1 Boring Old Man

Republican lawmakers stir up the ‘tea party’ crowd
Washington Post
By Dana Milbank
March 22, 2010

^{The Democrats were blamed for many horrible things — tyranny! socialism! corruption! – as they marched toward Sunday night’s passage of health-care legislation, but nobody ever accused them of making health reform look easy…}

^{But rather than calm the demonstrators, Republican congressmen whipped the masses into a frenzy. There on the House balcony, the GOP lawmakers’ legislative dissent and the tea-party protest merged into one. Some lawmakers waved handwritten signs and led the crowd in chants of "Kill the bill." A few waved the yellow "Don’t Tread on Me" flag of the tea-party movement. Still others fired up the demonstrators with campaign-style signs mocking House Speaker Nancy Pelosi.}

^{Democrats, to show they wouldn’t be intimidated, had staged a march to the Capitol from their office buildings, covering the ground where on Saturday African American Democrats were called racial epithets and spat on by protesters. Pelosi, carrying the speaker’s gavel, linked arms with Rep. John Lewis [D-GA], who was harassed Saturday but is no stranger to abuse from his years in the civil rights movement. Police ringed Lewis, Pelosi and other Democrats while the conservative activists formed a gantlet and shouted insults: "You communists! You socialists! You hate America!"}

^{The tone was little better indoors. Pelosi, holding a news conference after a meeting with her Democratic caucus, was heckled by a demonstrator. Inside the House chamber, Republicans placed on Democrats’ chairs photos of the Democratic lawmakers who lost their jobs in 1994. Rep. Marsha Blackburn [R-Tenn.] went to the well to say that "freedom dies." Rep. Ted Poe [R-Tex.], sitting in the front row in a way that displayed the Lone Star flag on his cowboy boots, said Democrats were on "the path of government tyranny." Rep. Paul Ryan [R-Wis.] warned of a "fiscal Frankenstein."}

^{After hours of procedural delays forced by the minority, Majority Leader Steny Hoyer [D-Md.] began the final stage of the debate with an appeal to rise above the insults. "We have seen angry people at the doorstep of the Capitol," he said. The angry people were closer than Hoyer realized. Rep. Mike Rogers [R-Mich.] hollered on the floor about "dirty deal after dirty deal." Rep. Devin Nunes [R-Calif.] likened the Democrats to Soviets. "Say no to totalitarianism!" he said. Somebody in the Republican seats shouted "Baby killer" at Rep. Bart Stupak [D-Mich.], an antiabortion Democrat.}

^{The legislators were making such a ruckus on the floor that they couldn’t hear the ruckus just outside their walls. The tea-party demonstrators chanted "Nancy! Nancy!" and held signs saying such things as "Red Queen Nancy – Joseph Stalin Was Not a Saint"…}

^{By the time Minority Leader John Boehner took the floor at about 10 pm, the mood on the floor was barely distinguishable from the mood on the lawn outside. "Shame on each and every one of you," the Republican leader yelled at the Democrats, as the GOP lawmakers gave him a standing ovation. Boehner said the Democrats were a "disgrace" to Jeffersonian values. Hell, no, you can’t!" Boehner shouted at the Democrats. "No, you can’t! No, you can’t!" echoed the protesters outside.}

^{But they could. And at 10:45 p.m., after 14 months of trying, 219 Democrats finally did.}

It’s dangerous to make analogies to the past – to distort the meanings, to borrow the slogans and the spirit while losing the essence of things. Certainly, the irony of John Lewis of Bloody Sunday [Selma Alabama, 1965] marching with Congressional leaders armed with a gavel to the Capital building isn’t lost on any of us. But there were other things from history: the Boston Tea Party, "don’t tread on me," communism, fascism, Joseph Stalin, totalitarianism. One almost expected to hear someone shouting "54º40′ or fight" or "Tippecanoe and Tyler too." And there were some not so savory epithets from our past as well: "Nigger," "Faggot," "Commie."

And as much as I might like to characterize what’s going on in the world of medical finance as being about "rights," I personally think it is really about how a heterogeneous, free market, capitalistic society  deals with exceptions – things that don’t fit the model. On the left, we like to talk about people who can’t get medical care. On the right, they like to talk about people who won’t do what it takes to assure their care. Victims or freeloaders. While there are plenty of both, it doesn’t even matter. What’s wrong with American Medicine is that a lot of people figured out that if you treated medicine like a business, you could make a whole lot of money. It happened in my medical lifetime and they sure made their ton of bucks, but they crashed the system in the process.

All of this is about people being taken care of when they can’t take care of themselves. When I went to Medical School, our training was mostly in a big Charity Hospital maintained by the City of Memphis – all comers welcome – or the Veterans Hospital – all vets allowed. That hospital is gone now, been gone for years. I went from there to a military overseas base hospital where the credential for care was simply being on the base. After that, there was another training program at another Charity Hospital that still stands, but has been poised on the edge of being bankrupt for years. So I didn’t fully live in the world of private medicine until I was in my middle forties, but I’ve been close enough to see medicine change dramatically during my time in grade. Places like John Gaston in Memphis, Grady in Atlanta, Charity in New Orleans, Bellvue in New York [wondrous places all] have gone to seed. And the privatization of public medicine just hasn’t worked for a lot of reasons.

I have a simplistic view of why it’s such a mess. The model of consumer/seller just doesn’t fit. No one wants to be sick or knows when it might happen. No-one wants to pay the medical bills for others, much less their own. Illness can’t really be planned for as an individual. And the Insurance Companies, Hospital Corporations, Pharmaceutical Manufacturers are in it for profit – by definition. So the seller can restrict access, price as they wish, but the consumer is in no position to "shop." And they shouldn’t be in that position. There’s no way from the outside to tell the difference between good care and glitz. There’s often no way to predict the need for medical care in advance either. Most basic medical care is nearly generic. The labels don’t really matter that much. You don’t need serial MRI’s for a broken bone. You need an x-ray and a trained professional who knows what to do. Most of those "ask your doctor if ____ is right for you" ads on television are for very expensive drugs that are no more effective that their simpler counterparts. Nowadays, a big piece of the cost of medicine is just plain fee churning, profiteering – in insurance costs, in legal protection from malpractice suits, in medical equipment, in medical billing, in drug costs. Medical care actually should be collective, should be socialized, should be managed outside of our economic model. It’s an exception. It always has been. That’s what government is actually for – dealing with things that individuals can’t do for themselves.