Just as aside

I just wanted to say that though I was disappointed with the limited vision of Samantha Power in that Colbert interview, I want someone with that kind of passion for doing good in the world and with that kind of honesty in her words and her feelings on my side in a policy discussion.

I just want her to think bigger than the circumstances, at hand. And not get lost in politics like it means more than it does.

Solving problems like the genocide in Sudan and the mess in Iraq mean an awful lot.

And I, for one, would want Samantha Power right by my side while we worked on it.

What we need is an open, no-holds-barred discussion

Perhaps Brzezinski is right. It is possible that a pullout, with coordination with those responsible for security, might work.

I don't know, is the truth.

What we need is a free, open, no-holds-barred discussion, especially with the American and Iraq troops responsible for security and the Iraqi political leaders responsible for political resolution of outstanding issues, about what should be done.

When you look at that Iraqi situation - the civil war and its relationship to the issues of power in the Iraq parliament - the problem of power and its distorting, and intentionally manipulative consequence, on resolution of important issues becomes all the more crystal clear. Radicals and terrorists and despots of all stripes have figured out that they can use and manipulate the disagreements of otherwise good faith citizens of liberal democracies and illiberal nations and cultures, alike, and newly democratized countries, like Iraq, to try to accomplish self-centered or self-righteous political ends that, generally, undermine more decent aims for the people of those nations or cultures, and for all of us.

They fuck everything up and make it really difficult, often intentionally, to find more decent resolutions that they believe undermine their power and the self-righteous aims that feed their power.

Everyone should have their two cents. Though I will say that I, for one, will not be taking everyone's input as seriously as those who I trust, more, are on the up and up about looking out for the welfare of the Iraqis and the American soldiers trying to protect them, right now.

This is what we should have for all policy questions, if we weren't such fuckin' ninnies. But it is definitely what we need with something as serious and high stakes as this question of what to do with this situation.

All I know is that I'm tired of liberal democracies and liberal peoples acting like liberal values only matter in some fantasy world that only matters in the land of make believe because we're too fuckin' pussy to take those values seriously in this world. Surely we can do better than this.

But that's what we need.

Power

The more I think about it, the more I am completely convinced that the most serious problems we face in the 21st century are around the question of power. How is distorts, manipulates, undermines, and fucks up otherwise legitimate and decent efforts.

On so many questions - war and peace, international security, law and order, criminal and civil justice, the economy, wealth equity, universal health insurance, education, psychology and individual and general mental health, language, communication, and honest discussion, race and gender issues, sexuality, even medical issues and the sciences - power undermines honest thought, discussion, and debate and honest resolution of long-standing issues.

It's not just that power corrupts. It confuses us. All of us. It makes everything hazy. And we all have to pretend like it's all so much clearer or that we understand it all more than any of us actually really do. It creates all sorts of tragedy with many of left with so many questions about whether such tragedy is really worthwhile, largely because it does so before a more open and honest and decent discussion can sort such matters out, which is exactly what ends up more genuinely sorting those matters out, over time, only after much distortion and confusion created by resorting to power to try to resolve the same problems.

It creates an environment of fear that is generally far worse than the original vices or problems it is meant to resolve. It is bad for everyone and their mental health as well as substantively making it more difficult, often to sort out and resolve problems. It makes bad choices and routes all the more tempting. It causes all kinds of tragedies and then doubles up to make it very difficult for those responsible for those tragedies to apologize or take responsibility.

It distorts our lives with fear and ugliness that then reifies itself as the reason for our need for it.

Power fucks us up in very serious ways, is the truth. And then it pretends that it is the fucked up nature of a world that it often creates is all the more reason we need it. It is like an abusive husband rationalizing his relationship with us. And we are gullible wives to its rationalizations.

And it is never satisfied until is has trapped all of us in its clutches, and even then it is never satisfied. And that is why it corrupts, and why absolute versions of it corrupt absolutely.

Because it often creates and amplifies the very fear that makes it hard for those who covet it to sleep without it.

Power fucks us up. All of us. And it has my soul sick with despair that we will never give it up.

And the only reality that gives me hope is that we always seem to fumble forward. Always. Even when we move backwards, as I believe we have in the last 7-8 years. Even as we fuck up our own and one anothers' lives with it. Even as we make it very, very difficult for people of good faith to believe in the world and the liberal democracies where it is still coveted so much.

Hope lies in the fact that we always fumble forward, eventually, even as we cling to the ugliness and abuses and bullshit - the power - for far too long.

That hope needs to become reality for even hope to be real. Perhaps even I, as well as my children, might be able to see that come to fruition.

What to do about universal health care

Regina Herzlinger, a professor of business administration at the Harvard Business School, has a proposal for universal health insurance that gets closer to a real solution, I think.

America, Insure Thyself

Her argument in toto:

"As Hillary Clinton and Barack Obama continue their battle for the Democratic presidential nomination, they also sustain a debate over what constitutes universal health care. Obama says Clinton's 'mandated' health-care plan is unaffordable for working-class Americans; Clinton says Obama's voluntary plan would leave millions uninsured.

Yet both candidates agree that affordability relies on government and big employers' continued involvement in deciding what kinds of products and services insurers can offer consumers -- and that's their big mistake. Instead, the candidates should step back and embrace a new way of thinking about health care: putting consumers first by empowering individuals to buy portable health coverage. Moving to a consumer-driven system will enable the universal coverage both candidates seek, because it will control costs and improve quality far better than governments or businesses can.

Since the 1970s, U.S. health-care financing has become increasingly centralized, with large employers and government programs now managing roughly 90 percent of spending. At the same time, health-care costs have routinely outstripped growth in GDP, wages and general inflation. The government's track record in picking winners and losers in health-care markets is terrible.

For example, Duke University Medical Center's innovative congestive heart failure program reduced costs by 40 percent by integrating the many providers needed to treat the disease and thus substantially improving patients' health. But Medicare pays only for fixed-price procedures, such as surgeries or doctor visits. The result? As Duke's enrollees became healthier and used hospitals less, Duke lost the revenues it once earned by filling those empty beds.One-size-fits-all payment systems used by massive buyers like Medicare help drive away the innovators who could lower health-care costs.

When it comes to embracing health-care innovation, however, Big Business fares no better than Big Government. In order for employers to get big discounts, they have to buy health care in bulk, offering just one or two basically identical plans to their employees. The result is consistent mediocrity. After all, how can Chrysler find a single health plan that works just as well for a 55-year-old diabetic with a bad back as it does for a 30-year-old triathlete who sees a doctor once every few years for a sprained ankle? Splitting the difference in these cases means that people do not get treated in the preventative or chronic-care settings that they really need.

Both Clinton and Obama support continuation of this dysfunctional model by leaving in place the existing employer tax deduction, and even offering additional federal spending to supplement it.

To expand health-care access and lower costs, our best option is to turn health-care purchasing over to the American people. Sectors driven by competition for consumer spending, like retail, display increasing specialization as providers offer niche products and services -- unlike our health-care sector, where, to paraphrase Henry Ford, you can have any plan you want as long as it's an HMO or a PPO.

Here's how to right the ship: First, as John McCain has proposed, end the employer tax deduction and give every American a tax credit to buy health care coverage -- in his proposal, $2,500 for individuals, $5,000 for families. This will almost instantly create an enormous 'pull' mechanism for insurance competition. Next, make even the sickest patients into true health-care consumers by paying insurers more for sick patients than healthy ones. About 80 percent of America's health-care spending goes toward 20 percent of the patients, typically those with one or more chronic diseases like diabetes or cancer. Giving a chronically ill patient the ability to choose among competing private plans would transform not only the insurance industry but also the health-care delivery sector, by spurring competition to offer better treatment models at an affordable price. People with congestive heart failure, for example, would favor health insurance policies that offered them an integrated care program, like Duke's, over ones that feature today's fragmented providers.

For an example of how universal, consumer-driven coverage can help control costs and improve quality, consider the system in Switzerland. Swiss employers enforce universal coverage by requiring individual employees to provide proof of health insurance; the poor and the sick are subsidized so that they can buy health insurance as readily as everybody else. The Swiss have excellent health status, at far lower costs than ours. Switzerland's health-care consumer satisfaction ratings are the best in the world.

In arguing the issues of universal coverage and affordability, Clinton and Obama rightly focus on the critical pieces of the health-care puzzle. But unless they address the question of consumer choice, their debate is much ado about nothing: We won't have truly universal health care until we have a mechanism to bring everyone into the system, and it won't be affordable until individuals and families can choose their own insurance coverage from competing insurers. Only consumer-driven health care will give entrepreneurs the flexibility to fashion a wide variety of appealing plans and services while allowing consumers to choose the most cost-effective coverage for themselves. Americans need and deserve a health-care system that is universal, affordable and innovative."

The logic of the Swiss system contradicts what I think is the sounder reasoning of Professor Herzlinger's proposal. But that is largely, I think, because Professor Herzlinger is holding a higher standard, as I do and as I think most Americans do and should, for what quality universal health insurance and access to health care should mean.

Professor Herzlinger's argument is exactly why I favor John McCain's health care proposal over what I do believe are the well intentioned proposals of both Barack Obama and Hillary Clinton, with my more marginal approval for Barack Obama's proposal.

I do think that we should seriously consider giving a free market with a democratic conversation about the need for universal health insurance and care a try, with a role for non-profits and voluntary giving to fill in gaps, and only mandated giving as a compromise in emergencies that cannot be handled any other way, and, perhaps, let some chips fall where they may. My thinking on mandates, at this point, is that they are generally counterproductive, even when they are understandable. A tax credit is certainly preferable to a mandate.

I think this is what has fucked up liberal democracies since their inception. Our lack of faith in our own values. Our lack of faith in liberty and democracy, for real, to help us help ourselves to solve even our most serious problems.

Me too, probably, when I think about it.

It would not just be nice for us to find and have that kind of faith. It would resolve many of our most serious challenges, especially the challenges of terrorism, despotism, totalitarianism and other forms of illiberalism that feed off of our lack of faith.

If I had only wish for my children, it would not be that they never experience hurt or pain, which is not possible. It would be that they are able to live in a world that stops taking seriously the legacies of fear and aggression to resolve our differences that have long dominated the world, and starts taking those liberal values seriously.