Reflections of a stormy petrel

One: there already are death panels in American health care provision. They are the accountants who decide how long the companies can afford to give healthcare to customers who have chronic or expensive conditions.

Two: the Republican notion that the current system can be tweaked or bullied to remedy such problems is nonsense. It is positively crazy. If seriously pursued, it will lead to a situation where corporations have to deficit spend to keep patients with chronic and expensive conditions alive, which will eat into their budgets and threaten the rise of a Fannie May and Freddie Mac situation.

Three: in order to deal with chronic, expensive or long-term cases, there is need of a body which is not only capable of but allowed to deficit spend. There is only one such body: the State. The State routinely deficit spends on such things as the police and the military, the courts and the jails, which never will bring in an income but which are indispensable for society. Indeed, Adam Smith's classic definition of the "expenses of the sovereign", by which he meant the public sector, is: all those expenses which are necessary for society but which the private sector cannot profitably pursue.

Four: it is an atrocious lie that people who demand a right to health care are "inventing new rights". The denial of health care to anyone is the denial of the three basic rights: life, because it places the person in the immediate and evident danger of death; liberty, and the pursuit of happiness, because it reduces what is left of life to a despairing struggle to be allowed to draw a few more breaths. If you think this is what the Founders meant, you are not only a fanatic, but a sadist.

A real and serious issue with exporting any European or Japanese model of universal health coverage to the USA is the size and diversity of the nation. The attempt to micro-manage the British Health Service - by now reduced, thanks to the growth of local parliaments, to England alone - from Westminster is notoriously one of the major problems with this body, although in my view neither the biggest nor the worst. To expand it over a country eight times as populous as England and sixty times as large would be to multiply problems to an intolerable extent, and to deliver to the Federal Government an amount of power which it is neither well placed nor legally supposed to handle. Any attempt at universal health cover must be based on the States, and, for choice, have its decision-making as far down the level of organization as is compatible with its goals. The issues with this are obvious: first, the inevitable rise of a "postcode lottery" of the kind that is being fought against in Britain as we speak, and much more deeply rooted in the vast differences between states; and second, the danger that some states might take their sets of ideological blinkers to health care provision. I am thinking both of those states that produce leaderships and governors that demand "equal time" for creationism in class, and of infernos of PC and denial such as the three West Coast states. For this reason, establishing an American Health Service would not only be a complicated business, but one that would demand a great deal of legally enforceable protections against mismanagement, and, if necessary, a certain amount of resource transfers from richer to poorer areas.

(Incidentally, I would like to point out that John McCain dodged one Hell of a bullet when he chose his running mate. Among those who favoured a young Christian conservative, the favourite was not Sarah Palin - although she was much better known than the media would have us believe - but Louisiana Governor Bobby Jindal, a man barely in his thirties and widely regarded as a rising star. The problem is however that, while both Jindal and Palin have expressed vague personal Creationist views, Palin has explicitly stated that she would not force her views on the Alaskan education authorities, whereas Jindal has been caught red-handed trying to slip Creationism into the Louisiana school curriculum. And there is far less excuse for him than for her, since he is a self-declared Catholic, and the Catholic Church explicitly rejects Creationism. Jindal is as unacceptable as a candidate to the Presidency as Huckabee - whom I condemned months ago for the same reason - and just as unelectable; and worse, in that as a Catholic he should know better.)

If the Republicans wanted to win at the coming elections - and, perhaps even more important, not to confirm every commonplace of anti-American propaganda throughout the world - they should have sent Cheney (and perhaps Rumsfeld) on a diplomatic mission to Antarctica for the last couple of months. His outburst about pretend drowning being a legitimate kind of interrogation has been manna to al-Jazeera, MoveOn.org, the Daily Kos, and the Brutish Broadcasting Creeperation. But what was worse was the number of would-be reasonable Republican columnists, people who claim to be the real mainstream of American society - and, increasingly, are - who, instead of suggesting that he should suffer from a few weeks of laringytis or that he should retire to the Rockies to fish and shoot deer, have lined up to support him, even claiming that pretend drowning is not torture. All of it, mind you, said with the earnest, moralizing tone with which they (rightly) denounce the New Jerk Dimes' assaults on American security and the crass exploitation of Mark Foley's flirts with young adults by the party of gay rights. Be serious: do you imagine that if such... call them procedures... were used by any American cop, against the worst, most murderous, and most provenly guilty, of gang members - the case against the gang member would not collapse in court, and the cop and his accomplices would not go to jail, among the execrations and disgust of all decent Americans? Have you morons learned nothing from the Abu Ghraib calamity? The West is held to a higher standard of behaviour than the stateless gangs of murderous thugs who hate it; and rightly so, for these are the standards we chose for ourselves. To imagine that American citizens are protected from treatment that is acceptable even for criminals of other countries is to make a nonsense of the first sentence of the Declaration of Independence. This should not even need saying; it should be as obvious as the sun in the sky. But evidently Cheney and a number of Republicans are blind to self-evidence.

A curse on the party spirit, and a plague on both your houses. The Foley affair showed the Democrats eager to throw overboard every bit of principle they had ever claimed with respect to gay rights, merely in order to show a little-known Republican in a bad light; and the water-torture affair now shows hordes of Republicans willing to throw overboard the very historical principles they claim to live by, the principles upon which the Republic was founded, just in order to support a morally tone-deaf old man. I can see the need of things like Guantanamo, special courts, and even limitations on published evidence, because this security crisis - it is hard to call it a war, though it has some of the features of one - is something completely new in the last few centuries of history: militarized banditry with a politico-religious justification, yet leaderless and stateless, with no state to hold responsible (though many are accomplices) for its soldiers' behaviour, no common uniform, organization, or aims, supported by an anarchic network of mosques, self-proclaimed leaders, Islamic financiers, and deviant secret services. In these circumstances, to hold the enemy to every word of the Geneva Conventions, which none of them ever signed, which none of them regard except with derision, and which never envisaged worldwide banditry of their kind is, whatever the US Supreme Court may happen to think, total insanity. But there is something much more important than the Geneva Conventions, which, after all, only codify the transient and ever-changing laws of war; and that is our own collective conscience, the values in whose name we have built our societies, the values in whose name our fathers fought and died against kings and tyrants. And if Dick Cheney thinks that these grey old rules may carelessly be broken for the delusion of advantage against a fanatical enemy, then he is almost as revolutionary and as destructive as that enemy; and to that extent, he has to be rejected by the sane majority of both parties.