Wednesday, August 26, 2009


Where I can discuss the news of the day.

Senator Kennedy's passing is the news of the day.  The outpouring of regard by the President and Vice President, along with his fellow Senators and those families whose lives he touched directly, has been moving.  The Vice President's remarks this morning were especially so I thought.

When my mother was disabled following her back surgeries it was Senator Kennedy's office that was the most helpful.  While Congressman Studds office got the ball rolling for her, it was only when the Senator's office got on the case that she got the attention she needed and the result she wanted.

My family has always been Kennedy supporters.  My first tie clip was a PT 109.  I believe that my grandfather cast an electoral college vote for President Kennedy.  I have a Robert Kennedy campaign poster in my classroom. I have read a great deal about the family, including a terrific little book about Honey Fitz.  I have read and studied this family as a story of shifting unifying political ideas in the 20th century.  Local concerns became national concerns became international concerns within 3 generations.  Only Teddy Roosevelt's political arc can be compared to it.

I attended the Senator's announcement for the Presidency in 1980. There was an article a number of years ago now in the Sunday Globe magazine in which I can be seen along the barricade as the Senator walked in.  I was 19 and studying political science.  The possibilities for government were very much on my mind and I was looking to hear what the Senator thought they were.  President Carter had said the country was suffering from malaise but had not offered a course of action for the community as much as he had for individuals. Candidate Reagan would take the position that there was a substantially limited government response needed and that no malaise exisited.  It was the return to a long standing public debate in American life. The Senator's role taught me a lot.

My friend Peggy Rice had an encounter with the Senator in the days when his behavior was suspect.  She had been invited to a party at Hyannis Port as her husband Peter had a relative that was marrying RFK's son. She sent me a memorable postcard in which she described the fading condition of the Kennedy Matriarch Rose (I describe it here with massive understatement) and how she had to dance with the Senator.  "It was gross." was the memorable end to the card.

My curiosity about the Senator always extended to why he served. He was the heir to considerable wealth, had noticeable appetites, and was subject to unrelenting criticism each and every day of his life.  He could have taken his ball and gone home.  I have never understood what he got from the positions he took or his willingness to stand in the political arena as a punch line. He would have been every bit as much a Kennedy had he not held office.  He would have been his brothers brother as a private citizen.  The place that John Kennedy Jr. and Caroline Kennedy have had in the public sphere proves the case for me.  Even the place that Joe Kennedy and Robert Kennedy Jr. have had proves it for me. He could have had all the perks and far less of the grief had he left office at any point.  I always wondered why he didn't and often wished he would for his own sake.  The trial of William Kennedy Smith was a very ugly episode and I wished then that he would just call it a day and go sailing. 

The issue of who will win that seat looms.  I will have to teach it now, along side teaching the ascension of Justice Sotomayor to the Supreme Court.  Political Science 101 taught that the succession crisis was the most dangerous in any regime. It will be fascinating to watch the potential candidates raise their funds, stake out their positions, and bargain among themselves over issues like possible debates and formats.  I would think the announcements would begin as soon as September 11.  The war will not be the biggest factor in the race but the anniversary of the terrorist attacts is a date that could be used as a break from the mourning that will have to last at least two weeks.  Two weeks from today is September 9th.

A primary will likely be held in late November or early December.  By law (unless it is changed and I believe the change could be challenged as an ex post facto law) the general election has to be held by the first week in February.  A late November election allows for an 8 week campaign season interupted by Christmas and New Years. That seems a reasonable period of time for any candidate to introduce and advance his or her record to the whole state.  I hope that it works out that way.

The passing of a public figure whose family has been part of the political fabric of Massachusetts for more than 100 years is destined to be an occasion for hyperbole. I won't add to it. I will look forward instead for materials to surface that lets us tell a bona fide historical story based on a record. There is currently a historian named David Nawsaw who is working on a biography of Joseph Kennedy Sr.  He was said to be given total access to a wide range of previously unavailable materials.  With the passing of the Senator and recently of his sister Eunice Shriver, there is only Jean Kennedy Smith to approve or reject the result of Mr. Nawsaw. We have the chance that a reformulation of the Kennedy family and its place in American life will emerge from his scholarship. For me that is the next stop in what has been a life time study.

Monday, August 3, 2009

Take Your Medicine

Where I can make a point about the current debate on healthcare.

Daily the headlines include news and commentary on a number of plans designed with a number of goals connected to medical services and their costs in the United States. I follow this discussion. I read each of the plans proposed by the candidates in the last election and an independent analysis done by the firm for which a colleague's son works. You could say I'm as up to date as much as a layperson might be.

The conflicts are not insurmountable. If medical care in all its forms is to be a market commodity then the time tested way of providing more of it is to increase its supply. We could fund more medical training with the caveat that this savings be reflected in the cost of care provided later. A greater number of doctors should provide for greater market coverage. This would eliminate the fear that care would need to be rationed to a greater extent than it is now and make no mistake health care is rationed now. We could also seek the prescription competition that is currently illegal. Surely there are countries with standards comparable to our FDA and we could import medicines from those countries and allow the market mechanism to lower price. These are a couple of ideas that would seem to be part of any solution that rests on a generally open market.

If on the other hand a collective decision was made that healthcare in the United States was not a commodity but rather was to be available to everyone regardless of means, and this is somewhat the case as no one can be turned away at an emergency room, then an attempt to control costs could begin with an emphasis on preventive care. Just as we require school children to be vaccinated in order to attend school, we could insist on standard screenings at appropriate ages that could interdict long term health issues. An example would be every thirty year old woman having the tests appropriate to her age and the tests being certified. The form would be included in a tax return. The results are kept confidential but that the test took place at all is an investment in lowering costs long term. Insurance companies are already rewarding proactive measures like this. A new designation of physician, a new means of providing medical service, emerges as a neccesity to replace the emergency room. The Nurse practioner model comes to mind. This would be the group who would carry out these new screenings.

The common point in either of these models is that there does not seem to be an incentive to become a doctor or nurse who provides medical services at a lower cost. This point was not addressed by either candidate in their platforms and it is not present in the current headlines and commentary either. That leaves this question for now:

How does the United States develop a policy that encourages people to be trained in medicine and act on that training at a lower cost short term and long term?