, and the subsequent clinic visits cost 96,000 BY Rubles each: the equivalent of $7.00 a visit. A pretty good deal if you ask me.

The EMTs, doctors, nurses - and most definitely Elena X. Karpovich - helped me through a scary time. Health care in Belarus is by no means a perfect institution, neither for visiting Americans, nor for local folks who lack an embassy representative. And each stage included plenty of hassle. But good people cared for me throughout the process, and I am grateful. Indeed, during my last visit with the ER doc, I learned how close he thought I'd come to losing my finger. At once, his scary instruction "Don't speak" made more sense. He was concentrating on each snip and every suture to keep me whole.

I await a visit with my primary care physician to check on infection and determine when the stitches can be removed. I hope she'll give me good news. But no matter what happens next, I am thankful for my adventures in Belarusian health care.

Europe 2012: Day 7 (Munich to Salzburg) Adventures in Austrian Health Care

Well, I got a chance to learn a little about Austria's health care system today. I woke up early today for a run and some street art photography along the Tumblingerstraße in Munich. Only I pivoted too quickly to avoid a speeding car and felt a stabbing pain in my right leg.

After trudging back about 1 1/2 miles to the hotel [today's a holiday, and I didn't see a single taxi], I went online and began the old RICE plan (rest, ice, compression, elevation). But hours later, after lugging my stuff to the train station and chugging south to Salzburg, I could still barely walk. At least I could hail a cab.

Checking in at the Schloss, the woman at the front desk heard my story and called another taxi. She said I'd be crazy not to get checked out at the nearby hospital. All my life I'd thought that these sorts of things are meant to be "walked off," but I just can't say no to an Austrian who means business. In this pleasantly efficient land of exclamation points [and honor-system newspaper stands too], there's little point in arguing.

So instead of tucking into some bratwurst at some cozy al fresco restaurant to celebrate my return to Salzburg, I found myself filling out forms at the hospital. My passport and insurance information were taken and I began to fret about the bill. The guy at the check-in desk assured me that the basic fee would be 187 EU - maybe more, but not likely a crazy amount. Almost reading my mind, someone nearby said, "You're not in America anymore."

I followed the blue line to the examination area where, after a couple questions, the nurse explained that I'd have to wait for an hour. She gestured to an old woman lying on a gurney in the hallway. I flashed back to that old Ringo Starr line: "I'm just happy to be here."

Assuring the nurse that I was in no rush, I asked if there was a restroom nearby. She replied, "no." Still smiling, I noted that, well, I'd have to pee sometime. I wondered how local folks manage this seemingly basic task. Luckily, an Australian visitor understood my plight. "He means the toilet." Oh, yeah... Once more my Puritan upbringing has jammed me up, inspiring me to select a pleasantly vague euphemism in a time calling for practicalities. "Cheers, mate!," said my new Aussie friend.

Soon enough I settled into a blue mesh chair in a long corridor. The guy next to me looked fine enough, until I noticed that his eyeball seemed ready to burst from his head. Maybe I'd overdone this whole thing. It was just a pulled muscle, after all. I could sit comfortably enough; I just couldn't, you know, walk. This guy's eyeball is pulsating out of its socket!

Still, I've got to admit, my situation felt scary. My research had confirmed that a really bad calf muscle injury could take weeks or even months to heal. Sometime (though rarely) these things require surgery. And I'm traveling all over Europe and China over the next two months. Still, sneaking a quick peek at the guy with that bloody, bulging orb staring back at me, I realized that I couldn't complain.

Almost exactly one hour later I heard an announcement in German that ended with "Mr. Wood." By this point, my leg had stiffened up pretty tight. I stepped slowly until a young woman gestured for me to quicken my pace.

Turns out, she would be my doctor this evening. She asked the basic questions, and then felt, prodded, and tugged her way around my leg. Little by little I became more certain that things would work out fine. Feeling a little silly, I said, "Really, I'll just be happy to know how should take care of this thing while it heals."

"You will have X-Ray," she explained. "Then I will tell you what to do."

Across the hall I endured a mild Pilates lesson. My X-Ray tech - all business - dragged my leg one way and then another to line up her shots. Looking up, grateful that she'd covered my genitals with a blue shield, I imagined myself back in the States, counting up the hundreds of dollars each minute in these rooms would cost.

Limping back to the hallway, I saw that old woman on the gurney once more. My X-Ray tech had slipped out another door and joined her. She still maintained her no-nonsense vibe, but I was happy to hear some kindness in her voice. I prayed that my visit had not wasted a single second that could have gone to that old woman's care. I remembered that I'd stammered a sheepish apology to the doctor during my initial consultation. "Better safe than sorry," I offered. Yes, she smiled.

Almost an hour later, the doc pronounced her verdict. My leg had good reason to hurt, she said, but there was no serious damage done. She gave me some pills and a reminder to walk slowly and calmly for the next few days. I thanked her and paid my fees. Cash only (due to a broken card reader machine). Exact amount too (no change available). I counted out each Euro, feeling nothing but gratitude. Now I'm back at the Schloss. My leg still hurts like hell, but at least I'm here.

Tonight's State of the Union

Wary promises that some members of congress might break tradition and deign to organize themselves in groups not aligned solely to exacerbate our deep cultural divide do little to assuage the sense that the state of our union is anything but strong. No, we're not in Civil War-mode, not really. Heck, I imagine that folks who endured the 60s could point to even more profound fissures in our nation a mere four decades ago. Still, President Obama faces a large and rowdy contingent of lawmakers who seem more indebted to Tea Party bombthrowing than to managing the people's business.

Health care reform (remember that?) is getting wound up for a second serving of anything-goes partisanship. Threats of a government shutdown are echoing through the halls of Congress (as opposed to the plodding of tourists who are now safely isolated from much the Capital Building - another loss to our grim post-9/11 world). And then there are various wingnut committee chairs bent on raining two years of nonstop investigatory fury on a president they'd cheerfully send to a Guantanamo Bay if they could. They presume, I suppose, that all this poison will bleed dry once the other side takes over, that then they'll do half the things they promised their constituents ("Department of Education? Sold to the University of Phoenix. IRS? New headquarters for the Chamber of Commerce!"

Pundits will opine that tonight's State of the Union will mark a major milestone in the Obama presidency - maybe one of those "make or break moments." Yeah. Problem is, they all are. Each speech is a crisp, clear moment of clarity that somehow blurs into the muddy maw of legal wrangling, vicious brinksmanship, pious grandstanding, and guilty handwringing that defines American politics these days. Just how screwed up have things become? Here's a clue: Some people say that Ronald Reagan couldn't get the GOP nomination now; he'd be damned for being too liberal. If that's not a sign that the state of our union is really a mess, I don't know what is.

So good luck, Mr. President. We need it.

2010 State of the Union

It's hard to react to last night's State of the Union speech, because it fulfilled its expectations so thoroughly and - I fear - so pointlessly.

Once more, President Obama delivered a broadly scoped, reasonably detailed, and occasionally artful address that said many of the things that must be said. I particularly appreciated the president's respectful yet direct engagement with the Supreme Court - some of whom were sitting feet away from him - just days after they handed down a singularly disastrous decision that further cedes our country to corporate control. The sum of Obama's speech was a reality-check for the nation and its new leader, a frozen moment of America's increasingly difficult dialogue about its future.

Last night's address introduced us to Obama chastened, a leader forced to profess empathy for fickle voters who seem perplexed that an economic crisis built over the past decade has not somehow vanished by the snap of his fingers. The government will cinch its belt, he promised. Better yet, bailout-banks will start paying the same late fees that cash-strapped Americans have long endured. And we will once again pledge to shrink the debt that has transformed our nation from powerhouse to poorhouse, like an alcoholic swearing off the juice when morning comes, just as we always promise.

Along the way, Obama admitted that comprehensive health care reform, that shimmering Brigadoon of the American imagination, will once again vanish into the mist. Abandoning hopes of universal coverage, the president ushered the nation down the well-groomed trail of compromised incrementalism. We may see a few improvements in health care delivery - apparently the First Lady is tackling childhood obesity - but the systemic faults that profit the insurance industry while plundering American budgets will almost surely remain.

You can bet that the wingnuts on both sides of the political spectrum will continue calling the president a fraud or a fascist, either because he does too little or too much. They didn't need to see the speech to know where they stand. Yet I imagine that most listeners recognized the president's efforts to define some kind of middle ground in American discourse. During the speech, Obama challenged the assembled Congress to think past its prejudices: "We were sent here to serve our citizens, not our ambitions. So let's show the American people that we can do it together."

Did his speech do any good? It's hard to say. But judging from reactions and broader political realities, I don't think so.

Republicans generally set on their hands whenever the president veered from generically popular themes such as tax reduction or troop appreciation, when they weren't otherwise smirking to themselves. And Democrats were little better. Yes, they stood and applauded. Glowingly, supportively. Still, I'm certain that members of the president's party mostly daydreamed about their own concerns. Even as they clapped and cheered, they seemed to peer past the peaks of Obama's oratory, fixing their eyes into the abyss of a suddenly vicious election cycle. Holding congress is the highest priority for a permanent political class.

Thinking back to the Massachusetts debacle, many Dems were thinking to themselves, even as the president called for a new national consensus, "Yeah, but when is the next former nude model who drives a pickup gonna appear on the scene? And will he come gunning for me?" Solving the problems of a generation means less to these folks than fundraising for 2010.

So President Obama delivered another fine speech. As usual, I watched and listened and marveled about how wonderful it is to have a national leader who reflects the complexity of our national aspirations: vision and practicality, confidence and humility, forbearance and courage. While many of my friends on the Right seem hellbent on transforming the president into a bumper sticker caricature, I still believe he's the best person for a lousy time.

Thus, to me it seems less a question of whether our nation can be saved. In an era of partisan bickering and popular disengagement, the question is more fundamental: Do we deserve to be saved?

We made it. Can we unmake it?

We have created something that, if allowed to live, will likely kill our country. A feat of engineering born in the nineteenth century, our creation had been strapped to the table for over a hundred years. Until now. The switch has been pulled and a monster has been set loose.

Literary types might read what happened yesterday through the lens of Frankenstein's creature, a seemingly sensitive and tragic figure (in Mary Shelley's novel) that nonetheless reveals the folly of human efforts to dabble with godhood - and then tries to kill its creator.

What have we done?

To answer that question, we should first consider a sad irony, that we've been watching the birth and death of another creature whose suffering seems to have been contrived to draw our attention away from the real story.

For the past year, many of us - myself, included - have followed the plot twists of the so-called health care debate, marveling at the machinations of a legislative monster run amok. We surveyed its hulking movements and traced its inevitable fall into the abyss of lobbyists and demagogues; we knew this monster was too shabbily patched together with stitched compromise and slapdash design to do more than stumble about. We knew it was too big to die, too horrible to live.

A handsome and heroic Massachusetts senator was elected to put a bullet in the head of the beast, and those of us guarding hope for affordable health care in America bowed our heads a little. We performed the narrative to its necessary end. The story was over, the pundits announced, and we turned the page - except that we'd been following the wrong plot all along. The real story had just begun, lurching from the depths of the Supreme Court.

Yesterday, five conservative jurists revealed their masterpiece, surging an electrical burst of law and hubris into a thing nearly as nameless as Frankenstein's creature, an entity given the innocuous title, "corporation." It had waited long on the slab and is now unchained. And now the American voter faces its own transformation into a golem to be marched and maneuvered by creatures of our own making.

I refer, of course, to yesterday's Supreme Court ruling (Citizens United v. Federal Election Commission: [link]) that dismantled the already teetering divide between corporate wealth and political power.

Yesterday's decision, that corporations have practically the same rights to contribute to political campaigns as people because (a) they are people and (b) money is speech, means that America's political class can finally abandon its fiction of accountability to the electorate. We might as well change our nation's name to The United States of Walmart.

Oh sure, big moneyed interests have always held sway over political hacks who view their positions as a job rather than a service. But a century of case law and legislation that generally banned corporations from contributing directly to the coffers of candidates is now gone. Until yesterday, corporations could string together glittery networks of fake storefronts and empty office "citizens groups," but they couldn't intervene directly in elections, if only because Americans on the Left and Right shared a tacit agreement that the creature created in 1886, the corporation-as-person, overly threatened the pretense of the level playing field or marketplace of ideas.

Thanks to yesterday's ruling, corporate "persons," entities not subject to normal restrictions of time or space - or age or conscience - "persons" capable of marshaling nearly unfathomable degrees of wealth, can now do just about anything that a flesh-and-blood person can do within the political arena, except vote. But these artificial persons need not vote when they can simply purchase the votes of lawmakers, which makes political power cheaper than electricity. Writing for the Huffington Post, Miles Mogulescu cites New York Times analysis of the profits reported by Fortune 100 companies during the 2008 election cycle. The total: $605 billion. Then Mogulescu does the math. Just what can you buy with that kind of money?

"A third of the Senate is up for reelection every two years. Let's say the largest corporations give an average of $10 million to each Senatorial Candidate [on average, adjusting expenditures up or down depending on the race]. That would be $3.3-$3.4 billion every two years. Let's say they spent another $4 billion on the Presidential election every 4 years or an average of another $1 billion a year... For less than 1% of their profits, the 100 largest corporations would likely be able to control the Senate and the Presidency, and through that, the Supreme Court" (emphasis added).

Mogulescu notes that he's not even accounting for the rest of the Fortune 500, just the top 100 firms. I should add that those profits reflect reported figures. We have no idea how much money these "people" are actually making. We have no idea just what we've unleashed. What we do know is that the American voter has been displaced from the political arena, where advertising dollars command more attention than good ideas.

Certainly we awaken today to the same country. New movies begin their runs this afternoon, the malls will swarm with shoppers this weekend, and a new season of Olympic games will commence in three weeks, setting televisions aglow with packaged heroes and high definition feats of human skill. And editorialists will continue to shake with impotent rage against the machine. Yesterday's New York Times called the court ruling a "radical decision, which strikes at the heart of democracy." Mogulescu calls it a "bloodless judicial coup." Still, we can hardly be surprised.

After all, we built this thing with our votes. And when our votes were ignored or twisted, or simply manufactured, we made this thing stronger with our silence. Centuries ago, Thomas Hobbes imagined a Leviathan composed of our strengths that would ultimately stand on the foundation of our fears. Yet I don't think even Hobbes could imagine what our collective fear of action, of getting involved, of taking responsibility hath wrought. Yesterday's court ruling transcends mere political theory; it compels us into the realm of science fiction.

That's why readers can so easily recognize the parallel. It's a classic trope: human beings create sentient lifeforms to serve them before becoming their tools - or their prey. Fredric Brown foretold the end of the narrative with his brief yet terrifying story, "Answer." In his story, all the computers in existence are integrated into a supercomputer. Mortal minds build it, but mortal powers can hardly match the collective power of this thing. Still, there is hope that the device will gather all the knowledge available to our puny minds and answer the questions that exceed our intellect. Thus the moment arrives and the switch is thrown. The supercomputer is online. An operator addresses the machine with the most obvious question: "Is there a God?"

A flash of lightning strikes the device, destroying the off-switch, and the answer marks the new day: There is now.

Read More

Editorial Board, New York Times: The Court’s Blow to Democracy

Keith Olbermann, MSNBC: Special Comment (clearly an essay that inspired my own)

Miles Mogulescu, Huffington Post: The Supreme Court's Non-Violent Corporate Coup

Note: I'm not the only one using Frankenstein imagery to make sense of this mess. As I was revising my own post, I came across Jason Linkins's piece, The Supreme Court's Citizen United Decision is Terrifying and found his own brief reference to Mary Shelley's story. Surely there are others who agree: The news today is nothing less than gothic.

After Massachusetts

Yesterday was really a stunner. Scott Brown - I still can't believe we're talking about a Cosmo centerfold hottie - claimed his Massachusetts Senate seat - the one held by Ted Kennedy since real life Mad Men were charging three-martini lunches to their expense accounts. And now Democrats gather for the famed circular firing squad.

There's plenty of blame to go around, a chain of shame that grows from national party hubris, rises through the ranks of ever-cautious wait-and-see-ers, and collapses at the doorstep of a singularly tone deaf candidate whose campaign even managed to misspell Massachusetts on a television ad. In a larger sense, though, we might simply be seeing further proof that Americans prefer to calibrate against one party taking too much power, tilting against the majority to ensure a fair fight (or just for the sheer orneriness of sticking a middle finger to the clowns in charge).

Either way, Democrats face a bevy of miserable options that mark a spectacular downfall from grace not seen since the dark morning after the 1994 races when Newt Gingrich vaulted from the bomb-throwing ranks to the Speaker's chair. When it comes to health care, Democrats can try to cram the Senate's version through the House, which would represent an impressive feat of arm-twisting by current Speaker Nancy Pelosi. More likely this administration and its congressional surrogates will watch dreams of health care reform vanish in the same puff of smoke and mirrors so well known by Clintonistas.

The insurance industry wins another victory as once again Americans are suckered into voting against their own interests - and against their own stated preferences, beaten silly by buzzwords like Socialism, Government Takeover, and the dreaded Obamacare. Surveying the wreckage of today's political landscape I feel like Charlie Brown, looking up crazily at the sky above only to find Lucy staring down, laughing. Health care reform isn't dead, but the pulse is fading. I am amazed mostly, well, that I'm amazed.

Me, I left the Democrats years ago. It seemed the most sensible way for Jenny and I, frequently clashing opponents when it comes to policy and politics, to have conversations that didn't end with shouting matches. Our choice to become independents removed much of the partisanship from our household, inspiring us to relax our previously fixed positions. But the big picture remains the same, as bumper sticker-spouters shuffle the deck chairs and the rest of us watch the damn ship sink.

It's amazing how one Senate race can change things - or, closer to the truth, reveal how things really are. It's disillusioning too, which I admit as a guy who performs gimlet-eyed cynicism while hiding a secret reservoir of hope that we may still pull our country out of the drink. It's all a little disorienting. Of course, maybe my shock is really about the nature of yesterday's victor, a guy with pictures that have to be pixelated for The Cobert Report.

My Republican friends are surely celebrating an amazing victory. I can hear the laughter and the clinking of glasses from last night's parties that never really ended. And I can even hear the question, with all traces of mockery concealed by genuinely glowing sentiment: "Hey, the Dems elected Stuart Smalley. Why can't we get a little beefcake?"

Sure, why not?

Waiting for Massachusetts

Political junkies like me are breathlessly anticipating tonight's Massachusetts election returns that will determine the next person to fill Edward Kennedy's seat, and not solely for the historical significance of this race.

No, this is more broadly about efforts to wrap up health care reform that had supposedly passed the high hurdle of compromise among Democrats. And from still a broader perspective, this is about the power of one party to employ the filibuster to derail opposition on the other side of the aisle, regardless of what most Americans claim to want.

It's strange how things got this way. Historically the filibuster, and its demand for a supermajority to be broken, was a rarely invoked hammer swung by a smaller party against its larger rival. When both sides possessed large contingents of moderates who could work together for the greater good, the filibuster reminded everyone to be civil.

Those days are long gone. One after another, big-thinking strategic thinkers have been sent packing, and the current minority party has decided to use the filibuster in place of meaningful debate and respect for electoral mandate. Politics becomes no more than mere tactics.

Yeah, I'm pissed at Republicans today, but this failure is shared by both parties. Each side is led by thick-headed, thin-skinned hacks who once would have been dismissed as bomb-throwing backbenchers, folks necessarily bypassed by bipartisanship. The problem is that virtually anyone who might be mistaken for being a "statesman" left the building long ago.

So we're waiting to hear if a former nude model, now a stalwart Republican, wins a seat once considered a mortal lock for the Dems and breaks their 60 seat hedge against filibuster. Even I, a Californian, am following this race closely; it's exciting political theater. But it is also quite sad.

Someone will win today's election, but no one will win the broader battle. Instead we see further proof of how selfish agendas have supplanted what Lincoln summoned as "the better angels of our nature."

No matter the outcome of this vote, and no matter what kind of health care reform finally reaches the president's desk (if any plan survives tonight's bloodletting), it's clear that America is sick - and getting sicker.

Obama Enters the Ring

For many observers, it's taken too long for Barack Obama to formally enter the ring of America's health care debate; he's chosen, some say, to hang behind the ropes while partisan hacks grapple with the art and fakery of a wrestling match. Well, now there's no doubt: this president has joined the fight for real.

Analyzing last night's speech before a joint session of Congress, Adam Nagourney (NYT; registration may be required) does a swell job of laying out the political side of President Obama's challenge when it comes to bringing real health care reform to fruition:

It is one thing to create and surf a political movement, as Mr. Obama did in capturing the White House. It is quite another to lead an uneasy country and a politically divided Congress toward tough decisions that create winners and losers.

In his speech Obama crafted a clear and coherent argument about the need for reform. He proposed specific steps toward a workable bill, and he masterfully personalized the debate by invoking one champion of health care reform, the late Senator Kennedy, pausing before his conclusion to consider the "character of our country."

And yet I think the president's finest moments were in the bumpiest times. Obama - courageously, I think - warned Progressives not to sink the ship by fixating upon the single-payer option as the only star in the heavens. And Obama rightly rebuked Republicans (many, but hardly all) for demagoging the debate with misinformation and outright lies about "death panels" and free passes for illegal immigrants.

At this moment, in a manner seemingly scripted by a Hollywood dramatist, some GOP back-bencher from South Carolina - Why learn his name? Even members of his own party will likely send him back to the minor leagues in 2010 - let loose with an epithet that shocked the entire chamber, responding to a president standing before Congress with the invective, "You lie!"

Part of me wishes that Obama would have seized that moment and called this loony out, by name if possible, thereby painting the entrenched enemies of reform with the face of a know-nothing bomb-thrower. Just as a successful bill should honor one of its longtime heroes - the Edward M. Kennedy Health Care Reform Law rings a bell - its villains should be named and shamed.

But Barack Obama is no back-alley brawler; the president was wise to pull his punches. Hitting the GOP and hoping to wrangle the necessary votes from Democrats alone will not work in this case. The country has been wound into confusion and frustration during a sweltering summer of health care town hall meetings that revealed little more than the disparate poles of American political discourse.

That's why I loved the moment when our young president cited Arizona warhorse John McCain by name during last night's speech, praising his 2008 opponent's contribution of an idea Obama hopes to sign into law: a health care safety-net for the most poor among us. Even through the distance of a television screen, I read McCain's bemused smile and grudging thumbs-up as a sign of respect: The Kid from Chicago has got the touch.

Nagourney writes that Obama is a fighter who works best against the ropes, and I agree that the president may yet pull this thing off. Still, many an idealist has been been carted from the health care arena on a stretcher. Last night's speech offered a way for our nation to rethink the narrative of this drama, but many grueling rounds remain before a meaningful bill can become law.

This year we will get the full measure of President Barack Obama.

Read Nagourney's Analysis: http://www.nytimes.com/2009/09/10/us/politics/10assess.html

Forming the Reformers

Today's NYT reports that Democrats could be "set to go it alone on a health bill." Yeah, that's a relief.

Honestly I understand their reasoning. Republicans have concluded that the pleasures of political payback exceed the exigencies of fixing our system run amuck, a cacophony that costs so much more than it needs and delivers so much less than Americans deserve, this nation offering the Greatest Health Care System in the World (has that trademark been assigned yet?). To secure any hope of surviving as more than a regional throwback, Whigs without wigs, the party of Reagan must stand for something, even if that something is the pathetic choice of "anti-Obama."

Once more, health care reform faces death from a thousand scalpels.

So the Democrats are going to manage the operation now, run the Republicans out of the operating theater. Well, can you blame them? When it comes to the GOP's responses to each Democratic give-away, from single-payer to public option to private co-op -- "socialized medicine!" they screech (as if the Defense Department isn't a "socialized military" -- it's clear there will be no bipartisanship on this deal. Can you doubt that President Obama has mused aloud in staff meetings, "We've got a filibuster-proof majority, we've got a wide margin in the House, why not take this mandate out for a spin?"

Don't slip on the blood-stained floor, Mr. President. It's bad enough to confront a calcified Republican Party, bent on mischief and possessing no willingness to offer Americans more than empty fears of pulling the plug on Grandma. But the Democrats will be no easier to wrangle. Blue Dogs on the Right; Progressives on the Left, and few members of Congress owing you personal favors. The mind reels with the ways a decent president can be unmade by indecent hacks. I personally find sad reminders of Carter's failed presidency in this ongoing mess. And then there are the parallels to an even darker time.

A recent Harper's article compared Barack Obama to Herbert Hoover, noting both leaders' intelligence, pragmatism, and willingness to tackle tough issues. Hoover got a raw deal in the popular historical depiction, painted as the guy who fiddled while the economy burned. A fair assessment holds that this Republican worked tirelessly to head off the Depression, confronting first the disbelievers in his own party. But Hoover could not overcome historical, structural, and personal constraints that blocked his good intentions. I wonder if Obama thinks about Hoover's fate when he wrestles with the health care conundrum.

I have hope. I've got to. This is the first president in a long while who possesses the power to actually change things.

But I fear too that Democrats, despite the best intentions of their standard-bearer, are unable or unwilling to define the debate, clarify the plan, sell the vision, and craft the details without slipping their own predictable mires. The leadership in the House and Senate manages to be both feckless and petty, and the party as a whole lacks the discipline possessed by their opponents. Barack Obama proved his mettle as a community organizer in Chicago, but can he organize this community of fractious, insular, self-serving politicians?

Oh god, save health care reform from the Democrats.

Read the article: Democrats Seem Set to Go It Alone on a Health Bill (Free registration required)

Every Cough and Sneeze

Every cough and sneeze from my fellow passengers on the bus reminds me of the scary possibilities of catching swine flu. These are strange days, with many folks gearing up for a full-blown panic. Should we be so frightened?

David Whelan, writing for Forbes, has posted a useful reminder about the comparative threat of swine flu. He notes that 30,000 to 50,000 Americans die from complications caused by seasonal flu each year. Each of these deaths is a tragedy, undoubtedly, but they are part of a normal cycle.

This new flu? It could be a profound danger, another 1918 catastrophe, but it could also be one of many threats such as the 2003 SARS epidemic that scared the hell out of us before fading into the background, an historical near-miss. Whelen also wisely notes the media's role in whipping these sorts of threats into a public frenzy:

Recalling SARS: "Cable news channels and other media sensationalized the outbreak as if it were a Hollywood movie—a real-life sequel to Dustin Hoffman's 1995 hit Outbreak. A medical historian at the University of Toronto, Edward Shorter, watched what was going on and called the phenomenon 'mass psychosis.'"

Read the entire article: History Says Avoid Virus Hysteria