They presumably believed it was worth spending wildly on two of their favorite initiatives: the war in Iraq and tax cuts for the rich.

Yes, our national debt is a major problem if uncorrected over the coming years.

But the recession we’re trying to climb out of is also very dangerous. It will be disastrous for millions of suffering people, as well as for the country’s future prosperity, if the economy stays in the doldrums.

How can we significantly reduce the budget deficit unless many more people can find adequate work?

Once people are getting paid, and not living in constant fear of losing their jobs or their houses, they’ll be spending more money, and when individuals and companies are earning more, government revenues will increase, thereby reducing the deficit.

The escalating cost of health care to our overall economy will still be a challenge, but thanks to healthcare reform brought about by President Obama and the Democratic Congress, access to decent health care should gradually improve for most Americans, and the staggering burden of insurance premiums on employers should gradually be reduced.

That is, the healthcare cost problem is manageable given the political will to solve it in a way that is good for Americans’ physical and fiscal health.

It’s amazing that some of the fiercest critics of the deficit seem uninterested in avoiding waste in healthcare spending. They haven’t minded healthcare costs as long as private-sector insurers, pharmaceuticals, and other companies are making big profits, often at the expense of our well-being. (Witness the Republican-engineered Medicare Part D, with its prohibition against Medicare’s bargaining for prescription drugs, and the infamous doughnut hole. Fortunately the healthcare reform legislation of 2010 will improve Medicare.)

State budgets across the country are undergoing severe cuts as a result of tax revenues lost because workers and employers aren’t making enough money. (By law, most states are forced to balance their budgets.)

When enough revenue isn’t coming in, states must make painful cuts. Cuts that affect each of us in some way, whether it’s larger class sizes for our kids; slower response by EMTs, fire, and police; deteriorating public buildings and parks; unrepaired roads; weakened public health initiatives; excessive college fees; lack of investment in projects that would improve quality of life; more people suffering from insufficient food, shelter, and other basic necessities.

The budget reductions in many states (and note that the fiscal woes of big states, like California, have economic impacts on the rest of us) will add to the number of Americans who are unemployed. That will further depress economic activity.

The constant drumbeat — led by Republicans in Congress, followed by some Democrats in Republican-leaning states — at this moment about the country’s deficit (admittedly a serious problem) is weakening the political will to extend unemployment benefits and to continue stimulating job growth.

Somehow the foolish idea of “cutting off your nose to spite your face” has taken hold with some citizens frustrated by current economic conditions.

Especially in times like this, we need government policies that protect people from disaster and that invest in America’s future prosperity.

We won’t climb out of the hole if we adopt the Republican philosophy of tax cuts for the rich (it’s the rich who mostly benefit from tax cutting), trickle-down on everyone else.

As President Obama said recently, “After they drove the car into the ditch, made it as difficult as possible for us to pull it back, now they want the keys back. No! You can’t drive. We don’t want to have to go back into the ditch. We just got the car out.”

All Americans have reasons to be grateful for Democratic initiatives that to date have prevented this economic collapse from becoming another Great Depression.

If you don’t know what misery the Great Depression brought about, ask your grandparents or watch a movie about the 1930s.

In those years, they didn’t have unemployment insurance, food stamps, Medicare, Medicaid, Social Security, FDIC insurance to protect people from bank failures.

Thanks to FDR and other Democratic presidents, Democratic congresses, Democratic governors, and Democratic state legislatures, these and other programs for the common good have prevented much of the desperate hunger and widespread homelessness of the 1930s from recurring today.

Don’t hand the keys over in November.

Or, as John Kenneth Galbraith said, “Politics is not the art of the possible. It consists in choosing between the disastrous and the unpalatable.”

We can probably agree that politics is not the art of perfection.  It’s not for purists.

But it’s the only way that citizens of a democracy can bring about a better future.

The untiring efforts – over decades of service — of people of good will are occasionally rewarded by an inching forward of progressive legislation.  It has been painful to follow the developments, but the health care legislation passed first in the House of Representatives, and then in the Senate on Christmas Eve, may become law early this year, if difficult compromises can be made between the House and Senate versions.

If it is does become law, once all the provisions are implemented (which will occur over several years) it will provide a significant relief for millions of Americans who now can barely pay their health insurance premiums, or can’t afford any insurance, or are denied insurance because of ill health, or who must stay in a terrible job just to maintain insurance for their families.  It will also mean that the rest of us don’t fall into those categories in the future. Many lives will be happier, healthier, and longer.

The disastrous choice is what we have today for a health insurance “system” for those not old enough for Medicare. Without the new legislation, in the coming years our health and our country’s economic well-being would be further threatened.

In future it may be possible to pass laws that do more to improve access to appropriate health care. (Other advanced countries have done it, with far less political turmoil.) Historians point out that when Social Security was first enacted, many Americans were not entitled to its benefits. In later years, as the public became more conscious of its positive effects, Social Security was expanded.

One of the clear lessons of the present health care debate is that political parties do matter. 

Republicans in Congress are doing everything they can to block progress on health care. This isn’t new. Republicans have traditionally voted in large numbers against legislation that would improve the lives of millions–such as Unemployment Insurance, Social Security, and Medicare–when it was first introduced.  After programs become popular with voters, Republican opposition is less vocal, but it’s always lurking (remember that our last Republican President tried to “privatize” Social Security).

Another lesson is how hard it is to get progressive legislation through the Senate even after it has passed in the House.

It takes 60 votes in the Senate to prevent a Republican filibuster. Currently the Senate has 58 Democrats and 2 independents. One independent is Sanders of Vermont, always a progressive voice; the other is Lieberman of Connecticut, who left the Democratic Party during the last election but whose vote was desperately sought in order to prevent Senate Republicans from blocking the legislation.

Another staggering fact about the Senate is that every single state has two senators and therefore gets two of the hundred possible votes.

Rural states get two votes. Industrial states get two votes. Heavily populated states get two votes (for example California, with almost 37 million residents). States with almost no one living there get two votes (for example Wyoming, with half a million people). Southern states get two votes. Northern states get two votes. States with more Republicans get two votes. States with more Democrats get two votes.  And so on.

Massachusetts has two precious votes. We must keep our two Senators in the Democratic column, working and voting – like Kennedy and Kerry –for the common good, for improving the lives of people, for a more just and compassionate society.

Don’t forget to go to your polling location on January 19 to vote for Martha Coakley, Democratic candidate for Senate in the special election to fill the seat formerly held by Kennedy. Polls are open from 7am to 8pm.

If you know that you won’t be able to get there on January 19, call or visit your town /city hall today to make arrangements for an absentee ballot:

Gloucester City Clerk, Dale Avenue, 978-281-9720

Manchester Town Clerk, 10 Central Street, 978-526-2040

Rockport Town Clerk, 34 Broadway, 978-546-6894

Your vote affects what gets done – or not done – in Washington. Many close elections have been lost because a few supporters stayed home.  Circle Tuesday, January 19, on your new calendar now!

Kennedy was defending traditional Medicare, not the type called “Medicare Advantage,” which is offered by private insurers, usually for-profit corporations.

Medicare Advantage is the result of the “Medicare Modernization Act of 2003,” enacted by President Bush and the Republican-controlled Congress of Bush’s first term.

This is the legislation that led to the Medicare prescription drug program with its infamous “doughnut hole.”

You may recall that the 2003 law prohibits the government from negotiating drug prices. (Why would Republicans, who rail about the cost of government programs, want to avoid the best deal for taxpayers?)

The 2003 law also increased the privatization of Medicare by paying insurers to offer health plans.

Medicare Advantage has been an extremely expensive program, costing far more than the Bush administration had forecast to Congress. (The administration threatened an official with termination if he revealed the true estimate before Congress voted. A month later, the cost estimate was revealed to be $100 billion more than the administration had told Congress.)

Medicare Advantage offers managed-care plans in which Medicare pays private insurance companies to provide care rather than paying doctors and hospitals directly.

The private-sector plans cost the government an average of 12 percent more than traditional Medicare for the same services, and they have been taking up a larger and larger slice of Medicare funding.

Senator Obama has expressed concern about “the exploitation of senior citizens by private insurers participating in the Medicare Advantage program. According to an analysis by the New York Times, tens of thousands of Medicare recipients have been the victims of deceptive sales practices by these private insurance companies, had claims improperly denied or denied without explanation, and received poor customer service in trying to get their questions answered. In some cases, the practices of these companies were found to have affected the health of patients by delaying access to urgently needed health care services and medications.”

(Obama has said that as president, “I will reduce costs in the Medicare program by enacting reforms to lower the price of prescription drugs, ending the subsidies for private insurers in the Medicare Advantage program and focusing resources on prevention and effective chronic disease management.”)

One of the biggest companies in the business is UnitedHealth, whose shares are traded on Wall Street. The firm’s president had total compensation in 2007 of $5 million and was recently charged in court as having had a role in the backdating of stock options. (His predecessor “stepped down” as a result of that scandal.)

One of UnitedHealth’s divisions offers the Evercare Special Needs Plan for People with Limited Income. The Boston Globe recently reported that Massachusetts officials have received numerous complaints about the plan’s marketing techniques.

The Globe quoted an attorney for Greater Boston Legal Services: “We’ve heard of cases where brokers have signed up people who don’t speak English … They didn’t tell seniors that there are networks, and they may not be able to see their own doctors. They promise that taxi rides to doctors’ offices and bingo games are part of the program. Some said they were from Medicare itself and that it was going under and they needed to sign up.”

As a result of the state’s review, UnitedHealth has decided to temporarily stop sales of the plan in Massachusetts. Will they now train brokers not to use misleading sales tactics?

The reason that Kennedy went to Washington while undergoing brain-cancer treatment was to prevent the private-sector plans from taking funding away from traditional Medicare.

When Medicare spending exceeds certain limits, automatic cuts are triggered. This year, the cuts could have meant a steep drop in payments to physicians.

The Democratic leadership proposed instead to reduce the excessive subsidies to private insurance companies. President Bush and Congressional Republicans wanted to protect the insurance companies.

At first Democrats couldn’t prevent a Republican filibuster because they needed one more vote — hence Kennedy’s selfless return to the Senate.

With our courageous lion in action, a few Republicans were persuaded to switch their position and voted with Democrats, ensuring passage of the bill.

This vote illustrates fundamental philosophical differences between the parties. Democratic plans usually emphasize the common good. Republican plans usually favor private profit, often at enormous cost to taxpayers.

Is it because those with good health insurance haven’t been worried about anyone else? Is it because voters have been scared by the myth of “socialized medicine”? Is it because of the political power of the for-profit insurance industry?

Many Americans have excellent health care because they get good insurance through their employers. Some very rich Americans have excellent care because they pay for it privately.

But the number of uninsured Americans is shocking, and it continues to grow. According to a report by the respected Kaiser Foundation, “Nearly 47 million Americans under the age of 65 lacked health insurance coverage in 2006, an increase of 2.1 million from the year before.” (The reason the report uses statistics for those under 65 is that Medicare—even though it doesn’t pay for preventive care—makes such a difference to the health of those it covers.)

It will be painful to learn how many more Americans lost health insurance in 2007 and 2008.

Many who do have insurance discover it’s inadequate. The numbers are hard to come by, but over time—until we finally adopt a health care system—more of us will likely fall into this category, postponing preventive care and recommended procedures because of out-of-pocket costs.

One measure of a nation’s health is the number of infant deaths per 1,000 live births. Our ranking is shameful – of 221 countries, we are in 42nd place.

Our non-system of health care has a devastating impact on the lives of uninsured children.

According to the Kaiser report, 26% of uninsured children have no usual place of care; 17% postponed seeking care because of cost; 12% had their last contact with a health care professional more than two years ago; 23% had unmet dental needs, and a whopping 37% hadn’t visited the dentist for more than two years. Since most are in families that can’t afford insurance, those kids who do manage to get better medical care are probably benefiting from painful sacrifices in other important areas of their family’s life.

Recently President Bush vetoed an expansion of Medicaid insurance for children (S-Chip). Congress couldn’t override the veto because most Republicans supported the President, even though Democrats had worked with a number of Republicans to make the legislation more palatable to Republican philosophy. Meanwhile, Bush’s budget for 2008—while touting an increase in dollars—would not cover all of the children already enrolled.

If we had a real system of health care, all Americans could receive good health care as a basic right.

The system could emphasize prevention, both because we want to improve the health of all Americans and because we need to reduce the long-term expense of preventable disease.

The system could replace the inefficiencies in billing that add billions to the cost of American health care.

The president of Johns Hopkins University, who gave an informative speech last fall, reported that at “the Johns Hopkins Hospital we have to bill more than 700 different payers and insurers. These are HMOs, PPOs, MCOs, IPAs and an alphabet soup of other organizations. Each one has their own set of rules regarding what services are covered, the level of reimbursement and what kind of documentation and pre-approval is required. It is an administrative nightmare.”

The patchwork quilt of health care in our country has become so tattered—more full of holes and yet more costly to provide every year—that there is pressure from powerful forces, including big business, to do something about it.

The devil will be in the details.

If a Democrat is elected President this fall with a strong Democratic majority in the House and Senate, the solution won’t be modeled on the confusing and expensive Medicare prescription drug program designed by President Bush and the Republican Congress. If you’re a senior, you’ve probably been baffled by differences among the private-sector plans and shocked at the increased premiums. If you’re a senior whose health depends on costly drugs, you know how unfair and painful that “doughnut hole” is.

If working for the common good becomes a priority for the White House and Congress as a result of Democrats gaining power this fall, let’s adopt a real system of health care which will promote the “general Welfare.”

Consider one dictionary definition of the word system: “the state or condition of harmonious, orderly interaction.”

Consider what it’s like for the nine million American children who have no medical insurance and the constant worries of their parents.

Most of us with good insurance debate whether a symptom is worth a visit to the doctor; our concerns may be the co-pay, taking a few hours off work, or wasting the doctor’s time.

But imagine the anguished debates of parents whose kids aren’t insured:

* Will the fever go away on its own? 
* Will the cut heal without stitches?
* Is the patch of red skin likely to mean an infection that will spread?
* Is it worth going into further debt to see a doctor? 
* Which pediatrician in town will see a new patient without insurance? 
* Maybe the best option is to get treated at the emergency room and apply for free care?
* Or wait a few days and see if the child improves?

If children suffer longer than necessary with a treatable illness, what is the impact on their schoolwork? What is the likelihood of their spreading infection to classmates?

How can these scenarios be prevalent in the richest country in the world, where many people spend thousands on surgery to remove the wrinkles of age?

Democrats believe that all Americans should have access to decent medical care. We think it’s a moral failure that this country hasn’t achieved what other advanced industrialized countries have:  health care for all.

It took a fight over decades – finally won because of the landslide victory of Democratic President Johnson and a Democratic Congress – to achieve Medicare, the system for providing health insurance (at least partial) to the elderly and disabled.

Republican Senator Mundt of South Dakota represented Republican philosophy well forty-two years ago when he advised against Medicare:

“No one can doubt for a minute that this is simply another step toward the neutralization of private responsibility which will eventually end when the Government assumes complete control over the destinies of all of our citizens from the cradle to the grave. The principle established here, when carried to its logical conclusion cannot fail also to be damaging to two segments of our free enterprise system – our physicians and our insurance industry.”

Now another battle in the long struggle to make medical care available to all Americans is being fought – this time on behalf of uninsured children.

Last month, the Democratic-led Senate passed a bill to expand the State Children’s Health Insurance Program to an additional four million uninsured children. (Thanks to Senator Kennedy’s leadership, six million poor children are already enrolled in the program, established in 1997.)

President Bush says he will veto the bill. He explains: “Their SCHIP plan is an incremental step toward the goal of government-run health care for every American. … I believe the best approach is to put more power in the hands of individuals by empowering people and their doctors to make health care decisions that are right for them.”

(In short, he agrees with the 1965 views of the Republican from South Dakota.)

This language is typical of Bush’s evasions. First, it’s no more “government-run” than Medicare. Second, how could uninsured kids empower doctors they don’t have to make the health care decisions?

Fortunately, eighteen Republican Senators joined Democrats in supporting the expansion. Without those Republican votes, the legislation wouldn’t have the slightest chance of becoming law.

But don’t give the Republican Party too much credit. Sixty-three percent of Republican Senators still voted nay, including New Hampshire’s Senator Judd. No  Democrats voted against the bill.

Some Republicans say Democrats are “playing politics” with this legislation. Yes, it’s political – meaning it’s about the kind of country we want. But there’s nothing playful or casual about it. Democrats have long pushed for fairness in health care.

In a 1945 speech to Congress, Democratic President Truman urged: ““We should resolve now that the health of this Nation is a national concern; that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all  the Nation.”

In the sixty-two years since Truman’s speech, lack of comprehensive medical care has become an acknowledged crisis for kids and adults, doctors, hospitals, and employers. If there’s a Democratic landslide in 2008, we can take at least a few more steps forward.

They may differ on which issues are the most pressing,  but concerns are frequently expressed about medical insurance, the cost of living, the war, public schools, college affordability, retirement security, environmental protection, civil liberties, jobs, and the budget deficit – even about the President’s idea of national security.

Since the 1980s, our government has been tilting Republican. Now that Republicans control the Presidency, Congress, and Supreme Court, our ship of state is under the command of the Republican Party.

Republicans hold the majority of state governorships, including our own.

When we review the state of our union, we’re looking at a vessel foundering under Republican philosophy: that private incentives are the automatic solution of most of society’s problems.

It’s fair to ask whether — if Democrats were in control — anything would be different.

To forecast what any candidate will accomplish when elected, we should look at the basic philosophy of his or her political party, past accomplishments of that party, other political forces, and the public’s concerns – as well as the individual candidate’s experience and talents.

The philosophy of the Democratic Party can be summed up as working for the common good. That’s why Democrats were responsible for virtually all advances on behalf of America’s people during the 20th century: Social Security, minimum wage, college loan programs, unemployment insurance, federal oversight of food and drug safety, Medicare, Civil Rights…

Each of these steps forward was under a Democratic President and Congress. Even then it was difficult to achieve these basic protections. There is no guarantee that they will be preserved competently (let alone strengthened) by those whose party opposed them from the start.

So what would Democrats do right now?

Since space is limited, let’s take just one issue of concern: health insurance.

If we had had a Democratic President and Congress for the past 6 years (that is, if the prosperous Clinton years had been followed by Democratic President Gore, Tom DeLay hadn’t engineered a Republican takeover of the House of Representatives, etc.)  we would now be on our way to health care for all Americans as a basic right.

Here are some reasons that this would become a reality, after so many years that champions like Democratic Senator Ted Kennedy have been advocating sensible solutions, against vociferous Republican opposition.

• The public is acutely aware of the crisis, because premiums are escalating, many of us don’t have coverage, or we have insurance only for catastrophic illness. It’s taking longer to get appointments, many hospitals have closed, and there’s a shortage of nursing care.
• The medical establishment – hospitals and doctors, who in the past opposed Democratic proposals to expand access – now recognizes that the tangled web of incompatible insurance plans, layers of red tape, and “free” care doesn’t work.
• Employers (from corporations to small businesses to local government) cannot keep paying giant insurance increases, in which the price of pharmaceuticals plays a major role. Health care in the US takes a greater share of economic resources than it does in other advanced countries. We don’t do as good a job of preventing illness as many other countries. Our infant mortality statistics are shameful.
• Democrats are responsible for our elders’ access to hospital and medical care, as a result of the Medicare program enacted under Democratic President Johnson and a Democratic Congress. Unlike the new Republican drug plan, which private insurers and the drug industry helped design, Medicare is – like Social Security – administratively efficient.

Because health care is truly in a crisis, both Democrats and Republicans are talking about it.

But Democratic proposals for fixing the mess will be very different from Republican proposals.

Given our basic philosophy and past achievements, you can be sure that Democrats’ priority will be for the common good: emphasis on access to preventive care (which enhances the quality of our lives and saves money in the long run), decent medical treatment for all Americans, and a single-payer system to eliminate administrative waste – that is, the best overall solution for our whole society. 

Our steps toward a comprehensive solution will be dramatically different in design from the new Republican Medicare drug plan, with its reliance on countless private insurers, expensive layers of paperwork, a prohibition on bargaining with drug companies, and the “doughnut hole” gap.

The Democratic Party and the Republican Party are very different in their philosophies. It’s important for voters to decide which set of values they prefer.