The public discussion of healthcare reform has been full of so many lies and myths that it is less a policy debate than bad theater.

Critics of reform (conservatives hoping to score political points and oppose Obama on anything; free market ideologues; those with threatened financial interests) have stooped to absurdity in their public pronouncements. One publication declared that severely disabled physicist Stephen Hawking would never get life saving medicine in a national health system, ignoring that Hawking is British—virtually all of his life saving treatments were done through their National Health Service.

As debate over reforming health care continues, these are some of the key myths that get in the way of truly meaningful discussion.

Myth #1—We have the best health care in the world

This is probably true for some Americans. But on the whole our system is among the poorest of all developed nations. We spend far more per capita than any of our peers on healthcare, yet health outcomes measures are no better in aggregate. The World Health Organization ranking of health systems rated 36 other countries as having better health systems despite spending far less. The U.S. was right behind Costa Rica (and only two spots ahead of Cuba).

But the reality of the failure of our health system is best seen by the thousands of people being turned away in Los Angeles last week at the massive free clinic set up by the Remote Area Medical Foundation (see Reuters story). When the country spending the most money can not meet the basic medical needs of so many of its citizens, it does not have a good (or just) health system, much less the best system.

Myth #2—Health reform will lead to less personal freedom

There is nothing in any of the proposals that requires anyone to give up her existing health plan. In fact, Medicare proves that public-private partnerships can result in individuals choosing their own plans and their own physicians. Opponents of reform have argued that any government involvement means loss of freedom. This ignores the reality that insurance companies, employers, and financial limitations are already curtailing freedom for many individuals. When co-payments are too high, or someone has no insurance and health care means going bankrupt, those are real losses of freedom. It is ironic that unwavering faith in the free-market (and contempt for any government role) is being expressed at the same time the country is recovering from an economic meltdown caused by too much greed and too little government oversight.

None of the proposed plans involve socializing medicine, creating a single payer system, or government run or owned hospitals. They merely acknowledge the reality that a morally defensible health care system will only come about with some government involvement.

Myth #3—Health reform will control costs by depriving patients of needed medical treatments

There is absolutely nothing in any of the reform measures that suggests or requires that needed medical treatments will not be available. In contrast, within our existing system, those without insurance or “under-insured” patients who can not afford rising out of pocket payments are denied needed medical treatments on a routine basis. Reform makes it more likely that patients will receive needed medical treatments (not less likely).

Myth #4—Health Reform will deny older Americans medical treatments at the end of life

The lies about “death panels” that Palin, Gingrich, and others have been spewing have led the Senate to withdraw one element of the House legislation that would have both reduced costs and increased patient freedom. This is the proposal that would have allowed payment to primary care physicians who spend time with their patients talking about the patient’s wishes with regard to end-of-life decision-making. Right now, 25 percent of Medicare is spent on the last two months of life. Families in these contexts often face difficult decisions with no idea of what a patient’s wishes are. In those settings, we typically default to providing more aggressive measures, even if it increases suffering and may be at odds with a patient’s wishes. Encouraging patients to make choices ahead of time–whether for more aggressive measures or for a greater focus on comfort at the end of life– promotes freedom and has the potential to reduce costs (since 80 percent of people prefer less aggressive care).

This is the precisely the role that government should be playing—creating incentives for good medicine that promotes patient autonomy—and to counter existing incentives which all too often lead to less choice, more suffering, and increased costs. When Palin, Gingrich and others portray talking about our wishes with our doctors as “death panels”, when they attack scholars’ work out of context, when they misrepresent what is in proposed legislation, they undermine any hope of rational dialogue about the ethical challenges presented by health care and the very important and very real challenges and trade-offs that should be the subject of debate.

Matthew E. Berger covered Palin’s vice presidential campaign as an embedded reporter for NBC News and National Journal. He is the author of a book on Palin’s campaign and political future, scheduled for release in the fall by Wiley.  The article originally appeared on Politico.com. The views expressed are his own.

Standard Washington political rules state that any presidential aspirants must finish out their term, write a book, travel to Iowa and New Hampshire, and start talking policy. Any deviation from the norm suggests political suicide, and many analysts have spent the past few days writing Sarah Palin’s political obituary.

But Palin never learned the rules, and she certainly doesn’t play by them. Palin has her own set of rules, which minimizes the expertise of political veterans and relies almost entirely on her gut. As times got tough during her vice presidential campaign, Palin began to ignore the advice of those around her and started doing the things she relied on to win in Alaska, specifically directly attacking her critics and speaking more to local media. Whether her small-town politics translated well to the national stage didn’t seem to register with her.

And under her personal guidelines, Friday’s announcement makes sense. The timing and her unscripted words — full of metaphors of basketball and fishing — made clear the decision had been reached without full consultation or preparation with political advisers. Palin had decided on a path, consulted few outside her family and moved forward.

Certainly, Palin’s decision to resign stems in large part from frustration over how her identity has changed in the past 11 months. Her allies in Alaska and Washington say she seemed unhappy in recent weeks, exasperated by the negative media attention and her inability to effect change in Juneau. Her combative tone with Levi Johnston and David Letterman suggested a woman thinking more about her family than her political future. Palin’s mother even told friends and neighbors she did not know how much more the governor could stand.

Once Palin chose not to run for reelection, she likely calculated there was no reason to stay. Before she was the darling of social conservatives, Palin was the ethics reformer who beat an incumbent governor of her own party by speaking out against corruption and gubernatorial largesse. That character was who John McCain thought he was getting as a running mate, and Palin never relinquished her title as a reformer. In her mind, lame ducks are bad and prone to malfeasance, and therefore she shouldn’t be one.

Palin has always run toward those who are cheering the loudest for her, ignoring and angering allies and backers who helped her along the way. When she ran for mayor, it was social conservatives. As a gubernatorial candidate, it was those seeking good government. And because the anti-abortion community flocked to her vice presidential rallies, she quickly forgot she had been recruited by McCain to appeal to Hillary Clinton moderates.

Increasingly, Palin’s base of support has been outside Alaska. Republicans never worked well with her because she didn’t court them and often ran against their interests. Democrats who liked her a year ago now see her as the national embodiment of the Republican right. Palin needs to be where they will cheer her name. And that’s why she’s leaving the governor’s mansion. By hosting a talk show or giving speeches, she can surround herself with those who speak her language and she can bask in their support. It will likely be enough to give her a sense of confidence that she can win over the entire Republican Party as a candidate for president in 2012.

Palin earned a public reputation as a fighter, given her bouts with political enemies and media naysayers. But privately, she is quick to retreat when things get tough. On the vice presidential campaign trail, she would lower her head and ignore advisers during the bad days, blaming others for her mistakes. She was also quick to retreat, both in college and as a state oil and gas commissioner, when reality did not meet her expectation. It has worked for her before, positioning her for future, higher office. So why not do it again?

Just because Washington experts don’t see how Palin can go from one shortened term as governor to the White House doesn’t mean she doesn’t see it. Palin’s career has been marked by quick, unorthodox decisions that have often worked out well for her. In her calculations, only when she listened to Washington has she stumbled.

© 2009 Capitol News Company, LLC

(Pictured above: A man holds a guitar with Governor of Alaska, and former Vice Presidential candidate, Sarah Palin’s last name written on it at America’s Tea Party held at Southfork Ranch in Parker, Texas July 4, 2009. Organizers say the event is an effort to work against further government expansion, bailouts and irresponsible elected officials. REUTERS/Jessica Rinaldi)

Telling young people to abstain from sex is “not realistic at all” — new mother Bristol Palin, 18.

The wisdom of Ms. Palin should be borne in mind by the leaders of the Group of 20 nations at their April 2 summit when they turn to trade.

The meeting comes at a time when worries about protectionism are mounting, because a number of countries have raised trade barriers and enacted other quasi-protectionist measures.

It is tempting to say, as many commentators have, that the G20 should vow to shun all new acts of protectionism, including any tariff-raising or more subtle actions such as “buy local” provisions in government stimulus programs. Unfortunately, such blanket pledges will be no more credible than teenage abstinence campaigns. The G20 must be ambitious on trade, but it must also be practical. Minimizing long-term damage to the trading system should be the overarching goal.

The G20’s effort on trade at its first summit last November was loaded with high-mindedness—and, as it turned out, hot air. The leaders said they would “strive to reach agreement” in 2008 in the World Trade Organization’s Doha Round of trade negotiations, which have dragged on for seven years. And they promised to “refrain from raising new barriers” for 12 months.

Alas, violations of both the spirit and letter of the declaration materialized within days of its promulgation.

An effort to convene a meeting to advance the Doha talks fell apart. Meanwhile, Russia raised duties on cars, pork and poultry; India raised tariffs on steel products; Indonesia imposed onerous customs requirements on certain imports. The U.S. Congress included a “Buy American” provision in its economic stimulus package, and Washington has started to bail out the U.S. auto industry, which helps domestic firms at the expense of foreign ones. Other nations are following suit.

As a result, proposals abound for the G20 to approve not only a “standstill” on all tariff hikes but a ban on buy-local preferences and subsidies that favor national producers. Also widespread are exhortations for the G20 to take a “just do it” stance on the Doha Round.

Desirable though it would be to see such an approach endorsed and implemented, the G20 needs to guard against another blow to its credibility. Let’s face some lamentable facts: Auto industries are going to be bailed out, and in an discriminatory fashion. (Congress simply isn’t going to grant loans to Toyota, even though Toyota has large plants in the U.S.) Anti-dumping cases are going to soar. More righteous verbiage from heads of state will do nothing to close gaps in the Doha talks.

So the principles guiding the G20 should be these: Make sure that the rules-based trading system survives. Don’t try now to open markets further; rather, focus on keeping protectionism, and quasi-protectionism, from becoming long-lasting features of the international economy, so that globalized trade can help the world recover and prosper anew. To the extent that anti-market policies are adopted, keep them temporary and limited in scope.

This means first of all shoring up the WTO, which is the ultimate guardian of open markets. The WTO keeps a lid on tariffs of its 153 member countries and adjudicates trade disputes that might otherwise flare into trade wars.

Specifically, the G20 should recast the Doha talks as an emergency anti-protectionism round. The partial deal that is currently on the table, though not at all far-reaching, would lower the legal caps on tariffs that many countries can impose. Adopting a package like that, while postponing action on other, more contentious issues, would help toward insuring against protectionism in the years ahead.

By Bernd Debusmann

WASHINGTON (Reuters) - What is a real American? As opposed to an unreal American, a fake American, an un-American American or an anti-American American.

The answer is in the eye of the beholder and his or her political orientation. The question, and variations of it, has been asked in several periods of U.S. history and has bubbled up again, one of a number of odd sideshows, in the closing stages of the campaign for the presidential election on Nov. 4.

Are real Americans a minority in this richly diverse country of 300 million? You might well come to that conclusion if you believe the definitions publicly provided by several Republicans, including Sarah Palin, the vice presidential candidate, and conservative radio and TV talk show hosts.

“We believe that the best of America is in these small towns that we get to visit and these wonderful little pockets of what I call the real America, being here with all of you hard-working, very patriotic, very pro-America areas of this great nation,” Palin told a campaign rally in North Carolina in mid-October.

John McCain, the Republican candidate, has also sung the praise of small town (real) America. “Western Pennsylvania … is the most patriotic, most God-loving part of America,” he said at a rally there.

A belief in God, judging from speeches by both McCain and his Democratic opponent, Barack Obama, is an essential part of American-ness.

Robin Hayes, a Republican congressman from North Carolina, provided details on Americans who do not qualify as real. “Liberals hate real Americans that work, and accomplish, and achieve, and believe in God.” Both Palin and Hayes later “clarified” their remarks to say they had not actually meant to suggest the existence of pro- and anti-American parts of the country. Nevertheless, their words prompted a vivid debate in cyberspace and on talk radio.

REAL AMERICANS AND EUROPE

It quickly went beyond geography and into political beliefs. “Is it possible to be a real American and to be a socialist?” radio talk show host Chris Plante asked his listeners in the Washington area. “Can you still be a real American if you believe that the regimes that govern in Western Europe are a better way forward than the system that we have here?” Callers reassured him that no, that was not possible.

How much influence conservative talk radio has will be apparent on election day. The Rush Limbaugh Show alone claims 12 million daily listeners and other conservative talking heads, such as Sean Hannity, also pull in huge audiences. But listening to them, it is difficult not to come to the conclusion that they are preaching to the converted and their shows function as big echo chambers.

As the real vs unreal Americans debate unfolded over a few days - teacup storms have been relatively short in this election — another Republican member of Congress, Michelle Bachmann of Minnesota, poured fuel on the argument. She suggested in a television interview that the U.S. media should “take a great look at the views of the people in Congress and find out if they are pro-America or anti-America.”

That conjured up the ghost of Republican Sen. Joseph McCarthy, who was helped in his hunt for hidden communists in the 1950s by a congressional investigative body called the House Un-American Activities Committee.

Sorting the populace into good people and not-so-good (or downright bad and dangerous) people is nothing new in an election campaign - the not-so-good people are always those of the other party. Seen in historical context, today’s good vs bad rankings are tame, as are negative advertisements.

When John Quincy Adams ran for re-election in 1828, for example, he called his opponent Andrew Jackson a cannibal and a murderer and he had unkind words for Jackson’s followers. The charge didn’t help. Adams lost.

In the 2008 campaign, attempts to portray one set of Americans (those living in rural areas and small towns) as more American than their big-city compatriots run counter to demographics. Nostalgia for a country that no longer exists?

According to the 2000 census - the counts are taken every 10 years - America’s big cities and their suburbs are home to 192 million people. That compares with just under 60 million in rural areas overall and 30 million in towns of fewer than 50,000 people.

A community of 50,000 people is large in comparison with Wasilla, the Alaskan town that had 5,000 people when Sarah Palin became its mayor in 1996. It has since grown to close to 10,000 - still small enough to fit the latest definition of real America.

(You can contact the author at Debusmann@Reuters.com)

]]> http://blogs.reuters.com/great-debate/2008/10/29/real-vs-unreal-americans/feed/ http://blogs.reuters.com/trail08/?p=12941 http://blogs.reuters.com/trail08/?p=12941#comments Sun, 26 Oct 2008 23:19:33 +0000 Jeremy Pelofsky http://blogs.reuters.com/trail08/?p=12941 Sarah Palin is trying to distance herself from the top of the ticket, John McCain.]]> WASHINGTON - As the 2008 U.S. presidential campaign enters its final week, reports are bubbling up about internal strife within the Republican ticket that suggest vice presidential candidate Sarah Palin is trying to distance herself from the top of the ticket, John McCain.

Palin over the last few weeks has publicly expressed her differences with McCain on issues such as a constitutional ban on gay marriage, the campaign's decision to no longer contest Democrats in Michigan and her distaste for automated calls that have drawn scrutiny.

Politico.com reported this weekend that Palin has also cast aside advice from former George W. Bush aides assigned to help her on the campaign trail, citing their handling of her debut. She was roundly criticized for her poor performance in her initial national media interviews.

The report said:

Those Palin supporters, inside the campaign and out, said Palin blames her handlers for a botched rollout and a tarnished public image — even as others in McCain's camp blame the pick of the relatively inexperienced Alaska governor, and her public performance, for McCain's decline.

"She's lost confidence in most of the people on the plane," said a senior Republican who speaks to Palin, referring to her campaign jet. He said Palin had begun to "go rogue" in some of her public pronouncements and decisions.

After that story emerged, CNN reported that aides from the McCain side of the house were fighting back, including quoting one unnamed aide who described Palin as a "diva" and that she was looking out for her own political future in case they do not win the White House next week.

The report said:

McCain sources say Palin has gone off-message several times, and they privately wonder whether the incidents were deliberate. They cited an instance in which she labeled robocalls -- recorded messages often used to attack a candidate's opponent -- "irritating" even as the campaign defended their use. Also, they pointed to her telling reporters she disagreed with the campaign's decision to pull out of Michigan.

A second McCain source says she appears to be looking out for herself more than the McCain campaign.

"She is a diva. She takes no advice from anyone," said this McCain adviser. "She does not have any relationships of trust with any of us, her family or anyone else.

The reports of the internal strife come as McCain and Palin have been for weeks trailing the Democratic ticket of Barack Obama and Joe Biden in national polls and in a tight battle for states that traditionally have been Republican strongholds like Colorado and Virginia.

However, the latest Reuters/Zogby/C-Span national poll shows that McCain has closed the gap on rival Barack Obama to five points after being down as much as 12 points.

Click here for more Reuters 2008 campaign coverage. 

- Photo credit: Reuters/Brian Snyder (Palin and McCain get off their campaign bus last week in Ohio.)