Blue Mass. Group has MOVED!!

Judith Miller caves; will testify in Novak-Plame-gate

As everyone knows by now, NY Times reporter Judith Miller ended her self-inflicted martyrdom by agreeing to testify before the Novak-Plame-gate grand jury, thereby releasing herself from jail.

A lot has already been said about today's events, and I don't have a lot to add.  Here are my two cents: (1) Miller's claim that she has "finally" received a "personal" waiver from her confidential source (Scooter Libby, Dick Cheney's chief of staff) is patently absurd - Libby's lawyers were widely quoted today as saying, essentially, we gave her the same waiver we gave her months ago, and we have no idea why she went to jail over this issue.  Fact is, it became clear that Fitzgerald was going to keep her in jail for months longer, so she caved.  Thus proving that the NY Times was flat-out wrong, to claim (as they repeatedly did) that Miller would never cave so there was no point in keeping her incarcerated.  (2) Arianna Huffington is absolutely right that Miller ought to follow in fellow Plamegate reporter Matt Cooper's footsteps and promptly publish, on page 1 of the NY Times, a full account of what she told the grand jury and of her role in the whole nasty Plamegate affair.  The Times has really sullied itself over its now-revealed-to-the-world-as-laughable insistence on what a martyr Miller was when, in fact, her source released her from confidentiality ages ago.  The least it could do is make public its reporter's involvement in one of the most vicious political vendettas to have come down the pike in a while.

We look forward to hearing from Special Prosecutor Patrick Fitzgerald in the near future.

The Zell Miller of Charlestown?

Fascinating column by Brian McGrory today about Charlestown State Rep Eugene O'Flaherty. It's mostly about O'Flaherty's opposition to Melanie's Bill, which would increase penalties for DWI repeat-offenders, along with a good deal of general mockery. (I don't know the details of the bill, but I'll say that I have as little sympathy for DWI repeat-offenders as possible.)

Going over their history, McGrory quotes an email he received from O'Flaherty after Finneran's indictment:

''I rarely write responses to low-level journalists but you really tick me off to the point where I wish I had been in high school with you so we could have playfully wrestled after school and you could have gone home to Mommy with tears in your eyes along with a black eye and a sore arse like I'm sure you did on more than one occasion."

How statesmanlike. To my knowledge, O'Flaherty has not walked the streets of Charlestown with his pants around his ankles, but this is pretty close.

Extra-juicy rumors (scroll to end) have been floated on this site about the possible candidacy of gay ex-priest Christopher Schiavone to challenge O'Flaherty -- "a vehement opponent of gay marriage", says McGrory -- for his seat. If that happens, grab the popcorn -- it'll be one for the ages.

Adam Reilly joins the blogosphere

Adam Reilly, who has written some of the Boston Phoenix's most interesting articles on local politics, has a new Phoenix-sponsored blog called Talking Politics.  It's on our daily reading list, and should be on yours too!  Welcome to the blogosphere, Adam.

Comcast blows off the voters

Boston Mayor Tom Menino and challenger Maura Hennigan squared off in a debate of sorts on WGBH's "Greater Boston" on Wednesday night.  I wasn't able to watch it (anyone out there care to offer a report?), but certainly voters in the city of Boston should want to see it before they decide how to vote on November 8.

So it's depressing to read in the Herald that Comcast, which apparently had originally agreed to make the debate available on its "On Demand" service until Nov. 2, has now reneged, and will make it available only for 48 hours after its initial broadcast.

On the one hand, it's hard to get too worked up about this.  Apparently, Comcast applies the 48-hour rule to all Greater Boston programs, and there's no indication (yet) that there's any secret conspiracy afoot at Comcast to withhold access to the Menino-Hennigan debate.  But on the other hand, is it really so much to ask of a cable company that they go just a little bit out of their way to improve democracy in the communities it supposedly serves?  I have no doubt that Comcast has the technology to make this particular program available through election day, as they originally said they would.  So why not do it?  Comcast spokeswoman and former Cellucci/Swift/Romney press aide Shawn Feddeman offered no explanation beyond saying that the 48-hour rule is their standard operating procedure.  Well, that's really not good enough.  This debate was the only time these two candidates will be going head to head, it's important for Boston voters to see it, and there's no reason beyond sheer laziness that Comcast couldn't make it available. 

So talk to Comcast (the "contact us" feature at this link wasn't working when I wrote this post, but hopefully it'll be fixed soon - UPDATE: Adam Reilly provides some phone numbers in the comments below).  Tell them you want them to make the debate available until election day, and that it's part of their responsibility as the major cable TV provider in the area to do so.  Comcast says it "has always believed in investing in the communities we serve."  Here's their chance to prove that they mean it.

UPDATE: Thanks to Adam Reilly for noting that video and podcast of the debate are available on the internet at this link.

Don't make him angry...

The normally mild-mannered Eisenthal Report turns green, grows enormous muscles and busts out of its shirt:

Outgoing Massachusetts Secretary of Administration and Finance Eric Kriss gave an interview that appeared in this morning's Boston Globe. In this interview, Kriss said that Massachusetts cities and towns are "in their worst financial shape ever" and that this is "a crisis largely of their own making." Kriss blames "overly generous" salary increases for public employees, a "failure to control" health care costs, and "aversion to development that could spur new tax revenue." These comments can be best described as bizarre and out of touch with the reality that faces local governments in Massachusetts. [my emphasis]

Yup, more victim-blaming from the Romney administration. Really, municipalities are facing the same squeeze that middle-class families are facing: Spiraling health care costs and real estate prices, which make it difficult to develop because it dilutes the tax base. Add Prop 2 1/2 making it impossible to raise revenues to fill the gap, and you've got a nasty squeeze.

I mean, "a failure to control health care costs"? How the hell does the city of Framingham or Leominster or whatever do that? Shouldn't that be the state's job? The feds'?

I came down hard on Charlie Baker -- probably unfairly and on too little information -- for bringing these things to light with Kriss and Romney in the room. If this is what he was objecting to, then he's got a point. My bad.

Patrick backs ACT

This is welcome news:

Democratic gubernatorial candidate Deval Patrick will deliver a speech today endorsing a plan [The Health Access and Affordability Act, written by Health Care for All] to establish universal health coverage [sic] in Massachusetts that is funded by hiking cigarette taxes 50 cents a pack and by creating a new payroll tax for employers that do not offer worker health plans.

Well, the bill is not a universal health care bill. The Globe really needs to get its facts straight.

But the bill is a major step forward, and Patrick's support is good to hear. Perhaps this will give the bill some traction and visibility, at least among his grassroots supporters. And it's also a way for him to distinguish himself from the Dem pack, for the time being.

Reilly counters:

Reilly's campaign committee issued a statement yesterday saying the attorney general will address the state's healthcare issues in the future, adding: ''No candidate can match Tom Reilly's experience and record of accomplishment in healthcare."

Great. Prove it by supporting the bill.

(Hat tip to the Healthy Blog.)

DeLay indicted

Someone commented here once, "A good DA could indict a ham sandwich." Well, Tom DeLay is no ham sandwich, friends.

The dominoes may be falling...

Somerville News: Jehlen wins by 1700+

Here's the link.

Jehlen 7466, White 5747, according to their source in White's campaign.

Should it have been this close? Does it reflect well on White? Or is this a statistical blip on an obscure special election? Heck, even we didn't say much about it after Jehlen won the primary.

Second Middlesex and Boston City Council elections are TODAY!

If you live in Boston, Somerville, Medford, Winchester, or Woburn (ward 2 only), be sure to stop by your polling place today.  Preliminary elections for Boston City Council, and the final election for the Second Middlesex Senate seat (Democrat Pat Jehlen vs. Republican Bill White), are happening right now.  Cos reports below on one of the contested Boston City Council elections. 

Please treat this post as an open thread on today's elections.  Seeing anything interesting out in the field?  Drop it in the comments!  --David

Since Boston City Council races are nonpartisan, there are no party primaries, but any race that has more than twice as many candidates as offices holds a preliminary today to narrow the field.

Boston has nine council districts, which each elect one councilor, plus four at-large councilors elected by the entire city. There are fifteen candidates on the ballot for the four at-large seats, so today's citywide preliminary will pick the eight who will be on the ballot in November. In most of the city, that's the only race on today's ballot.

The at-large race is getting all the attention. In one district, however, there are more than two candidates running for district councilor: the 9th, comprising Allston-Brighton. There are three candidates, and voters will choose two to advance to November 8th. One of those three is Dan Kontoff, popularly known to locals as "Dan the Bagel Man".

The incumbent is Jim McDermott, now finishing his first full term. In 2003, he was a new incumbent, having been elected in a special election mid-term. His opponent was the same Dan Kontoff, who garnered 17% of the vote in his first run for office. Since then, Dan also put his name forward as the Green-Rainbow candidate for state rep in the 18th Suffolk Special Election, which Michael Moran, the Democrat, won handily. This will be his third run for office.

The twist this time is another new candidate, Paul Creighton, is challenging McDermott. McDermott tried to get Creighton thrown off the ballot and avoid a preliminary, but it didn't happen. McDermott will probably have no trouble advancing to the November ballot, but if Kontoff gives Creighton a serious challenge for the second slot, it will be noteworthy. And if the Bagel Man surprises everyone by actually getting the second slot, it could be the big story of today's election.

2nd Middlesex Senate: Special election is TOMORROW

Don't forget: the special election to fill Charlie Shannon's Senate seat is tomorrow, Tuesday, Sept. 27.  Democrat Pat Jehlen is taking on "Republican" Bill White.

Not sure where to vote?  This site will tell you.

Don't forget to vote!

The appalling hoax of "intelligent design" moves to the courtroom

Courtroom proceedings begin today in the challenge to a Dover, PA school committee's misguided decision to require that a "disclaimer" (along the lines of "evolution is theory, not fact") be read to students with respect to the teaching of evolution (this requirement applies only to evolution, although it obviously applies to any scientific subject), to alert them to the "alternative" explanation of "intelligent design," and to mention a specific book available in the school library that advocates for "intelligent design."

Ironically, another news story published today reports that the decoding of the chimpanzee genome has allowed scientists to test one of evolution's most important predictions - the rate at which harmful genetic mutations appear.  Evolution passed with flying colors: the actual rate of harmful mutations in the chimpanzee matched what evolutionary theory predicted.  Another testable prediction made and confirmed.

As I've said several times before, what is so frustrating about this whole debate is that it's a debate at all.  "Intelligent design" does not make any testable predictions.  It therefore cannot be proven or disproven.  And it is therefore not a scientific theory.  Yet, the WaPo reports, ID's proponents have the gall to say that "it is up to Darwinists to prove ID wrong."  Nope - that is not how science works.  It is up to ID proponents to prove that there is at least somewhere a shred of evidence tending to show that their "theory" might actually be true.  Otherwise, their explanation is no better than this one, which hypothesizes that a Flying Spaghetti Monster created all life on earth.  So far, ID has utterly failed the most basic test of the scientific method.  The "Darwinists," on the other hand, have been doing it right: devising a coherent theory that makes testable predictions, and then testing them.  So far, it's doing quite well, which must have the ID crowd pretty scared.

Let us hope that the Pennsylvania judge hearing the Dover case cuts through the crap being spewed by the ID crowd and sends a strong message to them: put up or shut up.  It's time the conversation got a bit ruder on this subject.

"Internet advantage"?

In which my bloggy navel-gazing meets the Boston Globe... from the Globe's article on the challenges of the Deval Patrick campaign, I found this comment interesting:

''If our opponents think they can continue to cherry-pick short-term data as some kind of old-school evidence that they can beat us, we can't wait for the day when we are only seeing them in our rearview mirror," Byrd said. ''Our evidence is our grass-roots advantage, our Internet advantage, our million dollars raised since April, and our issue focus."

OK... so that internet advantage? That's us, and his pretty decent site. The question is whether he'll be able to leverage that, and his doubtless enthusiastic volunteer base, into getting wider name recognition and support. While I would love to toot the horn of this site and all the other MA lefty blogs, my impression is that our readership is small, deep, dedicated and possibly influential -- but not broad.

sco has a good breakdown of where the polls are for the Dem candidates, and Patrick is still pretty much unknown. Right now, frankly I don't see that many Deval Patrick bumper stickers, name tags, (neckties, samplers, stained-glass windows, tattoos, anything ), i.e. things that bump up his name recognition. So perhaps right now his campaign is based on depth, but lacks breadth. Is this a problem that needs to be instantly addressed, or is it by design?

Here's a future-tense variant on my null-hypothesis explanation of recent progressive victories in the lege: The Deval Patrick campaign will be the most significant test of whether the "progressive" elements are able to broaden their influence to something beyond low-turnout local races, which leverage high  levels of organization of a handful of mobilizable constituencies.

In other words, the progs are deep, but can they be broad? They've got a heck of a candidate, but he's leaning pretty hard on them. I'd love to know the strategy.

Stories from the Health Care front: #1

Here's the first of a hopefully longer series of stories about negotiating the treacherous waters of health care in MA. We've gotten some personal stories in some of the comment threads -- I'll put them on the front page as well.

I've "promoted" this story from the extended entry of this post to give it greater prominence: "Kerry" is a woman I know -- here's her story:

In 2002 I was a controller at a public relations firm.  During that year I decided to take a sabbatical, volunteer for organizations and causes important to me.  I started independent consulting, becoming self-employed, while volunteering and have earned a decent living.  I had access to health insurance through COBRA.  However, a few months after I left my previous employer, it stopped operating, each partner going off on their own and the health insurance contract which covered COBRA was cancelled.  I was offered an individual policy at a cost of $1,100 per month versus $250 per month which was far more than I could afford.  So I am without health insurance.

Early last March, after an ice storm here in Boston, I slipped and fell down the steps outside my home.  I tore and severely bruised muscles and had some internal injuries.  The resulting medical bills equaled close to $9,000 when all was done.

I discovered something when I received those medical bills.  I was required to pay into a fund to provide services to the uninsured even though I was uninsured.  And the fees I was charged were far higher than those the HMOs, insurance companies and large employers pay.  When I asked about it I was told by a senior manager in the billing department that the discounts negotiated by the HMOs and insurance companies had to be recouped somewhere and the only group without the negotiating power to get a discount was the uninsured.

I support the Health Care Initiative for the health of all communities and neighborhoods and for the nearly 600,000 who are just like me - uninsured in Massachusetts.

Welcome back, Ben!

It would appear that the mysterious Ben has decided to reactivate his extremely enjoyable blog, "Romney Is A Fraud."  He's got two recent posts up: the first - a must-read - recalls that Mitt Romney, reportedly under consideration by the Bush administration as the "flood czar" to supervise the rebuilding of New Orleans, actually vetoed millions of dollars in state aid in 2004 that was supposed to help the flood-stricken town of Peabody recover from a devastating rainstorm and to help it prevent future similar occurrences. 

The second post is about the Newton firefighters' recent, incredibly stupid, decision to protest their lack of a contract by blocking traffic at Newton Corner, thereby causing a massive traffic jam that backed up the Turnpike for miles.  Romney responded, correctly, by harshly criticizing the firefighters' actions.  What Romney did not mention, but what Ben reminds us of, is Romney's similar, incredibly stupid, decision to block traffic on Storrow Drive to take down the famous "Reverse the Curse" sign after the Red Sox won the World Series, thereby causing a massive traffic jam that backed up Storrow Drive.

What's particularly galling about Romney's pious hypocrisy on the firefighters' protest is his comment, quoted in the Globe, that "people standing in the middle of a roadway and inconveniencing thousands upon thousands of people, potentially putting lives at risk and causing accidents in the backup that occurs, [is] unacceptable."  Quite right.  Of course, that's EXACTLY what he did in the Red Sox stunt - through which, of course, he caused a traffic jam at the Government Center exit from Storrow Drive, a ramp routinely used by ambulances on their way to MGH or Mass. Eye & Ear.  I would also note that his description applies with remarkable precision to his administration's apparent intention to continue allowing concert-goers on the Esplanade to park on Storrow Drive, thereby causing ghastly traffic jams and blocking that same ramp.  I guess it's only when a union blockades a road and stops traffic for miles that it's a bad thing.

Welcome back to the blogosphere, Ben - we missed you.  Here's hoping you'll stick around!

"Uninsured in Massachusetts": We need your story.

(UPDATE: The first story is up. Send in your own!)

Remember last October? No, not that small matter of an election, I mean the Red Sox winning the World Series. The Sox fan site Sons of Sam Horn had a thread last year, urging the Sox to win it for friends who suffered through '78 and '86; for the 80-year-old Grandpa who's never seen a championship; for Ted Williams and Pesky and Yaz... you get the idea. It was very personal and touching. The thread is gone, but it's now a book.

Strange as it may seem, there are things more important than baseball. As a joint project of several of the MA Lefty Blogs and MassACT, we're getting personal stories about dealing with the health care system in MA.

If you've had experience dealing with our mess of a health care system, or know someone who has, we really need your story.

• If you've ever gone without insurance;
• if you've been underinsured;
• if you work full-time and don't get health benefits;
• if you own a small business and can't afford to insure your valuable employees;
• if you're self-employed and can't afford insurance, or find it's breaking your budget;
• if high deductibles or co-pays have forced you to forgo care; etc.

... We need your story.

It doesn't have to be long -- a few paragraphs is fine. You can be anonymous or attributed. (The only rules: It can't be libelous or otherwise obscene.)  You can comment on this thread, or email me (remove "REMOVE" from the email address). We'll keep the stories posted prominently here, but if we get enough, we'll start a new blog especially for that purpose.

Here's the first story, from a woman I know through activist stuff, who prefers to remain anonymous:

In 2002 I was a controller at a public relations firm.  During that year I decided to take a sabbatical, volunteer for organizations and causes important to me.  I started independent consulting, becoming self-employed, while volunteering and have earned a decent living.  I had access to health insurance through COBRA.  However, a few months after I left my previous employer, it stopped operating, each partner going off on their own and the health insurance contract which covered COBRA was cancelled.  I was offered an individual policy at a cost of $1,100 per month versus $250 per month which was far more than I could afford.  So I am without health insurance.

Early last March, after an ice storm here in Boston, I slipped and fell down the steps outside my home.  I tore and severely bruised muscles and had some internal injuries.  The resulting medical bills equaled close to $9,000 when all was done.

I discovered something when I received those medical bills.  I was required to pay into a fund to provide services to the uninsured even though I was uninsured.  And the fees I was charged were far higher than those the HMOs, insurance companies and large employers pay.  When I asked about it I was told by a senior manager in the billing department that the discounts negotiated by the HMOs and insurance companies had to be recouped somewhere and the only group without the negotiating power to get a discount was the uninsured.

I support the Health Care Initiative for the health of all communities and neighborhoods and for the nearly 600,000 who are just like me - uninsured in Massachusetts.

Judiciary Committee approves Roberts 13-5

John Roberts picked up the votes of three Democrats on the Senate Judiciary Committee - Leahy (Vt.), Kohl (Wis.), and Feingold (Wis.), along with all of the Republicans, in the Committee's 13-5 vote to send his nomination to the Senate floor.  It seems very likely that the Committee's vote will mirror what will happen on the Senate floor - slight more than half the Dems voting against, but a substantial minority voting for.  Like I said, this strikes me as the worst possible strategy, one that seems calculated to send no message whatsoever, and to stake out no ground for the coming battle over Justice O'Connor's seat.

In related news, there is a palpable sense of desperation among some of those who have been heatedly urging the Senate Dems to do everything they can (including a filibuster) to prevent Roberts from becoming Chief Justice.  Armando at Daily Kos has declared himself a failure and the Democratic party unsalvageable; People For the American Way declares the vote a "defeat for the Constitution and the country" and lambastes the Democrats who voted "yes"; and we can expect more of the same from NARAL and other loud anti-Roberts voices as the news of the Judiciary Committee's vote and the "defection" of three well-respected Democrats sinks in.  (Interestingly, Kos himself disagrees with Armando.)

With all due respect to those who were pushing it, however, I don't think the "Roberts must be defeated by any means possible" strategy was ever a viable one.  He's just too good a candidate - too smart, too accomplished, too polished, too non-threatening, too convincing in his advocacy of judicial restraint (which he may actually believe in).  And it was never realistic to have insisted on the kinds of commitments on specific issues that PFAW et al. wanted - that would have meant asking Bush to nominate a Justice who would move the Court markedly to the left.  That was never, ever going to happen. 

As I've said before, I am disappointed that the Senate Democrats are apparently not going to take some sort of stand on this nomination, either by all voting "yes" with conditions explaining their position on the O'Connor replacement, or all voting "present" to protest the withholding of documents (PFAW's assertion that the Dems who voted "no" have sent a "message" to other Senators and to the President that nominees have an "obligation" to make commitments on certain issues is, of course, utterly laughable, since Roberts will be easily confirmed without making exactly the commitments that PFAW wanted).  This unfortunate situation is, I think, partly the fault of those who loudly opposed Roberts.  By never taking seriously the notion that Roberts was as good as we can expect from this President, and by insisting on unrealistic conditions such as a specific commitment to abortion rights, the "no on Roberts" crowd made it very easy for others to paint them as extremists who would be unwilling to accept any Bush nominee, and left Democratic Senators in the impossible position of being seen as "traitors to the cause" if they vote "yes," or as "puppets of the unreasonable special interests" if they vote no.  It was, in my view, a huge strategic blunder, and we can only hope that it will not prove significant enough to weaken the Democrats in the coming, much more important, fight over Justice O'Connor's seat.

UPDATE (9/23): Scot Lehigh gets it.

Interview with John McDonough of Health Care For All

We're very pleased to present the following lengthy interview with John McDonough, Executive Director of Health Care For All.  John probably knows more about the issues involved in the ongoing health care debate than anyone in the Commonwealth.  Here is his bio, cribbed from HCFA's site:

John E. McDonough has been the Executive Director of Health Care for All, Massachusetts’ leading consumer health advocacy organization, since May 2003.  From 1998 through 2003, he was an Associate Professor at the Heller School of Brandeis University and a Senior Associate at its Schneider Institute for Health Policy.  From 1985 to 1997, he served as a member of the Massachusetts House of Representatives where he co-chaired the Joint Committee on Health Care.  In 1996, he led the successful campaign for passage of health access legislation to cover uninsured children, funded by new tobacco taxes, legislation which served as a model for the federal Children’s Health Insurance Program.

He currently teaches at the Harvard School of Public Health and the Boston University School of Public Health.  His articles have appeared in The New England Journal of Medicine, Health Affairs and other journals.  He has written two books, Experiencing Politics: A Legislator’s Stories of Government and Health Care by the University of California Press and the Milbank Fund in 2000, and Interests, Ideas, and Deregulation: The Fate of Hospital Rate Setting by the University of Michigan Press in 1997.  He received a doctorate in public health from the School of Public Health at the University of Michigan in 1996 and a master’s in public administration from the John F. Kennedy School of Government at Harvard in 1990.

The full interview appears below.  Unless you're already a health care superstar, you will learn a lot by reading it.  I know I did.

1. Many people are calling a constitutional amendment for universal health care. Why is the approach of HCFA/MassACT different?

Passage of the proposed constitutional amendment is one route to pursuing expanded coverage.  If approved by the Constitutional Convention and approved by voters, the General Court would have a constitutional obligation to enact laws/statutes to expand affordable quality coverage and submit them to the voters for their approval or disapproval.  MassACT (Affordable Care Today) proposes a ballot initiative for a law with clear and immediate coverage expansions and sources of funding to pay for them.  MassACT proposes a law/statute as the most immediate way to expand coverage to the greatest number of residents without coverage and to provide insurance premium rate relief.

2. What about Romney's plan? Isn't his plan universal?

The Romney plan proposes: A. Development of private, low-cost insurance plans to be available to all uninsured and other categories of individuals (target premium -- $200 for single adults in their 20s, higher for families and individuals in their 30s, 40s, 50s and 60s; B. Use of the Commonwealth’s existing health care safety net funding to provide premium support for lower income uninsured to purchase these new private policies; C. Penalties and state-wage withholding for individuals who don’t purchase coverage and for those uninsured who incur hospital bills.  The Governor describes his initiative as universal.

Problems/issues: A. Not one of the state’s private insurers has come forward with a detailed policy meeting the Governor’s target premium, and outlining benefits, costs, and other limitations.  Without such details (we’ve been waiting since last November), we cannot support the assertion that these low-cost plans are viable; B. We do not believe available funding from the existing health care safety net would be sufficient to finance adequate subsidies for lower income persons who cannot afford insurance purchase with their own income; C. We believe depletion of the existing safety net to pay for the Governor’s plan would severely jeopardize hospitals and health centers that provide the bulk of care for the Commonwealth’s uninsured; D. We believe the Governor’s “individual mandate” would create a series of trapdoors for vulnerable uninsured residents which would create long term financial hardship for low income folks whose only offense is getting sick.

3. What about Travaglini's plan? In your perspective, what is he trying to accomplish?

Senate President Travaglini has been the Commonwealth’s most consistent and reliable friend for low-income uninsured and MassHealth clients since he became president in 2003.  Last November, he set the health reform debate into gear by declaring his objective to reduce the number of uninsured by half over two years.  His plan, released in April, seeks to achieve this goal through modifications to the existing small (firms of 50 or fewer workers) and nongroup (individuals) insurance markets; he also proposes increased rates for MassHealth providers and public health funding restorations – all proposals we support.  We believe his proposed insurance market reforms would fall short of his goal to reduce the numbers of uninsured in half, and are disappointed that he did not direct any funds for coverage expansion.  We are hopeful that forthcoming legislation – coming in October – from the Legislature’s Joint Committee on Health Care Financing will address this deficiency.  President Travaglini is an important ally in the push for expanded coverage and we appreciate his sincere commitment to this cause.

4. Is there a difference between the Health Access and Affordability Act(House Bill 2777 and Senate Bill 738) and the Massachusetts QualityAffordable Health Care Act ballot initiative? Why have legislation and a ballot initiative?

The HAAA was filed in December 2004 as legislation for consideration in the 2005-06 session of the General Court – it is supported by the ACT Coalition (Affordable Care Today) and includes about 35 statewide consumer, health, labor, and business organizations.  It was our best effort at the time to define a progressive and pragmatic health care access expansion which also addressed issues of cost and quality. 

The ballot initiative was filed in August 2005 as a potential initiative petition for a law for placement on the November 2006 state ballot – it is support by the MassACT Coalition, a registered ballot committee.  MassACT includes fewer members than ACT – the legislative coalition – and the initiative is shorter and more precise than the original legislation.  MassACT formed for two principal reasons:

First, the history of initiative and referendum in Massachusetts demonstrates that a well framed ballot initiative can act as a significant impetus for the General Court to pass more meaningful and substantive legislation than they would in the absence of an initiative (two examples: 1994 campaign finance reform and the 2000 patients bill of rights); second, if the General Court fails to pass meaningful and substantive health access legislation, the initiative provides an opportunity for voters to weigh in on a serious and substantive plan. 

Right now, we estimate a 100 percent chance that MassACT will collect the necessary signatures and a 50/50 chance that the MassACT initiative will appear on the November 2006 state ballot.  That depends on how the Legislature reacts to the issues advanced by the initiative.

5. Who is helped by the Massachusetts Quality Affordable Health Care Act?

First, individuals and families under 65 will be eligible for MassHealth if their family income is less than 200 percent of the federal poverty line (FPL – about $38,000 for a family of four, $33,000 for a family of three).  Second, individuals and families with incomes between 200 and 400%FPL will be eligible for direct subsidies and/or tax credits to purchase affordable coverage.  Third, small businesses (fewer than 100 workers) and their workers will be eligible for subsidies and support to make insurance purchase affordable.  Fourth, all current private insurance policyholders and employers will receive immediate premium relief of $160 million per year.  Fifth, community health centers, hospitals, and physicians will receive payments from MassHealth at Medicare rates (roughly 95% of costs).

6. What if you have OK health insurance now, but it gets more expensive every year -- does this act affect you?

Right now, everyone with private insurance pays a hidden surcharge of $160 million per year to help finance the Commonwealth’s Uncompensated Care Pool which helps to finance care received by lower income uninsured persons at hospitals and health centers.  Because the initiative’s MassHealth expansion will dramatically reduce the rate of uninsured, and because about 85 percent of state’s uninsured are in families with incomes below 200%FPL, we can eliminate this unfair subsidy without jeopardizing the Commonwealth’s safety net.  Right now, employers who provide insurance – and their workers – are forced to subsidize the Pool and employers who don’t provide insurance for their workers.  Our proposal is the only one that provides immediate, concrete savings to existing health care consumers by ending this unfair cross-subsidy.  We propose other savings initiatives, though this is the most immediate.

7. (a) Does this act do anything to slow the rise of health care costs in general? (b) How do we avoid a situation like Tennessee, where their comprehensive program is being gutted?

A. Our legislation  (HAAA) proposes creation of a Commonwealth Cost and Quality Council to identify and implement health system interventions with the documented ability to improve quality and lower costs.  For example, a major source of patient injury and unnecessary cost is the epidemic of hospital-acquired infections in our acute hospitals.  These infections injure patients and cost many millions.  Some hospitals in Pittsburgh, for example, by focusing on this problem, have reduced the rate of such infections to ZERO.  Beyond this, the driving force behind rampant health inflation, we believe, is our system’s pathological embrace of the free market as the path the system savings – an approach rejected in virtually every other advanced nation on the planet (whether single or multiple payer).  As Will Rogers said, when you find yourself in a hole, first stop digging.  After 15 years of digging in the market competition hole, we still keep digging. Unfortunately, the Commonwealth’s track record with cost control (hospital rate setting: 1975-1991, RIP) ended in significant failure – and there is no serious proven cost control intervention which is politically viable.

B. Massachusetts can take pride in our deep and sophisticated network of health care access advocates who have constructive alliances with health care providers and payers to support and defend existing access programs.  We saw the results of this when the Legislature voted in 2002 to eliminate coverage for 50,000 very low income MassHealth clients.  While coverage was eliminated in April 2003, by July 2003 this alliance convinced the Legislature and Gov. Romney to restore coverage as of October 2003.  This network and alliance has won many other victories in behalf of coverage for our most vulnerable members of society.  It’s not perfect by any means, and we have many goals not yet achieved (i.e.: restoration of dental coverage for about 550,000 poor MassHealth adults); still it gives us confidence we will not see the kind of retrenchments experienced in Tennessee, Missouri and elsewhere.

8. What can be done to manage the costs that the state assumes under the re-insurance plan?

Reinsurance is a way to increase insurance affordability and rate stability by having the state assume a share of insurance costs for high cost cases.  It has been used with success in other states including New York and Arizona.  Because of the potential high cost, we suggest its use in a limited way to provide better affordability and rate stability in the small group and nongroup markets, the two most expensive and unstable portions of our insurance market.

9. Realistically, will we need tax increases to pay for this bill, beyond the cigarette tax increase?

Yes, and the necessary revenues to finance the bill and the initiative are contained in it.  First, we propose a 60 cent cigarette tax increase which will generate $160 million and lead to a significant drop in smoking rates.  Some complain that cigarette taxes fall disproportionately on lower income folks.  While this is true, it is equally true that: a. 100% of the benefits will help lower income families; b. lower income folks will disproportionately benefit from lower rates of disease and death. 

Second, we propose a new payroll assessment which will fall on businesses that do not cover their workers or cover them at inadequate levels (i.e.: Walmart).  The assessment will be 5% of gross payroll for smaller employers and 7% for larger ones (greater than 100 workers).  On average, employers who provide insurance to their workers pay about 15% of payroll.  So this new assessment is less than the cost of providing full coverage, affordable for employers, and adequate to finance all the subsidies and coverage expansions included in the plan.

10. For the state economy, is it better to have somewhat higher taxes and more insured people?

Most people who have coverage now feel they should not have to pay more to cover the uninsured because the cost of coverage is already so high.  We agree.  The MassACT initiative will not cost persons with insurance coverage anything – in fact, it guarantees premium savings.  It fairly spreads the cost of expanding coverage to those without among businesses that don’t cover their workers, government, and newly insured consumers.  We think that’s a formula the people of the Commonwealth can embrace.

11. (a) With the MQAHCA, employers will be mandated to provide a certain level of coverage. Is that going to be tough on small business? (b) What effect will the employer mandate have on companies considering locating in Massachusetts?

The MassACT initiative is not an “employer mandate.”  Hawaii is the only US state with such a mandate (employers must provide insurance to any employee who works more than 20 hours per week); federal law now prevents any other state from instituting such a mandate.  Further, the initiative is different from the “pay or play” universal health care law passed in Massachusetts in 1988, never implemented, and repealed in 1996.  I consider our initiative akin to a “health care minimum wage.”  In the same way there’s a wage floor below which no employer can pay a worker, we provide a health benefit floor or minimum each employer should contribute for their worker’s health security if they fail to provide coverage.   

Our proposed assessment is affordable for small employers and mitigates a significant unfairness in the current system where employers who provide insurance coverage directly and indirectly subsidize coverage for workers in firms that don’t offer coverage.  We are also confident the assessment will not affect companies’ decisions to locate in Massachusetts.  The companies which are mobile (have the ability to move from one state to another) all provide insurance coverage to their workers.  The companies that don’t offer coverage are overwhelmingly service, retail, and food service establishments (i.e.: Walmart, Dunkin Donuts) which lose their customers when they leave a geographic area.

12. What haven't I asked that you wish I had?

Two things:
First, many advocates of a taxpayer-financed single payer system criticize our plan because it’s not single payer.  Health Care For All supports single payer as the best solution to our health system problems, yet honestly sees no short term political viability for this proposal.  Back in 1996, when Sen. Mark Montigny and I led the fight for health reform which expanded the MassHealth program to more than 300,000 lower income uninsured families and individuals, we were constantly criticized for the same reason by single payer advocates.  Single payer was meritorious then as now, and still has zero political viability.  We need to find a way to support incremental measures which will help in immediate ways folks in desperate need today as we continue to educate and press for broader systemic change. 

Second, the questions presented by Blue Mass. Group to me are the most substantive and serious of any we have been asked by any media in the past 12 months.  As the mainstream media becomes increasingly shallow, uninformed, and disconnected from real policy conversations, the value of the Massachusetts blogging community becomes increasingly important.  Congratulations to you and the entire MA blogosphere – you folks are the best hope out there now for informed and meaningful political dialogue (and don’t forget to check out HCFA’s blog at www.hcfama.org/blog).

The new Inquisition

It's (almost) official: Pope Benedict XVI is expected to sign a new rule prohibiting any homosexual, even a celibate one, from becoming a priest.  The new rule supposedly will apply only to candidates, not to already-ordained priests.  Also, the Vatican will be sending hundreds of "investigators" to American seminaries to ensure that there is no "evidence of homosexuality" at these institutions.  Those "investigations" ought to be lots of fun for everyone involved.  ["Cardinal Fang!  Fetch ... the comfy chair!!"]  And it ought to do wonders for the priest shortage.

I'm afraid I don't see the logic of this new policy - and I will readily admit that I know little about church doctrine, so perhaps readers who know more than I do can enlighten me.  My question is this: let's assume we have two individuals, both with straight A's in their seminary classes, both fully willing and able to take a vow of chastity and to lead an entirely celibate life, one attracted to men, the other to women.  Let's further assume that neither has any sexual experience, since both have been determined to become priests since the age of 10.  Since by hypothesis they will both successfully swear off the whole subject of sex anyway, what difference does it make who they're attracted to?  Isn't this kind of like a no-smoking restaurant that will admit ex-smokers who used to smoke Marlboros, but not ex-smokers who used to smoke Camels?

The worst possible strategy on Roberts

OK, so it's not looking like the Dems are going to adopt my "everyone vote yes, but with a warning" strategy.  Nor does it look like there will be united front of "no" votes, though there will certainly be some.  So far, what I've heard is that Kennedy, Kerry, and Reid have announced they will vote "no"; Leahy (D-Vt.) and Baucus (D-Mt.) have said they'll vote "yes," and everyone else is thinking about it.

Another possible strategy, and I think quite an interesting one, would be for Democrats to vote "present" on this nomination, as a way of indicating that the administration's appalling refusal to provide highly relevant documents has left them unable to evaluate Roberts adequately.  A vote of 55-0 would be a strong message that better behavior will be required next time.  The first time I saw this idea was in the comments to this post in my Kos diary - thanks to all that mentioned it there.

The WORST POSSIBLE STRATEGY for the Democrats, in my view, is the one that they appear to be pursuing: everyone does what they feel like, with the result that, let's say, about 20 Democrats vote "no," about 25 vote "yes," Roberts is comfortably confirmed, and the Democrats have failed to stake out any ground whatsoever for the next nomination.  Look, we cannot, and probably (in my view) should not, prevent John Roberts from becoming the next Chief Justice of the United States.  But we CAN, and we SHOULD, send a powerful message of some sort to President Bush and the Senate Republicans that Justice O'Connor's replacement is a different kettle of fish because of her unique role on the Court.  If we fail to do that, we really suck.

Hack Attack

Little Bush has appointed a member of his inner coterie to investigate the blunders of his inner coterie during the Katrina disaster. Homeland Security Advisor Frances Townsend, a lawyer with no disaster relief experience, will lead the probe. The move is a desperate attempt to preempt Congressional demands for an independent inquiry.

Townsend's last investigative job, Bill Fisher reports, was to prepare an incisive review of the White House-commissioned "slam dunk" report on pre-Iraq intelligence failures. "You will begin to see action in a matter of weeks," Townsend said after she was appointed, according to the April Fool's Day edition of the Washington Post. We’re still waiting, Fisher notes. Some joke. [Cartoon Credit: Get Your War On]

MassACT needs people who act

but I don't mean Dustin Hoffman...

Let's be honest: Most folks aren't crazy about ballot initiatives, not even a lot of the folks who are getting signatures. I don't like having to decide on complicated matters in the voting booth -- that's why we elect representatives, right?

But as former Minnesota Governor Arne Carlson and former Washington Governor Booth Gardner argue in their op-ed in the Seattle Post-Intelligencer, the impetus for reform must come from the ground up. We have a few tools for accomplishing that, and this is no doubt the sledgehammer. It's not delicate, it's not nice, but if we get 100,000 signatures the legislature will sit up and notice. We'd rather they do it, but if they don't ... We Got Ballot.

As I've posted before, this weekend is the start of the signature campaign to put the Massachusetts Quality Affordable Health Care Act on the ballot in 2006. The act will reduce premiums, make it easier for more people to get coverage, and help small businesses afford coverage.

About 66,500 signatures are necessary to get it on the ballot; but supporters of major health care reform are hoping for 100,000 or more, to show the legislature the depth of support for reform.

We can affect this debate in a real, concrete way. If you've ever cursed the health care system, on your own behalf or for someone else, now is your chance to do something signficant for those 532,000 people that lack coverage.

• Download and sign the petition, and get some friends and family to sign it as well. (It's not brain surgery, but be careful -- it's an official legal document, signatures need to be legible, and it otherwise needs to be dealt with in a very specific way. They've got instructions on the site.)
• You can call MassACT's Lisa Vinikoor at (617) 275-2807 to volunteer to get signatures this weekend and next (especially crucial), or throughout the fall.

Reid's strategy on Roberts: is there a better way?

So Sen. Harry Reid (D-Nev.), the Democratic leader, has announced that he intends to vote against the confirmation of John Roberts for Chief Justice.  The liberal interest groups that have raised and spent gobs of money in an almost-certainly quixotic bid to defeat Roberts' nomination are, of course, ecstatic. 

But, as I've said a million times already, this nomination doesn't matter NEARLY as much as the next one, Chief or no Chief.  John Roberts is replacing the extremely conservative William Rehnquist.  He simply cannot move the Court very far to the right - most likely, in fact, he will move it slightly to the left.  Sandra Day O'Connor's replacement, on the other hand, can cause a huge shift in the Court.

I had dinner with a friend last night who had a very interesting suggestion for how the Democrats might maximize their leverage on the next nomination.  What if the Democrats announced that they would vote IN FAVOR of Roberts, en masse, for three reasons:

1. Roberts is extraordinarily well qualified, seems to personify "judicial temperament," and expresses modesty about the judicial role.
2. Roberts has made specific commitments on several important issues: he has said that he understands the Constitution's commitment to "liberty" to extend beyond physical restraint; he believes that the Constitution contains a right to privacy; he agrees with the result in Griswold v. Connecticut (the marital contraception case); he recognizes that Roe v. Wade is not only long-established precedent but that it has been recently reaffirmed in Casey, and that both of those decisions are entitled to substantial respect under the doctrine of stare decisis; etc.
3. Roberts is replacing Chief Justice Rehnquist, and therefore his confirmation will not significantly affect the ideological balance on the Court.

The message to the Republicans would be this:

Look, we are reasonable people, and if the President sends up someone who is well qualified, who has the right temperament, who is committed to preserving important aspects of the law as it exists today, and who is not likely to cause a seismic shift on the Court, we will support him or her, even if that person is far more conservative than we would like.  However, be advised that when the President announces his nominee to replace Justice O'Connor, he can expect support from Democrats only if those same three conditions - qualifications/temperament, specific commitments, and no seismic shift - are met.  If the next nominee does not meet those conditions, look for a filibuster.

It should be obvious by now that I think my friend's strategy is a pretty good one. 

Bottom line: I have ended up where I started when all of this began.  This nomination could have been so very much worse, particularly since Roberts is now replacing Rehnquist instead of O'Connor.  And Democrats cannot afford to be perceived as being opposed to anyone that Bush nominates (this is a serious danger: a commenter on this post reports that he received a fundraising letter from NARAL before Roberts was nominated asking for money to be used in opposing whoever Bush named).  If Democrats want to be able to win a filibuster fight on the next nomination, they will need A LOT of political capital, and A LOT of public support.  They are much more likely to have the capital and the support they need for that fight if they look reasonable on this one.

The Modest Mr. Rove

Recent headlines from the Gulf Coast this week have been dominated by a familiar combination: federal fumbling and payoffs to cronies. The incompetence is so stunning that even administration lackeys like Joe Scarborough have revolted.

Who is managing the fiasco fiesta? Karl Rove. Indeed, Little Bush has replaced relief chief Michael 'Brownie, you're doing a heck of a job' Brown (who prepped for his job as Judges & Stewards Commissioner of the International Arabian Horse Association) with a man who has even less experience with disaster relief.

The NYT broke the story last week, way down in a general piece on Katrina relief, and has not brought it up again. The Washington Post limited coverage to columnist Dan Froomkin. TV has been silent, as Fairness & Accuracy in Reporting notes. Everyone agrees, however, that the modest Mr. Rove is in charge.

Josh Marshall has been dead on: "Every Democrat should be hitting on this. Take the politics out of the reconstruction effort. He put his chief spin-doctor in charge of the biggest reconstruction and refugee crisis the country's probably ever faced. That tells you all you need to know about his values. Nothing that happened in the last couple weeks meant anything to him. And nothing has changed. Same as Iraq. Same stuff." Marshall is monitoring which outlets discuss the story. So far, only George Stephanopoulous … and, of course, the well informed readers of Blue Mass Group.

Signing on

If you go to a supermarket, farmer's market or other public agora this weekend and next, you will likely see folks asking for signatures to put various acts on the ballot in November 2006. This is to introduce the Massachusetts Quality Affordable Health Care Act ballot initiative.

Why sign it? Here are the reasons, from MassACT, the coalition supporting the initiative:

The ballot language:

• Reduces premiums - ending the insurance surcharge now tacked onto premiums to pay for uninsured patients who get care in emergency rooms and other sites.
• Increases quality affordable coverage - providing sliding-scale assistance to moderate-income families struggling to afford health care costs.
• Helps small businesses provide coverage - expanding the Insurance Partnership program and establishing a reinsurance program to reduce premiums.
• Makes our health system fair - funding expanded coverage through an affordable assessment on firms that refuse to provide coverage to their workers.
• Covers our children and most vulnerable residents - expanding the affordable MassHealth program.
• Lowers health costs and improves health - increasing the cigarette tax by 60 cents to reduce smoking and to fund affordable coverage.

***
So... I often hear from really really smart people whom I like and respect that they don't really understand health policy, that they're not really sure what's a good idea, or that there might be this or that unintended consequence to an ambitious reform ... I hear you. And I respect the integrity of saying "Gosh, I don't know," when you really don't know.

But what do we know? We know that our current system (or lack thereof, more properly) is a meat-grinder for the uninsured. We all have that feeling of "There but for the grace of God go I" when we hear these stories -- many of us are on the edge ourselves. All of us are paying the enormous 10-12% year-over-year increases, which with the truly frightening power of compound interest comes out to doubling every six or seven years.

In other words, doing nothing bears an enormous cost. We just don't have the luxury of waiting for the perfect health care system. To paraphrase Rick Pitino: "Single payer is not walking through that door." We don't live in a perfect world, and in public policy sometimes we have to choose what problems we're willing to live with, and which are beyond the pale.

This act will help real people, and it's doable now, and it's clear that the benefits, economic and humanitarian, far outstrip whatever costs. The law has been crafted by diligent, smart, decent, and eminently sane people.

It's the status quo that's unworkable -- let's try something else for a change.

Dramatis personae for the health care show

This is an introduction to the various players on the MA health care scene.

Note the two-pronged strategy by the coalition of groups led by Health Care for All: Legislation on one hand, ballot initiative on the other.

• Health Care for All (HCFA): The most prominent and veteran advocacy group committed to expanding access to health care, now 20 years old. They created the Health Access and Affordability Act and its sister ballot initiative, the Massachusetts Quality Affordable Health Care Act (MQAHCA). Led by Executive Director and former state rep John McDonough, who has an indispensible and readable blog.
  
  They generally push for significant but incremental reform; from their brochure: "HCFA switched in 1994 to advocating for policies that might quickly expand health crea coverage to the thousands of uninsured residents who couldn't wait until the political mood of the country changed".
  • ACT: Affordable Care Today! This is the umbrella organization for the coalition of groups supporting HCFA's bill in the legislature. The group includes the American Cancer Society, American Heart Association, Cambridge Health Alliance, Children's Hospital, Greater Boston Interfaith Organization, SEIU locals 615 and 2020, and many others.
  • MassACT: related to ACT, this is the umbrella organization gathering signatures for the ballot initiative. They are starting signature gathering this weekend -- sign up here to help out. (It's not hard.) 66,000 signatures are required to get the act on the ballot in 2006; 100,000 signatures, gotten in just a couple of weeks, would send a clear message to the legislature that they should do it themselves. Leverage.
    
    
• Health Care for Massachusetts: unfortunately similar name to HCFA, but laudable goals: They want to pass a state constitution amendment calling for "comprehensive, affordable,           and equitably financed health insurance coverage" for all Massachusetts           residents. The Constitutional Convention of September 14 was supposed to deal with this, but they only got to gay marriage. The group is confident that the May 10, 2006 ConCon will deal with the issue.
  
  
• MassCare: (UPDATE, from commenter cap404): This is the umbella group representing a statewide coalition of organizations that advocate a Single Payer system, and that is endorsing the Tolman-Hynes Healthcare Trust Bill.
  
  
• Robert Travaglini, Senate President: Announced in November his plan to cut in half the number of uninsured in Massachusetts. His plan notably includes a reinsurance scheme by which the state would pick up much of the cost of the most expensive health care cases. This would be good for insurers, since they get some cost containment. Hopefully they would then be more likely to expand the range of people they want to cover. He is likely to be squeezed between the governor's plan (called "Yugo health care" by some) and the more ambitious plans supported by HCFA/ACT.
  
  (For more on reinsurance, see this profile on New York State's plan:  "The Healthy New York (NY) Program is a state-subsidized reinsurance mechanism that reimburses health plans for 90 percent of claims paid between $5,000 and $75,000 on behalf of a member in a calendar year.")
• Finally, Governor Mitt Romney: Proposes a personal mandate for all to insure themselves; but somehow won't spend new money to cover them. Proposes using free-care money to insure people -- actually not a bad idea. Advocates creating bare-bones insurance programs with high deductibles and co-pays, which therefore will have little preventative value or benefit to taxpayers or the economy at large.

"Uninsured in America": Sacrificing the body

Wes of Walk in Brain is doing a book club of the blogs this week on "Uninsured in America: by Susan Starr Sered and Rushika Fernandopulle. I thought I'd chime in with some thoughts on this powerful and painful book.

This book presents the real-life stories of a number of people who have slipped through the ever-widening cracks in our patchwork of health care. They argue that to even call it a "system" is not accurate, since there is no organizing principle behind the assortment of state, local, private and public providers of health care that folks have to contend with.

The authors organize the book around a few concepts, most importantly the "Death Spiral": In our employer- and family-based health care system, if one is disconnected from these lifelines through job loss, inadequate coverage offered by the employer, or divorce or abuse, it becomes that much harder to stay healthy, which leads to dimmed job prospects, worsening health, and so forth. If they're available -- and they often are not -- the safety nets of Medicaid, workman's comp, and charity care are generally inadequate to the task of actually making people healthy enough to pursue employment at full strength.

Put it this way: It's impossible to have an employer-based health care system when employers don't want to hang on to their employees for most of their lives. With lifetime employment, the employer has a significant interest in keeping the employee healthy and productive, reducing costs throughout a lifetime. With the instability of the contemporary labor market, health costs are a hot potato to be passed off on someone else as quickly as possible. And some of those potatoes -- people, actually --  get dropped.

But the book isn't as wonky as I'm making it sound: It's made up of anecdotes about real people, ranging widely in socio-economic status, who all happen to find themselves without insurance. There's the hairdresser who makes $900 a month, who can't afford $200 a month in insurance (+ deductibles and co-pays, doubtless), and has a malfunctioning gall bladder and a history of ovarian cysts and endometriosis. Or the bar manager who sands down his bone spurs with an electric sander. Or the construction workers with mangled hands, hips, and backs.

The book uses the idea of "caste" to describe how the uninsured and unhealthy become a separate and permanent underclass in our society, marked by their infirmities in their very bodies. I actually disagree with this metaphor: their condition isn't permanent, it devolves before our eyes. They're mobile: downwardly mobile.

The more apt comparison is that of Social Darwinism: We've all seen the nature shows in which the antelopes come to the watering hole, stalked by the lion; the lion springs and the herd flees; and left behind to be torn apart are the old, the slow, the unlucky. In our health care system, we literally live like animals.

Look, you don't need to read a book to see this stuff: It's all over our area. Just go to Central Square, or ride a city bus (the 134 in Medford, for instance), and you can see it yourself: People too poor or unlucky to get decent medical care. I'm sorry, but all talk of "moral hazard" or "lifestyle of dependency" just goes out the window for me. Maybe some people will become "dependent" on the system -- so what? We are human beings -- we are not perfect, and should not expect everyone's health, genetics, intelligence, foresight and morality to be so. Given a choice between that and having our neighbors lose their teeth and become bent, mangled and broken because they can't afford to see a doctor, give me "dependency" every damn day.

Reading list for health care week

This is something of a repeat of an earlier post, but in light of Health Care Week on the Blogs, it's timely. This is a brief list of things I've been reading about health care in the last year:

• Uninsured in America, by Rushika Fernandopulle and Susan  Starr Sered. (Read a review here.)
  Just a tough, tough book. The authors meet a number of folks who have been sucked into the "death spiral": hard times (divorce, job loss, etc) + medical problems = more hard times + worse medical problems. Did you hear the one about the guy who uses an electric sander on his bone spurs? Oh, well, it's not that funny anyway.
  
• The Moral Hazard Myth, Malcolm Gladwell in the New Yorker.
  You feel lucky, punk? Well, do ya? Gladwell shows how we're distributing risk, and the human cost.
• The Best Care Anywhere, Phillip Longman in the Washington Monthly.
  "Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden. Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America's health-care crisis."
• The Quality Cure?
  NYT Magazine profile of Harvard prof David Cutler's ideas about health care reform: Quality, Knowledge, not Price (that's nice).
• Blue Cross Blue Shield Foundation's "Roadmap to Coverage" report, final version to be issued in October. Just read the executive summaries if you don't have time for the whole thing. Basically they state that the benefits of insuring people far outweigh the costs, when seen as an investment in the economy.
• "Re-creating our health care system":
  "It's ground zero, and citizens must take charge where elected officials have failed." An op-ed by Arne Carlson, former Republican governor of Minnesota, and Booth Gardner, former Democratic governor of Washington. It's up to us. No one is going to hand us a good health care system -- it must be formed from the ground up.
• Boston Globe, Sept. 15: "Fewer Companies offering benefits as costs rise".
  10-12 percent rises, year after year after year. At that rate it doubles about every six or seven years. (Are you getting twice as good care every seven years?)
• Boston Globe, August 31: "US Study finds rise in uninsured":
  The number of Massachusetts residents without health insurance jumped about 10 percent last year, surpassing the growth in the uninsured nationally and raising concerns whether climbing private health insurance premiums are shutting out middle-income workers." Gosh, you think? Census Bureau estimates there are 748,000 uninsured people in MA; other estimates put it at about 532,000.

More fun with internet domain names

Remember when the Mass. GOP bought up a couple of possible "Reilly for Governor" internet domain names and threatened to put anti-Reilly propaganda on the sites?  (So far, there's nothing on those sites, but maybe there will be when the campaign heats up.)

Well, it appears that some Democratic-leaning activists have taken a page out of the GOP's playbook.  As you know, Pat Jehlen, having won the primary for the Second Middlesex Senate seat, faces Republican Bill White in a special election on September 27.  White, like any good 21st-century candidate, has got a website, BillWhiteForSenate.com,  on which you can find out a bit more about him, make a donation to his campaign, etc.

The one thing you can't find out on White's website is what party he belongs to.  His entire site is remarkably devoid of any reference to the fact that he's a Republican.  This is no accident - to the contrary, it appears to be White's considered strategy to finesse his party membership (thanks sco). 

Now to the internet angle: some enterprising folks - we don't know who because they have purchased a private domain name registration - have put up a competing site, WhiteForSenate.com, the point of which is to remind the good people of the Second Middlesex Senate district that Mr. White is, in fact, a member of the party of George W. Bush, Dick Cheney, Tom DeLay, you get the picture.  The site is faintly amusing - one of the upcoming events reads "September 26: Election-stealing seminar with guest speaker Katherine Harris."

On the whole, though, this sort of stunt is not exactly the best way to elevate the level of political discourse.  Certainly, it's fair to ask Mr. White the extent to which he supports the stated platform of the party of which he is a member.  But to suggest - by posting a link on the joke site - that White supports, for example, the Article 8 Alliance (the dopes who want to impeach the SJC Justices who voted for gay marriage) isn't especially constructive. 

So let's have everyone behave like grownups.  Mr. White: if you're embarrassed about being a Republican, for God's sake quit the party and declare yourself an independent (it's probably too late to do this formally, but you could still say it).  You'll probably get a lot more votes, though the "R" is going to be next to your name on the Sept. 27 ballot, regardless of what you say in your campaign.  Otherwise, tell us loud and pro