At this point it seems like everyone is frustrated with health care reform. Liberals feel betrayed about the public option and worry that we’ll see little actual “reform.” Conservatives are skeptical about the proposals’ ability to control costs, and worry that expanding public programs without stronger cost controls will leave our country further in debt. Having debated compromises, and compromises of those compromises, many of us are left wondering whether health care reform even matters anymore. Well, as an American, I am disappointed in the broken political process; as a progressive, I worry my core values of justice and equity are being undermined; but as a doctor, I cannot give up on reform.

More than a year ago, Mr. Nelson*, a hypertensive man in his 50’s with two grown daughters and a college bound son, came in as a new patient. He had lost his job as a salesman and with it his health insurance. For awhile, he paid out of pocket for the medication prescribed by his previous doctor, but he could no longer afford them. The community health center where I work offers sliding scale payment and low cost medications, so when he began having severe headaches, he came in to see if we could help. His blood pressure was sky high and I was concerned that he could have a stroke, but he did not want to go to the emergency room fearing the costs. Instead, I wrote a few prescriptions, saw him several times over the next few months, and we finally got his blood pressure under control.

I saw Mr. Nelson again a few weeks back, and he has still been unable to find work. His wife’s employer does not offer health insurance, and with her salary and his unemployment benefits, their income is too high for Medicaid. He could purchase coverage on the non-group market if it was affordable, but he has looked and this is not an option. Over the past year, I have been worried about his daytime fatigue and snoring, and I suspect he has obstructive sleep apnea. However, he cannot afford the thousands of dollars for a sleep study and respiratory equipment, so he must delay this medical care. It is a gap that the health center cannot fill. Each visit he is upbeat about his family and his blood pressure, but I cannot help but worry that sleep apnea is causing permanent damage to his heart and lungs.

I have other patients like Mr. Nelson, and I’m sure there are many other Americans out there as well, who are just getting by, and maybe cutting their pills in half to make them last, and delaying medical care as they focus on more pressing matters like putting their kids through school. The health care horror stories are heart breaking, but thinking about my patients on the verge of a bad outcome or one illness away from bankruptcy, I feel impassioned to demand reform now. We cannot wait for the perfect plan. A health insurance exchange with subsidies for private insurance is not the same as a public health insurance option, but it would offer affordable coverage to Mr. Nelson. If 45,000 preventable deaths annually are attributable to lack of health insurance, the Senate bill, which covers 2/3 of the uninsured with subsidized private insurance and expanded Medicaid, could potentially save 30,000 lives. If this is not the purpose of health insurance reform, I’m not sure what is.

Many are calling for the House to pass the Senate bill, and fix issues like the level of premium subsidy via reconciliation. This won’t remake the American health care system into a model of efficiency and equitability, but it does move us from debate to action. It will help 30 million Americans who are uninsured. It will provide security to those with private insurance. It will strengthen primary care, prevention, and wellness. Waiting any longer is just not an option.

*I thank Mr. Nelson for allowing me to share his story. I have changed his name and other minor details in order to protect his privacy.

The Thursday before the unfortunate election in Massachusetts that I am sure will deal the coup de grace to an already paralyzed senate, I saw a 54 year old man, let’s call him Joe, who was sent to me, a cardiologist, by his primary care doctor. By his history and ECG, there was no doubt that the man had suffered a myocardial infarction at home in the middle of December (something his PCP thought he had to confirm by a nuclear stress test probably costing several thousand dollars). It was also clear that Joe was self-employed, uninsured, and  his finances were in shambles. In fact he admitted that he had to “raid” his childrens’ bank accounts in order to pay for heating oil and the state sales taxes he owed, which were due the next day. The opportunity of any myocardial salvage had obviously passed and as the patient did not have angina and no ischemia on his stress test, I thought that medical therapy would be a better option that submitting him to a cardiac catheterization. As I started to tell the patient that as a minumum, he should take aspirin, a beta blocker, an ACE-inhibitor and a statin, the first question was “How much will that cost me?”. After that, further recommended test (such as an echocardiogram) were only going to happen if his care was “free”. Unfortunately, this is a common scenario.

With health care reform on the verge of collapse, I guess all of us have developed a sinking feeling – at least the ones that thought we’d finally had overcome the US malady we call “health care” and were on the way to recovery. It is an angry feeling, and a depressing one. Mostly, I just don’t want to understand, but I am afraid I do. I just read today’s New York Times “Prescription” piece for January 23rd. It seems to confirm what I had suspected and in fact what I have heard from my patients: America has been duped out of believing in health care reform. The opponents of the process that would  insuring most Americans have successfully sown so much doubt and misinformation that many citizens now think it is a bad idea. We live in a scary era – can anyone blame the people? Unfortunately, it is they who will suffer.

The system that has been devised sounds too complicated, too expensive – and critics from the other side complain it does not cover enough people. That’s all good, I can see the point, particularly the one about cost, which is scary, in particular with the backdrop of two ongoing wars, a slowly (or maybe not yet) recovering economy and high unemployment.

It seems, however, that many object on the basis of the principle of liberty, aversion of higher taxes and government mistrust. Coming from Germany to the US now almost 10 years ago, it’s something I’ll never understand. It boggles my mind that free choice (i.e.the choice not to buy insurance) would top the principle of the “common good” and solidarity with the less fortunate. The NYT piece described the opposition ordinary citizens. Charles Burke, a 55 year old man managing a cafe, is reported stating he was against mandatory insurance as he has always paid out of pocket; and Irving Cable, also 55, as saying “I won’t pay it (…) and I’ll shoot the first person that tries to make me go to jail because I will not buy health insurance“. This sort of stance only makes sense if we really are consequential: if you do not have insurance, you pay with you own money. Any sort of subsidy, be it directly to health care consumers or indirectly through government payments for charity care, higher premiums that finance jacked up hospital and health care provider fees, is in fact a form of solidarity payment, though not a just or equal one. If you offered Mr. Burke and Mr. Cable a refund of every cent of any Medicare Tax he ever paid, at the expense of forgoing any government paid health care ever, maybe they’d accept. And maybe it would work for them, as they may never get sick. Maybe they won’t get heart disease or cancer and quickly end up with bills a multiple of what their savings might be. But maybe it won’t work, and they’ll end up just as Joe.

The problem will be that it will be less likely in the future to find someone to provide free care, in particular care that conforms with the standard.  Payments are on the decline, the baby boomers are coming of age and less and less health care providers are willing to work with Medicaid and Medicare patients. This may sound morally objectionable, but they are within their rights and one has to conissr teh economic situation, salary for staff, rent etc.  Others will leave Medicine altogether. At some point coverage will be so thin, it will significantly delay care – already it is said that 45,000 people die yearly due to lack of insurance. Indeed, judging by the fact that even I, a healthy, young, insured man cannot find a primary care doctor that is accepting patients in my city, we may already beyond that point.

Maybe we have to hit rock bottom? When we do,  it will be so more painful.  Many seated members of congress won’t be there anymore, having retired or been voted out. But as they would probably lose many Medicare benefits,  maybe they should be paying attention now.

(Crossposted at CureThis)

The most recent edition of San Francisco Magazine (which I read only when I see it strewn across piles and piles of books, journals and mags at my in-laws’ place in Sonoma) features a run-down found here on Healthy San Francisco, a health care access system for SF residents to receive care at nearly all health care providers in the city (My long-time SF friend reminds me that it’s not a health insurance plan so what you do when you get alcohol poisoning in Napa or get shot in Oakland – or vice-versa – is beyond me). I am looking forward to actually reading the thing and learn about its inner-workings, but what I find most intriguing is this commentary by SF Mag’s Editor-in-Chief Bruce Kelley.

Kelley states:

When it comes to national healthcare reform, I think we should throw participatory democ­racy out the window. This one policy debate would go better if the American public were silent and disengaged, refusing to blog, carp, watch Fox News, or exercise its voice. It would also be helpful to suspend the constitution, strip all interest groups of power, and install a temporary dictatorship. One smart person would make the final decision how to address the healthcare disaster. She’d be advised by other smart people. She would wave a wand. Then Congress would return from a short hiatus, and the sausage-making would resume.

Kelley goes on to tell that that’s basically how Healthy SF came to be – without anyone actually noticing – and since it’s such a hit, we should replicate the process and fix US health care a la SF.

Even though it doesn’t really matter, I gave it some thought. Maybe he’s right. Let’s get the right person to just…DECIDE. Of course, remember the last “decider” we had in office…

What about Obama? Well, are we talking Candidate “If I could start it all over again, I’d do single-payer” Obama or President “Let’s cut a deal with Big Insurance and Big Pharma so they play nice” Obama?

I thought again…how participatory is our national democracy now anyhow? When I yell or email or fax or call the Hill, who is actually listening? The play by the Golden Rule – He with the gold, makes the rules.

Whatever happens in DC, we need to point our eyes and efforts locally and follow SF’s model. We can keep better eyes on the gold when it’s in our own neck of the woods. But, we should be careful what we wish for in hoping other parts of the US take SF’s lead and steamroll health care reform of their own.

Kelley dreams “If only the nation were more like San Francisco.”

Amen to that.

(cross-posted at CureThis)

The US Senate convened today — the day before Christmas — and passed the Senate’s version of the famed health insurance reform bill, the Patient Protection and Affordable Care Act. This bill will move into conference committee with the House of Representatives’ version of the bill in January, before final passage. It is not a common occurrence to meet the day before Christmas. The last time the Senate held a roll call on Christmas Eve was in the year 1895, when Senators lifted a ban on government officers who had joined the Confederacy from serving in the post-Civil War military. Below are other interesting facts about the Senate.

• Today (Christmas Eve) marked the 25th straight day of debate. This is just short of the record for the longest number of consecutive days that the Senate was in session, in the winter of 1917 (thanks to @wonkroom on Twitter for this fact). The extended debate in 1917 was due to anti-war legislators stalling debate about whether or not to arm US merchant ships during World War I.
• The Christmas spirit inspired some poetry this week, from Illinois Senator Burris. He took to the mic and started with “It was the night before Christmas and all through the Senate, the right held up our health care bill, no matter what was in it.” …and he went on from there [link to poem transcript and video. Then, the New York Times, uninspired by the average poetry and meter of Burris’s rhymes, challenged its readers to think up more rhymes. Readers’ submissions are quite entertaining.
• On the etymology of filibusters: “The term filibuster was first used in 1851. It was derived from the Spanish filibustero meaning pirate or freebooter. This term had evolved from the French word flibustier, which itself evolved from the Dutch vrijbuiter (freebooter). This term was applied at the time to American adventurers, mostly from Southern states, who sought to overthrow the governments of Central American states, and was transferred to the users of the filibuster, seen as a tactic for pirating or hijacking debate.” (from Wikipedia)
• The longest running filibuster in US history was over 75 hours, when southern Senate Democrats tried unsuccessfully to block the passage of the Civil Rights Act of 1964.
• The filibuster and its buddy — the cloture vote (the supermajority vote of 60 Senators needed to overcome a debate-halting filibuster) — were invoked 112 times after the 2006 mid-term elections and projections continue to rise, rendering our American democracy subject to the whims of a few Senators. Here’s are two representations of the increased numbers of filibusters and cloture votes — in table format and in chart format.
• And an excerpt from President Obama’s remarks on today’s vote: “As I’ve said before, these are not small reforms; these are big reforms. If passed, this will be the most important piece of social policy since the Social Security Act in the 1930s, and the most important reform of our health care system since Medicare passed in the 1960s. And what makes it so important is not just its cost savings or its deficit reductions. It’s the impact reform will have on Americans who no longer have to go without a checkup or prescriptions that they need because they can’t afford them; on families who no longer have to worry that a single illness will send them into financial ruin; and on businesses that will no longer face exorbitant insurance rates that hamper their competitiveness. It’s the difference reform will make in the lives of the American people…”

January will bring a new year and the start of heated discussions among legislators, lobbyists, and advocacy organizations to reconcile the major differences in the Senate and the House versions of the health insurance reform bill. The National Physicians Alliance is working hard with other organizations, to try to strengthen the affordability provisions and improve the bill.

To the NPA Community,

It has been a tough week for health care reform.  As I write this letter, the public option, in any form, is no longer under consideration in the Senate bill and there are not 60 definite votes in the Senate for the compromise legislation.  Without 60 votes to end debate, health reform is over and the status quo wins.  This series of events in the Senate has left me angry, frustrated, and incredibly disappointed.

During the last 11/2 years it has been my privilege to serve as the Chair of NPA’s Secure Health Care for All Campaign.  I have watched with great NPA pride as thousands of you around the country have responded to numerous opportunities to stand up and amplify your patients’ voices in support of reform that would result in quality, affordable, health care for all.  Together, we have worked tirelessly to establish the choice of an affordable public health insurance option open to all; regulation of private health insurance companies; delivery system reforms that promote quality over quantity; and to guarantee health care as a basic human right.

It is now likely that not all of NPA’s goals are going to be achieved in the final bill.  Some nationally prominent voices are advocating that the Senate bill must not pass.  As I struggle to contain my personal anger with the Senate proceedings, I constantly return to the NPA mantra:  “put patients first.”

Although there will be no public option, there will be many benefits for patients in the final bill.  This legislation will enable 30+ million currently uninsured Americans to have access to quality health insurance and establish critically important regulation of private health insurance companies.  These companies will be prohibited from denying coverage for pre-existing conditions, from dropping individuals who become ill, and from establishing annual and lifetime spending caps.

Additional provisions create a floor on how much of the health insurance premium dollar must be spent on health care, establish processes for reviewing increases in health plan premiums, promote administrative simplification, and provide coverage for dependent children up to age 26 (House) or 27(Senate).  The House bill removes the anti-trust exemption for health insurers and medical malpractice insurers and contains strong provisions requiring federal standards for insurance plan transparency, disclosure and data collection.  It appears that the Senate will join the House in adding language to close the Medicare Part D donut hole.

Finally, the most important result of this legislation is that the principle that every American must have access to affordable health insurance will now be part of our law.  Future discussions in Congress will no longer center on whether all Americans should have access to care but on how we get this done.

Let’s be clear, there is much to be done to protect our patients.  The Senate bill in particular contains seriously inadequate affordability provisions for low-income people; weak mechanisms to increase insurance company competition and decrease health insurance premiums; and insufficient regulation of private health insurance companies.  This process is not over and just as none of us would abandon a chronically ill patient, the NPA is in this fight for the long run. Until final passage, we will continue to advocate for the strongest possible bill.  Looking forward, the horizon is filled with substantive issues concerning implementation, delivery system reforms, and affordability.  There will be important issues at the state and local level.  The NPA will be there throughout, standing with our patients demanding a just health care system.

Please let me know what you think.  You can make public comments in response to this letter on our blog: http://www.npalliance.net/blog/.  This letter will be posted on that website, and we welcome you to click “Comment” at the end of the letter and share your thoughts.  Or, if you prefer, submit private comments to our Board of Directors at npa@npalliance.org.  We want to hear from you about the current bill and what you believe to be the most critical issues that NPA should be alert to as we all go forward.

I am still frustrated, angry, and incredibly disappointed but I am not walking away. We are at the beginning of health care reform – a process that is going to require engagement, commitment, and stamina to get secure health care for all.

Count me in.

Val

Valerie Arkoosh, MD, MPH

Chair

Secure Health Care for All

According to a study published yesterday in the New England Journal of Medicine, 63% of doctors support expanding health insurance coverage through both private and public options.   NPR reported on this survey with the headline, “poll finds most doctors support public option,” and immediately elicited comment from the American Medical Association, since the organization has equivocated on support of the public option in its public statements, while the study explicitly demonstrated support for the public option among AMA members (62%).  Not surprisingly Dr. James Rohack, the president of the AMA (who has previously made confusing comments about the public health insurance option implying that subsidized private plans could be considered a public option), challenged the meaning of the findings, “[the public option] means different things to different people, kind of like the Rorschach ink blot test.”  However, his attempts to obfuscate only further emphasize that the official positions of the American Medical Association do not represent the viewpoint of most American doctors (or apparently in some cases even AMA members).

While it is true that there are different versions of the public health insurance option described in the bills coming out of the House, the Senate HELP committee, and the framework envisioned by Jacob Hacker, the findings of this study are not up for interpretation.  A Rorschach test is purposely subjective so a clinician can interpret a patients’ psychological state.  Conversely, good researchers ask precise questions and describe their methods in detail so that their findings can be reproduced.  The reputation and influence of peer reviewed journals, like the New England Journal of Medicine, is dependent on publishing quality research.

The consistency and reliability of the research demonstrating doctors’ support for public health insurance similar to Medicare should relieve us all of the fear mongering around “socialized medicine.”  Ironically, conservative politicians fear “government bureaucrats standing in between them and their doctors,” while their doctors do not.  The evidence is crystal clear.

In 2003, Ronald Ackerman and Aaron Carroll asked 3188 randomly sampled physicians, “In principle, do you support or oppose government legislation to establish national health insurance?” At that time 49% supported this type of legislation and 40 % opposed.

In 2008, the authors repeated the study, this time with 59% agreeing and only 32% opposing national health insurance.  They also asked, “do you support achieving universal coverage through more incremental reform?” 55% supported and 25% opposed this type of proposal.

And now, with the study by Keyhani and Federman we have another question directly relevant to the current health care debate:

Respondents were asked to indicate which of three options they would most strongly support:

1. Public and Private Options: Provide people under age 65 the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans.

2. Private Options Only: Provide people with tax credits or low-income subsidies to buy private insurance coverage (without creating a public plan option).

3. Public Option Only: Eliminate private insurance and cover everyone in a single public plan like Medicare.

63% of doctors chose option #1 – the public and private options. It is not clear to me how Dr. Rohack could be unsure what the public option means in this context.  It’s right there in the study’s methods.

These research findings are robust and consistent: doctors support national health insurance (i.e. Single Payer); but when asked specifically about a public health insurance option similar to Medicare and available to everyone below 65, they overwhelmingly support it.  There even seems to be a trend developing where a greater percentage of doctors support public health insurance.

Doctors are not afraid of government health insurance bureaucrats – we already have private insurance companies’ utilization reviewers to contend with.  The study’s findings may be a surprise to some, since doctors tend to be conservative as a whole, but the truth is that most doctors are sick of fighting with insurance companies.  The average physician spends 43 minutes per day and $65,000 per year on interactions with health plans; there have already been multimillion dollar class action lawsuits against Aetna, Cigna, Humana, Blue Cross Blue Shield, and others for underpaying doctors (among other charges), and ultimately we have yielded too much decision making capacity to managed care companies.

So when we talk about a public health insurance option, we mean a plan modeled on Medicare.  We do not mean a co-op; we do not include a trigger option; and we don’t want expanded coverage limited to public subsidies for private plans.  The data is there in black and white – in the shape of a bar graph, not an ink blot.

Aaron Fox, MD

NPA – NYC Local Action Network

Crosspost from: Be Active Blog

I loved Obama’s speech last night.

He had many excellent frames. I’ve been advocating for him to use George Lakoff’s frame’s of health care and he did just that.

A classic frame was talking about the public option like public colleges: “But by avoiding some of the overhead that gets eaten up at private companies by profits and excessive administrative costs and executive salaries, it could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better, the same way public colleges and universities provide additional choice and competition to students without in any way inhibiting a vibrant system of private colleges and universities. ”

Most importantly he brought health care from a policy issue to a moral issue.  He first brought up stories of people who can’t pay for their health care.  You can see another example, of a boy’s family who can’t pay for his cancer care here:
Nathan and Thomas’ Story

He then brought up Teddy’s letter on why a fellow American thought that his fellow Americans should have the same access to care that he did.

“On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of his own experience.  It was the experience of having two children stricken with cancer.  He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick.  And he was able to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can’t afford it. ”

Continuing he puts health care in the frame of the Family of Americans:

“That large-heartedness — that concern and regard for the plight of others — is not a partisan feeling.  It’s not a Republican or a Democratic feeling.  It, too, is part of the American character — our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.”

Keep talking about health care as a moral issue.  It IS in our country’s character to get everyone health care.  Keep telling the stories of friends and family who were denied by insurance companies for life saving care.  We are here to end that, because that is not the way we live in America.

“We did not come to fear the future.  We came here to shape it.  I still believe we can act even when it’s hard.  … I still believe we can do great things, and that here and now we will meet history’s test.  Because that’s who we are.  That is our calling.  That is our character.”

Thank you President Obama, for speaking to our hearts.

I am sure both sides of the aisle will find something to complain about, but I was impressed with Obamas speech on health care before a joint Congress.

It’s worth noting that a strong majority of Americans still favor a public insurance option of the sort I’ve proposed tonight. But its impact shouldn’t be exaggerated — by the left, the right, or the media. It is only one part of my plan, and should not be used as a handy excuse for the usual Washington ideological battles (…) The public option is only a means to that end — and we should remain open to other ideas that accomplish our ultimate goal. And to my Republican friends, I say that rather than making wild claims about a government takeover of health care, we should work together to address any legitimate concerns you may have.

First of all, after all what we have been hearing (mostly rumors), it is great to hear such a strong support for a public option. I think the way he presented his plan makes anyone still saying “No” look out of touch with reality and, honestly, morally challenged- and like your main concern is the insurance companies’ , not Americans’, well being. Maybe it takes working in healthcare and dealing with insurance companies on a daily basis (as a doctor and as an employer) to realize that they will not change their basic ways unless forced.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false — the reforms I’m proposing would not apply to those who are here illegally.

This was met by the “You lie” comment that apparently came from Joe Wilson, and made him (and the right side of the aisle) look really mature! But the way the debate has been going, why am I not surprised? This is the level opponents of health care reform are operating on. Apparently Wilson called to apologize… oh well….

Some of people’s concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens.

I must also say that I was impressed by the way he called out Sarah Palin and her consorts, and not surprised but saddened that most Republicans sat on their hands, and thus seemed to disagree with the inappropriateness of such lies. There was a piece on NPR this morning where they elicited seniors’ reaction to the speech, and people actually believe these claims!

Last but not least, I had the pleasure of seeing the speech with a relative from Germany, a country with Universal Health Care…. she was impressed, too, but completely perplexed by how bad things over here have gotten. Go figure.

The debate surrounding health care reform is not over! We can demand meaningful reform and the New York Local Action Network continues to be heavily involved in NYC.

Here’s a clip of Dr. Manel Silva addressing a crowd in Jersey City gathered at a candle light vigil in support of health care reform (and from the signs, the crowd is clearly in support of a public health insurance option):

And Dr. Viraj Patel sharing a patients story at a vigil in Manhattan:

59% of physicians support national health insurance and 55% support achieving universal coverage with more incremental reform. We need to get out there and let the country know that doctors want a health care system that is fair and that is focused on the needs of our patients.

Is health care an economic or a moral issue?

Let’s imagine for a moment that we were talking about education instead of health care.

At the time of this discussion, over 10% of children have no access to any schooling and 5% additionally only get to go to school 1-2 days a week (inadequate schooling). For the other 85%, they have access to schools, but if they have a learning disability, they may not be able to transfer schools, many have to pay for their books, and a large proportion of the rest have to pay their teachers their lunch money or they can’t attend (and lunch is getting more expensive by the day). And then there are the children who can only get one lens for their glasses, not two, because they can’t demonstrate that two makes it easier for them to read.

The question before Congress is whether or not we should give these children access to quality schools and ensure that children can choose a school that’s right for them (within a certain area) and not be denied going to the school because they had a prior need for glasses or have dyslexia.

To enable all of these children to get a quality education is going to cost money – lots of money. And we don’t necessarily have the greatest evidence in the world that even educating these children will save money in the long term – we think it will, but we have no guarantees.

So should we do it? Is this an ethical dilemma or an economic one? How should the debate be framed?

Senator Reid recently raised this question as a rhetorical one in a town hall debate on health care (see: http://www.lasvegassun.com/news/2009/sep/01/harry-reid-reform-moral-issue-financial-benefits/)

He sees it as a moral issue with economic benefits. But he is a partisan Democrat acting on his party’s behalf… or so some critics will claim. Or at least the claim is that the current health reform effort is simply another attempt by the Democrat liberals to enlarge the government and the government’s control in our lives with increased spending.

It is highly unfortunate that the issue of providing health care to those who need it has become a partisan issue. It is not one. And the fact that it has taken that tone saddens me. It should sadden all of us that instead of working together to try and tackle one of the major ethical issues of our time we allowed the discussion to be distracted by partisanship. Our education system is not perfect, but we have worked out a system where every child has access to education – not because it is cost-effective but because it is the right thing to do for children. As a recent post on this same blog pointed out, we need to focus on how to get health care to those who need it – we need to “get out there and do something about it.” The current health care reform may also not be perfect, but we collectively need to keep our eye on the goal of ensuring quality care for everyone who needs it and stop getting bogged down in party rhetoric – both of the ‘single-payer only’ type and the ‘anti-government run health care’ type. This is a moral issue. I think all Americans agree to some extent on that. Let that be the starting point and let’s get to work.