Thursday, July 12, 2012
The Changeable Mr. Romney
Our ideas are only intellectual instruments which we use to break into phenomena; we must change them when they have served their purpose.
— Claude Bernard, An Introduction to the Study of Experimental Medicine
It is a mark of the truly great man or woman who admits that he or she was wrong, irrespective of how often called upon to make such an admission and when a person is in the public eye for many years it is easy to say things that upon reflection are no longer reflective of one’s core beliefs. And that helps explain Mitt Romney who is endlessly accused of what is unkindly referred to as flip-flopping. His flips and flops are not the product of lack of character or conviction nor of expediency but are the result of sober reflection over the years and a thoughtful realization that earlier positions were wrong.
There are, as would be true of all of us, many examples of Mr. Romney changing his mind upon sober reflection. The most recent example followed the Supreme Court health care decision. The Obama health care initiative was modeled after the Massachusetts law that Mr. Romney successfully saw enacted while serving as governor of Massachusetts. That plan, like the Obama plan, imposes a penalty on those who decline to purchase health insurance, subject to some exceptions. When he was governor Mr. Romney explained that that penalty was not a tax but a penalty. When the U.S. Supreme Court said the identical provision in the health care law was a tax, Mr. Romney immediately recognized the error of his earlier ways and said it was a tax. (In taking that position he was forced to contradict a close advisor, Eric Fehrnstrom, who mistakenly said, soon after the opinion was handed down, that he continued to think it should be called a penalty, fee or fine rather than a tax.)
Some years ago Mr. Romney supported a path for illegal immigrants to become citizens, but a year later he said there should be “no special pathway to citizenship.” When he ran for the Senate in 1994 and for governor in 2002 Mr. Romney was pro choice. During a 2002 gubernatorial debate he said: “I will preserve and protect a woman’s right to choose and am devoted and dedicated to honoring my word in that regard.” During the2012 primary election season he said he supported the reversal of Roe v. Wade that protects a woman’s right to an abortion. (It is too soon to know if the July 12, 2012 Boston Globe story that says he left Bain Capital three years later than he’s been telling everyone will cause him to change his public position with respect to them.)
All of the foregoing changes of position are easily understandable and I am indebted to thevarious people who have taken the time to catalogue these and other examples of how Mr. Romney has gone through life with an open mind and changed it when it seemed appropriate. There is, however, one position he has taken that has not been addressed by any of the commentators and on which he should be asked to say what he would do if elected. With respect to the health care law and abortion, among other things, he has clearly stated what he will do if elected. He has not said, nor has he been asked, what he will do about trees.
His interest in trees first came to our attention when in January of the 2008 primary season he told an audience that it was a thrill to be in Michigan in the winter “where the skies are cloudy all day, trees are just at the right height. . . .” And in November 2011 he again repeated his pleasure at being in Michigan where “The trees are at the right height. The grass is the right color for this time of year, kind of a brownish-greenish sort of thing. It just feels right.” His fascination with the height of Michigan trees continued when on February 21, 2012 he told an audience during a stump speech that he loved Michigan and explaining his affection said that “The trees are the right height.” Confident of his assertion he later reaffirmed his admiration for Michigan trees to another group using identical wording. The thing that should concern us all is if Mr. Romney changes his mind and decides that the Michigan trees are NOT the right height, will he order the forest service and the park service to take steps to bring all trees in Michigan to the “right height,” an effort that could have huge fiscal implications. A related question is whether the “right size” for Michigan trees is unique to that state or would he attempt to impose his views on trees in other states. For a number of years he felt the Massachusetts model of health care should be adopted by the federal government and if he took that approach with trees it would impose a huge burden on the entire nation.
Mr. Romney has not addressed the trees in any meetings with the press thus far. Perhaps it will come up at one of the debates. As a casual observer and not an official advisor to his campaign, I would hope that as he considers the question he not lose sight of the forest for the trees.
Thursday, July 5, 2012
The Healthy, The Wealthy, The Poor
If a free society cannot help the many who are poor, it cannot save the few who are rich.
— John F. Kennedy, Inaugural Address
Not all of the states’ reactions to the recent health care decision by the U.S. Supreme Court are an embarrassment. Only a select few. Some States, like Oregon, welcomed it.
In 2008 Oregon embarked on a program to provide health care to some of its residents who live in poverty. It did not have enough money to cover all its impoverished residents so it set up a lottery system and folks who entered it got a chance to win health insurance coverage. Unlike lotteries at charity events, this lottery didn’t cost a thing to enter. The only requirement to participate in the lottery was that the entrant be poor and not have health insurance. The lottery was an instant success.
In 2008, 89,284 people entered the lottery and the lucky winners received that which those who live in other wealthy, industrialized nations get without entering a lottery-health insurance. Once the lottery had taken place its effects on those won was studied to determine the costs and benefits of the coverage. The study disclosed that 25 per cent of the winners were less likely to be burdened by unpaid medical bills and 40% per cent less likely to find that paying medical bills forced them to skip paying other significant obligations. Those who won were more likely to have a family doctor they visited regularly and enjoyed better overall health than those who did not have insurance.
Notwithstanding the success of the lottery many residents remained uninsured and Oregon is happy to abandon the lottery in favor of having all its residents obtain insurance. Bruce Goldberg, the Oregon Health Authority director, is not worried about the additional cost to the state. He said the Supreme Court decision is “very good news for the 600,000 Oregonians who do not have health care coverage. . . . Under the Affordable Care Act, the health care lottery for low-income Oregonians goes away and everyone wins. That is good for them, good for their families, and good for Oregon. They will have better health care and more financial security. . . .” If governors of some of the other states cared about the health of their citizens they would study the results of the lottery and might even decide to permit their Medicaid rolls to expand. They haven’t and they won’t.
A spokesman for South Carolina’s Gov. Nikki R. Haley, said: “We’re not going to shove more South Carolinians [600,000 poor people without insurance] into a broken system that further ties our hands when we know the best way to find South Carolina solutions . . . is through the flexibility that block grants provide.” Since there are no block grants available, if South Carolina fails to take advantage of the ability to expand eligibility, 600,000 poor South Carolinians will remain uninsured.
Governor David Heineman of Nebraska explains his opposition to expanding Medicaid eligibility explaining that if it is expanded it will affect state aid to education even though the federal government will pay all the cost of the increased costs of expanding Medicaid until 2017 and by gradually decreasing amounts until 2020 when states will have to assume 10% of the cost with the federal government paying the remaining 90%. Another Governor who is unambiguous in his response is Florida’s governor, Rick Scott.
Governor Scott has said that: “Florida will opt out of spending approximately $1.89 billion more taxpayer dollars required to implement a massive entitlement expansion of the Medicaid program.” Explaining his decision the governor said: “Floridians are interested in jobs and economic growth, a quality education for their children and keeping the cost of living low. Neither of these provisions (Medicaid expansion and insurance exchanges) will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.” Twenty percent of Florida’s residents lack health insurance. Mr. Scott is not among them. The state provides health insurance for him. If Florida took advantage of the expansion 1 million residents would get coverage.
Health insurance seems like a luxury only to those who have it, people like Governors Haley, Heineman and Scott. Since they refuse to take advantage of Medicaid expansion the law permits and largely funds, to help their impoverished citizens, perhaps they would consider starting a lottery. Oregon did it cover in an impartial manner as many people as limited funds would permit. The recalcitrant governors could do it to give the impression that they were doing something positive for their poor citizens even though they were doing far less than the law permits. Watching to see who won the lottery and, therefore, obtained health insurance, could be a source of amusement for observers who already have insurance and would give the uninsured but hopeful poor a distraction to take their minds of the other hardships poverty forces them to endure. Kind of like Hunger Games.
Friday, June 29, 2012
The V Word and the Legislator
[L]et God and man decree
Laws for themselves and not for me;
And if my ways are not as theirs,
Let them mind their own affairs.
— A.E. Houseman, The Laws of God, the Laws of Man
The beauty of it is the symmetry. Politicians and clerics here and abroad spend so much of their time trying to regulate what women they’ve never met can do with their bodies and what assorted body parts can properly be called in polite company that it’s nice when the penis gets some attention.
The vagina got attention when a few sensitive sorts of the male variety took offense at the word’s appearance on the House floor in the Michigan House of Representatives in mid-June. It made its appearance during a discussion by the male members (people that is) of legislation pertaining to women’s reproductive rights that was being considered on the House floor. The specific legislation was sponsored by the Republicans and proposed outlawing abortion after 20 weeks and requiring a woman taking the morning-after pill to do so in the presence of a doctor. The latter provision was not because the men believed women did not know how to swallow pills and might choke unless supervised. It was to make it more difficult for women to avoid pregnancy. In response to the concern of the men Representative Lisa Brown said to the assembled multitude that she was flattered that “you’re all so interested in my vagina.” In a show of support for Representative Brown, Representative Barb Byrum offered a proposal that a man be required to prove his life was in danger before he could get a vasectomy. The men in the House were horrified. They were so offended that the following day neither of the women was permitted to address the body (legislative) giving the men an opportunity to regain their composure. Representative Mike Callton explained his embarrassment at this word’s unwelcome appearance on the floor of the house (though not its proprietor’s appearance since that would be sexist) saying the word “was so offensive, I don’t even want to say it in front of women. I would not say that in mixed company.” Thanks to a German court the male member (non-person) has now taken center stage although not for the first time.
In 2011 the word made an appearance in a proposed ordinance in San Francisco that would have become Article 50 of the San Francisco Police Code. It was proposed by a group led by Matthew Hess who invented the famous “foreskin restoration device” that purports to undo the effect of male circumcision. Matthew believes boys and girls should be treated the same and says male and female circumcision are the same and both should be banned. The proposed ordinance would have made it unlawful to “circumcise, excise, cut, or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years.” The only exception was if the circumcision was “necessary to the physical health of the person on whom it is performed because of a clear, compelling, and immediate medical need with no less destructive alternative treatment available, and is performed by a person licensed in the place of its performance as a medical practitioner.” The proposed ordinance made no exception for those for whom the operation was required “as a matter of custom or ritual.” It was soundly defeated in the 2011 election. A court ruling has now achieved Mr. Matthew’s goals and gives comfort to those who approve of regulating other people’s bodies.
On June 26, 2012, a German court in Cologne, Germany ruled that circumcising young boys inflicted grievous bodily harm on the boys. It banned the practice. The case arose out of prosecution of the doctor who performed the circumcision on a 4-year old Muslim child whose circumcision went awry leading to minor medical complications. The court said “the fundamental right of the child to bodily integrity outweighs the fundamental rights of the parents.” It observed that the child’s body is “permanently and irreparably changed by the circumcision. This change runs counter to the interests of the child, who can decide his religious affiliation himself later in life.” The ruling was, of course, not well received by the religious groups who have used circumcision for years as part of their religious practices.
The Central Council of Jews in Germany called the ruling an “unprecedented and dramatic intrusion” on the right to religious freedom. The Central Council of Muslims in Germany called the ruling a “blatant and inadmissible interference” in the rights of parents. Although the ruling applies only to the jurisdiction in which the court is sitting, both groups demanded that the German parliament enact legislation protecting freedom of religion. They are concerned that although the ruling applies only to the jurisdiction in which the court is sitting, doctors in other jurisdictions will be reluctant to perform circumcisions for fear of being prosecuted. They want the parliament to act “to provide legal clarity in order to prevent attacks on religious freedom.”
Whether parliament will heed the request of the religious groups is not known as of this writing. What is known that is that it is another victory for those who believe that other people should be deciding for other people what sorts of rules should be imposed on other people and their bodies.