Thank you, Mr. Roberts

Word is out now that Chief Justice John Roberts switched his vote before Thursday's U.S. Supreme Court ruling on the Affordable Care Act.

And for that, I say thank you, Mr. Chief Justice. I could, perhaps, owe him my life.

I have been counting the months until 2014, when I should be able to purchase decent insurance through one of  the newly-established exchanges among states. The new law requires that they take me despite my preexisting condition -- chronic lymphocytic leukemia -- and that premiums be capped to that I can actually afford, like most middle-income people, to pay. If coverage is anything like it is in the current and temporary PCP -- the Pre-existing Condition Program that the ACA set up for adults who have been without insurance for six months -- it should allow me a much wider network, including out-of-state expert centers. And, unlike my existing insurance, it would probably provide for a stem cell transplant, should that day ever come.

This will allow me to get away from Merciless Healthcare Group, which was set up in Arizona as a state-backed plan for small businesses. Over the years what was once a limited HMO that took care of its members has become a penny-pinching HMO with ever-higher deductibles and co-insurance and an ever-shrinking network.

For example, the emergency room where I was diagnosed with CLL in 2003 is about a half-mile from my home. It is no longer contracted with my insurer, which no longer has a relationship with Northern Arizona Healthcare, the largest provider in the region. Today, to go to a contracted hospital I have to drive an hour and a half to Prescott, and that goes for getting CT scans or outpatient infusions as well. If you live in my county, you can't even buy into my insurance any more. I am what they called "grandfathered" in. (And, of course, no other insurer will touch me because of my CLL, at least until the ACA takes full effect in 2014.)

I suppose I should consider myself lucky to have insurance at all. Reading online forums, I have seen more than one CLLer describe attempts to deal with the disease without insurance. Chlorambucil may be affordable but it is hardly the standard of care these days. Neither is drinking a lot of green tea.

The whole question of the Affordable Care Act can be an emotional one for both sides. I plead guilty here. For me it may make a huge difference in quality of care, which could mean life and death. On principle, I also think a country that constantly touts itself as the greatest in the world should be able to provide real access to health care for everyone. American "exceptionalism" should not include an exceptional inability to create a workable medical system.

There was an anti-ACA sign held by one of the protesters outside the Supreme Court building while everyone waited for Thursday's decision. It read something to the effect of: "Obamacare: Thank you for paying for my poor life decisions."

CLL is not a product of poor life decisions, and neither are most cancers and chronic diseases. Sometimes shit happens. Let these people walk a mile in the shoes of the uninsured, or underinsured. Let them learn what financial and emotional strain truly are. Now that the election approaches, some Republicans talk of "repeal and replace," but in all the years they held power, at least post-Nixon, they never made an effort to address such matters as preexisting conditions. Given their continued lurch toward the hardline right, one expects they never will.

Please join me in voting Democratic this Fall, from the state level to the federal, to insure that the law is implemented as it should be. The ACA may be flawed in some ways, and it may need tweaking as it goes along, but is is a giant step for our country, and for many of our fellow CLLers, as well as other cancer patients.

Finally

Today, with President Obama's signature, health care reform became the law of the land. It’s not perfect but it’s a significant improvement over the mess we have now. The United States has taken a big step toward joining the industrialized world when it comes to insuring that the basic needs of its citizens are met.

It is a shame that thousands of Americans had to die on the way to this day because they couldn't afford insurance or because their insurance provider found a reason to drop them when they got sick or refused to cover preexisting conditions.

Despite their crocodile tears, Republicans did nothing when they controlled Congress and the White House to address those issues, not even basic matters of fairness that most reasonable people would agree upon. Now they have gone off the deep end, embracing all manner of wingnuttery.   

A new Harris Poll of Republicans shows that 67% believe that President Obama is a socialist, 57% believe he is a Muslim, 45% agree with the Birthers that Obama was "not born in the United States and so is not eligible to be president," 38% say the president is "doing many of the things that Hitler did," and 24% believe that Obama "may be the Antichrist."

And these people think they know better when it comes to health care?

Republican pols, of course, are running around like headless chickens pandering to the rightest of the right wing, squawking "repeal" and saying that Americans are against health care reform. Today's USA Today/Gallup Poll shows Americans supporting the measure by 49% to 40%. As Taegan Goddard of Political Wire pointed out on Monday, analyzing a CNN poll: “Parsing the numbers shows that many of those against the plan actually oppose it because 'it is not liberal enough.' In fact, 52% of Americans either support the current legislation or think it should be more liberal, while only 43% oppose the plan saying it is 'too liberal.' "

At some point in the future, people will look back and wonder what all the fuss was about. And more people will be alive to wonder, thanks to this legislation.

Living the not-so-good life in Sedona

Our little city of Sedona, nestled amid the red rocks of Northern Arizona, is a resort community and tourist destination. A lot of people retire here to live the good life, or choose to live and work here for the same reason.

It's reasonably affordable, as such places go -- unless you come down with a catastrophic illness and are subject to the whims and foibles of our health care system. I am not talking about myself here. I am talking about a couple in town who lost pretty much everything in a futile attempt to battle the wife's colon cancer. This was reported recently in our local newspaper, the Sedona Red Rock News. Here's a link to the story, entitled "Health system fails Sedona couple." Here are some excerpts:

It wasn’t long before all of the DiMarcos’ days were consumed with medical appointments, arguing with insurance companies and pleading for help from state agencies.

By 2007, their lifelong savings had dwindled to nothing, exhausted by treatments and drugs deemed ineligible for coverage by their insurance company. With no money left, Joseph turned to credit cards to pay for hotel rooms near hospitals, for co-pays and for pain medication.

. . . In spite of hundreds of thousands of dollars of tests and treatment, painful procedures and mind-numbing drugs, by 2008 Andrea’s doctors held little hope for her recovery and she was referred to RTA Hospice and Palliative Care in Sedona. She passed away two months later.

Joseph is left with the memories of a woman he describes as his soulmate, a twin flame with whom he wanted to grow old. He is also left with a mountain of bills, having to choose which one to pay each month.

In the latest print edition is another story (not online), this time about a patient with heart problems who faced the unfairness of the system first-hand. This involves the "churning" of insurance applications, in which private insurers look for an old condition or treatment you may have forgotten to mention and use it as an excuse to cancel your plan rather than pay for the care you desperately need.

My point here is that in any community -- even one of 15,000 people -- there is story after story like this. Health care reform is needed not only for the 50 million uninsured, but also for the many millions more who are insured, only to find that the system fails them when they need it most.

Here's a letter I just wrote to the editor of the News:

I’d like to commend the Red Rock News for its recent series of articles on how failures in our health care system have caused heartache and pain for local residents who are the victims of cancer and other serious diseases.

I am one of those stories. In 2003, I was diagnosed with chronic lymphocytic leukemia. Mine is a fairly aggressive form of the disease and I have required several rounds of chemotherapy. Fortunately, this has been covered by my health insurance, a state-sponsored program for small businesses. But the plan has its limits. It specifically excludes adult stem cell (bone marrow) transplants. I am 52 years old and the expert doctors I have traveled to see out of state (at my own expense, since my plan only covers a limited in-state network), have told me that I am unlikely to see 60 unless I get a transplant. These can run upwards of a million dollars out of pocket, well beyond my capacity to pay.

As you might imagine, private plans that cover transplants want nothing to do with me. Unless there is health care reform in Washington that requires all insurers to take patients with preexisting conditions, I face a bleak future.

I am all for keeping private insurers, but I also strongly favor a public option. Some mechanism has to be put in place to keep private providers honest, as your most recent article about the “churning” of health care applications demonstrates. If people cannot rely on their private insurance in a pinch, then they deserve an option where care is truly guaranteed.

To those who were recently seen protesting here against “Obamacare” and who argue that they don’t want the government managing their health care, I have this to say: What is so offensive about creating a system that preserves your sacred private insurance but also gives people like me a chance to receive life-saving care? Is it really preferable to have penny-pinching private insurance bureaucrats finding excuses not to give you the procedures and drugs you need? I’d take a government bureaucrat any day -- I’ve been dealing with them at the state level for years -- since they don’t have that vested interest in finding ways to deny me, or my doctor. Finally, if you really hate “socialized medicine,” then give up your Medicare coverage on principle. I’d gladly take it.

Sincerely,
David Arenson

THE COMPANY WE KEEP

Counties in blue have some sort of universal health care system. Countries in green are trying to institute one. Countries in orange -- Iraq and Afghanistan -- have universal systems instituted by the United States after they were invaded. Perhaps we have to declare war on ourselves to get universal care?

Dopey, dopey, dopey

Reading CLL discussion groups, and reading between the lines in those discussion groups, I am very much aware that some people deal with the stress of leukemia by taking drugs. And by drugs I mean alcohol and prescription antidepressants as well as illegal substances such as marijuana.

What is causing me to write about this is the tempest-in-a-bong over Olympic champion Michael Phelps. The 23-year-old swimmer was photographed smoking pot; from the overreaction of some people, you’d think he had been caught strangling mermaids with one of those ribboned gold medals.

Well, give me, and Michael Phelps, a break.

Somehow the United States managed to come into existence and prosper for its first 150 years without any restrictions on what you could put into your body. Alcohol, pot, laudanum, opium, cocaine, magic mushrooms, you name it -- all were there and ready for the taking as this country built itself into something ever more prosperous and successful.

But American respect for individual liberty has always had a counterbalance: our Puritan heritage, which entered the 20th century in the form of the temperance movement that brought us the Prohibition of alcohol.

Big success that was, of course. Since then we’ve been on a bender Prohibiting just about everything else, and that hasn’t been working, either. Our last three presidents all used illegal drugs in their youth. Our drug laws are a joke, which is hardly funny because of the enormous waste of lives, money, and resources involved.

Within the past 15 years or so, medical marijuana has gained a foothold in some states. It’s obvious that anyone with a flimsy excuse -- I do believe painful bunions were once used -- can get a doctor to prescribe pot in California. At least when it comes to marijuana, the absurdity of Prohibition is starting to break down. Gone are the days, and they were real, when people were sentenced to years in jail for possessing a joint.

* * *

I’m not a druggy personality. I like the occasional glass of red wine, but I find that being fully awake and aware in the here and now is more trippy than living in a haze. I experimented with the usual stuff in high school and college, but it’s been 30 years since I’ve smoked pot.

The only drug that I ever truly liked was LSD, which I took a half-dozen times in college. Sometimes it was revelatory, sometimes merely enjoyable, sometimes a bit of both. I recall laying on my back in the organic garden at UC Santa Cruz, watching as passing clouds smiled at me. Another time I was listening to the music of Johann Sebastian Bach, which wove itself into something resembling a complex Persian carpet right before my eyes. Never once, despite hysterical media reports that indicated it might be a real danger, was I tempted to jump off a building to see if I could fly.

In life, the Darwin Awards apply, whether you’re on drugs or not. Some people can handle drugs and some can’t.

I think we’ve all seen what happens to friends and family when people can’t cope with them, or when they take undue risks to get high. A family that has always been quite close to ours lost its sensitive and talented middle child to some bad heroin one night in New York City; he was in his 30s. Another kid I knew and worked with many a summer led a life of drugs and dissolution, stealing from his own parents as an adult, until he managed to ruin his body to the point that it killed him.

And I know many more stories involving our legal drug. alcohol; I have seen it bring heartache and pain, emotional and physical, to people who could have and should have had happier and longer lives.

I also know people in their 70s who have smoked pot their entire lives and seem none the worse for wear. Just about everyone I was close to growing up has violated our Prohibition laws on multiple occasions and most of them are quite happy and successful today.

Which leads me back to my point: Our drug laws are dopey. They’re not respected and they don’t work.

People will do what people will do, whether they’re 23-year-old swimmers or 60-year-old cancer patients. Perhaps some day American society will be ready for an adult discussion of drugs -- why they should be legal (or at least managed more sensibly) and why you should make the choice to use them sparingly.

Until then, let’s drop the hypocrisy. Let’s zip the flimsy moral outrage. Drugs are everywhere. They always have been, they always will be, and in a free society Prohibition will always fail.

Free at last

I must admit to having cried last night when Barack Obama was elected the 44th president of the United States.

Part of it was jubilation, the sort of feeling prevalent in Eastern Europe back in 1989 when the Berlin Wall came crashing down. As Marilyn said, it feels like we have finally gotten rid of the Ceausescus. That big crowd in front of the White House may as well have been carrying pitchforks.

But the big reason, the one that actually set me to sobbing, was the fact that my country has elected a black man, chosen a leader not for the color of his skin but rather for the content of his character. He will be the head of state, but he will be more than that: like all presidents, he is a symbol of the nation he leads. We do not have a royal family here, but we do have a first family, and they are Barack and Michelle, Sasha and Malia, and a puppy as yet to be named.

Oh, how far we've come.

Racism has always been a part of American life. Our very Constitution established that for census purposes “non-free” residents should count as three-fifths of a person. The Civil War may have ended slavery, but for at least a century afterwards we were enslaved by bigotry. Blacks have been lynched, denied the right to vote, denied educational and economic opportunity, denied the right to ride in the front of the bus. I am not all that old, but I am old enough to remember the events of the 1960s -- the fire hoses, the attack dogs, the murders of Medgar Evers, Martin Luther King Jr. and others -- black and white -- who laid their lives on the line to put an end to this madness.

And then, last night, Americans did something that signified in a profound way that we have changed, that we have become something different, that we have become something better than we were. There was something almost effortless about it, until we remember all the sacrifices it took to get here.

Those racists who were responsible for the Jim Crow laws, for the murders in the middle of the night, are no doubt spinning in their graves right now, working their way ever closer to Hell. Those who are still with us, who just can’t stand the idea of a black man as their leader, as their national symbol, have some waking up to do.

I saw a pickup truck recently with a Confederate flag sticker and the words “Kick Ass White Boy” written above it. Next to it was a big American flag. Well, Kick Ass White Boy just got his ass kicked. And I’ll take those Stars and Stripes back, thank you. They belong to a country that is bigger, grander, wiser, and more diverse than it once ever dreamed it could be.

This is the America I love, the one that shows it is, in ways, the Promised Land. It has not been all that many years since Dr. King spoke on the steps of the Lincoln Memorial. I remember hearing his speech as a kid, and his thrilling words have never rung truer than they do right now:

“And when this happens, when we allow freedom to ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all of God's children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual, "Free at last! Free at last! Thank God Almighty, we are free at last!"

A house of cards

What a mess we’re in. As Chris Dodd put it, we’ve entered an era of privatized profit and socialized debt.

Greed is at the center of it all, greed and lack of meaningful oversight, not just on the part of government regulators but also on the part of corporate elders who should have known better, or should have cared more.

Back in 1984, Marilyn and I bought out first house at a cost of $87,500. It was a definite fixer, an older home with an in-law apartment that had been added downstairs. The couple who owned it were divorcing. She lived upstairs, he was consigned to the dungeon, which he trashed. Termites had built themselves a magical kingdom in the walls. The fireplace was leaning away from the house. Roots from a giant willow tree routinely plugged up the sewer lines. It wasn’t in the best neighborhood. But it was just about the last house in Berkeley, CA for under $100,000 and we were lucky to get it, with 20% down and a 13.25%, 30-year fixed loan.

Jumping through hoops to get financing was expected, and made some sense. The lender needed to know that we could afford to pay the mortgage.

That was back in the good old days, when homes almost everywhere in the country were in reach of people with average incomes. I took a look at zillow.com, just to see how our first home has fared. Riding a real estate boomlet, we sold it in 1989 for $200,000, a record for the block. The boom steadied and the people who bought it from us sold it in 1994 for $235,000.

They’re probably kicking themselves. By 2003, it was worth around $580,000. In mid-05 the old dump reached its peak value, $818,000. Today, it’s $661,500 and heading south.

How can people pay for such huge mortgages? Smoke, mirrors, and lemming-like behavior. Things like 100% financing, or 80/20 financing, interest-only loans, ARMs from Hell, HELOCs, refinancing, issuing loans to the insolvent, paying routine bills with credit cards, which were passed out like candy.

As Suze Orman has repeatedly pointed out, financial management skills should be a required course in high school. Just because someone offers you something you can't afford doesn't mean you have to take it.

This madness started in California, then spread to Nevada, Arizona, Florida and a lot of other places that were considered desirable. I have been to all these places, have lived in two of them, and let me say here that none of them are THAT nice.

Anyone with common sense could see that this could not continue. Our Berkeley hovel more than tripled in value from 1994 to 2005. Were they thinking it would more than triple again, be worth $2.5 million in another ten or eleven years? And who did they think (in their right mind anyway) would buy it at that price?

That we are now in a financial crisis, built on bad mortages, should really come as a surprise to no one. It was almost like everyone, from Wall Street to Main Street, was doing financial crack. Everyone ran on overdrive, pocketing money that wasn’t there.

Now this binge has to be paid for, and we’re all going to suffer. Like most Americans, my visceral reaction to the idea of a $700 billion bailout involves a fair amount of disgust. I don’t like rewarding the avaricious. Especially when this money could be better spent on things like health care, cancer research, and so on.

But I am told that we have no choice. That’s probably the case. We have built ourselves an enormous house of cards, not just in real estate but in credit and investments, things that drive our economy and provide financial security and opportunity. It's a monument to folly that we will be paying for, one way or the other, for a long time to come.

The deadliest catch

I was brushing my teeth Friday when I heard that my neighbor John McCain had chosen Sarah Palin of Alaska to be his running mate. My first reaction was “Has he lost it?” My second reaction was a mirror-smudging spit-take upon hearing a TV reporter say, “Her favorite food is moose stew.”

In a single stroke, McCain gave up his best issue against Barack Obama -- experience -- and showed that he is just another cynical politician whose slogan, “Country First,” is meaningful only when it is convenient for him. In the process, he has insulted the intelligence of the American people and cast his own judgment in doubt, looking more like a desperate opportunist than the statesman he purports to be. In contrast, Obama’s pick of a solid and experienced running mate in Joe Biden makes him look like Lincoln, Washington, and Jefferson rolled into one.

Readers of this blog know that I have had reservations about Obama and his lack of experience. I ended up voting for Hillary Clinton in the primary. I have always liked McCain, more or less, though I disagree with him on a great many important issues. For the first time in my life, I have been questioning whether to vote Democratic. (Marilyn, furious about the sexism she saw during the campaign, plans on writing in “Hillary Clinton” this fall.)

Now, thanks to the Palin pick, John McCain has pretty much convinced me that voting for him would be an unacceptable risk. For there is no way on God’s green earth that someone who has served 20 months as governor of a state with fewer people than Austin, TX, and whose prior experience was as mayor of a town of 5,469, is ready to assume the presidency of the United States and the leadership of the free world. As today's editorial in the Fairbanks News-Miner puts it, "Most people would acknowledge that, regardless of her charm and good intentions, Palin is not ready for the top job. McCain seems to have put his political interests ahead of the nation’s when he created the possibility that she might fill it."

If something happens to the 72-year-old, melanoma-prone McCain, I shudder to think of Sarah Palin negotiating with Vladimir Putin, or finessing Kim Jong Il, or dealing with a sudden nuclear crisis in Iran. And I have to wonder, too, whether a President McCain might not do something as rash and impulsive and nonsensical as he did in picking Palin. John McCain has thus cast doubt on his own fitness to serve.

I really do have to wonder about his temperament -- which Obama mentioned in his speech Thursday night -- and which has been the subject of some not-so-quiet concern by McCain’s own GOP colleagues. "The thought of his being president sends a cold chill down my spine," Sen. Thad Cochran (R-Miss.), told the Boston Globe. "He is erratic. He is hotheaded. He loses his temper and he worries me."

Consider me worried, too.

And we may be hearing the word "Eagleton" pretty soon if this "Troopergate" investigation shows Palin to have been playing petty politics in the governor's office.

The Palin pick has been just another episode in what has been a bizarre political year. As Marilyn said the other day, “Doesn’t this whole campaign have an air of unreality about it?”

There is something about the GOP ticket that smacks of a bad sitcom (I nominate Tim Conway and Tina Fay for the leading roles) -- the story of a crusty, doddering war hero married to a beer heiress who runs for office with a gun-toting, moose-eating, hockey mom who also happens to be governor of the 49th state, where she and her snowmobiling-champion husband are raising their kids Track, Trig, and Willow (Paper, Scissors and Rock evidently having been taken, as someone pointed out). Oh, and between the McCains and the Palins, they have ten homes, so there’s always another venue for a hilarious misadventure.

Except, let's hope, the White House.

Your president after next, possibly as soon as January, seen here with what appears to be a group of neoconservatives.

Barack Hussein Dukakis

I have always felt that the Democratic Party represents the better angels of our nature, and therefore I have always voted Democratic, at least on the state and national level. (I did vote for a Republican for mayor of Sedona once but it was a nonpartisan race and I didn’t hold it against him.)

The hardest vote I ever had to cast was in 1988, when Michael Dukakis was running against the first George Bush. By election day, Dukakis had proven himself to be an inept candidate, aloof and out of touch. Some of you may recall his advice to farmers in Iowa to grow more Belgian endive. What sealed the deal with the public was his answer to CNN reporter Bernard Shaw’s question in the last debate, in which Shaw asked, "Governor, if Kitty Dukakis were raped and murdered, would you favor an irrevocable death penalty for the killer?" Dukakis’s emotionless, analytical reply -- a rehash of his views on capital punishment -- missed a golden opportunity to connect with the public on an emotional level. Instead, he appeared to confirm insinuations by the GOP that he was an “ice man,” too out of touch with the average American to be trusted to lead the country.

Barack Obama has a lot more going for him than Michael Dukakis, both as a candidate of intellectual breadth and depth and as a warm, witty, and emotional human being. One of his gifts, up to now, has been his ability to connect to voters. And then he went to Marin County, California, and gave a speech. Marin County, for those who don’t know, is just north of San Francisco, and is, if possible to imagine, filled with even more wealthy liberals than San Francisco. It does not surprise me that Obama was attending a fundraiser there.

I had a friend in college named John who hailed from Marin. His parents had a lovely home and were gracious people, even if one had to remove one's shoes at the door so as not to despoil the pristine white carpet. His father was a doctor, his mother a psychiatrist, and they played string quartets on the weekends -- no, not on the stereo, but in their living room, with instruments and two friends. John’s high school chums lived in a house I will never forget, perched on a hilltop in Sausalito with a commanding view of San Francisco, worth well more than a million dollars even in 1976. These people were well-tanned and drank an enormous amount of white wine on their stunning terrace. I recall going to Grace Slick’s house to meet more of John’s friends, walking down the stairs past gold records hanging on the wall.

Marin, to my eyes, was a wealthy, wondrous, and insulated world. But the experience of growing up there had led John to rebel; he became interested in his religious roots and studied to become a rabbi. Beyond that, he fell in love with New Mexico and wore cowboy hats and boots and blasted Country-Western music on the radio to the consternation of his parents. His hero was Kinky Friedman. Eventually John settled in Albuquerque. He was still a liberal and dedicated Democrat. But culturally, Lone Star beer in hand, he was somewhat the opposite of where he was raised.

And FYI, for those on distant shores -- and this includes New York and Los Angeles -- a lot more Americans can relate to John than to his parents.

Apparently Barack Obama may not be one of them. I was more than a little distressed when my party’s likely nominee went to Marin County recently and rolled this oratorical gutter ball:

"You go into some of these small towns in Pennsylvania and, like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing's replaced them. And it's not surprising then they get bitter, they cling to guns, or religion, or antipathy to people who aren't like them, or anti-immigrant sentiment, or anti-trade sentiment as a way to explain their frustrations."

Ouch. Dukakis-in-the-tank ouch. Dukakis failed the gut test. Obama is starting to require a little too much Pepto-Bismol for comfort.

It's not that Obama said people are bitter. We all understand that unemployment can send people into anger and despair. Nor does anyone argue that there will always be people who will take their frustrations out on others, however unfairly. The history of this country is filled, after all, with far too many examples of xenophobia and racism.

The problem is that Obama went one step further, ascribing people's passion for things that some Marin-ites might dismiss as "downmarket" -- such as guns and religion -- to a negative motive: bitterness about economic decline. The implication was, whether he meant it or not, that if their economic situation improves, residents of these towns would become less interested in guns and God and more tolerant of illegal immigrants. Perhaps this sort of armchair sociology appeals to a closed-door audience in Marin, but it is wrong on so many levels and betrays a lack of understanding of what makes this country tick.

One reason John and I could relate is that, for the most part, I grew up in small-town Arizona. Around actual cowboys. And Indians. And people who have guns. People who go to church. Like John, my experiences led me in somewhat the opposite direction from where I was raised. That's how I ended up in Santa Cruz, California, where John and I went to college.

But I've been to the rodeo as well as the opera. And I can tell you that most people do not have guns because they are bitter. They have guns because they like to hunt, or because they like to shoot bottles off fences like I did when I was a kid -- every boy I knew had a BB gun -- or because they view guns as a means of personal protection. They go to church, not mainly because they are upset about things -- though religion certainly is a means by which some people cope with the question of why bad things happen to good people, such as those who come down with leukemia. They go because it gives them comfort and structure and community and an answer to cosmic questions we all wonder about. They are not anti-immigrant because they are frustrated -- they are frustrated with illegal immigration, largely out of principle, because they believe other people should obey the laws just like they have to. This is called “fairness.” And when it comes to trade policies, many Americans think a goal of these policies should be to safeguard American jobs, rather than see them shipped overseas to the benefit of multinational corporations looking for cheap labor. Is this clinging to a sentiment out of frustration, or is it -- oh, I don't know -- common freaking sense? (For an excellent analysis of the full range of problems with Obama’s comments, read this at Politico.)

Obama’s remarks made me cringe because they remind me of the misunderstanding some people in my party have of what it means to live in Flyover Country -- that is, the space between the two coasts. What Obama doesn’t get, apparently, and what he needs to get if he expects to be president, is that rural and/or red state voters are a lot more complex than he gives them credit for.

We are all products of our experiences, and one reason I give Obama a pass on the Rev. Jeremiah Wright issue is that I do not know in my heart what it means to be black in America. But I can see, given our history and the struggles for Civil Rights that I witnessed as a kid, where the bitterness of some African-Americans comes from.

Conversely, understanding towns like those I grew up in, or those in which people in rural Pennsylvania live, is a bit out of Obama’s experience. The problem is that he is running for president and cannot win the election without the votes of at least some of those denizens of Possum Hollow.

All this may drive me to drink, as it has Hillary Clinton, who is now a good ol' girl who downs shots of whiskey and tells stories of her duck hunting days of yore. This is Clintonian political theater at its most entertaining, and Obama’s remarks may yet save her candidacy.

And the irony in all this is that if Obama is the nominee, Republicans -- the party of tax breaks for the wealthy, corporate welfare, and fringe social policies -- will again have the opportunity to portray the Democrats as the ones who are out of touch.

That's not reality, really. Which is why I vote Democratic. And perhaps this year, given the state of the economy and the endless war in Iraq, people will overlook some inappropriate comments. Even so, I'll be clinging to prayer if Obama becomes the nominee.

Al Gore on the second ballot

Well, a boy can dream. I’ve always liked Al. Behind that stiff exterior lies a man with a good sense of humor and a good head on his shoulders. I’m not going to rehash the travesty that was the election of 2000; suffice it to say that the past eight years would have been infinitely better for our country had Gore been in charge.

Now there is an ever-so-slim hope that he might yet mount a white horse, Nobel Prize medallion around his neck, sun block on his face to filter out the effects of ozone depletion, and ride to the rescue of the Democratic Party.

It looks like we may need it.

Not that we don’t have two good candidates -- it’s just that the longer they stay in the arena, flailing away like punch-drunk prizefighters, the more battered and bloodied and uglier they become.

On the one hand we have Barack Obama, whose ability to inspire is equaled only by what we don’t know about him. The Rev. Jeremiah Wright affair should have been a wake-up call, at 3 a.m. or otherwise. Not the obnoxious things Wright said. Not the fine speech Obama gave on race relations. But the fact that Obama knew it was coming, had known it for a year, and did nothing to nip it in the bud.

"If Barack gets past the primary," Rev. Wright told the New York Times in April 2007, "he might have to publicly distance himself from me. I said it to Barack personally, and he said yeah, that might have to happen."

So my question is, what else does Barack know is coming? What other distancing does he have backup plans for? (I am just a tad uneasy about this Tony Rezko trial, for example.) Obama is an interesting figure. He’s bright, he’s personable, he's full of potential. But I fear he could also be full of surprises. After all, he’s a politician (which will come as a shock to those of you who think he’s the Second Coming of Kennedy). Politicians spin things for the best, and they hide things they think might hurt them.

Speaking as a Democrat, it matters when these things rear their heads and hurt us as a party. (Is there a New York governor in the house?!)

Which brings us to Hillary Clinton, who has been well-vetted, and who we know, warts and all. Obama, who began this year on a pedestal, has nowhere to go but down. Clinton, who has endured often unfair sniping for almost two decades, has nowhere to go but up.

But that doesn’t mean she’s going anywhere, her campaign having blown it in the dozen or so states immediately following Super Tuesday, creating a pledged delegate shortfall that she can’t overcome without a miracle. (As Bill recently said, “It's the caucuses that have been killing us.”)

That won’t keep her from trying, of course. She plans on winning the nomination -- if not this time, then perhaps in 2012. It has been suggested, and not without some plausibility, that Clinton would rather see Obama lose the general election to John McCain than win it. This would, after all, make her the frontrunner for the party’s nomination four years hence, when Americans would be really, really, REALLY tired of Republican rule.

Is she that ambitious? I’d like to think not, but I don’t know. What I do know is that they’ll probably have to carry her out of the Denver convention in a straight jacket to get her to give up the fight. She has been waiting all her life for this, folks, and will not go gently into that good night.

Clinton’s recent approach to winning has been called the “Tonya Harding strategy” -- bash him on the kneecap and hope for the best. And the things that might still make her the nominee -- Obama’s inexperience or skeletons in his closet or a gaffe of some kind -- are the same things that the Republicans are counting on to help them win in November. So her strategy dovetails into their strategy, which is to create the perception that Obama is not ready to be president. This is not helped, of course, by anything that Obama might do to confirm that he is unprepared or too risky to take a chance on.

So we have a situation where two candidates, who are increasingly polarizing supporters on the other side -- witness the Carville/Richardson “Judas” dust-up -- will arrive in Denver without enough pledged delegates to win the nomination.

The superdelegates will have to come up with something, and I am not alone in wondering if Gore might be the answer. Back in the old days, conventions would sometimes select a dark horse on the second, third, fourth, or even later ballots.

Al Gore is hardly a dark horse. He is well known, experienced, a proven popular vote-getter, and more respected today than he was eight years ago. Al could mount that white horse, ride in to unite the party, and gain his rightful place in the Oval Office.

It probably won’t happen, of course, because politics is not like the movies. It is not like fiction. It is stranger.

Here we go again . . .

Flame me all you want but I am here to make the point again: We Americans must do SOMETHING to guarantee access to health care for all, including those with preexisting conditions.

Dr. Terry Hamblin recently posted to his blog about problems with the UK's public health service, the NHS. (Follow this link and search for "Travails of the NHS.") He describes the messes that can be created when bureaucrats, including committees of doctors, attempt to decide on treatment without expert knowledge. If it were not so sad it would be funny: Terry quotes one doctor who read about CLL briefly and said: "I have been reading about this subject for two hours. I am now an expert in the condition."

What is the take-home lesson here? I think it is pretty clear: The best standard of care requires that doctors with (genuine) expertise in a given condition be allowed to make the decisions.

But a couple of those who posted comments about Terry's piece drew another lesson, seen through the filter of their myopic glasses: "Cautionary tales such as this make me oppose national health systems being imposed in the US, " wrote one. "I'm not sure why there is such a hue and cry over the 'failure' of the American health care system when it is in many cases the envy of the world. . . . Changing to a bureaucratic-run system will be made at the peril of the patient."

Hmm. Somehow American veterans have managed to survive the bureaucracy at VA hospitals, and somehow elderly Americans have managed to cope with Medicare without keeling over in large numbers.

But those are asides. The essential point is this: The failures of bureaucracy do not mean that the US should not have a health care system that provides access to all. Access to health care is a moral issue independent of the manner in which it is instituted.

And bureaucracy is not the province of government-run care alone: We have all heard of -- and indeed, many of us have experienced -- cases in which bureaucrats working for health insurance companies in the US make ridiculous calls. They deny treatment, refuse to approve the right treatment, or reject an appropriate test. (Ask the family of Nataline Sarkisyan, or ask Hilary Skvov and then read this.) Indeed, the bozos making these decisions in the US often have no medical training at all; their job is counting beans. They could read about a given condition for two hours and still not know their asses from a hole in the ground, nor would they care. (A committee of doctors -- we should be so lucky!) In America, the fox guards the henhouse. The quality of our care may be excellent but getting access to it is another matter entirely -- even if you have insurance.

Ignorance is ignorance, be it in the public or private sectors. When it comes to patient care, doctors should be calling the shots. Coming up with a fair, workable system may be tricky but it is not impossible. We sent men to the moon, ferchrissakes. Americans want as much freedom of choice as possible, and as light a regulatory touch as possible, but they also want to be able to get the care they need. I have enough faith in my country to believe that we can finesse these matters and devise a system that works reasonably well for all.

None of this takes away from the fact that access to health care is a moral right in a civilized society. I will never forget the post I saw from a CLL patient who lost his job because of his condition and, having also lost his health care, was trying to combat his CLL with herbs. I am almost as sick and tired of those who use "bureaucracy" as an excuse to deny their fellow citizens coverage as I am of CLL.

Uh-oh, Obama

I was going to stay clear of politics for a while, but as some of you may have figured out I am a bit of a political junkie and I can’t really help myself.

As we all know, Barack Obama scored an impressive win in Iowa and now stands to reap the rewards with a probable victory in New Hampshire on Tuesday, where he is starting to lead in the polls. Could it be that the presumed Democratic nominee and next president, Hillary Clinton, is watching her dreams evaporate as Obama’s sunny message gets hotter and hotter and threatens to go supernova?

I saw Obama’s victory speech on Thursday and it was, indeed, a fine oration. Obama can effectively weave together our national story and his personal story and what it means to believe in ideals larger than ourselves. He is not quite so good at debating, or at one-on-one interviews, but give him a platform and a microphone and a prepared speech and he is right up there with Bill Clinton and Ronald Reagan.

Hope is always a powerful force in politics. And I think that one of the reasons it resounds so much now in the Democratic primaries is that for the past seven years most Democrats and many independents have felt profoundly hopeless and powerless. We have watched the country go downhill in almost every respect, often betraying those ideals we were raised to believe in, which has made it all the more painful. And until the Democratic victory in 2006, we were shut out of the process of governance by a take-no-prisoners approach exemplified by the leadership of Tom Delay in Congress and Bush, Cheney, and Karl Rove in the White House. All this happy talk from Republicans about “reaching across the aisle” didn’t start until after they became the minority party on Capitol Hill.

Barack Obama is a thoughtful man who offers an idealized version of how things ought to work, but I fear that is not the way they do, in fact, work. Almost every significant reform that has been accomplished in this country has come through, as Winston Churchill once said, “blood, toil, tears, and sweat.” The civil and voting rights acts of the 1960s passed not because everybody suddenly realized that it was criminal to deny people equal rights based upon race but rather because Lyndon Johnson twisted arms and busted heads to get the legislation through Congress. How did FDR get a conservative US Supreme Court to stop blocking some important aspects of the New Deal? By threatening to increase the number of justices and pack it with his own people. How did labor unions become established? Not by asking politely, but by workers striking and being beaten and dying in the streets. (The same is true, of course, of those who fought the long struggle for civil rights, without which the stage for Johnson's legislation could not have been set.)

Not everything has to be confrontational -- and I think most Americans are tired of the hyper sense of divisiveness that has characterized the Bush era -- but history is written by those who stand their ground and fight. For good or ill, Dubya has done just that on Iraq: he won’t take “no” for an answer, he insists on the rightness of his policy, and he has indeed kept us in there long after most Americans thought it wise.

And elections are won by negative things as much as positive ones. Attack ads work. Swiftboating works. Wedge issues work. And sad to say, as much as most Americans say they don’t like these things, they are indeed swayed by them.

Now, has something finally happened to change all that? Has there been come cosmic shift in the political landscape? Maybe I’m just getting to be an old fuddy-duddy, but I am skeptical.

That is the reality of politics, and that is why I prefer the John Edwards “fighting” approach when it comes to getting things done. My fear about the rather inexperienced (and possibly naive) Obama is that he could suddenly find himself facing bare-knuckled politics and not be capable of coping with it effectively. When was the last time, if ever, that we had a “gentlemanly” general election in this country? 1792?

It’s an exaggerated example, but Marilyn put her finger on it the other day when she said that what we Democrats need is not a Neville Chamberlain but a Winston Churchill. Chamberlain compromised with a man who had absolutely no interest in compromise and he accomplished nothing. I fear that there can be no real compromising with the GOP leadership, or with the entrenched corporate interests that try to run the show in Washington. Like Churchill, we need to recognize the opposition for what it is and we need to fight like hell.

In other words, blood, toil, tears, and sweat.

Is Barack Obama the man to lead that fight? Or would I rather have John Edwards or even Hillary Clinton at my back in a brawl?

Maybe I am wrong about Obama, maybe something has indeed changed in this country -- Mike Huckabee's "positive message" campaign is a breath of fresh air on the GOP side (good luck getting past the GOP establishment, Mike) -- but I have seen too much in history to believe that we will get, say, universal health care, without kicking some major ass.

John Edwards for president

It’s the new year, and it’s time to pick a new president. In just three days Iowans will caucus, and five days later the people of New Hampshire will vote, and then it’s off to the races, with Feb. 5 being Super Tuesday, when some 20 states vote, including mine.

I have been watching the debates, enduring extended interviews with the candidates on C-SPAN and Charlie Rose, and generally investing far too much energy in trying to make the right choice. If you haven’t figured out who you’re voting for, the time to do so is fast approaching. Maybe I can help.

Of course, if you’re planning on voting Republican, there is little I can do except to suggest that you take two aspirin, go to bed, and see if it passes. For everyone else, I offer the following analysis:

In a field of good Democratic candidates, John Edwards has the edge. He has the edge because of his health care reform plan and his dedication to putting it front and center if and when he becomes president. I saw his wife Elizabeth on C-SPAN the other day and she pointed out that John will make it his number one priority, with the intention of signing universal health care into law by July 2009.

Even if it takes a few months longer to achieve, no other candidate has brought the passion to this issue that Edwards has, and no one has as good a plan. As I have written in the blog before, Edwards would give Americans the choice of staying with private insurance or signing on with an expanded Medicare program. You will be able to vote with your feet as to which type of coverage you prefer. You will not be forced to choose 'socialized medicine," nor will you any longer be at the mercy of capricious market forces that leave many with no insurance, or with inadequate insurance.

Even if health care were not such an important issue, I would still be supporting Edwards. Like many Americans, I think things in Washington are dysfunctional. Big problems face us and no big solutions are offered. I also agree with him that part of the problem is that lobbyists, particularly those for corporate interests such as oil, drug, and pharmaceutical companies, call the shots too often. Why, for example, do you think Medicare is forbidden to negotiate with drug companies for lower rates for prescription drugs?

Politics is the art of compromise and the American political system is designed to balance competing interests, but there are times when the system itself becomes unbalanced and lopsided; in these times a leader is needed to put powerful interests in their place. Teddy Roosevelt busted the trusts. We need someone now to stand up for American families and American workers, not to compromise their opportunities away. This view is shared not only by some liberal Democrats like myself but also by libertarians like Ron Paul and conservative populists like Pat Buchanan.

So, for those who say Edwards is too confrontational, I’ll let the candidate himself reply. This is what he said when the New York Times asked him about Barack Obama’s nice guy approach and how it would play with insurance and drug companies:

"You can’t nice these people to death. You’d better send somebody into that arena who’s ready."

Can anyone seriously doubt the truth of that statement?

I appreciate that fight and that spirit, though I have not always been an Edwards fan. But something has changed in the man since 2004. I think his natural populist tendencies have come out now that he no longer has to hedge his bets representing North Carolina, a rather conservative state. And I think Elizabeth’s experience with cancer has helped the Edwardses focus more on what is truly important to them, which is something they have talked about. This happens with us CLL patients and it is natural that it would happen with them, too.

John Edwards has two other things going for him: He can reach across party lines and bring independents and some Republicans on board to win the election. And he can be a moving and impassioned speaker. I glued myself to C-SPAN and listened to his Jefferson-Jackson Day speech in Iowa, as well as the speeches of all the other candidates. His was the only one to bring a tear to my eye, and I felt he was more effective than the reasoned but reserved Obama and the somewhat robotic Clinton. In John Edwards we Democrats have a candidate who represents real change and an excellent chance of success in November.

The also-rans

As I said at the outset, there are a number of good Democratic candidates.

I have grown to respect Chris Dodd, whose impassioned defense of the Constitution and its protections for civil liberties, which the Bushies seem to regard as some sort of inconvenience, is appealing. His decision to return to Washington to fight the FISA bill, which would give a pass to telecom companies that handed your private information over to the feds without a warrant, is a definite plus. Dodd is clearly intelligent and experienced, though with a somewhat senatorial speaking style overlypunctuated by the word “here.”

Joe Biden also impresses. He has the right foreign policy experience and instincts to deal with thorny issues such as Pakistan, Iran, and Iraq. He has shown an ability to speak in short, pithy bursts that combine humor and common sense, and thus comes across as an appealing figure as long as he doesn’t start rambling. In his personal life, he is a man of quiet faith, of modest means, and one who has overcome the tragic loss of his first wife and infant daughter to a drunken driver.

In a country hungry for change, no one represents "new" quite so much as Barack Obama. The Illinois senator is just different enough -- young, African-American, not in Washington long enough to be a creature of the place -- that he appeals to the emotional need for, as Monty Python says, Something Completely Different. He is a good speaker and his argument that we need to rise above the sort of politics we have been experiencing has appeal. But I am forever reminded that, in the street thug world of elections, nice guys usually don’t finish first. I also think he is a little shy on experience. Three years in the US Senate, much of which has been spent campaigning for the White House, is a paltry amount of time to learn the ropes of governance. Serving in the Illinois state legislature may have been adequate experience in the days of Lincoln, but those were simpler times. I can accept the argument that judgment trumps experience, and while I appreciate Obama’s opposition to the Iraq war, one good call does not make for a record of good judgment. With Obama we are clearly taking a big chance: he may work out, he may not.

In contrast to Obama’s freshness, Hillary Clinton is the familiar choice, the establishment candidate. After all, she and her husband are the Democratic establishment, such as there is one. If “establishment” means stability and experience, it also means, for many, a failure to get things done. Voters think the Democratic Congress they elected in 2006 has largely failed them by playing the same old games. They are reminded of the Clinton era, and of concepts like “triangulation” and the definition of “is” and they are a little worried that another Clinton presidency will not bring the real change they hunger for. Perhaps this is a bit unfair to the senator from New York, but her campaign’s wanton attacks on Obama -- everything from kindergarten to cocaine -- have not helped overcome this concern. Hillary Clinton would probably be a good president, and I will happily vote for her if she is the nominee, but I do not think she is the strongest choice in the primaries.

I have a soft spot for Dennis Kucinich, who calls it as he sees it, who has been right on the Iraq war since the start, and who has challenged the other candidates to find principle and consistency in their actions. I am not sure the country is ready for him, but I appreciate the fact that he gives the left a sincere voice in party affairs.

Bill Richardson seems like a nice guy but somehow I do not get the impression, despite his long resume, that he is quite ready for the presidency, or that he has the debating and speaking skills to inspire and persuade.

Fortunately for us Democrats, the GOP field is about as weak as any ever was. Mike Huckabee has an easy manner and a good sense of humor but his ineptitude on foreign policy and his tendency to wear his religion on his sleeve will mean trouble in the general election. Mitt Romney flip flops more than a fish out of water and has a patrician, Kerryesque quality that is not appealing. He looks like a mannequin that has come to life, and he has all the personality of one. Fred Thompson is a decent enough fellow but dull and uninspiring, all the more surprising since he has made a career as an actor. Rudy Guiliani has no foreign policy experience, parrots the neocons who got us into this Iraq mess, and has made just enough bad judgment calls in his career to sink him in November.

Ron Paul has developed a following among libertarians and some traditional conservatives, who rightly think the Republican party has left its roots, sold its soul to corporate interests, and ended up in the land of fiscal irresponsibility, unnecessary foreign intervention, and disrespect for Constitutional rights. I would argue that not a few Paulites -- Paulies? -- might consider a vote for Edwards over someone like Romney.

And finally, there’s John McCain, the exception to the rule. I disagree with him half the time but I respect his independence of mind and his experience. He is the best-qualified Republican running and would do best in the general election. Here’s hoping he continues to grate on enough purist GOP voters that he is denied the nomination, just as he was in 2000.

Regardless of who the Republicans select, it promises to be a Democratic year. But we should not be overconfident; in my view our best bet to win and our best bet to bring about reform in Washington is John Edwards.

Sicko

No, I haven’t seen the Michael Moore movie. I don’t have to. I know the American health care system is in trouble.

And I’m warning you right now, there will be a little bit of ranting in this post.

I just finished reading a series of comments in a patient forum in which several people made catty remarks about how Michael Moore makes them ill, and about how that great bugaboo of the right wing -- “socialized medicine” -- will end life on Earth as we know it. (How many of these same people would volunteer out of principle to give up their "socialized" Medicare benefits, I wonder?)

The real sickos, it seems to me, are people who don’t give a damn about those of their fellow citizens who aren’t insured, or who have substandard insurance, or who can’t get insurance because they can't afford it, or who are rejected by insurance companies because of pre-existing conditions like chronic lymphocytic leukemia. People whose answer is “go to the emergency room, they have to take everyone.” Or “find a free clinic.” Or “establish a medical savings account,” as if the average American can sock away enough money to pay for the treatment of cancer or a chronic disease.

Tell it to this guy, who just “sold” his Stage 4 Non-Hodgkin's Lymphoma on eBay for $242.50. Since auctions eventually are taken down from the eBay site, let me quote from his listing, and let me also post a picture of him and his family so that you can see everything that is at stake here:

Well, I've sold almost everything I own to make ends meet, I've nothing left so I thought I may as well try and sell my cancer on ebay. I was diagnosed at age 39 with Stage 4 Large Diffuse B-cell Non-Hodgkin's Lymphoma in April of 2007. I Recently finished my 6th (and hopefully last) round of chemo-therapy. I am trying to sell mainly because of my families dire financial situation, but my little twin boys are afraid that daddy won't make it, so I promised them I would try and sell it on eBay.

I obviously cannot send anyone any physical cancer, but the winning bidder will receive before and after photos from PET Scans and MRIs done on my entire body. But mainly the winning bidder will get the satisfactory feeling of helping out a family of 5 in grave financial distress.

In mid October I am scheduled for another PET Scan. If that is clean I will be in complete remission and the winning bidder will also receive a thank you card every year on that date for the rest of my life. In the unlikely event that this cancer takes my life, the winning bidder will receive a short biography of my life and a copy of my obituary. There is no reserve so please bid high and help my family survive this crisis. If you need proof that this is no joke you can send me a message and I will give you absolute proof. Thank you and God bless!

Or tell it to the CLL patients who I see posting on forums saying things like: I need treatment but I have no insurance. How can I pay for it without going into bankruptcy? Or things like: I am taking herbs for my CLL because I lost my job and can’t get insurance.

I have seen both these comments, and many more, in the few years I have been reading patient forums.

Is health care a right or a luxury?

These situations bring up the question: In a civilized modern society, is health care a right or a luxury?

There was an interesting discussion of this on an Oprah show where Moore and others appeared. Here's a quote:

Princeton University professor Uwe Reinhardt, one of the nation's leading authorities on health care economics, says the health care debate all boils down to a single question. "Should the child of a gas station attendant have the same chance of staying healthy or getting cured, if sick, as the child of a corporate executive?"

Professor Reinhardt says people need to decide whether medical care should be like public education — where every American simply has a right to it — or if it should be treated like a luxury good. Currently, he says health care is like fine dining -- if you have the money, you get it, and if you don't, you won't.

When hurricanes or other natural disasters hit, Professor Reinhardt says the government steps in to help victims. "That's social insurance," he says. "It's a natural disaster, and I would say if a lady in Mississippi has breast cancer, isn't that a natural disaster, too?"

As Michael points out in Sicko, Americans rely on many socialized services, like the police department, public libraries and the fire department. The U.S. Army even provides socialized medicine for all enlisted men. "I'd like to call it Christianized medicine because this is what Jesus would do, right?" he says. "He wouldn't let the child of a gas station attendant go without."

Of course, the right-wing solution, even among some of those who profess their faith all too loudly, boils down to this: Go die. Stop bothering us. Let us continue to bankrupt this country through a misguided war that will put the nation in debt for a generation. Expand the program providing health care for children? Surely you jest. That will lead to more government (which, as we all know, is much worse than having more of a health care crisis). Heck, let the free market take care of it: sell your disease on eBay!

Lucky for me, I guess, that I'm an eBay powerseller. As a self-employed individual with cancer, I can tell you for a fact that it is impossible to get insurance without some form of government intervention. There is a patchwork of programs depending upon the state you live in; there is no consistency to it or to the quality of coverage. I will need a stem cell transplant eventually but here in Arizona there is no way that I can get insurance that will pay for one. Neither would there be a program for me in California. But both New Mexico and Texas would cover me. Fortunately, I am in a position to move. Not everyone is.

These issues are but a few of the problems our insurance system faces: Rising costs and declining benefits confront many in the middle class. Companies are squeezed financially and can no longer afford to offer insurance to their employees. For the first time, there is a growing demand from business as well as from average Americans that something be done. And the conservative solution of "leaving it up to the states," which are in varying states of financial health, is no solution at all.

So what is the solution?

As much as I admire Michael Moore for raising issues that need to be raised, I do not favor a single-payer national health system to replace private insurance. There was a time when I did, and then I came down with CLL.

One thing I realized is that in countries with systems where care is rationed -- and where oversight boards of some kind, no matter how well-intentioned, decide who has a right to get what treatment -- the drugs that my doctor and I think may help me the most may not be available. Rituxan is not easy to come by in either Canada or the UK, for example, and therefore the standard of care for CLL is probably not as good as it is here. Australians have a heck of a time getting some prognostic tests, like IgVH mutational status, done. These are some examples I know from personal experience; there are no doubt others that relate to other conditions.

I saw Democratic presidential candidate John Edwards talking on C-SPAN a week ago. He was being interviewed by reporters who cover health care issues. Edwards was among the first of the presidential candidates to lay out a comprehensive plan on health insurance and he may have hit upon a workable solution, or one that is about as workable as we're going to get.

Edwards would cover everyone, and everyone would have a choice: they could continue with private insurance, improved through the establishment of regional health care markets to increase choices and cut costs; or they could sign on to a Medicare-style public insurance program.

This makes the most sense to me: preserve freedom of choice while making sure everyone is covered. Edwards said that the beauty of his approach is that eventually American citizens would vote with their feet and gravitate toward the system they liked best.

What will they choose? Who knows. But it is evident from all the polls, despite the howling from the right, that they are no longer choosing to let things go on as they are.

I'll close with this quote from the Oprah article:

To get health care coverage for every man, woman and child in the United States, Professor Reinhardt believes it would cost about $100 billion in additional government spending. That's the same amount the government spends in nine months to fund the war in Iraq, he says.

AFTERWORD

This topic is an emotional one, as the comments section shows, and I plead as guilty as anyone. I am not always sure that I am right about a given issue but I am willing to go to the mat on this one.

There is one last point I want to make: If the private insurance system were willing and able to cover everyone and keep costs reasonable, I'd be all for it. For me, this is a practical issue much more than it is an ideological one.

But the private system is failing. Government, in the form of a patchwork of state programs and such federal efforts as SCHIP to cover children, is already involved. Medicare, for another example, has a major impact on compensation for care outside the Medicare system. It is a all a royal mess, and it would be far more intelligent for government to play a reasoned and constructive role in dealing with the whole problem, not bits and pieces of it. In this effort, there will no doubt be a role for private insurers and medical providers. But there will also by necessity be a public aspect, and it is a greater good to care for those without care than it is to deny care by refusing to change the system on ideological grounds. People who die of cancer and other diseases do not go to their graves as Republicans or Democrats: they go as human beings, and that is the bottom line for me.

RESOURCES

For a comprehensive rundown of insurance options state by state, visit this excellent website: healthinsuranceinfo.net

For information about states that have high-risk insurance pools that may cover patients with nasty pre-existing conditions such as CLL, go here.

State health risk pools that have websites:

• Alabama Health Insurance Plan
• Alaska Comprehensive Health Insurance Association
• Arkansas Comprehensive Health Insurance Plan
• California Major Risk Medical Insurance Program
• Connecticut Health Reinsurance Association
• CoverColorado
• Idaho Individual High Risk Reinsurance Pool
• Illinois Comprehensive Health Insurance Plan
• Indiana Comprehensive Health Association
• Health Insurance Plan of Iowa
• Kansas Health Insurance Association
• Kentucky Access
• Louisiana Health Plan
• Maryland Health Insurance Plan
• Minnesota Comprehensive Health Association
• Mississippi Comprehensive Health Insurance Risk Pool
• Missouri Health Insurance Pool
• Montana Comprehensive Health Program
• Nebraska Comprehensive Health Insurance Plan (CHIP)
• New Hampshire Health Plan (NHHP)
• New Mexico Medical Insurance Pool
• Comprehensive Health Association of North Dakota (CHAND)
• Oregon Medical Insurance Pool
• South Dakota Risk Pool
• Tennessee's Tenncare Program
• Texas Health Insurance Risk Pool
• Utah Comprehensive Health Insurance Pool
• Washington State Health Insurance Pool
• Wisconsin Health Insurance Risk Sharing Plan
• West Virginia Health Insurance Plan
• Wyoming Health Insurance Pool