Edward M. Kennedy

Today the family Senator Edward "Ted" Moore Kennedy buried him at Arlington National Cemetery after a mass. This followed a procession with the body and it lying at the JFK Library in Dorchester, and a celebration of his life last night.

When I heard the news Wednesday morning, I woke up to the radio. My clock ran a little ahead of time, and since I did not hear a headline, I had to deduce that something happened. Hoping against hope, I eventually heard the line closing the hour's news that Senator Kennedy had died overnight. As I got ready for my day, NPR went in the background, and more than once I teared up.

So many others have reflected on Ted Kennedy. The New York Times Opinionator Blog has a great collection of things people said about him. I probably cannot add much more in value, but since blogging is as much a selfish cathartic act, I will partake in my own reflections.

My contact with Ted Kennedy came from my mother who loved his two older brothers, John and Robert. She particularly held Robert in high regard and remembers his assassination quite well. Ted, marred by Chappaquiddick and his alcohol, always seemed to be a disappointment. Like so many, she constantly thought of his brothers.

Yet, Ted Kennedy rose to meet the challenge and exceeded them. What makes him so unique is that he did all of this in spite of all the problems. Yes, he grew up privileged. However, he did endure the tragedy of seeing three of his brothers killed. He had to deal with John's advisors working against his run for the Massachusetts Senate seat. As Chappaquiddick shows, he had great flaws. Yet, he reached out to people. People living in the Commonwealth of Massachusetts said that he and his wonderful staff would always work hard to help them with the little things. He really did love people, and that showed.

Beyond that, Kennedy was a brilliant legislator. He started in the Senate, and slowly worked his way up. When he lost the nomination in 1980, it may have served him well, for he dedicated himself to the work in the Senate. Kennedy developed his skills in a sort of modern era of great Senators, like Philip Hart. Kennedy always knew how to compromise legislatively without compromising his goals. He and his staff were always willing to help other Senators as well fit into the strange institution and showed a deep desire to work to find common ground for the common good. After all, one of his best friends and legislative partners was conservative Senator Orrin Hatch, with whom he often argued strenuously, but at the end of the day embraced.

The words used to describe Kennedy was the Liberal Lion. He gave voice to the weak and the powerless. He gave us all inspiration as to our abilities in many ways to transcend our petty differences and human failings. In so many ways, he reflected the type of values I held, and taught me a certain way of carrying myself in the world of policy and politics.

Talking with my mother the other day, she conceded that she finally realized now how much Kennedy had done. He was a great speaker, but he was a workhorse. So much of the best of what he did were stories of getting involved in the nitty gritty details of legislation and small feats that touched the lives of individuals. Not just through longevity, but through this practical idealism, Ted helped create for himself a practical legacy that may actually outshine his more famous brothers. Health care? Ted Kennedy is probably there. Education policy? Teddy's fingers are all over it. Civil Rights? Ted Kennedy was a protector of them.

Kennedy perhaps is one of the last great institutional members of the United States Senate still serving. With his passing, really only Senator Robert Byrd, who revolutionized Senate procedures, remains. Byrd himself is sick and deteriorating to the point of slowing down. In that sense then Kennedy's departure leaves a void in the Senate. No longer is there a Senator who serves his constituents but also transcends some larger stage and really enjoys the work of the Senate with no eye towards something more. Perhaps Senator Inouye may fit the bill of an institution, but he has less of the overt known quantity feel than Kennedy or Byrd.

As I sat that morning of his death, the most poignant moment for me came from the speech. It was the 1980 Democratic convention concession speech. Kennedy sounded more like a winner than one conceding. He outlined clearly his personal ideals and vision for America. It is political speech, but it is rousing. The last line in many ways is famous and Kennedy echoed it again during his speech in support of Barack Obama. It echoes the famous statement in Pirkei Avot about not completing the work and not being free to desist. That line caused me to lose it. Yet, it also inspired me once again to honor this man through living a life of justice and good deeds.

So I end with Kennedy's own words. Even without him here in this world, we must rededicate ourselves and realize that "for all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die."

Weird times for the Red Sox

So, it seems as though I occasionally need to get my Red Sox feelings out. So, today I write about two weird occurances over the last two days.

First was Thursday's game. Who on earth would have thought Nick Green would pitch? Here are some photos of the event. All I have to say is that it brings new meaning to the word journey man infield utility player. Technically, after all, the mound is infield, right . . . . That said, it is amusing, and you kind of have to feel good about the guy. They still lost. But, it made for a great story about a guy, you at least get the sensation is not the greatest player but has a really good work ethic.

Then last night, rain turned the game into a sloppy mess. Mr. Beckett's pitching was not nearly as good and there were some crazy plays like Mr. Varitek getting someone out on his way home. Hopefully, Mr. Beckett will find his pitching again. I try not to panic too much though.

American Exceptionalism and Health Reform

Normally, I am a big fan of American Exceptionalism. For the most part, it has done our country well, and I would argue it may act as a glue that holds our diverse society together. Unfortunately, it also leads to problems, like a flat out ignoring of important facts. Nothing has brought this to my attention more than in the current health care debate.

Today, on Meet the Press Senator Orrin Hatch (R-UT) claimed that the U.S. has the best health care in the world. (On a completely unrelated note, read Jon Cohn's response to the Hatch interview regarding numbers that would appear on the public plan by CBO. Yes Gregory did catch Hatch.).

However, signs show that this is not the case. Most recently the Robert Wood Johnson Foundation worked with the Urban Institute to publish an issue brief that asks if the U.S. has the best health care in the world. (Tip to Ezra Klein).

Here's a bit of a sample:

An analysis from the Urban Institute looks at the evidence on how quality of care in the United States compares to that in other countries and provides implications for health reform. Authors Elizabeth Docteur and Robert Berenson find that international studies of health care quality do not in and of themselves provide a definitive answer to this question.

What they do show is that the evidence for American superiority in quality of care (or lack thereof) is a mixed bag, with the nation doing relatively well in some areas—such as cancer care—and less well in others—such as mortality from treatable and preventable conditions.

And while evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

This is also not the first study to find this. Indeed, the brief itself is essentially a review of a lot of literature. Everyone has searched to find inklings that the U.S. has the best health care in the world by some measure. Only a few have found it, and it is usually confined to narrow areas and even so it is not overwhelmingly better. Note too that T.R. Reid in his new book and today's Washington Post makes a similar argument.

But, of course, there is this idea of American Exceptionalism that is so deep-seated into our culture that it makes up part of our situational milieu and reaches into our subconscious as part of our situation. It is the idea that America is exceptional. It is a leader in everything, and the best in everything. That cultural idea has roots to John Winthrop's famous "City on a Hill" idea of Boston and the colonies there serving as a new Jerusalem.

Unfortunately for wonks like me, there is really little that studies like this wonderful Urban Institute thing can do. It affects a deeper part of our situation, and the situation as Jon Hanson has often said, is much stronger than the disposition. Furthermore, I think deep down most Americans do find it troubling that we have a system that has so many individuals uninsured and that costs more than the rest of the world. Yet, we have our exceptionalism, and indeed, we have to believe that the world is just and right. The system justification theory then also kicks into the discussion, and the moves arise in this basic way

1. We have a system where millions are uninsured and cannot get coverage, and thus suffer needlessly.
2. We also have a lot of costs.
3. But the world is just, and we are the U.S., an exceptional country.
4. There must then be some sort of a reason for this matter.
5. The reason we have this problem is because people deserve it by not working hard enough and that we must be spending so much and have so much fracture that our system must do something right through innovating.

Now this is likely a poor oversimplification of what is going on, but I think my point is made. Such a sort of illogical conclusion is not something that one can easily get rid of, especially if it is deep-seated.

Unfortunately, health reform seeks to fight this, by pointing to the rest of the world saying we should become like them. That attacks our exceptionalism and that shows that our just world is perhaps not so. This leads then to resistance, and ultimately, a status quo bias.

Evolution and Religion

Today's NY Times has a great Op-Ed by Robert Wright at the New America Foundation regarding evolution and religion, a large debate that is often very complex and fraught with emotions. It is well worth reading in full. One should note that the piece is difficult and highly nuanced though.

One point Wright makes that is worth noting is that both sides make a fundamental error that is basically the same:

I bring good news! These two warring groups have more in common than they realize. And, no, it isn’t just that they’re both wrong. It’s that they’re wrong for the same reason. Oddly, an underestimation of natural selection’s creative power clouds the vision not just of the intensely religious but also of the militantly atheistic.

If both groups were to truly accept that power, the landscape might look different. Believers could scale back their conception of God’s role in creation, and atheists could accept that some notions of “higher purpose” are compatible with scientific materialism. And the two might learn to get along.

Wright makes an excellent point on how we attribute things. Both science and religion have deep seated and quite inspirational purposes. Science does achieve a very high purpose, understanding the unfolding of the natural world. Part of the reason why I wanted to go into science and actually had some mild success stemmed from that idea (I of course failed because I hated the lab, but that's another story for another time).

Also, there is the question as to what exactly is God's role in creation. That too for a believer like me is complex. God's role is not some literal creation. It may just be setting the algorithms in place. However, I think imprinting altruism into the larger evolutionary framework as an underlying phenomena that natural selection chose (and it appears in other animals) may be what is going on. I do not take creation with any literalness, as it has its textual problems (See Genesis Chapter 1 and 2). However, I do think that it is hinting at something powerful and natural, and that is something about order in the world and the capability of humans to see that order, and a way of inspiring us toward that common good.

Of course, I think Wright's piece will likely get attacks from everyone as disingenuous and wrong. I think both sides have put too much in stake in the so-called war, and each side really wants to just win. Sadly, that may be the evolution our society is taking on a lot of matters.

50 Years of the 50th State

Today is the 50th Anniversary of Statehood for Hawaii. It is perhaps one of the strangest and most complicated of all states to join the Union for various reasons. I attempt to poorly encapsulate the history of this event.

It goes back to the overthrow of the monarchy, illegally, in the 1890s. Queen Liliuokalani abdicated the thrown and white plantation owners imprisoned her in the palace as they declared a new Republic of Hawaii, with the sole point of joining the Union as a territory. As Robert Remini pointed out (I think) in his book on the House of Representatives, the U.S. was divided even during this time of high imperialism. Eventually Speaker Thomas Brackett Reed, who allowed the House not to become the morass that the Senate is, let the Annexation Bill through during McKinley's time, even though he opposed it. Soon American imperialism outright annexed Hawaii.

Oddly though, there was always a question as to whether Hawaii would become self-governing within the U.S. as a territory expanded or whether we would hold it solely as an imperial possession like the Philippines, with the hopes of one day turning it loose. On the one hand, it did have a lot of non-whites that people thought could not self govern. On the other hand, the Congress did during the annexation incorporate Hawaii, allowing the Constitution to follow the flag, unlike Puerto Rico, Guam, and the Philippines (See Downes v. Bidwell, 182 U.S. 244 (1901)). Interestingly though, there was a period where the Constitution did not follow the flag to Hawaii, but Congress's incorporation around 1903 (I think) solved that problem.

So, what was Hawaii? A colony to be governed from the metropole? Or some sort of entity that we hoped to groom to join the insoluble union of states? The question has never really been sufficiently answered.

In the intervening years, the territory saw some level of self-governance with the legislature, and an appointed but powerful governor. The Homestead Act of 1928 granting certain lands (bad ones at the time) to Native Hawaiians for rent at a very low rate. There was Pearl Harbor and the military bases. Sugar and pineapples drove the economy, but on the dawn of statehood, the new industry, tourism started to take grasp.

After World War II, the United Nations, which the U.S. helped create (something we often forget), created a little list of imperialist trust territories. These territories had to become either independent or incorporated. Hawaii made the list of territories.

The push was on. However, Southerners were no fan of a majority minority state. Meanwhile, back home a great deal of consternation arose among strange bedfellows. The Native Hawaiians saw an illegally taken state. White plantation owners feared of course the minority workers gaining control as they had more numbers.

However, a bill did move, and eventually a plebiscite was held with over 90% of Hawaii residents approving of statehood. Hawaii joined the union on August 21, 1959. It was removed from the UN list. This happened many years one should not too after having the U.S. Constitution follow the flag to Hawaii, and many question if the U.S. really moved out of self interest in holding the territory as a possession. One cannot say for certain what actually led to Statehood itself.

Yet, in some ways, the questions still remain. The State of Hawaii under the Admissions Act had to handle Native Hawaiian Affairs pending some resolution. That resolution still remains. The cloudiness of the territory, and the speed at which it was admitted post-UN Trusteeship, and most importantly the status of self-determination for Native Hawaiians (NB: I am not one myself) continues to raise questions for the future of the state as a whole. Will the Homestead Act survive? What is the future of the Native Hawaiians and their self-determination that the Admission Act itself implies? What will become of the last state to enter our union? Will others too finally follow or be set free?

As readers and friends may know, I have supported the Akaka Bill. My own personal feelings is still that statehood was right, and the only way for a state to leave is for consent of the American people as a whole through their representatives (states seceding on their own was answered in the period 1861-1865 though again Hawaii presents some unique questions since the overthrow and annexation was sort of more recognized internationally as a violation of customary international law). Still these questions dog me as someone who grew up in Hawaii and still cares for it.

Let us celebrate the past 50 years, let us look toward the future, and let us reflect deeply on the troubling questions too that history presents us.

Update: Paul Theroux's take (he once said "Hawaii is not a state of mind; it is a state of grace").

The Life and Death of the Public Option

A lot of people seem to have their hands up in arms about the recent Administration positions on the Public Option stemming from the Sunday morning babble. However, like so much of the debate, I think this is a matter of more heat than light.

The story really comes from this NY Times article, as well as this Washington Post report.

The Administration, however, has not really changed position all that much. They have consistently supported the public option, but never said it was a line in the sand. They have said this from the beginning.

However, both Jon Cohn and Ezra Klein point out this has been a point that the Administration has sort of held from the beginning.

Can you fault the Administration for not pushing harder on this? Probably yes. Their messaging has been below par on this, and many other health care reform matters (sadly I think the issue as framed and thought of by everyone does not play to Obama's rhetorical strengths. However, as Nate Silver points out in his posts here and here (both of which are worth reading in full) even though popular with most people, it is not popular with the people who decide all of this, a subgroup of 6 who are a subgroup of 100 people who represent states rather than people.

Yet, here's the concern. It is that the desire for the perfect turn into the enemy of the good. The public option is a good thing. Many liberals really want it. I really want it.

However, what do I want more? I want major reform that would eliminate pre-existing conditions as part of health insurance. I want subsidies for lower income individuals. I want better risk pooling in exchanges. I want some start on the cost control matter, whether through an IMAC.

In other words, even without the public option, we could get a lot of these. And what are the stakes otherwise? Well, for starters the Democrats will have dug their own graves in the midterm election and harmed their own President in a very serious way. They will also help contribute to the status quo, and cause greater problems.

Even without the public option most of the reforms I, the blogs on my reading list, and other policy people have advocated for that are contained in the bills make a major, yet not entirely sufficient step toward fixing our system. That is very important, because, I think it actually builds momentum toward fixing it. If health reform fails over what is really a much smaller aspect of the puzzle than many other matters, it becomes off limits for another generation. That is something we just cannot afford on both a moral and even a fiscal level.

Trying to Simplify Health Care

The various blogs I read have talked about these, so I'm going to do one myself for my friends too.

The first is the fine Washington Post health care cheat sheet. It is a major simplification, but it outlines exactly what is at stake, and seeks to reduce the heat and show the light.

Second is a flowchart, which many have posted before. There was the infamous House Republican Flowchart attacking the bill, and the equally if not more complicated Jon Cohn flowchart of the status quo situation.

However, now comes a flowchart that rules them all. It is again a simplification. The question is what level of granularity you look at with regard to these policies. And this seems to outline best what is at stake. Thanks to our friends at Donkeyliscious (and Nick Beaudrot in particular).

How simple can you make it?

Oh, these Red Sox

I became a Sox fan in the early 2000s, before 2003 when they almost won the ALCS and before 2004 when they won the World Series (which I really never expected).

I feel like that again. After what happened. People often say it's Fenway, which is a hitter's park. Perhaps too there is the strong psychological factor of the loyal fan base. But, we need to start winning on the road as the Globe points out.

And meanwhile, it is interesting. Our shortstop mess is really complicated as the Globe stated the other day, although I am hopeful as it does give us some flexibility.

Oh well. Time is ticking, but we can pick up some of the pieces.

Hawaii Employees, Brand Name Drugs, and Status Quo Bias

Today's Honolulu Advertiser has a worthwhile story about the State Employees Drug plans. The article essentially says that for cost savings measures various things have ocurred, many of which have angered state employees.

This highlights though an interesting question, and one that runs deeper within our framework of health care. One of the key ideas is that it requires generic drugs before one can get an exception of coverage for the brand name. You can still use the brand name if available, but you must pay both the generic copay and the price differential. Often the price differential is huge.

Study after study shows that generic drugs are just as effective as brand drugs except in certain cases. Yet, we still continue to use brand name drugs, and people often choose them. What then happens is they pay the higher brand name co-payment, but the cost is hidden, by the insurance picking up the tab.

This is not any way for a rational market to act. I sort of think that the structure of this new plan with regard to this one matter is probably the right move. It would control costs without any quality changes, and if there are problems, one can get an exception.

However, the outrage stems from a sense of the idea that "my doctor has prescribed this, and I have always taken this, why do you force me to change." That is the classic status quo bias. This bias sort of grows in our health care system, because so often it does not put pressure on people to change. Doctors too are notorious for status quo bias, often doing procedures that do not work, partly because that was how they were trained, it is difficult to stay abreast of the literature, and they often do not have any incentives to do otherwise.

Changing people's behavior is what we are trying to achieve here. The greater question that arises is if A is just as effective as B, but A costs 3 times more, why pay for A? Would not a rational market and consumer go towards B? That's sort of what this generic argument is about.

Or put another way, the state's new plan really is looking at the forgotten part of my favorite equation.

C = U x P

That would be the P. However, as I have stated earlier, and as the article itself shows, the resistance to P is much higher. Partly it is this strong status quo bias. Partly too, it disrupts in a deeper way vested interests in the system.

One final note. Liberals too should embrace cost sharing. I link back to our good friend Ezra Klein talking about various schemes in this manner.

Good Night Links

The NY Times gets down and dirty calling things lies.

And death panels are really linked to the estate tax, or rather the temporary one year of no estate tax and then the sudden revival of it at pre-2003 levels.

Joanne Kennan talks about advanced planning while Jonathan Cohn shows how others thought of the matter.

Ezra Klein interviews Karen Ignani head of America's Health Insurance Plans (AHIP).

Felix Salmon has a fascinating view of regulation of securities and wealth of the country.

Meanwhile, the scene cuts to a to lone dancer and you cry again.