The final Clinton-Obama Debate took place in Cleveland, Ohio, the place I was born and lived in for 29 years. From my point of view, Clinton won the debate on many fronts in spite of the fact that the media and her questioners are biased against her. When Hillary mentioned the fact she is usually asked the first question, I understood instantly what she meant. By answering the first question, Hilary gives Obama factual information about the issue that he may not possess straight away as Hillary seems to do. It is easier to criticize the first answer, then it is to answer the question in all its fullness which Hillary does very well. This is not to say that Obama can't answer any of these questions, but it does make one take pause wondering how well he could answer most of the first questions if he was given the opportunity. The questioners played softball with Obama for most of the debate.
Clinton hammered out her position on health care in understandable terms. From my vantagepoint, she won this debate because I agree with her position that health care should be mandatory for everyone which makes universal health care possible. Giving a person a way out of having health care coverage is risky and not wise policy.
Clinton was stronger when it came to the question about Farrakhan and anti-Semitism. The question was for Obama, although it was a positive that Clinton did add her own take on the issue and forced Obama in a way to take a stronger position than he did at first blush when he said he would denounce Farrakhan's anti-Semitism and his position on Israel. After Clinton spoke, Obama said he would both denounce Farrakhan's anti-Semitism and reject Farrakhan's support.
Clinton made points I felt in her answer about Putin's successor and Putin's continued influence as the real leader of Russia and the Russian people. It was a first question and she did an admirable job on this question. Obama basically repeated what Clinton said and reiterated his agreement on the subject. When talk of Kosovo came up, Obama went as far as to say that the Clinton administration had done an admirable job of putting procedures in place to deal with the various problems that might emerge in that part of the world. Was Obama just being magnanimous? Whatever Obama was doing or feeling, it pointed up the positives of Hillary Clinton's knowledge and history in foreign affairs.
I also feel in some ways the differences between Clinton and Obama were neutralized by this debate when it came to Iraq, NAFTA,and the economy. Clinton was effective when she continued to say she would be a fighter or would fight to make change happen implying she would not just talk about change, she would make it happen and that she knew how to do it. I think Clinton won the effectiveness argument. She will be the one to make things happen and she made me feel that she could do it. Obama made the point that he could persuade the public to believe in his policies. The majority of the public has wanted health care all these years and it hasn't happened. We are already persuaded on this score so I give Clinton more points in presenting herself as someone who can get things done.
Sharon Raphael
5 comments:
It sounds like this was the most interesting (and substantive) debate so far. I am basing that not only on what you wrote, but also on coverage from the NY Times and the BBC.
I have not been able to see any of the debates because I am in Argentina --- sometimes there are short clips from the debates, but always with a voice-over in Spanish. So I essentially get only the content that comes from the words themselves, without any of the tone, body language, etc. that has such a powerful (if unacknowledged) influence. Frustrating!
From what I have read about it, I agree that Hillary's healthcare proposal is better than Obama's, but I still don't think either proposal is worth much. In the last presidential election I felt that people in my category were completely invisible. As an unmarried freelancer, I HAD to get individual major medical coverage. But the insurance companies have no obligation to offer individual coverage. The companies can't single out an individual to deny coverage, but they can legally choose to drop individual coverage altogether. I had Mutual of Omaha health insurance but they decided to quit offering it nationwide. So I had to scurry around and find some other company to pick me up. Not so easy when you are middle-aged, even if you are in good health (as I am).
I listed to the presidential debates and the candidates' proposals about health care (I lived in the States then). Bush's solution to the problem of the vast numbers of uninsured was to give tax incentives (eg, tax credits) to individuals to encourage them to get coverage. Kerry's solution was to force companies to provide health insurance to ALL their employees.
And where did that leave people like me? I applied for insurance and got turned down, for spurious reasons (eg, no coverage for anything related to the reproductive tract, because I had had elective surgery several years earlier to remove uterine fibroids). Great. After that, you are on a blacklist, because a question appearing on every insurance form is, "Have you ever been denied coverage?" (I did later get BC/BS, by the way, but the whole process was demeaning, insulting, infuriating, etc. Like I had to bow and scrape and apologize for EVERY single health issue I had ever encountered, including getting older, which is also an "unhealthy" thing, right?)
Health insurance is regulated by individual states, and if you live in the South, you are basically screwed. Very company-friendly. It IS possible to get insurance that is specially designed for those who are turned down elsewhere, but in the state I was in, the premiums were something like $1000 a month, for coverage that was pretty crappy (and was designed for people with terminal conditions, not for someone healthy). I assume a person's views regarding the extent of the healthcare crisis is largely influenced by the state they live in --- if you are in a liberal, consumer-friendly state like California, New York, or Massachusetts, you probably have much better options than does someone living in the Deep South. But that's just a guess.
I felt invisible on this issue 4 years ago, and I still feel invisible. It doesn't really matter to me whether I would be forced to buy insurance (Hillary's plan) or simply encouraged to buy insurance (Obama's plan). If the insurance companies are still regulated on a state by state basis, and if they are not obliged to offer decent coverage for individuals, then people like me are still invisible.
Neither candidate's proposal goes anywhere near far enough, because both candidates are terrified of alienating powerful interests like the doctors, the insurance companies, and big pharma.
Eventually maybe things will get bad enough so that there will be a RADICAL change, a complete overhaul, rather than just continuing tweaking of a deeply flawed system. But I'm not holding my breath.
BJR,
Thanks for your comments on the health care issue. They are appreciated. I agree with you that both candidates don't go far enough. Don't you think a single payer tax based system would work best as Michael Moore in his movie "Sicko" and many others have suggested? Thanks.
Sharon Raphael
I think there should be a single-payer system, but that's just part of the solution.
One issue that rarely gets discussed is the set of expectations that Americans have. What do you expect the healthcare system to provide, and how much are you willing to pay for it? Of course there MUST be rationing --- some sort of cost/benefit analysis. Also, how should doctors be viewed, and what would constitute reasonable compensation?
American doctors have very high salaries compared to their counterparts in the rest of the world (interestingly, female doctors are at the low end of the salary range because they tend to drift towards more "nurturing" specialties such as pediatrics or psychiatric and away from the higher-paying procedures-intensive specialties that may require a longer training period). Also, there are procedures that are done here that are not done in some European countries, just because the cost is seen as being way too high for the perceived benefit. For example, I was told that Mohs surgery is not performed in Austria because the cosmetic advantage that if offers cannot be justified by the much higher cost/time required. The average American would consider failure to perform the latest, sexiest procedure grounds for a malpractice lawsuit.
I see Americans as being incredibly self-absorbed , egotistical and ignorant when it comes to the issue of healthcare. The perfect example is the negative attitude towards vaccination. Vaccines aren't given to help the individual, they are given to help keep the society healthy. But the concept of "herd immunity" is not something you could get across to someone who just thinks about ME ME ME!
Pharmaceutical companies are set up as for-profit companies, and as such they have a fiduciary responsibility to their shareholders. The question is not whether the pharmaceutical companies are "good" or "bad" but rather whether we as a society want to turn something as critical as healthcare over to a for-profit business. Big pharma develops drugs to treat people who have good insurance. That is in line with their responsibility to shareholders (and before anyone begins slamming big pharma, look at some of the holdings in your own 401(k), 403(b), mutual funds, etc. --- probably you are a shareholder, too!).
But what happens is that the companies just develop lots of me-too and lifestyle drugs, because they are focused on profits. There are almost NO drugs that are actually APPROVED for a pediatric population, defined as age 6-12, for example, and even fewer approved for newborns to age 6. From a business perspective, it doesn't make sense to do drug development for a pediatric population --- too many negatives. And even with adults, drug development is focused on lifestyle disorders (is treatment of erectile dysfunction really such a compelling medical need???) or disorders associated with a 1st world population. How many new drugs have been developed for tuberculosis, leishmaniasis, Chagas disease, malaria, etc.? Damn few or none at all. But you have INCREDIBLY expensive biologics developed now, and the companies are seeking approvals for new indications so that they can have more direct-to-consumer advertising to promote the biologics. The new biologics don't necessarily work any better than the older standard drugs, but they bring in LOTS of money. Companies actually try to invent new indications (eg, osteopenia) so that they can find another use for their drug.
The whole system is screwed up. You can't tweak it and make it work because it is based on flawed assumptions.
I never saw Sick-o. I'm sure it's good, but it would be too depressing!
As an article of faith, I believe that there are some very smart people in the US, people who have studied this problem and who could provide solutions if given a chance (no one individual, of course, but lots of bright people who could work together). None of them are politicians --- they wouldn't stand a chance. But the talent and the knowledge are there if the American people are ever ready to listen and change.
What is Mohs surgery? Sounds like you know a lot about health care and the different systems of health care around the world. You could write a book on topic or a series of articles. How about your own blog.
SR
Mohs surgery is a type of surgery to remove skin cancers (typically basal cell carcinoma). Skin cancers usually appear on sun-exposed areas, like the face, and those are the areas where appearance matters more to patients. In most cases skin cancers can be easily treated and do not recur, but it IS important to remove the tumor as soon as possible and COMPLETELY.
The surgeon could just excise the whole lesion, which is the conventional approach, and leave standard "safety margins" (in other words, take out a little more tissue surrounding the tumor just in case the tumor had spread a little) but cosmetically the outcome can be unappealing --- the patient is left with a tiny pit where the skin cancer was.
Mohs surgery is designed to remove EXACTLY as much as necessary, without taking more. As the surgeon carefully slices off a layer of skin, a pathologist looks at the excised tissue in "real time" and makes the call as to whether the surgeon needs to go deeper or can stop there. The cosmetic outcome is much better, but obviously it is a lot more time-consuming, resource-consuming, labor-intensive, etc. than a traditional surgical excision.
BTW, my description of Mohs is from a layman's perspective. I'm sure if any of your readers are dermatologists they can give you a much more accurate description!
What it comes down to in terms of healthcare is the question of whether patients have the "right" to "demand the BEST of everything" without regard to cost (and with a single-payer system, we ALL pay for everyone's surgeries, right?), or whether there can be a cost/benefit analysis that results in some procedures just not being covered. Given that many people are incensed at the thought of even having to accept a semi-private hospital room, I am not optimistic --- I think Americans would have to undergo a MAJOR change in their belief system.
I don't have a blog. I don't think I could deal with it --- too much hostility in cyberspace for my liking!
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