"Dr." Mario on Universal Health Care

Via Boing Boing, Dr. Mario-yes, that Mario-advocates for universal health care...in the mushroom kingdom. I honestly don't know what to say about a mind capable of creating this.

Howard Dean as HHS Secretary?

With former Democratic Senate leader Tom Daschle having to step aside, President Obama will have to nominate someone else to run the Department of Health and Human Services. There's no obvious choice right now. Eleanor Clift at Newsweek thinks it should be former Vermont Gov. and DNC Chair Howard Dean:

Obama doesn't have a Plan B. Daschle was a shoo-in for the job, and there is no deep bench of runners-up vetted and ready to serve. Still, Obama may surprise us. In order to regain political momentum and convey the impression that while losing Daschle is a blow, it's not a body blow, he might want to have Daschle's successor ready to announce before the crocuses come up. One prominent Democrat has made no secret of the fact that he would love the job and that's Howard Dean. He's a doctor; his wife is a doctor; and he's not beholden to anyone as far as we know. In fact, Dean was running against the entrenched special interests in Washington back when the presidency was still just a gleam in Obama's eye.

I love Howard Dean. Before Barack Obama came along, he inspired me to be impassioned about politics. Like many liberal bloggers, the thought of Dean being named HHS Secretary (especially to replace Daschle, who pretty much represents that kind of Democrat that Dean's '04 campaign railed against) would delight me on some level. Sen. Tom Harkin of Iowa, whom endorsed Dean in 2004 (not that it did him any good), also has announced his support. And the health care reform plan he got passed in Vermont and pushed during his presidential campaign is similar to Obama's. But he's unlikely to get it. Some of Obama's people, particularly Chief of Staff Rahm Emanuel, don't like him. But, more than that, I question whether he'd be effective.

Aside from the close personal relationship they developed after Daschle endorsed his presidential almost from the get-go, Obama was counting on his knowledge of Congress to push through comprehensive health care reform. Dean doesn't have any experience dealing with Congress, and let's face it, a lot of moderate and conservative Democrats wouldn't want to deal with him because they wouldn't want him to be seen with "that liberal."

Some of the other names being floated around, such as Tennessee Gov. Phil Bredesen (who passed a bipartisan plan that covered all Tennessee children), also lack experience dealing with Congress. So my guess is Obama will pull someone from their ranks. Possible nominees include Sens. Ron Wyden (whose own reform plan has the most bipartisan support of any right now) and Max Baucus, a committee chairman who (along with Ted Kennedy) would be a key player in getting health care reform passed.

To be honest, I don't know who would be the best choice. But, as I'm sure he knows, President Obama has to get this right. If he doesn't, it will greatly hinder the effort to institute what could be one of his greatest achievements - universal health care.

UPDATE: Reports are that Gov. Kathleen Sebelius of Kansas, who was the former insurance commissioner of the state, is at the top of the list.

Health Care And The Economic Crisis

Paul Krugman says that the present economic crisis will result in millions more without health insurance, and that health care reform should be part of any efforts to stimulate the economy. Reading this, it's easy to see his point:

People young and old crowd the hallway outside the locked door of the Arlington Free Clinic. They grip small pieces of paper that will determine whether they get in -- or give up and go home.

It's lottery day, and 45 county residents who lack health insurance and money to pay for medical care are competing for 30 openings on a cold afternoon in January.

Mary Gleason, a clinic volunteer, draws letters from a plastic box. Those holding matching letters will be ushered through the door for interviews. If they meet the clinic's criteria, they'll return in a couple of weeks to see doctors or other staff.

One by one, winners are separated from losers. Gleason plucks a Z, and a man holding a Z strides into the clinic. His broken arm had been set in a hospital emergency room, and he needs to see a specialist for follow-up care.

Another man, who has Parkinson's disease and urgently needs drugs to treat it, leaves disheartened. He will have to return in two weeks and try again in the next lottery.

The lottery is just one example of the fate of the newly uninsured -- the growing numbers who once had jobs and insurance and now seek treatment with neither. Although most of the clinic's clients have low incomes, the nonprofit, privately funded operation and others like it in the region are seeing more people who used to be solidly middle-class. Victims of the deepening recession, they're now wondering where to turn for help.

Add to that this story about a free dental clinic where hundreds waited in line, and many had to be turned away.

In a sense, many of us are playing this same lottery. Our health depends on our ability to keep well-paying jobs with insurance that might or might not evaporate in the midst of the worst economic downturn in decades. One day you might be covered under your employer's high quality plan, and the next you might be riding it out on the Medicaid you get with unemployment (for a limited time.) Krugman is worried because Obama hasn't made the big push for health care reform yet. I can understand why, but he's right; there's no addressing this crisis without addressing the fact that 48 million and rising face the devastation of illness and injury on their own.

We're Number One!

...in the number of uninsured residents, topping out a whopping 1 in 4 who lack any health coverage whatsoever. According to the article, this prompted John Goodman, president of the ultra-generically named National Center for Policy Analysis here in Dallas (whose nonsense we've covered before) to opine thus:

Mr. Goodman, who helped craft Sen. John McCain's health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

"So I have a solution. And it will cost not one thin dime," Mr. Goodman said. "The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American – even illegal aliens – as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

"So, there you have it. Voila! Problem solved."

See, you're not uninsured. You merely have an alternative means of payment! Never mind that debt collectors will hound you to your grave even if the government picks up the dime for hospitals that provide care for those who visit their emergency rooms, and NOBODY visits the emergency room for treatable but minor conditions that can worsen over time. With the flip of a magic wand, the health care crisis in this country is solved! Believe it or not, the total number of Americans without without insurance has declined, but only because more Americans have moved onto the Medicaid and Medicare rolls. Which actually, is a start.

UPDATE: I failed to note that Goodman has served as an adviser to the McCain campaign on the issue of health care. The McCain campaign is distancing from Goodman's statement (something that seems to happens a lot around those parts) though as Jonathan Cohn explains, McCain's approach on health care is still notably unserious.

Legislative/Policy Update

-Unfortunately, a bill that would have given District of Columbia residents their first-ever member of Congress (their representative to Congress is a non-voting delegate and residents currently can only vote in presidential races) was blocked in the Senate today. Senators voted 57-42, just three votes short of the 60 needed to overcome a GOP filibuster threat (which will simply cement their inability to get Africa-American voters for a few more generations). The bill actually would have created two new House seats: One for Washington, D.C. and one for Utah, which narrowly missed out on a fourth seat after the last census and was needed to get what bipartisan support it had. Many had thought they might have enough votes for passage. However, the White House had also threatened a veto anyway.

-According to Congressional Quarterly, the leaders of the Senate Budget Committee unveiled legislation Tuesday that would require the next Congress to address the long-term budget strain associated with Social Security, Medicare and other entitlement programs.

The bill would create a 16-member task force that would make recommendations by Dec. 9, 2008, on how to address soaring costs of programs such as Medicare, Medicaid and Social Security. The bill calls for the recommendations to be introduced as legislation in the 111th Congress, and both chambers would have to consider it soon after that Congress convenes in January 2009. Debate would be limited, and the proposal could not be amended. It would require a three-fifths majority vote in both chambers to pass.

The legislation was unveiled Tuesday by Senate Budget Committee Chairman Kent Conrad, D-N.D., and Judd Gregg of New Hampshire, the panel’s ranking Republican. The task force would be charged with looking at all aspects of the budget, including tax policy. “Everything is on the table,” said Conrad, D-N.D.

“We tried to take the politics out the runup to this work,” Conrad said, by putting off the task force’s recommendations until after the 2008 elections.

Conrad said he was not sure if the Budget Committee would mark up the legislation or whether he and Gregg would try to take it straight to the Senate floor. Gregg and Conrad said they had briefed the Senate leadership and several members.

House Budget Committee Chairman John M. Spratt Jr., D-S.C., and Paul D. Ryan of Wisconsin, that panel’s ranking Republican, have not said whether they plan to introduce similar legislation.

Sounds like an interesting idea.

-Lastly, Sen. Hillary Clinton unveiled her health care proposal this week which resembles not her proposal in the early 90s but rather those of fellow presidential candidates John Edwards, Sen. Barack Obama, and others. All contain provisions to expand federal programs to cover all children, offer subsidies to the poor, a cadre of business tax incentives and ultimatums, rolling back the Bush tax cuts to get the money, and both Edwards' and Clintons' plans have a Massachusetts-style "individual mandate" that requires everyone have health insurance as they do auto insurance.

All get us closer to the goal of "universal health care" but are pretty complicated for the average voter to understand. And as Michael Moore's "Sicko" pointed out, "universality" guarantees only that everyone has health insurance but doesn't prevent insurance companies in a for-profit system from denying care. Interestingly, a new CBS News poll shows a majority of Americans support the single-payer, national health system espoused by Moore: 55% supported "having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers." Just 29% favored the current system.

Given this level of support, why are none of the major candidates supporting such a system? None of the Republicans do, of course, and only two third-tier Democrats - Rep. Dennis Kucinich and former senator Mike Gravel - do. No doubt they fear the same insurance companies and special interests that went after "Hillarycare" and no doubt some are getting money from those interests. True health care reform will come only when a grassroots movement stands up and demands change from our elected leaders.