SHORT AND SWEET

The home page on my computer is the front page of The New York Times. So every time I click on my web browser I am treated to one of the best news sources in the country - which, I am embarrassed to say, I usually pass right by on my way to Google or some other web site. Not today.

Today's Times has a superb explanation of the president's health care reform plan, written by Paul Krugman, an op-ed columnist and winner of the Nobel Prize for economics. It is as clear and succinct an explanation as I have ever read. It is my pleasure to share it with my friends.

Health Care Realities,

by Paul Krugman

At a recent town hall meeting, a man stood up and told Representative Bob Inglis to “keep your government hands off my Medicare.” The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program — but the voter, Mr. Inglis said, “wasn’t having any of it.”

Fred R. Conrad/The New York Times

Paul Krugman

Go to Columnist Page »Blog: The Conscience of a Liberal

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Times Topics: Health Care Reform

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It’s a funny story — but it illustrates the extent to which health reform must climb a wall of misinformation. It’s not just that many Americans don’t understand what President Obama is proposing; many people don’t understand the way American health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance.

And that government involvement is the only reason our system works at all.

The key thing you need to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.

Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.

And in their efforts to avoid “medical losses,” the industry term for paying medical bills, insurers spend much of the money taken in through premiums not on medical treatment, but on “underwriting” — screening out people likely to make insurance claims. In the individual insurance market, where people buy insurance directly rather than getting it through their employers, so much money goes into underwriting and other expenses that only around 70 cents of each premium dollar actually goes to care.

Still, most Americans do have health insurance, and are reasonably satisfied with it. How is that possible, when insurance markets work so badly? The answer is government intervention.

Most obviously, the government directly provides insurance via Medicare and other programs. Before Medicare was established, more than 40 percent of elderly Americans lacked any kind of health insurance. Today, Medicare — which is, by the way, one of those “single payer” systems conservatives love to demonize — covers everyone 65 and older. And surveys show that Medicare recipients are much more satisfied with their coverage than Americans with private insurance.

Still, most Americans under 65 do have some form of private insurance. The vast majority, however, don’t buy it directly: they get it through their employers. There’s a big tax advantage to doing it that way, since employer contributions to health care aren’t considered taxable income. But to get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.

And it’s thanks to these rules that employment-based insurance more or less works, at least in the sense that horror stories are a lot less common than they are in the individual insurance market.

So here’s the bottom line: if you currently have decent health insurance, thank the government. It’s true that if you’re young and healthy, with nothing in your medical history that could possibly have raised red flags with corporate accountants, you might have been able to get insurance without government intervention. But time and chance happen to us all, and the only reason you have a reasonable prospect of still having insurance coverage when you need it is the large role the government already plays.

Which brings us to the current debate over reform.

Right-wing opponents of reform would have you believe that President Obama is a wild-eyed socialist, attacking the free market. But unregulated markets don’t work for health care — never have, never will. To the extent we have a working health care system at all right now it’s only because the government covers the elderly, while a combination of regulation and tax subsidies makes it possible for many, but not all, nonelderly Americans to get decent private coverage.

Now Mr. Obama basically proposes using additional regulation and subsidies to make decent insurance available to all of us. That’s not radical; it’s as American as, well, Medicare.

THE LATEST HURRAH

Sarah Palin used her final speech as governor of Alaska to reiterate several of her favorite talking points. Allow me to reiterated one of mine: the former governor is a dangerous demagogue, and anyone who underestimates her does so at their own peril.

Affecting a “poor me” demeanor and using her familiar down-home speaking style, Palin accused the press of fabricating lies, begging them to just, “...quit makin’ things up,” giving them short shrift as “people (who) choose not to hear me.”

She pandered to the military, repeatedly expressing her gratitude and referring often to the ultimate sacrifice made by some of Alaska’s young men in uniform. Those who disagree with her were dismissed as pessimists and apologists, accused of “tearing down America.”

Well known for her hunting exploits, Palin made a point of slamming animal rights advocates, especially celebrities, referring to them as, “delicate, tiny, very talented (at lying) starlets. They need to know we eat, therefore we hunt,” she said. Oblivious to the clash of metaphors, she then compared her love of Alaska to the protective attitude of a Grizzly with her cubs.

Pandering to yet another powerful voting block, she added that (the celebrities) “use Alaska as a fund-raising tool for their 2^nd Amendment causes.” Alaska can manage its own fish and game resources, she said, and doesn’t need the help of any “outside special interests (who) just don’t get it.”

Voicing one of her favorite themes, Palin explained her refusal of federal funds by saying, “We can resist enslavement to big, central government,” though it isn’t entirely clear just who is trying to enslave Alaska.

Don’t kid yourself, Sarah Palin is setting herself up for a run at the White House in 2012. Her woman-of-the-people image has tremendous appeal to a wide variety of Americans. Whatever shortcomings she may have, Sarah “Barracuda” Palin isn’t dumb and and is very determined. The Obama administration would do well to keep her on their radar screen. She is definitely not going away.

POST CRONKITE

Not surprisingly, Sunday Morning devoted their entire show to Walter Cronkite - they are a CBS show, he was a CBS icon - but I don’t see any of that non-stop, floor-to-ceiling, ubiquitous media coverage that accompanied Michael Jackson’s death. Why is that, I wonder?

Do you suppose it’s because Walter Cronkite couldn’t sing, didn’t dance much, and couldn’t walk backward while appearing to walk forward? Is it because he hadn’t sold tens of millions of albums, wasn’t spectacularly rich, and didn’t spend a fortune on a private theme park and under-the-table prescription drugs? Or was it because he was married to the same woman for 65 years and widely regarded as “the most trusted man in America” rather than being a dysfunctional, reclusive pop star and alleged pedophile?

No, I don’t think it's any of those things. I think the broadcast news media, of which Cronkite was not only a part but an originator, has lost its bearings, preferring to chase advertising dollars rather than follow meaningful stories, exchanging their integrity for ratings along the way.

The real loser, of course, is the public. Without a reliable source of information – and that excludes Face Book, Twitter, and Wikipedia – democracy is an illusion. If President Obama is truly concerned about the health of the naiton, he would do well to turn his attention to the news media.

That's the way it was

In 1966 I was watching the news in my Marin County apartment with my close friend and roommate, Lawrie Driscoll. We were both twenty. We watched CBS, of course. As far as I knew, everyone watched CBS. Finally, Lawried said that if Cronkite looked into the camera and said, “Lawrie, get me a cup of coffee, will ya,” he’d just head for the kitchen.

It wasn’t such an odd thing to say. Walter Cronkite was indeed the most trusted man in America. If he said it was so, it was so. When he came home from a tour of Viet Nam and declared that war unwinnable, Lyndon Johnson moaned to his staff that if they had lost Cronkite, they had lost the the American people ... and he was right!

It was a different time. Cronkite didn't start on a talk show and move up to the news, he made his journalistic bones reporting under fire in WWII Europe, later joining the extraordinary team led by Edward R. Murrow. They provided structure for the relatively new medium of broadcast journalism. Their integrity, passion, and devotion to professionalism were unquestionable.

Cronkite reported two of the most important events of the 1960s. Firs, of course, was the assassination of President Kennedy. I can see him now, sitting in his shirtsleeves in the newsroom, relating events to the viewers as they occurred. When he got confirmation of the president’s death through an earphone, he reported it calmly, glancing at the clock to note the East coast time. He paused for a moment – two seconds, no more – to get his own emotions in check, and then went on talking.

The second occasion, thankfully much lighter, was the day we landed on the moon. He was almost giddy with excitement. Cronkite had followed the space program closely, was on intimate terms with the people and the science, but still could barely believe it. “We’re on the moon,” he said, almost laughing.

When Cronkite retired, his seat went to Dan Rather, a tough, experienced reporter. There was no one better for the post. Rather did his best, but it wasn’t the same. It would never be the same again.

Walter Cronkite, 1916 - 2009

Looking for Dick

The critical issue in the Times story about hidden surveillance isn't so much whether the CIA was withholding information from Congress about a domestic surveillance program authorized by the vice president - though that is interesting enough - but rather, why the CIA would do anything on the authority of the vice president, and why the former V.P. isn’t being prosecuted for exceeding that authority?

It was always understood that Dick Cheney, a veteran politician and Washington infighter, had extraordinary influence as a counselor in the Bush administration. But if it turns out that he was in fact running what amounts to a shadow government by directing the activities of our intelligence agencies, this must be brought into the light, examined, and dealt with appropriately. The Obama administration owes at least that much to the people who voted for them.