Tuesday, March 23, 2010

HIGH DRAMA IN HEALTH CARE

March 25, 2010

Last Sunday's rush to passage of the health-care reform bill by the House of Representatives was an example of high drama you never thought happened in a place better known for droning diatribes made to an empty chamber. It was a parliamentary flurry of motions and amendments and scrupulously-timed speechlets and nail-biting votes. For those watching it on TV, the experience was positively exhilarating, a seldom-seen live civics lesson on how bills become laws, how your do-nothing Congress actually does something. It may have changed the minds of not a few young voters about the value of entering public service.
Another civics lesson, far beyond the scope of textbooks, was the way in which Speaker Nancy Pelosi and President Barack Obama marshaled their recalcitrant troops for the necessary 216 votes, an outcome quite uncertain just hours before.
To the surprise of almost everybody, they hauled in the two big fighting fish of totally different ideological species, single-payer proponent Dennis Kucinich and abortion opponent Bart Stupak, along with their respective schools.
Exactly how they did it may never be fully known. No smarmy sweeteners like those bestowed on certain Senators are yet evident; it appears to have been the result of fervent appeal to party loyalty, the promise that their respective objections would not go unheeded, and Obama's Voltairian mantra, "We cannot let the perfect be the enemy of the good." Whatever the tactics, it was a masterful display of the power of persuasion, Dale Carnegie on steroids.
Of all the high drama, swaying Stupak and his anti-abortion Democratic colleagues was certainly the highest. Long before Saturday's vote, this new little caucus, whose convictions had been excluded from the Democratic tent and platform for decades, became the makers or breakers of health-care legislation. They were no naïve fools, either, showing serpentine political acumen first in allying themselves with the Republican minority to block passage of last November's House bill unless highly restrictive language on abortion funding were included, and then in pulling the rug out from under them by going with their party at virtually the last minute on Sunday ("Baby killer!").
Stupak himself was the best of all. Last week, when the Network nuns defied their own bishops by coming out in favor of the bill, he enfuriated them by declaring that "on right-to-life issues, we don't call the nuns"; days later, he reversed positions and became their hero. Most interestingly, Stupak and Co. not only exhibited a flexibility seldom seen in the anti- abortion movement but forced flexibility from staunch abortion- rights advocates Pelosi and Obama. Both sides, for the time being at least, eschewed the perfect for the good.
Many more fascinating developments still lie ahead. The first is what enactment of this law will do to the fate of the Democrats in general and Democrat-in-Chief Obama in particular. Over the months, the public has expressed ambivalence at best and hostility at worst both to the legislation and to the legislative process itself. Republicans act convinced that they can still tap into fears of "socialized medicine" and fan a backlash to the majority party's parliamentary ploys; Democrats act convinced that once the law is on the books and people see its immediate effects, they'll come around to support it. We'll get a hard sell from both sides right through the November elections.
The second development is development; reforming the health-care system is a work in progress. Next week, Senate Republicans will try to thwart the House's "fixes" to the new law, then try to repeal it altogether; neither attempt is likely to succeed. Progressive Democrats will do the opposite, proposing gradual changes leading to what they've wanted all along, a sleek and seamless single-payer plan. Having a law in place may allow them to do what they couldn't do in committee; as with Medicare — initially indefensible but now indispensable — they believe that once people see government actually doing some good, they'll ask for even more of it.
As with much high drama, the denouement may be as exciting as the climax.

Sunday, March 21, 2010

THE HEALTH CARE VOTE

March 18, 2010

Can it possibly be? After a year of dithering, this week the Democratic leadership in the House of Representatives will actually attempt to ram through a health-care bill that has already passed the Senate and send it to the President's desk.
Forget the niceties. Forget bipartisanship. Even forget it's a bill many Democrats don't particularly like.
Just do it.
Finally, an act of courage from a party, or most of a party, now fabled for its spinelessness and liberal angst. Next thing you know they'll be taking on Big Coal.
Even their Supreme Leader Barack Obama has shed his failed big-tent strategy and is starting to act like Lyndon Johnson, postponing a trip to Indonesia to fan the embers of his dispirited base and to cajole his party's waverers in the House.
It's a do-or-die battle for House Speaker Nancy Pelosi and her minions. Unlike the Republicans, who stand like a stone wall against the legislation, the Democrats are the usual herd of cats. At one end, you've got all those Blue Cats that object because the bill goes too far; at the other you've got those Pink Cats that object because it doesn't go far enough; and then you've got the abortion-rights advocates and opponents, both reluctant to compromise.
Can Pelosi pull it off?
On the PBS NewsHour on Friday, pundits Mark Shield and David Brooks were both uncharacteristically flummoxed. "Right now they're short" of the 216 votes necessary to put the measure over the top, Brooks said. "But Pelosi is very smart and knows what she's doing. I don't see how they'll do it, but I assume they're very close."
If Obama, Pelosi, and Co. can come up with the votes, it will be the biggest legislative coup since Johnson passed Medicare in 1965, or at least since Clinton passed the surplus- generating tax hike by a tie-breaking vote in 1993. It would not only be a step towards reshaping U.S. health care; it would also give Democrats something like faith in themselves, a sense of solidarity that could result in bold initiatives on education, environment, agriculture, lobbying, obstructionists be damned. "Yes we can!" could at last be not a campaign slogan but a party mandate.
There's no doubt that the bill Pelosi wants to pass is flawed. It's your standard sausage, a mishmash of provisions that keep the present dysfunctional "system" virtually intact. Nevertheless, as many advocates of a "Medicare for All" single- payer system agree, it's far better than nothing, a modest reform that moves toward universal coverage and control of insurance- company policies and profits.
Believe it or not, there seems to be a certain sense of moral obligation to this effort. With mid-term elections coming up, many House Democrats in swing districts are rightly worried that a yes vote will give the Tea Party people ammunition enough to shoot them down. Their bet will have to be that Senate Minority Leader Mitch McConnell is wrong, that the American people don't "hate this bill" but are merely skittish about it, and that once it becomes a fact rather than a fantasy, they will eventually wonder how they ever got along without it, much like what happened with Medicare and, more recently, with Massachusetts' compulsory-insurance law.
Access to health care is not so much a matter of dollars as of justice. The Democrats now have the chance to show what they're made of. Amazingly, they just might be made of principle.

Thursday, March 11, 2010

"THE HURT LOCKER"

March 11, 2010

My college classmate Roger, a physician at the Fort Lewis Army base in Tacoma, Wash., came for a few days' visit early last November. In addition to the plays, concerts, and tourist sites he wanted to see, he searched the movie listings for one film: The Hurt Locker.
"It's a story about an Army bomb squad in Iraq," he told me. "A friend of mine recommended it — he's a very thoughtful ex- Green Beret. It's not playing anywhere in the Seattle area, but it's got to be here in New York."
It was, at only one place, an art-house in the Village. We went to an early-evening weekday show. The theater was practically empty, and most of those that were there were folks like us, Vietnam-era Boomers, some of them apparent veterans, a few with disabilities.
"I think it's hard to find this movie because most people don't want to deal with Iraq and Afghanistan," he guessed as we settled in with popcorn and sodas. "They don't want to hear about it or think much about it because it doesn't affect them directly. They go to the movies to escape, not to face hard questions."
So it was a big surprise to both of us that The Hurt Lockerswept the Oscars last Sunday. Now venues nationwide will multiply, and people will go just to see what they'd ignored all these months.
They won't be disappointed.
What makes this film unique and prize-winning is that it's not your standard war film — but that's because Iraq was not your standard war. In conventional war movies, as in conventional wars, there is a defined, uniformed enemy engaging in defined battle; battles are followed by relative calm, a time of release before the next conflict begins. In this film, as in Iraq itself, there is little release, and in that sense it falls more in the genre of suspense or horror. The tension is unrelieved because, as in a horror movie, no one really knows who or what the enemy is or when or where it will strike next: terror on every side.
Scenes showing the obsessed explosives expert Sergeant William James, played by Jeremy Renner, delicately unearthing improvised explosive devices and deftly snipping detonation wires keep your stomach in knots, and when the last critical wire is cut, you want to sigh in relief — but you can't. Your stomach knots again as the camera pans past alleyways and doors and balconies where Iraqis stand looking, watching, some with camcorders and some with cell phones, then turns to the three- member squad, themselves panning the same surroundings with their rifles.
There is no respite to the anxiety because it's clear that any one of these ordinary-looking people, man, woman, or child, could be a killer.
It is this unrelenting uncertainty that makes the film an overpowering experience. It is also the real-life uncertainty in the minds of the troops that has surely contributed to the extraordinarily high incidence of psychological trauma among our soldiers — one in five, by some estimates. It is horrible enough to kill a uniformed enemy, but there the guilt can be salved by clearly knowing exactly who the enemy are. In the conflicts in Iraq and now Afghanistan, the enemy could be anyone at all.
Prior to his medical career, Roger served as an officer in the Army; today he continues to serve those wounded in combat, both physically and psychologically. He knows things from the inside.
The other day, he e-mailed me: "This morning I heard a report about one of the hardest-hit platoons in Iraq, covered by a journalist who wrote a book about them called They Fought for Each Other. It was heartbreaking to listen to the trauma they had to endure. The platoon had been so over-exposed to IED's and death that they actually refused to go out on patrol one day, as they all met with a psych counselor and told him they would likely shoot anyone in sight due to their anger, and they felt it would be inadvisable to go out. The psychologist agreed, but the commander didn't, and they still didn't go out — a small act of mutiny which went unpunished. In the end, the commander actually praised the soldiers' judgment in staying behind."
Months after seeing it, the film was still playing in his head as it was in mine, as the invasion of Marja in Afghanistan began, the roads to which and in which were strewn with Taliban IED's.
In another e-mail, Roger wrote: "One line that impressed me in the movie was when Sgt. James is disarming a bomb and encounters the recalcitrant Iraqi driver who doesn't want to get out of his way. After finally forcing him to back up his car by putting a gun to his head, the sergeant's comrades jerk the Iraqi out of his car and beat him up. The sergeant says, ‘If he wasn't a terrorist before, he is now.' My impression is that war brutalizes everyone it touches — the good guys and the bad guys, from whatever perspective you define those terms. While we praise the sacrifices of our military people, we don't realize the physical and psychological devastation ravaged upon them by repeated ‘deployments' to war zones, especially to war zones as weird as those we are in now."
The Hurt Locker captures that weirdness precisely.

Tuesday, March 2, 2010

PLEDGE BREAK

March 4, 2010

That's NPR News at the top of the hour. Good morning, I'm Paige Turner, and as you've all feared, this is Pledge Week at KHBX, Public Radio 830. We're taking a break from Morning Edition to ask for your support. For the life of me, I don't understand why this works, but it does. They must have done studies. If I were you, I'd punch that preset on your radio and jive to the oldies till we're done with this stuff. That's what normal people do, but I am not you.
Are you still there? See, you Public Radio listeners really are different. You like us because you like our long, in-depth stories, and so I guess you must also like our long, shallow, repetitive, uncreative fund-raisers. It's counter-intuitive! Wouldn't you be more likely to make a pledge if these drives were entertaining? I don't know, maybe it's hypnosis: We put you into a trance with our monotonous drone and plant the urge to pledge into your subconscious. Yes, that could be it: You are now completely relaxed. When I clear my throat, you will become fully awake. Ahem! Now you will pick up the phone and dial 1-800-555- 1212, or log on to www.KHBX.org. This will only take a couple minutes, and afterwards you will experience a profound sense of well-being.
If that didn't work, consider this: We're commercial-free! — well, sort of. Unlike the all-news-all-the-time stations with their two two-minute stories followed by a minute of annoying commercials 24/7, all we have every hour all year long are a few minutes of modest little announcements from our corporate sponsors. They're delivered so soberly by our staff that they hardly qualify as commercials, don't you think?
Yes, I know Pledge Weeks are different; I admit they're like one giant commercial. But the genius here is that it's concentrated — all-commercial-all-the time, but for just three weeks a year. How cool is that? What if the all-news stations did it our way? What if our cousin PBS did it our way? They're the epitome of cleverness. They lure you in with spectacular specials and then, just when you're hooked on that Peter, Paul and Mary retrospective, they hit you with The Pitch for ten minutes at a time. That's not us. We don't lure, we don't even surprise. We do full disclosure weeks in advance, sort of like the military at Marja giving the Taliban plenty of notice to get out of town.
I digress. If you've already made your pledge, thank you, and I give you permission to change stations. For the rest of you, I really do hate to have your serene morning commute upset by this harangue, but think of it this way: It's sort of like what your mom did to you as a kid, you know? — "I hope you appreciate all I'm doing for you, and you better be grateful to me." This is listener-supported radio, and that means you! If you tune in every day — think about it, how many of you tune in every day? — and believe Fresh Air and Speaking of Faith are your God- given right, then shame on you. Shouldn't you render to us a fraction of what we render to you? Speaking of faith, doesn't your rabbi or pastor or imam tell you that every week or so?
If you're sufficiently guilt-ridden by now, salve your soul by picking up that cell phone on the passenger seat, checking the mirrors carefully, of course — we of all people don't want to get you in trouble — and call 1-800-555-1212 or iPhone an e-pledge to www.KHBX.org. If you're distracted and fatally plow into the car ahead, our station-manager Beatrice will lead you to the ring of KHBX supporters in the Paradiso. No kidding. We've set it up.
That's 1-800-555-1212 or KHBX.org. Oh, but wait, wait, don't tell me! Is there something positive here? Yes! We're not all about guilt. For a pledge of just $60 you will receive a sturdy, eco-friendly KHBX tote-bag to add to that vast collection in your closet. Sixty dollars! Why, that's just five dollars a month! That's crazily cheap when you think about it. What do you pay for your cable and phone? I'm back to guilt, but it's the truth! Call 1-800-555-1212.
And wow! Here's another great way you can pledge: Become a Sustaining Member! All you do is tell us to bill your credit card for a small amount every month for as long as you live or until you declare bankruptcy. Set it and forget it! What could be easier?
There. That's over for another 15 minutes. For most of the year, I'm a responsible news anchor. For three weeks, I'm a shameless huckster. I hate this, but what can I do? Help me redeem my self-esteem! Call 1-800-555-1212.
We now go back to Morning Edition, but first:
"KHBX is sponsored by ...."

EXPERIMENT IN AFGANISTAN

February 25, 2010

It's brilliant, really: a mini-war with minimum bloodshed, followed by a mini-MacArthur stabilization plan, a quintessentially American combination of prudent military force and benevolent reconstruction.
Rather than attempting to pacify all of Afghanistan at once — finally recognized as impossible in a country dominated by feudal war-lords — the American military settled on a localized strategy. They would pick a large city infested for years by the Taliban — in this case, Marja, population 80,000. They would give the enemy two weeks' notice of the upcoming invasion in the hope that most of the foe would flee, thus minimizing the devastating door-to-door combat that characterized the early days of the Iraq War, and with it minimizing civilian casualties. After two or three days of fighting — that was the initial prediction — the Taliban that remained would be taken care of — the die-hards would either die or get out of town, and the rest, persuaded more by their pocketbooks than by ideology, would be bought off.
Once the city had been secured, an indigenous government would be set up (much like General Douglas MacArthur did in postwar Japan), guided by career Afghan bureaucrats from Kabul: "We've got government in a box, ready to roll in," said Commanding General Stanley McChrystal before the incursion began. Schools, medical facilities, and rebuilding projects would be provided, mainly staffed by local people. Opium-poppy fields and heroin-processing plants would be replaced by legitimate agriculture. Finally, with all running smoothly, the U.S. and British troops would withdraw, leaving a stable and harmonious city-state and a model for similar actions in the future.
As David Sanger of the New York Times wrote recently: "In the Bush years, the rallying cry when operations like Marja began was ‘clear, build and hold.' President Obama has added a fourth step, ‘transfer.' At the end of the three-month-long review of Afghan strategy, Mr. Obama vowed he would begin no military operation unless a plan was in place to transfer authority promptly to the Afghans."
The idea is so beautiful, so simple, so American — but will it work?
The "clear" phase has already met with obstacles. The advance notice apparently did make a significant number of the Taliban leave, but it also gave them plenty of time to riddle the city with roadside bombs, which the military acknowledged it had not anticipated — imagine that. The allied troops have also been meeting unexpectedly strong resistance from resourceful Taliban snipers, and have been impeded in their efforts by stringent "rules of engagement" designed to avoid civilian casualties. The predictions of two or three days to subdue the Taliban have turned into a month or more.
Meanwhile, the "build" phase has already started. Two "schools in a box" — something I guess like FEMA trailers with desks and supplies for 25 students each, and presumably complete with teachers — have opened, and over a hundred locals have been hired for maintenance tasks, a small but quick infusion of cash into the economy.
The "hold" and "transfer" phases will be the most difficult to implement and sustain, because as configured they are much more difficult for the Americans to direct and control.
The news on "hold" does not look particularly good, if it ever did. The Afghan military, which was supposed to take the lead in the conflict and provide a friendly and familiar face to the occupation, has in fact lagged behind the American and British forces, suffering only two deaths to the allies' dozen. Its field commander, Gen. Sher Mohammed Zazai, last week proffered a fanciful account of the operation that conflicted entirely with the American version. Elsewhere, defections of Afghan troops to the Taliban have occurred, and there are reports that soldiers' wages are being siphoned off by their paymasters.
The Obama extension, "transfer," which is really the linchpin of the operation, seems like pure idealism. If, as the State Department has acknowledged, the Afghan central government is corrupt, why should we expect that any government set up in Marja could be any less so? As easy as it may be to buy off the Taliban, it may be just as easy for the Taliban to buy everybody back, including the government in a box.
The Marja project, hopeful as it looks now to Gen. McChrystal, may be hopelessly utopian. "Clear, build, hold, and transfer," though not called such at the time, was a strategy that worked in postwar Japan and Germany because those countries had a long history of social order and, astonished at the absence of Allied retribution, embraced their rebuilding plans enthusiastically.
It's different in Afghanistan. Nation-building can't work if there isn't a nation to build. The city-state experiment, because of its modest size, offers a better chance. But, I would predict, not much better.