Democrats have been running scared since the Economic Right deliberately set out to scare the hell out of them on Social Security. "Big Government is not the Solution, Big Government is the Problem".

It was the Big Lie, and this was true even back in 1983. The problems were never as big as they were sold to be. But sold they were. The second biggest con in the modern history of American politics was a huge success.

While less in numbers than they were six months and two years ago the vast majority of Americans, progressive, moderate and conservative still believe there is some fundamental problem with Social Security financing. And until they get convinced there really isn't a possibility of selling Universal Health Coverage.

It's not two battles it is one. For one thing the economic projections used by the Medicare Trustees are the same projections misused by the Social Security Trustees, not surprising since the two Boards are identical. Simply put the income projections of Medicare are underestimated, which explains in part why a Trust Fund that was once projected to run out 1999 is now projected to run out in 2016.

The path to Universal Health Care runs through universal understanding that Social Security is not in crisis and people who are telling you otherwise are the same people who are in the way of rationalizing the American health system.

The Right is Lying to You. Again. Still.

Until we can get that fundamental message implanted selling progressive policies faces an uphill battle.

Universal coverage is of course not silly, being available in numerous civilized countries. It will invite, at some point, a debate over what should be covered, which is necessary.

Dems are not on the sidelines in terms of ideas, only in terms of power. This is only because of a combination of effective organizing and campaigning by the GOP, combined with war propaganda. Interesting to imagine a vigorous debate about Iraq not being about something real, but some folks think there's no questions to consider there, I guess.

Dems will be back in power soon. Iraq and security, combined with the economy, will split the GOP like slavery did Democrats in the 19th century. Say goodbye.

I'm not in the instant-withdrawal camp. I'm in the "what the hell can we do?" camp. Since I was in the "Don't invade" camp before that became moot, I feel less obligation to figure out how to gracefullly complete or exit. I'm content to let Rummy twist in the wind.

The debate has to include the genesis of the war, though.

A better analogy might be the damage done to Democrats by Vietnam. After that, many decided they'd rather be right than win. Prior to Vietnam, the GOP was often in that mode. Being out of power long enough, they dropped principle in favor of winning.

"I feel less obligation to figure out how to gracefullly complete or exit. I'm content to let Rummy twist in the wind."

Apparently you're content to let the Republicans hold the White House for the next several elections as well, if you have such complete detachment from the reality of the international situation that will greet whoever is elected in 2008.

Before diving headlong into a catastrophe, the one thing about the health care landscape that needs to be acknowledged is that privately-owned hospitals in this country are nothing short of a criminal conspiracy. Anyone who believes that universal health care will bring down costs rather than allow them to skyrocket is ignorant of the nature of the system. (This includes Paul Krugman.) The pre-requisite for any such reform would have to be strict controls on hospitals, and achieving that is the true uphill battle. A VA-style system is only achieveable if hospitals are closely regulated, and I don't know if people have noticed but hospital corporations hold a bit of power in this country (see Frist, Bill and HCA). Throwing a bunch of money at patients, doctors and hospitals would have a disastrous budgetary effect unless the entire hospital system is either nationalized or regulated so heavily that it's difficult to distinguish between the two.

Meanwhile, since national healthcare would almost certainly reduce the majority of physicians to the upper edges of the middle class, one has to acknowledge the very real moral issue that would then be introduced: do we then allow doctors to unionize effectively for their own economic well-being, perhaps at the expense of the public? This is an ongoing problem in Germany, where doctors were on strike intermittently throughout the summer. Yet, if we want national healthcare to relieve the burden of the middle class, a move that would almost certainly put doctors firmly into that class, we would also be somewhat obligated to allow doctors to unionize for their rights and wages, lest we allow doctors to become effectively enslaved for the utilitarian good of society. Utilitarian arguments aside, you're not going to get very many qualified doctors to want to enter a profession that amounts to state subservience, particularly since doctors as it is pride themselves on independence (for better and more often for worse).

Anyway, this whole question is a hell of a lot more complicated than the CW and the doctor-haters make it out to be. And for a progressive community that prides itself on critical thinking, it should strike everyone as at least a mite suspect that everyone seems to agree, with an echo-chamber peculiarity, that universal coverage would be attended by minimal problems.

Speaking of not being in denial of basic reality, what if the reality is that Bush has put us in a situation in Iraq in which there are no nondisastrous outcomes, and our only option is to pick the course that leads to the smallest disaster? In that situation it does no good to complain that those promoting that course are leading us into a disaster. Of course they are! Every possible path leads to one.

DC Drinking Liberally

I don't know. Carter certainly put us in a situation with no non-disastrous outcomes in Iran in the late 70s, but since Republicans have held the White House for all but eight years since then, they've jolly well had to deal with it, haven't they? If you want the job you better think of something.

(That was worth two 4 votes, was it?)

We have examples of the two likely models for national health. Medicare is not disputed to be highly efficient, at about 2% overhead. The only dispute is over premium price or eligibility, or whether it should exist at all. The VA is also doing a pretty good job, when it is allowed to. Disputes there are over funding levels and eligibility, again.

Elsewhere there are versions of national health that prevent doctors from going into private practice, but that's not likely here. Being a state employee does not automatically imply subservience by doctors, either. Many government employees have significant autonomy, with US attorneys being an example.

A transition could be very tricky. That's where the problems will be. I'd like to see an expanded Medicare to start and a program of the gov buying hospitals and practices to become more like the VA.

Pilot programs are an excellent idea, but there's one other option. Both Kerry and Bush, during the campaign, gave cautious endorsement to allowing a selected group, possibly small business but it wasn't clear about individuals, to buy into the Federal Employees Health Plan.

I'd very much like to see a comparison between expanded Medicare and FEHP, with enough working AND unemployed-but-in-the-workforce people so the traditional demographics of Medicare don't skew it. FEHP is the closest realization of the Clinton Plan, in which staff at the Office of Personnel Management negotiated, on behalf of subscribers, with varied insurers. The market artificiality of employer-paid care was absent, and there were choices in benefits and costs.

FEHP was the third-best plan I had been in, the others being high-tech industries that regarded their staff, and their staff's health, as strategic assets. The key is the FEHP is multiple payer, and yes, has benefits managers. If the market-driven model can be comparable with Social Security, assuming strict analysis of health outcomes for comparability, it would be most interesting to know.

--
Howard

*equal opportunity offense to both extremes*

Doesn't the problem with that approach involve the division of the oil? (Just for starters?)

I hadn't heard of giving the divisions to other countries.

"It is unknowable how long that conflict [the war in Iraq] will last. It could last six days, six weeks. I doubt six months."Rumsfeld-Feb.2003

Yes, that is the first issue. But is the only point that the United States loses special oil concessions? The Sunni region does not have oil, and that is a big issue between them and the Kurds and the Shites in the current Iraqi civil war. In a partitioning, what concessions are made to the Sunnis? - or to the Syrians, if we are giving the Sunnis to the Syrians? What is in it for the Syrians?

Another big issue is - can the Kurds go it alone? They are not going to mix well with the Turks, at all.

Reading the stream of resposes above, I guess I see why we don't have a national health care system. No one can actually keep their mind on it.

Hey, people! The health care crisis is real. OK, so is Iraq and the whole Middle East, but they have plenty of blogs where you can vent.

Jan Knaus

I apologize for going so far off the original topic. The short answer is that, given that the United States is losing the war in Iraq, the United States does not really have much to say about the peace.

Those who are very concerned about the intentions of Iran are going to be very unhappy with Iran taking over the oil-fields of southern Iraq. That would give them a windfall fortune to use for whatever purposes they want.

Do the Shiites of Iraq really want to be independent of Iran? Once Iran gets a foothold in Iraq, they may want to control the Sunnis just to maintain order.

It is hard to see a stable solution just based on Iraq and Iraq's neighbors, isn't it? But the United States is the only Western nation that has had a serious interest in maintaining order in Iraq, so far - I am not counting the UK as being really serious. It is hard for me to see the United Nations wanting to get involved in peace-keeping.

Are the Sunnis going to end up the new Palestinians? What does happen after the United States pulls out?

Once Iran goes into Iraq, presumably they will want to take over the entire country. They would then inherit all of the problems that we have had in Iraq, but presumably they would be willing to commit more troops.

How would Turkey feel about Iran taking over all of Iraq? If they go in, does that draw all of NATO into the country? It boggles the mind to contemplate it.

If we argue that we need to stay in Iraq to avoid chaos, we seem to be assuming that there is a way we can steer all of these conflicts down to a soft landing. Without a genuine threat of chaos, however, it is hard to see that anyone will be motivated to help us with that task.

If the United States is sufficiently humiliated, perhaps some European states would feel willing to step in, but that raises the specter of renewed colonialism.

Iran has few friends. What are the chances of a pan-Arab solution? There are potentially many conflicts of interest there, too.

The catch is that by the time the United States is sufficiently humiliated that other nations would be interested in stepping in, the opinion of the United States about how to shape the peace will not count for much.

We never deal with anything or anybody but fellow westerners in interpreting the Islamic world. We propped up a strongman, the Shah, he falls and the clerics take over. We propped up the strongman Saddam, until he proved to be too volatile and then we toppled him, and the clerics take over. Democrat, Republican, British, French, Americans we keep reinventing the same ways to fail in the Mideast.

We still don't have a clue. So we'll just keep killing people and putting Americans in the way of getting killed hoping we fall upon a policy.

Nothing is going to work in this region until the people native to it figure out how to live with themselves and the rest of the world. I expect plenty are going to die before they figure it out. Why we should work so hard at making many of them Americans is the mystery.