Health Care For All Americans, Part 3: UPDATED

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Over the past few days, Dr. John and I have been having a fascinating discussion about this post from September 2008.  It is one of the first pieces I wrote for Extreme Thinkover,  before President Obama was elected, as well as at least a year before the serious work on what would become the Patient Protection and Affordable Care Act, known as “Obamacare” (but which I prefer to refer as “the ACA”) was being worked on.  It was also before Dr. John and I met and got acquainted.

I deliberately haven’t edited the post below, so our comments will make sense in the context in which they were written will make sense.  I think my readers will enjoy the back and forth between us, and I invite you to add your own comments, should you feel so inclined.

IMPORTANT: Read the comments starting from the bottom of the thread. It is where the discussion starts. And you may have to move up and down a few comments for our replies because of the way WordPress publishes them: by the time stamp of the comment/reply and not directly associated with a given submission.  Sorry for the inconvenience.

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Health Care for All Americans: Part 3

In Parts 1 and 2,  I discussed first, the assumptions needed from a medical perspective, particularly with respect  to the scope of treatment plans that would lead to optimizing the health of Americans, and second, how those assumptions would create a radical transformation in the health of Americans that would work its way through all aspects of daily life.  In Part 3, I now want to describe the logic that shows how the country would benefit.

We’ll start using my first assumption: Preventable diseases are prevented.

We could use any number of examples, but the format of the blog does requires some brevity, rather than a detailed White Paper or journal article.  I also acknowledge that the ideas I  present here have all been suggested by others, but this is how I choose to organize them.

For purposes of our discussion let’s call our example citizen, Larry.  Larry works full time for minimum wage, does not have  health insurance, and cannot afford to buy private insurance.  He also does not qualify for any government health care benefits.  Larry’s wife also works for minimum wage, but only 24 hours per week.

As long as his health holds, Larry can work and he has no medical needs.  He pays local, federal and state taxes and uses no special government services.

But let’s say that Larry gets pneumonia.  It is a very common viral strain, and can be treated successfully with antibiotics, and could have been avoided entirely if Larry had had a pneumonia vaccination.  Now he’s faced with a dilemma.  At first he thinks he just has a chest cold and he can wait it out.  Being a conscientious worker, he toughs it out and goes to work, but exposes his coworkers to the bug through his worsening cough.

By the weekend, Larry is really sick.  Over the counter cough medicines provide almost no relief, and on top of that, his cough is becoming increasingly productive.  He cannot sleep because of the cough and not being able to find a position in bed where he can breathe without effort and  pain.  Larry knows he needs to see a doctor, but having no insurance, he does not have a primary care physician, so he has no idea who to call.  Finally his breathing becomes so difficult that his wife calls  911.  Larry is taken to an emergency room by ambulance, but one on the far side of the city because the hospital closest does not like to take patients without insurance.

By the time Larry gets to an emergency room that will accept him as a patient he is nearly in respiratory arrest.   The ER doctor quickly diagnoses the pneumonia, but that it is so advanced that Larry’s life is in danger.  She intubates him immediately and transfers him to the hospital’s intensive care unit. It is four days before Larry’s condition has improved enough to send him to a “step-down” unit and two more days before he can be admitted to a medical unit room, and he is discharged two days after that.

Larry is fortunate that the hospital he is at has Certified RN and MSW Care Managers.  They work with him and his wife throughout  the hospitalization, develop a treatment plan and a discharge plan, set Larry up with a local medical clinic that treats patients without insurance, and provide his wife with food  vouchers and bus tokens so she can make the long trip back and forth to the hospital.

Despite all this, when Larry is wheeled out to the taxi to take him home, he has a hospital bill that is $250,000.  Since Larry and his wife together make too much money to qualify for Medicare, that bill rests squarely on their shoulders. He has no way to pay it back.  He will not be strong enough to work for at least another three weeks.  He will have not earned a dollar since he got sick, and won’t until he returns to work.  His wife’s income is not sufficient to cover all their bills,  and if they pay the rent, they will not have enough money to buy food.  The hospital sent home a week’s supply of medications, but after that, he will have to pay for them himself, and due to the damage to his lungs, he will need regular medications for at least six months.  Those prescriptions will cost over $800 per month.  Through the free medical clinic he can apply for medication cost support , but that can take up to four weeks to be approved assuming he qualifies.

Now multiply this basic scenario by twenty or thirty million Larrys a year. Every year. That is health care in America.

Here’s what happens.  The only good news is that Larry has survived a brush with death, ironically from a completely preventable disease.

Larry and his wife now owe the hospital $250,000.  They have no assets.  Even though they signed a promissory note with the hospital, no one is under the illusion that he will be able to pay back more than a few thousand dollars if he is a very conscientious person.

Larry and his wife owe the ambulance service perhaps $3,000.  They cannot pay it, or they will have to try to pay it off in very small amounts per year at a probably high interest rate.

Larry will lose at least a month’s income, and perhaps more if his recovery is longer than expected.  If he is very fortunate, his employer will hold his job until he can return.  In the meantime, his wife’s income is not large enough to cover their essential bills, starting with rent and food.  If Larry’s wife cannot get more hours from her current work, her only realistic option is to get another part time job, likely at minimum wage.  Whether that will at least let them pay for their basics is not certain.  It is also uncertain how flexible their landlord will be to let them catch up with their current rent.

It should be clear by now, that one simple, preventable illness has created a cascade of events that affects the economy, are extraordinarily expensive and completely unnecessary.  Yet, this is the true consequence of the current American health care system.

The hospital will have to write off the $250,000.  To compensate they will have to pass this loss, as well as hundreds of others per year, to their patients with insurance.

The ambulance company will have to spend a lot to try and recover their fee from Larry, and will pass those added expenses along to their other customers who can pay, either privately or with insurance.  If Larry doesn’t keep up with the payments, they may turn him over to collection, which will damage his credit.

Larry’s employer loses productivity from a good worker.  The company may have to hire temporary labor to fill Larry’s absence, which will be more expensive.

Larry and his wife lose essential income, which at minimum wage is marginal to begin with, and may jeopardize their ability to even house and feed themselves.

Every day that Larry does not work means that his wages do not generate taxes, local, county and federal, as well as FICA withholdings.  Multiply that by twenty or thirty million Larrys year after year and the loss is well into billions.  The impact of this loss of tax revenue and productivity is staggering on the national economy.

All this from a preventable disease that could have been stopped before it was started if Larry had had access to the most basic medical care.  Everybody loses.  The nation is weakened through attrition in ways no external threat could impose on us.   This national “epidemic” is progressive, it is close to end-stage, and we could all too easily end up with a terminal prognosis.  We may reach a point that we literally will be too unhealthy to survive as a nation.

We still have a choice.  Until the epidemic takes that away.

30 Governors Open Health Care Ghettos: October 1, 2013

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The governors from over half of the 50 states have or are considering refusing to establish Health Care Exchanges and to participate in Medicaid as provided for by the Affordable Care Act, (ACA) cynically known as “Obamacare.”  My assessment is that the consequences of this decision by the Chief Elected Officers of these states is going to in actuality create a third-tier, low quality health care environment.  Simply put, those states that offer to their residents full participation in the rights and privileges provided by the ACA, which is the law of the land, will develop in a few short years, into first-tier, high quality health care systems.  The states  that don’t, however, will within a similar number of a years see their health care, both private and public, degenerate into a ghetto of medical inferiority.

I call it…Read More

ACA Aftermath: Three Little Pigs & the Big Bad Wolf

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Three Little Pigs. Silly Symphony Original Release Poster, 1933. Courtesy Walt Disney Company.

Remember the story of the Three Little Pigs?  You know, one pig built a house out of straw and a second built a house out of sticks, while the third built a house out of bricks.  The antagonist is the iconic “Big Bad Wolf” whose ravenous appetite for pork knew no bounds.  Endowed with an impressive lung capacity he goes to each of the little pig’s houses and, as the story goes, “He huffed and he puffed and he blew the house down!”  (It’s more fun if you say it out loud with all the enthusiasm and glee a four year old would put into it.) The house of straw immediately collapses under this pneumatic assault, and the one made of sticks fares no better.  Their plump porcine owners scramble to find shelter in the house made of brick, which as we all know, survived the wolf’s hurricane-force winds, unscathed.  It is, of course a morality tale about being wise to the ways of the world and “building” the various parts of one’s life out of material that can withstand its big bad wolves, or storms, be they actual or virtual.  Either that or a clever publicity story concocted by the bricklayers union, but I prefer the former.

Now that the Affordable Care Act (ACA) has been declared constitutional by the Supreme Court of the United States (SCOTUS) there has been non-stop huffing and puffing by the Republican opponents of the law, who thought they were going to be rewarded with a Health Care house that was made out of straw, or at the worst, of wood.  SCOTUS, they reasoned, would strike down all or part of it so that they could legislatively “huff and puff” and finish blowing the house down.

Big Bad Wolf: “I’ll huff and I’ll puff and I’ll blow your house down!” Three Little Pigs, 1933. Courtesy Walt Disney Company.

But it turns out that the Court took the position of the third little pig and, in declaring the law constitutional, revealed a house made of bricks.  It’s rather like that moment on the television show, Extreme Makeover (Huh, something familiar about that…), where at the moment of climax as the family stands in nervous anticipation, the crowd yells in unison, “Driver, move that bus!”  Only in this scenario, the Republicans and their conservative wolf pack are not overcome with emotion at the fabulous new home standing before them, but rather are stunned, being confronted with an edifice made out of material largely impervious to their huffing and puffing.

Here’s the thing.  The story ends with the wolf leaving in abject defeat, his hunger unsated.  Conservatives, however, apparently lack the capacity to see they have lost this fight and therefore continue to huff and puff, launching into tirades to any convenient warm body holding a mic and a TV camera, insisting that they have actually won and it’s only a matter of four months until the General Election to prove that point.  Already, they have coined a new term to try to recapture their bluster: Obamatax.

We will be subjected in coming months to their incessantly chanting this new mantra as the justification for their huffing and puffing, but they fail to realize the American people just aren’t that stupid and soon it will become distracting background noise.  In fact, it already is.  Yes, the Supreme Court changed the word “penalty” to “tax” but despite the conservative’s vitriolic demonstrations of outrage and consternation over the ACA being declared “constitutional” there is nothing new here.  Nothing.

It is completely dishonest to claim that on June 28, 2012, President Obama imposed a new tax on Americans.  Completely dishonest.  And it only piles a huge mound of disingenuous, uh, bovine excrement, on top of that dishonesty to claim that President Obama lied to the country by promising there would be no new tax.  There wasn’t and isn’t.  Chief Justice Roberts bears the responsibility for substituting the words in his ruling.  The wailing and gnashing of teeth on the part of the GOP and the hyper-cons is all for show, political theater at its most profane.  Over-played and badly acted, at that.

The inconvenient truth for the Republicans is that the statue of their graven idol, Antitaxus Ultimatum, has feet of clay.  The Supreme Court just took a sledge hammer to it.  It now teeters, susceptible to collapse from the tiniest puff of air from a butterfly’s wings.  Or a poorly aimed huff from one of their own, say, perhaps one Mitt Romney?

I see two important lessons that Democrats should learn (and avoid at all costs) from the Republicans: If you lie to the American public long enough on the theory that the one who shouts the loudest is telling the truth, it does not take long for you to start believing your own lies.  Second, once you begin believing your own lies, you lose all perspective regarding the reality that ultimately the Big Bad Wolf failed.  He could not blow down the house made of bricks. Ever.

Why?  The answer springs forth in the words of the man who neither succumbed to the lie nor lost his perspective of what it means to be an American:

“…that this nation under God shall have a new birth of freedom, and that government of the people, by the people, for the people shall not perish from the earth.”

Abraham Lincoln, November 19, 1863. The Gettysburg Address.

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VINDICATED! Today a New Dawn Rose for a Healthier America

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CONSTITUTIONAL!

It is a day that even I wondered would ever come.  I began Extreme Thinkover with posts on the topic of comprehensive health care for all Americans.  I wrote in September of 2008:

The typical arguments for or against universal health care always focus on what the government will have to spend, what taxes will have to be raised to finance it at any level, or providing health care to consumers, i.e., virtually the whole population, has been, from my perspective, approached from the wrong frame of reference.

I put forth the argument on numerous occasions.  The Affordable Care Act, from my perspective, is a just solution to a miserably broken health care non-system.  It is just in the sense that this law creates a new level of access to medical assistance that Americans have never enjoyed, but that virtually every other First World country (and a number of smaller nations) has offered its citizens for decades.

The Affordable Care Act is the cornerstone of an inalienable right that makes possible in a tangible manner the chance for every person in the country to be healthier, and consequently enjoy the Blessings of Liberty. Yes, I can imagine the eyes rolling over that assertion.  But though it will take a generation, maybe more, to make that difference, doing nothing, that is, to go back to the pre-ACA situation, Americans would continue to be less healthy, costing perhaps trillions of dollars in avoidable care.  Now, at least we have a law, a system, that can turn that trend around.

Having worked in a hospital for over a decade and a half with daily patient contact, I can attest to the misery and personal suffering that those who have no insurance are forced to bear.  Add to that, my hospital is Catholic, with a mission to serve the poor and uninsured, and I have seen the incredible stress this very broken way of providing medical care has placed on my organization, restricting our capacity to plan for the future because tens of millions of dollars annually are required to subsidize those with no insurance.

I fully realize that the success of this change depends on individuals taking personal responsibility for their health.  I would contend, however, based on my experience with chronically ill patients who are poor or unemployed, they are caught in a vicious circle that all too often results in their getting the short end of the stick economically, for which access to medical care for wellness simply does not exist.

I could also put it this way, with the Supreme Court’s decision today, health care in America has finally stepped into the 20th Century.  The challenge now to us living in the 21st Century is fend off those who would overturn the law and plant us firmly back into the 19th Century.

People.  Real, live people with real live medical needs.  That is what the ACA is really about.  That is why for nearly four years, I’ve objected to the argument put forth by the law’s opponents that it was all about money and government.  I rejected that argument on both moral and ethical grounds.  Those who grouse that they are only paying for others bad habits are short-sighted, and in my opinion, fundamentally selfish.  To me, that argument is both highly ironic and paradoxical, because my experience with my neighbors has uniformly been that Americans possess a natural selflessness and generosity to help anyone in need.  But somehow getting the connection tied between to the two has been an uphill battle and continues to be.

For example, I have no doubt that if Sen. Mitch McConnell, Rep. John Boehner, Rep. Michelle Bachmann, or Sarah Palin were in a setting in which total strangers were injured and needed immediate emergency medical care, that every one of them would step up and wade in to help.  But all of them today condemned this law, despite the fact it acts on their behalf as well, so that their fellow citizens will receive that care as a matter of course.  And those patients won’t be nearly as likely to end up bankrupt as a result of seeking out that care.

Simply put, I don’t get it why they don’t get it. (I’ve got a pretty good notion why they think they don’t want to get it, however). Because of that great contradiction, conservatives like those mentioned above still want to overturn it legislatively.  I will continue to write to defend it.

(Yee-haw!)

Is Health Care a Constitutional Right?

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A Constitutional Right to Health Care?

The assertion that we have a right to medical care is one of the pillars supporting the Affordable Care Act.  Not the sole pillar, but one of them.

Photo Courtesy Blue Ridge Community College, NC

As with all of our rights, it has to be built up from some source that is part of the foundation of the national edifice.  Being a democratic republic, as I understand it, we in the United States have two sources.  One is the Constitution, and the other is the statutory authority given the various levels of government both federal and state by the Constitution.

Do we have the Constitutional right to medical care?  Read More…

The Supreme Court and the ACA: The Ultimate Death Panel?

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I started Extreme Thinkover in the fall of 2008.  The presidential race was in full swing.  Universal health care was one of the major topics that the candidates, media, and the public were debating.  One of my primary motivations for creating the blog was to have a forum in which to express my ideas about the health care debate.

I’ve worked in the health care industry for nearly 16 years and have daily contact with patients and families in the hospital.  I hear their stories, good and bad, about what these hospitalizations are doing to their lives.  Yes, what the hospitalization is doing to their lives.

Here in America, going to the hospital is not just about getting medical treatment; it’s also about entering a very broken and extremely expensive system. It nevertheless tries to limp along: In all fairness to the medical professionals who work very hard on behalf of their patients, in most cases, if you find yourself hospitalized, you get reasonably good medical care.

However, in the middle of this is an ongoing battle with the major health care players (hospital systems, health insurance, pharmaceuticals, medical equipment providers, etc.) all wanting to maximize their profits in an economic power race that too often is at the expense of the quality of care delivered to the patients who pay for their services, as well as forcing ever-increasing demands on their care givers to do more with less.  Admittedly, it doesn’t happen everywhere, but it is far too pervasive in Rube Goldberg “system” that passes for health care in America.

I wrote in fall 2008:

Here’s the question: What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?

That perhaps is not the question you expected to hear. The national conversation has focused on how much will it cost to provide all Americans with health insurance, how will the spiraling costs of health care be brought under control, will taxes have to be raised to pay for it, what will the roles of the health insurance industry, and the medical industries, and most of all the federal government be? Tough questions all around.

That question, “What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?” remains the key to a successful national health care program.  It also remains almost totally ignored by politicians, lobbyists, and, sadly the American public, none of whom have yet realized that without answering this question first, in my opinion, the debate about the cost cannot be resolved.  I contend this is why the health care law polls low for national support.

The current law, the Patient Protection and Affordable Care Act, passed in 2010, nibbles at the edges of what I think is essential, but it, also, is far too focused on trying to control medical costs.  And in case you are wondering, yes, I’ve read the law cover to cover.

Beginning Monday, March 26, the Supreme Court of the United States is going to hear arguments for and against the PPACA.  The primary question before the Court is whether Congress overstepped its authority regarding the interstate commerce clause of the U.S. Constitution by mandating all Americans (sort of) be required to purchase health insurance.  The debate is guaranteed to be rancorous, even in the sedate and forcibly polite setting of the Supreme Court.  The debate, though, once again is all about the money.  A healthy America will likely never even come up. The pundits will have a field day with this, without question, but I doubt any will see the fundamental flaw in all the arguments, based on my point of view.

Will the justices see past the smoke screen of political ideology, special interest group pressure, and inflammatory rhetoric that is fueling these proceedings?  If they do, and declare the law constitutional, there is hope that the ACA can continue to be refined, actually moving toward being a mechanism to support a healthier America.  If they don’t, by striking down all or parts of it, the Supreme Court will, for all intents and purposes, become the Ultimate Death Panel, condemning tens of millions of Americans to poor health, premature, and in some cases, an agonizing death because they will have been denied the right to even the most basic level of health care.  And that, tragically, just months before a law already on the books would have given them the care snatched away by the Supreme Court Death Panel.

Now we wait to see how this court rules on the fate of Americans’ health for generations to come.

The Thinkover:  When Patrick Henry uttered those iconic words, “Give me liberty or give me death!”  he wasn’t suggesting that death was preferred outcome of that stand for patriotism.  So far, the opponents of the ACA have been clueless to this obvious distinction in demanding “liberty” from the ACA mandate.

Swimming through Boiled Okra: The American Political Stew, 2010

Swimming through Boiled Okra:

The American Political Stew, 2010

Some Background:

I lived in Texas for three years while attending seminary at Texas Christian University.  Being a native of the Northwest, I was exposed to a whole new cornucopia of foods: great Texas barbecue, Tex-Mex, and Southwest cuisine. I learned how to eat grits the right way (butter and salt and pepper, or cheese—none of this milk and sugar over Cream of Wheat stuff).  To this day I love grits.

My one culinary defeat was okra.  For those of you who haven’t experienced this little vegetable,

Okra--Secret Dispenser of Slime. Photo: FowlerNurseries.com

Okra--Secret Dispenser of Slime. Photo: FowlerNurseries.com

it certainly looks benign enough in its raw form.  It’s also as popular as broccoli in more northern climes and a staple vegetable in numerous countries around the world.  You can see from the photo, it can look quite appetizing.  Okra can be prepared in many ways.  It can be breaded and fried (of course, most anything in the South can be breaded and fried—and usually is).  It can be boiled with all sorts of other foods.  Many people love it pickled.  It’s a popular ingredient in a wide variety of soups and gumbos.  That’s all fine and good, except…

Boiled okra is slimy.  For those three years I tried my best to sample okra in its various gastronomic manifestations.  I discovered, despite all this experimentation, that the only way I could handle okra was fried.  Fried okra is not slimy.  It just doesn’t have much taste for my palette, other than an oily breaded mushy…well…veggie-something-or-other. Take a look at the crosscut round of okra.  It looks a lot like a crosscut jalapeño pepper.  Only the jalapeño has both flavor and zing.

Okra Seafood Gumbo. One of a thousand ways to create vegetative slime.

In fairness to the otherwise popular vegetable, I selected two of my friends (completely non-random, and no intent to be so), on separate occasions, and who don’t know each other, and asked if either liked okra?  Their responses were identical to mine: Okra in soup is slimy and I don’t really like it.  So, what’s the point?  There are at least two other males in the United States who, without prompting as to reason, agree that okra in soup is slimy.  And none of us like it because of that particular quality.  And that’s important because of what comes next.

A Test of Your Gag Reflex:

Back to slimy.  Not just slickish slimy, but stringy and slimy.  As for stringy: A hundred times

Ultimate Alien Slime, Aliens, 1979, Photo Courtesty MGM.

worse than my grandmother’s over-cooked rope-strength stringy asparagus.  And as for slimy: pure gaggy slimy: You start to chew the spoonful of boiled okra, which just seems to release this gelatinous goo, resembling the stuff that drips off of your typical movie monster’s tongue or, uh, snout. As you try to swallow the bite the goo elongates itself so that by the time the first half of your bite has traveled the length of your esophagus, reaches your cardiac sphincter, and dumps into your stomach the other half is still trying to get out of your mouth and down your throat.

Gag.  Retch.  Get me something to wash down this uck!  Now!

An Analogy of the Absurd—But the Bridge to the Topic at Hand:

Imagine stirring a pot of okra the size of an Olympic swimming pool with that potential for such slimy viscosity.  Imagine swimming through a pool filled with such.  Michael Phelps wouldn’t be pleased.  Michael, whatever his other imperfections, would have the good sense to avoid such an Olympic sized pool of mucousity.

Okra Stew--Imagine an Olympic Pool filled with this.

Now to the Main Dish:

On the other hand, that exact unpalatable characteristic makes for a good analogy of the current state of American politics.  The so-called melting pot of America has been emptied of its finest ingredients, civility, respect, loyalty, etc, and filled to the brim with okra soup.  The blogosphere is boiling over with okra slime, from both the right and the left, but all too often the temperature of rhetoric coming from the right is higher.  In this context, characters such as Limbaugh and Beck, Palin and the Miz Liz of Cheney are but spices in an otherwise noxious recipe of political okra gumbo.

Last summer, we were caught off guard by the sudden rise to the boiling point of the Town Hall Meetings held in August during the Congressional Summer Recess.  But this year, the pot is already bubbling resembling those gloppy mud pots in Yellowstone National Park, and it’s still over seven months until the November mid-term elections.  Itsa bubblin’, like they say.  I think.

This year there will be no surprises.  Members of Congress in both Houses and from both sides of the Aisle may find it best to attend their town hall meetings dressed in a heatproof full-body firefighter outfit.  The political okra soup pot likely will reach a rolling boil even before summer.  The slop-slinging will probably be fierce.

The question is can it be sustained?  My observation last year was that the Sturm und Drang of the Tea Party’s birth and its rapid rise to an ear-shattering keen burned out before the end of the month.  Part of that, in my opinion, was it was “newsed” into numbness.

Numb News—It’s the American Way:

The success of cable/satellite/internet news with its around the clock accessibility very quickly has habituated Americans (and most of the world, undoubtedly) to a very short news cycle.  Inside of two weeks last August, people at the Town Hall Meetings screaming the same rant over and over lost its punch if not its volume. Though the opponents of everything Obama were taking great delight in the attention and media coverage they were receiving, they missed an unintended consequence of that saturation.  They unwittingly became passé. Almost with the predictability of an autonomic response, the polls shifted subtly, but the shift was critical.  It was pro-reform.

Inside the shift was the data that kept Health Care Reform alive, passing the House in November and the Senate on December 24. Despite the loss of one senate seat in January messing up the Senate Democrats’ supermajority of 60 seats the rhetoric of the opposition from the elected officials, the right-wing pundits and the “angry” right-wing citizenry did not shift.  Their message, although loud, consistent, and vitriolic, became less and less influential as each day passed.

That message also offered nothing: the “Let’s start with a blank piece of paper gambit” failed, not because the Republicans were united but because they had nothing to counter with.  If at the great Health Care Summit, the Republicans had shown up with a bill that could have been plopped down beside the one that had already passed (since December 24th, remember) that was half the height of the Democratic bill, Americans’ attention would have been riveted to know what was in that piece of legislation.  Instead the Republicans brought a blank piece of paper and kvetched for seven hours about the size of the already passed bill.  The three best words for this colossal error are: stupid, stupid, and stupid.

The opponents did not recognize their strategic error. They thought they were being consistent and united.  The president and the Democratic leadership, on the other hand, correctly interpreted the message as dragging itself down: that the public sentiment in a shift of even one or two points in favor of reform was far more important than the actual percentage of support or opposition was being rolled out weekly by the multitude of pollsters.  TV, Internet, Radio, newspapers, magazines along with pundits of all stripes missed that nuanced reality, their focus locked on a depth of field most conducive to seeing their ratings and profits and not the meaning of the changes.

Health Care Reform passed, astonishing and infuriating the Republican leadership and all sorts of right-wing groups.

Elections 2010: Jump in, the Okra’s in Prime Slime!

What’s next?  More of the same: A big pot of slimy okra political soup we will be forced to swim around in between now and November.  The Republican formula of Stupid3 remains the strategy they are taking into the Fall under the illusion (or delusion) it will be different this time and they will snatch the majority status from the Democrats in a great uprising of voter rage, or a groundswell of secessionist sentiment threatening the fabric of the Republic, whichever comes first.

I almost hesitate to write this next section for fear of tipping off the Republicans and the Tea Party supporters to the actuality of the situation that the colossal error they made attempting to kill health care reform remains a colossal error as they plan for the mid-term elections.

Poster Advocating Revolution. But What Kind? Photo: Menifee Tax Day Tea Party

The emerging rhetoric calling the administration a “regime” accompanied by repeated less than veiled threats of revolution and civil war, marches with guns in plain sight are not the next phase they believe it to be; it is rather an escalation of the same message.  TV and the other media again will create the opposite intended consequence the Right Wing wants to convey.  Their agenda, antics, and demonstrations will be covered ad nauseum, giving them all the coverage they desire, but dulling the impact of their effort: Why?  Very simply, Americans want “new” news.  Every day.  That is what we have been habituated to expect from the media.  It’s not a matter of how it’s slanted or editorialized, or punditized.  It has to be new.

This is an essential lesson the Democrats must keep in the center of their political radar screen, locked on like the Space Shuttle launching toward the International Space Station.  They have to remain disciplined in their own rhetoric as the campaign heats up.  The key: New talking points must be rolled out every week or so of what Obama and the Dems have accomplished and what they plan to accomplish after the polls close.  They don’t even have to counter what the Republicans are saying.  The Republicans will continue to tighten the trap they set for themselves in the broken record scenario they initiated upon Obama’s election in 2008, and the contrast between a constantly renewing fresh message and the broken record message will quickly create a gulf between the two in the Democrats favor.

Guns and Bombs Belong in the Movies and TV, Not in Real Life:

Why?  People crave the status quo.  The vast majority of U.S. citizens do not want revolution or civil war or any other highly disruptive political or social action.  We’re not talking about changes to health care—we’re talking about being able to go shopping or out to eat or on vacation, Friday night football, going to worship, school plays, and a thousand other everyday things we routinely do.

Domestic tranquility is what Americans want.  The news video of the bloody revolt and possible regime-changing coup in Kyrgyzstan is exactly the opposite of what Americans believe political change should be.  The more violent that situation becomes and the more coverage it will get because of American military interests in the country, the more nervous the typical American will be about the language in the okra soup.  They see suicide bombers belonging in Baghdad and Kabul, not valiant freedom fighters, 21st Century Minutemen here in the U.S. claiming they are wresting their constitutional rights from an oppressive and socialist government.  Regardless of how dissatisfied they may be about their taxes, Americans do not want bombs and blood flowing down the streets of their community.  The reason is straightforward: Americans make political change through ballots, not through bombs and bullets.

Tea Party Protester Advocating the use of Guns. But to Shoot What or Whom? Photo: TalkingPointsMemo.com

Swimming in the Soup of the Statistically Illiterate:

We can be certain that the media will continue to misinterpret the polls because they do not understand how to correctly interpret them to begin with.  Most political groups will continue to misinterpret the polls because they are always looking for an advantage for their side and a disadvantage for their opponents.  “Spin” is a set of heuristic blinders. Here’s why: Raw percentages are a flawed indicator of support.

We quote percentages as if they mean something absolute.  They do not.  Percentages provide information, just not what we typically believe it is.  The fundamental error in interpreting poll percentages is equating a final percentage of a vote with a pre-vote percentage.  The two are not equal indicators of support.  The better pollsters understand this and couch their questions with very precise language and report their results with statistical caveats that, for the most part, the media and the public ignore, and then they are surprised when the results don’t match the polls.  They blame the polls (some justifiably) instead of having the insight to realize they didn’t correctly read the data in the polls. We will see a lot of this in the next seven months.

Central Limit Theorem: One reason calculating percentage trends is complex. "In probability theory, the central limit theorem (CLT) states conditions under which the mean of a sufficiently large number of independent random variables, each with finite mean and variance, will be approximately normally distributed (Rice 1995)." Source: Wikipedia

Should we not believe the polls?  No, but be cautious about reading into the number what you want it to mean, rather than looking at the gap and vector of the differences between the two percentages.  That is where the real information is.  And understand there are ways to use the percentages that sound valid but are really nothing more than concoction and spin.  Second, don’t make the mistake of treating a final vote result with a pre-vote survey.  Even if the final outcome numbers are identical, they are two quite different metrics, almost to the point of being two separate statistical species.

Understand the spin-meisters of all the political parties and their various PACs are not going to give you the slightest bit of help in understanding any of this.  They are paid to convince you the numbers are always favoring their party or candidate, even if the most accurate interpretation suggests disastrous defeat.  They want the political okra pot to be as slimy as possible to confound your ability to squeeze the slightest bit of truth from the numbers.  No, it’s not pretty, and never will be, apparently, until the pot is emptied and a new recipe of soup, sans okra, is placed on the stovetop.

Is it November yet?  I can’t stand okra.

Okra: Abelmoschus esculentus. Photo: digthedirt,com