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"America has two great dominant strands of political thought - conservatism, which, at its very best, draws lines that should not be crossed; and progressivism, which, at its very best, breaks down barriers that should never have been erected." -- Bill Clinton, Dedication of the Clinton Presidential Library, November 2004

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Tuesday, May 20, 2003


Dean's Sunday discussion knocks Kerry's Health Plan back to boot camp

posted by Adam F. at Tuesday, May 20, 2003 permalink View blog reactions
I watched Gov. Dean Sunday at Sen. Harkin's candidate forum. I saw a moment that defined why Gov. Dean's background as a physician is the most critical item on any candidate's resume in the 2004 election. More about that in a minute. Then, Sen. Kerry released his health care package Monday. Sen. Kerry showed why sailors should not manage health care. Kerry’s proposals endorse creation of a two-tier medical system, one for the insured, and system of community clinics that has proven highly inadequate in the past for the nation’s needy. Many of Sen. Kerry’s proposals seem to revolve as much around Kerry’s military years as the rest of his rhetoric. “More PT, LT., more PT, we like it, we love it, we want more of it…” Lots of talk about making Americans more healthy, which is not a bad idea, but still will not prevent Americans from dying eventually. I haven't seen even O’Really try to spin that Dubya can end death in America (well... not lately, anyway). Americans run up a vast portion of their medical bills at the end of their lives. Nothing in Kerry’s plan even takes a sideways glance at that issue.

In Sunday’s forum, Gov. Dean had a frank discussion with a questioner about making the hard decisions on how we will have to decide how to spend limited health care dollars. In it, he discussed how important family/doctor discussions about plans people should make about quality of life at the end of their lives are and the need for encouraging those discussions as a part of the national discussion on health care. Most people run away from listening to these “morbid” discussions. I started paying attention to the issue of death with dignity after having briefly been knocked into a coma after an act of random violence that ended up putting me on Social Security disability for the past decade. The idea of being hooked up to a rack of machines and tubes to lengthen lives isn’t just distasteful for most Americans. It’s horrifying. It’s that image that started the “death with dignity” movement in the first place.

So we have two issues here. Health care money is limited and a huge chunk of it is spent at the end of a patient’s life using extraordinary means to only marginally extend a patient’s life when that life has no possibility of being saved and the quality of life during that period is nightmarish and repulsive to the vast majority of Americans in study after study. Howard Dean is the first public figure I ever heard link these two concepts into the possibility of some public policy that makes real sense, costs almost nothing in it’s implementation, and saves a whole ton of money. Why shouldn’t the President use the bully pulpit of the White House to encourage Americans to make living wills? Here we have perfect public policy in action. Americans can make their own choices on quality of life issues at the ends of their life and choose to leave this Earth in the manner of their choosing, and because Americans have been encouraged to make these choices, health care costs in this country will drop dramatically.

Wow. That makes almost too much sense for the American political system to handle.

By the way, one last point on the Kerry proposal. Kerry goes through the entire 10-page policy paper pdf file without managing to mention disabled Americans even once. Excuse me?

Adam F. Smith


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About Nation-Building

Nation-Building was founded by Aziz Poonawalla in August 2002 under the name Dean Nation. Dean Nation was the very first weblog devoted to a presidential candidate, Howard Dean, and became the vanguard of the Dean netroot phenomenon, raising over $40,000 for the Dean campaign, pioneering the use of Meetup, and enjoying the attention of the campaign itself, with Joe Trippi a regular reader (and sometime commentor). Howard Dean himself even left a comment once. Dean Nation was a group weblog effort and counts among its alumni many of the progressive blogsphere's leading talent including Jerome Armstrong, Matthew Yglesias, and Ezra Klein. After the election in 2004, the blog refocused onto the theme of "purple politics", formally changing its name to Nation-Building in June 2006. The primary focus of the blog is on articulating purple-state policy at home and pragmatic liberal interventionism abroad.