A Socratic dialog on health care reform (VIII)

While on his way to barter for health insurance through the Athenian health care exchange in the Agora, the philosopher Socrates has a chance encounter with Hippocrates, the father of medicine.

Hippocrates: Socrates, my dear fellow! Good day to you. But to what business are you hastening at such an early hour? And, I might add, with such a limp?

Socrates: Good morning, Hippocrates. Were it not for your timely greeting, I might have passed you by. I make haste to join the line of my fellow citizens who stand outside the newly formed healthcare exchange in the Agora. Finally, after years of waiting, we can sign up for affordable health insurance! I can hardly wait to compare the options, for alas! — as of late I have been plagued by this painful hip and fear the need of an artificial replacement.

Hippo: Ah, good Socrates, how sorry I am to hear of your woes! And yet, I fear that your painful hip may be the least of your worries in this healthcare debacle.

Soc: Whatever do you mean, Hippocrates? Are there not enough willing surgeons to go around?

Hippo: Of surgeons there are plenty, Socrates.

Soc: What then? Do you refer to the lack of affordable plans in the healthcare exchange?

Hippo: No, Socrates. A review shows that there are plenty of plans from which to choose. Moreover, with the increased competition, the premiums have dropped appreciably.

Soc: This is good news indeed! But tell me, Hippocrates, what are these concerns which you harbor in your heart?

Hippo: Have you not heard the latest news from the Senate floor, Hippocrates? There are those in the Congress who have plotted to derail the Affordable Care Act. If they have their way, the entire enterprise could come undone.

Soc: But what is this? Tell me more, Hippocrates!

Hippo: A small select group of representatives from the more conservative quarters have vowed to postpone the implementation of the Affordable Care Act for at least another year.

Soc: How can they orchestrate such a thing? Is the ACA not now the law of the land?

Hippo: To be sure, good Socrates, it is. But this select group has tied the postponement of the ACA to the budget bill now before the Senate. Because of their ridiculous amendment the Senate has refused to pass the legislation required to fund the government, the result of which being that all non-essential governmental employees are to be furloughed without pay indefinitely.

Soc: What? To jettison the funding of the Athenian government merely to undercut the implementation of a law on the books! But that is an outrage!

Hippo: (sadly nodding his head) To be sure, to be sure, good Socrates. But I am told that there is little which can be done to remedy the situation. The conservative party has closed ranks, despite the fact that there are many among its members who lament this action.

Soc: Such behavior is outrageous and unbecoming of statesmen!

Hippo: Alas, Socrates, there are few statesmen left in our time. Plato has informed me that this plot has been years in the making, for no other reason than to discredit the president and his program.

Soc: It would appear that politics is alive and well in our Athenian economy.

Hippo: Indeed, the Athenian Times reports that the current budget brinkmanship is just the latest development in a well-financed, broad-based assault on the health law. It gives one pause to wonder at the extent to which our politicians will go to rescind it, even if that means not funding the government and refusing to raise the debt ceiling, which would all but ensure a global Athenian default.

Soc: How small the problem of pain in my hip appears in comparison! Perhaps the mad hatters in the party of tea should consider hemlock.


Nearly one year after I chanced a brief Sunday morning repose in Robert E. Lee’s family pew at Christ Church in the Old Town section of Alexandria, Virginia, I found myself seated in a different sort of theater to view and reflect on the issues that led to our national schism and the bloodiest conflict in American history. Yesterday at a local movie house I took in a matinée showing of Steven Spielberg’s “Lincoln.”

Drawn from Doris Kearns Goodwin’s 2005 best seller “Team of Rivals: The Political Genius of Abraham Lincoln,” Spielberg’s cinematic chronicle of the last few months of Lincoln’s administration and life provides a fascinating window into the tumultuous times that led to the conclusion of the War Between the States.

Shaped by the times into which he was born, Lincoln strove to complete the second act of the great American drama that had been initiated by the founding fathers and would be carried forward in the Civil Rights Movement a century later.

Here we see Lincoln the man (deftly portrayed by Daniel Day-Lewis) wrestling with the members of his cabinet, arguing that the time is expedient to push forward his agenda for the equality of all men. A constitutional amendment would ensure its propagation for all time — or at least for as long as the nation for the last best hope on earth might endure.

Through Spielberg’s direction and Tony Kushner’s lines brought to life by the superb renditions of Daniel Day-Lewis, Sally Fields and Tommy Lee Jones, we witness the gruesome horrors of war as well as the messiness of the political process inside the beltway. (I use that term “beltway,” because it appears as though little has changed within the confines of that circumscribed area over the past 150 years. Despite the preponderance of political spin, the wheels of democracy turn ever so slowly, both then as now.)

Lincoln the man was given to fits of melancholy. He shared his disturbing dreams of isolation and loneliness with his wife, whose own constitution frequently bordered on hysteria. Rightly or wrongly, he expected that she would bear the same grief without complaint as he himself struggled to do. One scene where Lincoln and Mary engage in a vehement verbal exchange in the bedroom brings to mind Ingmar Bergman’s “Scenes from a Marriage.” The same scene repeats in slightly different form on the floor of the House between verbally abusive representatives Thaddeus Stevens and the gentlemen from New York.

Here also we glimpse the gentleness of Lincoln the father in his dealings with Tad, his youngest son; as well as the stern uncompromising stance with Robert, his oldest, in his refusal to allow the young man to enlist. Cloaked in the power of the presidency, Lincoln will refuse to compromise on what will become the 13th Amendment; while in his Second Inaugural Address he will also advocate for a gentle reconstruction of the southern states, “with malice toward none and charity for all.”

As the final credits roll and the viewer rises from his seat, he reflects that what he has just witnessed over the previous two and a half hours is in many ways a re-enactment of the political process of the past four years. Politics is a messy profession; yet a necessary one, if as a democratic nation we are willing to struggle toward those loftier goals dreamt of in uncommon hours.

To paraphrase Lincoln’s words, if we advance such freedoms, what greater good might lie ahead for us to discover?

Picking up a prescription

“This is Ahmed, our newest pharmacist.”

The owner of the drug store presents the immaculately groomed gentleman in the white coat. I smile and extend a hand over the broad expanse of counter top between us.

“I work in one of the medical practices in town,” I inform him, citing the name.

“Ah yes, I have filled prescriptions which you have written.”

“I’m here to pick up two of my own,” I say. “I called ahead to verify that they were ready.”

Ahmed searches the shelf. “Here they are,” he says, reaching for the white paper bag. “It looks as though your insurance company has applied the cost toward your deductible. You have a deductible, yes?”

I shrug my shoulders. “I don’t know. I just pay what I’m told.”

“We put it through your insurance and this is the final amount.” Ahmed shows me the printout—sticker shock.

He swipes my credit card to complete the transaction and places the charge slip on the counter for me to sign.

“We had to order the antimalarial preparation special,” he says. “Where are you traveling to?”

“Nigeria,” I tell him. “Medical mission.”

“Ah, I am from Africa too—Egypt—but I have never been south of the Sahara.”

“Just this week I have seen two Egyptian families in the office. Both are headed back to Cairo for the summer. There seems to be quite a bit of political dissatisfaction there right now.”

The smile fades from Ahmed’s face. “Yes, we are electing a president. But neither candidate is very popular with the masses, for various reasons. And this latest debacle with the high court—well, that has everyone upset.”

“So I understand.”

“It is a period of transition for us. Such transitions take time. It will be a long time before things settle out,” Ahmed says. “But, I am happy to hear that there are a couple of Egyptian families in your practice.”

“They are good people,” I tell him.

“Good luck on your journey,” he says. “I hope things go well.”

So do I. Transitions take time, and some take more time than others.

Town Meeting

I was exhausted from the six-hour drive home through the rain from Pennsylvania. I unloaded the car, stowed the gear, sorted through the mail and grabbed something to eat. The town meeting convened at 7:00 PM.

It was a short walk down to the local church. The parking lot was full. People filtered into the building, pausing at the small desk to sign the petition before ascending the stairs to the main parish hall.

Folding chairs had been set up in rows. Many folks ended up standing in the back and along the sides. Up at the front representatives from the postal service prepared their presentation. The community TV station camera panned the audience.

The meeting opened with remarks by the first selectman and the USPS district manager. The public relations spokeswoman presented a generic slide show, highlighting the financial plight of the postal service. Revenues had dropped by $30,000 at our local post office over the past two years. They were looking at profitability factors. No, they hadn’t made a decision to close the post office. That was the reason for the meeting. They wanted input from local residents. Everyone would be given a chance to speak.

A postal workers union representative voiced his dismay at the way the situation had been handled. Documents delineating proposed closings were circulated late; meeting times and places were unclear. In place of communication, Chaos reigned.

The union rep was clear. Be vigilant, take notes, draft documents, contact the powers that be. Keep the pressure on. Don’t allow them to get away with their underhanded approach.

One by one members of the audience rose to speak. Some voiced hardship in having to drive seven miles for mail, when before they could walk to the post office at the center of the village. Some wanted to know if the postal service was considering alternative locations in town. Others questioned the validity of the figures provided.

One erudite villager decried the modern postal service model. “You don’t seem to understand that the future of the USPS depends upon one thing—service. No one wants to drive miles to wait in line to be treated poorly by annoyed clerks who consider you a nuisance. At the village post office, one person serviced the needs of over 500 families, and she did it efficiently with a smile. That’s the sort of model you should be striving for—not the impersonal attitude of the DMV.”

Another fellow who had moved to the village from Brooklyn spoke. “In my old neighborhood, the postman knew everybody’s name. He knew the names of the kids on the block. He handed you your mail with a smile. That’s the sort of service I’ve come to know in this village.”

The spokeswoman responded to each comment in kind: “Thank you for voicing your opinion, thank you.”

Finally a man raised his hand to be recognized. “After you vacated the former location when the landlord told you the structure was unsound because of the snow on the roof, when were you advised that it was safe to return to the building?”

A hush fell over the crowd. The district manager stretched his neck from the tight collar of his shirt. “Two days,” he said.

The uproar was deafening.

“Two days! Two days? You mean you could’ve reoccupied the building in two days, and instead you made the decision to gut the office and move operations to another town? And you stand there telling us that you haven’t made a decision to close our local post office!”

More folks stood to speak. Several comments came on the heels of questions and observations from the audience before the postal representative could answer. I envisioned a meeting of the Sons of Liberty. Wasn’t New England the birthplace of the revolution?

In the end everyone had a chance to voice his opinion. As the meeting concluded, one woman summed up the general sentiment. “We might be a tiny town of two thousand people, but we’re diverse. We organized, we’re intelligent and we’re not going to let this rest. You haven’t heard the last from us.”

A thunderous round of applause erupted. Later, private discussions ensued, both inside the parish hall and outside in the parking lot.

An old-fashioned town meeting, New England style.

Who said all politics are local? I want to shake that person’s hand.

The rebirth of an idea

Along with most everyone else on the planet I watched the recent popular demonstrations in Egypt and their aftermath—most notably the subsequent downfall of Mr. Mubarak, the dictator who ruled that country for 30 years. And I must admit a certain titillation from observing the revolutionary fervor that has been sweeping across the Middle East in their wake.

The most fascinating thing about these spontaneous uprisings is the relatively peaceful nature of those demonstrating against their oppressive regimes. Granted, there have been armed confrontations; and sadly, people have died; but for the most part the resistance has remained firmly passive.

How pleased I was to learn that some of the basis for this resistance stemmed from the writings of a rather obscure, shy American now in his eighth decade. Prior to reading the New York Times article about Gene Sharp, I had never encountered the man’s name before.

As much as I am for insisting that credit be given where credit is due, I was somewhat bemused that the Times made no mention of former advocates of civil disobedience: Henry David Thoreau, Mahatma Gandhi and Martin Luther King among them.

It was Thoreau who penned an obscure essay in 1848 arguing for public refusal to support an amoral or unethical government—in his day a government that condoned the buying and selling of human beings as chattel. Thoreau registered his protest by refusing to pay his poll tax and was subsequently thrown in jail by the local constable, Sam Staples. He was released the following day when an unknown admirer paid the tax on his behalf. Indirectly, Thoreau’s essay helped to spur on the abolitionist movement, the Civil War and ultimately Lincoln’s Emancipation Proclamation.

Gandhi adopted Thoreau’s idea of passive resistance and used it to bring about effective political change in South Africa and India. “Civil Disobedience” was used as a manual for the Danish resistance against the Nazi invasion during World War II. Martin Luther King built upon the same set of ideas as he led the American Civil Rights movement in the 1960s.

Despite initial fears that the demonstrations in Cairo would lead to the establishment of an Islamic fundamentalist state, it has become apparent that the uprising was spawned by a secular civil base.

The Egyptian people have chosen to embrace their own political destiny, even though the ideas that inspired them have their roots in the writings of an American thinker.

A Socratic dialog on health care reform (VII)

Socrates pays Hippocrates another visit to discuss the latest political rumblings concerning the health care reform legislation.

Hippocrates: Good day, Socrates. I see that you walk with the step of a healthy man these days. I trust the former injury to your foot is now well healed.

Socrates: To be sure, my good friend and physician. Once again I find myself healed well, if not well-heeled. (chuckles to himself) But tell me, Hippocrates, what do you make of the recent resurgence of heated political debate in the Senate concerning our newly passed health care law?

Hippo: Ah, my good Socrates, know you not that the opposition has sworn to dismantle the law even before it is enacted? For they have sworn an oath to have it annulled before the legislative session is brought to a close.

Soc: By whose authority?

Hippo: By the mandate of the voters in the mid-term elections of last fall. The opposition is claiming victory on the basis of the mandate for change.

Soc: But I was of the understanding that the law contained many desirable provisions to enhance the coverage of health care for the citizens of Athens—forbidding third-party payers to deny coverage for preexisting conditions, guaranteeing the portability of coverage, removing the provision for lifetime caps on payments for care, and so on.

Hippo: What you say is true, my friend. But those of the opposition argue that the law is unconstitutional because it mandates coverage for all citizens—

Soc: (breaking in) Excuse me, Hippocrates, but is that not a good and desirable thing, to have coverage for all our citizens?

Hippo: To be sure, it is—but in this instance the law mandates that coverage be purchased by individual citizens if they have no provision for coverage from their employer.

Soc: I was under the impression that universal coverage was to be enacted as a right of every Athenian citizen.

Hippo: Alas, the single payer option was defeated in the preliminary debate. The lobbyists for the health insurance industry made certain of that through the influence of much silver coin in the pockets of the politicians. Likewise, the sorcerers bought their influence to insure that the price of pharmaceuticals could not be negotiated in the Agora.

Soc: It seems as though that which began as a good and noble idea has been degraded through bribes, trickery and quiet whisperings behind the scenes.

Hippo: Legislation is crafted much in the same way as sausage, good Socrates. In each instance the process is best left undisclosed to prevent a sudden surge of nausea and queasiness of the stomach.

Soc: Tell me, Hippocrates; is there no way to retain the noble points of the law while discarding the undesirable tenets?

Hippo: Undesirable to whom, Socrates? To those with influence and power? They will see the entire piece of legislation rescinded before compromising on these points. In the end we live in an era where the winner takes all in politics.

Soc: But our Athenian government is based on the premise of democratic rule. Ultimately, the people decide their common weal.

Hippo: Have you not heard that our supreme court has ruled that the multimillion drachmae corporations must be considered as bona fide entities having a political voice? A fist full of drachmae speaks louder than the jingle of pennies in a purse.

Soc: Then our democracy—

Hippo: Is but an oligarchy, my dear Socrates. Or better stated, a plutocracy in which the great wealth of the few controls the destiny of the many.

Soc: And what of the middle class, those of the artesian guilds and such?

Hippo: Alas, Socrates, they continue to disappear from the Athenian social strata. The gap has widened between those who have and those who have not.

Soc: What! Is there no political solution to this dilemma, Hippocrates?

Hippo: Perhaps, Socrates. You should pose that question to your old student and politico, Plato. He might be able to offer a feasible plan. I’m told he spends his days engaged in drafting a treatise that deals with such issues. He calls it The Republic.

Soc: Indeed, he has written “the price of apathy towards public affairs is to be ruled by evil men.”

The End of Something

The most stressful thing about a trip to Spain is the connections.  You have to wait, many times for several hours, to begin the next leg of the journey.  This time around things went well until I hit Madrid.  What should have been a 3-hour layover turned into a 4½-hour layover.  As a result, I arrived in Santiago late.  Thankfully, my sister-in-law was there to meet me.

After two more hours behind the wheel, we stopped at a local restaurant for something to eat.  It was a clean simple place, and the food was very good.  My sister-in-law treated me to a plate of pulpo a la gallega (octopus) and an entrée of rapé, a type of fish.  We finished the meal with a demitasse of coffee on the veranda.  It was a good way to wind down from traveling.  Half an hour later we rolled into Santa Marta.  It was just as I remembered it.  Everyone was there to greet me at the house in the narrow cobblestone street.

I was on my feet for close to 37 hours before I finally crawled into bed.

The next day I went for a long walk on the rustic path that runs along the edge of the estuary to the beach.  The sea undulated at my feet in gradations of blue and green, extending to the far horizon where it gave way to the faultless blue sky.  On either side the mountains rose up from the sea like prehistoric dinosaurs, their jagged peaks draped in torn green blankets where outcroppings of grey rocks broke through.  As I stood there buffeted by the wind, I understood once again why I love this country too much for my own good.  I lingered for quite some time before heading back to the village along the road.

Saturday was the wedding.  We gathered at the ancient stone church for the nuptial mass.  Outside, a small band of musicians played the drums and bagpipes as we exited through the courtyard.  Afterwards we boarded a bus for the next village down the coast, where wine and hors d’oeuvres were served by attentive waiters under a long white canopy on a small bluff above the beach.  The main meal lasted nearly four hours:  gambas, percebes, cigalas, rapé con patatas, carne de ternera, postre, an enormous amount of wine, both red and white, and to top off the meal, whiskey on the rocks and café solo.

At one point during the evening I stepped out and walked down to a small overlook and stood by the railing to watch the sea bathe the beach beneath a nearly full moon.  One of the guests, who had come from Navarra, appeared and struck up a conversation about the Spanish bullfight.  He spoke about José Tomás, the most artistic of all of the current matadors in Spain, who is recovering from a bad cornada, an injury to the femoral artery which he incurred when he was gored in Mexico this past spring.

The day before I left Spain, the provincial government in Barcelona voted to outlaw the corrida de toros.  As of Friday, July 30, 2010, there will be no more bullfights in Cataluña.  In an act of political capitulation, the Spanish national government voted to subsidize the salaries of workers in all industries associated with the corrida in the province of Cataluña for the next 90 years.

When Spain won the World Cup, Barcelonan taxi drivers displaying the national Spanish flag on their cabs were fined by the provincial police.

We are witnessing the beginnings of the disintegration of the Spanish state.