James Madison, John Roberts and Barack Obama walk into a bar…

No, it’s not John Roberts — yet.

It was a good day for Chief Justice Roberts and President Obama, for the Supreme Court, and for our country.

As my previous post indicates, I think national health care insurance is a good thing.  I was watching  CNN at 10:10 am when it put its foot in its mouth and announced that the individual mandate had been overturned, so I was doubly joyous when CNN reversed itself on appeal at 10:16.

Most Americans do not think much about how important it is to have an independent, life tenured high court.  Nor do we think much about how people will act — and change — when they have that kind of job security.  I used to spend a lot of time with judges and attorneys.  The interactions are interesting to watch.  The bar is a tribe apart.

Chief Justice Roberts put down his marker today — that he will not be taken for granted. is not in anyone’s pocket, does not see himself as an ideologue, and has ambitions for a legacy of his own.  He will be in his current position, good health permitting, for 20 years or more.  He has no reason to care how many people, conservatives today, liberals again tomorrow, are furious with him.  He cares what the bar thinks, his community of peers.

Barack Obama is from the same tribe of legal scholars.  He has four, maybe eight years to make his mark.  In this instance, he kept his cool under huge pressure and way too much second guessing (I mean, really, Robert Samuelson, what were you thinking?). He surely knew everything about the arguments being advanced by his attorneys, and together they came out with the winning position on his own legacy — and won on the issue of taxes!  God is nothing if not ironic, huh?

Since reading David Remnick’s excellent biography of Obama and its chapter about his rise at Harvard Law School, I have predicted that we will see this past four years less as a era of partisan politics than as a unique contest of wills and ideas between a President and Chief Justice. Obama and Roberts: two men of roughly the same age and training in constitutional law, with diametrically opposed views, each heading a branch of the U.S. government at opposite ends of Pennsylvania Avenue.  It’s a fascinating situation and one with few precedents.

Today showed how closely the two men are locked together in history  – in their hope to be remembered as leaders in a grand tradition of thoughtful, intricate legal analysis and argument about the role of democratic government tracing to the Founding Fathers and beyond.

Speaking of the Founders, wouldn’t James Madison have been happy today about how the system of separation of powers was bearing up under enormous strain? For a moment there, I was getting worried.

We all have a responsibility to make this health care system work better, for more people, and to control costs.  But we will do it together.  Massachusetts was the laboratory, so thank you Governor Romney too. We will all have what our members of Congress and the justices of the Supreme Court already have: health insurance!  Hurrah!

 

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You and Your Congressman’s Health Insurance

Thank god for the hours I spent watching ER!

The clock is ticking on the Supreme Court’s ruling on our health care system.  Nearly every person, from Supreme Court justice to elected officials to media and think tank pundits, who will make or influence the looming decisions on the future of the new federal health care insurance program has excellent health coverage.

Most particularly, every member of Congress has great coverage – and I should know, because I have it too.  Let me tell you, you should want what your Representative has and what the Supreme Court has.

Last spring, I entered a new world:  surgeries, intubation, MRI’s, sonograms, pathology reports, radioactive dyes, nuclear medicine, needle biopsies, chemotherapy, genetic testing and everything you see on TV shows.  For the first time, I had a deadly disease.  That’s when I began to experience the two Americas we are all living in.

“No one’s died of breast cancer since I started this practice,” my 40-something internist in northern Virginia reassured me last spring. Her mother and sister are survivors.  She’s right: new treatments make for more full recoveries from cancer and I will be one of them.

The very next week visiting in North Carolina, however, I heard a chilling story. “You poor dear, my favorite aunt died of breast cancer just a little while ago,” said Samantha, the young, white woman cleaning my hotel room.  This 32-year old aunt left a 12-year-old daughter.  She had no health insurance.  Chemo didn’t do much good at the end, and charity care didn’t begin to cover her needs.  Two years after her diagnosis, she died. How to explain the difference in perspectives? Physicians such as mine see mostly insured women, not Samantha’s aunt.

Two things saved my life last year: decades of taxpayer-funded medical research and lots of good treatment paid for by health insurance.

I have Blue Cross Blue Shield Federal insurance, one of the many programs offered by the Federal Employees Health Benefits Program (FEHBP).  This is the kind of insurance that Reps. Paul Ryan and Michelle Bachman have for themselves and their families, and which for some reason they think other Americans should not have.  In fact, many of those Members who oppose ACA are using it to insure their children.  Retired members of Congress such as Bill Archer who campaigns against health insurance for America have it.  The Supremes have it too.  To his eternal credit, Ted Kennedy wanted everyone to have what he had.  The FEHBP that covers all these so-important people has in fact been the model for many of the health care proposals we are debating, including the terrific program Gov. Romney so regrets launching in Massachusetts.  Ask a doctor in Massachusetts, as I have, and find out how it has changed life there.

Oh, and By the way, have you ever heard of a Congressman giving up his health care?  No, neither have I. But in 2010, a Republican Tea Party member and physician, Andy Harris from eastern Maryland, campaigned against Obamacare and then stood up in freshman orientation and wanted to know why his health care hadn’t kicked in just after his election.  Very clearly he wants it for himself, but not for you.

Last year, I selected my own doctors, clinics and hospital.  Hardly any doctor refuses to take federal employee insurance.  Instead insurers compete vigorously for this business, and they accept the risk pool that comes with it.  This is the power of large numbers in insurance which health care advocates want to leverage for all Americans.  Studies in Oregon and other states show that people with insurance benefit in many ways.

I finished surgery, chemotherapy and radiation last year.  My Alexandria Inova Hospital doctors worked as a team. They were great. The insurer provided prompt accounting of the lab tests, exams, and surgeries.  But the bills – oh my god, they rolled in like snowflakes in a blizzard.  The total cost for medical services was many, many thousands of dollars. But my husband and I had a cap of $5,000 for copayments, though, plus monthly premiums of $430.

Examining my bills, I finally understood why losing your insurance and getting sick can mean losing your house. The uninsured are billed at “full” rates, so their medical bills become astronomical quickly.  Anyone with any kind of health insurance is billed the preferred, lower rate, and their insurance coverage reimburses them for much of that amount.  The uninsured who get sick get much poorer much faster. Medical expenses remain one of the leading causes of personal bankruptcy in the U.S. Not only did I make a full recovery, we are not lying awake at night wondering how to pay the bills, or keep our home.  Getting Lost in the Labyrinth of Medical Bills by Tara Siegel Bernard in the New York Times lays out these scary issues — don’t miss it.

The moral of Samantha’s sad story is that whether or not you personally are insured, lack of good, affordable health insurance kills people we know and love. It puts us all at risk when loved ones are not covered, unless you don’t love them enough to help pay for lifesaving care or insurance.  It hurts our economy and our competitiveness, and it undermines and terrifies our families. As for me, I’ll keep on working, just as my husband has done following successful surgery last January.  We’ll support ourselves, pay more taxes, and save for retirement.  Universal health care insurance is win-win public policy: good for society and us.

But your Representative already knows that. He or she just doesn’t know if you know it. Don’t be silent, don’t be passive.  This is an important moment in America.  Obama did the right thing, we had to deal with this crisis.  And we did.  Will the Supreme Court now tell us to start over?  I hope not from the bottom of my heart.

 

 

 

 

Posted in Breast cancer, Civil society, Government, Health, Uncategorized | 7 Comments

The landline phone: Casualty of the 2012 campaign?

Sometimes change is pushed by annoyance and inconvenience, not just cost and usefulness.  That seems to be happening with the telephone system.

Surely I am not the only one to think it:  If I finally get rid of the landline, will those incredibly annoying marketing phone calls stop?

When did the sound of the phone ringing go from being a welcome ding-a-ling to an obnoxious interruption?  If I were running AT&T or Verizon, I’d be really worried about this political campaign stretching endlessly to the horizon.  It’s a turning point for the phone system, I think.

Landline phones have become the domain of the zombie fundraisers and push pollsters.   Friends working this political cycle tell me those of us living close to the capital have no idea how bad it gets in the swing districts when voters are targeted with constant phone calls by superPACs, political parties and candidates desperate for a few more votes or donations.  It’s the death knell of the landline phone system, I think. Who hasn’t thought of flinging it out the window when one more unknown caller tricks you into answering only to find stunning silence while the voice activated response comes alive? And this is from someone who regularly contributes to candidates.  (Maybe that’s the problem.)

There are many reasons for the rise of mobile technology but this is one.  If the zombies ever invade the mobile space, we are really done for.  There are solid reasons to have landlines, especially with a rise in natural disasters, but the way the system is being managed makes me fear for its future.  And of course it is the politicians who have abused the regulatory system by giving themselves exceptions.  They are killing their own golden goose.

Meanwhile, over at Facebook, my original peg last week of $30 a share is looking pretty good.

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The Value of Facebook

Connecting to my world on Facebook

Is Facebook worth more than $30 a share?  We will find out tomorrow and more importantly, in the days to come.  But it’s been worth a lot to me, so the question of what the value of Facebook is in our society now is quite interesting.  I thought today would be a good moment to explain its value to me.

“I don’t do FB.”  I hear this a lot, even though there are now over 900  million Facebook users so I am kind of wondering why I know so many hold-outs (besides my mom, I mean).  I usually respond, cautiously, that Facebook is essential these days, a social utility like the telephone.  And that means it is worth quite a lot. Why?

The word “friends” is a misnomer that confuses a lot of people who distrust the Facebook world.  How could you have 200 or 500 “friends”? My Facebook contacts are not a list of my friends – I am not equally close or intimate with all the people to whom I am connected.  But it is a genuine community of real people who know me, inside of which are different but overlapping circles of family, close and casual friends, colleagues from a variety of jobs and activities, neighbors from several homes, and classmates from various schools.  That reflects normal life pretty well, doesn’t it?

Facebook has become particularly useful when you are in transition – between homes, jobs, schools, travels around the world, anywhere you’ve created a circle of people don’t want to leave behind.  It’s great that it is global when, like me, you’ve lived in lots of different places.  Email – well, it just takes too much time to stay in touch with more than a few people, and who likes getting emails with large cc lists? Not all that personal really.

I left a job a year ago. In a flash I lost access to the email listserve with hundreds of colleagues with whom I had worked for years.  Not my first job transition. But this one has been very different. Through Facebook for the first time, I found myself in easy touch with many of the people with whom I used to have lunch and share jokes.  We still exchange shoptalk and rib each other, in real time.  When someone in my FB world has a big announcement – a new boss, a baby, a retirement, an event, or a birthday, I hear about it and see the photos.  When I do see or call them, it is much easier to pick up the conversation because I know they’ve been on vacation to Cabo, gotten a dog or changed jobs.  I even got invited to and kept track of my high school reunion in Addis Ababa, Ethiopia.

When I got sick last year, I could keep up with what my family, friends, and colleagues were doing even when I wasn’t getting around a lot.  I could check in on the antics of various young relatives, though I try not to comment on their pages!  When I finally told my FB friends that I had breast cancer (partly because it was getting hard to remember who I had told privately), I got an amazing flow of supportive messages from all over my world.  People kept track of my progress in private messages, visits and comments. Now that I am fine and back working, Facebook offers an easy way to pick up conversations, exchange messages, and search for people with whom I have lost contact.  It is quite efficient and definitely not a waste of time.  You put into it what you need, and you get out of it what you put into it.

That’s why when people say, “I don’t do Facebook,” I respond, “You should try it, it works.”  What I don’t say is why do you want to be left out, when you too will go through these normal transitions in life and this kind of new social media allows you to carry your relationships with you?  What is more valuable than your network?

So, Mark Zuckerberg, are you worth all the money the market is throwing at you in this IPO?  We’ll see over the long term, whatever that is in a social media world.  But thanks a lot for making possible these conversations, photo and news sharing with my family and friends.  Just remember please two things as Facebook grows:  privacy does matter, and so does doing good.  We look forward to seeing how this story will play out.

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Who Killed Z?

Unfilled, expensive but needed and effective drug prescriptions were found among her things.  Eligibility for the $1,000 Cobra payments had ended long before.  She last saw a therapist a few months before this sad day, though she wanted to continue.

A bright young woman who launched into real estate in Washington DC just as the market crashed, she found that “preexisting condition” meant U.S. health insurance was hundreds of dollars out of reach.  Suffering from a deep but treatable depression, stemming from horrifying traumas, she took one long look at the future and bowed out.  She couldn’t afford to live, and without help, life was not worth living. Methodically she wound up her affairs, wrote a will, organized her papers, wrote letters to friends and family, put her beloved little dog. in a kennel, and lay down to die.  She wasn’t found for many days.

I won’t give you her real name, because her family in Minnesota was devastated, as were her friends around the world.  Z loved purple, dancing, shopping, mint juleps, and international anything. She worked all over the world and spoke Japanese and German. She was the life of the party until she wasn’t.  She had a good job with health insurance but a difficult situation made her leave.  This being America, the home of the free and the brave, she never found affordable health insurance again. The awful news is that if Z had lived in Canada, she might still be alive.

So back to our question:  Who killed Z?  Well, we all did.  By accepting the political paralysis that besets our country, by not protesting the obvious fallacies in the arguments of slick politicians who all have great health care insurance, we let this happen.  More will come after Z, many preceded her.  The unemployed, the independent contractors, the consultants, the “preexisting conditions” tribe, all of them at risk if Congress succeeds in rolling back Obamacare.

Raise your hand if you have relatives without health care.  I have. And dear friends like Z?  I have. Raise your hand if you have ever paid for one of them to have health insurance because you were so worried.  I have.  Raise your hand if you would refuse if you were asked to help pay for a life-saving procedure for one of your nearest and dearest. I truly don’t know. For hospitalization when one of them had what we quaintly used to call a nervous breakdown?  For an accident?  Cancer?

Where exactly do you draw the line? How much money can you spare?  How long can you afford to help?  What jacked-up rates will you have to pay on their behalf since they don’t qualify for your low insured rate?

When does love run out? In Z’s case, it ran out in February 2011.  This is a real story.  I share it because it is also the second anniversary of the Affordable Health Care Act.  We should think about who we want to be as a country, and when we do, we should think about Z and all the people we love.

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Five Reasons to Come to the Yucatan

Five reasons to come to the Yucatan if you are recovering from illness or, in my case, from cancer:

– healthy, delicious food — a bounty of the freshest fruits and vegetables, many like the green “tree spinach” called chaya with unique antioxidant properties;

– climate — blue skies,  sunshine, clean air;

– exercise — walking everywhere in this flat city and swimming several times a day restores damaged nerves and muscles;

– culture — which restores the soul: all sorts of activities especially the romantic ballads of the famous trova music which is the heart of Merida;

and finally, peace of mind – the ease that comes from being in one of the world’s safest cities filled with  friendly, easy-going, courteous people.

Merida and its gentle, wise Mayan way of life is hard to beat.   Not to mention the lack of snow and ice!

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“Speech after long silence,” from Merida again

This blog was rudely interrupted last April when I was diagnosed with breast cancer.  The discovery of the lump came in the middle of the night just as I was about to return to Merida with my husband for a very special week meeting officials and townspeople after my op-ed in the Washington Post last March. The confirming call from the clinic came while we were there.  Margaritas help a lot in such situations, let’s just put it that way.

As I was swept up into months of medical treatment, I wasn’t in the mood to blog. In the summer, though, I went on Facebook and told my friends what was happening.  Why? Because I was having trouble remembering who knew. Some friends even got mad that I hadn’t told them.  Social media was in the end simply more efficient as a way to communicate.  It is how we live now.  And I got wonderful support from my family and friends from both email and Facebook.

Treatment finally ended, hair growing back, energy returning, and making a full recovery, I am picking up the blog with pleasure.  Lots of things to say about a range of topics.

And oddly, I am writing this from Merida where we are treating ourselves to a rare couple of weeks off. I am grateful to so many people here and in San Felipe for a warm welcome and to all of you back home for friendship and support in this difficult year.  Here’s a post this week from my friend Joanna van der Gracht de Rosada’s blog Writing from Merida that you might enjoy, complete with her favorite song, Santa Lucia.

We’ll be here a while longer and then up to amazing Mexico City for politics, art, business and food. So as Hamlet said, here is “speech after long silence.”  More soon.

 

 

Posted in Breast cancer, Facebook, Health, Merida, Mexico, Social media | Tagged | 3 Comments

Back in peaceful Merida this week looking at social capital

Children performing in Merida's plaza

I am so happy to be back in Merida this week, to follow up on the article I wrote about the Other Mexico last month and to meet many of Mexicans and ex-patriates who wrote me with their comments about life here.  I will be blogging and tweeting during the week, meeting with some of the local officials, and giving a talk about the “soft power” of social capital and how it feeds Merida’s special brand on Wednesday.

It’s a beautiful Sunday morning, and the elegant Paseo de Montejo avenue is closed on one side so everyone can enjoy it.  There’s a wedding party starting in our hotel, families coming to brunch with their grandparents, and other families are riding their bicycles, joggers are passing by, and there are preparations for a big walk to raise money for hemophilia. Later we will head to the plaza central to see teenagers perform Yucatan dances and hear some of the fabulous musicians who are contemporaries of the Buena Vista Social Club in Cuba.  I can’t wait to show my husband the Museum of Yucatan Song today.

Posted in Civil society, Communications, Public relations, Social media, Uncategorized | 2 Comments

What’s different this time in Mideast changes?

Author Malcolm Gladwell told Fareed Zaharia on the terrific new CNN program Global Public Square (GPS) that social media role in Mideast uprisings was “overhyped.”  He pointed to successful revolutions that took place pre-Facebook, in particular the fall of the Berlin Wall in Germany where 1.5 million people protested without the help of the internet.  Zaharia’s own perceptive analysis of the past 15 years of changes emphasized broadcast news as much as new information and networking tools.

Gladwell’s right, there have been other revolutions. But that was then and this is now.  I took part in a terrific discussion organized by ICT4D last week at John Hopkins SAIS about how social media was used in Egypt that suggested Gladwell may not be looking at all the new factors.

Analyzing social media in the Mideast,  “It’s not what you see, it’s what you don’t see,” said Amira Maaty of NED.  She was joined by Katherine Maher of NDI and Jeff Ghannam, author of a not-to-be-missed special report on the rise of social media in this region. Ghannam rightly reminds those of us getting giddy about these events that hundreds of Egyptian social media activists were persecuted long before the January demonstrations.

From what I can see, a combination of elements produced this combustion:

  1. Outrageous official corruption — Mustapha Nabli, the new Tunisia Central Bank Governor, and many others have repeatedly and specifically said that this was the spark in multiple countries.
  2. The huge demographic shift to a youthful population — half under 24 years.
  3. Media transformation with widespread availability of Arabic language broadcast media such as Al Jeerza interacting with low cost social media tools that young people understood better than their authoritarian elders.
  4. Breathtakingly rapid events and on-line organizing post-Tunisia – hours and days and weeks not months and years.
  5. The scale of the communication – the sheer volume of tweets, videos, blogs, broadcasts from Al Jeerza and so on overwhelmed the police state.
  6. Finally, smart, dedicated activists and brave citizens who used all these factors strategically to facilitate political events that were impossible even a few years ago.

Which was the spark and which the fuel?  Who knows.  Who cares?  I know a few of the Libyans expats working 24/7 to communicate, organize, influence and plead for a new era.  And let me tell you, they are living and breathing radio, email, Facebook, Twitter and YouTube and of course Al Jeezra.  Did social media make all this happen? No, the people did.  But does new media, including broadcast, make possible the impossible, and at an affordable price?  Yes.  Of course it does.   For now.

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Bahrain’s Brand: When Moderation Dies

A brand is what you are known for, like it or not.  I write sometimes about country brands, and that’s essentially what I was describing in my Washington Post op-ed about Merida, Mexico two weeks ago – a place that deserves its distinctive, different brand.

But let’s change the focus to another country I know well.  Bahrain has always been known as the “moderate alternative” in a harsh region.  Friendly, laid back, where women could drive and work, and Saudi men “relax” in nightclubs with (gasp) liquor, Bahrain positioned itself as a good place to live and do business, an alternative to Saudi Arabia across the causeway.  An ancient speck of land in a vast sea of sand and water, all it has to offer is a central location for financial and other services and being a nicer place to live. It was where you decided to go when your wife said she wouldn’t live in Saudi or Kuwait.

So now what does Bahrain do when it has ruined its brand?  What is its value proposition?  Even from here I can hear the suitcases being packed, the offices being relocated, the calls from families that have already left, and the inquiries about investment alternatives.  Without political stability and moderation, what does Bahrain have to offer?

I used to spend dead quiet weekends driving through the poor Shiite villages, with lousy housing, fading paint and no air conditioning in a place where summer temperatures can reach 38º C.  I am so sorry, I have no side in this fight, but this horrible political crisis just makes public the reality that anyone who has spent time there knew all along — that this was a terribly fragile situation, ready to break along Sunni/Shiite demographic lines.

And it now has. Humpty Dumpty has fallen off the wall and it will take all the king’s horses and all the king’s men to put him back up again.  If they can.  A brand once broken is dreadfully hard to recreate, especially for a country without other resources.  Which is why it is really important not to break it.  And that’s my point:  the financial price for this political drama will be deep and long lasting.

Posted in Communications, Uncategorized | Tagged | 3 Comments