We Won! (For the Time Being)

Last night, the Democratic Party won it's fight to reform health insurance. You'd think it was over, but it's not. The Republicans have sworn to repeal this legislation.

So, first, there will be another endless round of parliamentary maneuvers in the Senate to delay passage of the budget reconciliation bill. That will eventually fail, but in the meantime the Democrats will go through another round of shooting themselves in the foot by arguing over the bill.

Then comes the November congressional elections. At this point, the whole electorate will be fed up with the whole thing. This, however, won't stop the Republicans from lying about something else and continuing to stir up the pot. If the Democrats play true to form, they won't anticipate what the Republicans are going to do and will get caught flatfooted. They'll have to say such things as, "No the new health plan won't require you to get your nose pierced," while Fox News will swear up and down that it does. So, here's what I recommend:

• First, by the November, some of the provisions will be in place. Democrats should spend the next seven months all over the news showing people what is really happening. Point out that if you like your insurance, nothing's changed. Point out that people in the high risk group have finally gotten insurance and can breathe easier.
  

• Second, the Democrats should immediately and loudly and repeatedly portray Republicans as people who are perfectly happy with millions of Americans being without insurance. Put the Republicans on the defense for a change.
  

• Third, don't throw numbers like "40 million" around. Instead say, "one in six Americans are without health insurance." Think about what that means the next time you're in McDonald's.

• Finally, make them out to be the obstructionist, sore losers they are.
  

Make the debate about the Republicans and you'll win in November. Make it about health insurance and you'll lose to their next round of lies.

Health Care Hangs in the Balance

Well, here we are again, wondering what will happen to health care reform. It is amazing that we're still watching the Democrats fumbling around when there is a clear path to success.

Before Howard Dean took over as chair of the Democratic party, I used to say that Republicans are a bunch of vicious hypocrites and Democrats are a bunch of fumbling incompetents. Then Dean launched his 50-state strategy. I watched Obama run a great campaign and the Democrats in congress got majorities in both chambers. So I stopped saying it. Unfortunately, now that Dean has completed his tenure, the Democrats went back to their old ways.

So, in the hope that Democrats still have some potential, here's my message to those of them who are still on the fence about health care:

• This is why you became a Democrat. Democrats believe in the ability to government to help people. Democrats believe that government should help everyone, not just the wealthy. Here's your chance to act like a Democrat.
  

• Failing to pass health care reform will make you look inept. That's what the Republicans are counting on. Don't worry about people voting against you for passing health reform. They didn't vote for you in the last election. Worry about people who will vote against you for your legislative incompetence.

• You'll show Republicans they can lie and get away with it. Do you think they'll stop lying if health care reform goes away? NO, YOU IDIOT!! THEY'LL SEE LYING WORKED AND LIE MORE!!

• Don't be afraid of Republican lies. They lie because the facts are against them. Otherwise, they wouldn't have to lie. Don't be afraid to call out the Republicans on the their lies and don't be afraid to answer their lies with the facts. Just learn to make the facts understandable. Say it over and over and people will get it.
  

• I promise I'll vote for you if you support health care. I know I'll regret this, but I mean it. I dislike both my senators (Specter and Casey) immensely. But I'll vote for them in the primary and general elections if they can deliver on health care. Screw this up, and I'll vote for Felix the Cat first. This is especially true for you, Bob Casey, if you get sucked into the anti-abortion mess.

• The Senate bill is imperfect but it is still better than nothing. I'd be happy to see the public option in there. Hell, I'd like to see a single payer system, but I know it can't happen in the US. But since you can't make a perfect bill now, this will do. You can make the system better in the future, even without a single payer system, and maybe without a public option.
  

• Don't be afraid to use the budget reconciliation process. The Republicans used it to pass their tax cuts for the wealthy. You can use it, too. Make the Senate bill better with it. The fact that Republicans are yelling (and lying) so hard about it tells me they're scared. GO FOR IT.
  

• Don't worry about Republican hand wringing over the deficit. Instead, counterattack. It was Republicans who ran up the deficit with unwise tax cuts and two unfunded wars. They were the ones that created the economic mess we're in with their opposition to effective regulation of Wall Street. Economists will tell you that the deficit is not out of control, especially because interest rates are so low. Answer Republican lies with the facts.

• Health care reform is good for the economy. From reducing lost wages to reducing illness-related bankruptcies, better and more affordable health care is good for the economy. More affordable health care means more small business start-ups. Small business almost always fuels economic recoveries.
  

• Don't be afraid of a Republican filibuster on this or any other bill. Make the Republicans do it. Let voters see the spectacle of them staying up all night holding up the work of the Senate.

• Stop trying to get a bipartisan bill. In AA, they define insanity as doing the same thing over and over again and expecting different results. Get some sanity. The Republicans aren't going to help you.
  

And pass the damned bill!

Is Health Care Reform Going to Fail Again?

I've been watching the debate over health care reform and I'm losing hope that it will happen. People of good will can disagree about the best way to deliver health care to all Americans. But, we're not seeing that. Instead, the debate is about nonsense. Things like:

• You're going to substitute socialized medicine for my Medicare! (No, Medicare IS socialized medicine and nobody is trying to mess with it.)

• You're going to make health care elitist, so only the wealthy will have good health care! (No, the way it is now, only the better off can get good health care. Obama wants to make it less elitist.)

• The government will withhold health care and let old people die! (No, nobody has proposed that and nobody would tolerate that.)

• An anonymous bureaucrat will control my health care! (What do you think is happening now? With public health care, you can write to your congressman. Under the current system, you get to write to the company that denied you coverage.)

• It's going to be too expensive! (No, doing nothing is too expensive. Nobody has argued with President Obama's point at his last press conference, that doing nothing will double our health care costs in ten years, while further reducing the number of people covered.)

• I won't have the freedom to choose my health plan! (You don't have that freedom now. Your employer selects the plans you get to choose from. If you're lucky, the plan you can afford is adequate. If we have a "public option," that plan will be available to everybody, actually increasing choice.)

• I won't have the freedom to choose my doctor! (The way it is now, you have to choose a doctor who takes your plan. If your employer decides to change your plan, you might have to change doctors. That won't change unless regulations require insurance companies to accept all willing providers. Fat chance.)

• I won't be able to keep my current plan! (Yes, you will. There is nothing in any of the current proposals to keep you from doing that.)

• I'll be forced to buy insurance when I don't want it. I should have the right to go without insurance! (No, we're all in this together. You never know when you'll fall down the steps, get bitten by a mosquito carrying Lyme disease, or be diagnosed with cancer. Just like with car insurance, you pay into the system so you can get the benefits when you need them.)
  

The health insurance companies like the system the way it is. They're making money hand over fist. They don't want any changes and they are throwing money at both parties (1.4 million dollars a day!) to defeat reform.
Worse yet, the Republican Party has decided that defeating Obama is more important than helping US citizens. They have been actively feeding this nonsense through their usual media outlets. They ought to be ashamed of their lies, but I don't think they have the moral fiber.
There is no reason we should be holding to the current system. It's a social and economic mess. People are going bankrupt with medical bills, while others have no coverage at all and only get treatment at an emergency room when they are really sick. Furthermore, we cannot compete internationally if we continue to throw good money after bad for health care.
Every other western nation has managed to provide health care for all its people. Why can't we? There's only one reason we can't: We've got Republicans and they don't.
Blue Dog Democrats are bad enough, but at least they're willing to vote for something. If health care reform fails it will be on the Republicans, and they will happily take the credit. But, while they are celebrating, they should know there will be a lot of us who will remember what they did.
I guarantee you, if health care reform fails, the only time I'm going to vote Republican is for dog catcher. Then I'll get the meanest, nastiest dog I can find and set it loose.

JND in Top 100 Mental Health and Psychology Blogs

Just Noticeable Differences has been mentioned in the Top 100 Mental Health and Psychology Blogs. It is an interesting site, and I found some good stuff there. I appreciate the mention, especially when I haven't blogged since May. My goal this year was to blog weekly, and I haven't come close.

I have been extremely busy. Work has gotten chaotic and I have been spending all my free time at home either working on the house or, more often, writing reports. After you've spent several hours on a weekend writing such deathless prose as, "On examination, Mr. Johnson was alert and oriented in three spheres," blogging isn't high on the list.

There are several reasons work has gotten chaotic. First, as I've said elsewhere, fees for psychotherapy services are static. I will get a 3% raise soon, but with inflation about 5.6%, I will still still have to work more hours to stay even.

Making matters worse, there has been a lot of conflict in my office. I think it's due mismanagement, but hey, nobody listens to me, anyway. At this point, I'm so disgusted that I'd like to leave and restart my private practice. Unfortunately, I am the source of health insurance in my family and I would have to purchase insurance separately if I resigned. I calculate that if I and my wife were lucky enough to qualify for it, we would pay through the nose. There is also no guarantee that if we got sick and tried to use it we would be able to keep it. So, isn't this great? I get both ends of the health insurance mess at the same time.

I've learned one critical lesson from this. Republican opposition to national health insurance has nothing to do with taxes or small government or any other nonsense. Republicans oppose national health insurance because it makes employees more dependent on their employer. Because I can't just pick up and start a private practice, my employer has more control over me.

Like many Republican policies, this is at best penny-wise and pound foolish. At worst, it is self defeating. Opposing national health insurance helps the large corporations, but it hurts the US economy. The lack of national health care almost certainly hinders small business formation. Small businesses are an important part of our economy. It is small businesses that bring innovation into the marketplace.

So, I'm watching the campaign very closely this year. Having a Republican in the White House will probably mean 4 more years of this nonsense. Unfortunately, Obama has apparently inherited the Dukakis strategists: McCain is beating up on him and he's on vacation.

Net Neutrality

A few years ago, an idea was floated by the large ISP's that they should be allowed to prioritize the access to different web sites. The initial plan was focused on providing faster access to users for a fee. While that idea sounds logical, the devil is in the details.

High volume users, such as Google, have objected strenuously. It will certainly make their operation more expensive, but more importantly, small content providers who rely on Google will be affected by it. After all, the little guys get their start blogging on Blogger and similar sites. It will be those users who will be affected by increased costs to Google and other providers like them. So, little guys like me could be forced off the net.

Now, I know that losing me wouldn't be a great loss. I'm not controversial and I don't blog much. But losing me, means that you could lose someone more important. Why not, for example, make life more difficult for Daily Kos (who just happens to be blogging on this on May 19, as I am)? This is something that we need to be very worried about. The New York Times, in an editorial today, commented that the ISP's

have realized that they could make a lot of money by charging some Web sites a premium to have their content delivered faster than that of other sites. Web sites relegated to Internet “slow lanes” would have trouble competing.

This sort of discrimination would interfere with innovation. Many major Web sites, like eBay or YouTube, might never have gotten past the start-up stage if their creators had been forced to pay to get their content through. Content discrimination would also allow I.S.P.’s to censor speech they do not like — something that has already begun. Last year, Verizon Wireless refused to allow Naral Pro-Choice America to send text messages over its network, reversing itself only after bad publicity.

So, there is a risk that non-neutral access to the web could result in limiting access to sites that express ideas the corporations don't want. Do you think that will be left-wing or right-wing ideas?

I'm going to share an idea that I've held for a long time. It's a little crackpot, but no one I've mentioned it to has been able to punch holes in it. As I look back over the last century, it seems to me that liberal/progressive ideas flowered at two times: the 1930's and the 1960's. I believe it happened because both eras were marked by inexpensive and decentralized media, allowing the left to reach its audience.

In the 1930's, there was excess printing capacity as newspapers and publishers failed during the Great Depression. Radio was a new medium and small radio stations slowly started up. During this period, the Socialist Party flourished. Labor unions started to take off. Roosevelt's New Deal was inked. But then, during World War II, small newspapers and radio stations fell by the wayside. Both the draft and the defense industries needed bodies, and small radio stations and newspapers were a luxury that couldn't be afforded. After World War II, the remaining radio stations and newspapers started folding into ever larger corporate bodies. Since corporations are politically conservative, outlets for left-wing messages were closed down. Not surprisingly then, the 1950's was a politically conservative era.

In the 1960's, new legislation and regulations readjusted the radio spectrum and required that AM radio receivers also receive FM. This allowed FM radio to come into its own. Small family-owned FM radio stations started gaining listeners. The stations found new content in the music and the left-wing politics of the times. As a result, people heard messages that they would otherwise have missed. Left-wing politics bloomed. But in the 1970's, corporations began buying the small stations, and with centralization, left-wing politics again fell by the wayside.

If I'm right, Ronald Reagan was the Teflon President, not because he was the Great Communicator, it was because he was the Only Communicator. George II similarly got a free ride until the internet really matured. He could hide the coffins coming back from Iraq from television. But now he can't stop pictures of the war from being posted on YouTube and things are looking bad for the Republican party.

The Republicans understand this dynamic. Previously, they make no effort to hide their view that Public Broadcasting is a left-wing voice. They've worked hard to harass public television and have tried repeatedly to shut it down. They have also worked hard to relax the rules against corporate ownership of multiple stations in the same market. With the development of the internet, of blogging, of podcasts, of YouTube, and so forth, communications are again being decentralized. If we, who consider ourselves liberal or progressive, want to keep our lines of communication open, we need the internet.

"Net neutrality" refers to protecting the internet from prioritized access. The Times editorial indicates that several net neutrality laws have been proposed to Congress, but they have gone nowhere. Why am I not surprised? The Republicans don't want net neutrality and the Democrats are too stupid to realize how important it is to them.

Learn more about net neutrality at Wikipedia and at Common Cause. There are petitions to sign at SavetheInternet.com or MoveOn.org.

Ford, Nixon, and the Decisions We Make

The death of President Gerald Ford has reopened an old debate: Should he have pardoned Nixon for the crimes he committed during the Watergate scandal? The debate has bubbled up in both the blogosphere and in the letters to the editor in most newspapers. It's not necessary for me to provide any links; the debate is everywhere. It got me thinking about decision-making and the guilt we have when our decisions go wrong.

Many of my clients come to me saying, "If only I had done X instead of Y, things would have been better." For example, "If I stayed with my old job, and not taken that new job, I wouldn't have been fired, and I'd be able to pay for my kid's college today. My kids are suffering from my bad decision."

In order to help my clients with their guilt, I teach them about the reality of decision-making. Ford's decision to pardon Nixon is an excellent example. To make the decision, Ford asked himself, "What are the most likely outcomes if I pardon Nixon, and what are the most likely outcomes if I don't? Which outcomes would serve the greater good?" Ford thought that pardoning Nixon would bring the Watergate scandal to a quick end. Nixon deserved to be punished, but resigning in disgrace was enough punishment for him. I'm sure he knew people would disagree with his decision, and that would have political consequences for him.

In contrast, Ford thought, if Nixon were to be prosecuted, the investigation, the trial, and the appeals would drag on for years. There was no guarantee that Nixon would have been convicted. This, too would have political consequences for the Republican Party. Or, if Nixon was convicted, would it be overturned on appeal? So, Ford decided to pardon Nixon, thinking this would serve the greater good.

Today, Ford's critics argue that the country needed Nixon to be tried for his crimes if the country to truly recover from Watergate. They argue that pardoning Nixon increased cynicism about government by showing the powerful were above the law. Some say that the more recent scandals stem from that cynicism. They conclude that all the problems Ford was concerned about were worth it for the country to heal.

The old admonition, "Hindsight is 20-20," is relevant here. But, even in hindsight, notice that time only goes forward. There is no way for us to go back again, and find out what would have happened if Ford hadn't pardoned Nixon. So, we don't really know "what would have happened if...."

Imagine this scenario: Ford doesn't pardon Nixon. There's a long, drawn out, O. J. Simpson-esque trial, and Nixon is found guilty. He appeals, and his conviction is overturned because the jury wasn't impartial. The prosecutor, knowing a lost cause when he sees it, doesn't try Nixon again. How much cynicism would that engender? What would happen then?

At this point in the scenario, I'm overwhelmed by the possibilities. It's impossible to know what would happen next, especially as we become more removed from the original choice. Each choice opens up new choices and new possible outcomes.

OK, so we never have any way of knowing "What would happen if...." Does that mean we can't evaluate our decisions at all? Is there anything like a good or bad decision? Is this another fuzzy-headed liberal way of avoiding consequences? No. We can evaluate our decisions, but we have to change the way we look at them.

First, let me summarize:

1. When me make decisions, we are guessing about future outcomes. We cannot know how every possible decision might turn out.

2. We can never know what would have happened if we made a different choice.

3. All we can ever know is how our choices have affected us and are affecting us. Tomorrow, things might change completely.

4. Past choices continue to affect us. They open up some choices to us and limit others.

It is therefore unrealistic to evaluate a decision as "good" or "bad". Choices don't "work out." Instead, they put us on paths. Those paths may take us to places that are more or less desirable, but until we die, those paths don't end. Instead of asking, "Did I make a good decision?" I should instead ask:

1. Did I make the decision well? Did I consider a range of possible alternatives, consider my values, consult others, and think through my decision carefully? Or, did I just jump into it without any forethought?

2. Am I happy with the path I'm on as a result of my decisions?

Notice the implications here. We can make a decision carefully, and be unhappy with where it took us. In the same way, we can make a decision impulsively, and it takes us to some very good places. Overall, though, if we make our decisions carefully, we have a better chance at being happy with the path we take.

So, when my clients ask, "How could I have been so stupid as to do that?" I teach them it's OK to say, "It seemed like a good idea at the time." Because time only goes forward, we can't go back and change our decisions. However, we can always make more decisions and find better paths for our lives.

President Ford made a decision which may have cost him the presidency. That path must have been a difficult path for him. Personally, I agreed with the choice he made, although for other reasons, I voted against him. I respect him deeply, though. Despite pardoning Nixon, Ford still restored confidence in the presidency. He did it by making other choices throughout his presidency. I'm going to miss him. After the mess Bush has made, we desperately need another Gerald Ford.

Distrusting Experts

Judith Warner has had two recent posts (the first here and the second here) in her New York Times blog, Domestic Disturbances, reporting on studues on overscheduling children. In her second post, she states,

When I first read about Mahoney’s study, in Newsweek and then in the Boston Globe, I slipped the stories into a file folder I’ve kept in my office for some time now, labeled “Meaningless Social Science.” Mostly, it is filled with studies on day care. You know the kind: Day Care Causes Aggression, followed two weeks later by Day Care Causes Tooth Decay, followed two weeks later by Day Care Does Nothing Much at all.

This fall brought a wide variety of new entries: Time magazine had a story on whether TV causes autism, while Child had one saying that – contrary to popular belief – TV doesn’t cause attention deficit disorder. The American Educator had an interview with a cognitive scientist debunking everything other scientists have told us is true about left/right and girl/boy brain-based learning styles.

Reading these stories together, and bearing in mind all the contradictory “scientific” studies I have read over time about all kinds of aspects of childhood, motherhood and the interaction of the two, I thought: all these earnest, tightly structured, controlled, peer-reviewed, gleamingly scientific studies don’t have much meaning. Not individually, not reliably, for what they say (or dispute) about TV or A.D.D. or boy/girl cognition or after-school activities.

One commenter to her blog also made a sneering reference to "experts." Since, I guess I'm an expert, I take offense to all this.

It bothers me that the term "expert" has become a synonym for "fool." There has always been an anti-intellectual trend in America, and attacks on expertise (and, by extension, scientists) are a classic part of anti-intellectualism. These attacks seem to become particularly nasty during political eras dominated by demagogues. The McCarthy era of the 1950's was one example. Today is most certainly another. Why? That brings me to my main point.

In one sentence: Reality is not simple. Experts know this; most people don't want to believe it. They want good and bad to be be clear. If you do these things, you're a good parent; if you do this you're a bad parent. We are the good guys; they are the bad guys. My religion is good; your religion is bad. Demagogues play on this desire for simplicity. Unfortunately, if social science has taught us anything, it's that almost everything is open to qualification.

For example, we all agree that divorce is undesirable. Right-wing demagogues often decry the high divorce rate and declare that we have to go back to the good old days and make divorce harder. That way, people will just stay in their marriages, work harder at them, and everything will be fine. A nice, simple solution. But then the scientist says,

"Wait a minute. That nice simple solution won't work. Marriages are more complicated than that." Then the research starts to unfold, yielding complicated, conflicting results, raising more complicated questions:

Yes, children from divorced families are often more depressed and anxious than children from intact households. Hey, but some children do better after divorce when there's a lot of conflict prior to the divorce. But, wait a minute, how do you define conflict? How much is too much conflict? How about the ages of the children at the time of the divorce, how does that affect how well they do? And don't forget about the socioeconomic status of the parents.

All of this challenges the nice, tidy solution of the demagogue. So, it's not surprising that demagogues attack expertise. Today, they have so many outlets on radio, television, and the internet, that their ideas have wide distribution, and it's hard not to be influenced by it. But if you distrust experts, ask yourself this: Who do you want to design a bridge? Who do you want to operate on your heart? Who do you turn to if you're getting depressed?

In the social sciences, experts can inform and make recommendations about social policy and about personal choices. The data is always sloppy and conflicting because research is conducted at the fringes of our knowlege. The perfect answer is never clear. People read stories about the conflicting research in magazines and newspapers and become confused. How does one decide what to do when the experts don't know? This is when they often turn to demagogues and anti-intellectualism. But, those answers are the worst answers.

My answer to this problem is simple: Consider the data. Look in your heart. Then make the best decision you can. That's good enough.