Universal Healthcare: no magical solution

If those of us who participated in the Salisbury Forum discussion of healthcare challenges at The Hotchkiss School Friday evening expected explicit answers, we were disappointed. Dr. David Callahan outlined many of the contradictions that now block the way to universal coverage, but he suggested no magical way of overcoming them. There isn’t any.

What Dr. Callahan did was to outline the dilemma. The cost of care is rising far faster than incomes. Expectations increase with each new scientific discovery. Life expectancy has increased dramatically over the last half century. Many of us oldsters would long since already have fallen victim to disease or other ailments only a few years back. The longer we live, the more burden we place upon the social welfare system. In many instances we have taken out far more in benefits than we have contributed to Medicare.

The fearsome word “rationing� comes into consideration. More than likely, we would have to devise a system whereby eligibility for certain very costly procedures would end at, say, age 80. If a more elderly patient wanted, say, an organ transplant, he or she could still make private arrangements, but the government would not pay for the procedure. You or I might not like such a draconian rule, but it would the fairest way if cost were a major factor.

For my part I do not expect the insurance companies to devise a system that would truly encompass everyone. Understandably, they are profit-oriented. I believe the government must be involved in setting the basic rules and making coverage mandatory for every child and adult. We can argue from now until doomsday about the best means of bringing this about — through use of existing systems or through a single-payer system as I would infinitely prefer. But whatever is done or not done ought to be through thoughtful decision making and not a nostrum to be batted back and forth like a tennis ball.

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Would this be a productive assignment for Hillary Clinton? Through what can only be described as insufferable arrogance, she made an ungodly botch of the healthcare presentation to Congress during her husband’s first adminstration. Carl Bernstein’s admirable biography, “A Woman in Charge,� makes clear that her own rigidity was virtually as responsible as Bill Clinton’s uncontrolled tomcatting for the inglorious end of his administration. But in her two terms as junior U.S. senator from New York she plainly has learned a great deal and she might welcome an assignment on an issue about which she cares a great deal. She is a woman of formidable strengths.

But the notion that she would bring strength to the Democratic ticket as Barack Obama’s running mate is only superficially attractive. Obama needs to be able to chart his own way unencumbered by other obligations. And then there would be the matter of what to do with the hovering presence of Bill Clinton. What if, say, she were made secretary of health and he the representative to the United Nations? Or she might prefer to concentrate on becoming a major force in the Senate in the manner of a Ted Kennedy or Robert Byrd. But in my view she should not even think of being a replacement for the contemptible Dick Cheney.  

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It is always nice to think of our national officers as pleasant, likable persons. But being likable is not the criterion; being respected is. Franklin and Theodore Roosevelt enjoyed adulation, but their inner toughness is what made them effective. Abraham Lincoln was perhaps the most soulful of our presidents, but it was a hard core of steely resolve that saw him through the immense tribulations of the Civil War. Barack Obama, in my opinion, has engaged in some unnecessary pandering to the Israeli lobby in emphasizing the strength of American ties with Israel; he would have improved his stature if he had emphasized the necessity for both sides in the Israeli-Palestinian conflict to make hard choices for peace. That went for Hillary too.

In fact, I could wish for Obama and for his now election opponent John McCain to have a blessed surcease, a temporary immunity from being badgered for comments while they had a chance to think out their positions and their strategies.  Of course, it’s not likely to happen, but the country might be better off if it did.

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You can see it in the drivers’ eyes. They have no intention of slowing down as they speed through the Salisbury business section on U.S. 44, and if something or someone gets in their way, well, too bad. After nearly being creamed several times recently in the supposedly protected zebra crosswalk at the Salisbury post office, I am sensitive on the subject. I recall that several years ago a friend was struck, knocked down and seriously injured by a car the driver of which did not respect her right of way. What made matters worse was the seemingly cavalier attitude of the prosecution and the court. The offender, as I recall, was fined but served no jail time.

With the increased truck traffic on Route 44, I think there needs to be a more effective deterrent. The mobile speed indicator placed at various points along the way slows down those who pay attention to the speed limit, but it has little or no effect with the speed demons. I would like a camera to be mounted on a utility pole at each end of the congested areas in Salisbury and Lakeville, with a warning to drivers that photographs were being taken spasmodically. The license tag number of speeding vehicles would be photographed along with their speed as evidence for a husky fine and there could be no argument.