Health insurance reform inches along towards passage

Yes, everybody has to hold their noses when they dig into the gory details of the various health insurance reform proposals grinding their way through the digestive system of the snake called Congress, but the simple truth is that there is a lot of good stuff in there that will be a solid foundation for future health reform efforts. Sure, it would be nice to have a better proposal or even a perfect proposal, but we have got to focus on what is doable in the current political and economic environment. In any case, the various proposals are incrementally changed to make them more palatable to a broader political base. The net result is that we are getting closer and closer to a legislative package that can actually be passed by Congress and signed into law. This really is going to happen!

A vote in September is almost assured. Or, they could spend more time in September to improve the bill further, but that would be even better.

This is not the end-all of health reform. My personal view is that the real end-all proposal will come 3 to 5 years down the road after our social and economic and political system digests the actual reforms in the real world and then we will have solid support for a better, more comprehensive longer-term proposal.

I expect that we will have at least annual congressional efforts to tweak the reforms as we gain more real-world experience. Maybe even a couple revisions every year.

My condolences to those left-wingnuts who want a pure single-payer system. Ain't gonna happen. Ever.

My assurance to those right-wingnuts worried about a federal government takeover of the health care system. Ain't gonna happen. Ever.

To everybody else, there is something in reform for everybody. Maybe even including me.

-- Jack Krupansky

Pres. Obama should sponser a chat with Prof. Gates and "the arresting officer"

Given all of the "uproar" over the arrest of Prof. Henry Gates and Pres. Obama's own foray into the discussion, I think it makes perfect sense for the President to offer to sit down and have a "chat" with just the three of them present. It might not resolve anything or change anything, but it is just the president's kind of opportunity to show him at his "community organizing" best.

Right now, the "discussion" is happening in the national media, which is a truly horrible venue for resolving conflicts.

Pres. Obama could also go to Cambridge and host the "chat" there.

I really do think it would do some good, and give the president a chance to positively demonstrate his conciliatory abilities.

It would also be good because it would push the national media out of the picture. As well as any activists who might be spoiling for a fight.

The issue should not be how Prof. Gates is going to "fight" the Cambridge Police Department, but rather the issue should be how Pres. Obama can use his skills and the presidential office to actually make a dent in racial confict in America.

-- Jack Krupansky

Health care reform now!

I just wanted to clarify that although plenty of criticism can be heaped on current health care reform efforts, even by me, I am nonetheless 100% supportive of President Obama's effort to pass a comprehensive health care reform package real soon. I am 100% supportive of his discretion as to whether the package gets completed before the August congressional recess, or whenever he agrees to shift it. And, I am 100% supportive of his discretion to negotiate exactly which elements of reform are included in the final package (which can always be revised and extended in future years.)

As far as the timing, personally, I would not lose any sleep if it took another month or two or year or two, but I am 100% supportive of President Obama's "the urgency of now" philosophy. I also believe that health care reform falls under the "If not now then when?" philosophy since continued delay means... endless delay.

Maybe health care reform would be better next year or the year after, but it could also be a lot worse if the resolve to actually do it dissipates and politicians begin feeling that their reelection prospects are safer by continuing to delay.

Personally, I do not think that a delay of a month or two or a year or two will result in a substantially better package than the current options in Congress, so if we are really going to do it, we should just get it done, now.

So, let's have Health Care Reform Now!

And then we can all move on to other things!

-- Jack Krupansky

How will health care reform change health care for the average American?

I've followed the current effort at so-called health care reform in the media, with various descriptions of the various changes embodied in the various proposals, but it is still unclear what the net impact will be for the average American, or even for any American.

First, the overall reform effort is really focused on coverage and insurance, not actual care. Sure, there is a lot of talk about how incentives impact care, such as how many tests are performed, but ultimately that does not translate into a net impact on care per se and doesn't tell the average American (or any American) what changes they can expect to see. Or, are we all really expected to see a dramatic decline in the number of tests that doctors perform? I'm sure there is some fraud with regard to tests, but my hunch is that the vast bulk of tests are performed because the doctors simply need the information to provide better care. What exactly would you want to change here?

I am sure that some of the uninsured will be provided with coverage/insurance, but not all. So, how is the average uninsured American supposed to figure out whether they will become insured? And, at what cost. Even low cost insurance will likely still be unaffordable to many people in the uninsured category.

I still have not heard a good, solid reason for why health care reform, other than simply covering the uninsured, should cost anything, let alone a lot of money. Maybe the real bottom line is that a single-payer system is much cheaper and more efficient, so our "desire" to maintain a much more complicated system means that it will inherently be much more expensive and much more inefficient. Makes sense, sort of, in a bizarre kind of way.

There is a lot a talk about reining in health care costs, but even the talk focuses on the long-term, with expectations that costs will continue to rise in the short term. In truth, even with all of the talked-about reform, health care costs will continue to rise, albeit at a somewhat slower rate, at best. Why no serious effort to actually dramatically reduce the cost of health care? That's an easy question to answer, if you are not a politician: Because the single best and maybe only effective approach to dramatically scaling back health care costs is to do something resembling a single payer system, and that is unfortunately political dynamite. They disparage it as socialized health care or socialized medicine. Makes it sound horrible. The alternative, what we have now, is... anti-social health care or anti-social medicine. Is that really better. Do we really need medicine and health care that is so much less social?

I continue to believe that health care reform will come in two stages. The current effort is stage one. The good news is that this current effort will break the logjam and finally get people in a frame of mind to actually change the current "system." The bad news is that the system will remain somewhat broken and horribly inefficient and horribly expensive. The second stage, real health care reform, will come three to five years from now when people realize that the current reform "package" is simply not good enough to deliver the changes we need, and people begin to focus on how to transition from the current reform to something that actually resembles an efficient, effective, and economical health care system.

Meanwhile, I, like most Americans, continue to have no idea what my own personal slice of the health care system will look like a year or two or three from now.

-- Jack Krupansky

Lobbyists in sheep's clothing

I thoroughly enjoyed reading the article in The New York Times by David Kirkpatrick and Ron Nixon entitled "Lobbies Adopt Tone of Accord With President" which chronicles the extent to which the Obama administration has managed to get lobbyists to agree to work semi-constructively with the administration as legislative efforts are crafted in a spirit of compromise. The amusing part is how activists at both the right and left extremes of the political spectrum are really annoyed at this spirit of cooperation and collaboration (and concession.) For activists, compromise is not a virtue but the ultimate sin. Meanwhile, centrists, pragmatists, and moderates can all breathe a sigh of relief as the Obama administration blazes a trail of sensibility rather than extremist activism.

Even with most of the big lobbyists "onboard" and eager to "work with" the administration, there are plenty of non-lobbyist special interest groups in Washington that are "lobbying" (in a loose, non-legal use of the term) through whitepapers, advertising, editorials, whispering to the media, and other forms of "public education" that do not involve directly lobbying Congress, which is a regulated activity. The NYT article mentions a few of these organizations, but fails to highlight the important distinction between true lobbyists and mere spokespersons for special interest groups.

-- Jack Krupansky

Situation in Iran

Although I have made a number of comments on Twitter, this is my first foray into blogging about the situation in Iran. The situation is complex. That is part of why I have held off on commenting. I wanted to let at least a little of the dust to settle and see where things might be headed.

Originally, I titled this post "Democracy in Iran", but then I realized that the situation is not strictly limited or even necessarily directly related to democracy, per se.

Personally, I am very reluctant to attempt to categorize the situation in Iran as a true crisis per se, but I'll go along since the situation is in fact one that warrants some level of attention.

First, is there "a" crisis in Iran, or is this merely another crisis, or has Iran been a crisis since 1979? Or maybe the crisis dates from when the Neoconservatives decided that Iran was part of an Axis of Evil? It is unclear, or maybe all of the above.

Ultimately, I do have to say that it is simply too difficult to tell for sure, at this time, due to all of the hype and noise and hysteria that surrounds everything in the West that has to do with Iran.

Let me state some facts, as I seem them:

• I am a big believer in democracy. There is no better alternative, anywhere.
• I think all countries should be governed as democracies.
• I think Iran should be governed as a democracy.
• I do not think Iran's current government is close enough to being a reasonable democracy.
• I do not think Iran ever was close enough to being a reasonable democracy, not under the Shah, not before the recent election, not at any time back to 1979 (or before.)
• I do firmly believe that democracy is a very good thing and that it would be a very good thing if Iran were to develop a reasonable facsimile of a modern democracy. 
• The limited available evidence strongly suggests election irregularities, but the available evidence does not justify a strong claim that all of the evidence would "hold up in court" as proof of the degree of fraud that is currently claimed.
• I believe that there was some degree of fraud in the election.
• I do not know if there actually was enough fraud to change the election results.
• I believe that the people of Iran have a right to peaceful assembly and protest.
• I believe that the people of any nation always reserve the right to revolt, if they feel it necessary, but as a last resort. See the language in the U.S. Declaration of Independence.
• I believe it is horribly wrong for the people of any nation to actively encourage (or incite) the people of another nation to revolt. That needs to be a hard decision of the people within a nation, not incited by outsiders.
• I believe that the so-called Pro-Israel Lobby is a major factor inciting opposition to Iran in the West, especially in the U.S.
• I do believe that Iranian-American expatriates are also a major factor inciting opposition to Iran in the West, especially in the U.S.
• I believe that Netroots members and sympathizers are a major factor inciting opposition to Iran in the West.
• I believe that Netroots promotes a trans-national approach to politics and that makes the situation in Iran appealing to them.
• I believe that Netroots members and sympathizers are exploiting and taking advantage of the situation in Iran.
• I believe that Netroots is making the situation worse rather than better. 
• I do not believe that the U.S. government should be promoting or inciting regime change anywhere, including Iran. There is no firm evidence of current U.S. policy with regard to inciting regime change. There was such a policy to incite regime change in Iran, but there is no clear public record as to whether that policy has been rescinded.
• I do not believe that citizens of the U.S., including members or sympathizers of Netroots should be promoting or inciting regime change anywhere, including Iran.
• Throwing rocks in the street is not a peaceful activity.
• Lighting fires in the street is not a peaceful activity.
• Using the word "death" (to anyone) in a chant is not a peaceful activity.
• I do believe that most, a majority, of the protesters in Iran are in fact peaceful.
• I believe that the evidence is clear that some percentage of the protesters in Iran are in fact non-peaceful.
• I believe that there are Americans and members or sympathizers of Netroots that are encouraging, even if only indirectly, at least some of the non-peaceful protesting in Iran.
• I do not know, from the available evidence, what percentage of the citizens of Iran actually agree with the protesters in Iran (or their supporters in the West.) I presume, but do not know, that a significant percentage do support the (peaceful) protesters. How far they want the protesters to go is unknown.
• I do NOT think that it is at all up to those of us outside of Iran to lobby, promote, encourage, incite or otherwise seek to influence the people (or government) of Iran in how they choose what form of government they feel is best for them.
• The people of Iran (in Iran) are more than able, and presumably willing, to stand up at any time that they want to pursue whatever form of government that they want. They do not need our help, either as individual or our government.
• As far as I can tell, the people of Iran do not in any way need my assistance or support or encouragement to pursue their own agenda with regard to governance.
• I do support President Obama and his team as they work through the issues concerning Iran.
• I do not agree with any Netroots members or sympathizers who think that they are entitled to have their own foreign policy with respect to the protesters in Iran.
• The citizens of America do have a right to free speech, but incitement is not a right. Bloggers, and Twitterers, and the users of all forms of social media are certainly entitled to exercise free speech and give their own views, but once again, incitement is not a right. Users of social media need to remain cognizant that there is a line and that they should remain vigilant to avoid crossing over the line from protected speech to incitement.

To reiterate, there is far too much hype, noise, and hysteria surrounding everything in the West that has to do with Iran. That is very unfortunate. What is needed instead is calm and reason.

As far as Iran's so-called "nuclear ambitions", here are some facts as I see them.

• Iran is a sovereign nation. They do not need the permission of the U.S. to do... anything.
• I am opposed to the spread of nuclear weapons.
• I am opposed to Iran or any other nation obtaining nuclear weapons.
• I am NOT opposed to nuclear energy.
• I am okay with Iran developing nuclear energy.
• I am okay with Iran seeking to develop the full fuel cycle for nuclear energy, including refining, enrichment, and reprocessing of spent fuel.
• Iran, as a sovereign nation, has the right to energy independence and should not be strong-armed into becoming dependent on an external supplier and processor of nuclear fuel.
• The U.S., EU, Israel, the so-called Pro-Israel Lobby, and others are misguided in attempting to strong-arm Iran into giving up its right to develop nuclear energy.
• As a sovereign nation, Iran has a right to develop nuclear weapons.
• The U.S., EU, Israel, et al do not have a right to prevent any sovereign nation from developing nuclear weapons, per se. They can and should seek to dissuade others from developing nuclear weapons, but no sovereign nation has the right to demand that another sovereign nation not develop defenses as they see fit.
• Many decades of bullying and interference by the U.S. in the Middle East have destroyed U.S. credibility.
• The U.S. needs to restore its lost credibility in the Middle East. Continued bullying and interference are unhelpful.
• It is unlikely that Iran can be dissuaded from developing nuclear weapons as long as the U.S. continues to lack credibility as a peaceful nation in the region. The U.S. needs to recognize that fact.
• I am not convinced that Iran has an active nuclear weapons development program at this time. They may, but that is a poor excuse for the U.S. to continue to stumble on with very poor judgment in the region.
• I would hope that Iran would not threaten the U.S. or any other country with nuclear weapons.
• The U.S. always reserves the right to protect itself and that may involve strikes against other countries if those countries threaten the U.S. with nuclear weapon capabilities.
• Israel also has such sovereign rights of protection.
• The U.S. is currently doing a fairly poor job of dialing back the fear-mongering rhetoric concerning Iran and any so-called "nuclear ambitions." They need to do much better.

So, what should be done about Iran?

Well, our first order of business is to get our own house in order. Fix the economy, fix the broken financial system, fix the health care system, fix our energy strategy, work on our credibility as a peaceful nation, etc. That would be a start.

The U.S. needs to become an agent of peace in the world and in the Middle East, not an agent of fear as we currently are.

And then and only then should the U.S. (and its loud-mouthed activists) turn any attention on Iran.

Any questions?

-- Jack Krupansky

What is the meaning of happiness in "the pursuit of happiness"?

The U.S. Declaration of Independence states that we have rights to "Life, Liberty and the pursuit of Happiness", but what exactly did they mean by "Happiness"? The text from the preamble to the declaration:

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.--That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

It seems rather obvious from the context that "happiness" is not being used as merely a synonym for pleasure, so what is it really referring to?

The Wikipedia article on the declaration notes that Jefferson, et al were influenced by the writers of The Enlightenment. A separate Wikipedia article on the key phrase alone notes that John Locke may have been the ultimate source of the general language:

The famous phrase is based on the writings of English writer John Locke, who expressed that "no one ought to harm another in his life, health, liberty, or possessions."[1]

...

1. Locke, John (1690). Two Treatises of Government (10th edition). Project Gutenberg. Retrieved on January 21, 2009.

To me, that superficially suggests that Jefferson may have treated happiness as a reference to health and possessions, at least loosely speaking.

The Wikipedia article also notes that the Virginia Declaration of Rights had the language (by George Mason):

That all men are by nature equally free and independent, and have certain inherent rights, of which, when they enter into a state of society, they cannot, by any compact, deprive or divest their posterity; namely, the enjoyment of life and liberty, with the means of acquiring and possessing property, and pursuing and obtaining happiness and safety.

That is not inconsistent with Locke. I would interpret "safety" as roughly the combination of "life and liberty", so "happiness and safety" would leave us with roughly the rights of life, liberty and the pursuit of happiness. This suggests that Mason was considering happiness to be roughly "acquiring and possessing property."

I would superficially interpret property as roughly meaning livelihood, the means to support yourself and provide for your family and the prospect of accumulating wealth.

Almost immediately after the July 4, 1776 signing of the declaration, a draft of the Articles of Confederation were published, on July 12, 1776, with no reference to happiness. Article II said:

Article II. The said Colonies unite themselves so as never to be divided by any Act Whatever, and hereby severally enter into a firm League of Friendship with each other, for their common Defence, the Security of their Liberties, and their mutual and general Welfare, binding said Colonies to assist one another against all Force offered to or attacks made upon them or any of them, on Account of Religion, Sovereignty, Trade, or any other Pretence whatever.

Assuming that "Defence" substitutes for protecting Life, then it would seem that Happiness has been replaced with "general Welfare." To me, that is not inconsistent with interpreting "Welfare" as the means to support yourself and provide for your family, although the concept of accumulating wealth in the form of property is not explicit.

More than a year later (November 15, 1777) the final version of the articles were drafted and submitted to the states, with some wordsmithing, but no essential change in meaning. Article II became Article 3:

ART 3. The said states hereby severally enter into a firm league of friendship with each other for their common defence, the security of their liberties, and their mutual and general welfare; binding themselves to assist each other against all force offered to, or attacks made upon them, or any of them, on account of religion, sovereignty, trade, or any other pretence whatever.

For various reasons the articles were superseded by the U.S. Constitution, which also refrained from explicitly referring to happiness. Taking on a little more of the tone of the declaration, the constitution had a preamble, using the language:

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

Once again, it would appear that the role of happiness is subsumed by welfare. I interpret the term "general welfare" as meaning that pursuit of the welfare of the individual collectively benefits the whole of society.

Then came the Bill of Rights. Did that have anything to do with "happiness"? I think not. I think the rights and freedoms enumerated in the Bill of Rights fit more squarely under the category of liberty. Nothing in the Bill of Rights seems to relate directly to acquiring and owning property, livelihood, or accumulating wealth.

Overall, my take on these documents is that happiness and welfare seem to relate to the prosperity of the individual and that the states and the nation had a vested interest in the prosperity of the people as individuals.

I ran across a piece by Carol V. Hamilton entitled "The Surprising Origins and Meaning of the 'Pursuit of Happiness'." She quotes Locke from his essay "Concerning Human Understanding":

The necessity of pursuing happiness [is] the foundation of liberty.  As therefore the highest perfection of intellectual nature lies in a careful and constant pursuit of true and solid happiness; so the care of ourselves, that we mistake not imaginary for real happiness, is the necessary foundation of our liberty. The stronger ties we have to an unalterable pursuit of happiness in general, which is our greatest good, and which, as such, our desires always follow, the more are we free from any necessary determination of our will to any particular action, and from a necessary compliance with our desire, set upon any particular, and then appearing preferable good, till we have duly examined whether it has a tendency to, or be inconsistent with, our real happiness: and therefore, till we are as much informed upon this inquiry as the weight of the matter, and the nature of the case demands, we are, by the necessity of preferring and pursuing true happiness as our greatest good, obliged to suspend the satisfaction of our desires in particular cases.

That does suggest a more solid origin of Jefferson's pursuit of happiness, but still does not cut to the heart of the meaning of that happiness. I interpret the reference to liberty and happiness being its foundation as indicating that a person cannot experience true liberty unless they are also experiencing true happiness. In other words, without true happiness, liberty is for naught. You cannot feel truly free unless you are enjoying the pursuit of happiness.

Ms. Hamilton digs deeper and finally informs us that:

Properly understood, therefore, when John Locke, Samuel Johnson, and Thomas Jefferson wrote of "the pursuit of happiness," they were invoking the Greek and Roman philosophical tradition in which happiness is bound up with the civic virtues of courage, moderation, and justice. Because they are civic virtues, not just personal attributes, they implicate the social aspect of eudaimonia. The pursuit of happiness, therefore, is not merely a matter of achieving individual pleasure. That is why Alexander Hamilton and other founders referred to "social happiness."

That still does not answer the whole question, but at least informs a belief that pursuit of true happiness at a personal level does relate to doing good for the whole of society. If we read pursuit of happiness as the pursuit of social happiness, that leads us to inquire what form of "happiness" at a personal level would benefit the whole of society. To me, the answer is enlightened self-interest, pursuing activities that serve a dual purpose of directly benefiting the needs of the individual while simultaneously indirectly benefiting the whole of society. Pursuit of prosperity seems to fit that bill. The ancient philosophers speak of virtue and civic virtue, but I think that is compatible with enlightened self-interest.

In short, my reading of all of this is that Jefferson was using the happiness in the pursuit of happiness to mean prosperity with a strong sense of enlightened self-interest, with prosperity referring to livelihood, the ability to take care of your family, the right to enjoy the fruits of your labors (including at least a little pleasure), the obligation to give back to the community, and at least the hope of accumulating wealth in the form of property and money. Coupled with protection of your life and liberty, all of this would benefit both the individual and the whole of society.

-- Jack Krupansky