Foreign minister, an office that doesn't really mean much

But Beinart never mentions that Lieberman’s party won only 12.5 percent of the vote.

Right-o! Only 12.5 percent. Because that's . . . wait a minute! That's a significant proportion of the population! Voting for a racist demagogue! (Sorry! A "populist.")

More (if you care) here. From the always entertaining Commentary.

X marks the spot

I take issue with Jay Michaelson's premise, well expressed though it is:

Fundamentally, religion works by saying that “if X, then things are okay."

Jay's a spiritualist, so wherever he drills in the rock of religion he finds spirituality. The gut shall rule forever and ever. But plenty of religious people actually believe X. They think X is the real thing. It's called eschatology.

You can psychologize their claims all you want, but there are people out there who believe what they say they do. It would be great if Locke's claim were in accord with the facts on the ground, and we could stick our heads in the sand until the nutsos go away. But - whoever the nutsos are - some of their claims are to be debated on face value. Gay marriage is great. The world was not created in six days. Our Israel policy is not determined by Revelations. And so on.

The Ten Contradictions of American Health Care

Uwe Reinhardt at the Health Affairs Blog points out the contradictory wishes of most Americans with regard to health care.

[A]s the policy-making elite stews in its stalemate, the American plebs dreams of a political Messiah willing to build for them a health system that:

1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even worse, government bureaucrats.
2. Limits their families’ out-of-pocket payments for health care to make it “affordable.”
3. Keeps insurance premiums and taxes for health care low.
4. Does not ever ration health care, because that is un-American and practiced only by un-American alien nations with inferior health systems.
5. Does not allow public or private insurers to let “costs” or “cost-effectiveness” ever enter coverage decisions, because that would implicitly put a price on human life which, in America, unlike elsewhere in the world, is priceless.
6. Does not mandate individuals to purchase health insurance, if they do not wish to do so, if for no other reason than that this would be unconstitutional and, therefore, un-American.
7. On the other hand, grants every American the moral right – backed up by a government mandate called EMTALA– to receive critically needed and possibly high cost health care from hospitals and their affiliated doctors, even if they are uninsured and could not possibly pay for that expensive care with their own resources.
8. Controls Medicare spending, which is widely thought to be completely out of control, as long as it does not reduce payments to hospitals or to doctors or to producers of medical technology, or to any other provider of health care.
9. Provides universal health insurance coverage to all Americans, provided it does not mean raising taxes or cutting Medicare spending or raising premiums on healthy Americans.
10. Keeps government out of health care but somehow makes sure that insurance companies do not exploit patients through incomprehensible fine print, no one engages in price gouging – e.g., charge $10 for an aspirin — and no one in health care earns excessive profits (or any at all).

That’s all.

Pots of money pretty please for primary care training and diversity programs!

Here's a call to action (read: e-mail petitioning) from the Society for General Internal Medicine. Unfortunately, I don't know explicit criteria for judging the stimulativeness of any given line item, but I would hope curing sick folks (some of whom work and make things!) would rank somewhere pretty high.

Later this week, a joint House-Senate conference committee will meet to reach a compromise on a massive economic stimulus bill. The House version of that bill includes $600 million for primary care health professions training, diversity and nurse education programs. This would double the current level of funding, a long needed beginning to healthcare reform.Unfortunately, the Senate version of the economic stimulus bill does not include funds for these Title VII primary care training programs.

Please contact your two senators and your representative today! Lawmakers need to be convinced that the compromise bill they send to President Obama must include $600 million to help ensure the supply of primary health care providers, namely internal medicine, family medicine, pediatricians, dentists and nurses.

Good things in the stimulus package come in hundreds of millions

Look what Barack Claus brought down the chimney - the Federal Coordinating Council for Comparative Effectiveness Research! This is wonderful news. And I'll even try and convince the skeptics at some point.

The Catholic worker against torture

Mike Benedetti continues to be idiosyncratically (& admirably) activist - going to DC as part of Witness Against Torture.

Breaking News: Obama Cabinet Selection

Secretary of Jewish-American Literature.

The Emanuels Take Over

If Rahm is chief of staff, does that mean we get health care vouchers from his brother?

For the Sausage Factory: Various Health Care Proposals as Fodder for Compromise

Even in the midst of the presidential campaign, we should remember that there are a number of health care plans other than those proposed by McCain or Obama. Given the vagaries of politics, any given plan is very unlikely to be passed. Thus we should become familiar with the details of a variety of them, since any compromise will look like a hybrid.

More in Clinical Correlations.

Needed renovations, or setting the roof on fire?

Our exposure to health care policy - as part of our primary care curriculum - ran the gamut recently.

Last week we went to Washington to advocate for increased support for the primary care workforce. (In brief: we need more primary care health care providers. There aren't going to be enough of them, especially if we start covering the uninsured. We need to create incentives to help people choose to go into primary care rather than the oversubscribed and overpaid subspecialties.) We spoke to young, fresh-faced, intelligent, and hyperinformed health care staffers of some of the Capitol's most influential senators - they were genuinely friendly and happy to see us.

One senator's office is working on a creative idea left over (so they said) from Hillarycare, a "foundation" to ensure a funding stream for primary care education, training, and loan repayment, paid for by a tax on insurance companies. Of course, no one in the room disagreed with that. Everyone realizes that primary care training needs to be dissociated from the current system, private insurance companies and hospitals included. (Our very friendly lobbyist, paid for by NYU Medical Center and along with us to make sure we didn't say anything stupid, was not very excited to hear about this idea.)

This week (thanks to a colleague of mine, whose father is a fundraiser for the senator in question) we went to the office of the junior senator from New York. We spoke to her for fifteen minutes about the necessity to improve funding for the primary care workforce - she was impressively informed, realistic about the political obstacles, and . . . oh, who am I kidding? We were giddy. We got a picture, too!

On Friday, we visited Jack Resnick, an internist (let's say it: a primary care doctor!) with a practice on Roosevelt Island. "[In Washington,] they're talking about payment reform, which is . . . pffphpht! You have to tear out the guts!" By which he means - you have to alter the incentives so as to drastically reduce hospitalization. It's an open secret that hospitals are not the best places for sick people. They breed infections, deconditioning, delirium, psychosis. Resnick's approach (and the approach of this organization) is to closely monitor the chronically ill patients in his practice, keeping the hospitals at bay by providing patients sophisticated but sensitive care at home. It's more feasible for Resnick because (a) he lives on an island; (b) he's ready to devote himself nearly 24-7 to his patients. But this, he says, is the wave of the future - money saving, intensive, personal primary care for the elderly and chronically ill, taking away money from hospitals where it's not usefully spent (or, rather, uselessly overspent).

Resnick, and the AAHCP (see the link above), are behind the Independence at Home Act, a bill introduced in September which would experiment with cash rewards for house-call physicians that trim Medicare outlays for high-cost patients with multiple chronic conditions.

[revised per comments]

In Which a Kesher Israel Member Waxes Ecumenical

Psst, Joe! Does Barry Freundel think you and Sarah Palin worship the same God?

Well that's all right then

Worried whether your favorite presidential candidate will defeat the other party's lying traitorous scum and save our nation this November? If you care about health policy, don't worry about it. Neither man's plan has a pig's chance at a barbecue of getting anywhere near passage.

The Art of the Improbable

Today I voted for Paul Newell and Daniel Squadron. Nothing like casting your lot with the losing team! (And speaking of losing...)

* * *

You know what's useful? Reading political news.

Jewish geopolitics
Not paradoxical anymore.

I can't think of anything to blog. We're leaving for China next Monday, and I'm occupied with traveler's questions (will my bottles of Passover wine explode in my baggage? will my two-year-old daughter have to translate for us? will I learn to speak only a smattering of Mandarin, in a thick Fujianese accent?).

So I'll throw an article your way by someone who davens and teaches at my shul. I think it's very reminiscent of Michael Walzer's political philosophy.

Israel again [in the modern era] faces political decisions, such as to how to deal with other peoples and/or nations that critically affect their national security. Consider, for example, the following question: Is Israel obligated to construct the security fence, and/or otherwise to pursue policies, so as not to foreclose the possibility that a viable (and peaceful) Palestinian state can emerge in the West Bank? And, whether or not international law, or general moral principles applicable to Israel as a state, would so require, is there some, or any, particularly Jewish value that bears on this
question?

[. . .]

[. . .] Israel’s claim is not that it itself is a just, liberal state. Rather, Israel’s claim is that a state fostering Judaism (but still protecting the basic rights of all citizens) islegitimate within the context of a pluralistic international order that includes both other states dedicated to pure neutral-liberalism, and other states dedicated to “decent” particularist visions, e.g., to Islam, or to Christianity.

Such a pluralistic vision of the place and role of Israel vis-à-vis other nations has, I submit, very deep Biblical roots. Thus the vision of the end of days at the conclusion of Isaiah Chapter 19 is not a vision of an end to all nationalisms, nor a vision of Israel dominating other nations, but rather a picture of Israel co-existing with Egypt and Assyria:

In that day, Israel shall be a third partner with Egypt and Assyria as a blessing on earth. For the Lord of Hosts will bless them, saying, “Blessed be my people Egypt, my handiwork Assyria, and my very own Israel.”

We are not wrong

The New Republic has two post-mortems of Tuesday's anti-liberal revolution worth reading and quoting. One, though anonymous, is written (I confidently aver) in the hyper-literary, sometimes tortured style of Leon Wieseltier, though it does at times manage to stumble over eloquence on its way to the heights of purple prose:

There is honor, moreover, in a certain kind of loss. In our distracted and accelerated and gamed society, with its religion of winning, we sometimes forget this. But the many millions of Americans who believe that the tax code should be more fair; and that one of the ends of government is to bother itself about its neediest and least fortunate citizens; and that the morality of the market is not all the morality that a society requires; and that the Bible is not the basis of a democratic political order, or of our political order; and that robust stem-cell research, and science more generally, is a primary social good; and that gay marriage is a question of equality and not the beginning of the end of civilization; and that American troops must not be sent to war ignorantly or dogmatically, or without the means to win; and that the good reputation of the United States in the world is one of its most powerful historical instruments--the many millions of Americans who believe these things are not wrong. They are merely not a majority. But they are a very large minority.

The other is by TNR's editor, Peter Beinart:

[C]ultural sensitivity is one thing; principle is another. In their attempts to win rural voters, Democrats have already essentially abandoned gun control. That doesn't keep me up at night. But gay marriage is different. The fact that it is widely unpopular cannot obscure the fact that it is morally momentous and morally right. Liberals once lost elections for supporting civil rights as well and now look back on those losses as badges of honor. Eventually, since young people are far more tolerant of homosexuality than their parents, gay marriage will stop hurting Democrats at the polls. Until then, the party should try to win elections on other issues--and look forward to the day when conservatives apologize for trying to deny yet another group of Americans their full human rights.

Postscript: I've read in some liberal blogs (this suggestion is usually made by right-wing commenters, but let's take it in good faith) that we should embrace federalism in the service of gay marriage and other causes we hold dear. Let New York, Massachusetts, and the Blue Brethren move forward, and Wyoming will . . .catch up, or something. ("Heterosexuality forever!" at the courthouse door?) A historian friend, "DRF," made the following comment, which is worth posting separately:

I'm going to tackle the issue of a new federalism that was raised by elf and Zack. I, too, have been wondering if we are headed for a new federalism on social issues, and I'm not yet certain about how I feel about that, if indeed we are. But I adamantly disagree that antebellum federalism on slavery was a bad thing. It's true that antebellum federalism meant that there was a period of two generations (roughly, 1802-1865) in which slavery wa illegal in most circumstances in the states north of the Mason-Dixon line and legal in the states south of it. But the alternative to this was NOT to make slavery illegal throughout the U.S. If the framers of the Constitution had attempted to resolve the issue of slavery at a national level in 1787, the result would have been either (a) no federal union at all; or (b) the continuing legality of slavery throughout the U.S. And if slavery had remained legal throughout the U.S. in the early 19c, I doubt that northerners would have gathered the courage to push effectively for its abolition at a national level. Many northerners who opposed slavery in the slavery 1780s and 1790s were nevertheless anxious about the prospect of living in a multi-racial society; specifically, many feared that a large-scale "race war" would break out if slavery ended abruptly without a national plan for shipping ex-slaves back to Africa. When numerous states abolished slavery within their borders and managed to create peaceful (albeit segregated) multi-racial societies, those who witnessed the process gathered the moral courage and political confidence to push for an end to slavery elsewhere. On balance, then, I would argue that diversity in states' social legislation has often been a liberalizing influence, whether or not it's "fair" in the short run.