The hair is grayer, but the lean frame is the same. So is the black suit, suspiciously similar to the one (or ones) he has been wearing for three decades. Or maybe four decades.
Ralph Nader walked into a ballroom of public-health advocates last week as if he were walking onto his yacht or, in his case, a proud but leaky pram. He was at home.
He had clearly lured the more than 800 doctors and others to hear him and several folks, including me, discourse on ethics and the changing health-care system at the American Public Health Association’s annual meeting. As he arrived in the nick of time, the applause was strong, even joyous.
For sure, this promised to be a preaching to the choir since the crowd would be sympathetic to the Nader take on health care, which is not unlike his unwavering take on corporate America in general. It’s all screwed up, controlled by behemoths, insensitive to too many individuals, beholden to the bottom line.
Nader, 64, and our consumer advocate icon, has come a way since battling General Motors Corp. and its Corvair, making auto safety a national crusade. Of late, he has even berated the producer of “Sesame Street” for taking $1 million in sponsorship from a for-profit children’s entertainment firm.
He remains a sort of Pied Piper for the regulatory state, as fervent an advocate of the utility of government as one can find. Whether one agrees with individual analyses, there is the thrust to discern how policies touch the lives of those without strong advocates.
He opened by recalling his days at Harvard Law School and a course on landlord-tenant relations which, he said, “never got to the tenant.” It was a line surely used before but, like a well-practiced entertainer, the pacing and delivery was adroit, the impact favorable. He was on a roll.
While his expected 30 minutes on ethics and medicine quickly evolved into 50 minutes on a wide range of alleged corporate misdeeds, his views on health care were decidedly critical and began with a sense that the profession is not especially organized toward prevention.
It reflected his original holy war, against Big Auto, where he inevitably concluded that the industry was woefully late in dealing with traumas suffered by passengers, notably by its being tardy in installing seat belts. Medicine was slow, too, reflecting his sense of a guild largely out to protect its own, as opposed to a profession with a larger world view.
The lawyer in Nader, who is sometimes charged with being a tad too attentive to the guildlike concerns of attorneys, brings him to the issue of medical malpractice.
He feels it’s a big problem, one provoking insufficient action and, thus, the revoking of too few licenses. He doesn’t note the extent to which aggressive lawyering may muck up the disciplinary process.
Like many in the room, he has qualms about the rise of health maintenance organizations, which he contends have not been true to their initially stated aims of being health maintenance and prevention organizations. Burgeoning bureaucracies, disparate costs and less choice too often are the norm, he asserted.
To the complete satisfaction of the assembled, he praised Canada’s so-called single-payer system. Any problems with it can mostly be attributed, he claimed, to lowered payments to the provinces from the federal government and to slick, cost-cutting foreign investors who’ve taken larger stakes in Canadian health firms.
There are corporations “on a collision course with independent medical judgment.” Even supporters of changes under way in the American system must concede horror stories of patients not being admitted to a hospital or otherwise cared for because of the new economic reality.
And, he intoned, the medical profession faces Corporate Inc., as well as a federal government whose spending priorities are out of whack, at least as far as he’s concerned.
“If a family budget was allocated like the federal budget, the parents would be committed and the children taken away from them,” he said to vigorous applause.
In particular, there are princely sums spent on defense, such as those $2 billion-a-year B-2 bombers that apparently can only fly under blue skies and temperatures in the mid-60s. Heaven forbid there should be a drop of precipitation.
Nader also mentioned his having been at the Pentagon recently to a section that does health research and discussing with an official there the modest sums budgeted for matters such as combating global malaria and tuberculosis.
What part of a B-2 bomber could help that fellow come up with a new vaccine, Nader said he asked the gentleman.
“A couple of wheels” was the response.
Nader continued on, not quite focusing on the topic at hand, namely ethics and the changing health-care system, a point duly noted in a whisper by my fellow panelist, Nancy Dickey, a family physician in College Station, Texas, who is the president of the American Medical Association.
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Dickey, who is no shrinking violet, chagrined listeners with an opening comment that was short of reverential toward Nader.
“With practice, I hope I can maintain the standards you set,” she said facetiously. A few hisses were audible.
She stakes out more of a middle ground, unwilling to discount the utility of financial incentives but not denying that Americans can be shafted. “Work with us, Ralph,” she said at one point.
But that was all warm-up to her really endearing herself to the crowd by making clear what she thinks of their beloved, Canadian-style single-payer plan.
“Which border will you cross when, like the Canadians, you get fed up with the waiting lines?”
You would think she had just called for the overthrow of, say, Fidel Castro. The hisses were again audible, this time in Connecticut. But she was unbowed, knowing she was in enemy territory.
“Well, it was a group probably doing a lot of what Nader is talking about in terms of being the conscience of the health-care system,” she said when I contacted her later by phone.
“Everybody would like to see some form of universal access to care,” Dickey said. “We just part company on the mechanism. The AMA supports a system of individual opportunity and responsibility, individually owned insurance.”
Before bidding adieu, I asked what she really thought of Nader. She was less than effusive but short of antagonistic. He is, after all, an icon.
“I do suppose we need people to price the conscience of society on certain matters, though I’d prefer effective solutions.”
Didn’t get to 2nd base
Kenneth Starr’s appearance before the House Judiciary Committee climaxed with his combative interrogation by David Kendall, President Clinton’s attorney. At one point, Kendall displayed an exhibit, placing on an easel a blowup of a Starr press release as he critiqued the independent counsel’s methods.
Time ran out before he could put up a second exhibit.
Kendall and colleagues later disclosed it would have been a blowup of a Nov. 10 Tribune story by me which they believed underscored conflict-of-interest questions involving Starr.
The story disclosed that the Chicago law firm of Kirkland & Ellis, whose partners then included Starr (while he was independent counsel), conceded in a previously sealed affidavit that it gave legal help to a group weighing a challenge to President Clinton in the Paula Jones case.
The document also confirmed what the firm initially denied, namely that partner Richard Porter had faxed to the newspaper a document to be filed in the Jones case several days later.
How did the firm have that if it wasn’t playing footsie with the Jones camp? It initially danced around the question, then claimed work by Porter on his own time was no problem.
Kendall promises to autograph the exhibit and send it over. I dunno. Maybe I can send him a copy of the Starr report autographed by Tribune Company colleague Sammy Sosa.
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James Warren and Michael Tackett of the Tribune’s Washington bureau are hosts of “Unconventional Wisdom” at 7:05 p.m. Sunday on WGN-AM 720.