Essentially Contested America

The public option took a shot to the kidney yesterday.  The punch was hard and it was not fair, but it is just a part of the game.  The public option may be getting a standing eight-count in boxing parlance, but it should not be counted out.  In the next several weeks, the pressure will continue to build for a public option.  Eventually, the House of Representatives will pass a bill with a public option.  The Senate may not follow suit, but eventually will have to compromise on some form of a public option.  What form the public option will take is anyone’s guess.  However, it will be in a form that will allow all sides to claim victory and get on to campaigning for 2010.

This week, I have ahad a taste of what it might be like not to have health insurance for members of my family. Fortunately, my experience did not involve uninsured children, but instead an uninsured dog. My puppy, Owen, just turned 6 months old and he does not have health insurance. Being a risk adverse person, I investigated the insurance options when we got Owen. However, I soon learned that health insurance for dogs is prohibitvely expensive. Even simple catastrophic coverage cost at least $30-40 per month (For those who don’t know, “catastrophic insurance” is insurance that covers only “catastrophically” expensive health care for illness or injury), and regular health insurance coverage for dogs is simply not cost effective.

Last week, Owen had surgery. Fortunately, the surgery was routine (OK, we took away his ability to father puppies) and surgery for dogs is a lot less expensive than surgery for humans. Still, I paid several hundred dollars for his care. I had to make some tough decisions, such as whether to pay extra for the less invasive, less painful laser surgery, and how much to spend on pain medication (not to mention our worries about breaking or chipping the cone on his head – an added expense). Furthermore, when Owen’s stitches started bleding on Saturday afternoon, we had to decide whether to take him to the Emergency Animal Care and pay another large sum, or wait until Monday to have him re-checked by his regular doctor for free. Since Owen is, after all, a non-human animal, and since he continued to romp happily (as much as he could with a cone on his head), we decided to wait until Monday.

This experience got me thinking. I have a friend who is pregnant who only has catastrophic health insurance. I have another friend who has children and no health insurance. I imagine how hard it must be to make health care decisions for them. Wait until the cheaper doctor on Monday or go to the ER? Purchase the highest quality, least pain method of surgery or opt for the cheaper and plan to do lots of handholding? These decisions can’t be easy – indeed, they must be agonizing for the millions of uninsured parents with uninsured children in this country. I am lucky. Only my dog is uninsured. But I sure do feel for the many others are not so lucky.

This week, news circulated suggesting that President Barack Obama sent emissaries to attempt to convinced New York Governor David Paterson to exit the 2010 New York gubernatorial race.   I have heard some argue that the president’s attempt is anti-democratic and that the voters of New York should decide who their governor will be.  Of course, all would agree that New Yorkers should elect their governor.  However, given that the president is the de facto head of the Democratic Party, he has an obligation to do what he can to ensure that the person New Yorkers elect is a Democrat and that the person running at the top of the ticket is as strong as possible.  The stakes for the Democratic Party in the 2010 New York election are large.  A weak candidate may weaken turnout and affect down-ticket races.  Given that Sen. Gillibrand is crucial to count to 60 Democrats in the Senate, a strong gubernatorial candidate is important for reasons important to the national Democratic Party and its agenda.  As important is the redistricting that will occur in the wake of the 2010 Census.  The map that a Republican governor would endorse is likely to be far different than the one a Democratic governor would endorse.  Congressional seats may be in the balance.  If these are the concerns that drove Pres. Obama to encourage Paterson (and those who would have challenged Sen. Gillibrand) out of the New York primaries, his actions may be perfectly understandable and somewhat necessary as the head of the party.  Of course, the president may be wrong about the parade of horribles that could follow a Gov. Paterson primary run (and possible win) but that is a very different question than whether he should have gotten involved at all.

This may be an overly saturnine observation, but it seems that the United States is no longer governable–if by “governable” one means implementing the positions that win elections. The current Health Care Reform crisis is one of many such examples, but there are others also. Indeed, it’s a good test case. If we get a bill will it be one that favors the people or the Health Insurance companies? Four out of five congressional committees reported bills including a public option. One would think a public option is a sure thing. Right? Not necessarily. This fiasco turns off even those citizens who for the first time and who turned out en masse to support a candidate for president. How will this president reward them? Bold, courageous action is required, not politics as usual.

Last week, the Supreme Court heard the oral argument Citizens United v. FEC, which could become a landmark First Amendment case. At issue is the constitutionality of the FEC’s ban of anti-Hillary documentary sponsored by corporate funds. The Court could decide the issue narrowly, on the grounds that this particular commercial speech was clearly political and thus warrants the highest level of First Amendment scrutiny. However, comments by several justices at the oral argument hint that the Court may use this case as a vehicle for establishing a new rule – that commercial speech merits the same strict scrutiny as does political speech. Until now, the Court has applied a lower level of scrutiny to commercial speech. The reason for this practice is that because commercial speech is for profit, there is less of a danger of chilling that speech than there is for political speech. If the Court does use Citizens United v. FEC as a vehicle for establishing a new level of review for commercial speech, thousands of statutes that currently regulate business and commercial speech will fall under attack, and may be struck down. Monied interests, which are already far too powerful in our political system, would become even more powerful.

If the Court issues a broad ruling in Citizens United v. FEC, that would be consistent with a trend on the Court to protect the interests of property owners and businesses. The Court has established a new regulatory takings doctrine which makes it considerably more difficult for the government to regulate property in the public interest (though the Court’s ruling in Kelo was a step backwards in this line of cases). The Court has established new limits on punitive damages in tort cases brought against multi-national corporations like Exxon. If the Court, as expected, issues a broad ruling in favor of corporate commercial speech in Citizens United v. FEC, it will be just another Supreme Court ruling in favor of the “haves” at the expense of the “have nots.”

Interestingly enough, this week has seen the release of the Iraqi journalist who threw a shoe at President Bush on his trip to Iraq last year as well as the continued discussion of the Rep. Joe Wilson (R-S.C.) “You lie” lie thrown at President Obama during his address to Congress last week.  Interestingly, the two incidents and their aftermath are instructive.  The shoe-throwing journalist tried to make a point with respect to President Bush’s policy in Iraq and the resulting carnage that resulted.  His conduct was inappropriate, but one can understand that he felt compelled to do something after witnessing the carnage that he had witnessed in his own country.   His disrespect for President Bush, based on President Bush’s policies and their effect, was clear.  Nonetheless, he was, of course, arrested and sent to jail.  Rep. Wilson tossed his lie at President Obama not after witnessing carnage and not after seeing the effects of President Obama’s plans.  He tossed his lie at his president at an inappropriate place at an inappropriate time on an issue about which Wilson was inappropriately confused.  He showed disrespect to President Obama and the office of the President not based on what the president has done and not based on the substance of what the president said as the statement that precipitated the insult was true.  Rather, Wilson showed supreme disrespect for President Obama because he did not like what the president said and, I fear, because of who the president is.  The political price for Rep. Wilson’s actions as measured by the regard in which the public and his fellow legislators hold him should be significant.  However, almost certainly, the price will be a pittance.

Someone mentioned that without a public option, the health care reform bill will be a bill protecting Heath Insurance Company’s profits. Just how will health care costs decrease without competition? Opponents of the public option never seem to provide a satisfactory answer to this question.

Has American public discourse ever been as vitriolic and dangerous as it is now? If not, what’s the explanation? Is it protecting the wealthy by concentrating on relatively distractions such as the Obama “takeover,” and other issues that don’t go to the heart of the inegalitarian character of American society? It is possible for us to reverse the trend? What steps are needed to do so? Last night a cable station broadcast presented an exchange between a preacher and a gay talk show host. The preacher indicated that he would not have a problem with someone assassinating the president and told the talk show host that he should die of brain cancer like Teddy Kennedy. Can we just write this off as the Kooky fringe? Or should we be alarmed? And if the latter, what’s the remedy? The only remedy can be a concerted effort on the part of the responsible figures–are there any left?–on all sides of the political spectrum to denounce such discourse. Vitriol can lead to violence and even when it doesn’t, it certainly prevents intelligent discussion about fundamental matters of national concern.

How will the so-called “trigger” work? What will insurance companies need to do to avoid the trigger? Will the trigger have “teeth”? And what will “teeth” amount to? No one seems to take these questions seriously. As such, the trigger seems to be a gimmick providing cover for those who oppose a public action. There is no substitute for a public action. With a public option, it will be apparent whether choice and cost-effectiveness works. Without one there will be no baseline for determining whether insurance companies will be kept “honest.”

It’s been quite a week. I watched folks marching in the Labor Day parade carrying “Health Care Now” signs, and heard an enthusiastic crowd member call out, “Health care yesterday!” I talked to my friend whose husband lost his job about her difficult decision about whether or not to take her son to the doctor for an ear infection since it would cost over $100. I think of my friend who was just diagnosed with cancer. Thank goodness she has health insurance – I can’t bear to think of her having to forego treatment, as so many have who can’t afford it and lack the insurance to pay for it. I think of my friend with the severely disabled daughter who can’t move because after years, she finally got her daughter on state supported health care. I think, maybe relief is finally here for her and the 46 million uninsured in this country.

Yesterday, President Obama said that health care reform is not just an economic issue, it’s a moral issue. I agree. Why do the people who suffer bad luck such as loss of job or severe illness then have the further bad luck of not being able to afford health care? It’s just not fair, and it’s not in this way in any other advanced industrialized nation. Health Care (Reform) Now? I sure hope that it will be here soon.