The Health Care You Have, Not The Health Care You Want

I believe in health care reform, but since I can't read or listen to more than 20 or so words at a time without thinking about food or wanting to take a nap*, it's hard for me to sink my teeth into, you know, learning anything about it. Fortunately for me, there exist magazines to cater to me and my tiny attention span.

The New Yorker came out this week with Atul Gawande's kind of sweet overview of how universal health care evolved in slavering backwards socialist nations like France, Switzerland and the UK. The thesis is pinned to path-dependence: there was never a traumatic overhaul with bureaucrats scrambling to radically change everything, rather, things just kind of happened. For example in the UK, WWII required massive government assistance to put health services out in the sticks, where everyone's kids were fleeing, and then when all that stuff got bombed they had to redo it. So by 1948 the NHS sort of already existed.

Many Americans envision universal health care as a change on the level of a Bolshevik revolution, and the author's idea is that it doesn't really have to be that way. No one is going to shut hospitals down for 5 days and raise your taxes to 50%. You build gradually on what you have, and the result is an imperfect but workable patchwork-quilt-style safety net.

I like the idea of making universal healthcare a palatable idea, which Gawande does in a very straightforward, non-wonky way. The problem he overlooks, I think, is that for these European countries, there was a serious impetus for these incremental changes like war (UK), famine (France), everyone else is doing it (Switzerland). Here, it seems that impetus does not exist, but for the Cries Of The People (and who ever listens to those anyway).

Well, actually, there is the obvious: that nearly 50 million of us have zero insurance, but that doesn't seem to have resonated with many of us. (I don't like thinking that we're so callous as to say that a Teddy Grahams heiress should be able to have lots of extra money lying around for Botox but not have to contribute jack to a laid-off factory worker's cancer treatment. But maybe small, incremental edits to our collective consciousness have created that culture.) It does seem that at a minimum, almost everyone agrees that more people need to have their basic needs cared for. So, a journey of a thousand miles, etc. But will there have to be a catalyst to, you know, take that first step? A catalyst besides the problem itself? I hope an administration that is supposedly built on pragmatic competence will find a way to get us somewhere without requiring it.

*Which makes being a) married to an academic and b) the sister of a health policy nerd AWESOMELY FUNNY. Them: "So basically this method of measuring the effect gives us new ways to control for these variables, and predict the..." Me: "Look, a butterfly."

More Attorney-General Corruption - No, Not That Attorney General

It appears that, along with the suspension of basic civil liberties and wrong-headedness about the "War on Terror", the U.S. and Britain share corrupt attorneys general. The Guardian reported that the attorney general of Britain, Lord Peter Goldsmith knew of bribes being paid by the corporation BAE to Bush family friend, Prince Bandar of Saudi Arabia, but that Lord Goldsmith intentionally misled an international anti-corruption agency, the OECD.

What is more, Britain claimed not to let the OECD know about the payments because of "national security" concerns. Now, what, might you ask, are these "national security" concerns that would prevent the government of Britain admitting that they are paying off the royal family of Saudi Arabia? I'll let Tony Blair explain:

Standing beside George Bush, a close family friend of former US ambassador Prince Bandar, Mr Blair said it would have "wrecked" the relationship with Saudi Arabia if he had allowed investigations to go on. "This investigation, if it had gone ahead, would have involved the most serious allegations and investigation being made of the Saudi royal family," he said.

"My job is to give advice as to whether that is a sensible thing in circumstances where I don't believe the investigation would have led to anywhere except to the complete wreckage of a vital interest to our country."

Yes, that is right &mdash "national security" now includes protecting information about bribes paid to the Saudi royal family. I thought that we were in this entire war to advance freedom and democracy to the Middle East? So "national security" is used to protect a monarchy in the Middle East for no other reason than we don't want to embarrass the Crown Prince by creating an uproar because British tax dollars are going to pay into the sultan's slush fund.

Of course, Prince Bandar, in a statement to The Guardian, has denied that these were bribes, and through his "London solicitors", Herbert Smith says:

Whilst Prince Bandar was an authorised signatory on the accounts any monies paid out of those accounts were exclusively for purposes approved by MODA.

This is the exact problem in dealing with royal families and not democracies: The prince can withdraw money, by himself, anytime he wants to!!!.

What also truly amazes me about this second article in The Guardian is how careful they are to document exactly what they did in order to get Prince Bandar's statement and the editorial decisions that were made regarding the decision to go to print without any statement by the prince. To me, this is an amazing contrast to the way that I imagine American newspapers would handle the same situation. I imagine that the American media, whether the NYT or Fox News, would impugn the credibility of any person who dared challenge their authority and sensationalize the fact that they were criticized. Rather, The Guardian is simply matter of fact: we asked for a statement from this person on this occasion, that person on another occasion, informed the prince this is what we were going to do in order to give him one more chance and then we made the decision to go to print for x, y and z reasons. And, after he released a statement, we printed it and explained why the allegations made in it against our paper were false, using the evidence cited. Amazing.