The Iraq War

      Just before the invasion of Iraq it was well known in my church bible study group that I felt the invasion of Iraq was a disaster waiting to happen.  It would be a trillion dollars, 15,000 dead Americans, and not matter if we were there for 5 years or 50 years, the day after we would inevitably leave, the next thug would rush into power and likely be even worse than Saddam Hussein.  It seemed clear that our Air Force through satellite technology and precision bombing could easily have dealt with any threat of  weapons of mass destruction. 13 Years later the actual cost of the war is at two trillion dollars, 4,500 hundred dead American  military personnel, 32,000 wounded, hundreds of thousands of military children and families left with direct trauma from loved ones coming out of a war zone as well as the PTSD victims, 32 military personnel suicides a day, something much worse than Saddam Hussein taking his place, and the U.S. the blood of  hundreds of thousands of Iraqi civilians and military personnel on its hands. The first president Nouri al-Maliki, whom the U.S. had put in power to replace Saddam Hussein, got the ball rolling in his new role by sentencing his political opponent to death (had to be smuggled to Turkey), and now Saddam Hussein's Sunni Muslims, as well as their opponents, see no option other than large-scale, long-term violence until the other is crushed, oppressed, or dead.  There is enough revenge stored up against the West in all of the orphans and victims to last for centuries.

      And American's are left with the equivalent of verbal and political warfare at home launching blame at one another for the disaster of wasted time, money, and human lives.



 

  

findingthewisepath.com

By the way, as soon as I can get its domain name transferred from WIX to Squarespace, findingthewisepath.com will be off and running!

Celebrating "Tonight"

      I just remembered that some time ago I asked God that, if it was His will, and it fit in alright with the rest of His overall plan, could I please live until I'm around 90 (this would be for my daughter's sake).  And so, tonight it dawned on me, just in case, I had better start brushing my teeth twice a day.

______________________________________________________________________

      The above post "Tonight" is actually a blog entry from 9/13/2005, and the second recorded blog entry I ever made.  It has been sitting there unpublished as a draft since that time, for the good reason that it should have been, and perhaps still should be -- but for the urge I had to go back tonight and see when this blogging all began for me. This blogging is where I found I could sit for 16 hours, studying, writing in Christian blogs, thinking, learning through debating with many others the multivaried doctrines of my new faith, without falling asleep.  I did not know I could do that, nor did I know how much I could enjoy it. I could sit for hours, day after day, studying, writing, exploring, discovering, clarifying, problem solving, learning, watching, seeking, finding, observing people with some of the highest levels of academic achievement disprove and devour each other, handily and summarily, day in, and day out. It caused me to begin to lose heart, to not even want to go into this new marketplace of ideas,  yet, surprisingly . . , I did not fall asleep. That, for a while, was my biggest surprise. And then something happened and I came to find a richer, unexpected surprise.  Blogging, pondering, simply writing . . . clarifying thoughts, was good for the soul.  It bore fruitful understanding.  Using the symbols of thought, to develop and clarify thought, produced finally useful, clear and well developed, much needed, and much appreciated thought. How handy this proved to be in a world whose information often gets abused.     

      I wish I had saved my first blog entry.  It seemed so primitive and cloddish at the time that I soon deleted it out of embarrassment.  It went something like, "o.k. then, let's see, one, two, three, let's let 'er fly", and I pushed the "publish" button and recorded my first blog entry.  Man I was exhilarated.  I thought that post lacked the  style of a real class occupant of the blogisphere at the time (laugh) but now, wow, I wish I had kept it for the record.

      An hour ago it was a minute past twelve.  I had just submitted the final paper in the final class of a Bachelor's Degree in Applied Behavioral Science.  The educational experience has reaffirmed my trust in the value of the basics. They are good.  "Keep it simple, stupid"!  Everybody has heard that one. Isn't that actually a warning to a "smart" person to not betray their intelligence by letting bloated reasonings distort a more easily understood?  There is power in the basics.  Big ideas many times fail.  The basics remain, unable to be denied, and available to be readily applied better the next time. I'm not talking about inventing a better spaceship, I am talking about going moment by moment through the day. How faithful they can be.  Additional proof that He is faithful. Yet, complexity can be beautiful when it is a soundly interwoven series of well established basics.

And finally, consider taking a big chance at learning more about things you did not know you were interested in; start a blog. Find out what's in there. Surprises await you.

One day we brought boogie boarding to Eau Claire Dells

My daughter and I went to Eau Claire Dells County Park one sunny day this past summer and brought our boogie board.  That's simply a type of adult belly-board that came into popularity on the West Coast used as a body surf-board -- too small to stand on, but just right for boogie boarding (short for body-surfing with a belly board). We use them for paddling  far out into fresh water lakes to snorkel here in northern Wisconsin.  When she was seven and eight-years old she would swim with me far out into the middle of some of the small lakes up here, no fins, no belly-board, just for the sake of enjoying the water.  Since then we've given ourselves over to a much easier way to do it. I even have a 10 foot paddle board that we sometimes paddle out and use as a sort of raft as we snorkel, as well as just to sunbathe on.   

This was our first time at Eau Claire Falls and we just decided to bring the boogie board along.  Sorry for the quality of the You Tube recording below, but there you can see my daughter's first whitewater boogie board run.  Until then, she had no idea how fun these little boards could be on a river. My run was too ugly to watch (maybe some other time), but her's was good.   In her previous run, she had slid off of her board and lost it downstream (I had to fetch it).  But her second run was a keeper. I was just amazed after watching my flub that she agreed to do it.  Enjoy.

A Tail of Two Animals (tale coming soon!)

Psychology 101, Question 2, Option B

In mid-January, Lord willing, I will have a bachelors degree in Applied Behavioral Science.  My goal is to counsel young men and boys (now even young women and girls) at the Lincoln Hills School.  That is the youth prison here in Wisconsin.  Since I had taken Psychology 101 back in 1978 I was allowed to by-pass it this time around.  However, recently my academic adviser must have reconsidered, feeling that 36 years was an awful long time since having my last exposure to basic psychology, signing me up for it this term.  I am glad he did. The first time around was a life-changer in terms of understanding how the human animal tends to think.  This time is much richer.

School is paying off dearly;  I am stretching in every direction.  Things are good.  

The voice is continuing to develop, and I am back on the piano again in church, as well as sometimes playing bass guitar, six-string guitar, or simply singing harmonies.  The bible study there has been good and sometimes there is no music practice and I wind up in a rousing game of basketball in the small church gymnasium.  

So here then is an assignment that provoked some thoughts which I thought woud be interesting to share.  We'll see. . . 

 

Option B:
Explain the processes involved in how one senses the world around them (sight, touch, hearing, etc). If you had to give up one, which would it be? Why? What in your life (think about home, work, school) would be impacted by this lack of sense? How does perception influence your sensory systems?           

Response:

We take the world in through our senses.  If that were all that happened, then we would would all just be. . . (insert the name of your least favorite animal or political party, right  here).  But something happened to us, mankind that is, sometime within the recent past of less than 10,000 years or so.  Some would say it was with the discovery of agriculture somewhere around 7-10,000 years ago.  Others would point to a convincing lineage and historical record dated back to when it appears their God visited this already existing planet and created a whole new larger spiritual man with an entirely new set of attributes out of something that he had cultivated for billions of years.  At any rate, it is an amazing thing what, nearly inexplicably, happened to mankind not too long ago –  for there was a sort of complete transformation.  "Prehistoric Man" changed from nothing more than a "senses" driven high form of animal life, foraging, prehistoric, barely distinguishable in intelligence from any other animal, into something quite distinct.  Until then, like a trained animal, it was almost as if our existence was based primarily on an operant conditioning.  It was almost as if then some biological constraint had been lifted and we could all now simply “know”.  We were finally very distinguishably aware.  Not only could we substantively remember the past but we could anticipate the future and the tools of language sprung up with which we could talk all about things.  Suddenly we had multiple large families of complex languages, agriculture, and our diet was worse than ever! 

At any rate, we are man (male and female), distinctly “wise”, conscious of it, and best of all we are aware that we are conscious of it.  We have become well equipped with the tools of communication to evaluate and discuss our newly more developed and greater conscious awareness (LeFrancois, 2011, 2.5).  Prehistoric times ended and then we really had something to write about! 

By what process do we sense the world around us then?  The same way an animal does I suspect, with one big difference: the human has a very different main processing center.  Prehistoric homo sapiens seemed to have developed from an existence based on typical animal senses, instincts, and seemingly a heavily operant style of learning and existing into a more distinctly human way of processing.  Man was prepared with a very good main processing center.  She experiences life through her senses much like an animal, I’m guessing, but she interprets it much more uniquely.  We “sense”, and then ideally, before we respond, we do some major interpreting that no other animal species is equipped to do.   And somewhere in all of that is an interesting process that we are still trying to understand.

After consulting with my daughter, I determined that I would the most willingly give up my sense of touch or even smell.  I would much rather give up my hearing than my sight, notwithstanding that I am a musician, for, as my daughter pointed, matters of convenience (bumping off of walls, running from bad guys, etc.). I would certainly be a sad quiet day in some respects around here though if that were to happen, and joyous in others, because there is always plenty of else to do without hearing, and less whining to distract.

Reference

            LeFrancois, G. (2011).  Psychology: The Human Puzzle.  San Diego,    
                Bridgepoint Education, Inc. https://content.ashford.edu

I Found This in My Refrigerator.

This is some expired cottage cheese that I rediscovered in my refrigerator one day.  From white, it has turned into a color extravaganza bustling with new life forms.  There appears to be at least 4 different types of mold in there (maybe more).

They are likely to be bacteria (as opposed to fungi).  Generally speaking they are known as microorganisms (in many instances germs) -- or, the smallest creatures on earth.  From several miles beneath the earth's crust to high in the sky, microorganisms have a widespread presence on this earth.  From 200 miles above the earth, looking down, they are the only visible life form. We see them in special satellite photos taken of the oceans in early spring.  They are massive blooms of phytoplankton registering as fantastic swirls of green, blue green and red in the northern oceans.  Microorganisms have a fundamental and far-reaching organic dominance here on earth -- literally penetrating into every nook and cranny – and are absolutely everywhere.  But fear not, they have an irreplaceable part in nature and comparatively few of them are harmful to us.

Earlier in history, it was apparent to people that some spoiled foods were inedible and caused harm while others were actually pleasing to the palate – sour cream, sour kraut, I can’t think of too many others.  And that certain illness were caused by some sort of transmittable something or other.  We didn’t know how all of that worked.  Although, simple hand-washing, first recommended by the Lord, was already a well known first line-of-defense against the invasion of disease, it was still not entirely known why.

Then the theories started to fly.  There was the theory of spontaneous generation, as well as the bad air theory.  Then came Antonie van Leeuwenhoek in his dusty Holland fabric shop during the late 1600’s.  He opened up a whole new world of magnification to us and subsequently became known as “one of the most original and curious men who ever lived”.  By grinding glass lenses to ever-finer specifications, he could determine the thread counts on the bolts of linens he was buying to make his draperies and upholstery.  Soon, through these early magnifying glasses he also gazed at specimens of pond water about which he wrote, “. . .there were many very little animacules, very prettily a-moving. . . in such enormous numbers, that all the water. . . seemed to be alive.”  He soon had constructed 250 powerful microscopes that could magnify up to as much as 300 times.  He very accurately described bacteria and protozoa. Eventually he was recognized as a scientist of great merit.   

By the 1800’s microscopes were capable of magnifying 1000 times or more, and the “if. . . well, o.k. . . then. . . ” approach of deductive reasoning in the scientific method, a very sound, logical method for beginning to map out the physical intricacies of God’s creation.
 

Let’s fast-forward to the amazing story of Hungarian Dr. Ignaz Semmelweis.  Read his story on Wikipedia.  He proved that deadly infections were indeed spread by doctors simply not washing their hands between patients, yet unable to change the stubborn ways of his lazy-minded colleagues, and save lives, eventually wound up committed to an insane asylum, and went down in history as a sort of peevish genius.

The rest of the story through the “germ theory” is more fascinating than any science fiction.  We will forgo that here.

Microorganisms are ubiquitous in nature  -- they are everywhere.  Most don't reside in any specific plant or animal host but are free-living, could be isolated from the soil, water, plants and animals just about everywhere, and are not known to cause disease.  Others are capable of producing disease if they are introduced into a part of the body that is not meant for them to be in.  They will then invade, cause infection, and it is up to the many specialized antigen fighting cells in our body to stop them.  The ones here in the picture of the dish in the refrigerator are easy for the body's defenses to deal with.  Our eyes are our first line of defense (early warning system), then I suppose, our nose (less forgiving).  Our taste buds are next, then stomach acid with its fierce acid bath is next in line, and if all of those defenses don't work, our stomach muscles are next (eeewwww).

To disarm the ones that get past the body's defenses, we have to rely on the defenses that bacteria themselves use against each other.  These are what we know as antibiotics.  Antibiotics are what many bacteria use in their quest to not merely survive but to invade and dominate other cultures of bacterium.

I can't be absolutely sure what these various microbial culture in my dish are.  My microbiology professor would be able to name most all of them by sight.  But that is only after many trips to the microscope where they would be stained and analyzed by shape and post-stain adherence, whether they live in chains or clumps or any number of other tell-tale traits.

And then other men would go on to build better and better microscopes until one day the amazing electron microscope would be put together.  It would enable us to peer at not only now the miniscule nucleus of a tiny living cell unit, but at each of the billions of genes contained in them, and the variety of nitrogen bases that comprised them and the countless electron they consisted of.  And we now know that these unimaginably small and numerous hundreds and hundreds of trillions of particles that make up these things are simply giants in comparison to the smaller particles we have discovered yet cannot see.  Even if we someday are able to see them, there will be smaller particles yet to come that we cannot.  Our eyes and our tools are finite; they have limits.  Still, there is spirit. 

We know it is there.  Those particles in our immense minds containing our deep invisible thoughts, finally, that is wherein lies the miraculous, incomprehensible division between soul and spirit.  That’s where the stuff of life dwells.  The stuff of real life.  The stuff that Jesus had access to.  The stuff that Jesus was a part of, and had authority over.  Therein, God showed us where we came from, and what we meant to Him – what it all meant.

Jesus was able to show his irrefutable authority in that area to everyone he met.  No one doubted his spiritual import, but only questioned whether it was a good or bad, or if it even mattered.  He gave us the Creators model --  “That which is born of flesh, is flesh, and that which is born of Spirit, is Spirit”.  That was not just a generous revelation of what was what, but of who and what He was.  His purpose was to explain the creative God-head of the universe, which he was a part of.  His method was by demonstrating the existence of and difference between flesh and Spirit – organic life made of the elemental things of the earth, and eternal life consisting of similarly indestructible spiritual matter that held it all together.  His means was by coming and fellowshipping with His creation, teaching it about true life, which came from above, and demonstrating eternal life. This is Spirit. 

This is the God whom self-willed men did not want to find – the one with a fierce reputation for love and productive engagement with His creation, a constant invisible yet tangible and irrefutable presence which they were now accountable to. In the process “Man” was able to discover that he/she need look no further in their quest for Spirit because God left his testimony in Spirit – Spirit and Truth.  The only known truth who had demonstrated power over ‘spirit’.  Predictably, it was the same God, the only God, who revealed Himself since the beginning of the present earth and man’s presence on it.  It was a done deal.

 

Now we explore his magnificent creation knowing whose it is, where we are going, and of what we are made – flesh and Spirit.  If we listen and learn, follow and allow ourselves to be led by Him.With our marvelously curious minds and the powerful tools devised by them we look in amazement at the universe of micro-organisms, and beyond, and see how easy it is to forget that something greater than that is here.  He is here.  He is everywhere.

Unfortunately, Wisconsin's Constitutional Ban on Same Sex Marriage is Likely to be on its Way Out.

The American Civil Liberties Union filed a lawsuit for a group of same sex couples in Madison on Monday (2/3/14). They will challenge Wisconsin's constitutional ban on same sex marriage.  With their success in other states as an indicator, then they are likely to succeed.  Why?  Is it inevitable? Probably so due to the fact that the dominant culture in the U.S. has not succeeded in distinguishing "marriage" from a plain legal "contract", nor does it seem to mean anything more than that in our popular culture.  So, may it rest in peace.

Yet, it's unfortunate.      

If Christians cannot define marriage to a lost world, a Christian institution with origins in the nation of Israel, then they may lose it.  They cannot seem to be able to differentiate it from a Constitutional right.  So perhaps that is what they've let it become?  Unfortunately, statistically, in the area of divorce, Christians are already equals with non-believers.  

If we cannot distinguish a "marriage" as being a unique union between a man and a woman and a "legal civil union" as being between any two friends of the same sex desiring legal protection, then we have lost our salt.  There should be no confusion between the two types of unions.  Two people of the same sex cannot produce biological descendants together nor cultivate their own biological family -- they have no incentive to endure a marriage, nor even need a marriage in the first place, apart from legal protection.  The institution of marriage was originated for at least this type of description, composed of man and woman, husband and wife, a label for a unique nuclear family, or simply a unique unit of two.  The facsimile of two people of the same sex trying to do the same thing bears no likeness.  Two people of the same sex can still have an intense fondness, lust, love, with a physical attraction, but can only imitate the critical part of a marriage.  Two people of the same sex cannot go through the consummating act of a marriage, but can only dumb it down, lessen, and perhaps even render the institution as being of no affect, useless anymore, and far gone from its original definition.  Perhaps in the future, gays will marry, and heterosexuals will enter a simply more pragmatic agreement of a legal civil union.  It is already happening in Europe, and therefore likely to be picking up steam in the U.S., proving, finally, that a civil union can indeed accomplish all of the legal requirements of marriage desired by the homosexual subculture, yet they are still plodding forward politically to ultimately and inadvertently prove that the original marriage was unobtainable, and they have in the process contributed to making it obsolete.   

Marriage predates Democracy, yet unfortunately we have allowed the political system to redefine it and assume its ownership.  The same political system would instead have helped the over 90% in our country who are heterosexual to retain its uniqueness.  But it seems as though they (we, I) cannot defend marriage as being different than a simple "legal civil union" and now must give it over to being something, apart from lip service, mostly legal.  It has been given over to being a mere legal contract, a signatory of friendship that can be legally honored or broken in court of law as a friendship wears out, void of any nuclear family need for genetic identity and longevity or historical significance, and simply be scavenged now by any two adults of any description purely for its legal entitlements.

A civil union signifies legal entitlements between friends -- a social entitlement that should have been extended long ago to a battered minority here in our society from a humane social and political perspective, but now is finally ushered in as once worthwhile human institutions and marital values are dying and being ushered out.

And to the rest of the world the founding institution of marriage will have a ring of religious bigotry to it instead of the sound of unique beauty and promise that it was founded on, because God's people could not help it continue to stand as originally intended.  They could not define it to anybody else as being different than a mere political civil/legal union.  What a shame.

_______________  Update  ________  02/17/2014_______

What do you know . . . 

In Indiana -- for one -- they know the difference between a "marriage" and a "civil union".

This move can maintain a plain institution of marriage there.  They are the new forward thinkers.

A Research Paper on Health Care Policy.

Final Paper:  Public Health Care Policy

Todd Saunders

SOC 320 Public Policy & Social

Instructor: Vahik Ovanessian

01/20/2013

  

 __________________________________________________________________________ 

Public Health Care Policy

      The public policy process usually begins with an issue identified as a public problem.  The issue then must find its way through many competing interests and participants onto a narrow agenda of issues where, in whatever way it chooses, government decides how to deal with the issue.  It enters into the ‘would be’ process of problem solving.  The outcome can then range anywhere from having little to no effect, partially or completely solving the problem, or making the matter even worse.  This paper will take a comprehensive look at the health care policy problem here in the United States as well as the policy-making process itself.  It will do so by looking at the scope, nature, and evolution of the health care policy-making process.  At the same time it will look at the actors, institutions, and political concerns involved, as well as some of the approaches they used in formulation, adoption, and evaluation of health care policy.  It will then analyze public opinion and its impact on the process, and close with a look at present health care policy, its direction, and its potential future.

      Early in this countries history there was no formal health care system. Government’s involvement in the health care enterprise was generally limited to sporadic charitable provisions for the relief of the poor.  Beyond that, public health care was the headed up by religious groups and charitable organizations relying on patronage from the wealthy.  The beginning of our current system of health care may have begun in 1739 with public funding of the Pennsylvania general hospital in Philadelphia, the first health care facility in America.  The young physician with the idea had been impressed with a health care movement in Europe and the famous French hospital, the Hotel-Dieu in Paris.

      From this period, the U.S. health-care system is said to have begun evolving upon entrepreneurial principles. Government would assist in informing society about activities that would improve general health.  Financially, it would come to the aid of the destitute as well as people who were economically or physically disadvantaged.  To a growing extent, society at large was acknowledging that good health was intrinsic to not only human welfare but economic prosperity as well (Theodoulou & Kofinis, 2012. 11:1).

      Then, not too long after the expansion of state responsibilities came a number of scientific advances in the 20th century.  The number of preventive public health initiatives then began to rise.  Governments began to increase their role in curative care through regulation, funding, and the provision of care itself (Theodoulou & Kofinis, 2012. 11:1).

      If we fast-forward ahead to now, the U.S. health system has blossomed into a sprawling giant.  A bewildering complexity of institutions, barriers, programs, contradictory requirements, and red tape (Portes, Light & Fernández-Kelly, 2009.  pp. 487).  It attempts to serve at least two well-established needs.  One is economic prosperity, and two, is health.  Research demonstrates a direct link between the health of a society and its economic prosperity.  Societies need healthy populations to function.  Healthy populations are more productive than unhealthy ones, and productivity means economic prosperity (Theodoulou & Kofinis, 2012.  11:1). Economic prosperity is what most governments desire.  But health care in this economy is itself a commodity which you cannot get unless you pay for it.  So it appears to be the age-old tension of, “You have to spend money to make money”. But how much does a society then spend?  And what exactly does it get spent on?  And then, a common related question is whether access to basic health-care is a ‘commodity’, or a ‘right’? These and other questions must be debated and analyzed.  That is no easy thing.  Not only is the process toward sound public health-care policy a problematic, complex, and often contentious process, but it is said that nowhere has the discussion in the policy arena been more contentious than in that surrounding the adoption of health-care policy reform (Theodoulou & Kofinis, 2012.  11:1).

      On that note, let us move on to where the health care problem reentered public and political awareness and how it managed to stay there until the process resulted in adoption of groundbreaking reform. It was during the 2008 presidential election that the problems were again singled out.  They were rising health-care costs and the large number of uninsured Americans.  Maybe we should first recap the history of these two health care policy concerns.

      Out of concern for the uninsured, President Harry S. Truman proposed replacing private insurance with a national system.  That proposal was defeated in Congress by lobbying from American Medical Association (AMA) and insurance interests ((Theodoulou & Kofinis, 2012.  11:2). Shortly after that, health care once again returned to the national institutional agenda.  President Kennedy expanded health care with a program called Medical Assistance for the Aged, and by extending insurance to those who qualified for Social Security.  After him, through the War On Poverty reforms, President Johnson introduced the Medicaid and Medicare programs. Rising health care costs into the 1970’s destined the federal government to become more involved with both Medicare and Medicaid at the expense of the private sector.  Next, the introduction of the managed-care system and the Health Maintenance Organization (HMO) through the 1970’s and 1980’s could not succeed in controlling costs.  It simply shifted the burden further onto the private sector. Through the mid-1970s and early 1980s U.S. health costs were increasing at alarming rates.  Access was becoming still more limited, and the uninsured population was expanding quickly.  The 1974 National Health Planning and Resource Development Act (NHPRD) had not helped the larger problems of the time. Later, during the Reagan era, higher-use rates per insured in Medicare and an extension of the Medicaid-covered population appears to have assured ongoing cost increases (Theodoulou & Kofinis, 2012.  11:2). During the George H. W. Bush administration from 1988 to 1992 the need for health reform was apparent, as both costs and the number of uninsured continued to rise (Theodoulou & Kofinis, 2012.  11:2). There were many practical proposals forthcoming but no institutional consensus on what to enact.

      By the early 1990’s, there had been widespread calls for reform due to higher costs to both patient and provider.  This had caused a policy making shift from the systemic (public) agenda to the institutional (policy making) agenda (Theodoulou & Kofinis, 2012. 4:3). It could likely be said that there were more stakeholders now feeling the pain of the health-care policy status quo.  This desire for action captures the mood in congress when the Clinton administration first came to office. The administration stepped boldly into policy change.  He proposed creating a national health insurance system that would solve both the problems of escalating medical care costs and unequal access.  As it turns out, he tried to pass comprehensive reform too suddenly, instead of incrementally according to tradition.  The objective of his Health Security Plan was managed competition.  Its thrust was aimed at trying to shape market forces within the structure of national health insurance. It was perceived not only as too complex, but also as ‘too much government, too soon’  It opened itself up to being characterized as “socialism”, and thus a threat to individual freedom. 

      Next came George Walker Bush whose 2003 Medicare Prescription Drug Improvement and Modernization Act (MMA) expanded Medicare to include prescription drugs and allowed the individual to set up a ‘health savings account’.  He vetoed some additional legislation on the basis that it suggested a drift toward socialism. 

      That brings us back to the 2008 presidential election after which Barack Obama earned the right to be the presidential actor in the policy-making process of the period.  A year after he became president he pushed through the enactment of the Patient Protection and Affordable Care Act of 2010.  This put in place a health-care system that covered 95% of Americans.  It was a historic expansion of health-care policy in the United States.

      Let us look now at the policy-making process that predominated.  Two issues held the main stage. The first was cost containment, an international problem faced in all industrialized nations. The second issue, particularly in the United States, was the growing number of uninsured.  Other factors were: changing family structure, increasing labor force participation of women, and expanding public budgets. These trends all have important consequences for health care systems (Quadagno, 2010).  Policy analysts and actors, health-care professionals, and advocacy group all argue the health-care in America is in a state of near crisis, and one that is only likely to get worse as the aging population places increasing burdens on the health-care system (Theodoulou & Kofinis, 2012.  pp.11:2).  These forces all helped open the window of opportunity for health-care policy change.

      Some of the groundwork for change had already been laid by previous administrations.  George W. Bush had made it clear that he believed changes in health care were necessary (Theodoulou & Kofinis, 2012.  pp.11:2).  The Clinton administration had generated ideas in substance and strategy.  So what of change?

       The U.S. is a welfare state.  There are a variety of health care models used by the world’s industrialized welfare states.    There are three distinct regime types used by western nations. There are the "Social democratic" regimes which provide for extensive welfare benefits granted to all as a right of citizenship, such as in Sweden, Norway, and Finland.  The second type is the "Conservative" regimes which function through traditional family and hereditary status relationships, and are in France, Germany, Italy, and Australia.  And then, the  "liberal" welfare states which are characterized by extensive reliance on means-testing, a preference for the market over the state, and government subsidies to encourage private welfare (Quadagno, 2010.  pp. 127).  They include the United Kingdom, Canada, Australia, and the United States.  Another typological model used to describe the United States model is the “insurance model". Private insurance has always been an embedded actor in U.S. national health care policy.  In the insurance model medical services are distributed through free markets, and the state's role is limited.  Even with heavy state involvement the U.S. Medicare program does not cover all health-related expenses, but leaves a lucrative "medigap" market for private insurers (Quadagno, 2010.  pp. 127). 

      Interestingly, the birth of the insurance in the United States began in 1847 (Theodoulou & Kofinis, 2012. 11:2).  Its beginnings accompanied the emergence of medical facilities.  Back then, public and private support for a national insurance system in the U.S. was great.  The U.S. Public Health Service had been created in 1798.  But as time went on, by the early 1900’s, unlike in the industrialized nations of Europe, nationalized health care insurance in the U.S. had lost its appeal.  So privatized public health insurance policy was the only option.

       The nation’s first “prepayment” health insurance system was introduced in California and Michigan in 1933 by the private insurance company Blue Cross.  These plans then gradually spread to all states in the union.  This was a part of the evolutionary process that helped make the private health insurance industry a useful tool in national health care.

      Part of insurance industry involvement was by the employer providing insurance for the employee.  This is the largest single business expense for many employers (Quadagno, 2010.  pp.126). These expenses were designed to be tax write-offs. Through the years, with the constant and disproportionate rise in health care costs, employers have been cutting benefits and shifting more and more of the cost to employees.  This shift was a festering source of economic insecurity for those families. Family insurance premiums were raising by large percentages as well (Quadagno, 2010.  pp.125). Between 1999 and 2008, with health insurance premiums nearly doubling, the number of uninsured continuing to rise.  Health-care costs also were becoming a major contributor to the U.S. fiscal deficit (Theodoulou & Kofinis, 2012.  11:3). The business community was becoming aware of an impending crisis.  The recession that began in 2008 made these existing problems worse. Finally, some businesses lobbied government for a national insurance program.  One which would require all employers to pay their share of the employee’s health-care costs (Theodoulou & Kofinis, 2012. 11:3). 

      In a polarized political climate, the task of addressing an imminent health care crisis was not easy.  Proposing his plan before a joint session of a Democrat-controlled congress to resounding applause was a good public relations strategy.  His was able to begin to define the debate and shape public interests.  And with a fresh electoral mandate for a legislative initiative to address unaffordable health care he had immense relative power and a full arsenal of political capital.  Tangible power which derived its strength from an idea whose time may have come. It was a relative power which he could for the moment use to compel and coerce his fellow policy actors during design, formulation, and adoption of new policy (Theodoulou & Kofinis, 2012. 1:1).  He had gained the upper hand politically.  He appeared to continue to hold on to it until the implementation stage.  But policy enactment was not far away now. 

      In designing his proposal President Obama made an effort to work with key stakeholders in his plan such as employers and the insurance industry. He worked closely with congressional leaders and other key members of congress, seeking their involvement.  He met with and involved key actors in the health system.  This involvement and compromise was key to his policy’s success (Theodoulou & Kofinis, 2012.  11:3).

      His formulation of the policy sought to build on existing employment-based insurance, distributing costs across the board to all employers, putting an end to some employers’ free passes, and pooling all into a national scheme.  The policy’s goals would seek to regulate the market in such a way as to expand access to health care, stop the cost shifting, and add greater cost containment (Theodoulou & Kofinis, 2012.  11:3). 

      This kept the insurance industry happy as well.  They could expand the size of their employer client pool.  They were further made tractable by the ‘individual mandate’, requiring everyone to purchase health insurance, thereby expanding their pool of paying customers who now have government subsidies to help them purchase coverage as well.

      The health care field was found by President Obama in an amenable position.  Health care industry expenses were increasing beyond their control just like everyone else’s.  They would participate.

      To win state governments, Obama promoted their freedom to formulate and enact their own health-care policy and even increased their block grants to do so.

       Timing was key in the adoption stage of the ACA.  Obama pushed the proposal through the whole legislative process very quickly.  The process lasted about a year.  Public opinion actually began growing more negative at the beginning of the implementation stage.

      In public opinion, there are those who feel medical care is a ‘commodity’, to be bought and sold like any other market good.  It follows the market principle (Claassen & Highton,  2006).  pp. 414).  One weakness in this principle may be most evident in health insurance plans which refuse to cover some diseases and exclude pre-existing conditions entirely (Quadagno, 2010).  For many people, this puts health care beyond their reach.  The U.S. might rightly be perceived as being inconsistent to insist that a fetus has the right to be born but not the right to keep itself alive. 

      On the other side of public opinion you have some who hold that health care is a ‘right’.  A moral issue involving the principle of social solidarity.  This principle refers to an understanding that individuals and groups share common risks and that citizens of a community are obligated to care for each other in times of hard ship (Quadagno, 2010.  pp. 130). “Solidarity has three dimensions: risk solidarity, income solidarity, and scope solidarity. ‘Risk solidarity’ means that premiums should be unrelated to health risk, that each member of the group should have access to health insurance, and that the cost of disease and medical care should be distributed across all members. ‘Income solidarity’ emphasizes that premiums (or contributions) should be related to ability to pay and should thus vary with income. Finally, ‘scope solidarity’ means that members are entitled to receive a comprehensive package of benefits” (Quadagno, 2010).  The different ways these ideas can play out is subject to the individual nation’s own creativity.  Conveniently for President Obama and his side of the debate, a focus group research conducted for the Obama campaign found that the public responded most positively to messages that emphasized social solidarity, and that they rejected the idea that health care was a commodity (Quadagno, 2010.  pp.131). However, the same study also concluded that at the same time people clung to a fear of the threat of socialism and emphasized the importance of consumer choice.

      We have seen that there are differing opinions on the role of government involvement in health care.  What is at the bottom of some of them?

      It has been seen that policy makers and the public are each bound within a specific local reality that will influence their opinions.  Yet, evidence shows that is goes further than that.  There is a relationship between national histories and the direction of future public policy (Kikuzawa, Olafsdottir & Pescosolido, 2008.  pp.388). The same conditions with different historical traditions will mean differing levels of acceptance of similar public policy. It is thought that, through a general socialization process, citizens come to view their current government involvement in health care as the way things "should be" and that they tend to share those beliefs together (Kikuzawa, Olafsdottir & Pescosolido, 2008.  pp.387).

      Another complicating factor in public opinion is the finding that, "When policy increases (decreases), the preference for more policy decreases (increases)" (Kikuzawa, Olafsdottir & Pescosolido, 2008. pp.389).  Too much policy, good or bad, tends to turn people off.

      Still another influence on national health care opinion is how much one will personally benefit from national health care.  Certainly someone with a low income, who normally could not afford certain health care, will benefit more than someone well off.  And this will affect his opinion of national health care.

      What the future may or may not hold for national health care systems is the subject of many observers.  Some envision that aging populations and rising costs are likely to be a constant force in the future direction of national health care systems (Kikuzawa, Olafsdottir & Pescosolido, 2008.  pp.386). On another note, it has been shown that the reality of globalization is prodding national actors to look abroad at both the solutions and mistakes of other countries and use them to avoid mistakes of their own (Stevens 2001).

      Another consideration was that, in the United States, health care currently consumes one-eighth of national resources and is the largest item in many state budgets (Quadagno, 2010.  pp.131). If the rising cost of health care follows historic trends, that will get much worse.

      Researchers are seeing that the less support among citizens there is for government involvement in health care, the more poor health in the population (Kikuzawa, Olafsdottir & Pescosolido, 2008.  pp.).  Lax vaccination programs and poor preventative health care will be a part of that.  Even with better technology, if the U.S. does not improve in the area of education on health issues, then our low health outcome numbers will increase and so will the burden of poor health on the economy.

      Subsequent to adoption and during implementation of the Obama administrations ACA was a sort of counterinsurgence of the opposition.  Some did not want the policy change so badly in the first place that they decided to obstruct the implementation of it.  This is a normal part of the policy-making process (Theodoulou & Kofinis, 2012.  6:3).  Also, those in charge of the new policy’s execution did not get their jobs done.  That reality could affect the future performance of the policy and make evaluation very difficult.  These things all remain to be seen as the new policy emerges, develops and ultimately changes within our transient society.

      This paper has delved into the health care policy-making process in the United States.  It has looked briefly at the immense scope, the problematic nature, and the promising evolution which describes policy development and change in this country.   It singled out some of the actors, institutions, and political concerns involved, and some of the approaches they used in formulation, adoption, and evaluation of our health care policy.  It analyzed public opinion and demonstrated some of its potential impact on the process.  It then closed with a few thoughts on the precarious state of the present health care policy, some speculation on its current direction, and future evolution.

References

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