President Obama signs historic health care bill

The 44th President of the United States does what presidents for 100 years have been unable to do. One of the happiest moments that I have witnessed in American political life and, hopefully, a step towards a slightly more human and compassionate nation. Perhaps some of the 45 million Americans (like me) without health insurance will now be able to get some.

MD

Letter from Senator Edward M. Kennedy to President Barack Obama

Below is the text of the letter from Senator Edward M. Kennedy referenced by the President in tonight’s address to a Joint Session of Congress.

(Read at the White House website here)

May 12, 2009

Dear Mr. President,

I wanted to write a few final words to you to express my gratitude for your repeated personal kindnesses to me – and one last time, to salute your leadership in giving our country back its future and its truth.

On a personal level, you and Michelle reached out to Vicki, to our family and me in so many different ways. You helped to make these difficult months a happy time in my life.

You also made it a time of hope for me and for our country.

When I thought of all the years, all the battles, and all the memories of my long public life, I felt confident in these closing days that while I will not be there when it happens, you will be the President who at long last signs into law the health care reform that is the great unfinished business of our society. For me, this cause stretched across decades; it has been disappointed, but never finally defeated. It was the cause of my life. And in the past year, the prospect of victory sustained me-and the work of achieving it summoned my energy and determination.

There will be struggles – there always have been – and they are already underway again. But as we moved forward in these months, I learned that you will not yield to calls to retreat - that you will stay with the cause until it is won. I saw your conviction that the time is now and witnessed your unwavering commitment and understanding that health care is a decisive issue for our future prosperity. But you have also reminded all of us that it concerns more than material things; that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.

And so because of your vision and resolve, I came to believe that soon, very soon, affordable health coverage will be available to all, in an America where the state of a family’s health will never again depend on the amount of a family’s wealth. And while I will not see the victory, I was able to look forward and know that we will – yes, we will – fulfill the promise of health care in America as a right and not a privilege.

In closing, let me say again how proud I was to be part of your campaign- and proud as well to play a part in the early months of a new era of high purpose and achievement. I entered public life with a young President who inspired a generation and the world. It gives me great hope that as I leave, another young President inspires another generation and once more on America’s behalf inspires the entire world.

So, I wrote this to thank you one last time as a friend- and to stand with you one last time for change and the America we can become.

At the Denver Convention where you were nominated, I said the dream lives on.

And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

With deep respect and abiding affection,

Ted

A few thoughts from Paris on President Barack Obama’s healthcare speech to Congress

Barack Obama joue le tout pour le tout, read the first lines of the article in today’s Le Monde concerning the speech on healthcare of the 44th president of the United States to a joint session of Congress last evening. The Guardian newspaper in England declared that the “president issues rousing speech to Congress and promises not to be deflected from universal healthcare plan.”

This was a moment I confess that I have waited for with some trepidation, to see whether or not President Obama, a politician who, as Candidate Obama, was able to inspire even your jaded author as few politicians ever had before, would deliver on his promise of providing affordable, comprehensive healthcare to all Americans. As I have noted on this blog before, the current healthcare system in the United States - if you can call such a patchwork of private insurance schemes absurdly tied to employment status a system - currently gobbles up 17 percent of the U.S. GDP, as opposed to the 11 percent of GDP used here in France, a system that is not gamed by insurance and pharmaceutical companies as our current mode of operation in the United States is, but nevertheless guarantees universal healthcare. The U.S. system, currently ranked 37th in the world, according to the World Health Organization, is corrupt, stupid, brutal, wasteful and as expensive as anything I've ever seen, yet it has powerful forces with an interest in protecting it. I know this not just from statistics but from my own experiences and the experiences of my family and friends. I myself have been ineligible for any type of affordable healthcare since I went freelance full-time in early 2006.

This being the case, and given the vile and sometimes violent eruptions at various town hall meetings across the United States over the month of August, it seemed a reasonable fear that Obama, like many before him, might have been simply outmaneuvered by the frothing craziness and bile of the well-organized and well-funded defenders of the status quo. This, mixed in with a brew of right-wing demagoguery and naked racism, has created a rather poisonous political atmosphere in my native country, where a party that has been in power for 20 of the last 28 years simply cannot seem to get used to being in the political opposition.

However, much to my, dare I say it, joy, President Obama delivered brilliantly, giving what was certainly his best speech since his famous address on race in Philadelphia in March 2008, and perhaps one of the best political speeches I have heard in American politics during my lifetime.

Speaking of an insurance exchange to be created to allow individuals and small businesses to purchase affordable coverage, and a hardship waiver for those individuals who still cannot afford coverage, Obama did not advocate for the single-payer system that I and many who voted for him would have hope for. Nevertheless, his proposal would seem to take a great deal of power out of the hands of insurance company bureaucrats and point towards strenuous government advocacy to create a more just and equitable system that could not help but make Americans’ lives better.

Obama spoke terrifyingly of an Illinois man who lost his coverage in the middle of chemotherapy because his insurer found that he hadn't reported gallstones the man hadn’t previously known about. The man subsequently died following delays in treatment. He also mentioned the case of a woman in Texas whose insurance company cancelled her policy as she was about to undergo a double mastectomy because she forgot to declare a case of acne. When she finally regained insurance, the cancer had more than doubled. As Obama said “no one should be treated that way in the United States of America.”

Perhaps the most moving part of the speech came towards the end, when Obama evoked the name of recently deceased democratic Senator from Massachusetts Ted Kennedy, referring to a letter than Kennedy had sent him to be read in the event of his death, and to Kennedy’s own long struggle to reform the health system in the United States:

Imagine what it must be like for those without insurance; what it would be like to have to say to a wife or a child or an aging parent there is something that could make you better, but I just can't afford it....Large heartedness, that concern and regard for the plight of others is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise...

...We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.

Because that is who we are. That is our calling. That is our character.

After fearing for the month of August that Obama had lost control of the debate to the bitter fringe shouting that the sky was falling, THIS was once again the man we elected as president last fall. And once again, finally, it appears that we have a genuine advocate for the disenfranchised in the White House.

An additional note: At one point during Obama’s speech, when he asserted that the healthcare proposal now under consideration in Congress would not provide healthcare to undocumented immigrants in the United States (it doesn’t), Representative Joe Wilson, Republican of South Carolina, screamed “You’re lying” from the audience, a breach of decorum that I can never remember seeing before during a presidential address to both houses of congress.

Beyond the ignorance of Joe Wilson himself, who, judging from his performance, is little more than a repulsive piggish caricature of a good ‘ol boy, faced with Obama’s oratorical eloquence and sound political judgement, the Republican Party as a whole appears to be content to continue down a path of political irrelevance, defining itself as a regional, white, Christian party. It is a rather public political suicide that I think is unique in modern American history. Increasingly in the grip of a clutch of extremists, the GOP, a party that once gave us Abraham Lincoln, now behaves as a group of ill-mannered, uneducated spoiled children might.

If this is the best, most principled opposition to that Republicans can muster, I should think that Obama has little to worry about. And I hope the long struggle for national healthcare in the United States might at last be arriving at its defining moment.

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Senator Edward Kennedy, 77, dies

United States Senator Edward Kennedy was a great legislator on behalf of working class, working poor and otherwise disadvantaged and disenfranchised Americans, however flawed he was as a human being, and as powerful a voice for a national healthcare plan as we have ever had in my native country. May the road rise to meet you, wherever you are off to, Teddy.

The Guns of August

The Guns of August

By Michael Deibert

In November 1787, writing to William Smith from Paris, where I live, Thomas Jefferson, future president of the United States and then U.S. Minister to France, penned the following lines:

The tree of liberty must be refreshed from time to time with the blood of patriots & tyrants.

This month, outside a town hall meeting held by President Barack Obama in Portsmouth, New Hampshire to discuss his efforts to reform America’s health care system, a man named William Kostric appeared with a loaded handgun strapped to his thigh and a sign reading “It’s time to water the tree of liberty.”

At a town hall meeting hosted by Senator Arlen Specter, a longtime Republican turned Democrat, which took place in Lebanon, Pennsylvania, about 40 minutes from the working-class, largely conservative enclave of Lancaster County where I grew up, a disheveled man shrieked at Specter, who has represented Pennsylvania in the senate since 1981, that "one day God's going to stand before you, and he's going to judge you and the rest of your damned cronies.”

In the midst of the debate of overhauling our national health care system, these two eruptions were not isolated incidents. Attendees brought firearms to events held by members of Congress Gabrielle Giffords of Arizona and Steve Cohen of Tennessee, both Democrats. Death threats have been sent to four Democratic congressmen: Brad Miller of North Carolina, Dennis Moore of Kansas, Brian Baird of Washington and David Scott of Georgia. Baird’s office received a fax this month in which Obama was depicted as The Joker from the Batman film “The Dark Knight,” with a Communist hammer-and-sickle painted on his forehead and the words “Death to all Marxists! Foreign and domestic!” scrawled beneath. A similar fax was sent to the office of Scott, an African-American, with the added element of Scott, an Africa-American, being denounced as “a nigger” A large swastika was spray-painted across the sign for Scott’s office.

Firing the furnace of such sentiments have been such ideologues for the right as television host Glenn Beck, who appallingly play-acted the murder of House speaker Nancy Pelosi on his nightly show on Fox News, and the radio host Rush Limbaugh with his opining that President Obama is “trying to destroy the private sector as it exists...Let’s face it, President Obama’s black, and he’s got a chip on his shoulder...He’s using the power of the presidency to remake the country”

This is what the debate over health care appears to have been reduced to in the country of my birth. In a nation where some 46 million Americans currently lack any health insurance whatsoever, and millions more have only the most limited access to any kind of coverage, a reasoned, sober discussion on the best way to overhaul our fabulously expensive and fabulously inefficient system comes down to threats of political assassination and vows of divine retribution.

The words of Jefferson, who was writing at the time in defense of the French Revolution and the overthrow of a monarchy, are now used to intimate violence against the man who occupies the office that Jefferson himself once held, a man whom, in one of those exquisite bits of historical justice, is of mixed-race ancestry much like the children that the freedom-extolling Jefferson fathered with a slave, Sally Hemings, as Jefferson’s compunctions about slavery did not extend to not participating in the institution itself.

Today, however, the Republican Party of another storied U.S. President, Abraham Lincoln, which has been in power for 20 of the last 28 years, has been supplanted by Barack Hussein Obama, son of an ethnic Luo Kenyan father and a white American mother from Kansas, a man who seems very earnest about trying to re-tool much that is brutal, wasteful and stupid about American political culture. The party does not seem to be taking to opposition well.

The need to re-haul our health care system could not seem more dire. Knowing, as I do, people in the United States who have gone bankrupt attempting to cover their health care costs, as well as many more who put off going to the doctor, receiving treatment or buying medicine because they simply cannot afford the prohibitive cost, I am also myself a statistic. Despite working 50-60 hours per week as a freelance journalist, I have not had health or dental insurance since early 2006.

The current system, dominated by insurance and pharmaceutical companies and defined by a health-care scheme absurdly tied to employment status, is being portrayed by opponents of change as a triumph of American know-how worth preserving. But compared to the health care system of France, for example, the country where I currently live and from where Jefferson wrote his famous letter, its performance comes up woefully short. Though the French system has consistently been rated among the best in the world (while the U.S. system recently ranked 37th, according to the World Health Organization), the 11 percent of GDP that France spends on it is far below the 17 percent of GDP spent in the U.S., a cost that comes without the vast benefits, safeguards and universal coverage that the French system offers.

However, none of these costs and benefits are currently being debated, nor are the political leaders of the opposition to the new health care reform bill urging any sort of moderation in their discourse.

Former vice presidential candidate and Alaska governor Sarah Palin took to the social networking site Facebook earlier this month to denounce the “death panels” she charged the bill would create where “bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care,”, a completely false allusion to a provision that would allow Medicare to reimburse doctors providing voluntary counseling regarding end-of-life issues. Republican Senator Chuck Grassley of Iowa echoed Palin where he told a recent rally that “we should not have a government program that determines if you're going to pull the plug on grandma.” A memo by a volunteer affiliated with FreedomWorks, a conservative organization chaired by former Republican House Majority Leader Dick Armey, recently advised protesters on how to "disrupt" and "rattle" town hall meetings. Obama and the advocates of health care reform in the United States are routinely denounced as “socialists,” compared to Nazis and Adolf Hitler and the very legitimacy of Obama’s birth in the United States (which took place in Hawaii in 1961) is questioned.

Seeing the party of Lincoln reduced to a clutch of Talibanesque religious fundamentalists, science-denying climate change skeptics and openly xenophobic racists and bigots might be simply depressing if the implications were not so deadly serious.

A new report by the Southern Poverty Law Center concludes that “after virtually disappearing from public view a decade ago, the anti-government militia movement is surging across the country – fueled by fears of a black president, the changing demographics of the country and fringe conspiracy theories increasingly spread by mainstream figures.” The report echoed in its particulars an April intelligence assessment by the Department of Homeland Security.

In May of this year, George Tiller, a Kansas physician who performed abortions and who had been pilloried by the right and by television host Bill O'Reilly in particular, was shot and killed while attending a church service, allegedly by an antiabortion extremist, Scott Roeder. In June, Stephen Tyrone, an African-American security guard at the United States Holocaust Memorial Museum in Washington, DC, was shot and killed, allegedly by James Wenneker von Brunn, a Holocaust denier and white supremacist with a long history of anti-government militancy.

And, in perhaps a telling echo of the past, the words of Thomas Jefferson that William Kostric alluded to with his sign and gun outside of the Obama appearance in New Hampshire this month where the same ones that Timothy McVeigh, convicted and executed for carrying out the 1995 Oklahoma City bombing that killed 168 people, wore emblazoned on his t-shirt on the day of his arrest.

Having reported in the past on tumultuous political environments in countries such as Guatemala, Haiti and India, I have watched as pseudo-populist demagogues have often proved highly successful at using intemperate rhetoric to whip up groups genuinely or perceiving themselves to be disenfranchised to act against “the other.” I believe that as my country continues forward this August there is a real danger that a union will occur between the violent and shrill political rhetoric currently being spouted and actual physical violence against those who are being so demonized among anti-government elements of the right. I increasingly fear that I have seen this script played out before, always with the same disastrous results.

Much as we hold the intellectual authors and instigators of political violence in foreign countries such as Rwanda and the former Yugoslavia culpable for the actions of their underlings even though they themselves may have never carried a weapon into battle, the opponents of health care reform would do well to pause for a breath and look at the political climate they are creating and what its likely outcome will be. And they should remember the oft-forgotten words with which Thomas Jefferson commenced to conclude that famous 1797 missive from Paris:

"I know that there are combustible materials there, and that they wait the torch only."

Michael Deibert is a Senior Fellow at the World Policy Institute and author of Notes from the Last Testament: The Struggle for Haiti. His blog can be read at www.michaeldeibert.blogspot.com.

How Cigna HealthCare killed Nataline Sarkisyan

I had a very pleasurable break visiting family and friends in the United States for Christmas and then visiting an old friend in Roma for New Year’s. Back in Paris, awaiting my eventual departure for Congo, the skies roll across the city, briefly blue in the morning and then various shades of gray for the rest of the day. 2008 stretches out before us all, with presidential elections this fall capping off what I hope will be a gentler, more humane and healthier year, with greater freedom married to a greater sense of local and global community than we saw in the one that just passed.

It is fitting I suppose, to this hoped-for sense of shared community, that my first post of the year pay tribute to the 150-odd people, including nurses, students and relatives, who rallied in front of the headquarters of Cigna HealthCare in Glendale, California last month, to demand that the health insurance company reverse its refusal to pay for an emergency liver transplant for 17-year-old Nataline Sarkisyan . The California teenager, who wanted to be a fashion designer and had battled leukemia for three years, was fully insured by Cigna when her brother became a donor for a bone marrow transplant that doctors hoped would save her life. When complications arose after the transplant and Sarkisyan’s liver failed, doctors recommended the emergency transplant procedure

Cigna, which expects to earn an income of around U $1.2bn next year, thought otherwise, though, and refused to pay for the liver transplant on December 11th, on the grounds that Sarkisyan’s health plan "does not cover experimental, investigational and unproven services.”

The doctors at UCLA's Pediatric Liver Transplant Program and elsewhere at the hospital called CIGNA begging them to reconsider their decision but, to their own eternal shame, if true, would not perform the procedure unless the Sarkisyan family placed an immediate down payment of US$75,000 which it was, needless to say, beyond their power to do.

Faced with over a hundred protesters on its front law, CIGNA finally reversed itself, but only after Sarkisyan had lapsed into a coma while her fate was decided. CIGNA’s momentary drift into magnanimity came too late, though, and Nataline Sarkisyan died on December 20th, the liver transplant having never been performed.

As one of the nearly 50 million Americans without health insurance, I know that this is the nightmare that many Americans dread every day. But even for the Americans, like Nataline Sarkisyan's family, who are lucky enough to have health insurance, what is the value of that insurance when it lets you die in a hospital while denying you a life-saving procedure? What kind of country would allow such a system to flourish in the first place? How do CIGNA executives like CEO H. Edward Hanway and Executive Vice President Michael W. Bell not throw themselves from the windows of their lavishly appointed offices when they realize what they have overseen?

In this election year, perhaps the American public’s patience with the malevolent joke our health care system has reached its limit. The three major Democratic candidates - Barack Obama, Hilary Clinton and John Edwards - all have substantial plans to revise the nation’s avaricious, inefficient health care industry, although none go as far towards the French model of low-cost (though paid through taxes), high-quality, universal health care as I would like them to.

In the meantime, Nataline Sarkisyan has been laid to rest and the family’s attorney, Mark Geragos, has announced his intention to press the Los Angeles district attorney to press murder or manslaughter charges against Cigna, on the grounds that the firm "maliciously killed" Nataline Sarkisyan with its unconscionable refusal to provide her with treatment. I hope that he succeeds in getting the courts to act and hold the executives of CIGNA responsible for its murderously adversarial and exploitative relationship with its customers (behaviour which, among health insurance companies, is the rule rather than the exception). And I hope that someone is elected in the United States this fall with the courage to implement the radical change that such a faltering system demands.

Here we come, 2008. Deye mon gen mon.

W’s Christmas present to American children: Vetoing health insurance

As one of the nearly 50 million Americans without health insurance, my feelings about the American healthcare system - where private health insurance companies and physicians reap enormous profits by charging exorbitant premiums, denying care to the sick and artificially inflating the price of drugs - could not be more vehement. The American healthcare system is utterly, completely broken and even some of the more well-known proposals for rectifying it (such as that of U.S. presidential candidate and New York senator Hillary Clinton) strike me as woefully feeble in terms of addressing what is a terrible crisis for so many Americans. Speaking as an American who has spent much of his life living abroad, I can say with some authority that I don’t think I have ever seen a more predatory, exploitative approach to healthcare than I have seen in the United States. When taken in tandem with a consumer culture than encourages people to eat unhealthy foods packed with unnecessary sugars and hormones, the approach seems doubly cynical.

Along with the Bush administration’s irresponsible, negligent approach to climate change (which has lead the European Union to threaten to “boycott U.S.-led climate talks next month unless Washington accepts a range of numbers for negotiating deep reductions of global-warming emissions”), the healthcare debacle has, in the last week, thrown in the starkest relief possible to me how terribly out of synch the U.S., for so long a leader on so many issues, is becoming with the rest of the world.

This week, as the United States enters its holiday season, President Bush marked the occasion by vetoing an extension of the State Children's Health Insurance Program (SCHIP), which attempts to provides health insurance to children from families earning too much to qualify for Medicaid (a very low threshold indeed) but unable to afford private insurance. The SCHIP proposal sought to increase federal funding for the program by $35 billion over five years, adding around 4 million people, partially funded by a 61-cent rise on a package of cigarettes. To give you an example of the context of the price tag, the cost of the war in Iraq, by end of fiscal year 2007, was at least $456 billion, to say nothing of the lives of nearly 4,000 American service personnel and those of thousands of Iraqi civilians. Bush vetoed a similar bill in October and, in July, was quoted by The New York Times as saying that the bill was a step toward “government-run health care for every American,” "

You mean like every other country in the industrialized world? As the U.S. government has taken responsibility for the post office, the police, the fire department and the national defense, so should it take responsibility for providing health care for every American. Despite the many problems I have with the French government and other aspects of society here, I think that their health system, like that of some other European countries, remains a model of a responsible state approach to taking care of its citizens well-being that the United States could learn much from.

My native country simply cannot continue being so out-of-step with the rest of the world, so easily suckered by the false piety (married to brutal cynicism) of political snake oil salesmen like Bush and company. If the Democrats had any conviction at all and took their responsibility as guardians of the constitution seriously, we would be deep in impeachment proceedings by now. But alas, they greet this, like other outrages, with the feeblest murmurs of dissent.

My fellow countrymen have been fooled and lied to for so long by their government, I wonder if they will recognize the truth when it finally comes crashing down. Starting with the ridiculous banana republic farce of the 2000 election in Florida, continuing through the illegal use of torture and detention without trials of hundreds, possibly thousands, of people, through the illegal invasion of Iraq and the naked profiteering there that the administration’s cronies engaged in, the terrible abandonment of the people of Mississippi and Louisiana during Hurricane Katrina and now continuing with the denial of basic healthcare for American citizens, in a just world Mr. Bush, Mr. Cheney, Mr. Rumsfeld, Mr. Feith, Mr Gonzales and many more fellow travelers would at least be facing criminal and civil prosecution in the United States if not an appearance at a tribunal in the Hague.

It a strange time to be an American with an internationalist outlook on the world, proud of the open, optimistic spirit and intense creative drive of my country, but very worried about the direction that its political leaders appear intent on taking it, which seems to be straight over a cliff, ever angrier, more closed-off from the rest of the world and more authoritarian by the day. It’s still not too late to change course, but I fear that the hour is growing ever more late.

I’ll be in a better mood next post, I promise.

The Bush administration’s bad medicine

As the Bush administration, isolated but not, sadly, without weapons, draws to its shameful end, recent testimony by former Surgeon General Richard H. Carmona before a Congressional panel this week helped bring home just how rigid the regime’s quackery has been when it comes to matters of medical science over the last several years.

Among the points that Dr. Carmona made with relation to how he was told to do his job during his 2002 to 2006 tenure (that is, as the leading spokesperson on matters of public health for the administration) are the following:

• Dr. Carmona was ordered to mention President Bush three times on every page of every speech he delivered.
  
• On the topic of sex education, Dr. Carmona’s suggestion that the use of contraceptives be included was met with a refrain that the Bush government wanted to promote “abstinence only.”
  
• Global warming was dismissed as a “liberal cause.”
  
• Dr. Carmona was advised not to testify at a U.S. government racketeering trial of the tobacco industry by an administration that was simultaneously telling the government lawyer in the case that he, Dr. Carmona, was not competent to testify.
  

Quite a way to treat a double Purple Heart United States Army Special Forces veteran, no?

It’s good to know, as one of the 48 million Americans without health insurance, that the Bush administration had its priorities straight.