Robert Winer, M.D.

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Cheney, Clinton, and the Revenge of the Nerds

Dick Cheney and Hillary Clinton have this in common: fanatically obsessive nerdiness. Both meticulous craftsmen, they pursue their agendas with rigor and discipline. For now, their objectives differ, and not along the lines you might imagine. Cheney seems propelled by a patriot’s desire to keep America safe – a desire whose implementation has taken on astonishingly perverse proportions – while Hillary is driven by the imperative of being elected, to justify to herself how she’s spent the last dozen years of her life.

Cheney is purposive. Not interested in being in the spotlight, he’d rather be invisible, a faded grey eminence. He’s determined to chart the course of our nation according to his own perspication, and he’s interested in others only to the extent that they can serve his ends. The Washington Post reports that on 9/11, when the first tower pancaked, everyone in the room gasped, except for Cheney, who stayed focused, eyes locked on. At this junction Aspergers wanders through one’s mind.

I believe that Cheney has as his first priority keeping this homeland secure, and that he is entirely prepared to make us a police state if that’s what’s required. To that end he’s ready to sacrifice the entire Bill of Rights, the Geneva Conventions, international regard, the rights of the Congress, and, of course, public opinion. America has Vox Cheney. He might have been disposed to think of the Executive Branch as a monarchy in any event, but 9/11 sealed the deal. I don’t think that he is pro-business out of self-interest for I think he would be fully capable of protecting his own corporate investments without abetting the interests of others, if it came to that. Rather, I suspect that it has to do with aiding business to satisfy the entitlements of Republican constituencies, so that he can get the electoral support to continue his crusade. Dick Cheney is Jack Bauer without a conscience. And he’s remarkably competent, tactically and strategically, at every level, adeptly delegating or micromanaging as the situation calls for, in pursuit of his agenda. This is a brilliant methodical man.

Hillary, in one regard, is the precise opposite: at this point she seems to have no policy objectives at all. With all her energy channeled into a single goal – getting elected – she behaves with the flexibility of a rug salesman: do whatever it takes to seal the deal. Every step she takes, every move she makes, seems calculated, tested in her focus groups, calibrated by her people, plotted on her matrix. Nerdy? This is a woman who, Michael Tomasky reports, spent a chunk of her time at Wellesley College devising a better system to ensure the return of library books. When I heard that there’d been a small brouhaha about her cleavage on the Senate floor, I pictured her prep team measuring out the quarter-inches in advance. It’s unkind of me, but seeing a wry expression on her face in a Times front page photo a week ago, I found myself wondering how much time it had taken to train those facial muscles to contract that way. Hillarious rigor. She has me at the point that I can’t believe that anything could be spontaneous, certainly not a smile. And this is probably all smart strategy – she’s way ahead in the polls and she’s effectively neutralized Obama.

Though I wasn’t there at the time, I now feel nostalgia for the Hillary who had the passion to pursue her ideas about health care during her husband’s first term, even though her plan wasn’t popular and it didn’t help Bill’s prospects. That Hillary is missing for me, and I have no confidence we’ll ever see it again. I imagine she’ll spend her first four years mainly trying to position herself for winning a second term (Bill’s tenure besting hers would be really insufferable).

I have a theory about why winning has become such a super-ordinate goal for her, trumping all other concerns or motives. I imagine that the Monica Lewinsky business must have been really humiliating, and that she could easily have felt that the only self-respecting thing to do would have been to dump him, even during his second term. The only way that she could have justified bending over for Bill would have been by rationalizing that this sacrifice would be required for her to acquire the Presidency. It isn’t really relevant to my point that it also happens that this would be true. Despite many women’s contempt for her for staying, the fallout of her departure would have probably made a presidential run impossible. And if not impossible, way less effective without Bill. But I can imagine that for her, now, not getting the throne would mean to her that she’d been a fool for making this deal, and that would be completely unbearable in terms of being able to feel OK about herself. So she needs to win, at any cost, to justify how she’s spent the last twelve years. That’s the only thing that matters now. Her electorate is the Hillary Support Group.

A friend asked me if I’d vote for her if she gets the nomination. On the plus side, it would be nice to have Bill back in the White House; she might, like JFK, choose a great support staff; I’d rather have the Executive Branch leaning left than solidly right; and maybe I’m just too cynical about her current loss of her soul. On the other side, if she disappoints me, I’ll feel I only have myself to blame. That shouldn’t be a reason to stay home on Election Day: though I’d feel tempted, I’d just be protecting my self-esteem like she’s doing now.

The candidates who are taking stands are doing badly: McCain, Edwards, Kucinich, Paul. Those who essentially stand for nothing, in a policy sense, or whose predilections are totally fungible, are doing well: Giuliani, Clinton, Thompson, and Romney. Obama falls in between. He’s primarily arguing for a form of reasoned and collaborative leadership, rather than for a specific agenda, and this is going poorly now because it’s precisely not his temperament to stand up for himself and fight back. In the political arena it’s becoming increasingly apparent that his style is self-defeating, a 21st century reprise of Adlai Stevenson. The race will not go to the passionate or the thoughtfully reflective, it will go to the nerd, the technocrat best able to engineer this electoral season, and that, for better and worse, will be Hillary.

Michael Moore's "Sicko"

“Sicko” is a missed opportunity. I can’t understand why it has been lionized by the critics (the San Francisco Chronicle critical consensus rating has had it at or near the top of the pile for weeks). I thought it was glib, painfully cutesy, arguing by anecdote, riddled with editorializing music that was telling us what to feel. Moore is treating us like four-year-olds. Among the critics, the Washington Post’s Stephen Hunter was one of the very few who complained.

It’s not that Moore is wrong about the problem. Our health care system is hugely inadequate. The current issue of Consumer Reports details the state of our HMO’s and PPO’s and it’s a discouraging story. Corporate America could make a companion piece to this film filled with anecdotes of people who received life-saving health care in a timely way, interspersed with highlights of the weaknesses in the delivery systems in England, France, Canada, and Cuba, and we would feel moved by that too.

Moore is arguing for a single-payer system, like those in the aforementioned countries. While this may well be the direction in which we need to move, I’m aware that France and England have private care practitioners also (and that there are brokers in Canada who facilitate traveling to the States for medical care). If the system works so well, why do those doctors get used? What gaps in coverage are they closing? I’d like to hear a balanced account that argues why a state financed system, despite its limitations, is the way for us to go.

The problem, as I see it, is that the free market system doesn’t work well when it comes to health care. If you’re buying a home, you can be clear about what you’re getting and what you should be paying for it – you can have an inspector check out the structure and you can look at the pricing of comparable houses. If you’re purchasing a car, you can read Consumer Reports and learn about the vehicle’s repair track record and get their impartial take on the road worthiness of the options you’re considering.

But health care plans are much harder to appraise. As the Consumer Reports article points out, the people who are reasonably happy with their plans are those who haven’t been seriously ill. Consumer dissatisfaction rises sharply for those who’ve been sick and have had to use their plans in consequential ways. It is very hard to know in advance how good your coverage will be if you’re in trouble, and this makes it difficult to choose a health plan in an informed way. And so we respond to the sales pitch, the pricing, the convenience. Our employers may only have a single choice to offer us, and that choice will likely have been influenced by cost considerations that are not in the workers’ best interests.

As Moore effectively points out in “Sicko,” the incentives in for-profit health care are on the wrong side: the company, and its doctors, are rewarded for denial of care. In contrast, in some of the state-run systems, doctors get bonuses for effective care. If car manufacturers tried to increase profits by cutting corners, we’d see the consequences clearly in rate of repair data, and that would immediately have consequences for the manufacturer. But it’s not possible, and it will never be possible, to get this sort of information when it comes to health care. The inability of the free market to respond effectively to the quality of care may be the single best reason for us to have a single-payer system (with or without a private care alternative).

For a different Michael Moore, check out his very engaging confrontation with Wolf Blitzer on CNN.