“"Multiple Fictions" Drive Opposition to Health Law - Brookings Institution” plus 1 more

"Multiple Fictions" Drive Opposition to Health Law - Brookings Institution

Posted: 18 Jan 2011 03:54 PM PST

While reading "A New Definition of Health Care Reform" by James C. Capretta and Tom Miller, I was reminded of the old adage "if one can frame the debate, one wins the debate."

The health reform debate, they say, is between those who would use government regulation to try to control growth of health care spending and those who would rely on cost-conscious consumers operating in a competitive market place. The right way to reform health care, they say, is not government regulation but rather by shifting to a defined-contribution system in which people would bear the full marginal costs of insurance they buy. Medicare beneficiaries and Medicaid recipients should be given vouchers for the purchase of health insurance. Employers should do the same with private employees. The recently enacted health reform legislation, they say, extends fee-for-service medicine. For that reason, it should be replaced.

This critique is based on multiple fictions—about what the Affordable Care Act does, about what any plausible alternative would do, and about what the real issues in the current debate really are.

First, the federal health law clearly moves the health care system in the very directions that Capretta and Miller urge—toward a defined contribution system.

• That is true for most of the 16 million people who would be covered through the newly created health insurance exchanges. Subsidized clients in the health insurance exchange will receive vouchers to reduce the net cost of a moderate health insurance plan to a fraction of their income. If people want more generous coverage, they will have to pay for it themselves. That is what defined-contribution coverage does.

• Medicaid also is moving fast away from fee-for-service care toward services provided by managed care organizations operating under negotiated contracts with states. That is how most of those newly covered by Medicaid will be served.

• The law will impose a modest tax on high-cost private health plans starting in 2018. This tax will discourage the provision of highly generous insurance plans that accommodate inefficient fee-for-service care.

Like Capretta and Miller, I wish that tax applied to more plans and started sooner. That it does not results from the refusal of Republicans in the course of the reform debate to do anything else than vote "no." The first president to embrace limits on the tax breaks for employer-financed health insurance was Ronald Reagan. Republicans have long embraced such reforms. Had they been true to their tradition and participated actively and constructively in this debate, as a previous generation of Republicans did in the debate leading up to the enactment of Medicare and Medicaid, and as Democrats did in the process leading up to the passage of the Medicare Modernization Act in 2003, there is little doubt that coverage of the tax on high-cost plans would have been broader and it would have started sooner.

The next fiction is the idea that there exists some market-based reform that would operate immaculately free of intrusive government regulation. If consumers are to exercise real leverage on insurance vendors, they have to understand the choices they face. That demands that the range of plans be limited to a manageable number, that marketing of insurance plans be highly regulated and that objective literature written in plain English must be available to customers. It also demands extensive risk adjustment of premiums and subsidies for those who cannot afford the full cost of health insurance. All of this will require heavy government involvement. Come to think of it, each of those steps is part of the health law. If a well-functioning private market place is what Capretta and Miller want, they should be celebrating the bill, not joining calls for its repeal.

No, the health reform debate is not about a fictional war between market-based health insurance and government regulation. It is about whether to provide adequate subsidies to cover the uninsured and whether to begin a process of leveraging change in the delivery and payment systems through which one-sixth of the U.S. economy is devoted to health care. Under this administration's leadership, the last Congress laboriously and narrowly pushed through legislation ending the crippling stasis that virtually all observers of the U.S. health care system deplore. Their handiwork is not perfect, nor can its full effects be anticipated. Further legislation will unquestionably be necessary—to fix provisions that don't work well and to deal with unanticipated consequences of the legislation. Making that legislation work as well as possible now and figuring out what legislation will make it work better in the future should occupy the nation now, rather than a sterile debate based on a false issue and misrepresentation.

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A 'Warrior Woman' Confronts Mortality, In Verse - NPR News

Posted: 20 Jan 2011 04:06 PM PST

Heard on Talk of the Nation

January 20, 2011 - NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan, in Washington.

Writer Maxine Hong Kingston has been looking back for a long time. In her seminal work, "The Woman Warrior," she reached back into her own family history and even further back, into the Chinese folk tales that permeated her childhood.

Her new book is also a memoir, but this time a gentler sort. It's told in free verse and describes a journey that begins on her 65th birthday. It crosses the boundaries of identity, age and culture to pursue what it means to age and what it means to be an elder.

Later in the hour, drug decriminalization in Portugal. After 10 years, did it work?

But first, writer Maxine Hong Kingston. If you, too, have accumulated what she describes as a wealth of time, we want to hear from you. Does age alone make you an elder? How do you know? 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our website. Go to npr.org and click on TALK OF THE NATION.

Maxine Hong Kingston's new book is called "I Love a Broad Margin to My Life," and she joins us from the studios at the University of California at Berkeley.

Nice to have you on the program today.

Ms. MAXINE HONG KINGSTON (Author, "I Love a Broad Margin to My Life"): Thank you. I'm glad to be here.

CONAN: As we said at the beginning, you've been looking back a long time. Is the view different each time you start?

Ms. KINGSTON: Oh, yes. I do feel different every time I start. And often, I - there is some traumatic event, or there are big feelings that I have. And then there's the need to find the words for them or to express them.

And so every time I start, it's a different time of life, and so there are different feelings.

CONAN: You started this particular journey at the age of 65. It's an age - sometimes people are surprised to find themselves 65 years old.

Ms. KINGSTON: Yes. And actually, at the moment, I am 70 years old. And when I was 65, I thought I'd better get a head start on this and start thinking about it and not be in denial and truly face time and aging, and how will I live the remaining years well.

CONAN: You say - it's interesting. The book is, in some ways, a meditation on age yet, not on mortality, really.

Ms. KINGSTON: Well, in a way, it is about mortality, because I ended with a list of my dead, and I - you know, that is something that's not easy to take at this time in one's life, because the friends and family are dying, and people who were your companions as you grew up and grew older, they are leaving life now.

And when my friends and beloved people leave, I feel a draw to go with them, and I want to be with them. And so I do look at mortality, and I think about the feeling of wanting to go with them.

So how do I stop from going with them? I need to think of reasons for staying here and taking up the responsibilities of who I am now.

CONAN: There's a line, you say, you quote Henry David Thoreau - indeed, your title from your book comes sort of from Thoreau. But that's another quote. You say he wanted to live deliberately. And you say I want to die deliberately.

Ms. KINGSTON: Yes.

CONAN: Some people might be alarmed at that.

Ms. KINGSTON: Yes. Oh, I don't think that's alarming. I think that that's very comforting, that we can even learn at the very last moments of our lives. I think of the Tibetan Buddhists, who have an ideal that they would die with their eyes open.

CONAN: Deliberately, in other words.

Ms. KINGSTON: Yeah, yeah. But, you know, it's from Thoreau that I got this line and the title of the book, "I Love a Broad Margin to My Life." And he was writing that and thinking it as he sat in his little house on Walden Pond.

And he was actually sitting on the threshold of the doorway, and he was enjoying having lots of time and lots of space. And he was listening to the birds and the bugs and the - mostly, the silence of the woods.

And then suddenly, he hears the sound of band music, the brass and the drums. And it's martial music. And he says: My neighbors are getting ready to go to war with Mexico.

And then that's when he decides he's not going to pay his taxes to support that war. And I - when Thoreau says I love a broad margin to my life, I also feel that he's talking about national borders, and he's thinking about wide borders.

And so when Thoreau talks about the war with Mexico, I see that as reverberating right into our present time. And we are continuing to draw that border or that margin with Mexico.

CONAN: We're talking with Maxine Hong Kingston, her new book. Well, she just told you the title: "I Love a Broad Margin to My Life." And we'd like to hear from those - the book is, to some degree, about age and becoming an elder. When do you know you're an elder? How did you know? 800-989-8255. Email: talk@npr.org.

And you wrote - you just said a moment ago, you wanted to find out who you were now. The traditional role of those who have gathered that wealth of time you write about is the elder. How do you become an elder in this society, and how do you know you're an elder?

Ms. KINGSTON: Oh, I think that, first of all, you have to have an idea that one can become an elder. I think most people are unconscious of that. And being an elder means that you take up the responsibility, the responsibilities for the world, for educating everybody around you, for being a leader and actually having lived right so that you have the wisdom and the ideas and the vision to make a good world.

The - I admire Martin Luther King, Jr. very much for his - for becoming an elder, even though he was only 39 years old. But he had the vision of the beautiful community, and he worked for that, to build that and to show everybody how that's possible.

Oh, one thing about being an elder or being an older person, I find that I have to find ways to keep my optimism and hope alive and up. I see optimism as being my health, and the - I can't keep going with my teaching and my creating of the beautiful community without optimism.

CONAN: Let's get a caller in on the conversation: 800-989-8255. Ruth is on the line from San Antonio.

RUTH (Caller): All right. Thank you, sir.

CONAN: And are you an elder, Ruth?

RUTH: Well, you tell me. I'm 96.

CONAN: Well, is being an elder just about age?

RUTH: I'm told now that I am an elder. But I wouldn't have known it otherwise, because the important thing is to function and not think of yourself. If you can help others, and if you can manage to get out or see the beautiful things in the world and the things that are interesting and the things even that are ugly so that perhaps you can help in some way to change that, then you're not old. And that is the important thing, not to think of oneself only, but to think of the people around you and what they can mean to society and how you can contribute your own, also.

CONAN: Maxine Hong Kingston, you were trying to get in there.

Ms. KINGSTON: Oh, Ruth, may I ask you a question?

RUTH: I think. Anything.

Ms. KINGSTON: There you are at 96 years old. Do you feel that you are the same person that you were when you were 12 or 20? Do you feel that you are the same person, essentially?

RUTH: Well, if you place it at about 16 or 18 rather than 10 or 12, where you're really hardly only in the process of formation, I would say yes. Ideals remain. Concepts remain. Attitudes towards people remain. The desire to help others is installed by then. Your relation to the universe by then is a little bit more established. And you can see things around you that are around you and not just focus on oneself.

CONAN: Ruth, thank you very much. Those are interesting thoughts. Appreciate it.

RUTH: You're quite welcome. Good luck.

CONAN: Thank you. We're talking with writer Maxine Hong Kingston about growing old and becoming an elder. When did you know you were an elder? How did you know? 800-989-8255. Email us: talk@npr.org.

Stay with us. I'm Neal Conan. It's the TALK OF THE NATION, from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION, from NPR News. I'm Neal Conan, in Washington.

With a mother and grandmother who lived to be 100, Maxine Hong Kingston sees her age not as 70, but as 30 years to go. We're talking with her this hour about her new book, "I Love a Broad Margin to My Life." You can read more about what she hopes to do with her time at our website. Just go to npr.org. Click on TALK OF THE NATION.

And we want to hear your story. When did you know you were an elder, and how did you know? Give us a call: 800-989-8255. Email us: talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

AND Let's see if we can go next to Jodi(ph), Jodi with us from Rockford, Illinois.

JODI (Caller): Hi.

CONAN: Hi, Jodi.

JODI: The first time I thought of myself as an elder - I am an RN, and I had taken a lot of advanced nursing classes. And I was teaching, and so I feel like people looked up to me as an elder.

But I think the real time I realized I was an elder was a few years ago, when my mom passed away, and my father had already passed away. So our generation was now the older generation.

CONAN: Mm-hmm. So you were something of the matriarch at that point.

JODI: Mm-hmm.

CONAN: And how did it change your view on the world?

JODI: It made me feel a lot older, for one thing.

(Soundbite of laughter)

JODI: But I kind of felt like I needed to take charge of my nieces and nephews, as my mom had, teaching them about life.

Ms. KINGSTON: You know, Jodi, I like that word that you used, that you realized that you were the matriarch. And I had that feeling, too, when my parents died. All of a sudden, I saw that I was the oldest one, and I'm the oldest one of all the siblings, and I am now the matriarch.

And then one of my first responsibilities as an elder, I thought, oh, I am going to - I'm in charge of Chinese New Years now. And I'm the one...

JODI: Well, and I think - I'm sorry. I didn't mean to interrupt. I think the other thing is I've always been the one that has been in charge of the genealogy in our family.

Ms. KINGSTON: Yes.

JODI: So I really felt a big responsibility to teach all the rest of the family who we were and where we came from.

Ms. KINGSTON: Oh, that's just great. Me, too. I'm also the one in charge of the genealogy and making sure that the stories of the past get passed on. And I think being an elder also means that we know history, and not just the history of our lifetime, but the more reading we do, it makes -when I know history that goes back to the beginnings of time, including anthropology, then I feel that I am very old, that I am centuries old, because I lived history.

JODI: I love history myself, and my mother, what I asked her to do for years and years and years was I bought her a tape recorder and I asked her tell - to tape all those stories that she remembered about the Depression and World War II and just anything she could think of so that that wouldn't pass with her passing.

Ms. KINGSTON: Oh, yeah, yeah. I did that, too. I got a tape recorder and put it in front of my mother when she was about 100, and what she said was: I'm going to sing you an opera that I heard when I was 12 years old. And she sang arias for an hour and a half.

JODI: Oh, my goodness. That's (unintelligible).

(Soundbite of laughter)

CONAN: Jodi, I hope you had equal fun with your mother's recordings.

JODI: Oh, I love it. And every time I look through my mother's things, I find something new that I didn't realize that she had given to me because she basically gave me her scrapbook, which is not really a scrapbook, but a box of just things that she'd saved over the years: newspaper clippings, you name it.

And it's just so special when I look through it, and I find something new and different. And I just feel a responsibility to let the next generation know about it.

CONAN: Jodi, thanks very much for the call. Appreciate it.

JODI: Thank you.

CONAN: Here's an email from Larry in Ponchatoula, Louisiana: You know you are an elder, he writes, when you have more doctors than you have friends.

(Soundbite of laughter)

Ms. KINGSTON: You know what? I don't think that that really defines an elder. I think that means older, but not elder.

CONAN: Well, it's interesting. You tackle aging head-on in this book. You admit, for instance, you hate how you look in a photograph. Is it hard to be honest about those things?

Ms. KINGSTON: No, no, no. It's not hard, to be honest. Maybe a little hard in that I was afraid I was coming across as vain and - when I asked: Am I pretty? And, you know, this does sound so vain, and perhaps I should get rid of that kind of vanity.

On the other hand, I am - oh, maybe what I am trying for is to find a new aesthetic and to find a way of looking at a face and a body and finding the beauty in wrinkles and in a different texture of skin and color of hair. Yeah, it's a matter of making a new aesthetic.

CONAN: Can I ask the same question you asked earlier? And that is: Are you the same person you were at 12, at 16, at 25?

Ms. KINGSTON: Yes. I feel that - I can feel an essential consciousness that's the same. But my body also feels the same. I just feel that I am the same person, and I even have intimations that I was this person during my last incarnation and the one before that.

CONAN: Let's see if we can get another caller on the line. Let's go next to Tim, and Tim's with us from San Jose.

TIM (Caller): Good morning.

CONAN: Hi, Tim.

TIM: My view is I'm 69, and in the last few years, I've noticed that I've started talking differently to younger people. And I get that partly because I felt that a lot of elders that I - or older people that I had talked to really didn't have any messages for me, and I sort of wanted messages.

So I'm deliberately forming some base of communicating and passing on the heritage that I've developed through my life. And also in that conversation and in those remarks that I make, I try to not just reflect on my perfections, but also my imperfections and the mistakes I've made and somehow that I got through them.

Ms. KINGSTON: Oh, I think that's great, Tim, taking on the responsibilities of an elder and finding a way to communicate with younger people.

TIM: Yes. I especially find college students that - I volunteer at San Jose State University with some college students, and they give me a lot, too. They give me hope, because sometimes, I read too much newspaper or listen to too much NPR, and I get sort of, you know, anxious about the future. And I say: Wow, I hate to leave. And I know I'm going to leave in a few years, and that makes me nervous that somehow the world hasn't moved on. But when I see these young people and I hear their hope and their dreams, and they appreciate what I'm doing for them, that really - it just really hits me right in my heart.

CONAN: Tim, thanks very much for the call, appreciate it.

TIM: You're welcome.

CONAN: Here's an email just on his point he mentioned a moment ago: It's my birthday today, writes Bird(ph) in Minneapolis. I'm 42, and I first felt elderly about 10 minutes ago, when I realized I'd been listening to NPR for seven hours straight.

(Soundbite of laughter)

Ms. KINGSTON: Happy birthday, Bird.

CONAN: I wanted to read this, though, from Edward in Albemarle County in Virginia. As a gay man, I knew I was an elder after confronting and continuing to confront the HIV-AIDS epidemic from the 1980s until now. The overbearing emphasis on youth and what is now in gay communities makes me an elder, because I can tell the stories of gay solidarity and fighting AIDS and fighting the (unintelligible) of discrimination that we faced through those decades. Being an elder in gay communities might be 40s or 50s or even 30s, because in all too short frame of reference that comes from emphasis on youth and the attractions and other powers of youth.

Let's go next to David, David with us San Antonio.

DAVID (Caller): Hello, sir.

CONAN: Hi. You're on the air. Go ahead, please.

DAVID: Thank you. I consider myself an elder, and others actually told me I was behaving in a way that was uncommon back in '94, when my 11-year-old daughter was murdered.

CONAN: I'm sorry to hear that.

DAVID: It's all right.

(Soundbite of laughter)

DAVID: And I had to go and explain to my family in Pennsylvania and friends here in town, that it's okay to let go. It's okay. That you have all the memories from the past but you can call them back anytime.

Ms. KINGSTON: Mm-hmm.

CONAN: As you know, David, some people in your situation might, well, harbor grudges and resentments.

(Soundbite of laughter)

DAVID: I understand. I understand. I went through that. I've had - I had - it's not to say that I wasn't mad or angry. But I was - it was very easy to forgive. And it made it easier for me to live at that point. And so that's what I would tell people.

Ms. KINGSTON: David, you're a real elder in that you have experienced life's worst hardships and came out of it with messages of wisdom and how to live. And so, you've been through - it's like going through hell and then making that journey and coming out of it with messages for humanity.

DAVID: When I was younger, I worked on an ambulance. And I've had - as we're transporting them or carrying them out of the house even, I've had people die in my hands and that was 17 - 16 and 17 years old. So, maybe it was from then. I don't know.

Ms. KINGSTON: Mm-hmm.

DAVID: But I don't plan on dying anytime soon. I'm 57 and I figure I'm going to live until at least sometime in the 2200s.

(Soundbite of laughter)

Ms. KINGSTON: Good.

CONAN: David, let us know how it works out.

(Soundbite of laughter)

DAVID: Well, stick around. I'll let you know.

CONAN: Thanks very much.

DAVID: Have a good day.

CONAN: Bye-bye. We're talking with Maxine Hong Kingston about her new book, "I Love a Broad Margin to My Life." And you're listening to TALK OF THE NATION from NPR News.

And this is an email from Steven. And he writes, now, at 71, I believe the way become - one becomes an elder isn't just through years but through awareness. First of all, when we were younger, recognizing those who are elders in our lives, seeing them as valuable and taking them as models for life when we become their ages. Then, when we do wake up in our elder years to accept the role of eldership seriously, and to be a conscious participant in our multigenerational world.

And Maxine Hong Kinston, I wanted to ask you. There's so much emphasis in our society, it seems sometimes...

Ms. KINGSTON: Mm-hmm.

CONAN: ...that retirement is a time to let go of responsibilities, to -and you say, no, no. It's a time to take them up.

Ms. KINGSTON: Well, so often, when we are working to make a living, we -that takes up all the time. And for people who have jobs that don't directly relate to their ideals or their - to their true values, when they're able to let go of that job working for money, then there's lots of time left over to volunteer, to work for the - for ideals and not have to make money at it. So it's really - the older - you know, when we're young, we learned that we have to existentially create our being. When we're older, we continue to existentially grow our elderly self.

CONAN: I also wanted to ask you, so much of your book has been about defining yourself as an American. And also...

Ms. KINGSTON: Mm-hmm.

CONAN: ...defining your background - of course, is Chinese - and your parents' background. You have grown up - they've came from a China that was desperately poor. And you have come to age in an era where China is one of the emerging powers of the world and a strong place. I wonder, how do you think they would have seen that?

Ms. KINGSTON: Oh, my parents?

CONAN: Yeah.

Ms. KINGSTON: I think that it's - they would have always remember our relatives, the - and the people that are peasants, the lowest, poorest peasants. I have cousins, right now, who farm with water buffalo. And I've been to those villages and people are very poor, even though they have more than they used to.

The - when you look at China as this economic giant, that is just - the top people are rich. You know, China is the separation between the rich and the poor. It's the greatest anywhere. Probably, the only other country that has such a difference between the rich and the poor is the U.S.

So I think that my family - they saw China go through communism and the culture revolution. And so, right now, it's just one more change.

CONAN: Maxine Hong Kingston, thank you so much for your time today. Good luck with the book.

Ms. KINGSTON: Thank you.

CONAN: The name of the book is "I Love a Broad Margin to My Life." And Maxine Hong Kingston joined us from a studio at the University of California at Berkeley.

Coming up, 10 years after Portugal's decriminalize drugs. What happened?

Stay with us. TALK OF THE NATION from NPR News.

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Sabtu, 22 Januari 2011

“"Multiple Fictions" Drive Opposition to Health Law - Brookings Institution” plus 1 more

“"Multiple Fictions" Drive Opposition to Health Law - Brookings Institution” plus 1 more

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