An Open Letter to Sen. Hillary Clinton

Sen. Clinton,

First, please allow me to tell you how uplifting it is to see a woman mounting a serious campaign for the presidency less than a century after the ratification of the 19th Amendment. While the playing field is by no means level - especially in light of recent studies of attitudes concerning women in leadership - you are showing us all that women can accumulate the political, social, and economic power to seriously challenge the male-dominated nature of the political arena.

I think that you have been unfairly attacked in the past, made a target by an often misogynistic right wing for your refusal to act within the constraints generally placed on women in our country. Too often you have been derisively dismissed as "Billary," a product of your husband's undeniable political skills, as though you were not as much involved in shaping him as he has been in shaping you. The double-standards of our culture weigh heavily on you, as when you exhibit traits, such as cunning and ambition, that are often considered virtuous in men, you are condemned as a "bitch" by the gender police. That b-word, incidentally, should when applied to women jar our ears as much as a certain n-word does when applied to blacks. Both are verbal slaps that socially communicate not only hatred and derision, but, most importantly Get back in your place!

All of that said, I must confess that I have some serious concerns about you and your campaign for president.

First, while we both agree on the necessity of universal health care, I fear your plan to achieve it comes complete with corporate sponsorship. I know that you were burned the last time you expressed any sort of prophetic leadership on health care before, but that doesn't excuse your coming up with a plan that does more to line the pockets of an already-too-well-fed industry. I've never understood our irrational fear of socialized medicine.

While I think a great many goods emerge from a free (or, at least, relatively free) economic marketplace, that doesn't mean that all goods should be made subject to our insatiable desire for greater and greater profits. Further, I don't think that most Americans really believe this either. Despite the neo-conservative drive to privatize everything, we are still, by and large, willing to grant that our security should be provided by the public sector. We are still, by and large, willing to grant that our children should be educated in the public sector (though I'll grant that is contentious). And we are overwhelmingly inclined to let the public sector keep on handling our Social Security.

These are goods that most Americans agree have nothing to do with dispersing profits to shareholders. And, when it is placed this bluntly, I firmly believe that most Americans would also be willing to grant that their health would be best served by those whose only goal is to care for it, rather than by corporations that are first and foremost interested in profits. And, despite vast lobbying campaigns to the contrary, this is precisely what health insurance corporations are principally concerned with.

I don't need to cite statistics to you; you've been at this a lot longer than I have. [For such, readers of my blog should see this post.] You and I both know that universal single-payer health care would be considerably more efficient than the plan you're suggesting, in which private insurance is secured for each and every American (the health insurance industries most fantastic wet dream). You've seen the same numbers that I have, showing that while 4% of Medicare's costs are administrative, less than 2% of Canada's single-payer system are administrative, a whopping 30% of the average HMO's costs are administrative in nature. You just - like so many of your political peers - lack faith in the American people to come on board.

I am similarly concerned about your shifting position on Iraq. I won't mention your husband's ridiculous claim that he always opposed the U.S. invasion of Iraq. While opposing requires of one a great deal more than just private disagreement, you can't be blamed for your husband any more than my wife can be blamed for me. I certainly wouldn't want her held accountable for every ridiculous thing I've said. No, even though I suspect he said that to lend you some credibility in the anti-war crowd, I'll let him stand alone on that one.

What concerns me isn't that your position on Iraq seems to have shifted. That, to me, is the sign of a health, evolving person, who adapts their stances when confronted with new data that makes the previous stance no longer tenable. Would that our current president demonstrate that trait from time to time. No, my concern is more in your unwillingness to admit that your authorization of this quagmire was a mistake.

I know that your first few years in the Senate were dark and difficult years. We were living under a cloud of fear. While the threat of terrorism did not begin with 9-11, the public's awareness of that threat by and large did. And that public awareness, coupled with the drums of war, cultivated a climate of fear, a climate in which it was difficult to give anything less than full-throated support of any military plan. We had been attacked, and public sentiment demanded that someone must pay. And, with the Bush administration's conflation of Iraq and the "War on Terror," it is easy to see how you could have justified voting with the overwhelming majority.

But, Senator, you were wrong. Your current stance says as much. But your mouth won't admit it, and that concerns me. I know that women are held to a different standard, especially on national defense. I know that your political enemies would have painted you with the broad brush of "weakness" if you hadn't voted for the war, and with that same brush if you now admitted the obvious, that your vote was an understandable mistake, and that you regret it. But your inability or unwillingness to admit this obvious mistake, even as you now attempt to court the anti-war vote, concerns me. Perhaps it reminds me too much of the current president, who as best as I can tell has never recognized a mistake.

Alas, in a culture in which the cosmetic trumps the substantive every time, the real reason why I'm writing you today has nothing to do with health care policy or war. It is regrettably cosmetic, more of a "process" concern than a "policy" one. As fired up as I am over health care and the war, I wouldn't have taken the time this morning to write you (even if you'll never see this) if I hadn't seen this, an apparently trivial thing which, in our culture of trivializing the monumental (and especially vice versa) somehow stands for me as a symbolic act, the significance of which I reserve the right to unpack later.

I saw that you attacked Sen. Barack Obama for claiming to have not planned to run for president. I'll admit that Obama's claim, while trivial, seems disingenuous. In our culture everyone is planning to run for president, aren't they? Some of the evidence you present is even a little bit compelling, though it is offered in support of the trivial (What, after all, is at stake in Sen. Obama's claim, or in your rebuttal to it?). But what has me concerned is the last piece of evidence you offer: that in Kindergarten he wrote an essay titled "I Want to Become President."

Please pardon me, as I'm new at this whole political thing, but what the hell does that have to do with anything?!? I think I wrote that same essay, though I can now honestly say that I have no intention of ever running for city council, much less president. The spotlight shines too brightly on you politicians. I'm sure under such a bright light I'd make more than a few public blunders. But, dragging up what someone's Kindergarten teacher remembers about their political ambition?!? This is what passes for a presidential campaign?!?

No wonder as a country we are getting turned off by politics. I hate to make you a post child for everything that's wrong with the political process right now, as there are many equally compelling candidates for that. But I'm concerned about you. Try to get some sleep. Quit sweating the small stuff, and all that. One day you may have a country to run. And, if you think this is stressful...

Wonder What Stan Lee Thinks of This

The University of Kentucky just revised its domestic partner policy. Here is the news release. I'm sure I'll offer some comentary later, after I've had more time to study the new plan. It is billed as a way to provide domestic partner benefits in a way that will comply with the Attorney General's interpretation of the state constitution. I'll also let you know if and when the University of Louisville follows suit.

You can find all of my previous posts on the subject of domestic partner benefits here.

Domestic Partner Benefits Deemed Unconstitutional

The quest for anything resembling equal rights in Kentucky was dealt a huge blow yesterday when the Attorney General's office ruled that the policies at our state's two flagship universities (the University of Kentucky and University of Louisville) that would have allowed unmarried domestic partners of university employees access to health care plans are unconstitutional. You can read the Lexington Herald Leader's article here and the Louisville Courier-Journal's article here.

Here are all of my previous posts on the subject:

More Fuel for the Culture War's Fire, posted on July 15, 2006

"I know Stan Lee, and you, sir, are no Stan Lee", posted on October 18, 2006

and

Update on Domestic Partner Benefits at Kentucky Universities, posted on January 1, 2007

While Attorney General Stumbo's declaration is a strong blow against the effort to both improve the quality of state universities by allowing them to have more competitive packages with which to attract highly coveted talent, and to in at least one small way recognize the equality of gays and lesbians, I seriously doubt that this is the final word on the subject. This may, however, make life a little more difficult for Jack Conway, the Democrat candidate for Attorney General. He is running against the infamous wingnut lambasted here more than once, Stan Lee, who has made is political career torching gays.

There are a few interesting points here, worth taking at least a second to consider. The first is that yesterday's decision does not expressly tie health benefits to marriage. While both UK and U of L's plans were declared unconstitutional, the Attorney General's office did say that if they changed their definition of "domestic partner" to include anyone who happens to be living with a university employee, then that might be constitutionally permissible. At issue in this case, then, is not the expanding of health care benefits to include non-married partners, but rather the definition of "domestic partner," which is seen as being enough like "marriage" to violate the politically-motivated and totally unnecessary 2004 amendment to our state's constitution banning "gay marriage" or any similarly recognized arrangement.

The second is that Stan Lee, now running as the Republican candidate for Attorney General, is still not above lying about the plans in question. Once again, Mr. Lee has mischaracterized the universities' policies, telling the Courier Journal, "[A]s elected officials, we have a duty to be good stewards. At a time when our college students are facing double-digit tuition increases, this could be a tremendous waste of resources." However, all either of these plans allowed anyone to do was to buy health coverage. There would have been no loss of state or university money, as any additional costs were to be paid for by the domestic partners buying into the plan.

Additionally, according to the Herald Leader, Lee - despite the fact that the Attorney General's office essentially has agreed with him - is still trying to use this as a political office, attacking Attorney General Stumbo, a Democrat, for moving too slowly. He's also antagonizing for a special legislative session to, in his own words (as quoted in the Herald Leader) "finish this issue once and for all."

Finally, Jack Conway, the Democrat candidate for Attorney General (and, I should add, prohibitive favorite to win the election) seems to be trying hard not to trip over this political landmine, telling the Herald Leader that he agrees with Stumbo's decision. It will be very hard for him to find a way to lose to a lunatic like Lee, but if this becomes a bigger issue, blinding people to Lee's incompetence, he just might.

'Gotta love politics in this backwards state!

Right Livelihood

My family, like many other American families, is currently being ground under by the brutal and dehumanizing force that is the health insurance industry. Negotiating over the phone with those employed by this dishonest industry reminds me of the extent to which one who is by nature good can have their humanity subsumed by the Powers, Walter Wink's term for the spiritual (and generally demonic) aspect of corporate structures. The whole situation brings to mind the words of wisdom my Dad gave me as I left home to start my own life.

Bear in mind, as you read these words, that as an attorney, my father is a member of a similarly reviled profession, and so generally refuses to sit in judgment on how people choose to make their living:

As I walked out the door my father, who may have gone the last decade without so much as touching me, put his arm around me, looked deep into my eyes, and, voice trembling with the sort of emotion that he generally suppresses, said to me,

I want you to know you'll always be my son...
Unless you go to work for an insurance company.

Cultivating Health

Perhaps the greatest concerns in our country today are related concerns: the state of this nation's health, and the health of our health care system. A compelling case, of course, could be made for the consumption of fossil fuels, a non-replenishable fuel source that emits the greenhouse gases that are linked to global warming and deepens our dependence on foreign oil - even oil which generates revenue for terrorists and those who support them. But as great as that concern is - and the threats posed by global warming and terrorism are nothing to sneeze at - our generally poor state of health, and the poor health of our health care system, may be even greater threats to our collective well-being.

Today, at least 44 million Americans have no health insurance coverage, and an additional at least 80 million Americans have inadequate coverage. Another at least 40 million - mostly students - have coverage for only part of the year. This means that over 160 million Americans have either no access or limited access to the kind of care that they need to maintain their health without risking financial ruin.

Additionally, due to basic lifestyle and dietary choices, we are on the brink of a health crisis. While it is true that many, many health indicators are on the rise - in the last hundred years the average life expectancy of an American has risen from 41 years to over 70 years and climbing; over the last fifty years, adjusted for population increase, death from heart disease is down 60% and death from stroke is down 70%; over the last twenty five years infant mortality is down 45%, to just 0.7% of live births; most occurrences of cancer have declined since their peak in the early 1990s, and cancer deaths have been declining by about 1% per year since 1993 - there are also a few disturbing trends. Obesity and diabetes have been steadily increasing, and if these trends are not abated they may create an epidemic.

Over the last two decades, the number of overweight children in the United States has more than doubled. In some areas of the country Type 2 diabetes - caused by lifestyle rather than genetics - has replaced Type 1 diabetes as the most common form in children. Coupled with the rise in obesity among adults, which isn't exactly news, this isn't promising. Not only are we fatter than we've ever been, our children are fatter than they've ever been, which, if not addressed, will lead to increasing problems.

The increase in obesity among both American adults and children, coupled with the attendant increase in other lifestyle related health problems, has put a tremendous strain on the health care system. As of 2003, we are spending roughly $75 billion per year on obesity related heath problems, with over half of that being paid for by the federal government. That is a tremendous, and preventable, expenditure, and it places a drain on the whole system.

Currently roughly 20% of the population account for roughly 80% of the health care costs. However, as more and more Americans grow fatter and fatter, they will join that 20% of the population and increase the drag on the system. So, while advances in medical technology have thus far dramatically increased the average life span and dramatically decreased instances of preventable death by heart disease and stroke, those advances will not be able to keep us artificially health forever. At some point we will have to face the fact that what we eat and how we live matter, and that no pill yet developed can allow us to eat whatever we want and sit on the couch without suffering some serious health consequences.

As a culture we have a generally pathological approach to health. That is, we assume a baseline measure of health, and see any deviation from that as a kind of disease that needs to be addressed, and addressed medically. This model has its advantages. It is often able to describe and improve our condition. I may have a certain baseline health, and then my body may be invaded by a virus or a bacteria, causing a disease. The pathological model of health is able to identify and attack that invading pathogen, and thus fight off the disease that prevents me from being as healthy as I could be. Or, I may be basically healthy, only to fall down and break my wrist. The pathological model is able to identify and treat my acute injury, and help restore function to my wounded limb.

However, there are limitations to this pathological model. While it is true that the invasion of pathogens or acute injury can be obstacles to health, they are not the only obstacles. And, even when they are obstacles, they are not best fought off only by medical intervention. Our bodies are magnificent organic systems, and medical science in only just scratching the surface in understanding them. And while drugs and other medical technologies help heal injury and fight off invasion, those tasks are also natural tasks, performed by the immune system.

Every time you take a drug there are both intended and unintended consequences. This is the nature of taking powerful chemicals into your body. These chemicals change things. Some changes, of course, are beneficial. Others, however, are not. These unintended medicinal consequences are often called "side effects," though perhaps the best term for them would be "collateral damage." In the fight against disease, sometime health is put at risk.

I am not arguing that we should not take medications. I fact, I am currently taking an asthma medication that may well be saving my life. For the past month my asthma, which I though was under control, has been kicking my ass. By the end of last week I could barely breath. I often wake up in the middle of the night fighting to force air into my lungs. If it weren't for a medication, a drug, a powerful chemical that I take into my system, I may find that I can't breath at all, and slowly die in the middle of the night.

Many, many medications work like this, preventing deaths which just a couple of generations ago could not have been prevented. But these medications do have consequences. My asthma medication, for instance, alters my heart rate. Over time it may even do some slight damage. That it keeps me breathing, of course, more than offsets this possibility, but it is still a possibility, and not a very pleasant one. That is the nature of taking drugs to fight off acute health problems.

And when we use drugs to solve problems that could be solved by other means - by a change in diet or lifestyle, for instance - then we accept unnecessary risk. Instead of cultivating health by helping to build up the immune system naturally, we take chemical short-cuts, not realizing that these short-cuts are expensive both in economic terms and in the terms of over-all health.

An entirely pathological health care model leads to an over-dependence on medical intervention, and as such fails to appreciate the maxim that, all else being equal, the least restrictive or least invasive intervention is best. By contrast, an organic or holistic health model - one that appreciates the interconnected nature of all bodily processes, and the value of building up natural defences and cultivating health, helps us appreciate that what we eat and how we live matters. The goal of such a model is, as stated in the description, cultivating health. It does not see health as a sort of baseline figure that is attacked by disease. Rather, it sees health as something that can be built up or torn down by the choices that we make.

Cultivating health - that is, engaging in behaviors which raise your over-all level of health - can help fight disease and injury in a much less restrictive or invasive way than most medical interventions. Of course, medical interventions are often necessary. While orange juice and other foods rich in vitamin C and anti-oxidants may help build the immune system to fight off basic colds, if you have bronchitis or pneumonia you would be foolish to think that a glass of OJ is a preferred treatment. And, while certain foods and behaviors may help reduce the risk of cancer, there is nothing you can eat or drink that will make much headway against a cancer after it has developed. And, again, while changing your diet may reduce you "bad" cholesterol level, if you have a genetic predisposition to high cholesterol - like, say, my grandmother - you may need to take a pill every day no matter what you eat.

A holistic health model should be held up next to a pathological model, because both models are useful, and both models both describe our experience and help solve concrete problems. And, no matter how healthy we become, no matter how well we cultivate our health, we will, each of us, at some point, get so sick that we need more drastic medical intervention. Basic health care will always be necessary.

And, in our country - despite having some of the best medical care and technology in the world - our health care system is failing. Not only do we, as outlined above, have a crisis of uninsured and underinsured persons that isn't going away any time soon; but we also have escalating costs associated with even the most basic health care. While some of this is due, as mentioned above, to increasing rates of obesity and lifestyle related diseases such as Type 2 diabetes (and I don't mean to sound unsupportive or unsympathetic of persons who struggle with their weight, their diet, and such lifestyle related illnesses - we live in a culture whose eating habits are dictated more by economic interests than by caloric needs or health impact, and that cultural environment shapes all of our habits), a great deal of this is due simply to overhead, to administrative costs.

While there is a basic belief among many in our country that the private sector is far, far more efficient that the government, a quick look at our health care system reveals that often the opposite is true. Administrative costs in an HMO, for instance, dwarf those of any federal program. About 4% of Medicare's expenses, for instance, are due to administrative costs. Many countries with a more socialized health care system have even lower administrative costs than that. Canada, for instance, spends only about 2% or less on administrative costs. If the private sector were, due to the demands of the free market system, far more efficient than the public sector, you would expect then that administrative costs in HMOs to be at 1.5% or less. However, contrary to public expectation, HMO administrative costs soar at over 30%. No government bureaucracy rivals, for sheer volume of obfuscation and raw paper work, that of a "well managed" HMO.

Because of this, I am throwing what little weight I have behind HR 676, a bill that would introduce a single payer health care system. This bill has the support of the United Methodist General Board of Global Ministries, and much of the medical community. I will happily host a discussion on the merits of a single payer health care system (which is not the same as universal health coverage, as universal health coverage, while solving the problem of uninsured persons, does not solve the broader problems associated with our current system) in the comments section of this post.

As a nation we simply have to take control both of our health, and the health of our health care system.

[Note: statistics concerning obesity came from The National Obesity Society. Statisics concerning positive trends in overall health came from The Progress Paradox by Gregg Easterbrook. Statistics concerning the number of uninsured and underinsured Americans came from the United Methodist General Board on Global Ministries. Information was also taken from an editorial by the Louisville Courier Journal from Feb. 17, 2006, titled "Health Care: The Single Payer Vision," as well as from articles by Dr. Marcia Angell, and by David U. Himmelstein, MD and Steffie Woolhander, MD. All other statistics came from a presentation by Kentuckians for Single Payer Health Care, who can be reached by calling (502) 459-3393.]