On Daschle, on Killifer, on Gethner and Stevens . . .

. . . because it really is a type of repetitious scenario, trotted out periodically, this waiting for the gift of health care that supposedly comes down the chimney with what everyone needs.

Originally, I thought to comment on the post about Daschle and Killifer's removal due to tax irregularities, but the Daschle story brings up the speculation on what Daschle probably would have done had he overcome the scrutiny and become Obama's leader of the medical reform program. Now, thank Galen, Obama will be forced to find someone who may bring imagination, sympathy, and courage, not immobility and cowardice, to the problem.

Someone like Howard Dean, a former governor, an actual physician, who has dropped out of the Democratic picture although he had the imagination and courage to come up with the 50 state strategy. That vision managed to increase the voting margins even in the red states. But of course, Dean would not have had the political bent for compromise, and the whack-job image of him perpetrated by the national news media would have lingered. He would have failed before he took the oath of office. Nor do I think that the shill for the pharmaceutical establishment Obama has nominated for surgeon general will have the imagination and common sense of a Jocelyn Elders or C. Everett Koop.

First, some general thoughts on the matter of Daschle's tax "mistake." The fact is that the more money you make, the more aggressive your accountant tends to be. Democrat or Republican, there is an institutionalized practice of "pushing the deduction envelope" and the smart accountants know what the IRS parameters are for various deductions (home office and business miles for the little guys, shelters, shadow corporations, and income substitutions and deferrals for the plutocrats), and all of this is made easier by the IRS regulations constantly being blunted away from large corporate interests and high income audits as part of the philosophically imbedded "Wealth Transfer, Augmentation, and Preservation Act" integrated by Congress by design into every tax bill since Ronald Reagan's first oath of office.

(I should also point out that the insurance business is one of the more skillful at being able to hide all sorts of money making mechanisms by use of the concept of "incurred losses," and that insurance companies on the whole have been very profitable investments over the years. We should remember that AIG is going down the tubes because of their creative Drexel Burnham Lambert refugees who started their Financial Services legerdemain of credit default swaps. The actual property casualty and leasing operations were still very profitable.)

The abuse of the tax system goes on eternally on both sides of the aisle in Congress. Many of the guys in the Senate are millionaires, some obscenely so, like Bill Frist, whose riches come entirely health care and health insurance enterprises. (Have we already forgotten the former senior senator from Alaska? Have we forgotten Sarah Palin's fiddling with the perks?) Read David Cay Johnston's Perfectly Legal and Free Lunch if you are interested in the gruesome details, or follow his columns in the WSJ.

On the whole, it's good to see that Obama is taking the tax integrity matter seriously. Daschle was an important person, in Obama's compromise philosophy, for working out a deal on health care. That Obama was willing to take him out of consideration (I know, I know, it was his decision, and honest Tom Daschle made the decision himself) speaks to a core of integrity that is needed.

The real problem is that any plan Daschle engineered would have been a compromise against common sense and reality. I think we would have received a miserable deal under Daschle's leadership, similar to the miserable prescription drug program passed under Bush.

Why I think that can be illuminated by reference to AARP. Those of you who belong to that now 50+ year-old voting bloc, have been inundated with their countless mailings for their insurance programs (auto, homeowners, umbrella, wrap-around and supplemental Medicare, disability, term life, long-term care, etc). You may have also been solicited by their "United We Can" campaign for a reform of health care. You may have even been suckered into contributing to it.

However, did you ever notice that in all of their many articles on health care reform they always leave out a universal, single payer proposal? It's not even given a nod. Of course, the reason is not hard to see: they make a nice chunk of their income from their relationship with insurers. Now, it may not be a substantial chunk, and I have no interest tonight in reviewing their financial statements, but their consistent failure even to include a single payer option indicates clearly that they cannot think outside of the insurance box.

Daschle, for all of his knowledge, is too close to the insurance companies. (Let's just tail him over the next few months, shall we, and see the direction in which he heads.) Insurers will be the biggest obstruction to moving toward a decent health care system. They think that they are fighting for their existence.

In a just world, that should indeed be the case. Any health care plan that would extend coverage to all Americans at a reasonable cost--whether to the taxpayer or the government--must destroy insurance as we now know it, and turn it into a basically non-profit enterprise for basic coverage, and for-profit for cosmetics and frills desired by the better off earners and plutocrats.

The massive lay-offs now accumulating and accelerating will probably result in well over a quarter of the population having no health care by the end of 2009, and the belt-tightening at surviving companies after the layoffs will result in another third being severely under insured or having such high deductibles and premium payments (especially through the so-called Medical Savings Accounts) that medical expenses will start overwhelming their budgets.

I do not think that cost containment, managed care, computerized records, tax breaks or subsidies for those who cannot buy health care (one essential of the Obama plan) will be viable. When nearly forty per cent of the people in the United States are shut out of the system, the demonstrations, angry meetings, and confrontations will begin. The demonstrations will be especially telling if people finally understand what a great plan the members of congress receive.

This will be a signal issue in the economic recovery, though I don't think Obama knows it yet, nor does he know that he will have to steamroll the Republican rump opposition in order to get any useful and caring plan completed. And the biggest obstacle he has to overcome--in his own mind to start with--is that Americans must be taught to understand that there is nothing wrong with demanding health care. They must be convinced that it is a basic human right rather than a privilege or a commodity.