Saturday, July 25, 2009

Rabbi Michael Lerner Criticizes Obamacare, Confronts Serious Medicine--The Issue is Tangibility

"Why Can't Obama Convince the Dems?"--that's the pointed question about Obamacare posed by Rabbi Michael Lerner, for Tikkun. Lerner is an old-line leftist, albeit with a thoughtful spiritual bent. And so his answer to Obama is to couch a leftward lurch toward a single-payer plan in heal-the-world communitarian language. Advises Lerner: "Obama should rename 'single payer' the 'solidarity and caring for-each-other health care plan.'"

OK, we'll see how that prescription goes over. Obamacare was in trouble, even before the presidential detour into racially charged politics, for the simple reason that under Article I of the Constitution, Congress has more power than the Executive Branch; and so if Obama can't convince Democratic senators, such as Max Baucus, Kent Conrad, and Mary Landrieu to sign on to "single payer," well, that's that.

As noted in yesterday's posts about Mary Berry and Daily Kos, the problem with the soft liberalism of Obamacare is that it doesn't seem compelling to ordinary people--unless, of course, they read the fine print --in which case, they get scared. By contrast, the lefty single payer advocates, such as Lerner, do get genuinely excited over a Euro-style health care plan. Their problem is that they are in the minority.

The challenge that "health care" experts face is tangibilization--can you feel it? Can you taste it? Obama people could feel it and taste it during the 2007-8 campaigns against Hillary Clinton and John McCain, but not enough of 'em get worked up over Obamacare. And unfortunately for Lerner & Co., most people, vaguely in the middle, don't get worked up over an American NHS.

Indeed, ordinary people have a different set of preferences. For most folks, "medicine" is about getting results: you get sick, you go to the doctor, and you get better. (And on the doctor/caregiver side, the same thing: the patient comes to you, and you help him or her.)

And for many people, "health" has the same bottom-line orientation: You take care of yourself, eat right, exercise, etc., and you are healthier as a result. In both situations, medicine and health, there's a simple (or at least presumed) cause-and-effect.

But in the case of "health care," a curious kind of abstraction settles in. The government is neither the care-receiver nor the care-giver. Instead, the state is an intermediary, a financier--and maybe a ration-er. That's a scary prospect to many, and at best an uninspiring concept to many more.

What is popular is government-funded medical research--just about everyone thinks that that is a good idea. Such research is popular because it's tangible: It has the benefit of human interest, and quite possibly intense personal interest--for those who have the condition being researched, or know someone who has it, or think that they might get it. (As we can see, the constituency for medical research quickly hits nearly 100 percent of the population.)

If Obama had been talking about curing cancer, or curing Alzheimer's, he would be winning, not losing. Again, the issue is tangibility. As an aside, Education Secretary Arne Duncan shows that he has a sure grasp of this tangibility concept. He has an op-ed in The Washington Post this morning under this headline "Education Reform's Moon Shot." The "moon shot" analogy, of course, hearkens back to one of the greatest successes of Big Government operating in tandem with Big Science: the Apollo program, which took Americans to the moon in 1969, just seven years after John F. Kennedy promised that we would do just that. A promise to put a man on the moon is, above all else, tangible. And that's the point: If it's tangible, and if it's backed up with credibility, people might decide that they like the idea. By contrast, people rarely feel affection or warmth for intangibles. There's no guarantee that Duncan will succeed--plenty have failed before him--of course, in which case, he might some day regret ever having made the promise in the first place. But at least for now, we can admire Duncan's ambition, and hope that he succeeds, for the sake of all of us.

In the meantime, speaking of Serious Medicine, I see on the Tikkun site that Rabbi Lerner has been suffering from cancer. My best to him, of course, but a look at his personal health-related diary-blog shows an extraordinary attention to medical detail. Lerner could write a book about his cancer and treatment--maybe he will. And such a book would certainly be be interesting to a larger audience, because it's a real life story; all of us could think, "There but for the grace of God go I."

That's the point about Serious Medicine; it's about real life. Here's Lerner's latest entry:

The CT scan at UCSF of my lung shows that the cancer has been removed and whatever remains at a microscopic level has not yet returned in full force and may never do so! So, each six months I'll have a follow up scan, but right now, I'm as Debora puts it "squeaky clean." Ditto, the removal of the pre-cancerous tumor in my duodenum has been completed successfully and no further treatment is needed inthe foreseeable future except regular endoscopies and colonoscopies. Ditto, the anemia has been dramatically reduced!

The only sore spot, so to speak, is the enlarged prostate and PSA of 5.2, which my urologist is treating with the anti-biotic Cipro at the moment, but, if it stays way above the normal "1" level, will requirea biopsy sometime after September.

Again, we wish Rabbi Lerner a full recovery and the best of health, even as we note the Serious Medicine--not a shuffle in health care financing, and certainly not rationing--that it will take to make him well and keep him well.

He's worth it, and so are the rest of us.

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