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The progressive policy 1-on-1 continues b/w CA & MA

Today the CA Supreme Court ruled that banning same-sex marriage is unconstitutional. Previously, MA was the only state in the nation allowing same-sex marriage, following a similar ruling in 2004.

It feels like CA comes up again and again here in MA as our #1 competitor for health, energy, and civil rights policy. Sh*t! CA passed legislation funding stem-cell research! We've got to get on that, and hell, we'll actually make it work! (Ah, the beauty of second-mover advantage...hopefully it will work out as well as we follow their lead in adopting their low-carbon fuel standards...)

While we're at it, why don't we legislate universal health insurance and ensure that our infertility coverage is arguably the best in the nation?

Still, I hear CA is one of the best places for gays/lesbians to adopt. Their second-parent adoption laws are strong, and there's some deal about the use of the word "partner" on birth certificates, if I remember correctly. Though I think we did create some precedent setting law here.

Anyone else want to give a shout-out for their state's progressive policies, or add to this non-random, partial list? Thanks for joining my nerdy celebration of this historic and wonderful ruling in California today!!

Speaking Of Boring...

I am trapped at the car service place, having Paco (as I like to call him, or rather... as he told me he likes to be called) looked over.  The little guy (he's a Ford Focus) needs new tires, and some other stuff.

It's indicative, I think, of the problems our economy is having that this suburban Ford/Kia dealership is so amazingly solicitous.  Twice now, they've offered me a loaner car. This morning they did a 10 point inspection on the spot when I arrived. The waiting area has wifi (no one seems to realize - or need it - but me), full cable selection, coffee, and up to the minute magazines.

So while I take advantage of high speed download time, I just caught McCain's healthcare speech in Tampa on CNN. And here we go with another week of bad McCain news.

For the record: Clinton's and Obama's healthcare plans

I've been meaning to post my notes on a recent talk I attended with Prof. Jonathan Gruber, a healthcare economist at MIT who has consulted to Edwards, Clinton and Obama.  Gruber is the author of the research that supports Clinton's claim that Obama's healthcare plan will insure 15M fewer people than hers; several weeks ago, he hosted an informal Q&A on the elections and the economy with grad students in my department.  I don't have too much insight, but I do have some notes.  With Obama's false attack ads in PA running this weekend, what better time to post them? Healthcare wonks and advocates, take notice.  (Caveat: my notes are old now, so I hope I can translate them correctly.  All errors are my own.)

Gruber said that Clinton's healthcare plan is most similar to Massachusetts's new universal healthcare plan, which he explains has enrolled 400,000 new people, of whom 75% previously lacked insurance.

In Gruber's lifetime, the difference between the Dem candidates and McCain/GOP is the most distinct policy difference he's seen.  (McCain's plan: tax credits, no regulation, get insurance where you can, watch out for that moving bus! ...ok that last phrase was my own editorializing...)

He went on and on about the cost of healthcare, and how he considers it our most pressing national crisis, no question.  He said the average family plan in the U.S. costs $12,000, and that both Clinton and Obama agree that one-third to one-half of the income distribution will have to be heavily subsidized to make this affordable.

Both candidates want to reform the non-group market.  Gruber believes in mandates, and says Obama is disingenuous to say both plans will cover the same number of people. 

As for a single-payer model, Gruber says it is less innovative and offers less choice (others choose for us).  More importantly, he called it a political non-starter.  250M people are "happily insured" in the U.S., versus the 47M uninsured.  Also, the insurance industry earns $500-$700B per year.  Shifting to a single-payer model at the outset of reform efforts in this political economic landscape will not work.  He mused that a single-payer model could eventually evolve out of reform efforts.

He claimed that every major candidate has highly unrealistic positions given the national deficit.  He believes we have serious problems in the long-run, and that the major issue for the nation is rising healthcare costs.  He posed a rhetorical question, what's appropriate to spend on healthcare?  Gruber continued that two-thirds of healthcare spending is so productive that it compensates for the one-third that is wasteful, but to get rid of that chronic, wasteful one-third is to have to say no to treatments Americans want.  At this point Prof. Frank Levy, another economist studying technology and radiologists, interjected with his usual acerbic wit that when denied unnecessary x-rays and catscans patients act as if they're constitutional rights have been violated.  Good stuff.

Gruber said that we don't know how to control costs but that we do know how to cover the uninsured.  It seemed to me he clearly supported Clinton's plan, not least because she is quoting his research all over the place.  We academics like that kind of thing.

And a non-sequitur closing remark: Happy Passover!!

The People, United...

UPDATES BELOW THE FOLD

I still remember a painful discussion I had, years ago, with some new friends I'd made working on a political campaign.  We were discussing future plans, one of us who wanted to run for City Council (and did, and won). The discussion got heated - and I was the flame - over how to deal with the Teacher's Union, which the potential candidate, did not, necessarily, support, in all its goals.

This is all Democrats, mind you. In New York City.

As I did that night, I still support the idea of unions.  I don't, really, know a Democrat who doesn't. Support for organized labor, for the rights of workers, is a cornerstone of Democratic Party principles, as it should be.

Although in these days when just what we believe in is so... undefined... just don't ask too much more.

There's already a lot of discussion going on about this New Republic article on tensions within SEIU between Andy Stern, curerent hero of Democratic labor politics, and Sal Rosselli, the head of United Healthcare Workers West, one of SEIU's largest members. One could wonder, endlessly, about TNR's reasons for writing it. But I'd say, with the prospect of Democrats winning this fall coming on so strong... expect more of it. And, as with so many things in this heated Democratic season, expect it to touch on issues of class and economics and politics that haven't been examined in a while... and don't, necessarily have obvious answers.

Right By Your Side

Since my, um, neighbor, at the gym also noted it, too, I guess it's worth commenting on: Doncha hate when you finish your workout and go back to a near empty locker room... only to discover the only other guy in it is the locker right next to yours?

I mean, we laughed and all... but what is this? You go in, the place looks deserted, you pick a spot - no locks on either side - and you may have even accidentally opened it on some fool who goes lockless (which, frankly, strikes me as more embarrassing than going commando - I mean, dude, we're not thieves anymore, but Christ, did I want to see your socks?), and you change and go to work out, you come back... and bam! There he is.

And I hate to be one to admit it, but part of this is being gay at predominately straight gyms, because you want to get in and out without cruising some poor guy who, you know, is sensitive (and thanks to the gym, hot looking). In New York, I blame New York Sports Clubs, which has become the ubiquitous gym of choice for people who want a good gym without paying too much (otherwise it's NYAC or Reebok... or Crunch if you're all downtown and hip about it), so it's got Chelsea and the Upper East Side... and everything in between. And it's also the inheritor, for better and worse, of that ethos from the first gym craze of the eighties and nineties, when the synonym for Bally's was "Meat Market" (at my first Bally's, I had women hitting on me.  I swear). Now it's pansexual cruising, and everyone's a little wary... and we just want a locker of our own, away from the others... is that too much to ask?

Apparently, yes. And I thought I was the only one.  And now that I know that we're a group, I think we need a word for it.  Any suggestions?

Crazy, But It Feels Alright (Baby Thinking Of You Keeps Me Up All Night)

Along with the Iowa Caucus news of yesterday, one other story swept everything else off the headlines: Britney Spears and her drama at home.

In case you - like my Mom - only get your news from PBS and NPR, Spears was rushed to Cedars Sinai after a three hour vigil in her home, when she refused to turn over the two kids to Kevin Federline, barricading herself into a bathroom.

I don't usually write a lot of celebrity stuff - those who have followed my writing for awhile know that I used to have a paid online gig writing "celebrity news" stuff, which I've since given up (or they gave up on me, I can't really be sure).  Despite my teenage-like fascination with movie stars and celebrities, I don't really think there's much to write about them, most of the time.  What I find interesting about celebrities is what they say about us as a society, not, say, the ins-and-outs of Angelina Jolie and Brad Pitt as they traipse their multi-culti family all over the world.

(Though, on that note, it's interesting to point out that Pitt and Jolie have surprisingly solid cred almost everywhere you go - at our New Year's dinner, everyone spoke admiringly of their work in New Orleans and her work with Unicef. And of course, agreed they were both really really hott.)

Spears, along with Lindsay Lohan, Nicole Richie and Paris Hilton, has come to be a stand-in, I think, for a discussion of society's expectations for young women (I'll add Jamie Lyn Spears to the mix in a moment). It's not entirely fair, and much of our national disapproval for their drunken antics is , like so much of American values, deeply conflicted.  We get teased with the salacious views of lithe girls running around in handkerchiefs, then wag a finger at them for "bad" behavior.

And meanwhile, before our eyes, Spears has been falling apart.  Much like Owen Wilson.

On A Clear Day

One of the interesting aspects of a five story row house in Boston is that the view differs widely from floor to floor. My floor overlooks a park across the way that in Spring vanishes behind a sea of leaves from the many trees on the street, and in the park.  Below me, the rooms have a view more of the streetscape, and from the kitchen, there's a lovely overlook into the back garden.

But above me are two amazing vistas: one is a view clear to the tall buildings downtown, and in back is a view of row upon row of houses, as the height of our building gracefully lifts over the buildings behind (even their rooftop decks).  On a clear day, you can see quite far in both directions.

Today is just such a day as I finish a round of packing and prepare to travel.  On a clear day, I can face things a bit more directly, and I feel more comfortable saying that all of this is happening because an elderly relative is deteriorating, not in body, but in mind.  It's progressive and although treatments help, they can't, I see now, stop the progression completely.

It pains me to see someone who was so vibrant, so alive, so present, seem to vanish before me, replaced by a person I almost literally do not recognize.  When I first got here, there were good days and bad days.  On a clear day, things were relatively normal; on the bad days, things could become dark and frightening - mood swings, unpredictable behavior, no way to reason out a solution.

My nature is to want to help, to do what I can.  It's been painful to face that here is a moment where I cannot do anything, where leaving is what's best for me, and for the family. There won't be a lot more clear days, and the choices, as my Mother reminds me, don't get easier from here.  This move may not be exactly what I wanted, but I know, ultimately, that I'll be okay.  I can't say the same for everything I leave behind.  That, and the notion that for all of us, these cloudy days are what lies ahead.

More to come, when I reach my destination.

Don't Mess With Mr. In Between

Conservative crowing this week about new stem cell research that suggests some human cells (skin cells, in this case) can be "reprogrammed" to behave like embryonic stem cells may be the most curious kind of right wing triumphalism yet.  Almost nothing in thier back-patting is quite what it seems.

For one thing, the right claims the left has "virtually ignored" this development - odd, since the "mainstream media" they criticize so much had it on America's front pages yesterday - and refuses to acknowledge the breakthrough. The latter point also makes no sense - apparently, if we're not sufficiently awed, then it's not real. Nonsense.

But perhaps the oddest thing is trying to suggest that this discovery is vindication for Bush's refusal to fund stem cell research, and that studying embryonic stem cells is now a non-issue.   

Always Low... Something. Always.

With so many things to write about, I think I'll start with one from the front page of the Wall Street Journal - they led today with the news that some health insurers are chasing down accident victims for repayment of costs associated with their care should they win personal injury lawsuits. And the lead case they cite is sure to raise more hackels: Wal Mart recently won a massive judgment against a Missouri couple, Jim and Deborah Shank, after Deborah had sustained massive injuries, including brain damage, in a major car accident when she was hit by a truck (Wal Mart, where she worked, provided her health insurance; they had no involvement in the accident).

The concept at work here is "subrogation," in which insurers put a clause into policies (probably yours, too) that if you receive care for an accident that you later win renumeration for, some of the damage payment will be returned to the insurer to offset the cost of your care.  This does, in some ways, make sense: if you sue someone for causing your injuries, and ask them to pay your medical bills, which were already paid by your insurer, then you are benefiting twice. According to the Journal, this has become a fairly significant income stream for insurers:

The American Benefits Council and America's Health Insurance Plans, the health-insurer lobby, estimate health plans recoup some $1 billion a year in medical claims from accident settlements and other third parties. A cottage industry of auditing firms, benefit-recovery specialists and subrogation lawyers help them. They estimate that between 1% and 3% of health-care spending is potentially recoverable from such claims.

"In the past, employers used to think of this as an afterthought," says Tom Lawrence, chief executive of Memphis-based Benefit Recovery Inc., whose clients include Southwest Airlines Co. and hospital chain HCA Inc. HCA says it saw annual savings from recouped claims rise to $1.8 million in 2006 from just under $800,000 in 2000 after hiring the firm.

...

Until recently, employers and insurers generally didn't go after small claims. But more-sophisticated claims tracking has made it easier. Recovery companies systematically search claims for certain medical codes -- say, a sprained ankle or head trauma -- that flag a potential accident. Claims examiners then mail a questionnaire and often follow up with calls. If the injured person confirms it was an accident, the firm tracks whether the patient files an injury suit.

Of course, Wal Mart has taken this a step further.  Read On.

Coming Home

From today's New York Post, I linked into the story of the "Marlboro Man" soldier photo story - James Blake Miller, you may recall (or not), was a Marine photographed in tight closeup, cigarette dangling, whose image in many ways became a symbol for our modern soldiers in Iraq. Photographer Luis Sinco, who was among the finalists for the Pulitzer Prize in Photography in 2005 for this picture, befriended Miller and got to know him.

This week, Sinco chronicled in the LA Times Miller's struggles since coming home from Iraq.  Miller, like many soldiers, suffers from Post Traumatic Stress Disorder, and his struggles with depression and survivor's guilt have up-ended his life, and apparently ended his marriage.  It is long, but I'd recommend the whole piece, as it provides a longer view of the effects of war than one usually gets to see.

Sinco's photo of Miller became a touchstone for conservatives supporting the War in Iraq, and it will be interesting to see how they deal with a story that does not provide the kind of hopeful, positive ending of the sort they usually like.  Too often, I think, liberals like to tag conservatives as unconcerned with the aftermath of war.  I don't think that's the case, especially these days when conservatism is most present in the communities that send soldiers to war.  But I do think  there's atendency to minimize the difficulties veterans face, to suggest some sort of balance between the ideals of serving and the realities of war.  Ideals are nice, but they don't really offset the physical and mental injuries of combat.

I fear Miller will continue to be seen as more symbolic than real - a poster boy for all sides to use to blame the other fo not doing something different ("you don't care about their suffering," vs. "you don't support our troops when they're there, only when they're here and bitter" and such).  I work with a former marine who struggles with PTSD and so I found Miller's story simply moving, and heartbreaking. You can treat the illness.  You can't, I think, fix what has broken Miller.

Does this story tell us something about Iraq as it stands? I don't know; I think the question of how long we stay has always been about a tipping point: when do the dead become too many, when do the injured become too numerous, when does the suffering of our soldiers outweigh the potential for success. For those of us who think we should never have gone in, that tipping point was long ago. For others, it's just arriving, and for some, like George W. Bush, it may never come at all.What I think Miller's story points to is a problem we haven't even begun to consider.  When it ends - and it will - these soldiers will be cming home.  And they will be changed, and they will, many of them, be broken, and often in ways we can't fix.  And I don't think we have a goddamn clue how to deal with it.