Author: NG

I have a number of conservative friends. When we get together socially, we do not tend to talk politics for obvious reasons, although we know where each other stands on this issue.  However we do tend to email pieces back and forth that tend to support our various views. I suppose we do this just to let each other know that we have not changed politically.

Anyway, today’s latest conservative piece is a supposed letter from a medic soldier in Iraq supporting the surge. This letter has the usual conservative good, evil, democracy, freedom, only us, fight them there instead of here stuff in it, but it also gives a view of what may be happening over there, at least in this guys mind.  

I cannot vouch for the authenticity of this letter, but I do think it represents what many Americans still feel.  Even if a majority of Americans now do not support this Iraq effort, I believe it would not take too much more talk like that which is in this letter to bring that majority down.  I wonder what is the best way to fight such potential changes in beliefs, and what aspects of this conservative mantra are most damaging to potentially ending the war (see poll)? Here is the letter:

>>
>>
>> All,
>>
>> Below is an email from a Medic in Iraq explaining the situation and why
>> the surge in force is necessary from his perspective.  This was sent out
>> by our 3 Star Admiral John Cotton as an informative piece.  I assume the
>> source is valid along with his perspective.
>>
>>
>>
>>
>>
>>
>>
>> From the net…
>>
>> From a medic in Iraq.
>> Following the article I sent about Bush’s national address and
>> troop
>> increase, I thought it was a good idea to let you all know what
>> the
>> perspective is over here. I’m tired of hearing the media’s
>> skewed
>> version, the politicians squabbling over what they read in a
>> report, and
>> the average ill-informed American ranting about things he knows
>> NOTHING
>> about.
>>
>> I’ve been over here a couple of months now, and I’ve learned
>> more about
>> this country than a year’s worth of watching CNN. I’ve sat in
>> mission
>> briefs with Colonels, talked with village elders, had tea with
>> Sheiks,
>> played with the kids. And I agree with the President. We need
>> more
>> troops and we need to take greater action.
>>
>> There are 3 major factions here. The Sunnis, Shiites, and Kurds.
>> The
>> Shiites are in the majority, but Saddam was a Sunni, so he kept
>> the
>> Shiites in check. Everyone hates the Kurds, who are Christian
>> and in the
>> vast minority. The Kurds received the brunt of Saddam’s
>> murderous
>> tyranny. Now that Saddam is gone, the Shiites have taken control
>> of
>> Baghdad. The largely peaceful Sunnis are now the victims of
>> radical
>> Shiite terrorism. So the young Sunni men, who can no longer go
>> to work
>> and support their families, do what all young men would do. They
>> join
>> the Sunni militia and battle the Shiites. And thus the country
>> sits on
>> the brink of civil war.
>>
>> But this war is between them. They largely do not concern
>> themselves
>> with the U.S. troops. The insurgents who battle the Coalition
>> Forces are
>> from outside the country. And the biggest problem down here
>> isn’t the
>> insurgents. Its the politicians. The local politicians. Even
>> though the
>> country is controlled by Prime Minister Nouri al-Maliki,
>> downtown
>> Baghdad is controlled by radical Shiite cleric Muqtada al-Sadr.
>> The
>> Shiites follow al-Sadr and thus the Prime Minister does what
>> al-Sadr
>> says. Think of it as if a warlord controlled New York and
>> blackmailed
>> the President into diplomatic immunity.
>>
>> When 1st Cav (mainly 2/5 Cav) came here in 2004, they took
>> downtown
>> Baghdad (known as Sadr City) by force. It cost many lives, but
>> after a
>> year, we held an iron grip on the largest insurgent breeding
>> ground in
>> Iraq. The insurgents were afraid of the Horse People, and
>> rightfully so.
>> But when 1st Cav left, al-Sadr influenced the Prime Minister to
>> kick out
>> the Coalition forces from that area of Baghdad. He said the
>> Iraqi
>> military forces could hold the city. But all that happened was
>> al-Sadr
>> regained control of his city, and it is now a heavily guarded
>> fortress.
>> A place where insurgents and terrorists can train and stockpile
>> arms.
>> And we cannot go back in because the Prime Minister won’t let
>> us. Our
>> hands are tied.
>>
>> So where does al-Sadr get his backing? From Iran and Syria. Iran
>> supplies him with money and Syria supplies the terrorists. The
>> insurgents that battle the Coalition Forces are from Syria,
>> Somalia and
>> dozens of other places outside of Iraq. Iraq is literally a
>> terrorist
>> breeding ground. They have terrorist and sniper schools here.
>> Why not?
>> They train by teaching them to attack the military forces here.
>> And they
>> have an endless supply of these training tools. They have
>> factories
>> setup in Sadr City to build bombs. Both Iran and Syria have
>> openly
>> proclaimed their number one goal in life is to destroy the great
>> Western
>> Devil and the little Western Devil (America and Britain). Iran
>> wants to
>> control Iraq to further this purpose. Al-Sadr will get to “run”
>> the country and live like a king, but in reality Iran will pull
>> the
>> puppet strings. Iran will have access to thousands of radical
>> Shiites
>> who will do whatever al-Sadr tells them to. And Iraq will be
>> used as a
>> breeding ground for terrorism. Terrorism that will be targeted
>> directly
>> at America and Britain. The Iraq Study Group advised we should
>> let Iran
>> and Syria help with rebuilding? Bravo to President Bush for
>> striking
>> that idea down and vowing to keep those two countries out of
>> Iraq.
>>
>> So how do the Iraqi people feel about everything? Of course they
>> don’t
>> want the Americans here. But they would far rather have us here
>> than the
>> Iranians. My platoon visited an average Sunni village on a
>> patrol a few
>> days ago. Their only source of income was to farm, as they could
>> not go
>> to the city to work for fear of violence. Many of the young men
>> had
>> already run off to join the militia for no other reason than to
>> feed
>> their families. They had no school or hospital near them and the
>> community was dying. The village elder’s granddaughter was very
>> sick and
>> I was able to treat her. Afterwards he invited me and my Platoon
>> Leader
>> to sit in his house and have tea with him, and we talked about
>> the
>> situation.
>>
>> The people want peace. The Shiites kill the Sunnis because
>> al-Sadr tells
>> them to do so. The Sunnis fight back because they have no
>> choice.
>> They are glad Saddam is dead (Sunni or not), but do not want to
>> replace
>> him with another dictator in a politician’s clothes (which is
>> what
>> al-Sadr will become). And they especially don’t want Iran in
>> charge.
>> Many innocent Iraqis will die if this happens. These are the
>> words that
>> came out of the elder’s mouth:
>>
>> “We do not want America here, and America does not want to be
>> here. But
>> you cannot leave because the militias control the country.
>> America must
>> use the might of its giant army and sweep through, root out and
>> destroy
>> the militias. Then Iraq can be free and you can leave.”
>>
>> What appears to have happened within our diplomatic community,
>> is that
>> Prime Minister finally realizes that his days are numbered. If
>> al-Sadr
>> remains, he will be kicked to the curb. So hopefully he is about
>> to
>> allow us to reenter Sadr City, root out and destroy the enemy. A
>> dramatic troop increase will allow us to do this. And the Horse
>> People
>> are back and ready to finish what they started over 2 years ago.
>>
>>
>> If leave now, it will be a failure for democracy. Iran will con
>> toll
>> Iraq and the end result will be more terrorist attacks on
>> America. The
>> American people don’t want soldiers dying over here, but its better than American civilians dying over there.
>> C. Do NOT forget 9/11. They
>> will do it
>> again. The moment we loosen our grip on the noose, they will do
>> it
>> again. And the only way to root out the evil here is to stop beating around the bush, increase troops and destroy the insurgents once and for all. The Iraqi government cannot do this on their own. The Iraqi
>> security forces are inadequate for this task. We are the only
>> ones who
>> can stop al-Sadr.
>>
>> Feel free to share this with whomever wants a real soldier’s
>> opinion
>> about the war.
>>
>>

Healthcare system reform has been talked about for many years, but as long as providers and payers (insurance companies) did not support change, little was likely to happen.  Patients traditionally have been the most clueless in what to do, which points to the irony and desparate state of conservatives with their Consumer directed health care (CDHC) ideas.  What they are saying is let’s put the emphasis on the least qualified group and expect better healthcare. I don’t think so.

Well today I read an important policy document from a group that has a large say in possible reform, The American College of Physicians, and from what I read, I think they are beginning to get it finally!
Some document highlights:

The Solution: A Patient-Centered Health Care System
The solution to such inadequacies is to redirect federal health care policy toward
supporting patient-centered health care that builds upon the relationship between patients
and their primary and principal care physicians and supports the systems needed to
achieve better results. This would involve applying systems-based models that have been
proven to work in other nations’ health systems (adapting them to the unique
circumstances and needs of the United States) and in successful patient-centered health
programs within the U.S.
What is a Patient-Centered Health Care System?
A patient-centered health care system is one that:
* Provides continuous access to a personal primary or principal care physician who
accepts responsibility for treating and managing care for the whole patient
through an advanced medical home (AMH), also known as a patient-centered
medical home,* rather than limiting practice to a single disease condition, organ
system, or procedure,
* Supports the specific characteristics of care that the evidence shows result in the
best possible outcomes for patients.
* Recognizes the importance of implementing systems-based approaches that will
enable physicians and other clinicians to manage care, in partnership with their
patients, and to engage in continuous quality improvement,
* Introduces transparency in consumer decision-making and accountability for
getting better results,
* Creates new financing, reimbursement and delivery models that support the
ability of physicians and patients to provide and receive patient-centered care,
* Assures that all individuals will have access to care through a patient-centered
medical home (PC-MH) by providing affordable health insurance coverage to all
and creating models that will provide everyone with the option of receiving care
through a PC-MH.

I read this document, and am beginning to feel vindicated for many of my views about controlling healthcare at its source and for making everything accountable.  I will say that this patient centered care does not look much like CDHC in the least.  The primary care provider is in control and is responsible, and I believe that is more realistic!  

A proper payment system to cover everyone would still be needed, and if a single payer system is coupled with a primary care patient centered system as talked about in this document, well I believe we would be on our way.  The primary care providers would have to be held accountable to standards that both the system and the patients would be aware of.  Also, if not enough primary care providers were available to give all a medical home, that would point to the need for more providers, which should then be quickly addressed!  

I like this document as a recognition for needed change and part of the blueprint for getting there!.

This diary has two related purposes, and I cannot tell even myself which one is more significant.  One purpose is to make sure this community is aware of a new study recently released that shows how ridiculous Abstinence Only Education programs are in light of the following results from the study:

Results. Data from the 2002 survey indicate that by age 20, 77% of respondents
had had sex, 75% had had premarital sex, and 12% had married; by age
44, 95% of respondents (94% of women, 96% of men, and 97% of those who
had ever had sex) had had premarital sex. Even among those who abstained
until at least age 20, 81% had had premarital sex by age 44. Among cohorts
of women turning 15 between 1964 and 1993, at least 91% had had premarital
sex by age 30. Among those turning 15 between 1954 and 1963, 82% had had
premarital sex by age 30, and 88% had done so by age 44.

The second purpose of this diary is to tell those of you that missed it, that the Today Show did an extended piece on this report today, and they seemed to me to be in favor of the reports conclusions.  Does this mean the conservatives are finally losing their grip on preventing the MSM from acting rationally toward human sexuality issues for a change?

The entire report by Lawrence Finer appears in Public Health Reports / January-February 2007.  Here are the summary conclusions from this report:

Conclusions. Almost all Americans have sex before marrying. These findings
argue for education and interventions that provide the skills and information
people need to protect themselves from unintended pregnancy and sexually
transmitted diseases once they become sexually active, regardless of marital
status.

Kaiser Network’s Daily Women’s Health Policy also had a summary about the report.  Here is the important part from this summary for health policy folks:

According to Finer, at least 91% of women born between 1950 and 1978 said they had premarital sex by age 30, and 88% of women born in the 1940s said they had premarital sex prior to age 44 (AP/Chicago Tribune, 12/19). Finer said the margin of error in the report is less than one percentage point (USA Today, 12/20). “The data clearly show that the majority of older teens and adults have already had sex before marriage, which calls into question the federal government’s funding of abstinence-only-until-marriage programs for 12- to 29-year-olds,” Finer said, adding, “It would be more effective to provide young people with the skills and information they need to be safe once they become sexually active — which nearly everyone eventually will.”

Now as to The Today Shows piece on this, here is a link to this interesting video from this day.

I worked in a State Health Department in the late 1990s when the conservatives for the millionth time began trying to hold back the tide of human sexuality again.  I mean it brought the screwballs out of the woodwork.  All the middle age mother types that normally would be rational folks, just would lose their rationality in favor of this approach. They would forget their own pasts in what seemed to be almost a form of censorship, and of course would seem to forget the extreme dangers posed by NOT really equipping young people properly to protect their very lives through proper sexual education for all.  It seems we need to keep ignoring the obvious human nature finding from this study about every 25 years of so. The problem this time around was the conservatives got control of the federal government and the MSM (for a time anyway) and made this whitewashing of human instincts a sort of national policy.

Well hopefully studies like this along with the seemingly renewed rationality of the MSM will get national education policy on this sexual education issue back on a track that can logically and scientifically do some good for a change and stop diverting funds into pockets of misguided souls!

Corporate America IS only concerned about money in the long run, but that surely does not explain why the hell General Electric wishes to own NBC!  Why have large, multi-national corporations bought up all media outlets??  Is that the best way for them to make big money directly from the feeble TV shows that pass for entertainment.  I think not.  The multinationals are buying media outlets to enrich themselves indirectly through propaganda dissemination that opens the door to these corporation to the real money, namely global control of resources through control of people and governments.
I am convinced that Hillary’s vast right wing conspiracy does exist, and it maintains itself to a great extent by propaganda disseminated through media control.  The right wing bosses will not allow a free press with journalists doing their jobs, but will only give us Katie Courics, and shark attacks, and children all of a sudden being molested and kidnapped at epidemic proportions, and of course the threat of attacks from shady forces that just hate our freedoms.  Their desired motto is Be afraid, be very afraid, and trust your right wing government to protect you.  However, an interesting concept would be what would the right wing propaganda machine do if they sensed their BS was not working anymore??  Would they try to mind-alter the common man even harder, and/OR would they first try to throw some crumbs in the direction of the dissent to look more responsive??  Noticed the way I phrased this because even if they threw some crumbs, you got to know that their original mind-control agenda was still intact because their complete control of power is still dependent on their ability to keeps people’s attention occupied by the presentation of false, fear-inducing bogeymen and to blind people via extreme nationalism!!

Okay now for the point of this writing.  The American public may be starting to figure some of this out, and may be developing a certain paranoia fear and anger that their government and the current main-stream media are not telling them relevant true facts for them to base good decisions upon. If this is true, then some slight twist to the old dance with the intent to regain control must be coming, but what is it?  What could they do to both defuse the developing paranoia, anger, and mistrust while still being able to feed propaganda nonsense to the masses to keep control for their agenda?

I think most would agree with some of the general premise of this diary (see poll), and in light of that, what do you think will be the next step this right-wing government and this corporate controlled media will take to try and keep their advantage and control in light of possible changing public perceptions in this area.  You got to know IT’S coming and soon, but what will the IT be??  

This diary will not be a comfortable one to read around these parts, but it is really quite a simple work!  It was prompted in light of the Israeli-Palestinian conflict and the arguments around here about the hoped for proper course that this conflict should ideally follow, I have been thinking about human reality and whether progressive thought has been or can be realistic or just an outlier of potential human behavior?  If the latter, what would have to change to make progressive ideology and actions the norm

If you were assured of your and your loved ones basic needs being met for now and in the relative future, would you risk your life in a war?? Why?  On the other hand, if the ability of yourself or your loved ones to survive now or in the relative future was at risk, would you perish quietly while others took the available resources so they could survive?  What is the carrying capacity of any environment and how do humans not exceed it; OR do they exceed it and thus kill each other off?  
Mankind groups together in societies to try and assure that society’s survival, IMO.  When that society’s inhabitants sense survival threats, they try and assure enough resources for their survival even if other groups cannot thus survive!  Sound familiar?  Abraham Maslow described a pyramid of need to show motivation behind human behavior.  A graphic of this pyramid is below.

 While our deficiency needs MUST be met for survival, our being needs are continually shaping our more optional behaviors. This statement to me means that people will fight to survive by almost any means, but their upper level behaviors after their survival is assured is more arbitrary and optional.  I think that many of us here are discussing upper level motivations while much of the world, including the US government, is acting in the must area for survival!  This explains why we talk about all these solutions that never actually happen because our solutions do not deal with the survival reality of many groups.  If we want progressive ideas to be embraced by the future of mankind, we must assure that the lower level Maslow needs for everyone are assured for now and the relative future.  

Now how do we actually do that??? (See poll)

Think about the medical knowledge base we have today and how was it formed, who suffered to get it, and who can legally use it?  I am trying to show that we really do have a logical and ethical obligation to provide basic, meaningful healthcare to all, and if we as a society choose to delegate or restrict the provision of such healthcare to a certain profession, well then that profession assumes this social obligation.  First answers to the above questions.

— the medical knowledge base we have today was formed by trial and error experiments on people and animals in the existing world of the past.

–who suffered to get it?– All our relatives for the past hundreds of years.

–who can legally use it?–In the US, certain professions such as Medicine and Dentistry have been granted the sole privilege of using this knowledge hopefully for the good of mankind.  It is illegal for others to use this knowledge in a business relationship without the indirect/direct certification of the profession and the direct certification of the state (licensure and scope of practice laws)!

Given this analysis, how is it that many of our citizens lack access to these chosen, privileged providers.  Is this situation proper, whose obligation is it to try and fix the problem, and is anything happening.

Access to care problems seem to center on two main issues, finding a provider and paying that provider.  As I said above, only providers certified by these privileged professions and the State can give the care.  Paying for the care, which is often too expensive for many/most individuals to afford directly is through third party payers.  However about 20% of Americans (>40 million people) have no third party payer.

As for finding a provider, many poor people in especially rural areas are blocked out of access to good care by a combination of not enough certified providers, and the refusal of many of these certified providers to see the poor, who may or may not have safety net insurance (Medicaid). This problem is true in both Medicine and Dentistry, but it is and has been especially acute in Dentistry.  There has been much talk in America about health insurance reform and single payer versus consumer pay etc., but there has not been much talk about the supplier side issues that drive up cost and limit/prevent access.  I want to deal with some of these issues in the rest of this diary using dentistry (which I am very familiar with) as my main example.
Medicine began using lesser trained auxiliaries as providers 30 or so years ago, and it may well be that change that has kept the lid on the system from failing at least for now.  Dentistry in America has heretofore refused to allow real, independent midlevel providers claiming that it is a patient safety issue. However, midlevel medical providers have not proven to be dangerous, and mid-level independent dental therapists have been used successfully in Australia, New Zealand, and Canada for 50 or more years.  

In rural Alaska, dental disease is rampant, and nobody in the dental profession seems to care much about leaving the disease alone.  If dentists are not available to treat the disease (and they are not), then let the people suffer.  I mean it is a patient safety issue isn’t it??  What about the disease dangers however?  Well when some public health and tribal efforts try to do something about this chronic problem, namely to train midlevel therapist to treat these folks according to the New Zealand model, well here comes organized dentistry to claim foul.  Where are they with real solution ideas when there is only suffering?  Read the article below about organized dentistry’s attempt to stop the University of Washington from being the first University in America to offer a training program for mid-level dental therapists.

Here is a link and excerpt from the article
UW debates dental therapy program for Alaskans

What do New Zealand trained-dental health therapists and tooth decay in Alaska have to do with the University of Washington? Quite a mouthful, as it turns out.

In a guest column published by The Seattle Post-Intelligencer on June 29, Peter Milgrom, a UW faculty member in dental public health, accused the UW dental and medical schools of abandoning Native Alaskans and their oral health.

At issue is a pending application with the W.K. Kellogg Foundation, applied for by the UW School of Medicine’s MEDEX Northwest, a physician assistant program, and the Alaska Native Tribal Health Consortium (ANTHC) 18 months ago.

The $2.5-million grant would provide 24 months of Alaska-based training for eight to 10 dental health aide therapists (DHAT). Upon completion, the DHATs would be able to assume mid-level oral-health functions and treat Native Alaskans in their communities on a year-round basis. The program would be administered by the UW’s MEDEX Northwest campus in Bethel, Alaska.

Native Alaskans’ rate of tooth decay is at least two and a half times that of the general population. Dentists are scarce in rural Alaska where most Native Alaskans live — many villages are accessible only by plane or snowmobile.

“Because of ADA [American Dental Association] opposition, no therapist program has ever been mounted in a United States university,” Milgrom wrote.

If any profession is derelict in meeting its social access obligation, it should expect society to take its monopoly away!  In the healthcare access crisis in America, both affordability issues and provider type issues will have to be addressed for any meaningful solutions to happen, and these issues are directly related, IMO.  We will never be able to train and afford the number of doctors and dentists, as they are currently trained and paid, to do everything people will need.  We must be less guild conscious and more outcomes conscious in our scope of practice definitions so that number of providers and future costs of care can be kept at a reasonable level with adequate access to care for all.  It is all related, and some professional obligation to cooperate and even directly solve the problem should be demanded by the public. (See Poll)

The more the right wing conservatives control this country and its media, the more examples one can sense of their real attitude toward women.  We all sense they want to limit women’s control over their bodies in the reproductive area, and the conservatives are not shy about saying so.  Other women control areas are a bit more subtle such as women with children in the workforce.  Related somewhat to this latter point, I saw a piece on CBS news tonight which I can not help but believe is part of this right wing conservative attempt to put women back where they belong like they were in the 1800.
The segment can be seen on this link to CBS news.  Take a look at the story and the related video.  Come back here after reviewing this material.

Does anyone else besides me sense this is also part of the right wing anti-women’s rights campaign?  How dare those girls do better than boys in school!  Who do they think they are?  Don’t they know that the bible has chosen men to be the head of the household and the bread winners.  If women do too well in school and subsequently in the workplace, this goes against the bible and must be wrong.  Can’t have that.  Maybe there really is discrimination so those majority female teachers must be to blame. What to do, what to do.

I wish I could prove/find out who is really behind this lawsuit and this campaign by this kid and his father.  Now maybe I am too paranoid in my sense here, but IMO it is subtle messages like this combined with the not so subtle messages related to reproductive freedoms that could allow progressives to capture huge numbers of women voters if they were exposed properly and simply.  If these anachronistic views of women by the conservative right could be made into a clear campaign message and a clear platform plank was included to counteract such, I believe the stage would be set to win the vast majority of the women’s vote down the road.

First Massachusetts, now maybe PA!

A democrat in the PA Senate has introduced a single payer, universal health act into the PA Senate, The Balanced and Comprehensive Health Care Reform Act.  There was an article in my local paper saying that a similar bill will be introduced in the PA House soon.  
Here is the Senate Bill

Here is the Bill’s  Summary and description

Now I do not know if this has any chance of passing, probably not yet, but I suspect the time is fast coming when average folks will say enough is enough and start to push for such solutions, first in some states, but eventually on a national basis.  It is a lot like many progressive ideas and solutions in that you know they are right, you know we are getting closer to getting the public to wake-up to this fact, but we just do not know how long the status quo greedy forces can hold on to their niche!  Still, it is good to see ideas like this starting to happening in some areas!

Bush says things are getting better, and we will be able to begin disengaging from Iraq. Well at least one MSM network may wish to protest that BS. We are being attacked like sitting ducks more boldly than ever, which means to me we are losing security more than ever. Without basic security, what have you?? What are all these people dying for again??

CBS story

Deadly Attack On CBS News Crew
Two Team Members Killed, Correspondent Seriously Injured By Roadside Bomb In Baghdad

BAGHDAD, May 29, 2006

(CBS/AP) Two members of a CBS News team, veteran cameraman Paul Douglas, 48, and soundman James Brolan, 42, were killed and correspondent Kimberly Dozier, 39, was seriously injured Monday when the Baghdad military unit in which they were embedded was attacked.

I think this CBS attack may be a real tipping point for the adminstration’s ability to spin good things for Iraq. Big time and embedded news crews don’t get blown up after 3 years in a country where things are going well. CBS should go out on a limb and really challenge and expose the situation in Iraq and just how many American lives are we willing to FURTHER throw away. How terrible so many have already been thrown away. This US Iraq effort is a travesty against humanity in its mismanagement and the waste it has caused. Let see if the news media’s tone now changes!

So says some extremely interesting and timely articles released in Health Affairs today.  See the press release for a summary and access to the actual articles for an interesting read about how using private sector-like models with only local intiatives is like spitting on a forest fire.
The conservatives want healthcare to follow a market oriented, private sector model, and the American health care system is in a death spiral because of this in relation to access, quality, and cost.  The implications from these important and timely studies, IMO, is that a new all-inclusive paradigm run by states or the feds will be needed to make any real difference. Hopefully if progressive ideas ever become in vogue again, we can learn from all these relatively failed local solutions.  Health care really is different than other insurance-based risks and other market amenable commodities, and the sooner we as a society realize this, the sooner we can start working on real solutions instead of fiddling around while Rome (I mean America) burns!

Excerpts from the press release:

Impact Of Community Initiatives On The Uninsured Limited By Economic and Political Obstacles

Bethesda, MD — Those hoping that community-level initiatives can make significant inroads into the problem of the uninsured may be in for a disappointment. That verdict emerges from a package of five papers published today on the Health Affairs Web site.

By examining many recent community initiatives, the papers demonstrate the creativity and diligence of community officials in seeking to improve care and expand coverage for the uninsured. But the package also illustrates the political, financial, and organizational obstacles communities face in this area, especially when they seek to expand coverage.

Reliance on private sector limits scope

A similar message is conveyed in “Community Approaches to Providing Care for the Uninsured,” based on research conducted as part of the Center for Studying Health System Change’s (HSC’s) Community Tracking Study, a longitudinal study of 12 health care markets conducted every two to two and one-half years. Community-based programs “are often invaluable to those who are able to enroll,” but they tend to “serve only a small proportion of their community’s uninsured residents, barely making a dent in the overall problem,” according to the study by Erin Fries Taylor, a researcher at Mathematica and an HSC consulting researcher, HSC senior researcher Peter Cunningham, and HSC research assistant Kelly McKenzie.

The difficulties that local leaders face are the same as those that hinder progress at the federal level: money and politics. “Community programs in the CTS sites increasingly are clustered around private-sector strategies, likely because public resources targeted specifically to programs for the uninsured have become more constrained in recent years,” Taylor, Cunningham, and McKenzie note. “Greater reliance on the private sector seems to be limiting the scope of these programs in terms of the number of uninsured people served, compared with the managed care programs of the 1990s that could tap into substantial public funds and pursue ambitious enrollment goals.”