I just called Betty McCollum’s DC office and asked where she stood on passing the Senate plan. I was shocked that the office could not articulate a position on this. I can understand “yes,” I can understand “no,” but I can’t understand a leader sitting on her hands and waiting for more input. This is a crisis time and the outlines of the crisis have been evident for over a week. I’m afraid this wishy-​washy response left me feeling like my congressperson is weak and ineffectual.

After this past year of wrangling back and forth, I find myself urging my representative to hold their nose and vote for the Senate bill. And not only vote, but lobby her on-​the-​fence colleagues HARD to do the same. Yes, I hate what the Senate did, I can’t stand, especially, the abortion provisions, the Nevada deal, and much more of the mess they made. But we have worked too hard and fought too many special interests to let this moment pass by. Democrats have everything they need to turn ashes into victory here. As bad as the Senate bill is, it is not “toxic.” That notion is poison being fed to the Hill from the right. It is, in fact, antidote. Passing a bill, even the Senate bill, is the only way to wake up the public to what has been good in this fight all along. Once it is a done deal, we can wake people up to all the positive things that are in the bill (yes, even in the Senate bill). Democrats gain nothing by letting the moment pass, all the real toxins, the negative thumping of the right wing, remains our baggage if we cave in now. The only way to refute lies is with demonstration, and we can only demonstrate with action, and the only path of action left is the Senate bill.

I know you are not in a position to carry the water on this. But you are all I’ve got. You can call your representative now, during most important week of the year that was and the year to come, and ask them where they stand. This will define Democrats. Governing is not about getting everything you want, it is about compromise. Can the Democrats govern? We have majorities in House and Senate and we have the White House. There is nobody else to blame. Can we govern? Can we compromise? Can we make sausage? Now we find out. Today. This week.

(Not sure who to call? Check with OpenCongress.)

Yesterday Alex and I went to support President Obama’s call for healthcare reform at the Target Center in Minneapolis. We got a couple day’s warning of this event, and the Target Center is a huge venue, so I didn’t worry much about getting in. Sure enough, though it was great to be there, this rally didn’t have nearly the fire and sense of community that attended the campaign rally last June. I’ve put a set of pictures up, if you want a look.

When I got home, though, I learned that 9/​12 was the date of a huge rally in DC by opponents of the administration. I realized that part of the purpose of Obama’s quick visit to Minneapolis was to make sure that the administration caught a part of the news cycle. Sure enough, today’s online New York Times featured these juxtaposed headlines…

Well done, White House.

But not nearly enough to satisfy me. The President made a point of stating his support for a “public option” at yesterday’s rally. This statement got one of the largest rounds of applause of the event. Obama twice tried to move on, but had to wait for the cheering to die down. But today’s Star Tribune featured schizophrenic coverage stating on the front page that Obama reiterated support for the public option while inside running an NYT article noting that the Obama administration was letting the public option go.

I don’t know what to believe. But I do know that this playing of both sides of the fence leaves me with very little hope for how this will all play out. If we lose the public option but keep individual mandates, then I think the plan may be enough of a disaster to work for its defeat. I noted that Obama didn’t even mention individual mandates yesterday, so lets hope we don’t end up with that doomed scenario.

I’m looking for leadership on this one, I don’t think I’m seeing it.

School started yesterday and that got me thinking about lunch. How do you handle lunchtime? In Austria lunch is the big meal of the day and dinner is small and snackish. I love that. But here in the USofA it is hard to pull off that kind of schedule. Lunch is often away from home, at school, at work. Eating out (or eating school lunch) is one way to handle this meal, but that can be expensive and not-​so-​nutricious. The New York Times published a story on Bento Boxes that was full of interesting ideas.

Nathaniel has become very creative in the kitchen, devouring the Betty Crocker cookbook, making lunches and dinners all last week, and wondering when he’ll have time to cook during the school year. He also loves things Japanese, like sushi (well, some sushi). Maybe making bento boxes is an idea that would work for him?

Well, there we have it. Today the NYT started reporting that the White House is backing away from the “public option” in the healthcare reform making its way through congress. Non-​profit “health care co-​ops” are not a “public option”. We have had these sorts of plans in place already (see HealthPartners here in Minnesota, for example), but they cannot wield the clout to bring the insurance industry into line. The insurance industry has lost its way, its mission is no longer our healthcare, but rather profit. This industry stands between you and your doctor right now, working hard to prevent coverage of the care you need. The only tool in H.R. 3200 that even came close to holding this industry accountable was the public option.

With the public option gone, the main accomplishments of reform will be the requirement that individuals buy into an insurance plan and employers provide access to such a plan. Who wins? The very insurance industry that has failed this country for the last 40 years. The same industry that gives us the least effective most expensive healthcare of any industrial country in the world. This becomes a plan to increase their profits, not improve our health. This becomes a plan we should oppose.

The White House wants you to remember all the other things that this bill still does for you. Maybe. I am concerned that the insurance industry will find plenty of ways to game around these “protections”. The public option is something they would not be able to game around nearly as easily, that’s why they’ve opposed it so vigorously. We need to equal their vigor in it’s defense.

This CNNMoney article has been making the email rounds and just hit my desk, passed along by my father-​in-​law who says “as in all things, be careful what you pray for”. It warns that we will lose five “freedoms” with health care reform. Oh yeah?

Who are you kidding?

1. Freedom to choose your own plan?

Who has that now? It is our employers who choose our plans. Hell, many of us with pre-​existing conditions can’t choose _​any_​plan. Tell me which plan will accept Alex when he is an adult. That’s right: only government-​sponsored plans. This “freedom” is an illusion.

2. Freedom to be rewarded for healthy living, or pay your real costs?

This so-​called “freedom” is the antithesis of “insurance.” Of course you don’t pay your real costs or get rewarded for healthy living. Insurance is a group of us (all US citizens, lets say) banding together to say we will help one another. Everyone deserves health care, that is the basic assumption at work. If we all pay into a pool, then we can cover the costs for reasonable health care for everyone. Notice that almost no one pays “real costs”. Some pay more than they “needed” to (they were healthy and presumably don’t wish otherwise), others paid less than their care required (they got sick, so they are not feeling very lucky about this). The whole point of insurance is that we all pay into a pool in a predictable way to help each other with unpredictable expenses. Unfortunately, our for-​profit insurance companies have forgotten this.

3. Freedom to choose high-​deductible coverage?

Well, we know who benefits from this “freedom”: the very wealthy. Who else would “choose” a high deductible plan? Health savings accounts are a sham, designed to remove the healthy from the insurance pool. The point is, do we care about the health of our fellow citizens and believe that a healthier society will benefit us all or do we believe that each of us is out for him or her self? We need to design a system _​everyone_​can afford, not one just for the rich and healthy.

4. Freedom to keep your existing plan?

See #1. There is no such freedom now. Try changing employers and keeping your plan. Try staying at one employer for more than five years and keeping your plan. Our plans change every year and we have virtually no control over those changes. Doctors go in and out of “network”. Drug coverage changes. Deductibles rise. Copays rise. Where is the “freedom” here? Again, it is an illusion.

5. Freedom to choose your doctors?

See #1 and #4. Who are you kidding. You choose doctors that participate in your plan and the list of doctors participating in a particular plan shift from year to year. In fact, lately insurance companies and provider networks have taken to playing chicken, threatening to divorce and letting consumer outrage shake one side or the other down for a “lower cost”. This is nuts and it requires a huge expenditure of energy and resources to administer. Every once in a while (or if you are rich enough to pay “out of network” fees) you are lucky enough to get the doctor you really want, but for how long?

This article is a pile of steaming dung. It is the same dung-​platter that insurance companies have been serving us for decades. Where is the real cost in our healthcare system? It is in the for-​profit insurance industry that forces employers and providers alike to handle massive administrative complexity and renegotiate “choices” every single year. This is an industry that has forgotten that the reason we give them our money is so that they can spend it keeping our neighbors healthy, not so that they can take bigger and bigger profits off the top for “shareholders.”

A single-​payer health care system would actually give you all five of these freedoms, freedoms you do not enjoy today. How?

#1: Single payer would give everyone a baseline of decent health care. It would leave for-​profit insurers around to offer a variety of “cadillac” care for those who could afford it. Plenty of choice, just a baseline of decency to go with it.

#2: Your reward for healthy living would be your health. If you are motivated to be healthy (and most people really are), then you can build a relationship with whichever provider you wish.

#3: See #1, you can supplement your single-​payer plan with whatever bells and whistles you like, as long as you can afford them. Not much different from today.

#4: Without a dependency on employers to select from a menu of complex plans, health care becomes simpler. You always keep your existing plan, it is _​the_​plan. No choices each October. No worry if you have to change jobs or (worse yet) lose your job. You always keep your plan.

#5: You really can choose your doctor in a single-​payer system. The are all “in network” and they all benefit from the streamlined administration that comes from dealing with only one major insurer. Yes, some insurance industry “gatekeepers” would be traded for government bureaucracy “gatekeepers”, but at least you have a chance, every now and then, of electing the government.

Unfortunately, I don’t think the current Obama plan will grant us these freedoms any more than the current system. It falls far short of streamlining the system in ways that would lower costs and make a doctor’s life easier. But just because it is not perfect does not mean that the current system is worth saving. The current US health care system is a sham of smoke and mirrors, made so complex that it tires out most anyone taking a good look at it. It is a system designed to profit a few and avoid paying for the care that many need. It deserves to be overhauled, and even the Obama plan will make it better if not ideal.

The GroupLens team at the University of Minnesota has a new project, or at least one I just noticed: Cyclopath. This is a map of the Twin Cities with a social ability to mark blocks of the city with regard to their bikeability (potholes, hills, traffic, etc.). You can give it two addresses, describe your preferences (I like bikepaths and bikeroutes, but dislike hills), and it will find a route for you. After trying it out you can grade the route and leave comments for future cyclists. Very cool. If you bike around the Twin Cities you should check it out and get an account. Too bad they don’t let you save or share routes.

President Obama visited my niece’s high school in Green Bay today, rolled out his health care plan and took questions at a town hall meeting. My sister-​in-​love Holly was hoping to get in the door, she lives only a few blocks from the school. She asked for ideas of questions to ask in case she was able to attend. This is the question I sent her:

Mr. President, I am so pleased that you have made health care a top priority this year. When I look at the endless bills we get for health care and the fights I have with my insurance company to even get the coverage we paid for, it seems obvious that one of the biggest costs in health care is the cost of maintaining this supposedly “market-​based” system. Most of us in the real world don’t really have a choice about insurance, our choices are made by our employers. How does the plan moving forward right now address the huge costs of the redundant billing and decision making infrastructures that our commercial insurance industry represents? And why have single-​payer plans, which directly address this shortcoming in our bewildering health care system, been left off the table in your planning?

I don’t know if Holly got in or asked any question, much less mine. But from reports it sounds like someone brought up the issue:

President Barack Obama took questions from audience members after his speech on health care reform at today’s town-​hall meeting at Southwest High School.

After a member of the audience asked him if he supported a single-​payer health plan, Obama said he does not support what is being called “socialized medicine.”

“The majority of people still get their insurance through their employer, Obama said. “Rather than disrupt things, let them keep the health insurance they’ve got. There still is a role for private insurance.”

For others, however, who can’t get insurance privately should have an option for a public plan.

It is disappointing to hear Obama use codewords like “socialized medicine” to tar single payer. I’m not surprised, single payer was never even part of his campaign platform, but I am sad that he does not leave the door open at least a little bit. Employer-​based insurance is part of what is dragging our economy into the mud, but I don’t expect the light to dawn on the mainstream in this regard for at least another two years. It’s failure will be plenty disruptive. I certainly hope that what the president and congress is working on succeeds, but that is not my expectation. I think we’ll be back here before his term is up.

UPDATE: Holly did not get in after all. But she did see the motorcade! Here is my favorite moment from YouTube…

I’ve never smoked a thing, much less marijuana. On the other hand, I don’t feel terribly judgmental about pot. If anything, I think it is probably on par with alcohol, redeeming social qualities in a package I just don’t happen to enjoy (I run from smoke). It amazes me we spend so much energy outlawing the stuff, that seems like a true waste of time.

Andrew Sullivan’s Daily Dish has spent a good bit of time covering cannabis this season. Today I noticed two posts that discuss the value of pot in taming the emotional outbursts that attend Aspergers Syndrome.

One reader of the Dish writes:

I first tried cannabis at age 17. I quickly found that when I was medicated, people around me coped far better with my eccentricities. Like many ASDs I have a violent and explosive temper and am often described, especially by women, as a “Scary Guy.” The cannabis increases my tolerance for interruption and also helps me be more extroverted and therefore social.

Another chimes in with:

Example: my morning routine is to wake up early, put on a pot of coffee, let the dog out, pour my cup of coffee, let the dog back in, stir in my cream, then sit on the couch and read or listen to my iPod until my coffee is done. If I haven’t been smoking regularly, and my girlfriend comes down and lets out the dog BEFORE I put on the pot of coffee, that will completely ruin my day if not my entire week. I’ll be irritable by the time I get to work, and liable to snap at the smallest provocation.

On the other hand, if I had smoked the night before, I will notice that my routine has been jockeyed, but it just won’t bother me that much. The same goes for my social connections; when I smoke, I reflect upon, and come to value a social connection, but it’s a cognitive process for me… It’s not something I do naturally, and it’s not something I’m inclined to do if I’m sober (my mind says, “THERES NO TIME, THERES NO TIME”)

Now I wonder, might judicious use of cannabis help, for example, Alex cope with daily life? What if it were available in a non-​smoking, perfectly legal form? I get angry all over again that we spend out time outlawing something so benign as marijuana. What a waste.

I love this example of Twitter users passing along data despite themselves. It pulls together so many threads: Processing for visualization, data mining for gathering facts from Twitter, geolocation via MetaCarta, even a bit of Wolfram to round it all out. Though there are all sorts of legitimate critiques about the role of Twitter data for tracking disease vectors, the interesting fact, for me, is that one person was able to leverage free form Twitter entries into a visualization of non-​trivial data in just a few days time. This is a new world.

There are rumors that Apple is interested in buying Twitter. Alex thinks this may be an attempt by Apple to shore up its aging and less-​than-​reliable iChat infrastructure. I think it may be about data. Whoever makes Twitter less of a fail-​whale service will be sitting on an unprecedented hoard of realtime data, the commercial possibilities of which are as yet unimagined. We are just giving our lives over to this massive dataset. I’m not sure that’s a bad thing, but I do wonder what it will create.

A few days ago I spoke with Matt Entenza, one of the likely DFL (that’s “Democrat” to all you non-​Minnesotans) candidates for Governor here in Minnesota in 2010. My main concern was health care. I believe that resolving the growing health care crisis is essential to resolving our economic crisis, and I fear the Obama team is going about it the wrong way. Matt, too, insists that “Medicare for all” is more realistic than a “single payer” plan, and I do have to grant that making something actually happen is more important than tilting at windmills. Still, after some thought I sat down and wrote Matt the following email. I want to share it here for the record.

My fear about “medicare for all” is similar to my fears for the Obama plan. A “public option” which leaves in place the wealth and complexity of the private insurance infrastructure will likely fail. It will be left with scraps, the big money being in the hands of private insurers. It will depend on reducing payments to doctors and hospitals to make up for its lack of wealth. It will have to draw a harder line on the limits of care to afford covering those who join. It will underperform and put a sour taste in the mouths of those who trust it.

I think that, in fact, insurance companies know this. They are making such as stand on the public option because if they don’t make us fight for this scrap, we might have the energy to push for more. To simply defend and probably water down the public option in response will be just what they want, it keeps our mind and effort off the real battle: ending private insurance once and for all.

The value of single payer is much more than that it covers our citizens. The value is in the ways it simplifies practice for doctors and hospitals and for all of us. The way it could eliminate the maze of billing and contracts, eliminate the worries about degrees of coverage, eliminate the time wasted on making decisions every year about health plans and alternatives. We are all human beings, we are each given a body susceptible to similar disease and in need of similar care. Our nation, and if not our nation then our state, should take the opportunity to pool together the risks we all bear and provide for us one common solution that puts us all on equal health care footing.

Sure, there is room for private plans and a for-​profit health care industry at the margins. Elective care and extraordinary care will always be attractive for those who can afford it. They will thrive even in the face of a single public health plan that covers the basics.

But making a public plan just one option that “competes” against an industry as rich and misguided as our health insurance industry will, I fear, leave us spending way too much energy on the competition and realizing way to few of the potential benefits. We need to radically simplify this system to really gain the efficiencies that can transform the money we currently spend on the health industry into real health care.

While I realize that the “public option” and “medicare for all” may be easier sells, I am afraid they will not get to the heart of the solution we need. Now is the best opportunity we have had in decades to sell the solution we really need. Now is when the constituency for health care (that is every one of us) is most frightened by the gaps in our current “system”. Now is the time that small businesses, educational institutions, and government itself is being drowned by the costs of “managed” care. Now is the time that many feel at risk of losing their tenuous hold on the employer-​sponsored plans that tie us to companies we would rather not be doing business with given how poorly they treat us. Now is the time to make a push for the solution this state and this country really need. We need more than a “public option”. We need to remove the maze of private insurance. We need a simple plan that serves all of us. We need to trust government to deliver this in the way it did deliver on medicare many years ago.

Yesterday Andrew Sullivan quoted scienceblogs with regard to some CDC statistics, and they put it much more succinctly:

The simple truth is that one of the major reasons we have such a lousy health care system and receive such bad value for our money in the US is that we placed health care financing into the hands of the same folks who helped make our economic system such a disaster: private insurance companies, who are little more than disguised investment banks with the added incentive not to pay back their depositors (the premium payers).

We don’t need health care reform with a public option. We need one with public financing by default, perhaps with a private option for those who wish to and can pay extra for it.

Here in Minnesota, please consider supporting the Minnesota Health Plan.