By The Way, I'm Not Writing About Sarah Palin

At all.

I am not going to speculate about her resignation or her political future because I really don't care. If the Republicans nominate her, they deserve her. If they nominate a thinking candidate like Charlie Crist or Jon Huntsman, with whom I disagree on policy but respect as pragmatic statesmen, they will be the better for it. Don't expect them to nominate Susan Collins or Christie Todd Whitman though. They aren't feminist enough to nominate women who believe women should have rights, regardless of their defense of Palin against liberal 'misogynists.'

If you want to read about Palin from either perspective, pro or con, then Ron Chusid of Liberal Values offers questions into her character here, here, and here while Jenn Q Public defends her heroic courage in fighting chauvinism here. Pick your preferred brand, both writers communicate well and raise their questions or make their defenses with spirited ability and are worthy of your attention.

This is the last time I will mention her in a post until 2011, we'll see what happens when the primary cycle starts.

A Moment of Radical Reflection

I do not have a great deal of faith, as those who have read my last two postings already know, in the direction that congressional health care reform is headed. Both leading Democrats in both houses of Congress and the White House are refraining from committing to systemic reform of American health care, and systemic reform is what American health care needs. Most Republicans, of course, mean something entirely different by 'health care reform'; they mean the thorough gutting of government health care entitlements for the benefit of private insurers and an essentially unfunded (the tax credit proposed in the one Republican plan I have seen is not going to help anyone who actually needs help to pay for their health care) mandate to require Americans to fork money over to same. The depressing part of the mire into which health care reform is sinking is how close to one another the plan advanced by Teddy Kennedy and the plan advanced by Judd Gregg really are. They are closer to agreement than disagreement and this should make us all worry.

This, however, is not a post about health care. It is a post about thinking and thought. I am sure everyone who follows this blog has noticed my output has shrunk significantly over the last month or two. This is not because of a lack of topics on which to write, but the fear of boring repetition and the desire to clarify thought rather than merely regurgitate it. We live in a nation in which corporate entities with no official standing wield amazing political and economic power. In many ways, these corporate entities are the extended Department of the Economy. They donate massive amounts of money to politicians and claim protection under their right to 'free speech', when the issue is not speech but institutionalized bribery. Anyone claiming that this is not a factor in the health care mire, the labor mire, or the question of economic bailouts is either guilty of intellectual dishonesty or extreme naivete. This not to say that everyone in Washington is corrupt, though it can certainly be argued convincingly that Washington culture is too forgiving of corruption, but rather a critically realistic appraisal of the facts of American political life.

'Critical realism' is a philosophical term coined by and associated with scientists of religious bent who do not consider scientific fact as we know it and divine revelation to be mutually antagonistic, but this does not necessarily give full credit to the words and this certainly not how I mean the term, though I agree with the 'official' critical realists in their argument that God and science are not mutually exclusive. I choose to redefine the term in the same way that political liberalism has been redefined in some ways from classical liberalism.

'Realism', in my parlance, is the refusal to fall into utopian forms of thought but rather to see the world as it is and will most likely remain whether that sight is pleasant or unpleasant. Anarcho-capitalism, libertarianism, neoconservatism, and Jeffersonianism/Jacksonianism paleoconservatism are all utopian forms of thought. So is the Dominionist theocratic conservatism of the contemporary religious right. All of these systems make fundamentally incorrect assumptions about reality and human nature. Democracy does not magically make human beings enlightened superhuman creatures speaking in the voice of God as Rousseau and Jefferson would have us believe. Democracy is a more equitable method of apportioning decision-making, but it does not guarantee the decisions will be better. In the same vein, while capitalism is an excellent way of producing wealth, it does not guarantee the wealth will be fairly distributed nor does a free market guarantee that everyone with the ability who makes the effort will have an equal chance to compete in that market. Many people of superior ability will never become rich or successful (Charles Goodyear never received a cent for his name on the tires and died broke long before anyone got rich off of rubber and Nikola Tesla died in a tenement in New York City) while many people will achieve wealth and fame for dubious merit (Paris Hilton and George W. Bush, anybody?) because that is the reality of life. A free market will not change that, and the complete lack of regulation that 'free marketeers' advocate is not genuine free market capitalism but corporate fascism.

Likewise, communism, syndicalism, anarcho-socialism, and anarcho-communism are also utopian modes of thought. They are dependent on human nature being far better than it is. While I believe socialist thought is necessary in a civil society, it is ludicrous to believe that enforcing a socialist system will change human nature anymore than a capitalist system or a democratic system.

Nor does the Randian justification of the morality of the dark side of human nature and the evils of altruism and socialism inherent in objectivism present a solution. Then we face a dystopia in which up is down, black is white, good is bad, and predatory anti-social impulses are ultimately justified. In a very real sense, we are living in that world now, painting it in objectivist colors won't change it but simply make us all feel good about our greed and hate. Neoconservatives already preach a Randian morality when they rail against the welfare state, and Kenneth Copeland has already drawn Ayn Rand up in frightening Christian colors with the 'prosperity doctrine.' Ultimately, as horrified as she would be to hear the argument, Ayn Rand offers nothing more than John Calvin minus God, plus a happy, smiley face.

So, having rejected utopian forms of thought, where does that leave us? I'm not always sure. Democracy may not be a magic bullet to solve the world's ills, but it is (as Ben Franklin and Winnie Churchill reluctantly conceded) better than all the other choices. Citizens must have an equal voice in society in order for society to be equitable. History has shown that the little people can make a difference, for good or ill, and we Americans must embrace that part of the American dream rather than surrender to the economic fantasy of the house, car, spouse, and two kids. That is not only a dream that not everyone will realize, it is a dream not everyone even shares.

Conservatism, especially, has a proud history of rejecting realism. Both Ronald Reagan and George W. Bush dismissed concerns about the real costs of their philosophy of greed gone mad with platitudes about 'optimism.' Optimism is not simply faith that everything will turn out for the best in ignorance of real problems. That's willful denial of reality, or schizophrenic delusion. Nor is a critical, realistic examination of the real problem America and Americans face (coupled with the concomittant belief that those problems need to be addressed and there must be an effort to solve them) 'pessimism.' Yet liberals (whose fundamental flaw in recent years is their stubborn insistence on seeking a fair compromise with the unreasonable right) are the ones viewed as living in a fantasy world by many Americans. I will agree that they are to a certain point: the point that American liberals believe that an American politician who shares their principles necessarily shares their desire to realize their principles in the field of policy. I have harped on this before, but American 'progressive' Democrats chose overwhelmingly to vote for Hillary Clinton and Barack Obama in the presidential primary rather than a liberal candidate such as Dennis Kucinich. Both candidates were on the record as being extremely conservative (in the genuine sense of the word, the unwillingness to risk or waste effort or resources but instead to hold them in reserve) on the issues which liberals cared most about, and Senator Clinton especially had a long record of voting with the Bush administration when it really mattered.

So we must see the world as it is, not as we want it to be or wish it were, to be 'realists.'

However, being realist is not enough. We must also be 'critical.'

We must examine the world, address its strengths and its flaws in a forthright and honest manner, and seek to buttress those strengths while repairing the flaws that can be repaired and doing our best to ameliorate those that cannot to the best of our ability. Economics teaches us that, because of scarcity, there will always be an inequity of wealth. Rather than make utopian claims that the free market, a totalitarian government, a democratic form of government, or a communist system can solve those problems we need to admit that those inequities are real and inherent in the finite world in which we live and work to reduce those inequities as much as possible in the name of a stronger, juster society and to ameliorate the conditions of those most deprived. A critic speaks the truth as he sees it, and strives to see the truth and know it as best he can from his perspective.

Capitalism is the best form of economy, just as democracy is the best form of government, but neither will solve America's problems or the world's. Socialism is a fundamental need of any civil society as well, for a society that does not serve its members will not find any loyalty from its members. The Chinese believed imperial dynasties enjoyed the 'mandate of heaven' and that crimes against society would cause an emperor to lose that mandate. Democrats, republicans, and radicals have spoken of the right of revolution for many years. A society must serve its members equitably or it must be reshaped.

American political society requires reshaping. The Republican Party of today does not represent a genuine free market, or civil libertarian ethic anymore than the Democratic Party of today represents a genuinely egalitarian or inclusive ethic. Those of us loyal to such ideals must strive to better both parties for in our current political system we have no alternative, and our current political structure gives those parties control over the political system.

Freedom requires responsibility and judgment and, as much as the hard right wishes to deny it, Orwell was right... in a free society some animals cannot be more equal than others if the society is to remain free. Human nature is stacked against a free society and we must be aware of that fact and strive against it.

Conservative Republican Health Care Reform: These are the people telling us they want to protect us from rationing?

I've already written that the health care plan championed by Senator Teddy Kennedy (D - Massachusetts) leaves a lot to be desired at best. It seeks to rely on the dangerous crutch of corporate subsidization of employee health care while failing to address the major problems presented by our existing system. I likened it to the state health plan adopted by Massachusetts during the Mitt Romney administration, calling it 'Romneycare Plus.' Naturally, I stand by this attack. If the Kennedy plan is the best that the Democratic Party can produce, then the Democratic Party deserves a great deal of criticism on this issue.

The sad and tragic fact, however, is that the Republican plan being championed by conservative Senator Judd Gregg (R - New Hampshire) is far, far worse. Some of you may remember Senator Gregg, whom President Obama had nominated for Secretary of Commerce (and who first accepted and then repudiated that nomination in a manner that could not have looked more like a deliberate attempt to deceive and discredit the administration if the senator had been studying at the Actor's Studio in preparation for the performance) back when cabinet appointments were still the News Du Jour every day. Yes, that was a bit of an ad hominem attack. It doesn't prove the following argument in any way. It is, however, worth remembering.

Senator Gregg advocates a program called 'Coverage, Prevention, Reform' or 'CPR.' This program seeks to solve America's health care ills by penalizing working people and senior citizens in an attempt to force them to pay full price for private health insurance for which they would already be paying if it were within their means and met their health care needs; not to mention ignoring Medicare's highly successful competition with private health plans among those seniors who can afford them. They are not 'on the dole' because Medicare is cheap, if it were the failed and broken program described in the linked plug for CPR then very few of the people Senator Gregg wishes to force off of it would be on it in the first place . For those of you who doubt me in my description of CPR, please read the link. It is not a liberal analysis of the plan by left-wing advocates, but rather is an advocation of the plan as written by its conservative authors.

Take the following statement into account:

"Ultimately, this information would be used to tier Medicare copayments and deductibles to encourage beneficiaries to utilize 'higher quality more efficient providers.'" The single quotes within the larger quotation are mine, I want you to read the whole sentence and consider its meaning.

It is very difficult to come to any conclusion other than this: a primary focus of CPR is raising the price of Medicare for senior citizens to make them leave the program and purchase private insurance instead. Hardly the kind of health care reform desired in a system where the number one problem is economic access to health care due to consumer costs and the number two problem is rationing of service by for-profit providers in service to their bottom line. It should also be noted that there is in this sentence a tacit admission that private insurance cannot compete with Medicare on purely 'market' terms but must instead rely on government sabotage of Medicare.

There is a lot of repetition of the phrases 'preventative benefits' and 'disease management' in the text. They appear in bold print. Certainly these are necessary medical tasks that should be paid for, but they are not the sum total of American medical expenses and the simple fact is likely that preventative care is not the magic cure for health care costs that both liberals and conservatives claim to believe it will prove. I am certainly not dismissing the need for preventative care, but I am against siezing it as the sole great mantra of health care reform as is so popular. The reason the repetition of these phrases is so important, however, is because something is very clear about the thinking behind this plan: reading it suggests, to me, that its authors believe that the greatest victims of the American health care system are the private providers of health insurance and that the system must be reformed in their favor.

Why do I say this? For the bulk of Americans, this package amounts to an unfunded mandate to buy private health insurance. Despite repeatedly using the word 'quality' before the phrase 'health coverage', quality is never entirely or clearly defined. Indeed, the bullet point summary specifically reads:

"Designs a cost structure (not a benefit structure) in order to allow for flexible plan design." The emphasis is mine.

CPR contains no mechanism whatsoever to ensure 'quality health coverage' beyond the very subjective and limited areas of 'preventative benefits' and 'disease management.' In fact, despite the focus on preventative benefits, the Medicare portion suggests a belief that seniors are getting too much preventative care. Senator Gregg appears to think so. I quote:

"And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not."

Many medications require frequent blood tests to monitor levels of medication in the patient's bloodstream. As an epileptic under medication for grand mal siezures, I can attest to this personally. Any visit to a doctor's office that I make inevitably entails a blood test. As a man on the wrong side of thirty, sugar and cholesterol tests are becoming more necessary as well. The preventative care requirements for such testing for seniors is greater than in my case as a thirty-two year old male. Not lesser. A certain number of office visits for check ups and progress reports are a necessary part of preventative health care for anyone, as well, moreso for seniors.

It should also be noted that someone is always paid more when physicians order more tests, procedures, and office visits... whether the physician is paid or not. Private insurance does not change this fact anymore than Medicare does. Either way, you pay a co-payment for every test, procedure, and office visit. Proper preventative care will mean more of these for most people (who do not see the doctor enough) rather than less. To be fair, Senator Gregg's specific indictment of Medicare's overuse of preventative care is not in the subject of the proposal as linked. However, it is a fair assumption that the attitude of a great advocate is based on belief in the substance of the object of his advocacy.

The most insidious part of CPR, however, is the secret tax hike. CPR makes health insurance premiums and care costs totalling over $11,500 a year per family or $5,000 a year per individual taxable income if you receive coverage through an employer-funded program and places the same ceiling on its proposed tax exemptions for health insurance premiums. Anyone who has any experience with health care costs realizes how low these numbers really are. Assuming an individual paid a premium of $100 per month (my share of the premiums paid when I had employer-paid care came to more, I am guessing most people's expenses do), then that means there is still $7,000 a year of premiums not at all covered by the tax exemption. Worse, some people require actual medical care beyond their premiums. Since the cap has already been eaten up by less than half the cost of premiums, none of this is covered. So the tax incentive for private insurance is essentially meaningless and the tax exemption for medical premiums on your payroll taxes is mostly history.

The result of all this is to make health care more expensive for most people, harder to get for most people, and to force the working class and senior citizens out of employer-paid care and Medicare and into the private market despite the fact that most of us can't afford private coverage in the first place and many of us can barely afford employer-paid coverage as corporations slough off more and more of the costs on their employees.

So where is the reform? And why are they talking about rationing care for seniors? Isn't that the horror story they use to scare people away from 'socialized medicine'? The notion of 'rationed care'? It looks like the biggest purpose would be to institute a system of care rationing to scare people away from 'socialized medicine' with which the oh-so-effective 'free market' cannot compete.

Something smells bad.

Et Tu Teddy? Conservative thinking on Health Care is not just a Republican problem

I am a great admirer of Ted Kennedy. He is a great senator and, as ugly an incident as Chappaquiddick was, he could not have been a worse president than Jimmy Carter. I still maintain he would have been a better choice.

Unfortunately, Senator Kennedy is falling prey to the creeping conservatism the Senate has displayed on major issues since the election of President Obama. Most disturbingly, Senator Kennedy is displaying this conservatism on the issue of health care. For those of us who saw the senator as perhaps the last senatorial champion of meaningful health care reform, this is a trifle disturbing.

Senator Kennedy's proposal is 'Romneycare Plus.' I suppose it makes sense for the senator to see this as a natural starting point based on the 'success' of Romneycare in his own state. His plan mandates insurance coverage as many states mandate auto liability insurance, but would offer a competing public health plan open to anyone who wished to purchase it. This is certainly an improvement on the baldly Romneycare-esque ideas discussed by the White House, which have dropped President Obama's original campaign proposal of making the congressional health plan available to the general public. A public component is necessary for any health care reform project, as a pure free market plan merely agitates the existing problem of provider negligence, corruption, fraud, and depraved indifference without increasing access to medical care for those currently without insurance or offering real solutions to those unhappy with their current health care options.

The problem is that the senator isn't entirely willing (or doesn't believe the voters willing) to publicly fund the public component of the reform plan. Instead, his proposal would expect American business to continue to subsidize health care for their employees or else to subsidize the public plan instead. I am no great booster of the culture of the American corporate community, which is why I don't want to see them continue to control health care as they do now, but I also recognize the real economic handicap that our current employer-paid health care system lays upon American business. One of the strongest arguments for public health care is the economic benefits to be gained from removing this handicap. Instead, Senator Kennedy offers us a moderate plan designed to mollify conservative opponents of single-payer while delivering a backhanded liberal slap to the face of American business. That isn't just a failure of policy, it is also a political error that will doom any such proposal.

As I have said before, I advocate a system in which the profit motive is removed from health care and the system is under the control of doctors and patients rather than bureaucrats either corporate or government. I believe a single-payer formula is the best way to fund such a system, because of the benefits to both health care costs (which will be lowered by the broad cost sharing of a national plan into which everyone plays taxes) and the economy (which will benefit from a system in which business does not have to shoulder half of the nation's health care costs) and because it is simply the right thing to do. However, France and Germany have non-profit health care systems in which private business still plays a role and Sweden has a for-proft system which operates very well under a far more equitable balance of socialism and private enterprise. All three of these systems are worthy of examination as well.

The fundamental barrier to health care reform is not cost: despite conservative propaganda, tax increases to pay for public health care would be off-set by the disappearance of inequitable insurance costs and increased access. It is the attitude of Americans on the issue. Despite all the evidence showing how bad our system really is for more than half of Americans, they persist in the claim that American health care is superior to that of countries in which citizens can go to the doctor when they are sick. 45 percent of Americans may indeed enjoy great health care, but the larger portion of the population does not. The selfishness of the 45 percent does not justify denying the needs of the 55 percent.

The number one complaint voiced by opponents of public health care is that waiting times for non-emergency doctor's visits will increase. First of all, this does not have to be true. It is merely a possibility. Second, prolonged wait for non-emergency service is a fair trade for affordable health care guaranteeing I can see a doctor when I really need to.

That is the real problem. Some people just find their own convience more important than the health and lives of Americans.

Plans like the current White House proposals, Senator Kennedy's proposals, and others that attempt to curry to that misaimed priority, will ultimately not deal with the real problems in American health care.

The Health Care Topic Not Everyone Considers: How should we pay our doctors?

One of my frequent sources for outside opinion from the left, Ron Chusid, made me think about the aspect of health care I had not considered most closely before. As something of a policy wonk with strong feelings on this particular aspect of policy, my focus on health care has been the individual's access to quality health care and the cost to that individual. I have not considered, one way or the other, just how doctors should be paid. This has changed a lot over the years.

In the past, many doctors were the 'country doctors' and 'town doctors' of storied movie and television lore. Such doctors were an early form of 'socialized medicine.' They did not punch a clock, but rather were on permanent call should someone need emergency medical assistance and either kept regular offices hours during the week, made regular rounds, or some combination of the two. In return, they were supported by the community. Some of them lived in a home built or paid for by the community, others moved from guest room to guest room, sleeping with one family and then another on a rotating schedule. All were frequently dinner guests at the homes of their patients, some ate all their meals in community homes. If the doctor was paid in hard money at all (and not all were) it was from a community fund into which all the members of the community paid. One could not get more 'socialist.'

Urban doctors (as the phenomenon of urbanization took deep hold in the US) usually worked in hospitals. Hospitals were either public institutions, supported by local tax money, or private charities supported by philanthropists or religious groups. These sources of funding were much stronger than in today's 'for profit' hospitals, and the individual charges to patients were much lower. Doctors frequently lived in the hospital, particularly younger doctors (this is the source of the term 'resident' in medical parlance), and often ate there. Doctors in private practice, usually older doctors, were paid by their patients on a per visit basis.

Health care reform and the largely mythical question of 'cost control' (mythical in the sense that the thesis 'many medical costs can be controlled at the supply end of the spectrum' is questionable at best, many things can be done to control consumer costs) frequently focuses on medical procedures (the much villified 'unnecessary procedures' and the more genuinelyrather than doctor compensation. When doctor compensation is mentioned at all, it is used as a fear tactic by conservatives claiming that the US medical system will suffer a brain drain if doctors cannot get rich. It should be noted that since younger doctors at the low end of the profession are as underpaid and overworked as established doctors at the high end of the profession are underworked and overpaid, the question of how doctor compensation affects health care costs and how health care reform might or should affect doctor compensation becomes an important consideration.

Ron quotes Ezra Klein, blogging for the American Prospect, talking about just this subject. The primary resource for Klein's article is a poll by Kaiser/NPR. Klein, citing the poll and showing a nifty graph, demonstrates that 25% of the people polled believed their doctor should receive a yearly salary while a whopping 70% believed their doctor should be paid for each visit with patients. Klein than says:

"Honestly, I'm surprised patients even have an opinion on that. And it might be a very weak opinion. But for now, the public prefers that doctors get paid for each thing they do than on a salary basis. They prefer, in other words, that doctors have an incentive to do more rather than do less."

It can be taken that way, if one wishes to read it that way. Except that, under the current system, the final word on your medical care is not your doctor. It is either the isurance provider that pays for your care or the HMO or hospital that pays your doctor. This is an important distinction. It is also important to remember that there are times when it might be in your interest for your doctor to do more rather than less. Ron notes:

"Many have experienced the horrors of the HMO era in which doctors were actually paid based upon how little care they provided. Many also see the difference between the more old fashioned model of doctors in private practice as opposed to the increasing number of doctors who are employees paid a salary. They have seen the difference between a doctor who is motivated to work long hours to care for their patients and salaried doctors who check out at 5:00."

Ron makes a very important point for basing doctors' pay on service provided to patients rather than service to the clock. I work for myself, and in 'private practice' I am paid for the work I actually do, not for my time on the clock. While one can argue that a doctor in a hospital might deserve compensation for his availability, I agree with Ron that a doctor's primary compensation should not be for punching a clock.

To repeat an example I gave in my comment on Ron's post, compare the way doctors are compensated with the way lawyers are compensated. An associate in a law firm (the rough equivalent of a resident in a hospital) is paid a salary, because they are an employee. However, their pay is greatly affected by their billable hours (more productive lawyers are paid more) and most law firms pay extra compensation for courtroom hours. Lawyers in the same position as doctors of equivalent experience are incentivized to work more rather than less. What is more, lawyers who do not meet firm standards of billables will see their pay drop and may be fired. While this exact model may not be the perfect choice for medical compensation, it outlines a stark difference between the employment models.

I should note that prescribing more drugs (something many liberals bash, as the model which incentivizes doctors for prescribing specific drugs is clearly mistaken) or ordering more procedures (which some hospitals and doctor's offices do indulge in when they know a patient has a plan that will pay for it) are not what I am talking about. These are certainly corrupt practices which liberals rightly bashed. I am talking about the time and care the doctor gives a patient. Prescription incentives and procedure incentives may be fat in need of trimming, but doctors should be incentivized to give the highest quality care to the patient rather than worship the clock.

The major problem with health care reform is the obsession with 'medical costs' as if some miraculous reorganization of the system will magically make things cheaper. If one obsesses with 'medical costs' than one rapidly becomes confronted by the fact that the newest medications and medical procedures will always cost more. The cost of innovation will always be applied to the cost of care. Liberal discussions of trimming wasteful costs and conservative paranoia of 'rationed care' are equally removed from the real problem.

The real problem is the cost of medical care to the consumer and the fact that high consumer costs reduce access and quality of care. The uninsured bum in the emergency room is not given the same quality of care as the teacher with state insurance, and the teacher is not given the same quality of care as the millionaire who can afford to pay every cost out of pocket. This is a very real 'rationing' problem that exists in our current system, and economic rationing will not be solved by bureaucratic rationing. The added 'rationing' effect of provider corruption, which is all but required in order to make a profit, only makes it all worse.

There is no easy solution to the problem of medical costs, and liberals who say the government can solve it all and conservatives who say the market can solve it all are equally wrong. The government cannot lower the costs of the best medical research. In fact, the kind of quality controls that the government needs to impose on prescription drug research and marketing and medical technological research might very well increase the costs of those processes. Lying about this or hiding from it is only counterproductive to health care reform. The market cannot improve the situation because free enterprise must make a profit to remain viable. As long as research companies, medical providers, and hospitals are driven by the need to make a profit then consumer costs will continue to rise and Americans will continue to be denied access.

The only problem that can be addressed is consumer cost, and this problem can be addressed in at least two ways. It can be addressed by spreading consumer cost as equally as possible among the largest number of consumers and subsidizing the rest (which our current system attempts to do and fails) or it can be addressed by addressing the profit motive of corporate health care. France and Germany have gone a very long way toward solving many of the problems discussed through the latter method, with some of the former. Sweden has done even better through the former method, with some of the latter.

Which brings me back to policy. First and foremost, physician pay needs to be restructured: doctors must be incentivized to serve the needs of their patients, not the needs of HMOs or hospitals. This will have a definite effect on the overall quality of care. Second, a way must be found to address consumer costs and individual access. There are plenty of possibilities, but I admit to having particular pereferences.

I admit to favoring a system in which everyone receives access to a primary care physician of their choice and that physician and the indivual patient have the responsibility for health care decisions. I do not believe bureaucrats should make such decisions whether they work for insurance companies or the government, whatever system we choose we must be certain that neither corporate nor government interests can restrict access to treatment nor countermand the most informed decision made with the advice of medical experts.

Economic access, however, is as important as bureaucratic access. As employers increasingly slash benefits in difficult economies and small business owners have never been in a position to effectively provide benefits to their employers, I believe greater government involvement in the payment process is necessary. There should be dedicated, government subsidized health care plans for small business owners and their employees, in which the costs normally borne by the employer are borne by the government. This would dramatically increase the ability of entrepreneurs to compete in the national marketplace. I've said before that the current two-payer system, in which American business subsidizes a significant portion of the nation's health care costs to save American taxpayers a buck is a far more crippling economic burden than any corporate tax. Those costs should be picked up by the government as well. Any necessary tax increases to pay for health care would be entirely compensated by people receiving health care. While these two steps, by themselves, are not the entire process of reform they are a far bigger step we have taken along the right road since Medicare.

If I sometimes appear a broken record on the topic of health care it is because this is the single most crucial area of American life in need of truly radical reform.

Senator Arlen Specter (D - PA)

This one surprised me. I mean, there had been some gossip on HuffPo about the possibility about the time the GOP was bashing Senators Specter, Collins, and Snowe for voting with the administration on the stimulus bill. I would never be surprised by Specter voting with the administration, he has more in common with moderate and conservative Democrats than with reactionary Republicans. Yet I would not have believed he would so willingly give the Democratic caucus a filibuster proof majority.

After all, the election judges have ruled that Al Franken won the Minnesota Senate race and it is unlikely that the state Supreme Court will overturn the election, now that the ballots have been counted. Which means, when Franken is seated, that will make 60 (counting independent Joe Lieberman and Democratic Socialist Bernie Sanders) votes in the Democratic caucus. Though Specter denies that he will be 'an automatic 60th vote for cloture', the pressure he feels in the Democratic caucus will be very different from the kind of pressure he felt in the Republican caucus. Rather than being pushed to obstruct, he will be pushed to help govern.

I have never been a huge Specter fan, but my biggest problem with him has always been the way he beat up Anita Hill during the confirmation hearing of Justice Clarence Thomas. His voting record has shown the kind of attempt to exercise sound and independent judgement that can and should be admired. He has never been either an ideologically rabid conservative nor a knee-jerk liberal. He's been left of most Republicans on abortion and gay rights, though hardly a leader on either issue. I understand that this move is primarily one about political self-protection and that the GOP essentially pushed him into this. I think it a terrible mistake on their part. He does them much more damage as a Democrat than he did them as a moderate Republican, and this only happened because the Republican Party chose to make it happen.

Watch two members of the Democratic caucus, however: Senator Ben Nelson (D - Nebraska) and Joe Lieberman. Either one could decide they have more power in a Senate that is not filibuster proof. Lieberman could jump caucuses and Nelson could drop his Democratic party affiliation and join the Republican caucus as an independent. If either happens, don't be shocked.

Money For Nothing: is the Best Education Policy No Policy at All?

Now stop a moment. Don't let the title scare you. I haven't switched parties, I am not going to write a piece about gutting or disbanding the Department of Education (if we are going to start slashing cabinet departments, Homeland Security is the only genuinely expendable department that immediately occurs), and I am certainly not going to talk about defunding public schools. I believe there needs to be a federal involvement with education and that we should certainly not be spending less money. I'm simply not sure I believe in education 'policy.'

President Obama started outlining his education plan all the way back in March, but I did not write a piece on education then because I wrote two pieces on foreign policy, one on health care, and a couple polemics against GOP attacks on the EFCA. I've continued to be primarily occupied with political polemic throughout April, however, and I feel a pressing need to get back to the kind of meaty policy wonkery that motivated me to start writing in the first place. The most important issues (in my mind at least) may be health care and the economy, but I have written on both those topics quite a bit and I haven't tackled education aggressively yet.

I'll start with some of President Obama's ideas, which include: incentivizing teacher pay based on student performance, ending state limits on charter schools, and lengthening both the school day and the school year.

As it happens, I have reservations about the first two and outright oppose the latter two.

I am all for raising teacher pay across the board, improving the pay scale for experienced teachers, and adding incentives for the best teachers choosing to go to the worst schools. I think all three of these things are good idea. Nor do I have a real problem with ending or modifying teacher tenure, though I do believe this must be looked at carefully. There are benefits to tenure as well as negatives and a more judicious granting of tenure and a more aggressive willingness to weed out bad apples before they are tenured might be far more appropriate than simply ending tenure. Still, the question of whether to retain, eliminate, or modify tenure is not the pressing issue to me that it is to either teachers' unions, top-to-bottom reformers, or hard-line conservatives opposed to spending money on education.

My biggest reservation is the idea of incentivizing teacher pay based on 'student performance.' Now if you are one of today's current crop of gung ho back-to-basics school reformers, this may offend your sensibilities on a vast scale, but it needs to be said: None of the currently en vogue methods of measuring 'student performance' has anything to do with actual education. Neither classroom grades nor test scores measure what a kid has actually learned. The former measures the child's ability to go through required motions to pleasure authority and the latter measures the child's ability to negotiate modern standardized tests. What is more, in the case of the latter, there is the very real and valid concern that teachers are teaching the test rather than educating students. This is already a concern because of No Child Left Behind, and it was a serious concern among many teachers and parents even before that.

Standardized tests do not measure students' level of education, they measure a student's ability to take a test. As a great example, former New Jersey Senator and basketball star Bill Bradley had a miserably average SAT score... and yet he was a Rhodes scholar. Take a moment to think about that: if standardized tests were really an accurate measure of education then such a thing would not be possible. Yet our educational culture relies more on standardized tests than ever, not less.

As for grades, many elementary, middle school, and high school grades are based on completing and returning homework more than any other factor. Much of the homework is tedious and redundant to students who are actually learning in class and the brightest, most successful classroom students are the least likely to feel a pressing need to wade through pages and pages of the same books they covered all day at school. They blow off the homework and their grades suffer. Yet they have actually learned more than anyone in the classroom, which is precisely why the homework is so tedious for them.

Consider as well that many of the quasi-literate, dumbed down, historically ignorant high school graduates of whom we all complain have successfully navigated their time in school without failing. They all got decent grades and decent test scores and managed not to learn anything despite it all. Not so easy to track 'student performance' as it first appeared, is it?

Charter schools are a more difficult issue still. The conservative knock on charter schools is that they are expensive, while the liberal knock on charter schools is that they drain money and talent from 'regular' schools. Many charter schools are highly successful and I understand why the urge to eliminate limits on such schools is so appealing. But the final word on the issue is this: if charter schools are really so great, why the bloody hell aren't all schools charter schools?

If charter schools work, which they appear to, why is it a question of simply building more? Why are we not converting all of the schools in the country to the charter school model? If such a thing were done, then the liberal knock on charter schools would vanish. They would not drain money and talent from 'regular schools' because there would be no 'regular schools.'

The dirty secret is that charter schools are primarily so successful because the deck is stacked in their favor. The admission process is extremely selective, students who are not considered likely prospects for academic success are not allowed through the door. Students who do not meet the performance standards are not kept in charter school programs but instead dumped back into 'regular' schools. Thus much of the success of charter schools is manufactured.

This not to say that transforming the school model from the traditional system in place today to the charter school model is not worth doing. It can be argued that the working model of the charter school is far more versatile and fosters a far better atmosphere than the standard school model. It is simply important to understand that not every student is going to get straight As, regardless of the school model. Regardless of grades, however, every student can learn. This is the real issue, and the obsession with grades and test scores has obscured this. Many of the reasons public education fails so many of our students can be found in traditional public schools, particularly in poor communities. Changing the model has always shown great promise. The problem is that no one has ever changed the model, they have simply built schools using a different model and allowed the same old problems to continue with the rest of the system.

So you see, more charter schools is not genuinely meaningful until we are willing and able to convert the entire public school system into the freer model.

Which brings us to the two portions of the White House education plan which strike me as the most counter-productive: lengthening the school day and the school year.

We are warehousing our students as it is. Parents get less time with their kids, kids get less genuinely free social time (instead having their socialization experience replaced with regimented, formalized experiences which can affect their entire social outlook for the rest of their lives), and a great deal of non-productive time in which kids are simply sitting in school being bored by minutiae already serves to beat our kids down. I went to public school and can heartily attest to the effects of institutionalized bullying (and let no one tell you differently, the school system create an environment that encourages bullying and punishes the victims rather than the bullies, because it is the victims disturbing the faculty and administration routine), teacher apathy (and the powerlessness of non-apathetic teachers to to act on their better judgement), and administrative group-think. Subjecting our kids to more of all that is not going to improve the situation. It is going to aggravate it. School violence will increase significantly.

The biggest problem with the American school system is not in the schools, though it colors nearly every aspect of the schools. The biggest problem with the American school system is the idea that children can be standardized. Every child is a unique individual with unique needs. While huge class sizes, overworked or burnt out teachers, standardized tests, and reams of homework may be real problems that aggravate the attempt to treat kids like interchangeable spare parts, they are the symptom and not the disease. The disease is the belief that education can be systematized, that one magic system can apply to every kid, that individual effort and attention are not necessary, and that the student has no part in the education process. This is an institutional, cultural problem embedded deep in school administration. In the mind of the workers in the average school district office, they are the education system and the school and students are an afterthought. My mother tells a story in which, during tough economic times, a school district made the decision to cut teachers' salaries... and then outfit the district offices with the newest and most expensive copy machines. This kind of thinking, the notion that kids and teachers are supernumaries, is at the root of the problem.

Much of this is rooted in the idea of 'education policy.' Education policy is all too often geared to the idea that systems can be applied to all children and produce immediate, miraculous results. Fads, conceptual gimmicks, and just plain silly ideas have been espoused with rabid devotion, all without understanding that in a free society we are mentally and spiritually whipping the capacity to operate in a free society out of our kids. We have corporate schools to fit the corporate economy, and frequently it becomes difficult to tell the place of work in adulthood from the school in childhood.

The federal government should set academic standards, set teacher standards, police school district programs to make sure that children learn real science, real history, real math, and real literacy rather than broad conceptual images of these things, and above all else it should make sure the public school system can afford to operate. But setting policy from the top down has proven increasingly ridiculous.

The best people to decide education policy may be the teachers in each indvidual classroom, and in a free society the best thing we can do may be to give them the freedom to do it and get out of their way. Maybe, then, we can blame the teachers' unions if we don't like what we get. As it stands now, we have only ourselves to blame.