Lion in State

The name Ted Kennedy triggers an immediate response in most Americans, a response either very positive or very negative. But from those who knew him, the response is overwhelmingly positive. Even his most powerful political foes speak highly of him, highlighting his willingness to work across party lines and his commitment to helping people everywhere he went.

Although he was a Senator from Massachusetts, he often represented the disenfranchised across the country. His home state is among the smallest in the nation, but his vision stretched from one coast to the other. He cared deeply about the big issues that affect us all, whether we’re in Texas or Maine.

Civil rights. Education. Gay rights. Universal health care.

He was a leader on all those fronts, and many more.

His personal life often distracted from his political accomplishments, but in the end, it will be his 47 years in the Senate that defines how history views him. And I think it will do so kindly.

He had a family name that he leveraged every chance he got. He didn’t talk much about being a Kennedy, but he used the power of that name to achieve more than either Jack or Bobby did. He took longer, but most of his fights were long-term projects. They would have taken longer than a presidential tenure.

In the end, the country is better off that he never became president. Instead of 8 years to pursue his goals, he had 47. Like Martin Luther King, he didn’t live to see all his dreams realized, but like MLK, he got a lot done.

He’s lying in state tonight at his big brother’s library and museum, and people have been lining up since the early hours to pay their respects. Thousands lined the roads along the route of the motorcade that took him there. It’s the kind of response one would expect for a president.

That he commanded the respect and affection of his opponents as well as his supporters paints the full picture of the man. And that in spite of his personal foibles.

No man is perfect. None will ever be. But some are more perfect than others when it matters. He was a horribly-flawed human being, as most of us are. But he never lost sight of the world he wanted to help create.

One that was better, fairer and more just than the one he inherited. And that will be his legacy, one earned over decades of relentless work.

He was called "the lion of the Senate" for good reason, and I will miss his roar deeply and profoundly.

We loved him well. He was not ours to keep.

Fear Factor

When Sarah Palin goes out stumping and using the phrase "death panel" to try and re-define end of life care and counseling, my stomach turns. I can't imagine what her motivations are, other than a pure and unadulterated attempt to stoke fear in the far right wing of her party. It amounts to nothing more than pandering, and it's in very poor taste.

I have dealt with more than one of her "death panels", and they have been composed of health-care professionals who wanted to give everyone involved the information they needed to determine treatment for the person they loved. They were straight-forward and painfully honest. They told us things we didn't want to hear, but they did so honestly.

That's what end-of-life counseling boils down to: having the right information to make the right decision, whether it is the patient or the family making those painful decisions.

The way the radical right has framed this debate, I would be a murderer for asking that treatment be withdrawn from a terminally ill patient because I knew what was going on and what the outcomes would almost certainly be.

If you follow this debate to its natural end from the Palin point of view, I should not have been informed or had the opportunity to withdraw care. And no doctor or nurse should have been able to give me the information I needed to make the right choices, much less mention that it was available. That the right to counseling on this most difficult issue shouldn't exist.

It is pandering on an obscene degree that belies a gross lack of conscience or sense of moral justice.

Terminally ill people deserve the right to good medical counsel. They need to know the possible outcomes and the implications of them. And so do patient's families.

That anyone would question this centrally important part of health care leaves me walking around with my hands in the air saying "What? What? She didn't really say that, did she? Oh, my God. She did."

Campaigning on a platform of restricting end-of-life care (and she's campaigning-you betcha') should give every voter pause. Apart from restrictions on free speech and professional practice, it's just plain old wrong.

Limiting health-care providers' speech in those situations is not only immoral: it's irresponsible and unethical. It would leave the provider in the position of violating the law or violating the oath they took as a licensed professional.

Given all the problems we have with health-care right now, this is one more thing that should not be politicized or bastardized. And it has been.

When people are dieing, they deserve the ability to determine their futures. And when they can't make those decisions, their family needs to be able to do the same with the best information possible.

As a people, we should not let our cultural reticence to talk about death infect the debate about health care reform that is decades over-due. And politicians who use blatantly false statements to exploit that fear do their constituents a great disservice. All Americans would be better served by a healthy and honest debate about the issue.

Mouthy Redux

What follows is a letter I sent to the Austin American-Statesman. They require letters to the editor to be short (150 words) and to the point. So this is the condensed version of my opinions about health care. For a more complete version, go here. For Daniel Gross's insight go here.


Rationed Health Care and Why We Aleady Have It

Its time to set the record straight about rationed health care: we already have it. I am insured and can see a GP almost any time I want. But I usually have to wait 2-3 months to see a specialist. With a very good plan.

I watched a friend with similar coverage grow sicker with cancer as his doctor battled the HMO for the best care and not the cheapest. Weeks after diagnosis of an aggressive and fast-growing tumor, his insurance company finally let him get the treatment his doctor had first recommended.

It was too late. He died a few months later.

My partner has coverage through the VA, and, yes, they ration health care. But not to any degree larger than my private insurer does. He gets high-quality health care that is as good as what costs over $600/month for me.

Rationed health care is a moot point. Its already here. And its spelled HMO.

Bite Me

I am sick to death of hearing about “death panels”. I wish someone would put either me or Sarah Palin out my misery. She’s taken one of the most sacred trusts anyone of us hold, that to care for a loved-one when they can’t care for themselves, and perverted it into nothing less than a blatant political tool. For someone who has experienced end-of-life counseling more than once, it makes me nauseous to see what has been a part of quality health care since professional, trained doctors have existed singled out and labeled a “death panel”.

If you’re lucky, you will have a doctor or a panel of doctors assemble to tell you or those responsible for your care the truth that you may not want to hear but need to know. How does one make a decision without knowing the facts? The options? The probabilities?

That’s what end-of-life care has always been, and it continues to be one of the most important components of health care. Withdrawing care is never easy, but withdrawing care without adequate information is unconscionable.

I’ve never had to do that and hope I’m never faced with that situation.

I doubt that doctors will cease the practice, whether they’re paid for it or not. It’s part of being a doctor. Or a good one, at least. Most private insurance would pay for it.

When Daddy died a little over two years ago, the team of doctors that was treating him assembled to talk to us about the grim prospects and what our options were. They provided information and described what can only be called cascading organ failure: his liver had failed, causing his kidneys to fail, causing his blood to thin, causing his heart to require medication to function. His eyes were bleeding and he was hemorrhaging under the skin all over his body. He could not be stabilized to the degree required for a liver transplant, even if one were available.

They gave us all the God-awful truth, but we made the decisions. The hard ones. The ones we didn’t want to make.

That is what end-of-life counseling is, and also what Sarah Palin is calling a “death panel”. Such rhetoric is ingenuous at best and appalling in general. It ignores the simple but obvious truth that end-of-life care is called that for a reason. It seeks to politicize what is often the hardest thing someone ever has to do. It cheapens the grief of those who have made hard decisions after getting the information they need to make those decisions.

Life and death should never be political footballs.

Mrs. Palin apparently doesn’t realize this. She created the concept of “death panels” out of whole cloth. And then got the media to report it. Never mind that not even the semblance of truth has come out of her mouth in the last several weeks.

No doubt, she will continue to contort, distort and generally misrepresent any proposals for health care reform. She will continue pandering to the extreme right wing of the Republican party rather than being sensible or even honest.

I think she might very well put herself out of her own misery (and mine, too) by imploding on a national stage. She’s made some pretty big claims that she can’t substantiate with real evidence, and the press is getting closer and closer to biting her Alaskan fanny real hard.

If only I could.

The Big Chill

I'm being mouthy again, but sometimes I think have to or I will die. This is what I sent both my national Senators tonight. I have no idea if it will do any good, but I don't think it will do any harm.

Dear Senator,

Two nurses in Kermit, TX (Winkler county) were recently indicted and arrested because they reported a doctor to the Texas Medical Board. While the Medical Board has informed the DA of Winkler County that the nurses in question (Anne Mitchell and Vicki Galle) broke no laws, the case is moving forward.

They had concerns about the quality of care in their rural hospital and could not find anyone to address their concerns within their hospital. So they filed a complaint.

Texas law explicitly prohibits retaliation against nurses for exercising their legislatively-mandated role as whistle-blowers. You can read details of the case here: www.texasnurses.org.

While I realize that you have very clear constitutional limitations when it comes to judicial branch issues, after you review the facts, I ask you to intervene on whatever level you are able and, at the very least, put a corrupt and unjust county government on notice that it is being watched.

The illegal acts were done by the county sheriff and the DA, not by the nurses who acted in good conscience and faith, trying to make sure their patients had the best quality health care available.

A strongly worded letter to the DA deploring this injustice would be appropriate in this situation. That is probably the limit of what you can do, But anything you can do to put them on notice that they're being watched will advance the cause of nurses advocating for their patients.

Nurses are both the first and last lines of defense for their patients. Without the protection to advocate for them, the quality of care will plummet.

It may seem like a small story from west Texas, but the implications are staggering. If speaking up about sub-standard treatment leaves one facing a $10,000 fine and 2-10 years in prison, the quality of health care will continue to deteriorate. If these charges stand, the effect will be chilling.

Any number of health care workers will not report concerns about quality of care. The prospect of a large fine and 2-10 years in jail for reporting someone for sub-standard practice will do nothing to advance health care in this country for any one.

Please do anything you can. Make me want to vote for you.

And I vote.

On Race in America

Several years ago I dated a black man for about a year. I gained a new perspective on race in America in the process. It didn't surprise me that my mother, who grew up and has lived all her life in the deep South, was more upset that I was dating a black man than that I was dating a man. What surprised me was the reception we received from other black people.

When we were out for the evening and I slipped away for a few minutes to get drinks or use the restroom, someone invariably came up to him and demanded to know why he was with a white boy. They told him things like "You need to be with a strong black man." Or a "righteous black man". That was my favorite.

He always laughed it off. He was a peace-maker, and that was one of the things I loved in him. But those incidents always disturbed me.

We obviously didn't care about the race issue, but other people did, on both sides. I always wondered what business it was of theirs, anyway.

We aren't together any more, but our parting of ways had nothing to do with race. We had different priorities: I wanted a long-term commitment, and he couldn't make that step.

I always wonder, though, if we were still together, would we still be getting the same chilly reception from both sides?

The gay thing was over-shadowed by the race thing. Two things that are basically nobody's business, any way you look at it.

As a country, we've come a long way, but we have a long way to go. We are achieving the "more perfect union" that our forefathers wrote about so eloquently, but we have not reached perfection. I've seen the racial issues go from civil rights marches when I was a boy to protests and riots in the 70's and 80's to the entrenched race-baiting we live with now.

Racism is no longer fashionable or socially acceptable, but it lives underground, popping its ugly head up at times like now with the Harvard professor and the cop. Who was the racist? I don't know. Maybe both.

I've seen stranger things, but it’s not a call I think I could make.

What is also unfashionable is talking about it openly and honestly, leaving preexisting assumptions on the doorstep; forgetting the politics and speaking as true, authentic people without agendas of any sort. But it's our only hope to get beyond the stalemate we find ourselves in. Until we drag ourselves out of this quagmire, we will not get much closer to achieving the "more perfect union" that should be our ultimate goal.

I can understand resentment on both sides of the spectrum, but isn’t it time we moved forward? We are a 233 year old country acting like third graders on the playground. Doing so benefits no one and harms every one.

When it comes to race in America, it’s time to quit throwing blame around like bullets and grow up. Act like adults instead of third graders. Walk the extra mile, if necessary. Whatever it takes to move us forward, because we’re idling in neutral right now.

Reset

Steve Ballmer, the Microsoft CEO who almost never has anything interesting or that makes much sense to say, broke the barrier of irrelatively this weekend. In an interview with "Fortune" magazine's web site, he made the distinction between the economy "rebounding" and "re-setting". It's an important distinction.

The crash started last year and accelerated in the first quarter of this year. All the markets hit rock bottom on March 9, taking 40% of the value of our collective investments with them and dragging once-powerful companies down in the undertow.

Lehman Brothers collapsed under the pressure. GM and Chrysler went begging to the Congress. Merrill Lynch had a shotgun wedding with Bank of America. One unit of AIG brought them to the brink of global failure.

Since then, GM and Chrysler have both declared bankruptcy and are depending on government money both to operate and to drive customers to their dealer outlets. Bank of America alleges that it was coerced into acquiring Merrill Lynch, even though their website displays both names. And AIG is quietly liquidating its portfolio of companies (including the one that manages my retirement account, for disclosure purposes).

These companies shared a culture that rewarded speculation and not actual real-money profits. GM and Chrysler kept churning out cars that people increasingly could not afford to buy or operate. The price of gas skyrocketing didn't stop them from pushing tricked-out SUV's that got 15 miles a gallon. And they gave their executives huge bonuses for doing so.

Merrill Lynch failed, but before the wedding with the shotgun, it paid out executive bonuses that defy imagination for a company that is going under. AIG did the same thing.

I have to shake my head and think "what were they thinking?"

Before they crumbled under the weight of reality, they were reporting profits based on unrealized gains. What people thought their assets were worth until they found out the truth.

Cascading mortgage defaults were the precursor of cascading credit defaults, country-wide in all industries. Credit that had been too easily available to anyone suddenly dried up for almost everyone.

The Dow has gone from over $13,000 to $9,171 today. It's under-valued as a rule, but it won't see $13,000 for a while. Expectations have changed. Companies have to earn real money to see their stock price go up. They have to reset their values to account for the bad debt they've taken on.

I have accepted that I’ve lost at least 15% of my IRA portfolio, after it reset at a more realistic valuation. From a 40% loss, I’ve gained 25% back. Anything more will be slow coming.

The markets and the economy in general is in the process of resetting to a more realistic standard. One that doesn’t record income from highly risky loans and investments that on the broader scale undermine the entire system. And I accept that. I don’t like it, but I accept it.

While critics of the infusion of government cash into the system via multiple bail-outs and subsidies of the private sector rant and rail about principles, those very bail-outs and subsidies have averted a depression that was potentially bigger than the one Roosevelt tried to fix.

The Great Depression is called that not because it was great for the people affected, but because of how it affected them. The destruction of the economic system that the Hoover administration refused to address on principle hit almost everyone in the country. They lost their homes, their farms, their ability to provide for their families.

The latter is the most debilitating blow a man can take. It makes a Great Depression a greater depression on a personal level.

We have avoided that outcome, to date. We’re not out of the woods, by any estimation. But the concept of resetting expectations makes more sense than anything else I’ve heard. And I’ve heard a lot.

We cannot and should not expect or wish for a market that is over-valued because of risky loans and questionable financial products. We should instead seek a market that is driven by real money profits and not speculation on credit-default swaps.

Lehman's is history. Bank of America doth, I think, protest too much. GM and Chrysler limp along, trying to sell their existing inventory even while closing or preparing to close factories right and left. No one even talks about AIG anymore. They've gone from being the largest insurance conglomerate in the world to being largely irrelevant.

We’ve made our bed, and slept in it. Now we must try get the sheets untangled from the pillows and the comforter.

We must reset. Call it collective rehab, but we have to adapt to a more realistic world.