Health care, youth and age

[More than 5000 people have visited this site in the last seven days. Most of you visited because of a fradulent email comparing President Obama to Hitler, which has been circulating under my name for the last five months or so, and whose circulation has dramatically increased this month. You can read its full history here. Quite a few, however, have appreciated what they found and apparently intend to return.]

Since we have had so many interesting comments about health care, I am going to begin with that subject before moving on to something else.

I am sorry, to begin with, that the reader who described himself (I think that's the right pronoun) as a "career civil servant" has so little respect for his, and my, profession. Actually his comments illustrate the biggest problem surrounding the health care debate: the American people's colossal ignorance of the most basic facts. This is not altogether surprising. TV news has a notoriously short attention span and hardly ever provides enough information to understand a complex issue, and it is very easy to pass through even a leading university today without learning much of anything about the workings or history of government and public policy. In this case the relevant facts are as follows. The US government already runs two health care systems, Medicare and the Veterans Administration system. Both are extraordinarily cheaper than privately provided care. Nor is there any real need to worry that the proposed public option will be any different. Although I myself did not know it until yesterday, the public option in the bill being considered by the House of Representatives is simply an extension of the Medicare system to the general population. Here is the text of the letter which the progressive caucus in the House sent the White House last week--short, to the point, and far more informative than 99% of the media coverage on the subject.


Dear President Obama:

Thank you for continuing to work with Members of Congress to draft a health reform bill that will provide the real health care reform this country needs.

We look forward to meeting with you regarding retaining a robust public option in any final health reform bill and request that that meeting take place as soon as possible.

Public opinion polls continue to show that a majority of Americans want the choice ofa robust public plan and we stand in solidarity with them. We continue to support the robust public option that was reported out of the Committees on Ways and Means and Education and Labor and will not vote for a weakened bill on the House Floor or returning from a Conference with the Senate.

Any bill that does not provide, at a minimum, a public option built on the Medicare provider system and with reimbursement based on Medicare rates-not negotiated rates-is unacceptable. A plan with negotiated rates would ensure higher costs for the public plan, and would do nothing to achieve the goal ofproviding choice and competition to keep rates down. The public plan with set rates saves $75 billion, which could be lost ifrates are negotiated with providers. Further, this public option must be available immediately and must not be contingent upon any trigger.

Mr. President, the need for reform is urgent. Every day, 14,000 Americans lose their health care coverage. We must have health care reform that will effectively bring down costs and significantly expand access. A health reform bill without a robust public option will not achieve the health reform this country so desperately needs. We cannot vote for anything less.

We look forward to meeting with you to discuss the importance of your support for a robust public plan, which we encourage you to reiterate in your address to the Joint Session of Congress on Wednesday.

Lynn Woolsey
Raul Grijalva

The comment which I posted yesterday reminded me of another health care story which I heard about seven or eight years ago, involving my late friend William Strauss, the co-author of the books on generations and eras of American life upon which so much of these commentaries are based. For the last 25 or so years of his life Bill earned his living as the co-founder and co-producer of the comedy troop the Capitol Steps. The troop employed about 25 people and provided health insurance under a group policy from a private insurer. (Unfortunately I can't remember which one it was.) In 1999 Bill was diagnosed with pancreatic cancer, but was given a new procedure called a Whipple, and spent at least a week in the hospital. He was initially declared cancer free, but within a few years tumors had appeared in his liver, and he had several near-fatal chemo treatments before he eventually died in 2007. (See my obit under December 2007.) Anyway, a year or two after the initial surgery, Bill told me an interesting story. The insurance company had informed the Capitol Steps that their group premium was going to be doubled or tripled--I can't remember the exact details, but it was a huge increase, big enough to make it impossible for the company to function. Their intention was obvious: to recover the entire cost of Bill's initial treatment. Fortunately he managed to drop out of the plan, easing their concerns, and get health insurance through his wife, a public servant. Had he not done so, he would either have gone bankrupt, died years earlier than he did, or both. I am sure that story is not unique.

I am beginning to see a need to collect citizens' stories about health care, and I hope that any readers here who have any that they feel are significant will also share them in comments. If that is sufficiently popular, I'm thinking about putting up a whole new blog devoted solely to posting them.

The gentleman who pointed to the lack of community spirit in the United States in comparison to other Anglo-Saxon countries (or, he might simply have said, other advanced countries) had an important point. I suggested in another forum that the Europeans, in particular, take civic responsibilities more seriously because they actually experienced the effects of Nazism first hand and know how important it is to provide basic services and a real safety net. The United States was 50 years behind Germany and about 30 years behind Britain in getting social security. More importantly, it's clear that through the New Deal era and the High that followed,a substantial Republican minority (though far from the entire Republican Party) never accepted the expanded role of the government. Then, sadly, in the 1960s, the whole issue of providing for less-well off Americans became hopelessly entangled with racial issues. The antitax movement, I am sorry to say, succeeded in much of the country because it was a movement against giving any kind of benefits to undeserving minorities. In much of the South that even translated into a prejudice against now-integrated public schools. Now President Obama and some Congressional Democrats are trying, amidst a very hostile climate, to restore some sense of public responsibility.

On another front, I began reading last night a most remarkable book, Packing the Court, by the political scientist James Macgregor Burns. While so far I have read only the first few chapters, it has already inspired quite a few reflections.

I got to know Professor Burns two years ago when I spent a year as a visitor at Williams College. He was then 89, and just had his 91st birthday. He was showing no signs of age, however, a point that is more than confirmed by this book, which does a brilliant job of condensing the entire Constitutional history of the United States into a relatively short space. I shall probably have more to say about its content when I have finished it, but one fascinating point is already clear: it is an example, like much of my own work, of how profoundly we can all be shaped by our youth.

Burns himself tells how he heard in February 1937 of President Roosevelt's plan to pack (in effect) the Supreme Court by adding six new justices--one for every justice who had reached the age of 70 without retiring. He and most other scholarship students, he reports, favored the plan. During FDR's first term the Court had struct down the National Recovery Act, the first Agricultural Adjustment Act, the Guffey-Snyder Coal Act (which regulated that basic industry), and a state minimum wage law. The ability of the "nine old men," several of whom had been born before the Civil War, to overturn the will of the President and Congress in the midst of a national emergency, appalled many Americans at the time, and created something of a scholarly backlash. Several scholars argued that the framers had never intended to give the federal courts the power to overrule federal legislation. The young James M. Burns evidently accepted that argument. What is more interesting is that he accepts it still, 70 years later--making him virtually the only American I know who would make that argument.

Although he obviously has strong convictions on this point, Burns is much too scrupulous a scholar to bend the evidence. He briefly but succinctly goes over the debates in the Constitutional convention and during the ratification process on this point, and certainly did not convince me that the Founders unequivocally shared his view. And although I must wait to finish the book before going into this in any more detail, it seems to me very arguable as to whether on the whole the Supreme Cout's power of judicial review has been a good or a bad thing. Yes, the Court overturned both much of the Reconstruction legislation that tried to give former slaves equal rights and much important work of the New Deal (although it retreated, partly because of some fortuitous vacancies, after FDR lost the court packing battle, and did not invalidate Social Security, the Wagner Act, or federal wages and hours legislation.) But I, like Burns, am marked by my youth, and I grew up under the court of Earl Warren, William O. Douglas, and Hugo Black, which outlawed segregated schools, established the Constitutional rights of defendants, and eventually even legalized abortion. (That last decision, I have come to believe, was a mistake. Abortion in 1973 was already legal in some major jurisdictions, including both New York and California, and I think that abortion rights would be more secure today had the issue been left in the hands of legislatures.) It is not easy to see how many of those changes--especially integrated schools in the South--would have come about without the Court, but at the same time, it is true that liberals came to rely far too much upon it. In addition, the Court became a rallying point for conservative activists, whose persistent efforts to establish a right-wing majority are now bearing fruit.

Burns's book, at any rate, is a great inspiration to me, since it suggests that I too might have as much as 30 years of productive historical work ahead of me--and the nation benefits from hearing such a voice, an echo of an earlier time, whose relevance may in fact be returning.

It is perhaps because Burns, like myself, is an academic, that he has had no trouble sticking to the beliefs he formed so early. In my case, the Vietnam War made me a skeptic about American third world interventions, and nothing that has happened since has changed my mind. Movers and shakers, alas, tend to change with the times. In 1962, a new foreign service officer just out of college was posted to Vietnam. Full of energy and self-confidence, he asked to be appointed the provincial adviser in Ba Xuyen province in the Mekong Delta, with a population of over one million people. This was the era of the strategic hamlet program, and Vietnamese officials immediately assured him that they had completed several hundred hamlets. When he insisted upon seeing them, however, he discovered that quite a few of them were simply neighborhoods in the largest provincial towns, while others had not had any actual work done on them. The problem, he remembered in the 1980s, was that the distribution of aid to the provincial government was tied directly to the number of completed hamlets they could report. (One of many parallel stories about today's Afghanistan can be read here.

The name of that young foreign service officer was Richard Holbrooke, who today is the President's special envoy for Afghanistan and Pakistan. I have been hearing a good deal lately about Afghanistan from people who have spent time on the scene, and their reports, combined with the news, suggest that the situation there is much worse than the situation in South Vietnam in 1962. While everyone agrees that the Afghan people do not want or like the Taliban, they also agree that the Taliban is by far the most dedicated and organized political force in the country. Operating in Afghanistan is a logistical nightmare without secure supply lines, and the country is simply too large and American forces too small to create a NATO presence among the whole population. The main excuse for our involvement, as stated by Secretary Clinton and by Holbrooke,is to prevent the Taliban from taking power in Pakistan, but since 1) much of the Pakistani government has always wanted the Taliban in power in Afghanistan and 2) the Taliban has grown exponentially within Pakistan since we drove them out of Afghanistan, I am not convinced that that argument makes any sense. Holbrooke's 1985 oral history effectively described his own frustration at trying to get the reality of the situation across to higher ups, including President Johnson. While I have no specific information on this point, I am afraid today younger Americans may be having the same trouble with him.

This post has already ranged widely, but I shall make one more unrelated comment. During the election campaign last fall I had one recurring thought. Every time I saw, or heard about, a small child, it occurred to me that if Obama won--as he did--the youth of America would grow up without seeing anything odd or unusual about a black President in the White House. Sadly, I see now that I was wrong. The disgraceful, hysterical response to the President's decision to make a brief speech to schoolchildren on Tuesday shows that many parents are failing a basic test of citizenship: to teach their children some essential respect for our government and those who have been elected to it. It is already clear that, like Lincoln and Roosevelt, Obama will face paranoid, utterly unreasoned opposition, derision and hatred until the day he leaves office. Yet those examples show that such opposition need not prevent the President from doing what has to be done. Meanwhile, despite their parents' opposition, some of today's youth will grow up to revere the first President whom they remember. Three years ago, James Macgregor Burns explained to me that his family were rock-ribbed Republicans.