On Monday, May 21, 2012, the American Institute for Contemporary German Studies (AICGS) at Johns Hopkins University, will host a conference on “The Potential of Linking Quality of Medical Care with Payment Structures in the German and U.S. Healthcare Systems.” The conference will be held from 9:30am to 3:15pm at the

SEIU Conference Center
1800 Massachusetts Avenue, NW
Washington, DC 20036

Bringing together an interdisciplinary group of scholars and experts from Germany and the United States, this conference discusses pay for performance schemes in Germany and the U.S. The conference is part of the Institute’s project on Health Care in the U.S. and in Germany, which examines issues of health care reform in both countries. Please view the draft agenda here.

AICGS is a Washington-based, independent, non-profit public policy organization affiliated with Johns Hopkins University that works in Germany and the United States to address current and emerging policy challenges in the German-American and transatlantic relationships.

Admission is free, but please register on AICGS’ website and contact Kimberly Frank at kfrank@aicgs.org with any questions you may have.

Ascension Health of St. Louis is founding parent and sizeable shareholder of Accretive Health, according to a story in St. Louis Today.  Mark Eustis, the Fairview CEO came from Ascension Health.  Dr. David Pryor, former Allina CIO, is now executive vice-president of Ascension Health Alliance  and recently was ranked by Modern Healthcare magazine as the 15th “most influential physician executives in America.”

Here is a link to a recent article on Ascension Health.

See: also Ascension plans $2 billion “health city” project in Cayman Islands.

We were in Washington during three days of Supreme Court hearings on Obamacare.  My students took time to walk the Court’s roped lines of demonstrators while the media was interpreting the hearings as not going well for the new law.  That was to be expected.  True to its roots in the August 09 “death-paneled” town hall meetings, the law is presumably flawed. 

The House passed one law and the Senate another.  They became one without the usual Senate-House conference committee.   It was by far the most comprehensive change in the nation’s health policy in its history. Health care is incredibly complex to begin with.  Improving it on the ground and then translating those reforms to policy change makes it even more complex. 

While every other developed nation in the world, starting with Bismarck’s Germany in 1881, chose a social insurance model to expand health care access, quality and affordability, the U.S. chose by far the most expensive route to expand quality and access the world has ever seen and made it all unaffordable while leaving 6% of Americans who never have insurance of any kind, and 18% who have it infrequently. Not a single elected Republican anywhere in the country supports it.  So don’t be surprised if the Court asks tough questions which lawyers aren’t trained to answer. I remain optimistic that the Chief Justice will look at the decision as a landmark for the Roberts Court, which, of course, it is. 

As a circuit court or two pointed out, virtually every American requires health care services at some unpredictable time in our lives and we provide those services regardless of ability to pay.  Those Americans who choose not to insure against the odds they face are shifting costs to taxpayers.  Thus creating an economic challenge that Congress may regulate as it did when enacting the Social Security Act and its Medicare, Medicaid and CHIP provisions, and required, for example, that we all buy Medicare hospitalization coverage.

HEALTH PROFESSIONALS AND OBAMACARE

If America’s health professionals, health systems, and health insurance leaders were polled on the future of Obamacare, they would oppose repeal and favor bi-partisan reform.  These are the people who are likely to make a difference in the degree to which the reform law is a decisive issue in the 2012 campaigns.  (More at nihp.org)

For 18 years I’ve taught health policy to health professionals on their way to an MBA in Healthcare at the Opus College of Business at the University of St. Thomas.  I teach 12 hours on campus, three days in Washington DC, and four weeks online.  Scott Kulstad, a graduate, now assists me between gigs as a specialty center administrator at Fairview Health System in Minneapolis.  This year we focused on the ACA health policy reform law, now known as Obamacare.  Student projects in finance reform, Medicare reform, and healthy people/communities will be presented to a public event on campus May 17^th.

Here’s what I know they’ve already learned.  From the Republican Chair of the MN House Health Committee and his Democratic predecessor (now minority leader of the Democrats in the House):  The number of legislators willing to undertake to understand and translate the complexities of healthcare into policy has shrunk to the point you count them on one hand.  In a 202 – person legislature most of the rest, especially the new majority, want policy summarized on one page and, preferably, in sound-bite form for constituent consumption.  Ditto in Congress.

In a three day seminar in DC I have 24 faculty present, most with many years of policy experience and everyone on one side or the other of the debate over the future of Obamacare.  Like Senator John Barrasso MD (R-WY) presented just before Sister Carol Keehan, CEO of the Catholic Health Association.

Before we began, the students ranked themselves on familiarity with the new law on average 2.2 on a scale of 1 to 5.  On Obamacare they were 7 for, 4 against, and 15 undecided.  At the end they were 3.8 on the familiarity scale and 19-1-5 (one left early) for Obamacare.  Why the big change?  (Remember each is paying something like $65,000 for the MBA.)  First, the new law has at least a 20-year tail of Democrat and Republican consensus on it.  While it can be improved, it’s not bad.  Second, if the law is repealed, the political climate in the country is such that system reform will regress and replacing and reforming will not happen in their lifetimes.

Which reminds me, when health policy reformer Cong. Claude Pepper (D-FL) died, he went to heaven and asked God whether health reform would ever be successful in the U.S.  To which God replied with good news and bad news. “The good news is, yes it will.  The bad news is, not in my lifetime.”

REPUBLICANS WANT MEDICAID TO BE A STATE PROGRAM

The Supreme Court heard testimony on the subject, had experts write amicus briefs on it, and justices will argue it is constitutionally vulnerable.  How they do that in light of more than 50 years of history is beyond me.  Republicans and Democrats have always supported federal government assistance to the states to provide care for low income and disabled populations.  It started in 1960 with a Congressional commitment to pay 50% of the costs to counties.  In 1965 it morphed into Medicaid coverage for women with dependent children with a minimum essential benefit (sound familiar?).  Seven years later it was expanded to cover the long term care needs of persons with disabilities. 

One of the reasons Medicaid is a vehicle for coverage expansion to the nation’s working poor is the rising costs for basic coverage.  States can manage the cost containment aspects of coverage in a variety of ways that reflect changes in care delivery generally in their communities.  But they’ll never pick up the tab without our federal income tax.  A majority of the states do not have the tax capacity to finance access to healthcare plus education and all other state needs. A large minority are simply politically unwilling to do so.  Simple block grants of federal taxes to states unwilling to use it for healthcare don’t solve the problem.  Only accountability, as written into current law, will do that.

WILL HEALTH SYSTEM REFORM CONTINUE WITHOUT THE LAW?

Of course, reform will continue in some for form or another.  Some of it aimed at driving value, others simply driving profit on niche marketing access to select services. Most health professions, systems and insurers want/need the former.   It is clear to them that from the debate over the enactment of Obamacare, national policy-makers have chosen to pin our future on private health care and private insurance rather than our current mixed public/private bag or a single payer or all-payer alternative.   Only informed consumers making value-based choices will make private markets work.  Without competitive insurance markets and expanded coverage consumer choice will not have the impact on cost containment that it must have.  Without competitive markets and informed consumer choice, the financial incentives communities and care providers need to reduce the cost of unnecessary care are gone and we regress to the mean old price/cost escalation.

We policy types all know the huge variation that exists in health and health practice in various parts of the country.  What we don’t fully appreciate is the power of information on variation to bring about dramatic change.  When combined with financial incentives to change.  I am told that 10 health insurance companies sell 85% of the private insurance market today.  And five companies sell 75%!  That kind of clout makes a huge difference compared with what can be done out of CMS with traditional Medicare.  For example, in Minnesota already 50% of the Medicare beneficiaries are in private Medicare Advantage.  An even greater percentage of Medicaid beneficiaries have private managed care options.   It’s not a political problem anymore.  But it can’t be left to decisions by one state at a time because companies don’t do business in states, but with people.

I’LL STOP IT ON DAY ONE

It is truly unfortunate that Mitt Romney has drawn the line on Obamacare. He says he will do all in his power, and that of Republicans in Congress, to repeal the health reform law.  Public opinion informs us that neither the Presidential nor the congressional elections will be decided on Obamacare.  President   Obama will make sure of that this fall. My Healthcare MBA students, after three days in Washington recently, came quickly to the conclusion that once repealed; the health law will neither be replaced nor reformed.  A majority of Americans will soon realize that polarized politics,  the influence of rant/slant media, and the difficulty of doing complex policy change in anything but a crisis, makes what they need in coverage and affordability impossible without  Obamacare.  Better to improve the current law than to go back over and re-start the debate.

WHO WILL BE THE HEALTHCARE TRANSFORMER?

News that Newt Gingrich’s nifty little health care transformation empire is filing for Chapter 7 bankruptcy means that when the current campaign is over, the Newt will return to health policy but under another name.  The bankruptcy filing shows just how popular he was as a “mentioner”, motivational speaker, and door-opener to a cross section of the medical industry, many of whom are now creditors left holding his bag.  But some are publicly, and perhaps naively, quoted as say they don’t mind doing so.

What’s this say about the kind of persons we are electing to deal with health policy transformation?  Not much.  It tells us that with the occasional exception of a Paul Ryan, nobody wants to do the heavy lifting of health policy, preferring the “just say yes to Ryan” or “just say no to Obama” approach to decisions that have billion dollar consequences to all Americans.

THE INSTITUTE OF MEDICINE RECOMMENDS WE TAX HEALTHCARE TO PAY FOR HEALTH

I wish I had thought of that one.  Many states seem eager and able to tax healthcare services provided by doctors and hospitals in order to fund expanded access to these same services.  The IOM in advice to the Secretary of HHS and Congress says that such a tax at the national level , on services and on insurance, should be levied to reward the millions more Americans who work at staying healthy and using the healthcare system as little as possible. Click here for more information.

Here’s why it’s a good policy suggestion.  The young and healthy are already paying for the old, the accidents, the ill, and the disabled in large employment groups and in many other ways including the new health insurance rules including the insurance mandate.  Public policy must encourage good health.  Rather than doing everything we can to financially reward poor health, preventable accidents, avoidable chronic illnesses, we ought to start reversing incentives.  This is one important and obvious and encouraging way to do it. There are others.

Republicans immediately attacked the recommendation as “half-baked and absurd”.  Sen. Orrin Hatch (R-UT).  The IOM advisory panel said it would be better than taxing products we don’t like such as sugary drinks.  Health policy expert Ken Thorpe said leaving the rewards for good health to health plan benefit and cost-sharing design is better.  Both make sense, but if we are going to do tax reform in this country, and we can’t do it without bi-partisan cooperation, the more ideas on the table the better.

ROMNEY’S THE ONE

Few people doubted Mitt Romney’s staying power as a candidate in the primary elections.  Most people assume a different Romney will now appear to challenge President Obama.  I doubt that.  So does the Obama campaign which is drawing bright political lines between Democrats and Republicans rather than between the President and his Republican opponent.  The campaign will feature the greatest “shock and awe” marketing war in history, but the ground game will make the difference.  The President must deal with the realities of economic recovery in a world of disruptive influences. 

Romney need only credit the good news to Republicans and bad news to the President.  Then hope the electorate that survives the shock and awe campaign will trust him and his party with the toughest four years this country has faced since the second term of FDR.  Trust requires a belief system and the “walking the talk” of a leader. A D.C. insider recently said of Romney, “he is in danger of becoming Don Draper (of Mad Men) in this campaign – handsome, smart, but very hard to trust.”

PRESIDENT OBAMA THINKS HE’S GOT HIS NUMBER

It’s one, as in 99-1.  The wealth gap is the answer to the spending/revenue gap.   President Obama will compare Romney’s personal 13.8% tax rate on millions of dollars of Romney income and the life style it makes possible, with the rate middle class Americans pay on a fraction of that while struggling to keep one home and a job with decreasing fringe benefits.   I, for one, am sympathetic to the argument that the President hasn’t connected with most Americans on the “I can feel your pain level.”  The Warren Buffet tax is politics, not middle class empathy. On the other hand, who believes Mitt Romney has ever felt pain to say nothing of having learned how to express it. 

DIVIDED WE STAND

It looks as though President Obama has learned how to unite traditional Democrats in a cause that seems quite familiar.  Republicans have only one unifying theme so far:  Beat Obama.   Suppose Romney wins.  Then what?  Who governs? The Tea Party/Freedom Works Armey/Murdoch-Fox News slant and rant crowd have given us a Congress and 26 states of extremist Johnny one-notes that make it impossible for the Romney we’ve seen so far to govern.  Karl Rove and Crossroads GPS say there’s plenty of room in a conservative right of center space for the large number of us independent conservatives.  What evidence does he have that when a pendulum starts to swing to the far right it has to swing back now, just because it’s a Republican pendulum?

 CROSS TOWN HEART ATTACK

 Medtronic is one of the state’s premier corporate enterprises and the world’s largest medical device company.  Its stock has been in some kind of investor “limbo” for many years and the corporate C-suite is in constant turmoil.  Meanwhile west cross-town rival Boston Scientific has been trying to recover from the decision to take on a second-rate Guidant operation.  St. Jude Medical which is its east cross-town rival has been doing very well thank you under the leadership of peripatetic Dan Starks. 

But this week investors are abandoning St. Jude while it tries to fight a public relations battle over which implantable heart-device company headquartered in MN has killed the most patients because of failed device leads.  Minneapolis Heart Institute cardiologist Bob Hauser started the battle with his published research on St. Jude’s Riata leads in The Heart Rhythm Journal.  Hauser is the same expert who blew the whistle years ago on Guidant’s implants which indirectly led to its sale.

WHAT IS THE MARKET TELLING MEDICAL DEVICE COMPANIES?

Something that Minnesota and other political representatives seem unwilling to tell them.  That device companies and device investors can no longer rely on a dysfunctional medical market place, and on fee-for-service and fee-for-product insurance reimbursement policy to be successful with each “improvement” in functional devices. 

Medical specialty organizations, whose members had been absorbed into the financial rewards of a culture that anything new is a life-saving innovation, are beginning to support efforts to strengthen the FDA’s role.  In judging safety and developing improved standards of efficacy and even effectiveness for devices, drugs and diagnostics.  It’s about time that legislators invested our research money into the FDA’s efforts at evolving evaluative science rather than in making start-up investors wealthy off of potential market failures.

COULDA SHOULDA HOUSING POLICY

When President Obama came to office the housing market was crashing under the weight of bad home ownership subsidy policy, private and public.  Obama appointed housing expert Shaun Donovan as Secretary of HUD and I waited for the time he would recommend that state and local government housing authorities be financially supported in their efforts to save their communities from the blight of the over-built and the over-leveraged, using their three decades of experience with administering low and moderate income housing.

The federal investment, I thought, should come from helping to write down loans for qualified borrowers in markets where the prices would fall but ownership could prevent further blight until some rebound occurred.  Nothing happened because the Federal Housing Finance Agency, eager to help sustain Freddie Mac and Fannie Mae, thought mortgage write-downs were a waste of money/time.  Finally, this week the FHFA is reconsidering.  Healthy people and healthy communities depend on healthy housing markets.  State and local governments are in the best position to determine health status, not the guys in Fannie/Freddie and their protectors who made personal fortunes taking down the market to begin with.

MINNESOTA VOTERS TO DECIDE WHO HAS A RIGHT TO VOTE

Much of my life in politics has been spent trying to encourage public participation in the political process.  As a Republican I sought to encourage small contributions to campaigns through tax policy.  As a member of the Senate I sought to break the hold of Political Action Committees on the margin of campaign influence.  I am proudest,  however,  of bi-partisan efforts to uphold the Voting Rights Act in states with a record of discrimination against citizens based on race, and of my leadership in passing and persuading  President Reagan to sign the Voting Rights for the Handicapped Act which required states/local governments to take down physical and other barriers to persons with disabilities.

I broke from my party on issues like election-day registration because I believed that states and local government should develop whatever assurances are necessary to prevent outright fraud.   I supported motor voter legislation which my Senate colleagues from the South hated with a passion because it made it possible for lower income and racial minorities to register at same time/place they registered their motor vehicles.

Why do MN Republican legislators insist that MN join Missouri and Mississippi by changing our constitution to require government I.D. to vote?  Why have Republican legislatures in many states done all they can to discourage voter registration drives by prominent civic organizations?  Not because they and we Minnesotans don’t have bigger problems for them to attend to.  I suspect the same “anti-voters that aren’t like us” sentiment I saw in southern senators is what I feel in the current crop of extremist legislative measures.  Call it the “Obama’s nothing but a community organizer” problem my party has in representing all Minnesotans and in improving representative government in our state.

“The selection of a lay president represents a new era in the long history of Saint John’s University, yet I want to emphasize the continuity that will be at the heart of this transition,” Hemesath said. “A Saint John’s education has been transformative for generations of young men precisely because of the Catholic Benedictine heritage that makes this institution a rare and wonderful gift to higher education. The privilege of serving as Saint John’s 13th president is both tremendously exciting and humbling. The Saint John’s community both shaped and shapes me, and it is a rare gift to be able to lead my alma mater through this important transition in the relationship between the monastery and the university.”

Hemesath, 53, graduated summa cum laude from SJU with a degree in economics and received his master’s and doctorate in economics from Harvard University. He has been on the economics faculty at Carleton since 1989 and has served as faculty president since 2009. Before coming to Carleton, he was on the faculty for two years at Tufts University in Medford, Mass. His wife, Elizabeth, teaches in the religion department at St. Olaf College, and they have a son, Cameron.

“I was reminded throughout the search process of the many groups who care deeply about this place, this institution, from the members of the monastic community, to the many alumni around the world, to the staff and faculty and the student body,” Hemesath said. “It is clear that I will have exceptional support from the community as we build a strong and vibrant future for Saint John’s.”

“The Board selected Dr. Hemesath because he is passionate about Saint John’s University’s ability to transform young men’s lives through its commitment to the liberal arts and its embodiment of Benedictine values, and because of his outstanding background as a scholar and faculty leader at Carleton College,” said Ann Huntrods, chair of Saint John’s Board of Regents. “Dr. Hemesath is uniquely qualified to lead Saint John’s at this historic time. It is apparent that Dr. Hemesath understands the importance of the ties between the university and the abbey even as their relationship evolves.”

In addition to teaching micro and macroeconomics, Hemesath teaches courses on international economics, Soviet and post-Soviet economics and health economics. His research interests focus on the challenges facing the former communist countries as they reform their political and economic systems. This research has taken him to Russia and given him the opportunity to teach in the master’s degree program at Kiev-Mohyla Academy in Ukraine. Hemesath participated in the Pew Fellowship in International Affairs at Harvard in 1990-91, and has been using cases in his courses ever since. Hemesath is currently the director of EthIC, the Ethical Inquiry at Carleton program. The program is designed to develop curricular and co-curricular activities that encourage the exploration of ethical issues throughout the Carleton community.

Hemesath is also deeply committed to off-campus studies programs. He has directed three Associated Colleges of the Midwest programs in Krasnodar, Russia, and has been faculty director for Carleton’s Economics Seminar at Cambridge University five times, most recently in summer of 2007.

“On behalf of the Saint John’s community, I extend a warm welcome to Dr. Hemesath,” said the Rev. Robert Koopmann, OSB, 12th president of Saint John’s University. “I am confident he possesses the personal skills and professional experience needed to lead this great institution. He brings with him a thorough understanding of contemporary higher education and a deep appreciation for the Benedictine values that are so important to our community.”

“I am delighted that Saint John’s University has chosen Dr. Hemesath as its next president, and I am eager to begin our partnership in leading these two great institutions,” said MaryAnn Baenninger, president of the College of Saint Benedict. “His background and qualifications are stellar. More importantly, he has high aspirations for SJU, as I do for CSB. I believe that together our leadership will guarantee a bright future for CSB/SJU.”

Hemesath is the first layperson to be appointed to a full presidential term at Saint John’s University. Daniel Whalen ‘70 served as interim president from 2008-2009.

Our “What the Experts Say” column this month features the first of a three-part series of commentaries by Dr. Robert Nesse, CEO of the Mayo Clinic Health System, that encourage physicians and other care providers to embrace delivery system change.

In the opening paragraph of his first column, “A ‘Wicked Problem’: Healthcare System Reform and Change,” Dr. Nesse writes: “In light of the Supreme Court review of the Affordable Care Act and the political brouhaha that surrounds it, I know that many providers of health care have mixed feelings about the future of our industry. Let me share with you my cautious optimism as we work to design and then implement the new system of health care in America.”

 “I believe that the healthcare industry is spending too much time trying to defend our past successes and preserving old systems,” he continues.  “It is time to move on.  We need to change. We need to understand the issues and accept the truth, discover and design our response, and move on. And as we move on, we must address these three questions: What can we do to solve the problems of health care in America? What are fundamental attributes that medical groups must have to succeed in the future? Why should we do it now?”

In this series, Dr. Nesse provides his perspective on each of those questions.  In the first, Dr. Nesse explains why he believes that health care reform is a “wicked problem,” what he means by that characterization, and what he believes providers should do to help solve that “wicked problem.”

Find out why health care reform is a “wicked problem” by clicking here.

See www.AccountableCareFacts.org for more information, or contact the Council of Accountable Physician Practices, www.amga-capp.org.

http://www.startribune.com/lifestyle/health/145867655.html

Jeff and I, as federal government employees and retirees (he next year), benefit from a health insurance exchange called the Office of Personnel Management which provides all federal employees/retirees choices of qualified health insurance plans.  Why not make it possible for everyone to have similar choices?

See PBGHC for more information.

“All across the nation there are mainstream Republicans lamenting how the party has grown more and more insular, more and more rigid. . .but where have these party leaders been over the past five years, when all the forces that distort the GOP were metastasizing?. . . Leaders of a party are supposed to educate the party, to police against its worst indulgences, to guard against insular information loops.  They’re supposed to define a creed and define boundaries. Republican leaders haven’t done that.”

David Brooks NYT 2-28-12 is my kind of Republican conservative. Together with Democrat Mark Shields he recently won a prestigious national journalism award for civility in political discourse for their work at the PBS News Hour. And, I might add, for how they present politics to America in their solo stands around the country.  Brooks is the cerebral conservative. Shields is the funniest liberal whom I’ve ever known.  However, I am taking Brooks’ most recent column personally.   David accuses Republicans like me of “privately bemoaning where the party is headed and in public doing nothing.”

There’s nothing funny about that. The cancer that’s killing this party has its roots, not in the conservative-moderate tussles we had in the old days in state parties and in the national party. Rockefeller supporters in 1968 did more for Nixon in 1968 than McCarthy supporters did for Humphrey. And the Ford and Bush supporters went all out for Reagan in 1980.  And Reagan found success in appealing to conservatives and moderates. 

The problem is what presidential candidate Barry Goldwater said about extremism in the defense of liberty being no vice that’s killing us. The Republican Party has made a virtue of extremism.  With plenty of help from the old confederacy, the religious right, the counter-culture hierarchy of the Catholic Church, Brooks’ “bobos in paradise” who want a world that looks just like them so they move to the exurbs and favor deportation of the American children of illegal immigrants.  The list’s a long one.  How often we hear “values” and “liberty” and “American exceptionalism” in every speech.

If every public policy problem is defined in moral terms, and every man claims a divine origin for his political beliefs, there’s no way in a representative democracy to find consensus about what’s the right solution.  When, as now, every elected representative of one political party can define all the problems facing this country in terms of everything one man has done as president, that’s extremism.  When, as now, the conservatives of my day – like Orrin Hatch and Bob Bennett of Utah – are threatened with extinction and moderate Sen. Olympia Snowe gives up 33 years of experience because “nothing is likely to change in the near future,”  that’s extremism. 

When, as now, every Republican signs a pledge never to raise any kind of tax, to cut a preferred list of public expenditures but never to touch tax preferences, and to promise never to fund anything that has the word Public or the word Parenthood in it, that’s extremism. And when a generation of Republicans, who have joined Democrats in bi-partisan efforts to ensure the civil rights of every American including every woman, have been sent to the sidelines by Republican primaries and caucuses, you know that’s extremism. 

So I say to my friend Mr. Brooks.  We RHINOs or RINOs or POSSUM are history.  The day we, like Sen. Olympia Snowe yesterday, and Sen. Kay Bailey Hutchinson before her, walk out of long careers as Republican Senators, you know partisan extremism is winning the day no matter what we may say or do.  It’s wishful thinking to believe they can be educated or informed – except by the electorate.  When will it change?  Therein lies the challenge to RINOs like me.  Can you support the least extreme Republican candidate despite the fact he and his party across the country oppose the kind of centrist public policy reform this country needs desperately to bring about the new economic security and the new national security most of us seek for America?

TOO MUCH THEOLOGY

Amateur and professional. At least for me.  I got used to listening to Congressman, then Senator Rick Santorum, lecture me on what his church taught him was wrong with my approach to public policy.  We’re both Catholics and occasionally went to the same church in DC.  But that was back when voters respected their elected representatives for how well we responded to their public policy needs, not their spiritual.  And in Congress most of us could talk about our personal faith in appropriate settings, without getting personal about it.  As he, and the rest of the Republican candidates, appear compelled to do today.

SEPARATION OF CHURCH AND STATE

President J F Kennedy made it possible for Catholics like Santorum and Gingrich to run for president without having their loyalty questioned.  Rick Santorum would repeal Kennedy’s interpretation of the civic responsibility of elected representatives.  In 1982 the Surgeon General of the U.S. was C. Everett Koop MD, one of the first pediatric surgeons in America and an outspoken conservative.   He had to deal with issues of contraception as the HIV AIDS epidemic swept the country. 

Three of my very conservative Senate friends were angry with him so he asked me to arrange a meeting with them.  At which he listened and then said simply, “We have a million ordained ministers in this country, but only one Surgeon General.  That’s me.  As long as we have this problem it makes no difference what I happen to believe about homosexuality or contraception or whatever.”  I must do my duty as the law and my professional judgment dictates.”

FREEDOM OF RELIGION

The U.S. Conference of Catholic Bishops (USCCB) speaks for the Roman Catholic Church in America on matters of faith and morals involving individual Catholics, Catholic sponsored organizations like hospitals and universities, and on public policy.  Until recently the church hierarchy has focused on forming individual consciences.  Increasingly, however, Rome has focused its influence on matters relating to health policy as the Vatican upgrades its counter-cultural moral priorities to focus on the legal interpretation of individual rights relating to defining life, marriage, family and reproductive health. 

With it has come much closer scrutiny by Rome and by American bishops of what is taught in Catholic schools and the services provided in Catholic health care facilities, including Vatican oversight of mergers and acquisitions of Catholic hospitals and USCCB oversight of individual hospitals and hospital-based services.  When, in 2009-10, the House and Senate health reform bills wended their torturous way toward passage, the USCCB was adamant against expanded coverage in both bills despite advice from Catholic members in both Senate and House.  Even when the Catholic Healthcare Association negotiated additional protections against public funding of abortion and a presidential executive order to guarantee it, USCCB said NO.

CATHOLIC BISHOPS AND THE REPUBLICAN PARTY

The Obama administration interpreted the health insurance benefits section of the new law to include inclusion of reproductive health services including contraceptives, but exempted employers engaged in religious activities.  The USCCB took the position that Catholic universities and health systems are engaged in religious activities by reason of their charitable purpose. The administration, supported by the Catholic Healthcare Association and others, view the health and education services differently and requiring the employment of professionals without regard to religious belief.  These employees, they agree, should not be denied access to health service benefits prescribed by law.

The USCCB not only disagreed, it decided to characterize the administration position as “an insidious attack on freedom of religion” guaranteed under the First Amendment to the Constitution, thus joining the issue with contemporary Republican social issue politics.  Ralph Reed, who ran the religious right voting campaigns for Republicans and now chairs the Faith and Freedom Foundation, calls the administration position “an unexpected gift.”

Cardinal Timothy Dolan of New York makes it obviously partisan when he says that American bishops do not plan to align themselves with any particular candidate or party in elections. HOWEVER: “We bishops are pretty realistic to know that sometimes one of the best things we can do for a candidate whom we do not particularly like is to dramatically support his or her opponent.”  It is disingenuous for a cardinal of the church to argue that the church has not aligned itself with the Republican Party in America on health policy reform.

A LOT OF US ARE HURTING

I seem to recall that during the presidential primary season in 2008, the contest on the Democratic side for the party’s endorsement seemed to bring out the best in all of the candidates. This was especially true after the first “Super Tuesday” in February when Hillary Clinton had to deal with the reality of the Barack Obama potential. She pulled out all the stops, so to speak, including Bill Clinton.  But the Senator from Illinois just kept improving.  Not by attacking her, but by tackling the tough personal issues with which he was faced – like his pastor and friends in Chicago, his race and his experience.

My Republican party’s primary campaign is so opposite.  Candidates pretending to be someone they weren’t before deciding to run vs. candidates who take pride in standing for something that Barack Obama (or Mitt Romney) isn’t.  Each election is not so much a choice to narrow the field, but to avoid supporting one consistent front-runner. The 2010 election seems to have stirred in the Republican voter such consistent antipathy toward President Obama and anything he says or does. You’ll never convince me that a great deal of it is not racist. And this election has generated in billionaire ideologues and religious extremists the urge to get out in front of the parade.

 In the states, Republicans are busy legislating subjects best left to clerics and conscience. The party of strict construction and original intent is busy subjecting our state constitutions to the whims of partisan public opinion and Super Pac policy, while President Obama’s job approval rating seems to improve with each party caucus or primary election.

THE FIRST WEEK OF LENT 2012

This is the first week of Lent and we Catholics are focused on change.  Let’s call it “change we can believe in” to borrow a phrase from the campaign of a candidate our official church does not “like,” to quote our newest cardinal.

Lent is when we make time to look at ourselves, who we are, who we are becoming, how we might change in ways we believe we should.  People like me sometimes go through our lives doing whatever works for us without realizing the consequences.  Until we meet God in a way we cannot avoid. I first learned that, believe it or not, from a phone conversation that Joe Biden put me up to with Oprah Winfrey.  Before, I learned it by experience.

As someone who early on found his vocation in public policy and public service I have always tried to identify myself with what I believe, not with what I do.  I know myself to be a Republican, a Catholic, a husband, father and grandfather, and one who has made a commitment to share his experiences as such with others.  As a teacher, a writer, a public speaker, and an analyst in something like this Commentary.  Until lately.  It’s become so difficult to express what is going in my heart as I watch the politics of an exceptional country in a world that is increasingly dependent on trustworthy leadership.  Politics of extremism masking as virtue.  Politics of NO making change we can believe in at a time in history when we need it most well nigh impossible.