We’re not ready for Single payer healthcare (because we disagree on basic morality) Warning – this is a draft of a much longer paper, I hope!

“A common incantation during debates on health reform… is ‘that we all want the same thing; we merely disagree on how best to get there.’ That is rubbish.” – Uwe Reinhardt

In a 2011 Republican Presidential debate, candidate Ron Paul was asked a pointed question about what to do with someone who needed expensive healthcare but did not have insurance: “Are you saying that society  should just let him die?” Some in the crowd jeered “Yeah!” Paul indicated that as a physician, he did not find it acceptable to do so and offered charitable care from “churches” based on his experience of practicing medicine in the in the early 1960s, before Medicare and Medicaid, eliciting applause from the crowd.

Last year, I attended the Keystone Progress Conference in Pittsburgh, PA for a few hours. I attended a panel discussion of progressive candidates who lost their elections in deep red districts. One of the things I heard was straight out of this Ron Paul universe – all four of these candidates said they were surprised that so many of the conservative voters were afraid, of having others “get over on them.” That these others would get free healthcare and they were going to have to pay for it, for “those people” to be freeloaders that they would have to subsidize, etc.

In 2013, Dan Munro, writing for Forbes magazine, on the anniversary of Martin Luther King, Jr.'s “I have a Dream” speech, pointed to several myths so common to conservative thought about America, in particular our backwards interpretation of the “bootstraps” fable:

“the myth that literally anyone – through hard work and determination – can rise out of any poverty and become rich and prosperous. We salute, praise and deify everyone who does. But there’s a dark side to this myth. Anyone who doesn’t isn’t working hard enough – or doesn’t have enough determination. In effect, they’re a loser – and nobody wants to pay for the healthcare of those losers.”

Veronica Combs paraphrased it as ”There is a real meanness in the conversation about who should have healthcare, an implication that people who need help somehow don’t deserve it, or that they are taking advantage of ‘the rest of us.’”

All of this, of course, is not really news. Making a moral case for universal health care in any form is denounced as socialism or “not the job of government,” or as Ron Paul said, that we must “assume responsibility for ourselves.” The American Medical Association has famously opposed movement towards universal healthcare, from the Truman Administration to the passage of Medicare and Medicaid and through opposition to major parts of the Affordable Care Act.

Martin Luther King, Jr., noted that “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” Many have railed about the inhumanity of Americans towards each other regarding healthcare, and the late Professor Uwe Reinhardt has asked for decades, “To what extent should the better off members of society be made to be their poorer and sick brothers’ and sisters’ keepers in healthcare?” Americans, capable of unbridled generosity in helping individuals pay for a transplant or some other services when the individual in question is deserving, are ruthlessly coldhearted when compassion is requested for those they deem undeserving, as the Tea Party crowd showed us in 2011.

Reinhardt was clearly stung by the idea that his adopted countrymen (he was German born US citizen) rejected this solidarity, in contrast to every other nation’s resounding “yes” to the question. He also pointed out that the way Americans avoid the moral question that faces us is to play the game framed by the introductory quote: we pretend that the problem is that we disagree on policy, writ small and large, and find ourselves down rabbit holes about the reimbursement for an anesthesiologist for a fifteen minute unit of time with or without a nurse anesthetist!

Every other nation has started with the moral and ethical question over their values as a society and worked towards a solution to provide healthcare to all their people, “deserving” or not. As another professor noted:

"The last time I taught in the Semester at Sea program, I found it necessary to interpret for our students the rich “social capital” that runs through the Northern European societies we were visiting. What they knew and had read in their guide books was that not many people are in church on Sunday morning, especially compared to the florid religiosity of the United States. So their working assumption was that Americans take religion seriously and Europeans don’t. The new thought that amazed them was that the unchurched Europeans live in social democracies deeply saturated with historic Christian values, while the much-churched Americans celebrate a society characterized by a ruthless social Darwinism that the God of the Bible, Old and New Testament alike, denounces."

What is preventing us from having the basic moral argument about our values regarding health care? The answer is three-fold. The first is a strong puritanical streak in American culture that prompts many of us to divide our fellow citizens into camps of deserving and undeserving people. The second is a now unfathomably large industry that has much to lose should efficiency and order find their way into the American Healthcare system. The third is our human cognitive biases that lead us to sloppily assume political and moral positions that cold be overcome with rigorous analysis and vigorous debate.

-----------------

More to come? Thoughts?

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Three Books: A Summary of a Doctors for America Session held at the National Leadership Conference

Three Books: A Summary of a Doctors for America Session held at the National Leadership Conference on November 9, 2019

I recently did a workshop session at the Doctors for America National Leadership Conference in Baltimore. The session was titled Prospect Theory, Medical Industrial Complex and Social Justice in Health Care: 3 Important Books. I have recently had the opportunity to be able to devote some time to thinking about healthcare reform in general, and the distressing lack of progress toward universal healthcare in America spanning my entire career and beyond.

I came across the late Uwe Reinhardt's last book, Priced Out, which was a summary of his life's work: the ludicrousness of America's Healthcare Wonderland, as he calls it, and the ineffectiveness of any moral arguments to persuade the American political class to move towards universal healthcare. I had the opportunity to exchange a few emails with Prof. Reinhardt about 5 years ago. At that time, he seemed quite pessimistic about the opportunity of America moving forward. In his book, however, his life partner, Prof. Cheng, in her epilogue, makes it clear that he remained optimistic about America's chances for universal healthcare. He thought, she said, that we would probably stumble towards it and not actually make a cultural or societal decision, but that we would eventually get there in fits and starts.

Prof. Reinhardt's chief concern is that we never have the moral discussion required to propel us towards a universal healthcare ethic. Without the ethic, he argues, there can be no successful transition to a universal system. He has said that during healthcare debates, we have an incantation, "’we all want the same thing; we merely disagree on how best to get there.’ That is rubbish.”

He is right. We do not agree. We agree on the left that universal healthcare is an imperative, and those on the right agree that healthcare is a market commodity and should be treated like any other good or service. Of course, progress is made by convincing enough people in the middle that one's policy proposals or political arguments are worthy of implementation. One need not win over everyone. Medicare, Social Security, civil rights, and so much of America's progress in the past century was not unanimous. Given the opportunity, many conservatives would still reverse the New Deal, the Great Society, and of course, the Affordable Care Act.

Progressives have failed to win the moral and political arguments in favor of universal healthcare. As Wendell Potter has pointed out, the methodology of the entrenched and well-funded interests opposing progress are simple: fear, uncertainty, and doubt. Simple and devastatingly effective.

The Undoing Project: A Friendship That Changed Our Minds by Michael Lewis holds many of the answers as to why it is so effective. The book tells the story of the two psychologists who developed Prospect Theory. Prospect Theory was the basis of what we now call behavioral economics. It is the exploration of why we make the decisions we make. It is about why we make the irrational decisions that we make.

Briefly, our brains are fooled in a variety of manners. We have fast, intuitive thinking. This thinking is swayed by a variety of biases. Gains and losses are perceived from specific reference points. The fear of loss, risk aversion, is far more powerful than the lure of gain. Things that come to our mind easily, either through recency or frequency (availability) greatly impact our decision-making. The fast, intuitive mind is influenced heavily by these biases. And unfortunately, the fast, intuitive mind is very confident.

Our more logical, slow thinking brain is analytic. It is also unsure of itself because of its self-critical analysis. That is why a plausible and emotionally resonant feeling, as Mark Twain might say, is halfway around the world before a detailed policy proposal gets its pants on. Or, as Stephen Colbert might say, truthiness works.

There are many lessons to be gained from Prospect Theory, but the key insight from Daniel Kahneman is that “We don’t choose between things, we choose between descriptions of things.”

After reading The Undoing Project I was somewhat optimistic and excited about the possibility of using some of these techniques to combat the campaign of fear and uncertainty and doubt that is awaiting us as we march into an election year with healthcare reform as a major point of contention.

Unfortunately, I then read An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, by Elisabeth Rosenthal. Dr. Rosenthal provides a discouragingly comprehensive evaluation of the medical industrial complex and how it has come to dominate every aspect of the provision of healthcare. The chapters catalog the breadth: health insurance plans, hospitals, physicians, the pharmaceutical industry, the medical device industry, testing, laboratory, and all other manner of ancillary services, contractors, billers, coders, collections agency, researchers, not-for-profit organizations, and of course the rise of the massive healthcare conglomerates, euphemistically known as “integrated delivery systems.”

As Don Berwick recently wrote, there is $1 trillion of waste in the healthcare system. And one man’s waste is another man’s revenue. Dr. Rosenthal details all that waste and in doing so, lays down the markers on the battlefield. One side is well-funded and is fighting for its very existence. Or at least fighting for the very upscale version of its current existence, and desperate to avoid a comparatively spartan OECD-like existence.

As Upton Sinclair once said, "It is difficult to get a man to understand something if his livelihood depends upon his not understanding it." As Wendell Potter more recently said, “Health insurers have been successful at two things, making money and getting the American people to believe they’re essential.”

I finished my remarks, and opened up the floor for discussion. We spent a fair amount of time reviewing the concepts above. I specifically asked for help in developing framing and arguments that might help us in our advocacy work. Several themes emerged, and I have highlighted them here.

1.    Talk about the moral case for health care. We discussed the deserving-undeserving framing, the puritanical streak in American politics, and the fear of others "getting over on us." I told the story of having gone to a progressive conference after the 2018 election. I had the opportunity to hear from four progressive candidates who lost their races in conservative districts. All four of these candidates said they were surprised that so many of the conservative voters were afraid, almost exactly as I had phrased it to you, of having others ‘get over on them.” That these others would get free healthcare when they were going to have to pay for it, for “those people” to be freeloaders that they would have to subsidize, etc.

2.    Talk about work arounds and hassles. I pointed out that the second half of Dr. Rosenthal’s book was a guide for those who are trying to deal with the Wonderland of American healthcare. While quite useful in the here and now, it amounts to a series of workarounds of the system as it exists. Useful, to be sure, but it is not a prescription for ending the need for workarounds. As Teresa Brown recently put it in a New York Times piece, American healthcare system is one giant workaround.

3.    Talk about student debt, medical school tuition and physician income. We had a discussion about the rabbit holes, as I call them, of excruciatingly detailed policy points surrounding any healthcare reform. As Uwe notes, whenever this happens, we then engage in protracted and useless arguments over the value of quarter hour of an anesthesiologist time, or other some such parochial detail of concern. It was pointed out that these concerns arise out of the value of medical school education and residency training, the heady medical school costs and student debt, as well as physician income. The group argued to take these issues head-on. Have a discussion about subsidizing medical school and have a discussion about the relative value of the various specialties. Have a discussion about work hours and on-call time, medical liability, and the many other practical issues moving towards universal healthcare system.

4.    Talk about price control and administrative simplification. There is no love lost between physicians and the rest of the healthcare industry. There is also no love lost between consumers of healthcare services and the healthcare industry. The group felt that it was well worthwhile to point to alternative methods of controlling costs in the healthcare system. We discussed Prof. Reinhardt’s maxim that “It’s the prices, stupid!” We discussed the unconscionable waste of time and money spent dealing with health plans, from in-hospital utilization management to outpatient prior authorization for everything from procedures to medicines to wheelchairs. These issues potentially put us on the same side with the public and politicians.

While driving home from the conference, I began listening to Daniel Ariely’s Predictably Irrational. Prof. Ariely spends a significant amount of time discussing the difference between market norms and social norms. The way we behave around wages, prices, rents, and other payments are our market norms. The way we behave around doing each other favors, helping one another and other activities that do not involve financial exchanges, are our social norms. He provides many examples showing that things one might do unhesitatingly under the structure of social norms, are out of bounds under market norms. For example, lawyers asked to do work for a nonprofit company at a very low rate reject the proposal. Lawyers asked to do pro bono work readily agree. Injecting finance into a situation that normally operates on social norms profoundly alters the perception.

It occurs to me that this is at the center of Prof. Reinhardt’s assertion in his book. We will endlessly and vociferously debate on the number of and reimbursement for, angels dancing on the head of a pin, and always avoid the underlying discussion of whether we, as Americans should be the keepers of our less fortunate brothers and sisters for their healthcare needs.

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Kasich makes faith argument for Medicaid | The Columbus Dispatch

 

Talking to reporters, Kasich pleaded for legislators to approve the expansion.

“The most-important thing for this legislature to think about: Put yourself in somebody else’s shoes. Put yourself in the shoes of a mother and a father of an adult child that is struggling. Walk in somebody else’s moccasins. Understand that poverty is real.”

Kasich continued: “I had a conversation with one of the members of the legislature the other day. I said, ‘I respect the fact that you believe in small government. I do, too. I also know that you’re a person of faith.

‘Now, when you die and get to the meeting with St. Peter, he’s probably not going to ask you much about what you did about keeping government small. But he is going to ask you what you did for the poor. You better have a good answer.’ ”

Kasich makes faith argument for Medicaid | The Columbus Dispatch

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How Austerity Kills - NYTimes.com

 

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity. (Germany preaches the virtues of austerity — for others.)

As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions. Over the past decade, we mined huge data sets from across the globe to understand how economic shocks — from the Great Depression to the end of the Soviet Union to the Asian financial crisis to the Great Recession — affect our health. What we’ve found is that people do not inevitably get sick or die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life or death.

How Austerity Kills - NYTimes.com

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Testimony for PA Senate Democratic Appropriations Committee Public Hearing on Medicaid Expansion, March 8, 2013

Good morning. Thank you for conducting this session and for inviting me to speak. I am Dr. Chris Hughes, state director for Doctors for America, a nation-wide group of physicians advocating for high quality, affordable health care for all. I have been an intensive care physician for my entire career, now approaching 25 years, and within the past year I have also begun practicing hospice and palliative medicine. I am a former Trustee of the Pennsylvania Medical Society and Chair of the Patient Safety Committee. I have completed graduate studies in health policy at Thomas Jefferson University, and I am now teaching there, in the Graduate School of Population Health.

I tell you this to let you know that I can get down in the weeds with you about the nuts and bolts of implementation of the Affordable Care Act, and I know a fair amount about health care financing, access, cost shifting, and all the rest. But you have fine panelists assembled here today who have been doing this for you, and I know you all know your way around these topics as well. That’s why you’re here.

I am here as a physician and a representative of my profession. Every doctor you know, and every nurse and pharmacist and social worker and everyone in the front lines of health care, for that matter, can tell you stories of how our health care system has failed someone. Our system fails people regularly, and often spectacularly, and often cruelly, day in, day out.

I've had patients who work full time in jobs that fall far short of the American dream. They get by, but they can't afford health insurance.

I'll give you a few of my patients’ stories here, not just to point out the obvious- that we are mistreating our fellow human beings – but that we are misspending countless dollars on the wrong end of the system.

There's the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn't make it and ends up in the ICU with diabetic ketoacidosis.

There's the construction worker who has a controllable seizure disorder that goes uncontrolled because he can’t afford to go to the doctor. He ends up in the ICU, on a ventilator – life support - multiple times.

There's the woman who stays home to care for her dying mother and loses her insurance along with her job. When her mother is gone and she finally gets to a doctor for herself, her own cancer is far advanced. She goes on hospice herself.

The laid-off engineer whose cough turns bloody for months and months before he “accesses” the health care system – through the Emergency room and my ICU with already far advanced cancer.

Shona’s attendant, of course. [Shona Eakin, Executive Director of Voices for Independence, in her earlier testimony.]

These are people who are doing the right thing – working, caring for family members – and still have to go begging for health care. How many hours does an American have to work to “deserve” health care? 40? 50? 60? We, as a society, are telling these people that their work, their lives, are not valuable enough to deserve access to health care until they meet some standard of employment in a job that has health insurance.

While doing some research on Medicare cost savings, I ran across a paper from US Sen. Tom Coburn with this quote: "Medicaid is a particular burden on states, consuming on average 22 percent of state budgets." I don’t quibble with the number, I quibble with the mindset that leads one to think that the suffering of millions is a non-factor in the decision making. And the fate of patients is not mentioned in his paper.

Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, ( let me repeat that, “Jim DeMint and Trent Lott” ) wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. "Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for 'free.' "

Their No. 1 priority? It was to "Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage."

Medicaid expansion and the Affordable Care Act will get us closer to this than at any time in our history.

You will hear some physicians speak out against all of this. But what you generally will not hear is their leadership and organizations speaking out against it, except perhaps in the deep south. There is a reason for this. As leaders of our profession, we have to come to terms with the idea that we are not just in it for ourselves. We are in it for our profession as well, and that means we have to put our patients’ interests above our own, and that means we have to do our best to ensure that everyone has access to high quality, affordable health care. Don’t just take my word for it. The American Board of Internal Medicine Foundation and other organizations put together a Charter on Medical Professionalism about ten years ago, specifically making this, fair distribution of health care resources, a part of our professional responsibility. If you go to their website, you will find that virtually every physician organization you can think of has endorsed it. That means the anesthesiologists and orthopedic surgeons as well as the pediatricians and the family practitioners.

For Medicaid expansion specifically, we should note here that the major national physician organizations, including the AMA, and the organizations representing internists, family practice, pediatricians, psychiatry and more, all endorse Medicaid expansion. On the state level, all of these organizations state chapters endorse it as well, with the exception of the Pennsylvania Medical Society, which I am chagrined to say, has endorsed general terms of expansion only.

But this concept is really not controversial among physicians and health care providers. We see everything from the catastrophes to the small indignities. They are tragic, unnecessary, and we are on the road to ending them.

Some in the provider community have expressed concerns about Medicaid in particular as the way we are providing access, so I would like to take a moment to address the concerns we hear most often.

First, that Medicaid is “bad” insurance. What is bad about Medicaid is largely fixed in the ACA. Namely, it is very poorly reimbursed for providers. You’ve already heard from others why hospitals want it, why advocates want it, but for providers in primary care, the frontlines of health care, they get a major boost in reimbursement under the new law. Pennsylvania has historically had awful reimbursement in the Medicaid program, among the worst in the nation. Now, reimbursement will go to par with Medicare reimbursement, a huge incentive for providers to take on Medicaid patients whom they may have been reluctant to see previously. There are other new innovations such as Patient Centered Medical Homes, the new Medicaid Health Homes (which, by the way, we have also not begun implementing in PA – maybe another panel?), and other innovations, coming down the pike, that should really give people who previously had no chance at excellent care, a chance to avoid complications, avoid the ER and avoid the hospital. To live in good health.

I’ve also heard the strange claim that having Medicaid is worse than having no insurance. I suppose that in a vacuum where there is no good data, and where one sees, like I do, patients with no insurance or Medicaid, who don’t know how or aren’t able to access a doctor, you could look at patients who get very sick and mistake that association and attribute that to Medicaid, but we do have data now. In Oregon, due to a fairly bizarre set of circumstances a few years ago, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more. Incidentally, I heard a cable talking head complain about the Oregon data because it didn’t examine outcomes, such as deaths and such. A fair point if we had more than a year’s worth of data! I, and most other health professionals, would argue that the results they have seen already are impressive and worthwhile in and of themselves.

People often ask me why I am so passionate about this, and I always tell them, “I blame the nuns.” Growing up Catholic, there was nothing so drilled into me as Matthew 25. We used to sing a hymn based on it, “Whatsoever you do to the least of my brothers,” on a regular basis at Mass. And we went to Mass before school every day!

It turns out this is a pretty universal sentiment. I checked. Go to the websites of every mainstream religious denomination – Anglican, Methodist, Mormon, you name it - and it will be in there somewhere: The Social Gospel and Social Justice. Dignity of the individual. Our duties to the less fortunate. It is part of our national Judeo-Christian heritage, and a component of every major religion and philosophy in the world, with one notable exception – Ayn Rand’s. And I mention Ayn Rand and her most famous book, Atlas Shrugged, because it is perennially listed as the second most influential book in America, after the Bible. A damning fact for us.

In spite of that, I am glad that social justice and a commitment to the fair distribution of our health care resources is integral to the sense of duty of my profession, the nursing profession and all health professions.

I often say that I encourage debate about how we get to universal health care, but I refuse to accept that America, alone among all modern nations, and Pennsylvania in particular, will reject the idea that we need to get there.

A final thought from health care economist Uwe Reinhardt, regarding all of the reasons given about why we cannot achieve universal health care; he says, “Go tell God why you cannot do this. He will laugh at you,”

Right now, Medicaid expansion, the Health Insurance Exchanges and many other components of the Affordable Care Act are our best hope. Let’s not squander it.

Thank You.

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Remarks on Medicaid Expansion

I had the privilege of testifying in favor of Medicaid expansion for Pennsylvania at a hearing of the PA House Democratic Policy Committee, chaired by Rep. Dan Frankel of Allegheny County. (Follow the link for the agenda and other speakers.)

Good morning. I am Dr. Chris Hughes, state director for Doctors for America, a nation-wide group of physicians advocating for high quality, affordable health care. I have been an intensive care physician for my entire career, now approaching 25 years, and within the past year I have also begun practicing hospice and palliative medicine. I am a former Trustee of the Pennsylvania Medical Society and Chair of the Patient Safety Committee. I have completed graduate studies in health policy at Thomas Jefferson University, and I am now teaching there as well in the Graduate School of Population Health.

I tell you this to let you know that I can get down in the weeds with you about the nuts and bolts of implementation of the Affordable Care Act, and I know a fair amount about health care financing, access, cost shifting, and all the rest. But you have a fine panel assembled here today who can do that for you, and I know you all know your way around these topics as well.

I am here as a physician and a representative of my profession. Every doctor you know, and every nurse and pharmacist and social worker and everyone in the front lines of health care, for that matter, can tell you stories of how our health care system has failed someone. Our system fails people regularly, and often spectacularly, and often cruelly, day in, day out.

I've had patients who work full time in jobs that fall far short of the American dream. They get by, but they can't afford health insurance.

I'll give you a few of my patients’ stories here, not just to point out the obvious- that we are mistreating our fellow human beings – but that we are misspending countless dollars on the wrong end of the system.

There's the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn't make it and ends up in the ICU with diabetic ketoacidosis.

There's the construction worker who has a controllable seizure disorder that goes uncontrolled because he can’t afford to go to the doctor. He ends up in the ICU multiple times.

There's the woman who stays home to care for her dying mother and loses her insurance along with her job. When she finally gets to a doctor for herself, her own cancer is far advanced.

The laid-off engineer whose cough turns bloody for months and months before he “accesses” the health care system – through the ED and my ICU with already far advanced cancer.

These are people who are doing the right thing – working, caring for family members – and still have to go begging for health care. How many hours does an American have to work to “deserve” health care? 40? 50? 60? I’ve seen all of these.

Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, ( let me repeat that, “Jim DeMint and Trent Lott” ) wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. "Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for 'free.' "

Their No. 1 priority? It was to "Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage."

Medicaid expansion and the Affordable Care Act will get us closer to this than at any time in our history.

You will hear some physicians speak out against all of this. But what you generally will not hear is their leadership and organizations speaking out against it, except perhaps in the deep south. There is a reason for this. As leaders of our profession, we have to come to terms that we are not just in it for ourselves. We are in it for our profession as well, and that means we have to put our patients’ interests above our own, and that means we have to do our best to ensure that everyone has access to high quality, affordable health care. Don’t just take my word for it. The American Board of Internal Medicine Foundation and other organizations put together a Charter on Medical Professionalism about ten years ago, specifically making this part of our professional responsibility. If you go to their website, you will find that virtually every physician organization you can think of has endorsed it. That means the anesthesiologists and orthopedic surgeons as well as the pediatricians and the family practitioners.

For Medicaid expansion specifically, we should note here that the major national physician organizations, including the AMA, and the organizations representing internists, family practice, pediatricians, psychiatry and more, all endorse Medicaid expansion. On the state level, all of these organizations state chapters endorse it as well, with the exception of the Pennsylvania Medical Society, who have endorsed general terms of expansion only.

But this concept is really not controversial among physicians and health care providers. We see everything from the catastrophes to the small indignities. They are tragic, unnecessary, and we are on the road to ending them.

Some in the provider community have expressed concerns about Medicaid in particular as the way we are providing access, so I would like to take a moment to address the concerns we hear most often.

First, that Medicaid is “bad” insurance. What is bad about Medicaid is largely fixed in the ACA. Namely, it is very poorly reimbursed for providers. You’ve already heard [I assume] from HCWP why hospitals want it, but for providers in primary care, the frontlines of health care, they get a massive boost in reimbursement under the new law. Pennsylvania has historically had awful reimbursement in the Medicaid program, among the worst in the nation. Now, reimbursement will go to par with Medicare reimbursement, a huge incentive for providers to take on Medicaid patients whom they may have been reluctant to see previously. There are other new innovations such as Patient Centered Medical Homes and others, coming down the pike, that should really give people who previously had no chance at excellent care, a chance to avoid complications, avoid the ER and avoid the hospital.

I’ve also heard the strange claim that having Medicaid is worse than having no insurance. I suppose that in a vacuum where there is no good data, and where one sees, like I do, patients with no insurance or Medicaid, who don’t know how or aren’t able to access a doctor – you’d be amazed at how often this happens – you could look at patients who get very sick and attribute that to Medicaid, but we do have data now. In Oregon, due to a fairly bizarre set of circumstances a few years ago, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more.

People often ask me why I am so passionate about this, and I always tell them, “I blame the nuns.” Growing up Catholic, there was nothing so drilled into me as Matthew 25. We used to sing a hymn based on it, “Whatsoever you do to the least of my brothers,” on a regular basis at Mass. And we went to Mass before school every day!

It turns out this is a pretty universal sentiment. I checked. Go to the websites of every mainstream Christian denomination in America and it will be in there somewhere: The Social Gospel and Social Justice. Dignity of the individual. Our duties to the less fortunate. It is a component of every major religion and philosophy in the world, with one notable exception – Ayn Rand’s. And I mention Ayn Rand and her most famous book, Atlas Shrugged, because it is perennially listed as the second most influential book in America after the Bible. A damning fact for us.

In spite of that, I am glad that social justice and a commitment to the fair distribution of our health care resources is integral to the sense of duty of my profession, the nursing profession and all health professions.

I encourage debate about how we get to universal health care, but I refuse to accept that America, alone among all modern nations, and Pennsylvania in particular, will reject the idea that we need to get there. And right now, Medicaid expansion, the Health Insurance Exchanges and many other components of the Affordable Care Act are our best hope. Let’s not squander it.

Thank You.

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Why I Am Pro-Life - NYTimes.com

Why I Am Pro-Life - NYTimes.com

In my world, you don’t get to call yourself “pro-life” and be against common-sense gun control — like banning public access to the kind of semiautomatic assault rifle, designed for warfare, that was used recently in a Colorado theater. You don’t get to call yourself “pro-life” and want to shut down the Environmental Protection Agency, which ensures clean air and clean water, prevents childhood asthma, preserves biodiversity and combats climate change that could disrupt every life on the planet. You don’t get to call yourself “pro-life” and oppose programs like Head Start that provide basic education, health and nutrition for the most disadvantaged children. You can call yourself a “pro-conception-to-birth, indifferent-to-life conservative.” I will never refer to someone who pickets Planned Parenthood but lobbies against common-sense gun laws as “pro-life.”

“Pro-life” can mean only one thing: “respect for the sanctity of life.” And there is no way that respect for the sanctity of life can mean we are obligated to protect every fertilized egg in a woman’s body, no matter how that egg got fertilized, but we are not obligated to protect every living person from being shot with a concealed automatic weapon. I have no respect for someone who relies on voodoo science to declare that a woman’s body can distinguish a “legitimate” rape, but then declares — when 99 percent of all climate scientists conclude that climate change poses a danger to the sanctity of all life on the planet — that global warming is just a hoax.

The term “pro-life” should be a shorthand for respect for the sanctity of life. But I will not let that label apply to people for whom sanctity for life begins at conception and ends at birth. What about the rest of life? Respect for the sanctity of life, if you believe that it begins at conception, cannot end at birth. That radical narrowing of our concern for the sanctity of life is leading to terrible distortions in our society.

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Health care for all: Expanding Medicaid would save lives, suffering and money - Pittsburgh Post-Gazette - Printer friendly

Health care for all: Expanding Medicaid would save lives, suffering and money - Pittsburgh Post-Gazette - Printer friendly

My Piece on Medicaid expansion from the P-G:

Health care for all: Expanding Medicaid would save lives, suffering and money

One of the most common questions I get asked about the new health care law concerns how expanding health insurance coverage to millions of low-income families through Medicaid will affect those who already have insurance. "What will all of those new people with access to health care do to the rest of us? Will it make it harder to get access to our doctors? Will they clog up our emergency rooms and hospitals?"
As someone whose profession takes a strong position in favor of universal access to health care, I have a hard time saying anything but, "What a great problem to have!" It turns out to not even be a problem.
Massachusetts did this many years ago, as we are being frequently reminded, and the results are in. Use of emergency rooms is down, waiting times to see a primary care doctor are essentially unchanged and there has been a vast expansion in the use of preventive services: mammograms, colon cancer screens and prenatal care, for instance. Doctors and the people of Massachusetts overwhelmingly favor continuation of their program, and they are now proceeding to the really hard part: getting costs under control. Stay tuned!
An even more interesting experiment is being conducted in Oregon via an unhappy accident. Due to a shortage of funds, Medicaid eligibility was determined by lottery, creating a natural experiment of haves and have-nots. In the first year, those who were enrolled were 70 percent more likely to have a usual source of care, were 55 percent more likely to see the same doctor over time, received 30 percent more hospital care and received 35 percent more outpatient care, and much more.
Every doctor you know can tell you stories about how the lack of access to health insurance and health care has injured a patient's health, life, limbs, finances or all of the above. I've had patients who work full time in jobs that fall far short of the American dream. They get by, but they can't afford health insurance.
There's the cabbie who recognizes his diabetes and determines to work harder and longer so he can buy insurance before he is stricken with the label even worse than diabetes: preexisting condition! He doesn't make it and ends up in the ICU with diabetic ketoacidosis.
There's the construction worker who has a controllable seizure disorder that goes uncontrolled. He ends up in the ICU multiple times.
There's the woman who stays home to care for her dying mother and loses her insurance along with her job. When she finally gets to a doctor for herself, her cancer is far advanced.
So, for me and my profession, the most expansion for the most people is a best-case scenario. But others see expanding health insurance only through a short-term budgetary lens and consider covering nearly everyone a worst case.
For one thing, this view ignores the incredible deal states get when they accept Medicaid expansion. According to the Kaiser Foundation, by 2019 Pennsylvania would add about 482,000 new enrollees; another 282,000 who are eligible but don't know it would come into the program. That's more than three-quarters of a million people with access to care.
Critics point to the potential cost to the state of more than a billion dollars over six years. That's a lot of money, but the federal government would pay more than $17 billion -- over 94 percent of the cost. Furthermore, the additional billion would be only 1.4 percent more than Pennsylvania's currently scheduled spending over that period. Even in a best-case scenario, with insurance for an additional 1.1 million Pennsylvanians, this figure would rise to only 2.7 percent.
One can choose to focus on the costs to the state and federal governments, but we spend many of those dollars already on the wrong end of the care continuum. Our governments already pay for patients who cannot pay for themselves, largely by cutting big checks to hospitals.
You can take care of a lot of diabetic cabbies for a lot of years for the cost of a stay in the ICU. Just because the costs don't show up as a line item in a government budget -- it could be labeled "Exorbitant Amounts of Money for Preventable Complications and Deaths" -- doesn't mean we don't pay them.
A frequent talking point against expanding access to health care, "You can always go to an emergency room," is actually dead on. Literally.
The law requires emergency rooms to treat and stabilize patients even if they have no means to pay. But no emergency room does cancer screening. Or prenatal care. No emergency room manages diabetes. Or congestive heart failure. As a result, many people don't seek treatment until they are nearly dead.
Patients forgoing care or medicines because they can't afford them simply shifts the costs from keeping people healthy to our extremely expensive system of "rescue care." And remember, Massachusetts' early experience and Oregon's current experiment are showing the benefits to the entire system of getting people taken care of before they need an ER or ICU.
Not long ago, expanding access to health care was a nonpartisan goal. As recently as 2007, a bipartisan group of U.S. senators, including Republicans Jim DeMint and Trent Lott, wrote a letter to then-President George W. Bush pointing out that our health care system was in urgent need of repair. "Further delay is unacceptable as costs continue to skyrocket, our population ages and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for 'free.' "
Their No. 1 priority? "Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage."
Medicaid expansion, as well of the rest of the new health care law, represents our best effort so far in reaching these once-bipartisan goals. Pennsylvanians deserve an expansion of health insurance and health care, a healthier state, a healthier workforce and to continue the journey toward my profession's goal: excellent, affordable health care for all.
Christopher M. Hughes practices intensive care and hospice medicine in Pittsburgh and is the Pennsylvania director of Doctors for America (www.drsfor america.org).

First Published October 4, 2012 12:00 am

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Stunning Healthcare Overture from Bipartisan Group of US Senators - 2007

Healthcare Legislation in This Congress? - Michael Barone (usnews.com)

I followed Ezra Klein's link to this letter from 10 Senators, 5 Republicans and 5 Democrats, written just two years before President Obama took office! Read it, as it is stunning how far the Republican Choo Choo has gone around the bend.  [Courtesy USNews.com and Michael Barone.]

Now Wyden and nine other senators, five Democrats and five Republicans, have sent the following letter to Bush. Very interesting.

In addition to Wyden, the letter was signed by Republicans Jim DeMint of South Carolina, Robert Bennett of Utah, Trent Lott of Mississippi, Mike Crapo of Idaho, and John Thune of South Dakota, and Democrats Kent Conrad of North Dakota, Ken Salazar of Colorado, Maria Cantwell of Washington, and Herb Kohl of Wisconsin.

The text of the letter follows:

February 13, 2007

The Honorable George W. Bush
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear Mr. President:

As U.S. Senators of both political parties we would like to work with you and your Administration to fix the American health care system.
Each of us believes our current health system needs to be fixed now. Further delay is unacceptable as costs continue to skyrocket, our population ages, and chronic illness increases. In addition, our businesses are at a severe disadvantage when their competitors in the global market get health care for "free."
We would like to work with you and your Administration to pass legislation in this Congress that would:
1)Ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.
2)Modernize Federal tax rules for health coverage. Democratic and Republican economists have convinced us that the current rules disproportionately favor the most affluent, while promoting inefficiency.
3)Create more opportunities and incentives for states to design health solutions for their citizens. Many state officials are working in their state legislatures to develop fresh, creative strategies for improving health care, and we believe any legislation passed in this Congress should not stymie that innovation.
4)Take steps to create a culture of wellness through prevention strategies, rather than perpetuating our current emphasis on sick care. For example, Medicare Part A pays thousands of dollars in hospital expenses, while Medicare Part B provides no incentives for seniors to reduce blood pressure or cholesterol. Employers, families, and all our constituents want emphasis on prevention and wellness.
5)Encourage more cost-effective chronic and compassionate end-of-life care. Studies show that an increase in health care spending does not always mean an increase in quality of outcomes. All Americans should be empowered to make decisions about their end of life care, not be forced into hospice care without other options. We hope to work with you on policies that address these issues.
6)Improve access to information on price and quality of health services. Today, consumers have better accessto information about the price and quality of washing machines than on the price and quality of health services.
We disagree with those who say the Senate is too divided and too polarized to pass comprehensive health care legislation. We disagree with those who believe that this issue should not come up until after the next presidential election. We disagree with those who want to wait when the American people are saying, loud and clear, "We want to fix health care now."
We look forward to working with you in a bipartisan manner in the days ahead.

Skyrocketing costs! Competetive disadvantage! Universal access to health care! Class warfare! Inefficient US health care! Wellness! Prevention! Cost effectiveness! Compassionate end of life care! Expanding palliative care services! Health care in the US is broken!

Who knew Jim DeMint was a socialist before he was a Tea-Partier?

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The Republican turn against universal health insurance

The Republican turn against universal health insurance

In 2007, Republican Sen. Jim DeMint of South Carolina sent a letter to President George W. Bush.

DeMint said he would like to work with Bush to pass legislation that would “ensure that all Americans would have affordable, quality, private health coverage, while protecting current government programs. We believe the health care system cannot be fixed without providing solutions for everyone. Otherwise, the costs of those without insurance will continue to be shifted to those who do have coverage.”

Read that closely. DeMint does not say he wants legislation that would ensure all Americans have “access” to coverage — the standard rhetorical dodge of politicians who don’t want to oppose universal coverage, but also don’t want to do what’s necessary to achieve it. He says that he wants legislation that ensures all American actually have coverage. He says that without making sure every American has coverage, “the health care system cannot be fixed.” For good measure, DeMint wants to achieve this “while protecting current government programs.”

It is amazing how crazy - and mean-spirited - conservatives have become. None of that WWJD girly nonsense for the new conservative movement.

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An immoral budget that shuns social justice - JSOnline

An immoral budget that shuns social justice - JSOnline:

In response to Ryan's Republican budget last year, the U.S. Conference of Catholic Bishops warned House leaders that "a just framework for future budgets cannot rely on disproportionate cuts in essential services to poor persons." Just recently, the bishops' conference called on Congress to protect the safety net from harmful budget cuts. Ryan has ignored their wise counsel.

Ryan takes his Catholic faith seriously and has defended his policy approach in strong moral terms. But it seems he needs a refresher course in basic Catholic teaching. The Catholic justice tradition - as defined by bishops and popes over the centuries - holds a positive role for government, advocates a "preferential option for the poor" and recognizes that those with greater means should contribute a fair share in taxes to serve the common good.

Ryan and other conservatives hold tax cuts for hedge fund managers on Wall Street sacred even as they dismiss concern about rising income inequality as "class warfare." In contrast, Pope Benedict XVI denounces the "scandal of glaring inequalities." This is an accurate description when the 400 wealthiest Americans now have a greater combined net worth than the bottom 150 million Americans.

It seems that Ryan's budget is more indebted to his hero Ayn Rand than to the message of Jesus. Rand, a libertarian icon who mocked all religion and rejected the Gospel's ethic of compassion, has been praised by Ryan for explaining "the morality of individualism." Catholic values reject such radical individualism and the social callousness that it breeds.

- Sent using Google Toolbar

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Robert F. Kennedy Quotes (Author of Thirteen Days)

Robert F. Kennedy Quotes (Author of Thirteen Days):

A nice collection of RFK quotes. I think this is my favorite.

“Too much and too long, we seem to have surrendered community excellence and community values in the mere accumulation of material things. Our gross national product...if we should judge the United States of America by that - counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and the jails for those who break them. It counts the destruction of our redwoods and the loss of our natural wonder in chaotic sprawl. It counts napalm and the cost of a nuclear warhead, and armored cars for police who fight riots in our streets. It counts Whitman's rifle and Speck's knife, and the television programs which glorify violence in order to sell toys to our children.

Yet the gross national product does not allow for the health of our children, the quality of their education, or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage; neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile. And it tells us everything about America except why we are proud that we are Americans.”
― Robert F. Kennedy

- Sent using Google Toolbar

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Why We Fight

Forgive the World War II reference, but as I write this, I am reminded of the estimate of 45,000 deaths attributable to lack of access to health care, not even counting the countless maimings, wounding, and psychological hurt inflicted on the uninsured and under-insured in America, it seems appropriate. It is not an existential threat to our democracy, but this is, make no mistake, a battle for the soul of our country. As Michael Moore put it in “Sicko,” is America about “we”or “me?”

As physicians, we are obliged to be about “we.” In the Charter on Medical Professionalism, we are enjoined to seek social justice in the delivery of medical care, to be good stewards of our health care resources. Specifically, physicians “should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.”

We are also our patients fiercest advocates, and that includes those who can afford to see us and those who cannot. We all have our favorite collection of horror stories of the American healthcare system leaving individuals to fend for themselves with no hope of accessing the system until it is too late. Part of my anecdote collection is here, and I always trot it out when I am told a third hand anecdote about how bad health care is in “other countries.” For most Americans, health care is pretty good, but for the uninsured or under-insured, America is a third world country: access to care is completely dependent upon ability to pay.

Remember that, only in America of all advanced nations, have we answered “No!” (or perhaps “Hell, no!” from some) to the question of whether, as Uwe Reinhardt has put it, “As a matter of national policy, and to the extent that a nation's health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family?” Medical ethicist Arthur Caplan argues that lack of access to health care is a fundamental road block to equality of opportunity in America, that placing the additional hurdle of untreated illness on a large segment of society is inherently unjust.

It has been pointed out that Americans are singular in the world in our Christian religiosity, but this religiosity is characterized by public policy consistent with ruthless Social Darwinism in many respects, while Europeans are pointedly irreligious, yet have structured their societies to function along a very progressive commitment to social safety nets, social justice and equality of opportunity, as well as a very Teddy-Rooseveltian distrust of great accumulated wealth.

I, as do many, take pride in my religion's unwavering commitment to Social Justice, Glenn Beck's disapproval notwithstanding. It is what keeps me a Catholic, and I am sure it is what keeps many in other traditional churches. It is, in fact, fundamental to every religion, Christian, Jewish, Muslim, Hindu, Buddhist and more, and most non-religious philosophical paradigms as well. I am well aware, however, that the most influential book outside of the Bible in America, “Atlas Shrugged,” and its author, vehemently reject all such sentiment as counter-productive nonsense. And this book is widely commended by conservatives who consider themselves deeply religious Christians.

So, this basic ethical commitment to fairness, tending to the sick, the poor, the treating of others as we would wish treated, is pervasive among every population in the world, except for those who follow the Ayn Rand school. I cannot fathom this, as I think the cognitive dissonance of holding both Christianity and Rand dear would be incapacitating, but there it is, and it is rampant in our political and clerical classes.

The argument is frequently made to me that their Christianity only allows for individual charity, not state sponsored programs. That is nice in theory, but as even Mike Huckabee acknowledged:

“If there are a certain number of kids from single-parent homes who aren’t going to school and don’t have health care, you can say that’s not government’s job,” Huckabee told me. “Well, sweet and fine! But you know what? If the kid’s sitting outside the door of the hospital choking with asthma, do I sit there and say, ‘Oh, I’m sorry, I don’t think, philosophically, government should get involved’? I’d much rather the kid get help than I sit around and say I’m so pure in my ideology.”

And, frankly, the milk of human kindness has not flowed freely enough anywhere in the world to provide health care to a population, and I don't expect it to do so now. I don't think giving it another century to work itself out is a reasonable strategy.

We fight because of the fundamental unfairness of the system to so many. One in six Americans is uninsured, another one in six under-insured; the deaths, injuries, bankruptcies, anguish and degradation of basic human dignity are why we fight. The America I grew up in was working on being better than this. The Great Society programs of LBJ took us a long way forward, and we have been painfully stuck in place until the passage of the Patient Protection and Affordable Health Care Act in 2010.

PPACA represents our rejection of treating so many of our brothers and sisters and our patients as lesser human beings, less deserving, less worthy of our help. Let's keep fighting for “We the People,” and fight those only concerned about “me.” Ayn Rand and Glen Beck notwithstanding.

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Think Progress » Catholic nuns break with bishops and urge passage of health care reform.

Think Progress » Catholic nuns break with bishops and urge passage of health care reform.

Ok, the nuns are for it:

The health care bill that has been passed by the Senate and that will be voted on by the House will expand coverage to over 30 million uninsured Americans. While it is an imperfect measure, it is a crucial next step in realizing health care for all. It will invest in preventative care. It will bar insurers from denying coverage based on pre-existing conditions. It will make crucial investments in community health centers that largely serve poor women and children. And despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. It will uphold longstanding conscience protections and it will make historic new investments – $250 million – in support of pregnant women. This is the REAL pro-life stance, and we as Catholics are all for it.

So is the Catholic Health Association and prominent Catholic and Evangelical scholars.

What's up with those darned Bishops?

Go to the ThinkProgress link at the top for all the links.

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Tea Partiers as Christians - Big Fail

Non-negotiable Core Beliefs from TeaParty.org's Dale Robertson
(Founder/President) and my comments in italics.

Illegal Aliens are illegal.
Pro-Domestic Employment is indispensable.
Stronger Military is essential.
Gun ownership is sacred.
Government must be downsized.
National Budget must be balanced.
Deficit Spending will end.
Bail-out and Stimulus Plans are illegal.
Reduce Personal Income Taxes a must.
Reduce Business Income Taxes is mandatory.
Intrusive Government Stopped.
English only is required.
Traditional Family Values are encouraged.
Common Sense Constitutional Conservative
Self-Governance is our mode of operation.

....and Yes, we are a Christian Nation!

So, let's start with the hilarious first, "Yes, we are a Christian Nation!" Well, not hilarious, just sad. Look through all of those and tell me which items would get Jesus all fired up? Nothing about universal access to health care ("when I was sick"), nothing about the unprecedented dependence on Food Stamps, not only to buy food ("when I was hungry"), but for subsistence needs ("when I was naked"), nor anything about our embarrassingly high incarceration rates for Americans ("when I was a prisoner").

But these "Christians" did include those damn illegal aliens!! The Bible is terribly draconian on aliens:
Exodus 22: Do no wrong to a man from a strange country, and do not be hard on him; for you yourselves were living in a strange country, in the land of Egypt
And Leviticus is even worse: The alien living with you must be treated as one of your native-born. Love him as yourself, for you were aliens in Egypt. I am the LORD your God.
Anyway, may as well go through the rest of his list, briefly.
Pro-domestic employment. OK, we can agree on this one. However, I expect their view is very anti-union, which the Pope, at least (he's Christian, right?) opposes.

Thus, the encyclical rises strongly to the defense of labor unions, which are still vehemently opposed by large numbers of politically conservative Catholics. The pope notes that unions "have always been encouraged and supported by the Church.

Stronger Military. How about smarter military? How abut defunding "Star Wars," and preparing for the wars we are fighting and will fight in the future: "wars" against terrorist organizations. Oh, wait, that's law enforcement and intelligence. Then how about focusing the Pentagon on human resources instead of lining the pockets of Haliburton, Blackwater, Northrup and the rest of the Military industrial complex. Eisenhower was so prescient and wise:

Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter plane with a half million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people. This is, I repeat, the best way of life to be found on the road the world has been taking. This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron. ... Is there no other way the world may live?

Gun Ownership is sacred. Fine, this is way low on my list of issues to get exorcised about but gun rights are not unlimited. Again, I don't see this as being near the top of Jesus' list for important aspects of national governance. Also, why is it that the most heinous crimes always seem to be done with legally purchased guns?
Government must be downsized, National Budget must be balanced, Deficit Spending will end. Reduce Personal Income Taxes a must. Reduce Business Income Taxes is mandatory.
Typical right wing BS. Run up the most massive deficits in the history of the country, first under Reagan and again under Bush, then bitch about it as Democrats try to clean up the mess (Clinton for Reagan, and Obama for Bush). I'll let you all in on a little secret: Tax cuts never have, never will pay for themselves. "Supply side" economics, wherein lightening the tax burden on the wealthy so that they will supply more products and thus stimulate demand is as S-T-U-P-I-D as it sounds. Besides, investment income is taxed at such low rates already, the wealthiest in America have far lower tax rates than the rest of us! Patriots like Teddy Roosevelt would be out there railing against this injustice.
Bail-out and Stimulus Plans are illegal. Very stupid, poorly thought out, way too generous to Wall Street with not nearly enough regulatory "burden" injected in return for the favors. Did anybody else notice that the same stupid Ayn Rand- Milton Friedman stupidity that led to the S&L Bailout under Reagan-Bush I led Phil Gramm to believe they could do even more damage to the tenuous regulatory environment in place in the 90's and everything would turn out just swell - for the "Fortunate 400", and the pretty fortunate 40,000.
Intrusive Government Stopped. This is just so funny because of where I expect they see the government is being too intrusive and where I think it is too intrusive. I am one of those silly Bill of Rights types, and so I reject pretty much every intrusion into the lives of Americans that the chickens in the Bush administration thought were so vital to national security. And yet, I have been paying attention enough to realize that intrusions into the affairs of Corporate America in general, and Wall Street gambling, in particular, are vital to the stability and prosperity of the country.
English only is required. I guess this goes up above with how we treat each other and the strangers among us. I think Jesus, who spoke Aramaic, while living under Roman rule, might have a touch of sympathy for the non-English speaking.
Traditional Family Values are encouraged. This is a little tricky, in that Jesus and Christian tradition is so clearly liberal in matters of economics, social justice, immigration, etc., and yet Jesus was pretty darn tough on sexual issues. So, I'll make an offer to the Tea Partiers: You make Jesus' rule against divorce into law, help us with the big social justice issues like universal health care, reforming prisons, strengthening workers rights, and more, and then we'll go after gay marriage. Deal?
Common Sense Constitutional Conservative Self-Governance is our mode of operation. I really don't know what the heck this means, but I did find it amusing that there is another organization called "We the People" (From the Constitution - get it?) that is an ANTI-government, Tea Party type organization.
But I do think this last bit is critical: I think progressives view government as "us" (as in "We the People") and conservatives view government - when they are not in power - as them. Even when my party was not in power, I still believed government was us, but that we had failed our country by allowing the Siths to win so many elections.
So, in summary, these people who constantly complain that we are not acting as a Christian Nation, seem to completely miss the point of Christianity, the social justice mission, the generosity of heart, the embracing of the weak, the poor, the hungry the sick, the loving of those NOT like us :

If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. And if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. (Luke 6)

Cheers,
---------
Update just to add this from
"...How terrible it will be for those who make unfair laws, and those who write laws that make life hard for people. They are not fair to the poor, and they rob my people of their rights. They allow people to steal from widows and to take from orphans what really belongs to them. (Is 10:1-2 NCV)"

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A Christmas Carol's Social Justice Lessons...

Social Justice - Loyola Press:

Since Jim Carey's new "Christmas Carol" is number one at the box office, and we need to talk more about the moral case for health care reform in particular and with governing ourselves in general, I'm reposting this, from the Jesuits...

"In Charles Dickens's classic A Christmas Carol, Ebenezer Scrooge is visited by the spirit of his former business partner, Jacob Marley, who has come to alert Scrooge to the three spirits who will visit him in an attempt to save his soul. When Scrooge asks Marley why he is laden down with chains and irons, Marley explains that he is wearing the chains he “forged in life” as a punishment for not making better use of his time on earth. Scrooge protests, “But you were always a good man of business, Jacob.” To which Marley laments, “Business! . . . Mankind was my business! The common welfare was my business; charity, mercy, forbearance, and benevolence, were, all, my business. The dealings of my trade were but a drop of water in the comprehensive ocean of my business!”

There's more, and I thought it is still a nice Christmas message...

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Southern Baptist Convention: Politics trump morality

Unbelievably (or not), considering Richard Land's history, this position on health reform:

In his August 18, 209 press release, Dr. Land states that he opposes the current House bill, H.R. 3200, but does believe that health care reform is needed.
According to Land, he "recognize[s] the need to rework certain elements of the health care equation in America. While the health care industry in the U.S. is relatively robust, it is not without flaws. And there is a segment of the American population, either because of their income level or their medical condition, that needs responsible and well-regulated government assistance."
Dr. Land doesn't believe that greater government involvement is the answer. Dr. Land believes that tort reform is one of the biggest avenues of savings in the health care industry. He states, "If we had tort reform, just tort reform, getting the stinking, rotten lawyers out of the business of ambulance chasing, we would eliminate about $50 billion of medical costs every year that doctors have to pay for malpractice insurance which is then passed on to you in the form of bills."
Dr. Land does believe that in a country as prosperous as the United States, every one should have guaranteed access to some level of health care, though he rejects government involvement. According to Land, the "answer is to provide alternatives and incentives for most people to be in health care that they provide for themselves, and then the government can focus like a laser on those who aren't able to provide it for themselves and you give them a basic level of health care. If I could use the car analogy, everybody should have a Chevrolet. Those who can afford it can get Cadillacs or even Mercedes."

It is amazing that Mr. Land's SBC seems to have more in common philisophically with Ayn Rand than Jesus Christ. Or the Pope.

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