Caretaker for Clinton's Seat

If Gov. David Paterson wants to resolve his dilemma over replacing Hillary Clinton by naming a caretaker and letting the public decide in 2010, the perfect choice is at hand--a wise, experienced, respected politician who knows New York State better than any other: Mario Cuomo.

At 76, the former governor would be junior to a platoon of octogenarians in the Senate, not to mention 91-year-old Robert Byrd of West Virginia, and in the Obama Administration's struggle during a time of national stress, would be a powerful ally in pursuing legislative solutions.

The idea of a caretaker choice was broached during the New York Times ill-fated interview with Caroline Kennedy yesterday:

"At one point, she said that it might have been preferable to seek the seat in an election, noting that 'it would give me a chance to explain exactly what I’m doing, why I would want to do this, and, you know, to get people to know me better and to understand exactly what my plans would be, how hard I would work.'

"But she would not say whether she thought Mr. Paterson should appoint a caretaker candidate to fill out Mrs. Clinton’s term, which would allow Ms. Kennedy and others interested in the seat an equal and unfettered chance to campaign for it in 2010."

The "others" would include Mario Cuomo's son Andrew, who is now New York's Attorney General and a possible opponent for the gubernatorial nomination against Gov. Paterson that year.

In the complex political geometry of two years from now, Paterson could show voters now that he has the best interests of the state at heart by selecting the most articulate advocate for their interests during a crisis and letting the issue of political families' heirs wait until then.

Kennedy, Cuomo or None of the Above

New York's Governor David Patterson, himself a second-generation politician, is faced with a hard dynastic decision now that Caroline Kennedy has made it clear that she wants Hillary Clinton's Senate seat.

In the Empire State, unlike those where money talks and talks, political bloodlines matter in the choice between a former president's daughter and a former governor's son, Andrew Cuomo, to replace a former First Lady.

To complicate it even more, Cuomo is divorced from Caroline Kennedy's cousin Kerry, whose brother, Robert Kennedy Jr. only recently took himself out of contention for the Clinton seat.

In political experience, Cuomo is a quarter of a century ahead, starting in his father Mario's administration in the 1980s and going on to serve as chairman of New York City's Homeless Commission, then in Bill Clinton's cabinet as HUD Secretary and now as New York State Attorney General.

But Caroline Kennedy is a serious, intelligent public figure-by-birth whose close ties to the new President could be an advantage for residents of the state even without experience in the rough-and-tumble.

Gov. Patterson, who inherited the job after Eliot Spitzer's downfall, should, of all people, know that character counts in public life. Making the choice will be a test of his own, and he may just surprise everyone by picking None of the Above.

All-in-the-Family Politics

The colonists who left England to escape hereditary rule would be surprised to find so much of it in American politics two centuries later as jockeying begins to fill Senate seats vacated by members of the Obama Administration.

Name recognition has been important in contested elections, but it seems to be a major factor in appointed positions as well.

For Hillary Clinton's Senate seat, those being considered include former New York Governor Mario Cuomo's son Andrew, Robert Kennedy Jr., Caroline Kennedy--and even Bill Clinton. For Obama's vacated position in Illinois, the front runner is Jesse Jackson Jr. and, in Delaware, the newly appointed Ted Kaufman is widely believed to be keeping the seat warm for Joe Biden's son Beau in 2010.

Nepotism has produced mixed results in recent American politics, as the histories of George W. Bush and Hillary Clinton suggest, but it's disconcerting to find inherited star quality playing so big a part in naming members of Congress' upper chamber.

Barack Obama's success this year was an important victory for meritocracy in American life, but the aftermath is showing that family connections still count.

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.