In All Things

Some onlookers might find it problematic or even scandalous that a group of nuns supported the current health care reform bill whereas the U.S. Catholic bishops opposed it in pursuit of stronger protections against the possibility of abortion coverage and worried about costs. Some news reports seemed to position the nuns over against the bishops, as though there was some sort of internal rift going on or a battle over authority, neither of which is the case.

Surely it is obvious that on health care, these nuns have special expertise, having founded and operated some 600 U.S. Catholic hospitals and entire hospital systems for decades. Both the nuns and the bishops speak with authority on these prudential issues. My own view is that the highly public airing of the two different positions is a healthy development. I assume that both groups not only oppose abortion, but also acted on their principles and followed their consciences. That’s the kind of thing we Catholics have come to expect from our faith leaders, which the nuns and the bishops are. What is both positive and valuable is that their actions demonstrated in full public view, and with civil, reasoned explanations of their particular positions, that Catholicism is no monolith in the public square.

Being a Catholic (a very good Catholic) does not necessarily result in political uniformity. And it does not, even when the legislation proposed is a matter of life and death, which health care, abortion, and paying for care ultimately are. Rep. Bart Stupak, Speaker Nancy Pelosi and many other Catholic lawmakers have worked hard to ensure that the legislation does not contradict their own principles. Their efforts are yet another version of modeling before the public how faith is applied on the job. You see, faith cannot truly be legislated. But free and judicious exercise of faith can improve the legislative process.

Karen Sue Smith

Hindsight isn’t always 20-20, but often it is. Now that the Democrats have lost their shot at a filibuster-proof majority in the Senate (which is all it ever was, really, given the two independents and the pack of Blue Dogs), they must be flagellating themselves over the obvious. Before tackling health care reform they ought to have changed the procedural rule that makes the 60 votes necessary. Had they accomplished that, nearly all Americans might be insured now, and other future reforms would be much easier to legislate. As it is, that opportunity may be irretrievable.

“May be,” because sunny President Obama still hasn’t given up his efforts to bring both parties together. And Congress may yet find some way to turn much or some of the reform measures into law.

Health care aside, the Democrats’ failure to put first things first (to put the procedural over the substantial, in this case) brings up the importance of foresight now, instead of hindsight later. Foresight is never easy, and especially today with so many global and domestic crises roiling the political waters all at once. But foresight, learning from mistakes, perseverance and building some unity where polarity threatens to divide the nation are what leadership is all about.

Consider the next Congressional election: What can be done now to ensure a fair and accurate race? Both parties ought to make certain that voting machines work in each district; that eligible voters are encouraged to vote, not dissuaded from voting by threats, misinformation or other impediments. The Supreme Court’s recent unleashing of limitless corporate money in electoral campaigns must be curtailed as much as possible. What about campaign finance reform--is that completely dead? Or can more be done? Such questions and focus are just a start for starters.

Citizens ought to demand serious actions and policy proposals, too. Not just sit back and watch political football: one team runs toward a goal and the other knocks them down. The national and international goals are too serious for such spectator-like behavior. Democracy itself is the game we’re playing.

Karen Sue Smith

With her last-minute bid for a seat in Congress, Imelda R. Marcos is making yet another comeback. The flamboyant Mrs. Marcos has made several comebacks over the decades since she stepped down from the stage she occupied for 20 years as First Lady of the Philippines. When she and her husband Ferdinand E. Marcos, the two-term president-turned dictator, were exiled in 1986, she endured the humiliation. But after her husband’s death, she not only returned to the country, but ran for president a year later. She lost the 1992 election, garnering just 10 percent of the vote, but that did not discourage her. She ran for and won a seat in Congress as Representative of the District of Leyte, her home province, and served a three-year term. She ran for president again in 1998, but withdrew in favor of the candidacy of her friend, then Vice President Joseph Estrada. Estrada won, and so did Mrs. Marcos in one respect: During his administration, many of the lawsuits and criminal charges filed against Mrs. Marcos for graft and corruption were dismissed. And the Supreme Court overturned the one major conviction against her. The government of President Corazon C. Aquino had accused the Marcos family of stealing nearly $5 billion from the Philippine treasury, but was never successful in recovering the money.

Now, at 80 years old, Imelda Marcos is seeking her second Congressional seat, this time in Ilocos Norte, the northern province where her husband once held the office. If she wins the election in May, it may say less about her personal star power than it does about the powerful role money and patronage still play in winning elections in the Philippines. The event could also turn into something of a dynastic coup, depending on the outcome of two other races. Her daughter, Imee, is running for governor, and her son, Ferdinand Jr. lleft his own Congressional seat to run for Senate.

Karen Sue Smith

The public option is “an option.” No one would be forced into it. Rather, it would be offered along with other choices in what has been called “a health insurance exchange.” The benefit of an exchange is that it would allow consumers to compare plans and then to choose for themselves.

The plan would also be structured as a nonprofit, government run insurer (similar to Medicare, which is huge and well liked by those covered by it). The nonprofit piece is important because those running the plan would not be working to achieve maximum profit at all times. Right now there are some nonprofit insurers in the United States, but a government plan could be large enough to negotiate prices with pharmaceutical and medical device companies and with physicians; it could compete with private insurers, many of which are large. (Because of an amendment to the House bill made by conservative Democrats and a deal the administration has struck with drug companies, that ability of the public plan to bargain on drugs may have been weakened. But that was the original hope. (In my opinion, Medicare should also have that power, but Congress has not allowed it so far.)

The biggest plus of any public plan is cost savings: with lower overhead and marketing expenses, a public plan could maintain lower costs than private insurers. Its savings would provide incentives for private insurers to cut their premiums, too, or to appreciably increase coverage or service. In that way, even holders of private insurance would benefit from the public plan. For a chart on how well Medicare holds down expenses right now in comparison with private insurers see an article from The New Republic by Jonathan Chait.

Who could buy insurance in the public plan? Not everyone, at least not at first. Since the reform would require every American to have insurance, some 46 million people would be entering the insurance market. The public option would be open first to those uninsured persons in the lower income brackets—those who most need the cost savings. Later, others might be allowed to join, according to some schedule the government would set up.

That means that employers would not rush away from their private insurers to take advantage of a lower cost public option. Notice, that this favors private insurers. It also helps the govt (the taxpayer), which will be subsidizing the insurance of low-income people. It behooves the government to “subsidize its own plan,” which would save taxpayers more money.

One more point. Some areas—and some states, often rural states like North Dakota—have just one main insurer. For example, Blue Cross Blue Shield has 90 percent of the ND market. With a public option such market dominance could change, giving people more choices.

The public option, then, gives more choice, real taxpayer savings, accountability and competition. The goal is that it would eventually be self-sustaining, financed by the premiums paid. The key to making that a reality, however, is lowering costs.

The five obstacles to health care reform named in the America editorial of Aug. 31-Sept 7, is hardly an exhaustive list. Other obstacles keep getting in the way. I’ve identified five more below.

1. Distrust of government. Andrew Kohut, president of the PEW Research Center, asked rhetorically whether Medicare itself would be passed today, if a bill to establish it were up for a vote in Congress. He didn’t think it would pass, because Americans today are more suspicious of government than they were in 1965. That’s the year President Lyndon B. Johnson signed the Medicare bill into law, with an aged Harry Truman on hand as the nation’s first Medicare recipient. Readers may have their own explanations for why distrust and cynicism have grown. But it is hard to understand cynicism about the government’s role in health care because Medicare, which now has a long, positive track record, enjoys immense popularity among the seniors and others enrolled in the program. And Medicare is a single-payer, government run system. What I don’t understand is why seniors aren’t the biggest supporters of reform--that would make more sense to me.

2. Money and interest groups. Money talks. It air time, newspaper space, advertisements; it talks in Congress and in state houses. As an industry, health care makes up one-sixth of our Gross Domestic Product. Interest groups have sent lobbyists to Washington to promote their own particular interests. That seems to be the American way, but does it, can it, result in what’s best for us as a society? It is possible—indeed we may be watching it happen—to chip away at a reform package so that what starts out looking like a significant improvement, ends up a bare shadow of its original self. It will take concentration and focus for legislators not to trade away the basic reforms we need: to both expand and improve care, while also cutting costs.

3. Needing to work with systems already in place. America’s health care is currently a combination of private insurance (for-profit and not-for-profit) and government programs. It is politically unfeasible to start from scratch (anyone who thinks it is hasn’t watched the August campaign to derail reform). Still, some people wonder why Congress doesn’t expand Medicare to include more Americans, since it works, it is less expensive than private insurance, it’s popular, the program itself is a leader that other health providers follow. And the government has reason to think it can find real savings there. Again, Medicare is a single-payer option that members of both parties like.

4. Public ignorance. This may be the toughest obstacle to overcome. For the public will need to know what is actually in the proposed legislation if they are to evaluate it knowledgeably. Individuals should also know what kind of insurance they have or need. Instead, we have seen a protestor demand that government “take its hands off my Medicare.” And we’ve seen willful ignorance by commentators and members of Congress who should know better, like the assertion that Stephen Hawking, the British physicist who has muscular dystrophy, wouldn’t even receive care in Britain. Hawking, who lives in Britain, publicly refuted the absurd claim.  

5. Complexity. Health care issues are often difficult to understand; sometimes they require a level of expertise that most people simply do not have. Although medicine is based on science, it involves uncertainty and many unknowns, not just at the level of diagnosis but throughout treatment. And the stakes—life or death and quality of life—are complicated to sort out. Ethics and religion play a role. Illness, injury and disease are complicated, often not well understood, and typically connected as in “this treatment or drug can cause this side-effect, which can cause X and Y.” Prevention and treatments do not always work. Sometimes there is no cure. Health is multifaceted: body, mind and spirit are linked.

Medicine is also a big, complicated business: think of hospitals, rehab units and rest homes; think of boards, administrators, physicians, nurses, technicians, pharmacists, researchers, office workers and enough employees to maintain 24-hour care 7 days a week. Complexity makes people cautious about change; while trying to improve what is broken, one must not damage what works.

The New York Times editorial on Sunday (8.23.09) had more information than I was able to impart in my blog “Who Are the Uninsured?” last week, about one group within the nearly 46 million people in the U.S. without health insurance: the 13 million young adults aged 19-29. This information is important because speculation drives opponents of reform to postulate about this group, imaginings not based on fact. It is also important for those who are thoughtful but still undecided about health care and who want to learn more about the actual profile of those without health insurance.

Here’s what the Times reported: "These are not, for the most part, healthy young professionals making a sensible decision to pay their own minimal medical bills rather than buy insurance that they are unlikely to need. The Kaiser foundation estimates that only 10 percent are college graduates, and only 5 percent have incomes above $60,000 a year, while half have family incomes below $16,000 a year. Many of these younger people would be helped by reform bills that would provide subsidized coverage for the poor and an exchange where individuals can buy cheaper insurance than is now available.”

One last point: Even though the Times editorial calls it a sensible decision for a young health worker to forgo health insurance and to pay for care as needed, it is only sensible in one respect: that in general the risks are low, so the individual can save money. But the risks are never zero. Moreover, by mandating basic insurance coverage for all, the government ensures that the insurance pool will expand to benefit society at large. Then, if a young, strong person is injured or becomes ill and faces enormous bills, well beyond what he or she may have imagined, that individual benefits from the coverage as well as society at large.

I was both surprised and chagrined to see the reaction against the views expressed in an Op Ed piece in the Wall St. Journalon Aug. 12, 2009:“The Whole Foods Alternative to ObamaCare” by John Mackey, co-founder and C.E.O. of Whole Foods Market Inc. The opinion has ignited a boycott, or at least strong talk of one, by some people on the left. I thought liberals, by definition, were attuned to a marketplace-of-ideas approach. Hence my surprise. 

The reason for my chagrin is that our nation is now engaged in a civic discussion on health care reform, where all sorts of different viewpoints, expressed civilly and with some command of the facts, should be welcome. Civility is a virtue without a party. 

While I myself do not agree with much of what Mr. Mackey espoused (like the Thatcher quote about “socialism,” and the other buzz words dropped in to get unsuspecting people riled up: “new entitlement” “a government takeover of our health-care system” and more), his piece was in other respects seriously argued. It gave an interesting example of how Whole Foods provides health insurance and also subsidizes health savings accounts for its employees; it made eight counterproposals; it expressed the author’s philosophy about the root causes of poor health and the links between good food, good health and the responsibility of adults to make good choices (I strongly agree with Mackey’s responsibility point). 

Since Mr. Mackey’s proposals deserve discussion, I’ll discuss his suggestion that the IRS make it easier for taxpayers to make a tax-deductible donation to support “the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.” I had independently come up with a somewhat similar notion in “3 Wild Ideas re Health Care,” my August 10th blog. There I recommended adding a donation box on the IRS tax form by which filers could give $1 specifically to health care. It was an undeveloped brainstorm, but I thought of it as a way to raise some money and create grassroots support for health care—a national priority. Mr. Mackey he didn’t limit his thinking to a check-off box. And he left the donation amount open-ended, stressed that it be tax-deductible and allocated strictly for the uninsured. I would support Mr. Mackey’s idea, and would hope taxpayers would be generous if given such a chance. My only stipulation (and here Mr. Mackey and I may diverge widely) is that such a charitable donation must not be the sole or primary method by which nearly 46 million uninsured people in our country (35,920 of whom are American citizens according to the U.S. Census Bureau) would be covered. 

In my view, health insurance must be required if it is to be universal and fair. Elsewhere I have drawn an analogy between the requirement for auto liability insurance and the proposed requirement for health insurance (my blog “Collision Insurance for Health Care”). To see how well Mr. Mackey’s idea would work for the uninsured, let’s apply it to the case of car owners: Forget the required liability insurance; any driver who wished to could go without it. Mr. Mackey wants “to move toward less government control and more individual empowerment.” So what would happen when an uninsured driver got into a car accident? Well, the only money at hand would come from charity—from those good souls who made a tax-deductible donation especially to help out uninsured car owners. How well do you think that would work as public policy? If you had no health insurance, is this how you would want coverage for yourself and your family? 

Right now, the data from the U.S. Census Bureau are about to become obsolete; a new report is expected at the end of this month. It will provide information for 2008. What we have currently is information for 2007, and it’s the best we have. I haven’t read the entire report, but I have looked at a few pertinent pages. The Report is called “Income, Poverty, and Health Insurance Coverage in the United States—2007.” You can find it online.

Number of Uninsured 

It shows that in 2007, 45.657 million people in the U.S. were uninsured; rounded off, 46 million. Soon we will be able to see whether the number of uninsured has increased as a result of the recession. Which is likely. 

Sometimes that 46 million has been used to refer to uninsured “Americans,” however. That is not accurate if by “Americans” you mean “citizens,” not just the people who live here. To arrive at the number of “American citizens” without health insurance, you must subtract 9.737 million people who are “not citizens” (nearly 10 million). There are 35.92 million citizens, rounded off, 36 million. 

It matters to many that taxpayer money not be used for anyone other than citizens, which is what supposedly underlies this preoccupation with accuracy. But the critics ought to know that there is no proposed health reform bill in Congress that includes non-citizens. None.

Sometimes critics of the reform have taken their own liberties with the Census data, like calling people in the “not citizens” category “illegal aliens.” That’s absurd. Plenty of people who are not citizens live in this country legally. 

Profile of Uninsured

In the U.S., most uninsured people live in the South; they live in households with less than $50,000 a year in income; 26.8 million of them worked during 2007; 21 million of those worked full-time. 

Not all uninsured people are poor, or old, or under age 18. The two largest groups are those aged 25 to 34 and those aged 45 to 64. Some uninsured people live in households with higher than average income, not just above $50,000, but above $75,000. 

Why is that? Perhaps the Census explains why, but I didn't find the explanation there. What is obvious though, if you think about it, is that that statistic alone—a household income of $75,000 or more—doesn’t reveal much. It doesn't tell you how many people live in those households; or how many wage earners live there; or how many dependents; or how much debt the household owes. Without more information it isn't clear whether such persons could afford health insurance. It is probable, however, that some of the uninsured are healthy, young, highly paid workers who could afford insurance, but  prefer not to pay for it and to pocket the extra earnings instead. They could just pay for care if and when they need it. That practice is a legal option in many states. That would change, by the way, with House reform bill HR 3200, which requires everyone to purchase health insurance; one of the goals of the reform is universal coverage.

Few taxpayers express rage against the government for requiring owners of motor vehicles to carry collision insurance (known in the industry as liability insurance). And I’m aware of no exceptions to this law. Given the risks and damage from a collision, the requirement sounds like common sense. Few drivers stop at collision insurance either, but prefer to purchase fuller coverage. But collision coverage is a sensible minimum.
    
So why is it that when the government proposes to require minimum health coverage that some people cry foul, and rant about excessive government intervention and government takeovers?

It is true that a collision typically involves another car, not just one’s own, which is the reason for liability against lawsuits. Still, people do run into trees and off roads all by themselves. Health care is analogous: those without health insurance—for whatever reason—do get sick and end up in emergency rooms and hospitals, seeking health care. Many of them, not having insurance to cover their bill, do not or cannot pay. That leaves hospitals holding the bag. The federal government pays hospitals some of their out-of-pocket cost (you hear about these as “reimbursements”), but not all of it. And those costs are passed on to other hospital users who do have insurance in the form of higher hospital prices. True, none of us actually sees the bill for all the “free” care given to some, but it isn’t free: taxpayers and hospital users have been paying for it all along, and will continue to unless there is reform.

Those who use medical services without paying their bill pass on the charges to the rest of us. So wouldn’t it be better for the government to require all individuals to purchase health insurance for themselves? Car owners have to buy insurance, and everyone benefits.

There’s more. Since most health insurance in our country is provided through employers, doesn’t it make sense to require all employers to provide it? Otherwise, only some do, leaving workers without a vital benefit that is available to others. This is what the House health care reform bill would do: require employers to provide coverage to workers. An exception is made for employers too small to afford full coverage. For small businesses, the bill proposes minimum payments based on the number of employees. In other words, even small businesses would pay “something” toward coverage. And as with auto insurance, anyone—individuals and employers—are free to supply further coverage. These are just minimums.

For all these reasons, I think the proposed bill is better and fairer than the current system. It requires the same minimums from everyone, while also providing assistance for those who are unable to afford health insurance. No one can simply opt out and leave their health bills to others. And we know a requirement can work: we’ve already seen it with auto insurance.

If you have ever wanted to see Josephine Baker dance, this Introduction gives you the opportunity. “The Jazz Century,” a lively, moving and comprehensive presentation of graphic art, music and film, is on exhibit now through October 18, 2009, at The Centre de Cultura Contemporánia de Barcelona, one of the city’s seven major art museums. Travelers who love art and/or jazz may want to set aside a morning or afternoon to see it and also to attend any of the jam sessions, scheduled to accompany the exhibit. Meanwhile, anyone can view an interactive Introduction to the exhibition online.  It provides select examples of art, film, television clips, photography and audio from the wealth on view.

Much of the exhibition is joyous, like Henri Matisse’s book of rhythmic colored cutouts, “Jazz” (1947) or the film clip of Fred Astaire’s tribute to the great tap dancer, Bojangles, who also appears in the clip. But jazz has more than rhythm; it also has blues.

As I walked through the large exhibition one morning in July, I found three things that literally moved me to tears: first, the singing by Billie Holiday of “Strange Fruit” (1939), a haunting blues song about a lynching (to hear it, go to the Swing section the online Introduction, audio), and then two different photographs. One showed a lynching—a subject I have seen depicted before, but I still found this image disturbing. The other photo showed the naked, charred body of black man who had been burned alive, now surrounded by white men in suits. I also saw a Looney Tunes cartoon of Betty Boop on a safari that I remembered having seen as a child; it showed the prevailing stereotype of Africans when it was made. As I stood looking at this exhibition in Spain, I felt ashamed of my country’s history of violent racial prejudice and its obviousness to the rest of the world. Yet these African-Americans are the people who gave us jazz. This exhibition celebrates them (shown in caricature and in photographic portraits) and their contribution.

The exhibition is organized chronologically, and begins in New Orleans around 1917, when a recording of a Dixieland band first used the word jazz on its album cover. In hindsight, one can see from minstrels, gospel music, coon songs, the cakewalk and ragtime that African-American music was on the verge of making a spectacular breakthrough, which became known as jazz. As an art form, jazz has influenced the graphic arts, photography, television, videos and film, and literature—all of which this exhibition makes vivid through examples.
    
Many Americans will be familiar with the next section, “the jazz age,” chronicled in the slick black-and-white photographs of Man Ray and the art of Jan Matulka, a Czech-born American painter, and Miguel Covarrubias, a Mexican painter and illustrator, whose work appeared in major U.S. magazines like The New Yorker and Vanity Fair.

The topics covered include
• the Harlem renaissance, where Duke Ellington and Louis Armstrong first made their mark and a young artist, Jacob Lawrence, was an art student
• the European jazz scene with Josephine Baker
• the era of swing and boogie woogie
• jazz during the Second World War (William H. Johnson’s painting, “Jitterbugs”)
• Bebop (Thomas Hart Benton’s “Portrait of a musician”)
• jazz in Barcelona, which had its own jazz club and jazz magazine
• jazz on the West coast, mainly California (Thelonious Monk, Cannonball Adderley)
• the Free Jazz revolution, inspired by Jackson Pollock and Romare Bearden
• and the contemporary period, where Winton Marsalis is king (Andy Warhol, Jeff Wall, Jean-Michel Basquiat and Kara Walker).

My only disappointment with “The Jazz Century” took place when I tried to order the exhibition catalogue and learned that it was translated into Spanish and French, but not English. Since the exhibition itself catered to English-speakers, I had the mistaken impression that the catalogue would as well.

I highly recommend the exhibition and the online Introduction. The show sets jazz within its worldwide context and 20th century time frame, and convinces the viewer and listener that jazz is responsible for an impressive set of artistic ripples

Members of Congress have no choice, really. They must work within the constraints of what is politically feasible. But ordinary citizens need not, at least not always.

Attempting to free myself from such constraints, I have temporarily put aside all the big-picture proposals currently being discussed, and which I think have merit, like:

• extending health insurance to virtually all of the uninsured—by extending the reach of Medicaid; by mandating coverage, while providing subsidies to very small businesses and individuals with low-incomes; by fining individuals without insurance and employers who do not provide coverage; by taxing health-related products and industries; and by ending the Bush tax breaks for the wealthiest Americans, soon set to expire

• funding comparative effectiveness research, so that research compares new procedures and drugs with each other (not just with a placebo or with one other competitor) and also with current procedures and drugs to determine which work best. It isn’t always the latest thing.

I also support proposed measures to finance the reform, like

• replacing the procedures-based system that Medicaid currently uses to reimburse healthcare providers, with a care-based system—the quality vs. quantity argument. This sounds like an improvement whether it cuts costs or not.

• moving to electronic record-keeping, which would improve the efficiency of care  by eliminating duplicative record-keeping and tests, and give a variety of physicians  access to the same information. Safeguards for patient privacy and security would also have to be instituted, though, which could add costs unless Congress has already accounted for this in the bill. But electronic record-keeping promises benefits, even if it doesn’t reduce costs by as much as some have suggested.

•setting up a public insurance plan, that is a nonprofit government-run plan, so that consumers would have it as one choice among many private plans, and it could determine what the actual costs of coverage are, what is needed when and where, and serve as competition for private companies. Right now, there are only a handful of major insurers in some areas of the U.S., which makes choice of insurer very limited. As for a cooperative mix of for-profit and non-profit plans that are not run by government, why not have that as well—only without government subsidies, since the argument against the public plan is to keep government out of private business.
 
Meanwhile, however, perhaps as a frustration-coping device, I have begun to wonder what I might propose if anyone asked me (unlikely). Brainstorming requires the freedom to consider even the wackiest, most implausible ideas. My contention is that if enough citizens seriously engaged in it, someone—perhaps an America reader—might come up with an idea that is both helpful for reform and feasible, and which is new and worth broadcasting. The real crux is paying for reform—something the general public seems less and less willing to do. So please offer your own wild ideas on that topic in the comment space.

Three wild ideas for financing the reform:
1. A sugar tax: Yes, this notion comes to you from a perennial sweet tooth, and it builds on a proposal that has already been considered publicly as a health-related way of paying for the reform, a tax on sugary soft drinks. Some critics of that notion asked, why us? why would soft drink makers be saddled with such a tax? Hmm, I thought. They’re right. Why not extend the scope rather than throw out the idea completely. Why not levy a small tax on every product (from candy to breakfast cereals to soft drinks to wine—every food) that contains sugar above a certain percentage or that exceeds set amounts. Or it might be structured so that the more sugar an item contains, the higher the tax. Some qualified team of physicians and nutritionists, for instance, could work out reasonable, health-based standards, and legislators could fine-tune the details.

If every consumer paid something small (a penny per item, say—six cents on a pack of soft drinks or a box of chocolates), the money raised would go directly into the government’s revenue stream for health care. We would get the money back in services and benefit from better, more extensive care and coverage. This little tax would earn money year after year, even as it raised public awareness of the health dangers of too much sugar and, one hopes,

The Reason: while sugar in moderate amounts is not harmful to health (any more than liquor or alcohol is), many products contain quantities of sugar that make it a prime contributor to rising diabetes and obesity, which are enormous health concerns, and increasingly so for children. Or the products are consumed in such quantities that they become a health risk. We have a liquor tax and a cigarette tax to help combat particular ill-effects, why not a sugar tax designated solely as revenue for health care?

2. A health bandwagon: The government wouldn’t have to initiate this bandwagon, but it could. Or it could just augment the work of other groups and individuals. If you are old enough, think of the “President’s Physical Fitness” program that John F. Kennedy sponsored in the sixties. Or of private groups like Weight Watchers, AARP, health clubs, product sponsors and advertisers, as well as church and civic groups—all of which could promote in a new way, with a national focus on health, “healthy habits” like a health eating and exercise. A new bandwagon is an idea anyone or any group could run with, promoting creative ways of involving parents, children, teachers, seniors, and all other Americans. And it could involve millions, inspired to get on the bandwagon.

Since childhood obesity is on the rise and can turn into diabetes and a lifetime of illness, it should be one of the first issues addressed. Something for Michele Obama to stand behind? Or some child stars?

The trick would be to keep such a campaign positive, lest public sentiment turn negative against the overweight, the ill, or the old. The idea would be for each American to  “do something more,” to take personal responsibility for prevention of disease and to improve their health—whatever it is. Those who are ill or suffer a chronic condition would merit society’s applause, and improved health, by doing all they can to lessen the ill effects.

The Reason: This program would focus on societal good. Getting in better shape would be seen as a patriotic act, not merely as good for each individual. The population would be respectfully invited and encouraged to do its part to improve the nation’s overall health and fitness, getting ourselves “in better shape.” That would be a boon if it could motivate citizens to take responsibility for constructing the society we want to live in. The long-term rewards:  generations of healthier Americans more active in constructive government.

3. Add a line to the federal IRS form—a little box taxpayers could check so that  $1 from one’s tax refund goes to health care. I’m not kidding. I realize that there are zillions of important and worthwhile causes that taxpayers could support and that dozens of charities are facing hard times in this distressed economy. But health care is a national priority that begs for universal support. I even realize that opponents of the reform are balking at the costs, to the point of denying the need for reform, despite all the evidence that shows it is imperative. Putting a “gift” option on the form would raise some money, without costing much of anything. It would also extend our role as stakeholders, perhaps the more important reason for doing it.