Sunday, January 3, 2010

Health Care Reform Musings from Dixie

Blogging now from South Carolina, the cradle of the Confederacy.  This was the first southern state to secede from the Union on December 20, 1860.  We all remember the portentous headline from the Charleston Mercury that rattled the nation and President-elect Lincoln, who was still 3 months away from taking office.  Prior to his inauguration, 6 sister states would join South Carolina to form a confederacy.  They would try by force to form a new nation.  And we think President Obama has a heavy load?
I learned years ago, during one of my yearly historical sojourns, that strong echoes of the Confederacy survive. We came to a Charleston, South Carolina to a Bed & Breakfast and were greeted by the proprietress. We exchanged pleasantries and told her we were anxious to see some of  the area’s civil war treasures.  With a steely demeanor, she admonished me. “Round here,” she said, “we call it the War of Northern Aggression.”  Her statement was much more powerful heard in her slow, southern drawl, than read here.  I’ve never forgotten the moment.  Words matter.  History still lives.

Thanks to Lincoln and some determined Union generals, and perhaps to divine providence, the government of the people, by the people, for the people, did not perish from the earth.
While the nation today is indivisible, as kids used to recite daily in school each morning, the country is highly polarized. While there won’t be shots fired at Fort Sumter any more, there remains a surfeit of seemingly irreconcilable conflicts that bitterly divide us.  Our most vexing issues – war in Afghanistan and Iraq, abortion, global warming, civil liberties, domestic economic policy, racism and church-state issues – all generate vitriol and hostility in the public square.

And then came health care.  Whistleblower readers know of my skepticism and suspicion about pending health care reform (HCR) legislation.  Despite my own partisanship, I have been struck by how raw and divisive this issue is, and will surely be for years to come.  The votes in the House and Senate demonstrate this.  Nancy Pelosi had barely a vote to spare, and Harry Reid had none.  The Democrats determined that they had no legislative partner on the other side, so they forged ahead on their own.  The GOP now threatens to use the Democrats’ legislative success against them in 2010 and 2012.  Instead of invoking Lincoln’s philosophy from his 2nd inaugural address, with malice toward none, with charity for all, we all entered the health care reform as gladiators.  As a result, there are many good ideas that are casualties stranded on the legislative battlefield.

Who’s fault is all this?  I’ll let the readers assign blame for this acrimonious and divisive process, and there’s plenty of it on all sides.  Judging by some comments received to my posts, I deserve a measure of responsibility also, which I accept.  Certainly, the public doesn’t have much confidence in the folks who are representing us.  Gallup poll results from last week report that Congress’s approval rating continues to soar at 25%.  Half of those polled believed that Nancy Pelosi and Republicans in Congress were ‘political losers’ in 2009.  Inspiring statistics.

Our words matter, as the innkeeper in South Carolina taught me. Indeed, many loaded terms have been hurled to scare, obfuscate, ridicule and attack. How would we describe the HCR conflict in Lincolnian terms?  Is it a Health Care Civil  War?  A War of Democratic Aggression?  A War Between the Parties?  A War to Free the Uninsured?  Is it really about health care or is it about political power and control?  Lincoln is lauded today for having included political rivals in his cabinet so that he could receive a diversity of advice (and, perhaps, neutralize the opposition).  What a refreshing concept.   It’s a shame we did not mimic this approach with health care reform.  Is Lincoln’s model of soliciting advice from adversaries merely a historical artifact to be studied, but is not relevant in our time?  Weren’t there good ideas from both sides of the aisle that could have been incorporated into health care legislation?   Apparently not.

For some issues, there can be no compromise.  Lincoln recognized that the nation could not be divided and survive.  He could not ‘split the baby in two’.  But health care reform does not pose an immediate existential threat to the nation.  We could have done it better.  Both sides plotted, strategized and blew up bridges.
South Carolina was on the wrong side of history.  And so are we.

Whistleblower is a year old.  Many thanks to the readers.


  1. I enjoy your blog.

    I don't know about you, but I was so busy in December I'm taking the first week off in January to recover from the Post Colonoscopy Stress Disorder.

    The current machinations about health care remind me of Thrasymachus, who might have been quotes saying, "What is justice other than the triumph of Democrats over Republicans?"

  2. I also enjoy your blog. You appear to be an enlightened Doctor. But I respectfully disagree with your health care reform comments.

    If you were in my situation, subjected to the private healthcare insurance industry with a pre-existing condition, you would understand that all the money in the world cannot buy me true healthcare insurance. I pay for insurance, but I don't really get it. And I fear for lack of coverage if I do put in a claim for a condition I'm supposedly covered for (rescission).

    First steps are rarely perfect, but this will be a start (I'm paraphrasing from Paul Krugman).

    Yes, "health care reform does not pose an immediate existential threat to the nation", and individuals like me are often casualties of majority decisions, but I really think our country is wealthy enough to join the rest of the civilized world in providing a baseline of healthcare coverage.

  3. I agree that we have the wealth. We lack, however, the political will. The money wasted on unnecessary medical care - performed for various reasons - would provide all the funding we need to do health care right. Excessive medical care is someone else's income. Those who are gaining from the system will fight to protect their interests. Thanks for your comment.

  4. Dear Dr. Kirsch,

    My name is Barbara O’ Brien and my blogging at The Mahablog, Crooks and Liars, AlterNet, and elsewhere on the progressive political and health blogophere has earned me the notoriety of being a panelist at the Yearly Kos Convention and a featured guest blogger at the Take Back America Conference in Washington, DC.

    I’m contacting you because I found your site in a prominent political and health reform blog search and want to tell you about my newest blogging platform —the public concern of health care and its reform. Our shared concerns include health reform, public health, safe workplaces, and asbestos contamination.

    To increase awareness on these important issues, my goal is to get a resource link on your site or even allow me to provide a guest posting. Please contact me back, I hope to hear from you soon. Drop by our site in the meantime—


    Barbara O’ Brien