What's so funny, you may ask? North Korea, you may recall, is a member of George W. Bush's famous Axis of Evil, along with Iran and Iraq. Bush coined the term in a 2002 State of the Union address to emphasize to the American public how dangerous these nations are and how important it is that we be tough with them (read: go to war).  Now, suddenly the Axis is one member smaller, and not because we crushed them with nukes, but because we negotiated an agreement with them.

That's right, negotiated. Negotiated. Let's all say it together: ne-GO-ti-ated.

As in, we talked to them for a long time, and they agreed to back off on their nuclear enrichment program. No less than Mr. Bush himself says that the verbal agreements in place could greatly improve tensions in East Asia: “This can be a moment of opportunity for North Korea. If it continues to make the right choices it can repair its relationship with the international community.”

Simply amazing what diplomacy can do when you give it a chance. 

The rest of this essay writes itself. If this approach worked with North Korean dictator Kim Jung-Il, widely regarded as one of the most unprincipled and brutal dictator in the world, why wouldn't it have worked with Saddam Hussein? Why won't it work with Iran? What excuse could anyone possibly give me for the war in Iraq now that would dissuade me from believing we did it (1) for oil, and (2) because the Bush administration thought it could win the 2004 election if we were at war.

The irony is galling. We had to invade Iraq over WMDs that didn't exist, and succeeded in cutting a deal with North Korea over WMDs that probably do. Almost 5,000 Americans dead, 30,000 wounded, hundreds of thousands of Iraqis dead, and over 2 million refugees now homeless because Bush said diplomacy was not an option.

We have all known somebody in our lives who always knows better, the hardheaded fool who has to do things his own way no matter what anybody says, and who, after everything else fails finally does what people told him to do from the start and he succeeds at last.

There is nothing to do but laugh at them. It beats crying. 

Lest we think that politicians are only interested in taking rights away from guilty people, Congress is this very day moving to take rights away from the innocent. Since 2006, George Bush has been pressing Congress to pass a law that not only allows the President to tap any phone call in the United States without a warrant as long as he says he is doing it to prevent terrorism, but also grants immunity to any telephone company that did an illegal wiretap in the past. 

That's right. Any phone call you make any time can be tapped. Without a warrant. And there is nothing you can do about it. You can't even sue the government to find out the reason you were tapped. You have no rights. All your phone calls are free for the government to pluck, whenever they feel like it, and you can't do a damn thing about it.

I've written about this before. Earlier in the year, members of Congress tried to push a similar bill through, but were blocked by a filibuster. So they are trying again. What Congress and the President want to do is to make it illegal to sue a telephone company for a warrantless wiretap. Why is this a big deal? Because there are 40 or so lawsuits against telecom companies for illegal taps in the courts right now. If this law passes, all the lawsuits will be dismissed. These lawsuits are the only chance the public has of ever finding out what the White House was tapping and why. We don't know if the Bush administration was really hunting terrorists or if they were collecting information to blackmail people and win elections, or even to find out illegal stock tips they could use to steal money in the stock market. We simply don't know.

The government certainly has to do some things in secret. But secrecy should be a last resort, not the norm. If this law passes, secrecy becomes the norm. No citizen, now or ever, will be able to challenge the validity of a federal wiretap. 

This is amnesty for criminals. The criminals are the telecom companies who tapped calls without a warrant, and the government officials who told them to do it. These criminals get off scot-free, and the law that got them off the hook could go down the same week conservatives howl because detainees now have the right to a court hearing in which the evidence against them is presented. I am both furious, and afraid, of the people in charge of this country.

One of the most outrageous parts about this bill is that it was drafted up with the approval of Democratic leadership. President Bush is 9 months from leaving office, his approval ratings are below 25%. He is weak as a kitten. Why won't the Democrats stand up to him? The only answer I can come up with is that some of the people in the Democratic leadership are hiding something that will come out if the telecom lawsuits come out. Perhaps they took money. Perhaps they used the wiretapping for their own advantage. Whatever it is, it appears both the White House and the Democratic leaders have done something terribly wrong and they are pulling every stop to legally cover themselves. If we citizens do nothing about it, they will get away with their criminal behavior. 

It is said we are at war. War is no excuse for taking rights away from citizens. Throughout its history America has mostly fought wars for rights -- what a sad end we are coming to if we consider war a good reason to flush rights down the toilet. 

I was struck by this case because my own marriage is, in a certain sense, interracial. I am white and my wife is Punjabi Indian. Since Indians are often included under the Caucasian umbrella, our marriage may or may not have qualified as interracial under the old laws. Still, my sympathies are deep.  Interracial marriage is not defined by the net difference in melatonin concentrations between two skin samples. It is defined by the way society reacts to your marriage, and the way it regards your children. Since my wife and I have at times experienced feelings of uncertain acceptance, I feel we have known at least a hint of what the Lovings knew. Moreover, since my wife is a first-generation immigrant, and her family's first language is Punjabi, not English, there is a cultural difference between us that is in some ways deeper and more nuanced than that experienced in an interracial marriage between two Americans.

It is hard to believe the Loving decision was in 1967, within the span of our lifetimes. My wife and I live in Mississippi, one of the states that had strong anti-miscegenation laws, and yet, I am happy to say, we have not had very many problems. That alone is a reason to celebrate.

But that is not what I am thinking about now. I am thinking how glorious it is to be married to someone who is different from you. How beautiful the differences are, how being married to someone from my same cultural background would at this point seem so, well, boring.  Our challenges have been our triumphs. Our scars are the testimony of love, far more so than a marriage certificate can ever be. It is sad to think that within a generation past there were laws to prevent such sublime joys, but we learn. There is no stopping us now.

Today is a great day. Happy Loving Day to all.

Made it 1 and 1/2 miles, which is quite poor by my standards. I really thought the weight training would maintain my aerobic capacity at least a little, but I was very wrong. Not that I was ever a great runner, but there were times in my life when I regularly ran 4 to 5 miles, and long periods when I covered at least 3 miles a day.

For me, starting to run is like quitting cigarettes. I've done it a thousand times. Each time I go for several months, build up my endurance, then move on to something else. When I return to the track, I am back to the beginning, rewriting the oft-written running plan, this week 1.5 miles, next 1.75, 2.5 by the end of the summer, and on and on. When I limped off the track, I was reconstructing dreams of running a 10 k, maybe by the fall.

So here I am, at the beginning, again, wondering if I am too old for beginnings, but I don't have time to think about that. Gotta start figuring out a schedule. 

An MRI costs about $1500. Now, I consider this price scandalous, considering that in most developed countries MRIs cost a fraction of that, but no matter. The main point is that a hospital charged an insurance company $1500 for a test and never bothered to send the results to the doctor who ordered it. For $1500 the test report should be printed in gold leaf and hand-delivered to my desk by a Persian eunich.

This kind of thing happens all the time. I doubt 50% of the tests I order with a dollar value above $500 appear on the patient's chart in 2 weeks. 

I don't have a degree in business, but I have worked long enough to see that every business has a Top Priority, something that they value more than anything else. Top Priority may be making good hamburgers, or picking up the garbage on time, or having every order fulfilled by close of business. In the case of medicine, Top Priority too often is getting paid. In this case, we had to make phone calls in advance to get this MRI pre-approved. No money, no test. The MRI center made certain the check was in the mail before the patient was in the machine, but as for delivering the report to the right person on time, well, they'll get to that later.

Lest anyone think I am scapegoating the MRI people entirely for this situation, I will say that I have been on the other end of it. I have provided services to a patient, expecting to be reimbursed, only to be later denied. It's not a good feeling, and it is the kind of thing you don't forget the next time you are in the same situation. No one likes being cheated.

So many medical organizations put "Pay Me First" at the top of their priority lists. The problem is that when you make something #1, it tends to take the shine off whatever is at #2. I see it often: Medical organizations that worry so much about getting paid  that quality of care starts to slip. It's not greed -- well, not greed entirely -- that drives this. Most medical practices consider themselves lucky if 70% of the services they bill for are eventually paid. When 30% of your bills go into the uncollectible file for one reason or another, you tend to focus on getting your money whenever you can.

That being said, I alight again on "there's no exuse." The object of medical treatment is good health, not getting paid, and it is distressing that many organizations in medicine don't see it that way. If there is any urgent reason for health reform in this country it is this: Everybody worries about money all the time, and it puts us all in bad humor, and bad habits, and bad medicine. 

The man who shot her, Dwight Powell, is now in state prison. (His accomplice is still free, because Powell refused to give police his  name.)

Raines has, since the shooting, suffered from degenerative disease of the temporal mandibular joint, or TMJ, and over time the joint has deteriorated to the point where Raines can no longer open her mouth. Today she weighs 89 pounds and gets all her nourishment by drinking liquids through a straw. She needs joint replacements of both TMJs, but the artificial joints will cost $14,000, and her insurance will not pay for them.

The angle WWL chose for the story is that Powell, as an inmate of the prison system, would be eligible for the TMJ implants if he needed them, but Raines, the woman he tried to murder, cannot afford them. Although this angle adds to the sense of injustice of the story, I think WWL missed the more important point: Raines has health insurance. In fact, she has two plans, not one -- Medicare and United Healthcare -- and between the two neither will pick up the tab.

This is the real problem with health care in America. You may think you have health insurance, but you really only have the coverage your insurance company decides you can have. Few Americans, after all, really choose their health coverage. Most people take what their employers give them, or what Medicaid or Medicare offers. Very few people gets a choice -- in fact, the average auto insurance company allows buyers more coverage options than employers do. Carol Raines does not remember ever signing a document excluding TMJ replacements from coverage. But I promise you United and Medicare had no trouble finding the clause that allows them to do it.

The reason we don't have a decent health care system in this country is because about 70% of all Americans have either private insurance or Medicare, and sit fat and happy thinking they are covered. Certainly their insurance companies lead them to believe this is the case. The reality is that insurance serves most people well as long as the problems remain mundane, problems such as allergies, hypertension, or diabetes. When problems get complicated and expensive, the helping hands folks in the insurance business often do little more than help to hand their customers the bill.

A 2005 study by Harvard University showed that the average American who filed for bankruptcy that year had $12,000 in medical bills. Worse, 68% of these people had health insurance, and 50% of all filers cited health expenses as an important reason for their bankruptcy. The one thing insurance is supposed to do more than any other thing -- protect the client from the financial consequences of catastrophe -- is the one thing health insurance repeatedly fails to do.

 I have patients like Carol Raines, patients who have suffered severe financial setbacks from medical bills despite having all the coverage they could possibly get. You could be the next victim. It could be only a single blood test, or trip to the ER, or as in Raines's case, a terrible misfortune not of your own making, away.

That is the story the WWL news story missed. Until we, as a nation, realize that even those among us with "good" health insurance are terribly exposed, there will not be meaningful health care reform.

The junta that has controlled Myanmar (formerly Burma) since the 1980s is resistant to allowing foreign aid to come in. The President and the First Lady are urging the junta to allow U.S. assistance, which is fine, as far as it goes. The French are calling for the U.N. to invade Myanmar and forcefully deliver aid, which is much more like it. There are only a few days left before this disaster becomes a secondary disaster of infectious disease and starvation. There is no time to wait for a corrupt government to come around.

Unfortunately, in U.S. politics everything comes back to Iraq. Our army is pinned down over there, meaning the U.S. really doesn't have the personnel to spare for a military-led rescue. Which is what critics of the war have always pointed out: As long as we remain in Iraq, our hands are tied everywhere else in the world. So we get to wait while the U.N. gins up to molassas speed in an attempt to step in.

 It's a very sad day for the people in the West who want to step up and help. But not nearly as sad as it is for the people of Myanmar.

Land Lines

 
He couldn't sleep. Rove had let him and Marsha go "without prejudice," but something was not quite right. Cardinal sat up late thinking, but he couldn't figure out what was wrong. He reached for his cell phone, then stopped himself. With the new FISA laws, using a cell was about as safe as skywriting.

Instead he picked up his old fashioned land-line and dialed. His was a rotary phone, the model that hung in his grandma's house the day Ma Bell died. He recently installed it because an insider had told him the NSA computers had a bug that sometimes caused them to miss the old pulse dialing. The call went through, and a voice mumbled on the other end.

"Hello, Marsha?"

"Cardinal."

"I hope I'm not interrupting anything. You don't have someone with you tonight, do you?"

"You mean, am I sleeping with someone? No, Cardinal. In case you forgot, I was in Istanbul for the last 6 weeks trying to get you out of a Turkish prison. I've been in the U.S. for 12 hours and no, I haven't had time to hook up."

"Good. Anyway, I want to ask you something. Something bothers me about the way things went down today. I can't figure out what it is, though."

"You mean because Rove let us off so easily."

"That's it."

"Let's talk about it tomorrow. Remember, I am still your attorney, so our private conversations are protected. We can meet in my office. They won't bug us."

"You assume the Feds have ethics. Let's talk at a public place instead. I'll come to your office and we'll walk."

The next day, Cardinal picked Marsha up at her office and they headed over to the public library. "G-men don't read," he said. "At least not in this administration."

They sat at a desk in the card catalog room. No one under seventy in sight. "All right, here's the deal," Marsha said. "I think the government is using you as a pawn, a distraction."

"A distraction? From what?"

"I haven't figured that one out yet. They send you out on a dangerous mission, and you create all kinds of havoc. You did it twice, once with the hijacked plane, and then in Syria and Turkey. The noise you create allows them to do other things, without the public noticing. You take up all the public bandwidth, you might say."

"Marsha, the hijacking was an accident. We just happened to come across the ELFs --"

"You think so? I think the ELFs were a plant, to get you to do, well, you know, what you always do. Ever heard of the ELFs before, or since?"

"Well, no."

"Precisely. They were government. That's why we got out of the hijacking scot free. It is also how we got out of Turkey. The Feds let us create a distraction, and then when the distraction was no longer needed, they got us out."

"So you think Rove suckered us."

"I do. The question is, what was the distraction for? I've been checking the papers, looking for suspicious happenings while we were creating our diversions. During both times we got into trouble, two things happened. First, there was a major flood. Second, a blockbuster pharmaceutical was withdrawn from the market. Now, I can't see how the government could control a natural disaster, so I am thinking there is a connection with the drug withdrawals."

"Like what?"

"I haven't figured that out yet. Maybe terrorists are trying to poison people. Maybe the government has a shady deal going with the big pharmaceutical companies."

"Well, I guess we have some detective work to do."

"Yes. There is a major pharmaceutical convention going on in Las Vegas this week. I think we need to get over there and do a little investigating."

"I'm up for that. The place will be swarming with pharmaceutical reps. I hear those chicks are hot."

 

The cause of death? Reckless campaign promises, made by the two remaining Democratic candidates in the debate Wednesday night. This is how Walter Shapiro reported it in Salon:

Wednesday night's debate may have more lasting significance if either Obama or Clinton is elected president than it did in helping sort out the primary field. Pressed by [moderator George] Stephanopoulos to make a "read my lips" no-new-taxes-on-the-middle-class promise, both candidates took the bait. Clinton expressed this Republican-esque promise in unequivocal terms: "I am absolutely committed to not raising a single tax on middle-class Americans, people making less than $250,000 a year." Obama eagerly joined in this bidding war, saying, "I not only have pledged not to raise their taxes, I've been the first candidate in this race to specifically say I would cut their taxes."

Both of these candidates have been traveling coast to coast, promising sweeping health care reform. Now, I do not pretend to be a financial whiz, but I know enough about health care to say with confidence that it will be impossible to provide universal health care without raising taxes. Obama/Clinton may respond by saying that we will find the money to insure 47 million Americans by (1) ending the Iraq War, (2) making health care more efficient, and (3) allowing the Bush tax cuts on the rich to expire.

Hoooey. The Republicans have been foisting this something-for-nothing nonsense for decades now. It never works. Real, comprehensive health care reform will require tax increases on everyone. A mandate requiring every American to carry health insurance is, in itself, a tax. Clinton proposes mandates. Obama does not, but as soon as he looks at the budget numbers if he is elected president, he will change his mind. I don't think universal health coverage can be achieved without mandates, at a bare minimum.

At any rate, whichever health care reform is proposed, it is completely irresponsible for any candidate to promise that he or she can make it happen without broad-based tax increases. No other industrialized nation manages it without some kind of tax, be it direct (via income) or indirect (with mandates). It can't be done.

From my perpsectivie, health care reform is DOA on the Democratic side without taxation at least on the negotiating table. Let's assume Clinton is right and reform can be financed purely through savings from requiring everyone who can afford it to buy coverage. This is a big if. To put such reforms on the table without at least a backup plan for financing is ridiculous.

People who are serious about health care reform will admit it will be expensive and may require new taxes. People who won't are candy salesmen.

All this talk about who has the courage to answer the phone at 3 AM,and neither candidate has the guts to tell Americans universal health care is going to cost them money. Well, maybe we'll find someone serious about reform in 2012. 2008 is already history, as far as I am concerned.