My sense of obligation in this particular area has been heightened in recent weeks as a result of pondering the ramifications of some of the end or life issues raised by Conservative participants in the great health care reform debate currently mesmerizing large segments of the populace, elite and otherwise.   In response to their fervent remonstrations, I have been moved to think long and hard about the proper role of national health care systems.

The good things they should do are rather obvious, and all of them are more or less easy to achieve by a wealthy nation such as the United States.  Despite the protestations of Conservatives and ethically obtuse Blue Dogs, we can easily afford the kind of system we need. One of the most obvious indications that this is indeed the case is the fact that many nations endowed with far less wealth than the United States provide excellent health care for their citizens of the sort that would be appropriate in this nation.

Thus, the decision looming before us is not about the money, it is, instead, about morality and basic Human Rights.  As a result, we have wandered, almost aimlessly, into a confrontation with the necessity of making a major decision about what we are as a people, and what we might hope to become.  Moreover, the decision before us has ramifications just as important as those associated with the anti-slavery debate, or the one that resulted in women receiving the right to vote.

Health care for everyone, from cradle to grave, will fundamentally enhance the nature of human life in this society.  As a result,  it is imperative that those of us who support the cause, as the late Senator Edward Kennedy eloquently noted, need to be seriously engaged, and doing our level best to make honorable health care reform happen.

Having said that, I want to address some of the problems inherent in massive, nationalized health care systems that we need to anticipate, plan for appropriately, and hopefully avoid.  I should begin by noting that we in the United States who are alive today have experienced a golden era.  Despite widespread, endemic poverty, and all that the existence of such a problem implies, the nation as a whole has prospered for many decades in a relatively auspicious manner.

In addition, we have enjoyed a relatively stable political climate.  We have experienced assassinations, riots, and many kinds of violence associated with politics.  Nonetheless, the basic framework of government has remained stable, and the social fabric of that which has come to be known as “the American way of life” has evolved in many positive ways.  Most people probably agree that Barack Obama’s election to the highest political office in the land is proof that this is true.

As we move forward with noticeable, and uncharacteristic, uncertainty into this new century, we need understand that some better days are ahead.  But most certainly, and this is where the worst possible case thinking comes into play, we also need be aware that some unavoidable, troubled times lie dead ahead.

The key point to understand is that the health care system we need should be designed to withstand all the worst possible scenarios we can reasonably imagine.  For example, it needs to be designed such that it remains functional during times of massive economic dislocation.  It also needs to be designed such that it can withstand the inevitable pressures to do wrong, which will almost certainly accrue from any sort of extreme ideological swing to the right or left that may occur in the national political system.

During this relatively tranquil moment of domestic peace, and Liberal Democratic goodwill, it is proving relatively easy for most of us to focus almost entirely on all the good things associated with well-managed national health care programs.  Nonetheless, it is vitally important for us to understand during times of stress, turmoil and widespread paranoia such programs can be transformed into grotesque venues for exploitation, suffering and death.  Any cursory review of the ways in which such programs have been used to abuse citizens over time in countries around the world will reveal that there are good reasons for us to be cautious, and to insist on the establishment of strong protections for the rights of citizens.

We also need to devote much more attention at this particular moment in time to carefully examining all the ways in which the U.S. health delivery establishment has violated the rights of citizens in the past.  Such investigation will reveal that the infamous Tuskegee Experiment is/was the tip of an iceberg of abusive practices by health care personnel here in the U.S., who have perpetrated many oppressive, and probably illegal, abuses against U.S. citizen, including widespread, forced sterilization.

Such personnel also have a long history of conducting unconscionable, and sometimes deadly, experiments on unsuspecting, uninformed citizens.  In addition, the health care system has historically accommodated prevailing systems of endemic oppression involving caste, class and race in ways that continue to have devastating consequences on the lives of those who hail from targeted groups.   Given this, I am particularly concerned about the manner in which the death penalty is used here in the United States.  Separate and apart from that issue, I recommend that  increased critical attention be devoted to the role of health care personnel in the capital punishment industry.

Anyone doubting the validity of this assertion should take the time to read Medical Apartheid, by Harriet A. Washington.  Furthermore, I hope I am not the only one deeply concerned about the role that some U.S. medical personnel have played during the past few years in Iraq, Afghanistan, and other black sites around the world, in connection with the so-called War on Terror.

It seems reasonable to ask whether the U.S. medical personnel who are, or have been, engaged in such activities are disqualified from participation in the national health care program currently being constructed in Washington?  Under what set of circumstances might they be disqualified?  Before any new programs are established under the heading of health care reform, we need to know whether the civilian and military spheres of health care will ever be permitted to merge, and if so, in what ways?

Do medical personnel who move back and forth between the two systems experience ethical conflicts?  If so, what are they, and how might they be precluded from occurring in the first place?  This is the time to address such e issues, and we need to thank Conservatives for forcefully bringing them to our attention.  And in direct response to t valid concerns they have raised about potential abuse, I recommend that the program currently being developed in Washington include a provision that specifically prohibits government participation in end of life decision-making at any time, for any reason.

Finally, I want to reiterated my strong conviction that the best way for the nation’s political leaders to show their good faith regarding the high standards that should be associated with every aspect of the emergent national health care program is for them enroll the rest of us in the system that protects their health and well-being.

That’s what equal opportunity is all about.  Either they believe in it, or they don’t.

For better or worse, we, the people of the United States, are currently doing democracy as well as we possibly can. It is not perfect, but it seems to be working. The stakes are high, and the political maneuvers muscular. Some kind of bill will likely be passed in the name of health care reform, but the contents have not been codified.

The situation is fluid, and no particular coalition of partisans, including the one containing the President and all his supporters, can assume victory is theirs. As I watch the historic drama unfold, I can’t shake the escalating feeling that the dialogue is being conducted at too high a pitch.

People need to calm down. We also need to moderate our tone and behavior. Everyone needs to be more courteous. This can be accomplished without any faction losing face or advantage.

Having said that, I want to put my words into action by being more courteous myself. For example, I don’t intend from this point forward to be accusing anyone else of being an “avatar” of any sort. Moreover, from this point forward, I intend to devote more time and attention to understanding the opinions being expressed by those with whom I disagree.

In keeping with that practice, I take this opportunity to publicly acknowledge that Conservative participants in the health care reform debate are exercising a vitally important function. Given their ferocious opposition, they are forcing the Obama administration, and its supporters, to produce better ideas, more coherent proposals and better budget strategies.

Most important, Conservatives have raised several points that need to be taken more seriously by proponents of reform. This is particularly the case regarding a question repeatedly raised by Conservatives: what is the proper role of government regarding individual end of life decision-making. Like many of the Liberals and Progressives who have publicly commented on the matter since Conservatives began getting into everyone’s face with the question, I initially rejected this line of opposition as ridiculous, and somehow or another, intellectually underhanded. But after devoting close attention to the point Conservatives have been making, in sometimes clumsy and crude ways, I have come to believe that this issue needs to be addressed.

Decisions passed into law in the name of health care reform are going to fundamentally influence the character of life in this society. Moreover, any significant mistakes made now will almost certainly become institutionalized in ways that could end up harming us for decades. Given this, it does not take genius to understand why it makes sense for us to calm down and carefully articulate the proper role of government in regard to this aspect of life.

I suspect we will eventually come to understand that the establishment of a quasi-nationalized system of health care will also require the establishment of strong safeguards which ensure that citizens rights are protected as scrupulously as possible, separate and apart from budgetary considerations.

For now, I want to salute the august Conservatives who have done all or us a favor by forcing us to look more closely as this critically important issue.

In my next blog entry, I will address some of the most important negative ramifications of mishandling this matter.

In the interim, and in passing, I should like to note that this democracy stuff really is a lot like making sausage…

With the passage of time, this fundamentally important transformation would inevitably contribute substantially to the United States becoming a more thoughtful and humane nation. The domestic and global results of such a transformation would be a blessing for humankind in every section of the globe.  People around the world immediately recognized this possibility when Obama was elected. This is one of the primary reasons why his victory was wildly cheered by joyous multitudes in many nations.

Nonetheless, if the forces of resistance win more than they lose in the current struggle over health care reform, much of the current optimism which exists in the nation regarding the possibilities of enacting meaningful, progressive reforms will be substantially extinguished for much of the next generation, if not longer. Given the high stakes involved, it should not surprise that those who oppose health care reform are waging a more vigorous fight than the one waged by a similarly constructed coalition during the recent presidential campaign.

Even though health care reform enjoys broad support across the nation, the opposition is spending expending extensive resources in its effort to create the impression that most people don’t want it. In addition, opponents of health care reform are spending many millions of dollars in order to build resistance to the proposals currently being negotiated in Congress.

I am particularly struck by the disturbingly large number of health care reform opponents who have recently been showing up at town hall meetings armed with pistols and military-type assault weapons. Many aspects of their highly choreographed performances remind me of the scantily clad Malaysia warriors one occasionally sees striding incongruously along the streets of East African cities.  The warriors are commonly armed with glistening machetes and menacing, five-foot long spears. They are striking figures, and people provide them wide berths as they stride along, exuding confidence, pride, and an aura of potential danger.

Nonetheless, everyone knows, including the unarmed, thoroughly urbanized city dwellers witnessing the comings and goings of the Massai warriors, that they do not constitute a threat to the established socio-economic order. This is primarily due to the fact that machetes and spears have little utility in the domesticated corridors of urbanized corporate and political power where Africa’s future is being forged.

A similar truth pertains to the eclectic assortment of gunslingers recently showing up for the television cameras outside town hall meetings focused on health care reform. The gunslingers, who are garnering lots of attention, will eventually prove to be inconsequential to the health care debate’s outcome. Like the Massai warriors who stroll the streets of Nairobi and Mombasa, their weapons are best suited for environments far removed from the arenas wherein the fate of matters such as national health care will be determined.  My enduring hope is that the gunslingers are only attempting to make a symbolic point about their alleged right to bear arms while attending nonviolent public meetings with high-ranking government officials. Assuming the best, they will eventually come to understand that each of them needs good, affordable health care just as much as each of us.

Unfortunately, this is not the case for those who are leading the fight against health care reform. They include spokespersons for insurance companies, the pharmaceutical industry, and a disreputable coalition of running dog accomplices associated with the two dominant political parties.
Their claim to the contrary notwithstanding, these people are essentially reactionary mouthpieces for those who profit from the current system. They represent vested interested interests that have exercised virtually unchallenged power in this nation for generations. And they will need to be dislodged if the best health care interests of the largest number of citizens are to be accommodated properly.

Make no mistake about it. This incredibly powerful coalition is committed to the maintenance of a criminally unbalanced status quo that consigns millions to unnecessary pain, suffering and premature death. Moreover, there is a real chance that they will prevail yet again in their effort to thwart the nation’s best interests through the use of copious threats, poisonous rhetoric, fantastic lies, clever evasions and dirty tricks of the sort employed in the mass media by clever, unprincipled, avatars of division and oppression.

Faced with this very real threat, people of goodwill need to gird themselves for a long hard fight that will inevitably include episodes of failure, and periods of doubt and confusion. Through it all, progressives need to remain cognizant of the fact that we have the right to create a society, which provides adequate, affordable health care for each of us. Given the fact that our current health care system is bankrupting us, we must never lose sight of the fact that we literally can’t afford to fail.

Most important, progressive individuals, groups and organizations need to use the current health care reform struggle to build a national movement dedicated to the elimination of each of our most important social problems. This long neglected work is important, not only because of the critical necessity of relieving unnecessary deprivation and suffering, but because it is needed to establish the social and economic foundations necessary for the nation to competently function in the decades immediately ahead.  In other words, the United States no longer has the luxury of permitting huge swaths of its population to subsist in deprived circumstances, bereft of minimally adequate health care.

Finally, progressive participants in the health care reform struggle need to transform the nature of the debate. Cost is not the issue. Any nation that can afford 6,000 foreign military bases, and two wars fought simultaneously, can afford the cost of health care for each of its citizens. Nonetheless, the Obama administration is being hammered by specious allegations that their health care reform plans are too expensive.  Without completely ignoring the matter of costs, the administration would be well advised to shift the terms of debate. The discussion needs to center on Human Rights, and administration spokespersons should be making the point, as often as possible, that providing adequate, affordable health care is a legal necessity.  The concept that health care is a right is easy to understand, and it provides a clear, unambiguous point for rallying the broadest possible level of public support for the most comprehensive, public option proposals currently being discussed.

In any event, taking into consideration the tattered, dated, sorely neglected condition of much of the nation’s socio-economic terrain, it is clearly apparent that even if progressive forces win the health care struggle currently underway in the nation’s Capitol, much work will remain to be done. For example, we also need to enact major reforms pertinent to labor rights, unemployment, education, housing, homelessness, equal opportunity, nutrition, climate change, the so-called prison industrial complex, and foreign affairs.

In addition, our top priorities list needs to emphasize the urgent necessity of ending U.S. military participation in Iraq and Afghanistan as soon as possible. For the time being, let’s do what we can to ensure that our government commits to supporting our right to receive adequate, affordable health care.
In keeping with the egalitarian spirit of affirmative, mutual support that should inspire the unified national system we seek, I recommend that citizens, each and every one of them, be provided the same coverage provided the highest ranking members of the United States Government
Passage of a health care reform package committed to this end, would provide a game changing, conceptual template for transforming our society. That’s because such a wonderful, audacious commitment on the part of government would almost certainly engender correspondingly creative responses throughout society.

Government actually serving the people in such a fundamentally positive way would also engender a level of trust and respect that would make it possible to enact the reforms—at every level of government–that so many of us so desperately need.