What the Numbers Tell Us

Probably the best way to track the effectiveness of the speech is via approval ratings and surveys that ask voters whether they approve of the Obama plan or the way he is handling health care reform.

Did we see any movement one way or the other when comparing the numbers for today versus the numbers for yesterday.

Rasmussen tracks presidential approval by comparing Obama's strongly approve ratings with his strongly disapprove numbers. According to the Rasmussen, 33% of all voters survey strongly approve of the president's job Performance while 41% disapprove. This means his overall rating for September 10Th is -8 which is unchanged from September 9Th.

Additionally, 44% of all voters surveyed approve of his health care reform package while 53% disapprove.

At this point, the speech appears to have made little impact with voters. Of course, Democratic members of Congress were a target group of the speech as well. The speech may have swayed them. Also, it is important to note that opinions may change as the media forms a consensus message of failure or success. This could take a few days to crystallize

Rasmussen

Meet Joe Wilson!!

A quick thumbnail sketch of the man who heckled the president during the nationally televised speech.

Obama's Healthcare Hail Mary

The pundits proclaimed this as the make or break speech for President Obama and his health care plan. Of course, the media issues the same dire warning in July and August. The networks know a sense of urgency or impending doom means more viewers!!

While the jury is still out regarding this latest effort, the White House must grapplw over its inability to communicate a precise, easily digestible message to voters. Of course, this problem exists because they are still not certain as to what this bill Will ultimately look like and what it will accomplish. Current efforts are truly all over the place even though the public option still creates the most buzz.

5 Freedoms You Could Lose. . . .

in the new proposed health plan. Worth pondering what ever your position.

And here's the current system . . .

in an easy to understand flowchart:

http://voices.washingtonpost.com/ezra-klein/assets_c/2009/07/HealthCareMap.html

Flowcharting the proposed health care system

Interesting flowchart put together by Congressman Brady:

http://www.house.gov/apps/list/press/tx08_brady/71509_hc_chart.html

Gratitude, Gifts, and Health

Here's a fascinating passage from Paul Tournier's The Meaning of Gifts. I wonder what it might say about current views of healthcare and nationalization?

"[Y]oung people are profoundly unhappy because they have lost a sense of gratitude. They can speak only of rights. Health is a right and sickness a frustration of this right. Healing, so quick now, thanks to our antibiotics, is no longer a gift from God. Happiness is a right. Since no one achieves it, despite all our modern conveniences, everyone is the victim of a frustration complex. No gift can bring joy to the one who has a right to everything. Even love has been devalued; it is but a commonplace convenience which the sexes render one another, without there being any deeper self-commitment. There is no real giving of the self!

"No giving. This word “giving” brings to mind the subtle transition from gift to trade. For it seems to me that it is in this profound human need to give that we need to give that we need to seek for the desire for trade, commerce, and even for farming and industry. For these “offer” men the goods which they need. That the pleasure of giving is reciprocal, that it is organized into exchange systems, that the invention of money has generalized it on a world-wide level has in no way changed its physiological meaning. The best businessmen, those who illustrate most truly the business mind, are men who like to give, who like to please the customer. They always feel as if they were bestowing a gift with their merchandise, adding again a kind word and a beautiful smile. They also feel that they are recipients of a gift when people pay them.

"Effective advertising has its roots in just such an attitude of mind. Because these men are themselves convinced that they are offering what the client needs, they are able to persuade him that it is so. . . . Is it not interesting to look upon the whole of economic life from this point of view? Not just as an instinctual need to procure for oneself the means of subsistence, but equally as a universal, spiritual need for exchanging with others: In other words, to see it as the need for interpersonal contact." (31-33)

True Community & Health Care

The following is from the essay "The Work of Local Culture" by Wendell Berry. While Berry is discussing the general failure of community life and place in the United States, his insights on trust, story, local place, and doctors, I think have ramifications for how we should think about the prospect of a national health care system in this country. First, Berry:

"When a community loses its memory, its members no longer know one another. How can they know one another if they have forgotten or have never learned one another’s stories? If they do not know one another’s stories, how can they know whether or not to trust one another? People who do not trust one another do not help one another, and moreover they fear one another, and this is our predicament now. Because of a general distrust and suspicion, we not only lose one another’s help and companionship, but we are all now living in jeopardy of being sued.

"We don’t trust our “public servants” because we know that they don’t’ respect us. They don’t respect us, as we understand, because they don’t know us; they don’t know our stories. They expect us to sue them if they make mistakes, and so they must insure themselves, at great expense to them and to us. Doctors who are in a country community must send their patients to specialists in the city, not necessarily because they believe that they are wrong in their diagnoses, but because they know that they are not infallible and they must protect themselves against lawsuits, at great expense to us. . . .

"Several decent family livelihoods are annually paid out of the county to insurance companies for a service that is only negative and provisional. All this money is lost to us by the failure of community. A good community, as we know, insures itself by trust, by good faith and good will, by mutual help. A good community, in other words, is a good local economy. It depends on itself for many of its essential needs and is thus shaped, so to speak, from the inside-unlike most modern populations that depend on distant purchases for almost everything and are thus shaped from the outside by the purposes and the influences of salesmen." (157-158)

"The loss of local culture is, in part, a practical loss and an economic one. For one thing, such a culture contains, and conveys to succeeding generations, the history of the use of the place and the knowledge of how the place may be lived in and used. For another, the pattern of reminding implies affection for the place and respect for it, and so, finally the local culture will carry the knowledge of how the place may be well and loving used, and also the implicit command to use it only well and lovingly."(166)

(From the 1990 collection What Are People For?)

Berry argues that local culture is dependent upon relationships of face-to-face trust and mutual life and involvement in the day-to-day business of work and worship and play. Without that trust, we have a culture of personal protectionism and tort that renders our healthcare fraught with impersonality and consumerism. While Berry does not suggest this directly, I think his chief insight is that healthcare should not be commodified to begin with. Medicine does involve money, but when we make medicine and health a matter of market relations we have already started down the road to a broken system, one lacking personhood and genuine compassion; that is, one that is is neither healthy nor caring.

Of course, I am not denying that doctors should have a reasonable livelihood, as should medical researchers and educators. (Though, pharmaceutical reps are another matter entirely. . . ). Nonetheless, we currently have a system where much of our health and sickness is turned over to people we do not know and that we must trust despite our lack of any true knowledge of who they are or what their characters are like. And because we have commodified medicine and medical care, the natural and unnatural inequities in wealth have given rise to a state where strangers decide whether our sickness is worth giving much or any attention to, and where expensive procedures may easily devastate poor and working families in short order. We decontextualize health by making it a matter of management and numbers, rather than persons, their stories, and our relations with them in our communities.

A national system, which hopes to fix these problems, may or may not help curb the current excesses, but I doubt whether it can finally heal them. It participates in the anonymity and dangerous policy-decisions of technocrats who believe they know best what others need, though in all honesty, these are just numbers on a ledger to be balanced. Any system that robs us of our personhood and reduces us to an aggregate of material individuals is already shoddy in its workmanship from the get go.

If you demand of me money for numbers on a ledger to serve those I do not know, then understandably, it might feel like robbery, but if you speak to me of helping Toby and his premature twin daughters or David's cherished aging father or my own brother with mental retardation, then health and care become meaningful again, matters involving people whom we love.

Paul Tournier & the Meaning of Persons

The psychologist Paul Tournier was another important contributor to Christian Personalism. Especially important to his work as a therapist and a medical doctor was the stress on treating patients as persons with full dignity and not as simple cases to be solved. His thinking was clearly influenced by the Jewish philosopher Martin Buber who distinguished between I-Thou relationships and I-It relationships.

Tournier defined persons as those characterized by both a separation from others and a connection to others: "the double movement" of "a separation followed by a relation. By the secret the person is formed, and then by communication of the secret is affirmed." In other words, we each have things that are ours particularly yet they are also communicated in acts of trust to others. In doing so, we open ourselves as more than atoms in relations of defense and negotiation. We risk our inner beings with others.

This leads to another aspect of personhood, that of commitment and responsibility. "The personage," according to Tournier is "an external appearance which touches the personage of others from outside," while "the person communicates inwardly with the second person, the 'thou'." In Tournier's thinking, this inward offering is essential to our growth and development as moral and aesthetic beings. He sees this as important in marriage and in healthcare:

"The true dialogue [in marriage] is not the first easy communion, wonderful though it be--the impression one has of sharing the same feelings, saying the same things and thinking the same thoughts. The true dialogue is inevitably the confrontation of two personalities, differing in their past, their upbringing, their view of life, their prejudices, their idiosyncrasies and failings--and in any case with two distinct psychologies, a man's and a woman's. . . . Marriage thus becomes a great school of the person, through the level of personal commitment it entails and the exacting quality of the dialogue that demands it."

"For me as a doctor to become a person, to attain completeness as a human being, the road is the same as for my patients, and I must commit myself to it before I can hope to lead them along it. It is the road of personal dialogue with God and with my fellows. There is a decisive turning I must take, that leads me into the word of persons . . .It is this aptitude for personal contact, which is created and nourished by being sincerely sought after, which is the proper medicine of the person. . . . There comes into being a 'reciprocity of consciousness,' to use M. Nedoncelle's admirable expression. I allow my person to be discovered and known, and at the same time discover and know the person of my patient. It is in this that the medicine of the person demands a personal commitment which is not called for by technical medicine."

Physician's Oaths

Honor physicians for their services,
for the Lord created them;
for their gift of healing comes from the Most High,
and they are rewarded by the king.
The skill of physicians makes them distinguished,
and in the presence of the great they are admired.
The Lord created medicines out of the earth,
and the sensible will not despise them.
..........................................................
. . . give the physician his place, for the Lord created him;
do not let him leave you, for you need him.
There may come a time when recovery lies in the hands of physicians,
for they too pray to the Lord
that he will grant them success in diagnosis
and in healing, for the sake of preserving life.
He who sins against his Maker
will be defiant towards the physician.
--Sirach 38: 1-3, 12-15
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Charles S. Yanofsky has complied a series of physician's oaths. What's interesting is how they each ground their medical ethical commitments in differing metaphysical ways. His own reflections at the bottom of the page are worth reflecting on and disagreeing with in some cases. To me, a fundamental discussion of health care should begin with what its purpose and role is under God in relation to human beings:

1. How does the Trinitarian nature of our faith shape our view of the community's role in health care?
2. How does the ecclesial shape of our Christian experience speak to health care?
3. How does our understanding of human beings as the imago dei guide our views on health care as a service and potentially as a gift?
4. How does a Christian view of economy, ecology, culture, and market shape our treatment of the social and ethical realities of modern health care?
   

Graph of the day - uninsured

How big is the problem of the 'uninsured' in the US? Various numbers tell different stories. Typical number of people lacking health insurance is 45 million of those living in the US. The graph above (from keithhennesey.com) shows that the worrisome number is probably somewhat less than 45 million. As Keith Hennesey writes,

• "Of that amount, 6.4 million are the Medicaid undercount. These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly (intentionally or not) tell the Census taker that they are uninsured. There is disagreement about the size of the Medicaid undercount. This figure is based on a 2005 analysis from the Department of Health and Human Services.
• Another 4.3 million are eligible for free or heavily subsidized government health insurance (again, either Medcaid or SCHIP), but have not yet signed up. While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room (or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care. There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.
• Another 9.3 million are non-citizens. I cannot break that down into documented vs. undocumented citizens.
• Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level. For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000. For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.
• Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids."

Here is more on the uninsured.