The Link to Original Article

By TIMOTHY EGAN

Timothy Egan on American politics and life, as seen from the West.

After the last insult had been spat from the Senate floor, after final passage of a legislative attempt to do something significant in this messy democracy, a leading voice of the opposition made a public prediction:

“People will be hunting Democrats with dogs,” said Senator Phil Gramm of Texas.

This was 1993, in the fragile first year of Bill Clinton’s presidency, on a vote to raise taxes for the wealthiest 1.2 percent and cut them for the poor and small businesses. That budget bill passed without a single Republican vote.

What followed was the greatest period of peacetime prosperity in modern times, a budget surplus of $559 billion and a president who left office with an approval rating of 66 percent — the highest of any since World War II. But first, some Democrats were indeed hunted, particularly in the South, which has been cleansing itself of the party since the Civil Rights era.

Gramm went on to deregulate the banking industry, setting the stage for a binge of economic nihilism that nearly brought down the world economy.

That fight in 1993 is worth recalling this Christmas Eve, as the voices of the apocalypse rain down on Democrats who dare try to expand health care for their fellow Americans.

In many ways, the budget vote 16 years ago ushered in the modern era of hyper-partisanship. Right-wing talk radio hosts were just entering their steroid phase, threatening any Republican who voted for a bill that ultimately led to budget surpluses.

From then on, nobody could “respectfully disagree.” Moderates were called wussies, traitors and socialists. When Republicans gained control of everything, the fringe Democratic left took their rhetorical cues from their angry counterparts on the right. This year, things became coarser still with the “tea party” extremists, who taught Republicans in Congress how to shout “You lie!” to the president and cast aspersions on something so innocuous as a pep talk to school children.

What the Senate has done this week will not break the economy or cure all that ails a profoundly imperfect health care system. “What we are building here is not a mansion,” said Senator Tom Harkin of Iowa. “It’s a starter home. But it’s got a great foundation.”

For that, it deserved at least a handful of Republican votes. Can the bill, without its public option, making reforms that many in the G.O.P. advocated in last year’s election, really be so one-sided that not one lone Republican could support it?

I was hoping for a profile in courage, just to signal a truce of sorts during this awful epoch of toxic nastiness. Instead, we got cowardice. But by the rules of political combat dating to 1993, the opposing party can take no other stance.

So, there was Tom Coburn, Republican of Oklahoma, all but calling for the Almighty to strike down an aging Democratic legislator, when he urged people to pray that at least one senator would not make it to the chambers during a snowstorm. His colleagues took it as a clear reference to the ailing, wheelchair-bound, 92-year-old Robert Byrd.

And there was Mike Huckabee, showing once again his Gomer Pyle piety without Gomer’s sincerity, comparing the vote of Senator Ben Nelson, the last Democratic holdout to join his party, to Judas Iscariot, who sold out Christ.

Topping them all was Michael Steele, the Republican National Committee chair, saying Congress was “flipping the bird” to the American people with the vote to expand health care. Daniel Webster he ain’t. But let’s put that quote up on the board for posterity.

The other side was not much better, with Democratic majority leader Harry Reid comparing opponents to slave holders.

For now, Americans are against “the bill,” whatever they think it is. But strong majorities favor a public option, and reining in insurance companies, and overhauling the medical industrial complex. They want reform. They just don’t want the fight.

As people get a chance to see what’s actually in the bill, sentiment will shift. Over time, it closes the dreaded doughnut hole, which makes cash-strapped seniors pay for their meds at the point when they are most in hock to Big Pharma. It forces insurance companies to cover people with pre-existing conditions. By creating an exchange where people can shop for coverage, the bill seeks to bring care to 31 million additional Americans. And it does all this, according to the independent Congressional Budget Office, by reducing the deficit $132 billion over 10 years.

There are new taxes on tanning salons — already dubbed the Boehner tax, for the preternaturally bronzed Republican House leader from Ohio — and those at the highest end.

Will Democrats run on it, or run from it? That depends on whether they take a long view, and fight, or a short view and cower. There are plenty of people in the latter camp. The former can look to the lonely legislators who stood with Bill Clinton in 1993 and say “told you so,” while grandchildren listen at Christmas.

It seems to me that at the end of the day, every life has a mixture of what I chose to call “Control Created Destiny” and “Fate Created Destiny”.

Our birth event is an example of Fate Created Destiny. We didn’t chose our family, our neighborhood, our physical characteristics, our gene or DNA based health characteristics.  Arguably, our future lives are shaped in many ways because of these conditions at birth.

How well we do in our getting educated, what do we do with our education, what jobs do we chose, where do we chose to live, what cars we drive, who do we date and marry, what kind of house we live in are examples of Control Created Destiny.  Because we controlled the event in making those choices.

Is that really so?

In almost all those situations that we may call are examples of Control Created Destiny, it can be argued that our individual fate did play a role. For example, most of us can probably think of situations where somebody in our school or college or university did far more brilliantly than we did or the other way i.e., was a very poor student. And yet, at the end of the day such a brilliant student ended up with a miserable life because of health or because of family events or because of circumstances beyond his or her control. The other so called poor student did wonderfully well in his/her later life because of a great mentor he found or because he suddenly found money due to an inheritance that he wasn’t aware of or because he accidentally landed in owning a business through marriage.

There are obviously a lot of instances where people did very well in all walks of life because of sheer hard work, discipline and focus in becoming the best there is in their chosen fields.

What seems to me is true in almost all, if not all, situations is that no matter which life one observes, there seems to be a mixture of events that are based upon individuals control and also purely a coincidence or an accident. When it is a result of controlled event then we may call it Control Created Destiny(CCD) and when it is a result of pure chance, luck or accident then we may call it Fate Created Destiny(FCD).

But therein lies the rub, the problem of logic.

Once we accept that we do have chance events in our lives, that we cannot escape from such chance events in our lives then we must also pose the question that those events in our lives that we chose to call actions that we controlled and thus our destiny could also be a result of Fate driving it. What is there to say that the action we took to control our destiny was not so “fated” for us to take? That the actions each individual takes whether or not such an individual is “driven”, “action oriented”, “type A personality” or “lethargic”, “lackadaisical”, “lazy” is a result of how fate chose it for that individual.  It can be argued, for example, that the student who worked hard to educate himself well was so “fated” to do so. He couldn’t do or be otherwise no matter how much he thought differently. He had no other choice because that was his fate. That seems to be the problem if one accepts that Fate Controlled Destiny does exist and do happen.

Can we accept that our lives has to have a mixture of both CCD and FCD? Is that a logical conclusion? That we live with both; some events we do control and some we do not.

Reconciling to that way of thinking is a possibility, I suppose, but to me, that argument is weak because once we “accept” the logicality of FCD then it naturally argues in favour of CCD being a result of the same.

If we can get away from “accepting” that our lives has no place for chance events, accidents, coincidences then it is possible to believe completely in one and only CCD for ourselves.

But, can we really deny that our life is completely bereft of any chance event? Chance events that had a role in shaping some of our lives, if not all?

An old Urdu couplet goes something like this:

Layee hayaa aaye, le chalee kazaan chale

Na apni khushi aaye, na apni khusi chale

Loosely translated it says:

Fate (birth) brought us here

Death takes us away from here

Coming here was not our choice

Neither is going away our choice

In other words Life is “fait accompli.” If Birth and Death are not of our own choosing then is it not a possibility that all other events in our life are similarly of not our choosing? Perhaps Fate is like the smart spouse or the smart boss who get their things done but the person actually doing it feels as if their accomplishment was due to their own decision making.

Most of us would probably observe that Obama exemplifies what Control Created Destiny implies. His focus, his hard work, his well defined goals, objectives, his intellect brought him to where he is. In his recent Nobel Lecture he observes:

Somewhere today, in the here and now, in the world as it is, a soldier sees he’s outgunned, but stands firm to keep the peace. Somewhere today, in this world, a young protestor awaits the brutality of her government, but has the courage to march on. Somewhere today, a mother facing punishing poverty still takes the time to teach her child, scrapes together what few coins she has to send that child to school — because she believes that a cruel world still has a place for that child’s dreams.

The soldier, the young protestor, the mother, they all have the same audacity of hope that Obama harbored in him. The child of that mother may reach the same heights of human achievement that Obama reached and then again, may not.

It all depends upon what kind of “fait accompli” that child has.

Or, do we accept our life events as evidence of dualism of both “action” and  “luck” and ignore the rationality and logic of luck determining our actions?

May be Shakespeare answered this dilemma a long time ago when he observed “all the world is a stage and we mortals are merely players”

That a small group of individuals or one individual with their own agenda of whatever sort can succeed in going against the clearly demonstrated need of a National Universal Health care reform by the citizens of the country, as a whole, is not only dangerous precedent from a political standpoint but also demonstrates a moral degradation of its elected leaders who have decided that they can chose to be the “death panel”  for millions of their fellow countrymen because it suits their agenda to do so. It is a power play for these individuals, an ego trip of their psyche that dominates their behaviour where nothing is immoral anymore.  The precedent set by the behaviour of this minority group of few (or one) in this instance of health care reform bill can be devastating. The future of any country, any empire in the history of human kind shows how such a beginning of its leadership’s moral degeneration ultimately and almost invariably leads to a demise of that empire.  It is the “butterfly effect”  that becomes a moral chasm of huge proportion and thus irreversible until it is too late.

From a different perspective of such leadership behaviour, of such  increasingly ineffective democratic system the question of  “sub-optimal solutions” (as described by Tom Friedman in a recent op-ed in New York Times)  becomes more and more relevant. Nations which cannot implement solutions of any major proportion at anytime and has to continue to accept only incremental passages of solutions to get to its ultimate need (if ever?) is a nation that will continually find itself behind other nations with far more effective democracy or alternative political systems. The current Health Care system, for its citizens,  in USA is one such obvious example.

Is this the future scenario for USA in other areas as well?  I hope it is not too late for a course correction of its moral compass, hopefully, to be demonstrated by the future elected leaders of this country.

But, I wonder, if this is truly the case?

Assume for a moment that our current system of Health Care, the market based Health Care providers, were to allow a system of universally affordable health care for all, regardless of locations -rural, urban, north, east, south, west corners of all states of USA. And, that such health care were to be available to all citizens without any fear of losing them because of limits and caps,  because of some prior condition of health, because of loss of job, because of relocation or of not having any access whatsoever because of some pre existing conditions. Arguably, if the universe of insurance included demographics of all ages – young and old, healthy and sick, rural and urban dwellers – then such a possibility is conceivable from actuarial basis.

If such a health care system existed for the citizens of this country just as it is experienced by the citizens of all other developed nations then I wonder if those, who can be labeled as Progressives otherwise, would be calling for a “Single Payer System”?

Absent that, it is just a means to a noble end.

by James Surowiecki The New Yorker  November 23, 2009

John Kenneth Galbraith wrote that all financial crises are the result of “debt that, in one fashion or another, has become dangerously out of scale.” The recent financial crisis was no exception, with everyone—homeowners, private-equity investors, our biggest banks—taking on enormous amounts of debt. If it’s frustrating that the government is footing the bill to clean up the mess, it’s even worse that the government helped pay for the debt binge that created the mess in the first place, thanks to a tax system that actually subsidizes borrowing. Debt didn’t get dangerously out of scale because the system was broken. It got out of scale, in part, because the system worked.

The government doesn’t make people go into debt, of course. It just nudges them in that direction. Individuals are able to write off all their mortgage interest, up to a million dollars, and companies can write off all the interest on their debt, but not things like dividend payments. This gives the system what economists call a “debt bias.” It encourages people to make smaller down payments and to borrow more money than they otherwise would, and to tie up more of their wealth in housing than in other investments. Likewise, the system skews the decisions that companies make about how to fund themselves. Companies can raise money by reinvesting profits, raising equity (selling shares), or borrowing. But only when they borrow do they get the benefit of a “tax shield.” Jason Furman, of the National Economic Council, has estimated that tax breaks make corporate debt as much as forty-two per cent cheaper than corporate equity. So it’s not surprising that many companies prefer to pile on the leverage.

There are a couple of peculiar things about these tax breaks—which have been around as long as the federal income tax. The first is that they’re unnecessary. Few people, after all, can save enough to buy a home with cash, so home buyers naturally gravitate toward mortgages. And businesses like debt because it offers them tremendous leverage, making it possible to put down a little money and potentially reap a huge gain. Even in the absence of the deductions, then, there would be plenty of borrowing. The second thing about these breaks is that their social benefits are pretty much nonexistent. Advocates of the mortgage-interest deduction, for instance, claim that it increases homeownership rates. But it doesn’t: in countries where mortgage deductions have been eliminated, homeownership rates haven’t dropped. Instead, the deduction simply inflates house prices. The business-interest deduction, meanwhile, may lower an individual company’s taxes, but it also means that the over-all corporate tax rate is higher, so its real impact is to give companies with lots of debt an unjustified advantage.

If the benefits are illusory, the costs are all too real. Economies work best, generally speaking, when people are making decisions based on economic fundamentals, not on tax considerations. So, as much as possible, the tax system should be neutral between debt and equity, and between housing and other investments. It’s not, and, worse still, as we’ve seen in the past couple of years, debt magnifies risk: if companies or individuals rely on large amounts of leverage, it’s much easier for bad decisions to lead to insolvency, with significant ripple effects in the wider economy. A debt-ridden economy is inherently more fragile and more volatile. This doesn’t mean that the tax system caused the financial crisis; after all, the tax breaks have been around for a long time, and the crisis is new. But, as a recent I.M.F. study found, tax distortions likely made the total amount of debt that people and companies took on much bigger. And that made the bursting of the housing bubble especially damaging. So encouraging people to take on debt qualifies as a genuinely bad idea.

But it’s not an easy situation to change. In 2005, a special Presidential panel on tax reform actually proposed eliminating the business-interest deduction and severely restricting mortgage-interest tax breaks. Those proposals, predictably, went nowhere. But we’re in a different historical moment now: the perils of too much borrowing have never been clearer. And there are precedents, on a smaller scale, for these kinds of changes. In the U.S., people used to be able to write off the interest they paid on credit cards. That tax break was abolished in 1986, and, the same year, the mortgage-interest deduction, which used to be unlimited, was capped. Great Britain, meanwhile, abolished its mortgage tax break in 2000. Similarly, there are a number of countries, including Brazil and Belgium, that don’t give corporate debt a tax advantage over equity, while, just last year, both Germany and Denmark cut back sharply on their business-interest tax breaks, limiting how much interest companies can write off. Given the weak state of the economy and of housing prices, a wholesale rewriting of the tax code may be a bridge too far right now, but there are plenty of reforms—capping deductions, phasing them out over time, restricting their use by heavily leveraged companies—that would move in the right direction.

The clearest hurdle to these changes may be political, but the bigger hurdle is, in a way, psychological: because tax breaks on debt have been around so long, we can hardly imagine what it would be like if we changed them, and we tend to underestimate their influence in shaping our behavior. Subsidizing debt seems harmless simply because we’ve always done it. But the fact that you’ve had a bad habit for a long time doesn’t make it less dangerous.

By NANCY GIBBS  TIME Monday, Nov. 23, 2009

Happiness is a sappy word and a flimsy concept — more fleeting than contentment, several octaves lower than joy. But happiness is what pollsters test and economists track, however clumsily, so we’re stuck with it as the medium for measuring our mood. Not surprisingly, that mood has bounced around over the years, with the general sense of well-being hitting its lowest points in 1973, 1982, 1992 and 2001, all recession years. So why is it that at least some aspects of the Great Recession of 2009 appear to have made people feel better? (See 10 big recession surprises.)

In January 2008, the Gallup-Healthways Well-Being Index was launched. It was designed to work like a Dow Jones average of attitude. At least 1,000 people are surveyed daily, 350 days a year. (You can see how happy people are broken down by congressional district; Utah turns out to be the merriest state, West Virginia the glummest.) When the markets tanked last fall, happiness did too, and anyone who has lost his or her job, house or health care is probably still in a world of pain. But here’s the funny thing: by this past summer, overall well-being was higher than it was in the summer of 2008, before the Apocalypse. In fact, the latest report finds America’s cheeriness at an all-time high. An August report from the Pepsi Optimism Project (POP) positively fizzed: Americans are more optimistic now than a year ago about their well-being (88% vs. 84%); health, finances, relationships and odds of finding love (70% vs. 61%). Don’t trust soda-company polls? Consumer Reports confirms that we don’t plan to spend much money this Christmas, but the vast majority of us — 87% — expect this holiday season will be as happy as or even happier than last year’s. Meanwhile, the Secret Society of Happy People (which “encourages the expression of happiness and discourages parade-raining”) reports traffic to its not-so-secret website has increased since the downturn. (See 20 ways to get and stay happy.)

Everyone — or at least everyone who claims to be happy — has some reason for finding the upside to the downturn. Mine has to do with the end of Expectation Inflation, a phenomenon that can be as corrosive to our spirits as price inflation is to our savings. Expectations are a mash-up of hope and conceit, what you’ve earned and what you imagine luck might hand you as a bonus for just showing up. So what did it mean that over the past generation our expectations grew so big so fast that we had effectively supersized the American Dream?

Some parts of raised expectations are plainly good. We expect to live well into our 80s because medicine keeps getting better. Many more high school students expect to go to college. In 1973, 47% of recent high school graduates attended college; last year 69% of new graduates enrolled. We expect our gadgets to get smaller and smarter, cooler and cheaper, because technology evolves exponentially, and at light speed. (See how to plan for retirement at any age.)

But the Great Recession has also exposed our magical thinking about what constitutes a middle-class lifestyle. Flash back a generation to the house with the white picket fence. It had a black-and-white TV with an antenna, a car in the garage, a chicken in every pot and two kinds of lettuce (light green and dark green). Now the average house is more than 50% bigger, the car is twice as powerful (and there’s often more than one), the TV is flat and gets 900 channels, and we expect the grocery store to have strawberries year-round and about 50 flavors of mustard. Small wonder we started charging our life-insurance premiums on our credit cards; we only expected to pay when we died.

So while optimism is the all-American anesthetic, at some point Expectation Inflation was bound to take its toll. I’m struck by how many people tell pollsters that the voluntary downshifting and downsizing of the past year have come as a kind of relief. Maybe we’ve lowered our standards. But we already knew that money can buy only comfort, not contentment; happiness correlates much more closely with our causes and connections than with our net worth. Americans may have less money — charitable giving in current dollars dropped for the first time in 20 years in 2008 — but about a million more people volunteered their time to a cause. Which makes me wonder: Is it a coincidence that eight of the 10 happiest states in the country also rank in the top 10 for volunteering?

Whatever you make of the psychology of happiness, we know something of its physics. It rises as it ricochets off other people, returning to us stronger by virtue of being released. It gets bigger when we don’t care if it gets smaller; we stopped buying all the stuff we didn’t need that was supposed to make us happier, and we seem to be happier for it. And who would have expected that?

The Nov. 12, 2009 Paul Krugman Op-Ed column in New York Times titled “Free to Lose” discusses the economies of Germany and USA during the latest couple of years and clearly establishes why and how Germany has weathered the “Great Recession” better than USA.

When it comes to Health Care Reform for the citizens of a country;  only in USA, of all the developed countries, the alternative of Government’s obligation to provide help and support in this arena to its citizens is not considered a relevant choice. I do know that there is an element of  hypocrisy involved in this argument (a la Medicare, VA) but overall the point is immensely valid, given the political discussions we have witnessed during this year.

To what should we attribute this unique pseudo-national characteristic of not willing to admit that USA does not have the monopoly of innovation in all matters.  Why can’t we have the luxury of learning from others the time-tested solutions? Why do we always have to re-invent the wheel? Are we so much better in our intellectual and management capability that what demonstrably works for other so many nations (just look at the satisfaction levels of citizens of those countries and other demographic metrics of Health Care provided by third-party global organizations) can be pooh-poohed by our arrogance?

Is it our arrogance, is it being an ugly-american that explains why a large segment of our society and an elected cadre of leadership, are bent upon saying “NO” to anything and everything that provides a society-at-large some of the same benefits that a vast number of our brethren in other developed countries are privileged to have?

When does statistics like “more veterans in USA are dying every year than in Afghanistan due to no Health Insurance”;  ”45,000 people are dying every year due to no Health Insurance”;  ”45 million people live their daily lives without Health Insurance”;  ”more than 1 million people lose their homes every year due to Health related costs” start to question our conscious as a society of humans and stop from becoming just a set of data?

There should be a limit to our ARROGANCE from becoming our enemy.  And, finally, let not the pursuit of excellence of a unique Health Care reform for USA come in the way of our seeking a good solution that works everywhere else in a civilized developed world for all their citizens.

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Post-Publish addition: Dutch View of Choice in U.S. Care: It’s Limited

This article and the interview is just one illustration of what we in USA can learn from others.

It so happens that this same edifice Taj Mahal evoked two different perspectives from two contemporary Urdu poets in the 50′s. One of them, Sahir Ludhianvi, who was Marxist in his heart, said:

Yeh chamanzaar, yeh nadi ka kinara, yeh mahal
Yeh munaqqash daro diwaar, yeh maharaab, yeh taq
Ek sahanshah ne daulat ka sahara lekar
Hum garibon ki muhabbat ka uraaya hai mazaak
Mere mahaboob kahin aur mila kar mujhse

A rough translation in English might say something like “by building this lovely architectural beauty with its delicate ambiance and with all its glory, in this serene surroundings an emperor has made a mockery of, has insulted the feelings of LOVE of a common, ordinary, poor person and so, my love, my beloved let us continue to meet somewhere else.”

The other poet, his contemporary, Shaqil Badayuni, made the following observation:

Ek sahanshah ne banake haseen Taj Mahal
Sari duniya ko muhabbat ki nishani di hain
Iske saaye mein sada pyar ke charche honge
Jo khatam na ho sakegi, aisee kahani di hain

Talking about the same monument, this poet says “by building this exquisite Taj Mahal, an emperor has given the world an icon of love under the shadows of which there will always be discussions of love and unending stories of man’s indulgence in love will continue for ever.”

Two contemporary poets with two different perspectives about the same monument Taj Mahal and yet there is a commonality and shared respect towards the human emotions called LOVE. They may have had different feelings about the architecture, about the surroundings, about the ambiance and yet they could not and did not deny their exalted and healthy respects for love – the undeniable human emotion.

However, I did also strongly feel that Love and Romance are but the two legs of a three legged stool called Marriage. For a marriage to last and happily sustain, the partners who shared love and romance at this point must also share an unhesitating feelings of friendship towards each other. This third leg of the stool – this true friendship provides the sufficiency and complements the necessary conditions for marriage – love and romance. True friendship is demonstrated when each of the partner has no hesitation whatsoever to share with the other the ups and downs, the joys and the pathos, the best of times and the worst of times, the darkest of nights and the dazzling days, the excitements and the depressions.

So, if I were to toast them – my nephew and his bride – I would have wished them their current flame of love and romance to be eternal and I would have wished that nothing would dwindle it because the friends that they will, forever, be.

President Obama and Congress will soon make defining choices about health care and troops for Afghanistan.

These two choices have something in common — each has a bill of around $100 billion per year. So one question is whether we’re better off spending that money blowing up things in Helmand Province or building up things in America.

The total bill in Afghanistan has been running around $1 million per year per soldier deployed there. That doesn’t include the long-term costs that will be incurred in coming decades — such as disability benefits, or up to $5 million to provide round-the-clock nursing care indefinitely for a single soldier who suffers brain injuries.

So if President Obama dispatches another 30,000 or 40,000 troops, on top of the 68,000 already there, that would bring the total annual bill for our military presence there to perhaps $100 billion — or more. And we haven’t even come to the human costs.

As for health care reforms, the 10-year cost suggests an average of $80 billion to $110 billion per year, depending on what the final bill looks like.

Granted, the health care costs will continue indefinitely, while the United States cannot sustain 100,000 troops in Afghanistan for many years. On the other hand, the health care legislation pays for itself, according to the Congressional Budget Office, while the deployment in Afghanistan is unfinanced and will raise our budget deficits and undermine our long-term economic security.

So doesn’t it seem odd to hear hawks say that health reform is fiscally irresponsible, while in the next breath they cheer a larger deployment of troops in Afghanistan?

Meanwhile, lack of health insurance kills about 45,000 Americans a year, according to a Harvard study released in September. So which is the greater danger to our homeland security, the Taliban or our dysfunctional insurance system?

Who are these Americans who die for lack of insurance? Dr. Linda Harris, an ob-gyn in Oregon tells of Sue, a 31-year-old patient of hers. Sue was a single mom who worked hard — sometimes two jobs at once — to ensure that her beloved daughter would enjoy a better life.

Sue’s jobs never provided health insurance, and Sue felt she couldn’t afford to splurge on herself to get gynecological checkups. For more than a dozen years, she never had a Pap smear, although one is recommended annually. Even when Sue began bleeding and suffering abdominal pain, she was reluctant to see a doctor because she didn’t know how she would pay the bills.

Finally, Sue sought help from a hospital emergency room, and then from the low-cost public clinic where Dr. Harris works. Dr. Harris found that Sue had advanced cervical cancer. Three months later, she died. Her daughter was 13.

“I get teary whenever I think about her,” Dr. Harris said. “It was so needless.”

Cervical cancer has a long preinvasive stage that can be detected with Pap smears, and then effectively treated with relatively minor procedures, Dr. Harris said.

“People talk about waiting lines in Canada,” Dr. Harris added. “I say, well, at least they have a line to wait in.”

Based on the numbers from the Harvard study, a person like Sue dies as a consequence of lack of health care coverage every 12 minutes in America. As many people die every three weeks from lack of health insurance as were killed in the 9/11 attacks.

Health coverage is becoming steadily more precarious as companies try to cut costs and insurance companies boost profits by denying claims and canceling coverage of people who get sick. I grew up on a farm in Yamhill, Ore., where we sometimes had greased pig contests. I’m not sure which is harder: getting a good grip on a greased hog or wrestling with an insurance company trying to avoid paying a claim it should.

Joe Lieberman, a pivotal vote in the Senate, says he recognizes that there are problems and would like reform, but he denounces “another government health insurance entitlement, the government going into the health insurance business.” Look out — it sounds as if Mr. Lieberman is planning to ax Medicare.

The health reform legislation in Congress is imperfect, of course. It won’t do enough to hold down costs; it may restrict access even to private insurance coverage for abortion services; it won’t do enough to address public health or unhealthy lifestyles.

Likewise, troop deployment plans in Afghanistan are imperfect. Some experts think more troops will help. Others think they will foster a nationalist backlash and feed the insurgency (that’s my view).

So where’s the best place to spend $100 billion a year? Is it on patrols in Helmand? Or is it to refurbish our health care system so that people like Sue don’t die unnecessarily every 12 minutes?

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