Confidence On The Issues

We hear from so many Democrats -- quite often elected Democrats playing pundit -- that the party's problem is that people care first and foremost about national security and they don't like what they hear from Democrats. For too long, that's been the conventional wisdom. And such conventional wisdom leads to certain Democrats saying patently silly things like, "we need to talk tough about national security, and I will do that... in six months." So I really hope that everyone's paying attention to the signs indicating that the conventional wisdom has been overturned.

The AFL-CIO blog and Georgia10 point to a some new Gallup polling showing that Americans' top three concerns, in order, are access to healthcare, Social Security, and "availability and affordability of energy."Polling Report has the full results, which show people are more concerned about kitchen table issues than personally being attacked by terrorists. It's interesting to me that the poll did not include the war in Iraq as one of the "problems facing the country." Had it been included and a majority of those polled counted it among their top concerns, I think the results would still be good for Democrats. But aside from the civil war in Iraq, Americans seem to be incredibly uneasy with the direction of the country, and on the issues that concern them most, they've already rejected the Republicans.

Matt Singer at PLAN has an interesting and somewhat post praising former Oregon Governor John Kitzhaber for his timing in launching his healthcare reform campaign, The Archimedes Movement. Many have seen Kitzhaber's campaign as the likely beginning to a 2008 Presidential run. With Joe Trippi on board as an adviser, that may well be true. But he's also a doctor, so it's clearly an issue he's legitimately interested in.

It's not as if I'm advocating an abdication of national security as an issue we should campaign on. What I'm saying is that Democrats need to act like winners on every issue. Even the Republican pollsters at Rasmussen acknowledge that Americans trust Congressional Democrats on national security matters more than they do the President. And I think when it comes to the Democrats' newly released national security document, we ought to focus more on the 'redeploy, eliminate Bin Laden' message and less on the specifics.

I guess my ultimate point here is that if Democrats act like they're on the defensive, it leads people to question their position. Look at what a little bit of stubborn cockiness has done for the Republicans over the years. The people are with us. That doesn't mean that we now rest on our laurels and coast to November. But acting like winners and showing a little confidence would certainly not be a bad thing for the Democrats right about now.

Hillary Rodham Clinton: Behind The Music Part II

It has been alleged that Hillary Clinton was "the leader of the only attempt in 30 years to get universal health coverage." First let me say that I commend Bill and Hillary Clinton for making health care an issue in the 1992 campaign and the bona fide attempt of the Clinton administration to achieve universal coverage. But let us not forget that a substantial portion of the career of Senator Ted Kennedy was also devoted to this goal and that 2000 presidential candidate Bill Bradley, also came up with a plan (however flawed) that would have provided near full coverage. Let us also not forget that during the same period in which the Clinton plan was announced, Senator Paul Wellstone introduced a bill to create a publicly accountable single-payer system that was endorsed by the New England Journal of Medicine. My point here is that there is no need to genuflect to Hillary Clinton as "the only" Democratic leader who has ever tried to do anything about health care.

The problem with Bill and Hillary's approach to health care reform is that it was an attempt to compromise with a market based system that had no incentive to compromise with them. The American "health care industry" makes its huge profits by denying care to as many people as possible. It then plows a portion of these profits into the campaign coffers of elected officials. Hence the reluctance of politicans to take on the industry in a fundamental way. Here's what Dr. David Himmelstein, who teaches at Harvard Medical School and is a cofounder of Physicians for a National Health Program (http://www.pnhp.org/), said about a meeting he had with Hillary back in the early 90s: "When I presented the case for national health insurance to her, she said, 'Can you name any force capable of taking on the $300 billion dollar a year HMO and insurance industry?'When I said how about the president of the United States leading a crusade of the American people,? She asked me for something real."

As Nancy Welch who interviewed Dr. Himmelstein for The Socialist Worker online (http://www.socialistworker.org/2004-2/51 7/517_11_DavidHimmelstein.shtml)has pointed out two results of the Clinton administration's attempt to compromise with the private insurance industry were: 1)the abandonment of a four decade long committment to National Health Insurance by the Democrats; and 2)a signal to investors that managed care was safe place to be which in turn stimulated today's corporate dominance of the health care system.

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Buying Healthcare From A Used Car Dealer

Why do retirees hate America? Don't they understand that when they ask the President hard questions, people in Iran are listening? I'm not even sure what that means, but I've heard from Republicans that questioning the Bush administration is the scariest thing ever. On Wednesday afternoon, a bunch of retired bullies openly took Bush to task on everything from global warming to healthcare. It seems that the White House crowd screeners have gotten lazy.

Trying to promote the disastrous Republican prescription drug program, Bush spoke to what I'm sure he'd assumed would be an easy crowd of retirees in Maryland. But the crowd apparently wasn't interested in merely serving as props for the President. Instead, they asked some real questions, many of which he couldn't even begin to answer. My favorite, because it has a lot to do with something I've been quite interested in lately, had to do with the cost of healthcare in America.

Another audience member brought up disparities between hospital costs for patients with and without insurance. That got Bush going on a favorite topic of late -- how health care consumers have much less information about the price of services in advance than with other types of purchases.

He got a bit tripped up when making the comparison to vehicle shopping -- something he has not done for years.

"When you go buy a car, you know exactly what they're going to charge you," he said, drawing laughs -- and then adjusting his remarks.

"Well, sometimes you don't know," he said. "Well, you negotiate with them. Well, they put something on the window that says price."

This was Bush's classically sloppy way of trying to deliver the latest Republican talking point -- that the answer to the rising cost of healthcare is raising it some more. This new "skin in the game" talking point from the Republicans is something Ezra Klein and Kate Steadman have been discussing quite a bit lately at TPMCafe. I think it's worth exploring here as well, if for no other reason than to expose its sheer stupidity. Essentially, the Republican argument is that since many Americans' healthcare bills go to their insurers, people are too insulated from healthcare pricing. In other words, they don't have enough "skin in the game" to be genuinely concerned about it. If people saw the prices they're charged for treatments, surgeries, etc., the theory goes, they would haggle those prices down, much as they might a used car. At the end of the day, this means scrapping health insurance in favor of out-of-pocket payment for healthcare through health savings accounts.

If there's any one issue on which the Republicans are going to lose the American people, this is it. Quite simply, I fail to understand how they can sell this proposal by telling people that they're not yet paying enough for healthcare. As of last year, a comprehensive Kaiser Family Foundation poll found that 67% of Americans believe they've paid more for healthcare over the past five years. And in the same poll, 70% of those who are uninsured said that the reason is that insurance is too expensive. Among the insured, 65% worry that their insurance will become to expensive, 66% worry that they wouldn't be able to afford a serious illness, and 71% worry that they might lose their insurance when they're elderly. Hearing that they aren't paying enough for healthcare just isn't going to resonate.

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National Nurse: Exciting news to report!

Crossposted at Howard-Empowered People (guest blog)


The National Nurse Team is delighted to announce that the bill to establish an Office of the National Nurse has been introduced on the floor of the House of Representatives on March 8th, 2006. The bill is HR 4903 and can be viewed in its entirety later today or tomorrow here.  We all thank Representative Lois Capps (D-CA)and her dedicated staff for introducing this bill during the second session of the 109th session of Congress.


HR 4903 establishes an Office of the National Nurse that will:

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Doctor Deflates Key Malpractice Myths

Listening to NPR on my drive home earlier, I caught an interesting item on 'Marketplace' about Harvard's five teaching hospitals starting a program counseling doctors to apologize when they make mistakes. It sounds incredibly obvious, but apparently, that's not the case in the medical profession. Quite simply, apologizing for making mistakes is not something doctors have been trained to do. If anything, it's the other way around. Host Kai Ryssdal's guest was Harvard Medical School surgeon and New Yorker writer Dr. Atul Gawande. You can listen to it online, but I transcribed part of the interview here, adding emphasis on a few key points.

Gawande: It's certainly an area that's made us as physicians very nervous. The idea that you might apologize, and the next thing you know, that apology will be used against you in court will clam people up. But there isn't much evidence, when people have looked for it, of people using apologies against physicians in court. And then, there have been some really interesting experiments in the last couple of years. One in Colorado, they've had over three hundred patients now where they have come forward when a mistake has happened and said, "we made a mistake and we want to make this right." They reached an early settlement with the patients to make sure that their medical care and costs are taken care of and the patients got help faster. Less than one percent of the people who are actually hurt by medical care get help through the medical malpractice system, in part because they have a hard time finding anyone to take their cases, and then the cases take five to seven years, and then a lot of them lose.

Ryssdal: Are you less likely to be sued if you're just a nice guy and you communicate well with your patients, whether it's for good or for evil?

Gawande:The ones who do go to malpractice suits are frequently the ones with physicians who don't communicate well and don't have a good relationship with patients. So part of this is about cementing the relationships with patients so that we are not provoking them into malpractice suits. I think the more fundamental and moral reason here is it's the right thing to do. As painful as it is -- and I've made my share of mistakes and find it hard every time to be honest about it and fess up to patients -- but in the end, it always go better.

Ryssdal: Do you think this decision might lead somehow to better medicine, in that doctors and surgeons would be less likely to practice defensive medicine if they know that in the end, there could be a good outcome?

Gawande: I think that there are two ways that it might make things better. Number one, many people will tell you stories of having things go wrong in medical care and then the team seems to disappear. Suddenly, people aren't talking to them and that sense of suddenly becoming isolated would be important to make that disappear. The second way is it would allow us to focus on getting past the issue and focus ourselves on what we need to do for the patient.

It's interesting to hear someone from the medical profession deflate some of the right's favorite myths about medical malpractice. President Bush, whenever he makes the case for his brand of 'tort reform,' always claims that being forced to practice defensive medicine is scaring doctors away from providing quality care. It seems much more likely, if what Dr. Gawande says is true, that it's actually the myths about defensive medicine that are scaring doctors away from quality care. The idea that doctors screw up and then compound their screw ups by severing communication with their patients is insane. And yet it happens again and again because these doctors have been told repeatedly by the insurance industry and their allies on the right that fear of lawsuits should trump fear of subpar care. It's sick.

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