Who Let the Dogs In? (40 page)

H
AVE
YOU NOTICED
that the health-care system is not working? In fact, it’s falling apart. And the most curious thing about that is how few of the people for whom the system still works—and they’re the ones who make the decisions—are aware of it.

It’s like the old story about frogs and hot water. If you drop a frog into boiling water, it will leap to get out, but if you drop a frog in cool water and then gradually heat it up, the beast doesn’t notice. Or so they say. Another factor is the now-constant cognitive dissonance we have in this country as a result of the ever-widening gap between most people and the people who run things. If you have health insurance, the system is a pain in the behind but it works. If you don’t have health insurance, you are flat out of luck. And in case you hadn’t noticed, more and more employers are deciding not to offer health insurance, or using “temporary” workers or outsourcing various tasks so they won’t have to cover the workers.

If you don’t have health insurance, the system is an insane nightmare. A new book by Dr. Rudolph Mueller,
As Sick as It Gets: The Shocking Reality of America’s Healthcare,
lays out the problems as well as any I’ve read. But the book is just one more grain of sand in the beaches of evidence we already have that the system is breaking up.

At South by Southwest, the Austin music festival, a panel on health care for musicians—who are largely uninsured—produced this nugget: Did you know there are more than one thousand concerts given every week by musicians for other musicians to raise enough money for an operation or medical treatment of some kind? It’s a beautiful tradition, but it doesn’t work. All the generosity of all the musicians in the country—and so many of them are endlessly generous with their time and talent—doesn’t begin to cover the cost of medical treatment for even a few.

As they say in bridge circles, let’s review the play. Ten years ago, we knew the system was a mess and Bill Clinton got elected in large part by promising to do something about it. Hillary Clinton got the assignment and conventional wisdom in the political world is that she blew it. She did make political mistakes in her approach, but the far more important reason the attempt at reform failed is that the insurance industry spent $10 million to defeat the bill. Remember Harry and Louise?

Since then, the politicians have been afraid to try reform. The smartest of them, including Bill Clinton and Senator Ted Kennedy, have been trying to move the ball incrementally—tinkering with Medicare and Medicaid, starting a program to insure poor children. But the system is falling apart faster than they can move to fix it. A Patients’ Bill of Rights is not the answer. It won’t provide health insurance for a single additional individual.

The most maddening thing about the sheer stupidity of America’s health-care system is that the far better alternative is perfectly clear. Every other industrialized nation manages to do this better than we do. The answer is universal health insurance, a single-payer system. Every time we start to get serious about reform, the right wing starts screaming, “Socialized medicine, socialized medicine.” And then we’re all supposed to run, screaming with horror. But if you want to see horror in action, try the emergency room of any large public hospital in this country. And for a truly hilarious experience, try to get emergency medical help on Christmas Eve.

Look, this should not be a for-profit system. We need to phase out all for-profit or investor-owned provider and insurance organizations. Mueller suggests a onetime fair buyout of all such organizations. The good news is that doctors are no longer impeding serious reform—in fact, doctors are having such a hard time under the current system, they’ve been radicalized on the subject and can now be counted on to help with reform.

Conservatives reflexively start moaning about the cost of a “big, new government program.” Actually, what’s costly is the system we have now. Americans already spend 58 percent more than the weighted average of similar nations for health care.

“It is a system wasteful beyond belief and manipulated by a lobby focused on providing the highest profits for the their self-interest and their investors, and mammoth cash flows to companies that should not exist or not be involved in health care. The system is also paying for an extremely large number of sick people who would not be sick under any decent universal health care system,” writes Mueller.

Sitting around deploring the current system will not fix it—there are citizen action groups all over the country working on this problem. It is easy to find them and get involved. You don’t have to be on the Internet; the phone book works fine. We can’t wait for the political system to get round to doing something about this: We need to help ourselves now.

March 2002

The IQ of Bush’s Gut

W
ELL
, THINGS DO
seem to be going to hell, don’t they? The beauty of having fled to Mexico for a week to escape the endless blat of television news is that it leaves you with enough energy to tackle the subject of the Middle East—if not with cheer, at least with hope.

And that does appear to be the missing ingredient here—the expectation that anything at all can be done about the situation. Of course it can. The Israelis and the Palestinians are not condemned to some eternal hell where they have to kill each other forever. There is no military solution, but there is a political solution—and they will get there. The United States is obliged to broker the deal because there’s no one else to do it.

The situation could certainly use a couple of good funerals, but failing that luck, we have to deal with what’s there. It is possible to deal with people who are beyond persuasion by either fact or logic, which to an outsider is certainly how both the Israelis and the Palestinians now seem to be behaving. Political solutions to apparently intractable situations can be manufactured. While the world has been paying very little attention, the Irish Republican Army has actually been destroying its own weapons dumps. Who thought there was a solution in Northern Ireland five years ago? Or on Cyprus, where the Greeks and the Turks enjoyed a history of hostility of far superior antiquity to that in the Middle East? This can be done.

The second important point is that the situation demands respect for its moral complexity. That’s where we are slightly handicapped by our president, the moral simplifier. From the beginning, the trouble with “war against terrorism” has been the definition of terrorism and the immutable fact that one man’s terrorist is another man’s freedom fighter. After he got us involved in this war on a noun, Bush then upped the ante and announced it was a war between good and evil, and we would continue until we had eradicated evil. Oh man, this is going to be a long sucker.

It is precisely because of this rigid good-versus-evil oversimplification that Bush has been sort of snookered by Ariel Sharon into blindly supporting his actions because they are supposed to be “anti-terrorist.”

The worst news I’ve read lately is several reports quoting people close to Bush saying, “He feels in his gut . . .” He feels in his gut it is his mission in life to fight terrorism. He has a bad gut reaction to Arafat. Trust me on this when Bush starts thinking with his gut, we’re in big trouble.

Let me say for the umpteenth time, George W. is not a stupid man. The IQ of his gut, however, is open to debate. In Texas, his gut led him to believe the death penalty has a deterrent effect, even though he acknowledged there was no evidence to support his gut’s feeling. When his gut, or something, causes him to announce that he does not believe in global warming—as though it were a theological proposition—we once again find his gut ruling that evidence is irrelevant. In my opinion, Bush’s gut should not be entrusted with making peace in the Middle East.

Bush’s gut does not like complexity. When you’re in the middle of a moral crusade against evil, it’s damned annoying to have to stop and grapple with unpleasant complications, such as that we have to keep letting Afghani farmers grow opium poppies, or that our allies the Saudi Arabians foment terrorism, or that our allies the Pakistanis seem to have quite a few “freedom fighters” of their own. Moral complexity is a condition of life, and we will serve neither our own interests nor those of the Middle East if we keep pretending this is good versus evil.

There are many Palestinian terrorists. The Palestinians also have legitimate grievances that must be addressed. Sharon himself started this second intifada with his cruelly reckless and deliberately inflammatory visit to the Temple Mount. Took no genius to see what that was going to touch off. If you want to blame this intifada on someone in particular, Sharon is the leading candidate.

It is, however, more useful to concentrate on what can be done now. Any settlement will have to include getting the Israeli settlers off the West Bank—another instance where Sharon has ill-served Israel. Removing the settlers is not a job anyone would envy—that’s where one sees the fanaticism on the Israeli side.

There has been much discussion of the suicide bombers as though this were some huge new spanner in the works. Everyone from shrinks to political scientists has had a go at explaining them, but it is at base a political phenomenon, a function of anarchy and powerlessness. I believe Sharon has reacted in a criminally stupid way, guaranteed to do no good at all. He is so focused on his old enemy Arafat that he is destroying Al Fatah, which will leave, of course, only Hamas.

Actually, as a conflict, the Israeli-Palestinian mess is a known quantity similar to other conflicts over territory. It is the United States that is facing the truly bizarre situation: terrorists without territory.

I am in no particular position to preach to American Jews (or anyone else, come to think of it), but as a deeply worried Christian supporter of Israel, I think American Jews have an important role to play in this delicate and dangerous situation. The impulse of all Jews to support Israel totally—especially when Israelis are being blown up—is entirely understandable. But it’s not necessarily helpful to Israel in this situation.

I do not think this is a time that calls for uncritical support. Despite the occasional full-page ad from some group pledging blind fidelity to Israel and blaming everyone but Sharon, I am impressed with the level of real debate and even agonizing going on among American Jews. Anyone who tells you criticizing Israel at this parlous time is somehow helping the Palestinians must be as dumb as, well, John Ashcroft, who maintains that to question the president is to help terrorists.

It is troubling that the Bush administration approaches this new attempt at negotiation so tepidly—indeed, as though it has been dragged into it kicking and screaming. It has always been a worry that Bush has so little expertise on the Middle East around him—Condi Rice, who may be his best, is notoriously weak in this area.

It truly doesn’t help to play the blame game, but this administration was warned again and again that the escalating violence would finally break into catastrophe. And still they did nothing, apparently out of blind anti-Clintonism: Clinton pushed for a Middle East peace, therefore Bush wouldn’t. Hell of a policy. Onward.

Last week, I began a sentence by saying, “If Bush had any imagination . . .” and then I hit myself. Silly me. But if he did, he could put together an extraordinary peace commission involving any combination of Jimmy Carter, Colin Powell, Bill Clinton, George Mitchell, James Baker, Kofi Annan, Nelson Mandela . . . you get the idea. You can name your own players. Meantime, all we can do is wish Godspeed to Powell.

April 2002

Halliburton