Health Care on Life Support

In eyeball-to-eyeball confrontation, the President blinks by telling governors he will let states opt out of the individual mandate for medical insurance in 2014, three years earlier than the reform law allows.

After a waste of two months with a House dog-and-pony show of repeal and Senate failure to go along, the bipartisan mess that politicians have made of American health care is now a post-disaster triage scene after last November's electoral catastrophe.

As the Obama White House starts to back off, Republicans refuse to take "yes" for an answer. Sen. Orrin Hatch, who eulogized Ted Kennedy as "a United States senator who was dedicated to the last to advancing the vision of America that he held so dearly," is now fighting what Kennedy called the cause of his life with near-apoplectic fervor, denouncing Obamacare and calling the President's new concession "bullcorn" on PBS.

Hatch is up for reelection next year and can feel the hot breath of the Tea Party, which blew away his Utah colleague Bob Bennett after 18 years together in the Senate.

In this atmosphere, the battle will only grow more bitter and worsen a literal life-and-death struggle with political posturing while health care deteriorates.

In the real world, insurance companies still siphon off one of every three dollars that should be spent on patient care and tie up doctors, hospitals and labs with claim-prevention paperwork.

Providers struggle to find innovative ways to make patient care better but are overwhelmed by the insanity of the system.

One of the best doctors I know is forced to cut back his practice severely by converting to Concierge Care, in effect charging patients a hefty annual fee to keep qualifying for his services.

Even before the new law's reforms take full effect, the old system is collapsing. We don't have death panels yet, but rationing is well on its way, with Washington blowhards on both sides beating up on one another as patients sit unattended in waiting rooms.

Update: A New York Times editorial challenges Republicans to match the President's willingness to change with ideas of their own:

"Alternative approaches might include replacing the mandate to buy insurance with a system to automatically enroll people in health plans, reformulating tax credits for small businesses and low-income individuals to encourage near-universal coverage, adopting such liberal approaches as a single-payer plan or a public option, and even moving all or part of the enrollees in Medicaid into new health insurance exchanges. These would all have to be done without driving up the federal deficit or reducing benefits, affordability and coverage."

Waiting for a response from Dr. Boehner or Dr. McConnell, they should not hold their breath.

Obama, Person to Person

Personalizing an issue is an old ploy, but Barack Obama has reminded so many of us why we put him in the White House.

Rallying support for health care, the President pressed the case of Natoma Canfield, a 50-year-old Ohio cancer patient. He had used her letter to him at a meeting with health insurers, and now he was telling a crowd:

"She’s self-employed, she’s trying to make ends meet, and for years she’s done the responsible thing...bought her health insurance through the individual market.

"And it was important for her...because 16 years ago, she was diagnosed with a treatable form of cancer. And even though she had been cancer-free for more than a decade, the insurance companies kept on jacking up her rates, year after year.

"So she increased her out-of-pocket expenses. She raised her deductible...she didn’t want to be in a position where, if she did get sick, somebody else would have to pick up the tab…

"But despite that, Natoma’s insurance company raised her premiums by more than 25 percent. And over the past year, she paid more than $6,000 in monthly premiums. She paid more than $4,000 in out-of-pocket medical costs, for co-pays and medical care and prescriptions. So all together, this woman paid $10,000--one year. But because she never hit her deductible, her insurance company only spent $900 on her care...

"Now, what comes in the mail at the end of last year? A letter telling Natoma that her premiums would go up again by more than 40 percent."

The climax of Obama's story is that, in January, she had to let her insurance lapse, and last week she collapsed and was diagnosed with leukemia.

Now, under all this public scrutiny, the Cleveland Clinic is saying it "will not put a lien" on Ms. Canfield's home, while seeking public assistance to help cover her costs.

Two years ago, while running for president, Obama talked about a young white woman who worked for his South Carolina campaign.

Explaining why they were there, Ashley Baia had told volunteers that when she was nine, her mother was stricken with cancer, lost her health care and filed for bankruptcy and that she "convinced her mother that what she really liked and really wanted to eat more than anything else was mustard and relish sandwiches. Because that was the cheapest way to eat."

"She did this for a year until her mom got better," Obama said, "and she told everyone...the reason she joined our campaign was so that she could help the millions of other children in the country who want and need to help their parents too."

When it was the turn of an elderly black man to explain why he was there, he answered, "I'm here because of Ashley."

That experience typified his campaign, Obama said then: “'I’m here because of Ashley.' By itself, that single moment of recognition between that young white girl and that old black man is not enough...But it is where we start. It is where our union grows stronger."

Since then, our union has failed to grow stronger, but despite stumbles along the way, we have a President who has held onto his humanity and is still here for the Ashley Baias and Natoma Canfields.

"To save one life," says the Talmud, "is as if you have saved the world."

Barack Obama is still trying.

How Obama Misread America

Unlike JFK, Barack Obama's defining moment has arrived, not in the clarity of going eyeball-to-eyeball with a foreign power over nuclear weapons but head to head with Congress in a muddled confrontation he failed to anticipate sufficiently or control.

No matter how incredibly unfair it may be to compare the Cuban Missile Crisis to today's impasse over health care, presidents don't get to choose what will test them. The nature of their response is what counts.

Both Kennedy and Obama came into office with youthful energy and promises of change. In a calmer time, JFK immediately tripped over the Bay of Pigs disaster, took full responsibility and learned the limits of presidential power and the need to prepare the public for decisive actions.

Obama, on the other hand, beset by multiple crises, has not had the luxury of such on-the-job training. He has been forced into finger-in-the dike actions of economic stimulus, auto industry rescues and bank bailouts in the face of solid opposition from Congressional Republicans, using his trademark eloquence to paper over differences as well as he can.

What can be counted against him is the failure to learn from all this that mounting a massive overhaul of health care, no matter how urgently needed, would require a well-defined proposal and a period of public education to have any success against the inevitable lobbying of health insurers, providers and their legislative lackeys.

In this, Obama failed to benefit not only from the experience of John F. Kennedy but Bill Clinton, whose 1990s failure predicted what would happen. Instead of offering firm leadership, this President unwisely deferred to Congress, courted an intransigent GOP and allowed reform to balloon into an unholy mess of compromises, side deals and sellouts.

Now, he is in crisis, at least partly of his own making, as he prepares yet another speech tomorrow on "the way forward" to reconciling and passing what never should have arrived at his desk in the grotesque form that it inevitably will, no matter how many fixes are negotiated between now and then.

It is too late now to start from scratch, so the President will have to take the advice of Warren Buffett, who has a bigger financial stake in America than anyone else, and "get rid of the nonsense" in the Senate and House versions and retain what will stop feeding "the tapeworm that's eating at American competitiveness."

As a transformative figure, Barack Obama is at a crossroads where he will have to show us what he has learned about leadership.

Health Care Holocaust

People, real people by the thousands every year, are dying for lack of medical treatment in the world's richest nation, and after a week of politicians posturing over piles of paper, policy wonks are stunning us with this truth.

A new study shows 68 Americans under age 65 die every day because they don’t have health care, a number that will rise to 84 by 2019--a total of 275,000 needless deaths in a decade.

The numbers from an advocacy group, Families USA, comport with earlier estimates by the Urban Institute and the Institute of Medicine, dry statistics that conceal mass murder by indifference without concentration camps or gas chambers.

Sophisticates who consider such statements overwrought should explain how their cost-benefit analyses make such an outcome inevitable as they advocate, in Sen. Tom Coburn's response to the President's weekly address today, that we "scrap the current bills, which will lead to a government takeover of health care, and we should start over."

Along with this prescription for indifference, a leading GOP presidential hopeful for 2012, Tim Pawlenty, wants to change federal law to allow emergency rooms to turn away patients--"do a little triage," even for those who come in with what Fox's Greta Van Susteren described as "horrible chest pains." (Pace Sarah Palin and her Democratic death panels!)

At the Health Care Summit Thursday, several Democrats tried to focus the discussion on what their constituents are suffering under the current system, but the Republican response was typified by smug Eric Cantor tapping his pile of papers and insisting that "we Republicans care just as much about health care as the Democrats do," while questioning the legality of forcing all Americans to buy health insurance.

At the end of the day, Cantor and his cohorts made it clear that they "simply don’t want to pass comprehensive health-care reform," while the President said of the uninsured, “We can debate whether we can afford to help them. We can’t say they don’t need help.”

As GOP numbers crunchers press their argument with dollar figures, their constituents should take a look at the costs in human lives which, in a time when catastrophic illness can overwhelm middle-class families as readily as the poor, is a threat across the economic and political spectrum.

Making health care reform an us-against-them issue is insane.

Health Care: The TV Show

Big breakthrough for bipartisanship: The table for the health summit has been changed from U-shaped to O, allowing more Republican face time for TV cameras.

Such symbolism typifies an encounter in which the White House will try to put back together a bill that was blown apart last fall by hand grenades from monolithically opposed Republicans and nakedly greedy Democratic swing Senators.

In the rubble of public disgust and Tea Party rage, the effort to start over is being dismissed as "political theater" by GOP legislators while being promoted as significant by the President's Congressional supporters.

Max Baucus, who kept making backdoor deals with "moderate" Senate Democrats, is now an outspoken believer in "the disinfectant of the sunshine. The more we have got questions on both sides, gradually the American people are going to see more and more and more that we really do need health care reform.”

Maybe so, but behind the scenes of a dog-and-pony show to placate highly vexed voters, the President is reportedly picking up pieces of the demolished reform to settle for covering half of 30 million uninsured Americans at one-quarter of the cost.

This would be accomplished by requiring that insurers let people up to 26 to stay on parents' health plans and by expanding Medicaid and the Children's Health Insurance Program, rather than a broader effort with an estimated price tag of $950 billion over 10 years.

As the talkathon starts, the President's hopes for progress, already compromised by dropping the public option and limiting real controls over greedy insurers, providers more oriented to bill than cure and patients who consume health care like a free lunch, keep receding.

But the sound bites will be as abundant as drug manufacturers' samples and other goodies for doctors' offices.

Which Beast to Starve?

Today brings a sharp contrast in political philosophies and economic reality. As Paul Krugman discourses on three decades of Republican attempts to shrink government and "drown it in the bathtub," President Obama discloses his intention to stop feeding the free-market monster that has devoured American health care.

In advance of Thursday's summit, the White House leaks a proposal to oversee and limit double-digit health insurance rate increases such as those the President denounced in his weekly address Saturday.

Legislation introduced last week by Sen. Dianne Feinstein would create a seven-member rate board, the Health Insurance Rate Authority--consumer, industry and medical representatives and experts in health economics--to determine which increases are justifiable and which are unconscionable by insurers who are siphoning off one out of every three dollars spent for "overhead" and profit.

This attempt, finally, to rein in a greedy industry, along with restrictions on denying care to policy holders, should become the centerpiece of streamlined reform legislation to replace last year's fiasco of a bill.

Its thrust, to protect Americans from private greed, is revealing in the light of GOP efforts to "protect" them from their own government, starting in the Reagan era.

The starve-the-beast strategy, Krugman writes, was "a game of bait and switch. Rather than proposing unpopular spending cuts, Republicans would push through popular tax cuts, with the deliberate intention of worsening the government’s fiscal position. Spending cuts could then be sold as a necessity rather than a choice, the only way to eliminate an unsustainable budget deficit."

They did just that in the Bush II years, but his tax cuts for the wealthy and unfunded wars ballooned the deficit, even as Congress couldn't muster the courage to cut popular programs like Social Security and Medicare.

Now both messes, budget deficits and health care, have been inherited by a Change president who is struggling to deal with them over the adamant opposition of those who played the biggest part in creating them.

This week will show how far he can get in trying to slim down the private beast, but it will take his new budget deficit commission a long time to start putting government on a subsistence diet.

U-Turn on Health Care (and More)

Democrats are rediscovering the old saying, "just as well to be hung for a sheep as a lamb," as they edge toward passing health care by a simple majority in the face of Republican roadblocks that have aroused public outrage.

"I've had many conversations this week with the president, his chief of staff, and Speaker Pelosi," Senate Majority Leader Harry Reid said Friday. "And we're really trying to move forward on this."

Such an effort would call the GOP bipartisan bluff and make a bet that voters, after being flummoxed by thousands of gobbledegook pages with tradeoffs and sellouts, would respond favorably to a stripped-down bill with the main elements of reform that opinion polls show they want. Even the public option is poised to make a comeback.

In his weekly address yesterday, the President railed against recent double-digit premium hikes: "The bottom line is that the status quo is good for the insurance industry and bad for America. Over the past year...as millions of Americans lost their coverage, the five largest insurers made record profits of over $12 billion."

In the days before a much-vaunted bipartisan summit on health care, the White House finally seems ready to engage the GOP monolith of misrepresentation that has been winning elections and blocking progress on the President's agenda.

Republicans, says the White House Communications Director, "have a role to play in solving problems in this country, or be accountable to the electorate for choosing not to."

Peace-loving as he may be, the President would do well at this crucial point to consult some relatively obscure Shakespearian wisdom:

"To whom do lions cast their gentle looks?/Not to the beast that would usurp their den./The smallest worm will turn being trodden on,/And doves will peck in safeguard of their brood."

Barack Obama has to get his Congressional worms to start making a U-turn on health care--and more.

A Simpler Health-Care Summit

In a pre-Super Bowl interview, President Obama told Katie Couric about a televised bipartisan health-care meeting on February 25th "to go through systematically all the best ideas that are out there and move it forward.”

If he hadn't been absorbed in the game, watching Bill Moyers Journal a few hours later might have given him a more productive idea than sitting down with members of Congress who have spent months bargaining and bastardizing reform into a monstrosity that few Americans understand and that the majority disapproves.

Moyers interviewed Dr. Margaret Flowers, a Maryland pediatrician, who gave up her practice to advocate a single-payer system, Medicare for All, of which the President as a candidate called himself a "proponent" and which polls at the time showed approval by most Americans.

For her pains, Dr. Flowers, representing thousands of physicians, has been patronized, ignored and arrested three times for trying to get a letter into the President's hands, reminding him where he started in the debate that has devastated his Administration by disgusting millions, Right and Left, with the political system.

"I was so surprised," Barack Obama said two years ago about Congressional deliberations, "when the voices of those who support a national single-payer plan/Medicare for All were excluded in place of the voices of the very health insurance and pharmaceutical industries which profit off the current health care situation."

The President's surprise has certainly subsided by now and, before he subjects Americans to another dog-and-pony show with those who wrecked his attempts at reform, he would do well to precede it with a televised conversation with Dr. Flowers, who is no politician but has earned a stake in the debate beyond her career as a physician.

It may not move Congress much, but such an encounter would remind Americans of where he started in all this and how distorted debate over the issue has become.

Invite her to the White House and tell security to skip the handcuffs.

Update: The level of serious engagement to be expected from the health-care summit is reflected in expectations from Senators on both sides.

Democrat George Miller says, “If the Republicans’ health care plan was a plan for a fire department, they would rush into a burning building, and they would rush out and leave everybody behind.”

Republican Judd Gregg is worried that the meeting would be “an arena for political theater.”

Just so. Is the President looking for political points to scratch up enough consensuses on meaningless GOP talking points or, at the very least, will he reset the debate beforehand back to its essentials and openly admit that he is settling for crumbs, let alone half a loaf?

Where Have All the Grownups Gone?

The Republican National Committee chairman, who has been charging audiences up to $20,000 a pop for his words of wisdom, offered up a free sample yesterday, accusing Democrats of being willing to “flip the bird to the American people” in the health care debate.

Michael Steele's elegant formulation came after Tom Coburn combined his credentials as an MD and evangelist on the Senate floor Sunday by suggesting, "What the American people ought to pray is that somebody can't make the vote tonight. That's what they ought to pray."

Dr. Coburn's entreaty for divine intervention was taken amiss by Dick Durbin, the Democratic Whip, who saw it as putting the evil eye on the failing health of 92-year-old Robert Byrd: "When it reaches a point where we're praying, asking people to pray, that senators wouldn't be able to answer the roll call, I think it has crossed the line."

Coburn's prayer went unanswered as Sen. Byrd made it to the 1 a.m. vote, which he cast with a raised finger followed by a fist pump.

If Durbin's line was meant to mark the boundaries of civil discourse in Washington, it has all but been erased in this season of good will as one of his own colleagues, Sheldon Whitehouse, compared Republican opponents to Nazis, Southern lynch mobs and "taunting crowds" of the French Revolution.

If and when health reform finally passes, it will take decades to learn how it has affected the health of the American people, but in the process, the body politic has come down with a high fever.

At a signing ceremony, Dr. Obama will have to write a powerful prescription to counter that.

Update: The Washington Post adds a holiday note by reporting Byrd's warm greeting by old Senate friends and his zinger for Coburn in a statement: "The Bible says love thy neighbor as thyself. I would hope that we could debate the pressing issues in front of the American public on their own merits without appealing to the Almighty for obstruction, of which there seems to be no short supply in Washington,"

Trade Health Care for More Stimulus?

The weekend "victory" in the Senate has Pyrrhic written all over it as 2000 pages of proposed legislation is on its way to being held hostage by the likes of Joe Lieberman, Mary Landrieu, Blanche Lincoln, Ben Nelson et al. What we have now is an abortion of a bill that will only get worse as the back-alley bargaining goes on.

Here's a radical idea for the President of Change: Take most of it off the table until after next year's elections and put your full weight behind another stimulus that would speed up economic recovery, create jobs and shove it down the throats of Republicans who are using the incoherence of health care reform to confuse Americans who are terrified about the economy.

"Most economists I talk to," Paul Krugman writes today, "believe that the big risk to recovery comes from the inadequacy of government efforts: the stimulus was too small, and it will fade out next year, while high unemployment is undermining both consumer and business confidence.

"Now, it’s politically difficult for the Obama administration to enact a full-scale second stimulus. Still, he should be trying to push through as much aid to the economy as possible. And remember, Mr. Obama has the bully pulpit; it’s his job to persuade America to do what needs to be done."

It would take political guts for the President, after all his talk about the urgency of health care reform, to take most of it off the table temporarily and put the effort and money into turning the economy around.

Settle for passing the noncontroversial elements now--i.e., no cutoffs for preexisting conditions--and move on to a full-scale assault on what is really worrying Americans.

Democrats who have to face the voters in less than a year should be able to unite and help him get something meaningful done.

Update: Joe Lieberman, dubbed by Joe Klein, "the Senator from Aetna," is digging in on the public option, in what the Wall Street Journal calls his "trademark sonorous baritone" but others would call a weasely whine, promising to filibuster against the public option. Harry Reid may buy him off before the final vote, but it's saddening to see a pivotal role being played by someone rejected by his own party's voters in the last election. Is this the way to get health care reform?

Sexual Politics of Health Care

As Harry Reid pressures holiday-homebound Democrats to vote for a start of the Senate health care debate, Republican resisters have found a new weapon to use against the bill--a sudden deep concern about how it might threaten women's bodies.

Seizing on a quasi-government task force's report this week recommending that annual mammograms start at 50 rather than 40, the GOP has gone into full outrage mode.

"This is how rationing begins," warns Rep. Marsha Blackburn. "This is the little toe in the edge of the water. This is when you start getting a bureaucrat between you and your physician."

Never mind that Secretary of Health and Human Services Kathleen Sebelius immediately made it clear that the US Preventive Services Task Force “is an outside independent panel of doctors and scientists who make recommendations” and who neither “set federal policy” nor “determine what services are covered by the federal government.”

“The task force has presented some new evidence for consideration,” she noted, “but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

In fact, the recommendation has provided a starting point, as it was intended to do, for debate of the issue, rather than a mandate, and has met heavy resistance from physicians and patients as well as the American Cancer Society.

But the Republican opposition is doing its thing again. Just as it converted voluntary end-of-life discussions into death panels, the know-nothings are trying to turn a scientific finding into a mandate to frighten American women.

The GOP elephant these days is looking more and more like the three monkeys who see no evil, hear no evil but speak it at every possible turn.

The Birth of Death Panels

A long-time Congressman offers a lesson today about how politics and the media collude to distort rational discussion.

In an Op Ed, Rep. Earl Blumenauer of Oregon explains how his bipartisan proposal to have Medicare pay for voluntary end-of-life discussions morphed into death panels:

"I found it perverse that Medicare would pay for almost any medical procedure, yet not reimburse doctors for having a thoughtful conversation to prepare patients and families for the delicate, complex and emotionally demanding decisions surrounding the end of life. So when I was working on the health care bill, I included language directing Medicare to cover a voluntary discussion with a doctor once every five years about living wills, power of attorney and end-of-life treatment preferences...

"Indeed, the majority of Congressional Republicans supported the similar provisions for terminally ill elderly patients that were part of the 2003 prescription drug bill. In the spring of 2008, Gov. Sarah Palin of Alaska issued a proclamation that stated the importance of end-of-life planning."

During debate, no one in Congress offered any objection until Betsy McCaughey, who had savaged Clinton health care, in a radio interview claimed that the provision would "absolutely require that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."

That statement was labeled a "Pants on Fire falsehood" by the Pulitzer-Prize-winning Politifact, but Sarah Palin, a McCaughey clone, raised it to a higher level on her Facebook page with the warning that "my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’" while Rush Limbaugh chimed in and the Republicans in Congress all joined the attacks as if they had received their marching orders from on high.

The town hall flareups ensued, and the wall-to-wall coverage, Blumenauer says, "shows how the news media, after aiding and abetting falsehood, were unable to perform their traditional role of reporting the facts. By lavishing uncritical attention on the most exaggerated claims and extreme behavior, they unleashed something that the truth could not dispel."

The furor has subsided and health care reform is moving ahead, but the death panel fear surely lingers on in the public opinion polls that find Americans equally divided about the bills.

Health Care as a Pyrrhic Victory

There is a rueful note in today's New York Times report of impending White House triumph in "a process that has at times seemed on the brink of anarchy":

"After months of plodding work by five Congressional committees and weeks of back-room bargaining by Democratic leaders, President Obama’s arms-length strategy on health care appears to be paying dividends, with the House and the Senate poised to take up legislation to insure nearly all Americans."

One criticism of all this chaos can be easily dismissed--that, as Matthew Yglesias shows, "Obama needs to be nicer to Republicans." Lack of bipartisanship on health care is like accusing the President of refusing to play tennis when nobody is on the other side of the net.

More important is the reality of Democratic Sen. Benjamin Cardin's observation, “When you are seeking 60 votes, every person is a kingmaker."

For only one example out of many, there is loathsome Joe Lieberman who, after being allowed to keep his committee chairmanship despite campaigning for McCain last year, is threatening to filibuster against any public option in totally predictable loyalty to the insurance companies that dominate his state rather than the President who forgave his own disloyalty.

Meanwhile, as the Wall Street Journal rails against "The Worst Bill Ever" ("Epic new spending and taxes, pricier insurance, rationed care, dishonest accounting: The Pelosi health bill has it all"), it's hard to refute those epic distortions about the many thousands of dense pages that are working their way through both houses of Congress.

These coming weeks will be a test for the Obama "arm's-length strategy," his instinct for consensus rather than strong leadership from the top.

According to one of his favorite philosophers, Reinhold Niebuhr, "Moral reason must learn how to make coercion its ally without running the risk of a Pyrrhic victory in which the ally exploits and negates the triumph."

But on the other hand, the mid-20th century's most eminent Protestant theologian never had to contemplate the arm-twisting that passes for reasoning with both allies and foes on Capitol Hill.

As in the debate over Afghanistan, the President is going to have to step up with decisiveness and persuade all the competing interests to follow his leadership.

The Speech: "Yes We Will"

In Barack Obama style, optimism is not cheerleading but understanding the situation, finding the best answers and getting to work on them without delay. Tonight, we saw that approach, expressed with more assertion than we have seen before from the President in charge of saving the American economy.

“While our economy may be weakened and our confidence shaken, though we are living through difficult and uncertain times, tonight I want every American to know this,” he said in his address to Congress. “We will rebuild, we will recover, and the United States of America will emerge stronger than before.”

If there is a word that means the opposite of "demagogue," Obama defined it tonight by devoting his speech to detailing the difficulties without minimizing them while stressing the steps needed to save jobs, save homes and get the banking system working again.

He told us "we have lived through an era where too often, short-term gains were prized over long-term prosperity; where we failed to look beyond the next payment, the next quarter, or the next election. A surplus became an excuse to transfer wealth to the wealthy instead of an opportunity to invest in our future. Regulations were gutted for the sake of a quick profit at the expense of a healthy market. People bought homes they knew they couldn't afford from banks and lenders who pushed those bad loans anyway. And all the while, critical debates and difficult decisions were put off for some other time on some other day."

In his even-handed way, the President emphasized his desire "not to lay blame or look backwards," but added that "it is only by understanding how we arrived at this moment that we'll be able to lift ourselves out of this predicament."

He acknowledged widespread resentment over the bank bailouts but made it clear that "we cannot afford to govern out of anger, or yield to the politics of the moment. My job--our job--is to solve the problem" and promised "I will not spend a single penny for the purpose of rewarding a single Wall Street executive, but I will do whatever it takes to help the small business that can't pay its workers or the family that has saved and still can't get a mortgage."

Beyond the immediate crisis, the President laid out long-range answers to energy independence, health care reform and improved education, insisting that they can't be delayed, because "to fully restore America's economic strength is to make the long-term investments that will lead to new jobs, new industries, and a renewed ability to compete with the rest of the world."

It was not called a State of the Union address, but the Congress and the country got a good look at what political leadership should be that was underscored, for comic relief, by a lame Republican rebuttal from Louisiana Gov. Bobby Jindal, full of stale platitudes about what government shouldn't do at a moment in American history when only government can stop the bleeding that free enterprise has inflicted on the country.

Ted Kennedy's Last Hurrah

He turns 77 tomorrow in a life much longer than those of his brothers Joe, Jack and Bobby, who died young and violently before he had reached the age of 40.

In four decades since then, Ted Kennedy has lived in the shadow of legends yet survived to make his own place in history, the last son of a generation "wired to be optimistic," as he tells a reporter today.

“That’s the way I was born and brought up,” he says. “That’s the way we’re dealing with the challenges we’re facing now.”

He is living his last days struggling against the ravages of a brain tumor but refusing to give up the political fight of his life in the Senate for universal health care. He collapsed at Barack Obama's inaugural lunch, but Ted Kennedy has spent his life coming back from setbacks.

"Since the diagnosis of his brain cancer last May," the New York Times reports, "Mr. Kennedy has been given all manner of tributes and testimonials, lifetime achievement awards, medals of honor and standing ovations. But even as those accolades have provided sweet solace--and even some dark humor--as he endures grueling treatments, Mr. Kennedy...has been intent on racing time rather than looking back on it."

In these days of fear and anxiety, he is a living reminder of how much Americans can endure and overcome. Ted Kennedy said it best himself at the Democratic convention last summer:

"As I look ahead, I am strengthened by family and friendship. So many of you have been with me in the happiest days and the hardest days. Together we have known success and seen setbacks, victory and defeat.

"But we have never lost our belief that we are all called to a better country and a newer world."

Happy Birthday, Senator.

Smoke-Filled Lungs and Empty Stomachs

A 21st century corollary to the idealistic hope, "Suppose they gave a war and nobody came," could be "Suppose everybody stopped smoking and tobacco farmers grew food instead."

The outlandish idea of devoting millions of acres to feeding hungry people rather than shortening their lives is reflected in new stirrings by Big Government and Big Money.

The House of Representatives will vote this week on a breakthrough bill to empower the Food and Drug Administration to regulate tobacco as it now regulates food, drugs and medical devices, an important step toward bringing a death-dealing industry under control.

Meanwhile, two billionaires--New York Mayor Michael Bloomberg and Microsoft founder Bill Gates--are pledging $375 million to fight what they called a global tobacco epidemic.

As food shortages rise and health care is unavailable to multitudes, inhabitants of a rational world might see crop rotation from tobacco to food as a logical way of filling empty stomachs and cutting down on cancer and heart disease at the same time.

We are living in a rational world, aren't we?

Picturing a President

If Barack Obama is sworn in next January, last night's debate may prove to be the turning point when American voters started seeing him as more than a gifted candidate. Hillary Clinton's job was to create doubts about his fitness to be President, but she ended up giving Obama the opportunity to demonstrate he has the qualities for the job.

After a peevish start (citing a Saturday Night Live skit to air her grievances against the questioners), Sen. Clinton worked hard to present herself as Presidential and rattle Obama into appearing less so. But he never took the bait.

In 15 minutes about health care, he defended his position without demeaning hers. When she accused him of wanting to bomb Pakistan, he restated his more nuanced position and pointed out that the Bush Administration had just done what he proposed in taking out an al Qaeda leader. When she criticized him for not "rejecting" Louis Farrakhan's support, Obama pointed out that he had denounced his racist views but would be happy to reject them as well, if there was a distinction.

As the long campaign has gone on, Obama's command and self-confidence have been visibly growing, thereby undermining the arguments about inexperience the Clinton campaign has tried to use against him.

In this last debate before the nomination is decided, he demolished them. In the general election campaign, John McCain will have to work very hard to prove that his years in Washington qualify him to make better decisions about the future than Barack Obama.

Health Care: You Bet Your Life

In offering solutions for medical insurance, politicians of all stripes keep reassuring voters about their right to be treated by "the doctor of your choice" rather than some faceless bureaucrat in a white coat under socialized medicine.

There are problems with this argument. Most Americans are now covered by HMOs, which present them with lists of "in-network" physicians either on their payroll or who have agreed to pre-set fees and, in many cases, face pressure to make life-and-death decisions on what's best for the insurers' bottom line.

In California, this divided loyalty recently came into focus with Blue Cross' attempt to enlist doctors in reporting patients who fail to disclose previously existing conditions.

"We're outraged, "the President of the California Medical Association responded, "that they are asking doctors to violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality."

The Blue Cross backed off, but the sanctity of the doctor-patient relationship is definitely showing symptoms of stress. New York Attorney General Andrew Cuomo is suing UnitedHealth for operating "a defective and manipulated database that most major health insurance companies rely upon to set reimbursement rates for out-of-network medical expenses.”

Translation: If you see "the doctor of your choice," your insurer will stiff you on how much of his or her bill they will pay.

That aside, there is the question of how Americans pick their physicians when they can. From all evidence, most do so more casually and with less information than they gather before buying a car or trying a new restaurant.

There is no Zagat guide to medical services, and consulting the "best doctors" lists of regional magazines only leads to the discovery that most are not taking new patients. Too often, the decision is based on the casual advice of a friend or neighbor.

The US Department of Health & Human Services has a few rudimentary suggestions for getting information, but for the most part, finding the right doctor is no more fact-based than finding the right mate. You have to trust your instincts and hope for the best. No politician can help with that.

Exposed! Obama's Kindergarten Secret!

Is it sexist to say Hillary Clinton is getting shrill? If you think piercing screams only come from women, remember Howard Dean in 2004. But that was after the vote in Iowa. Clinton's tone there now is rising in pitch as her poll numbers go down.

What's disturbing about the decision to attack Obama is not that Clinton is doing it but doing it so lamely. "I have been, for months, on the receiving end of rather consistent attacks," she announced stiffly. "Well, now the fun part starts. We're into the last month, and we're going to start drawing the contrasts."

Obama took the opening: "This presidential campaign isn't about attacking people for fun, it's about solving people's problems, like ending this war and creating a universal health care system. Washington insiders might think throwing mud is fun, but the American people are looking for leadership that can unite this country around a common purpose."

The official "Hillary for President" web site went after Obama for saying, "I have not been planning to run for President for however number of years some of the other candidates have been planning for."

This heinous untruth is exposed by quoting Obama's law school classmates, brother-in-law, third-grade teacher and, most damning of all, his kindergarten teacher, who discloses he wrote an essay, "I Want to Become President," proving that he was an ambitious tyke even back then.

As this pathetic attack is released on the official Clinton site, over at the gloves-off "Hillary Is 44" location, which has been vilifying Obama for months, the leadoff fusillade accuses him of "lying" seven times in the first ten lines.

On his blog, Robert Reich, who was in Bill Clinton's Cabinet, asks, "Why Is HRC Stooping So Low?" while refuting a "series of slurs" against Obama over Social Security and health care

Why indeed and, if the former First Lady feels she must stoop to conquer, why isn't she doing a better job of it?

Why Can't Kucinich Catch On?

On the two key issues for 2008, Denis Kucinich seems to be in tune with Democratic voters. He wants to get us out of Iraq, and he favors a single-payer not-for-profit health care plan.

But his campaign is stuck in the second tier of candidates in single digits. Why? Is he too short? Is his name too hard to pronounce and spell? Does he make voters uneasy by unconventional moves such as his recent visit to Syria? Do they tune out because his solemn air makes them uncomfortable?

Amid all the talk about a woman or African-American in the White House, there seems to be a resistance to taking Kucinich seriously because, in some way, he is not stereotypically presidential--too ethnic, too working-class, too head-on in confronting issues without softening the edges.

He voted against the Iraq war and, in 2004, paid his dues by earning double-digit percentages of the vote in the Maine, Minnesota, Hawaii and Oregon primaries. But this time, he comes off as a “tweener,” not as slick as John Edwards or eccentric enough like Mike Gravel to show up on a Bill Maher panel.

If we were living in a Frank Capra movie, he might have a chance. Growing up so poor that his family was often homeless, fighting his way up in Cleveland politics and slipping back so far that in 1982 he reported $38 on his tax return, coming back to win a seat in Congress and the heart of a beautiful, idealistic young woman, Dennis Kucinich is an exemplar of what used to be the American Dream.

But these days, Frank Capra movies seem to be appropriate only for Christmas, not Election Day.