Want to Fix Health Insurance? Turn to Marx

Patience, I'll get there....

My wife Erin is reading Methland, Nick Reding's account of the destruction wrought by methamphetamine in rural America. Reding connects the increase in meth use to the consolidation wrought by Big Ag (see also commentary by Patrick Deneen).

Over buffalo burgers last night (yes, we live well), Erin explained how Reding also manages to work Karl Marx's critique of Adam Smith into the argument:

Smith's capitalism depends on lots of small actors in the market, none of whom individually can wield enough influence to skew prices... or to unduly influence the government that regulates the market. The "Invisible Hand" is invisible because it is the product of umpteen Main Streets, not one Wall Street. The Invisible Hand doesn't require much regulation, since real competition is a pretty good check on individual power.

But Marx says the market's mandate to "grow or die" means all those competing actors start cannibalizing each other. Capital consolidates, and the Invisible Hand becomes visible: we can identify a few big firms that dominate the market, unduly influence prices, and (worst of all) mingle and merge with government just when we need government more to check the power of these growing gargantua.

And then I thought about health insurance. The Invisible Hand cannot work in health insurance. Thousands of tiny firms would have thousands of tiny risk pools that couldn't cover their costs, espcially not when we're talking the high costs of modern medicine. Insurance depends on spreading the risk; the bigger your pool, the better you spread the risk. Insurers have to eat each other—grow or die. That's why health insurance now lacks competition. It doesn't require an evil plot (though you can argue that); it just requires insurers to act exactly as Marx said they would. Consolidate, get big, control the government with lobbyists.

The conservatives opposing health coverage reform by chanting "Let the market solve" assume that Adam Smith's principles still apply. But the free market can't work in health insurance. There is no Invisible Hand, only big Visible Fists like Aetna and Cigna.

The only way you check the power of those big actors in the market is through stronger government intervention. Uncle Sam Insurance offered as an option alongside private insurance might help, but Marx's critique strengthens my belief that, in health insurance, the best solution is to carry the logic of consolidation to its inevitable conclusion: combine everyone into one nationwide risk pool, a single-payer system for all Americans.

Blog-MSM Synergy: Pierre Paper Builds Local Story from Madville Times Post

Back at you, David!

Pierre Capital Journal political reporter and blogger David Montgomery isn't afraid to acknowledge that he gets good story ideas from the blogs. Today he tips his hat toward my article last week on the patterns of commuter income flow in South Dakota. Montgomery found the Bureau of Economic Analysis data I discussed so interesting that he whipped up a big story for his paper (not the blog, but the news that pays his rent!) focusing on what those data say about his neck of the prairie around Pierre.

Blogs don't exist solely to compete with the mainstream media. We can work together, putting more eyes on more problems, sharing and expanding ideas, and building stories and understanding together.

David, you're welcome, and thank you for the acknowledgment!

Munsterman Wants SD Off Federal Teat... But How?

Just a little empty rhetoric from South Dakota gubernatorial candidate Scott Munsterman:

It’s true that we were able to balance the budget this year during our legislative session, but at what cost? Balancing our budget required an infusion of $71 million of federal stimulus money from the national government. Crawling on our knees when times get bad is not a good sign of a healthy, fiscally responsible state that budgets for the future. South Dakota can take care of South Dakota [Scott Munsterman, "Fiscal Leadership Is a Must," Let's Wake Up South Dakota, 2009.08.21].

Yeah yeah yeah. South Dakota has never taken care of South Dakota. We have consitently taken more money from the federal government than we pay in.

I look forward to Munsterman's putting some meat on the plate: tell us exactly what $71 million worth of programs you plan to cut. I'm sure $71 million in budget cuts will go over splendidly in the Republican primary. And then in November... well, we can only hope candidate Munsterman will give us the chance to test that strategy in the general election.

Governor Rounds Disingenuous on Indian Health Care

Insurance salesman and South Dakota Governor Mike Rounds offers disingenuous arguments about Indian Health Services to make the case against health care reform:

The rate of diabetes, obesity and tobacco use is high on Indian reservations across America. And due to a lack of federal funding, patients can't always get the treatments they need.

"Indian Health is an example of a government run system in the United States today," Rounds said.

Congress has a treaty obligation to provide quality health care on reservations, but Governor Mike Rounds says historically, it doesn't happen.

"Apparently they disagree, because if you take a look at the funding for Indian health, it's about half of what it is for other government paid for programs, which is Medicaid and Medicare," Rounds said.

Rounds says reform is needed but is afraid if Congress passes a government run health care system, all South Dakotans would suffer.

"I don't think you take a system in South Dakota that provides good high quality care for 91 percent of our population and throw it out and say, 'Guess what? We've decided on a lark that we're going to start over with a brand new system that has no evidence of success,' at least if you're comparing it to Indian health," Rounds said [Don Jorgenson, "Indian Health Care: Rounds' Concerns," KELOLand.com, 2009.08.21].

What Rounds gets wrong:

1. H.R. 3200 and the big debate we're having this summer is about reforming health insurance, not having the government own and operate hospitals, hire doctors, buy medicine, etc., as it does with the Indian Health Service.
2. Rounds contradicts his own argument: he says the fact that Uncle Sam doesn't give IHS enough funding shows Uncle Sam can't do health care, but then he acknowledges that government manages to fund other health care programs at double the IHS levels. Which is it, Governor Rounds: can government find the funding for health care or not?
3. If IHS lacks funding, it's because its "customers," American Indians, comprise less than 2% of the population and have little political clout. The customers of Medicare comprise 13% of the population—that proportion could double as baby boomers retire—and they have disproportionate political clout (old folks vote!)
4. "No evidence of success"?! Right: dozens of other indutrialized countries using some form of public health insurance and achieving cost savings and longer life spans are just left-wing propaganda. The public option in the city of San Francisco that has insured more people without knocking private insurers out of the market is a figment of our imagination (although the NYTimes op-ed touting San Francisco's success was written by William Dow, a former member of President George W. Bush's Council of Economic Advisors).

Governor Rounds is right that Indian Health Services struggles to provide care. We have a moral obligation to increase funding for IHS and live up to our promises. But we also have a moral obligation to recognize the difference between government-run health care (that's IHS) and reforming health insurance. That's what President Obama wants to do... and that's what insurance agents like our governor want to avoid at all costs... even the cost of twisting the truth.

Resurrect Water Project Aspirations Through Sanitary Districts -- A Legislative Proposal

Call Jay Trobec! We've got a Severe Brainstorm Warning in Lake County!

Water quality on our lakes here in Lake County hasn't been too bad this year. Lake Herman has had some stinky days, but the rain and cool temps have kept the green scum at bay compared to other years.

Nonetheless, our lakes do have problems with silt, nutrients, carp, and algae. Unfortunately, efforts to to improve water quality in Lake County this summer have gone nowhere. Folks seeking to form a water project district on Lakes Madison and Brant suffered a ballot box defeat so stinging they folded up their tent and went home. Inquiries from Lake Herman residents as to whether we could use our sanitary district funds to maintain filtration dams and grassy waterways have met with stiff opposition from half of our board—i.e. Lawrence Dirks, who is singularly focused on stockpiling tax dollars to someday build a central sewer system—as well as the apparently very narrow statutory authority of the sanitary district.

On Madison and Brant, a big problem was that folks didn't want to create a new taxing authority on top of their sanitary and road districts to work on water quality. On Herman, a big problem is that statute doesn't appear to let us spend money on anything other than a multi-million-dollar sewer system that isn't going to get built.

I think I just found a solution. We don't need to create new water project districts. We simply need to amend state law to permit sanitary districts to assume the powers of water project districts.

There is precedent for this proposal: I learned from Jerome Lammers that state law allows sanitary districts to assume the powers of road districts (see SDCL 31-12A-20.1). All we need is for District 8 legislators Representative Gerry Lange and Senator Russell Olson, both of whom live at our lakes, to co-sponsor a bill to add the following provision to Chapter 46A-18:

46A-18-20.2. Sanitary district assuming water project district powers. The board of trustees of any sanitary district incorporated under chapter 34A-5 may submit to the voters of the district at an annual election or a special election called and held in accordance with chapter 9-13 the question of whether the district shall be authorized to exercise the powers of water project districts incorporated under this chapter, or the petitioners' application for incorporation filed in accordance with § 34A-5-6 may request such authority. Upon approval of the grant of such authority by a majority of the voters voting on the question, or upon entry of the order incorporating the district if the application has requested such authority, the board of trustees shall be authorized to exercise all powers which a water project district organized under this chapter may exercise, including the powers granted by §§ 46A-18-31 to 46A-18-73, inclusive.

Check those numbers before passage, but otherwise, there you go, Gerry and Russ! House Bill 1001 for the 2010 session, all written up and ready to go, good practical legislation that will benefit your neighbors!

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p.s.: I'm working on a new website for the Lake Herman Sanitary District. The site is built on Drupal, so I can publish district info much faster and more conveniently than on the original sanitary district website, which requires offline FrontPage/Notepad editing and FTP transfer. And we all know FrontPage is dead. I'll keep working—let me know what you think!

Hubba's House: South Dakota's Blooming Jon Stewart?

Matthew J. Trask, the mastermind of Hubba's House, generally steers clear of politics. But this weekend he scores a citizen media coup with a spontaneous 10-minute interview of South Dakota's elder statesman George McGovern.



Dang right I'm envious, Hubba! Envious... and proud of what we regular folks can do with a pocket camcorder and the Internet (though to call Matt "regular" is to be "loose with the truth"). It beats anything we see on regular local TV. It's Jon Stewart Lite: less political edge, but no lack of interesting political observations as quoteworthy as anything in that Sioux Falls paper (McGovern names Daschle as one of South Dakota's monumental historical figures; McGovern sees Heidepriem riding pro-Dem trend to gubernatorial victory in 2010). Hubba also interrupts less than Jon Stewart. That's good online TV!

Watching these two intelligent South Dakotans talk in a bookstore made me think how nice it would be if our current elected officials would sit down with regular folks for on-the-record conversations like this. Sure, Representative Stephanie Herseth Sandlin could take Michael Sanborn up on his invitation to a Decorum Forum town hall. But I'd be happy to see more moments like Hubba's interview with McGovern: no studio, no crowd, no particular agenda... just good conversation.

And note that title on the video: "Mr. McGovern and Me"—a nice reminder of how close we ought to be able to keep even our greatest political figures.

Wrath of God: Ordain Homosexuals and Women... or Else?

The ELCA has approved the ordination of practicing homosexuals. John Piper, a Baptist preacher in Minneapolis, is claiming that God sent that tornado through town this week to register His disapproval. That claim wins SD Humanist's disdain; Pastor Piper's meatheadery also elicits six very appropriate questions and objections from Pastor Shel Boese. [Update 12:50 CDT: Father Tim adds his theological perspective as well!]

Let's test Pastor Piper's claim against a South Dakota story:

Pioneer Lutheran Church up by White used to be ELCA. According to the church history page, "Since the ELCA has drifted from its Lutheran and evangelical roots, Pioneer has associated more over the past five years with Lutheran Congregations in Mission for Christ." Their June 2009 newsletter indicated that a call to missions pastor Tom Walker was predicated on his willingness to leave the ELCA and join the LCMC.

The church's website offers a number of resources. Among them:

• an article by Greg Lockwood arguing scriptural support for excluding women and homosexuals from ordination (Lockwood also digs male headship and denies it is "oppressive or demeaning to anyone.")
  
• Council on Biblical Manhood and Womanhood – Recovering Biblical Manhood and Womanhood, called a "useful resource," even though only one author in it is Lutheran. Co-editor of that book, and member of that council: Pastor John Piper.
• an article that says the Rapture is non-Scriptural bunk.
  

Pioneer Lutheran's pastor, Tyler Hepner, adjunct professor of religion and philosophy at SDSU, is also part of a budding Lutheran seminary in Brookings. Pastor Hepner calls honest atheists like me "spiritual parasites."

Ruins of Pioneer Lutheran
[photo courtesy Brookings Register]

Pioneer Lutheran burned down in the wee hours of April 19, 2009.

So if, as Pastor Piper claims, God goes snapping off steeples to indicate his displeasure with the ELCA's vote on human sexuality, what does he make of God leveling a church that leaves the ELCA, preaches male headship, links Piper's book, and hires a pastor who takes pokes at atheists?

Given enough time and Google, I could find some statement or action by pretty much anyone that I could portray as a sin that explains some misfortune rained down on them by a wrathful God. But is that really a worthwhile rhetorical game? And is it really something with which an ordained pastor should waste his time?

I don't know... maybe we should all check our home insurance policies.

We Are the Death Panel

Who decides if Grandma lives or dies? Under H.R. 3200, Grandma does.

Watching Jon Stewart's interview with death-panel myth originator Betsy McCaughey¹, it occurred to me that we are the death panel. You, me, anyone who signs a living will. Ah, but not every living will: only those living wills that ask for the doctors to at some point stop trying.

To the details: McCaughey continually cited "Page 432" of H.R. 3200, the House bill on health care reform.² Here on the Net, it's not page 432; it's Section 1233(b)(3)(A)³, archived at this URL: http://www.opencongress.org/bill/111-h3200/text?version=ih&nid=t0:ih:2880. The text (which Stewart read verbatim after McCaughey's flustery page-flipping):

For purposes of reporting data on quality measures for covered professional services furnished during 2011 and any subsequent year, to the extent that measures are available, the Secretary shall include quality measures on end of life care and advanced care planning that have been adopted or endorsed by a consensus-based organization, if appropriate. Such measures shall measure both the creation of and adherence to orders for life-sustaining treatment.

In other words, H.R. 3200 adds living will consultations and adherence to the 153 quality measures that are already part of the Physician Quality Reporting Initiative (PQRI). Doctors get an incentive for reporting this data (2.0% this year).

McCaughey says this provision will give doctors incentive to deny care and let patients die against their wishes. In her nightmare scenario, you sign a living will saying you don't want to be kept alive on a ventilator, then come to the hospital four years later with some serious trauma. Facing death, you change your mind and decide you'll take the ventilator, but the doctor says, "Uncle Sam will slap me if I don't adhere to your living will, so I'm not hooking you up."

But Section 1233(b)(3)(A) causes no such thing. This provision only calls for the doctors to report their assistance in creation of and adherence to living wills. They get their incentive for reporting. Even if a doctor goes ape and doesn't consult on or adhere to a single living will, as long as she faithfully reports that non-adherence, she gets her PQRI incentive.

Under Section 1233(b)(3)(A), the only person deciding that a patient will die—or live, or fight to live, or get treatments A, B, and C but not D—is the patient. The patient chooses to have an advanced care planning consultation (which, under HR 3200, Medicare pays for). The patient writes down her wishes in a living will, a document the patient can modify at any time⁴. And if the patient comes to the hospital and can't express her wishes, the doctor has her wishes on paper to follow, whatever those wishes may be... or at least may have been when that document was signed.

Not one line of H.R. 3200—not McCaughey's vaunted "Page 432" or "Page 425" anything else—empowers any government official to decide when to "pull the plug on Grandma," a claim that even the progenitor of that snappy phrase, Senator Charles Grassley, has completely repudiated. Senator Grassley agrees: the only person making end-of-life decisions under H.R. 3200 is you.

So who is the death panel? Right now, if you don't have a living will, it could be your kids, your doctors, your obstinate daughter-in-law, who knows who. If you get a living will, it's you... and H.R. 3200 will pay for your effort to get informed and put your choices in writing.

Oh yeah, and H.R. 3200 will help millions of Americans get insurance, save money, and save lives.

¹Update 12:05 CDT: The day after her embarrassing performance on The Daily Show, McCaughey resigned from the board of Cantel Medical Corp. What?! a deceptive opponent of health coverage reform was working for the medical industry?!

²She cited it, but after making a show of lugging what she said were the first 500 pages of the bill on stage, she couldn't find it, didn't have it sticky-noted or highlighted or even, apparently, in sequential order. She looked like a novice debater, rolling into a debate round with five tubs of evidence but not able to find her central Disadvantage argument.

³Did you notice that McCaughey tried to make it sound as if Sec. 1233 and "Page 432" were different parts and that if Stewart had only read Sec 1233 he wasn't talking about the part of the bill with which she was defending her position?

⁴HR 3200 pays for end-of-life consultations once every five years. The bill makes an exception for folks whose medical/care situation changes significantly. And even if you don't qualify for that exception, nothing stops you from going to your doctor or lawyer and changing your living will as often as you want; you just pay for those visits yourself.

Oil in Elk Point or Wind in Howard: Pick Your Energy Future

Bob Ellis probably wants these environmentalist extremists in Howard to "take a hike", too:

Most of the talk about green job development has focused on urban areas, especially depressed, inner cities. But yesterday the conversation turned towards Rural America, and what’s already been accomplished there.

The conversation was initiated by Repower America, who held a press conference in Howard, SD to show their support for The American Clean Energy and Security Act. The organization believes the legislation could help bring 5,000 new jobs to South Dakota.

Because it is home to two wind energy companies, Howard (pop. 1071) was the perfect community to showcase this potential. Those two companies, Knight & Carver Wind Group and Energy Maintenance Service, offer good paying jobs that have helped diversify the town’s economy [Mike Knutson, "Green Jobs in Rural America," Reimagine Rural, 2009.08.21].

Conservatives like Bob Ellis cheer the potential construction of an oil refinery that will pollute the air, water, and land around Elk Point. I'm glad that Ellis can enjoy a little state affirmation of his worldview this morning, but that doesn't free us from the tarpit old-energy thinking that will only perpetuate our addiction to a dwindling resource.

Fortunately, some rural visionaries are looking for ways to change how we produce and use energy in hopes of creating real energy independence. The folks in Howard have been able to draw two energy businesses to town that have made actual progress toward producing domestic energy and jobs without big environmental impacts. Asking such visionaries to "take a hike" is the epitome of short-sightedness.

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p.s.: Have you noticed how the KELO graphic of the proposed Hyperion refinery is all smoky and brown? Think about it. (I wonder if Perry Groten chose that image....)

pp.s.: Another Hyperion, Hyperion Power Generation, and some other companies are looking at a possibly greener energy solution that oil refineries: micro-nukes! Hmm... would small nuclear reactors give us greener power... or just a nice green glow?

ppp.s.: Hat tip to eager reader Tony Amert: If we really want to break oil addiction, maybe we could fire up some nuclear reactors next to the ocean and make jet fuel out of seawater.

Musical Interlude: The Airborne Toxic Event

The State of South Dakota grants Hyperion its air pollution permit, and all I can do is talk about music?

When I discovered radio in seventh grade, I was enthralled. All through junior high, I danced in my room and drove imagined masses to ecstasy with rollicking tennis racket air-guitar solos. I memorized and transcribed lyrics and mimicked the vocal stylings of everyone from Men Without Hats and David Bowie to Cyndi Lauper and Madonna. And Journey. And Van Halen. I lived and died by the triumphant ascent and agonizing fall of my favorites on the Rick Dees Weekly Top 40. Most importantly, in every lyrical twist and guitar solo, I sought and often found some cosmic significance, assurance from ethereal voices that, Tina Turner be damned, love is heroic, forever, a battlefield, whatever.

I was weird. Everyone is weird in junior high.

In high school I started broadening my musical tastes with South Dakota Public Radio ("your sound alternative, broadcasting on these translator stations..."). Our dynamic high school choir director Miss Edwards revealed to me the wonder of Schubert's Mass in G and voices raised in Latin. At university, SDSU's newborn KSDJ helped pull me away from top 40 radio. Then Alberta's amazing CKUA ruined me, turning me away for good from cookie-cutter pop stations broadcasting focus-grouped playlists and sterile non-local DJ chatter.

Up against the like of CKUA, Jazz Nightly, and the World Café (the Rock Garden Tour is still proving itself), South Dakota's top 40 stations just can't compete.

But every now and then I spin the dial, and once in a rare while, I hear something new on pop radio that makes me feel that junior-high vibe, that crazy sense that the whole world turns on one song.

Such was the song I heard coming out of the radio from B93.7 a couple weeks ago. Then I heard it again last week, driving through North Dakota at high noon on Prairie Public Radio.



"Sometime Around Midnight," by The Toxic Airborne Event. A poetic, plaintive rock crescendo packed with angst and verbal gems tied just right to the music:

...the piano's this melancholy soundtrack
to her smile..

...she's laughing, she's turning,
she's holding her tonic like a crux...

...the curl of your bodies
like two perfect circles entwined...

...but she makes sure you saw her
as she looks right at you and bolts
as she walks out the door,
your blood boiling, your stomach in ropes
and your friends say what is it
you look like you've seen a ghost...

...and all the poetry goes to emotional hell in one pounding, animal cry: "You just have to see her, you just have to see her, YOU JUST HAVE TO SEE HER...."

This song shouldn't grab me. It doesn't speak to my daily life. My days of feeling "hopeless and homeless" as I crash through unsuccessful love affairs are long gone. Every time the girl I love looks right at me and bolts, she generally returns a few hours later with groceries, and we go happily on chasing our three year old and laughing with Jon Stewart together.

Starships aren't part of daily life, either, yet Star Trek can still move me. The Toxic Airborne Event pulls off a similar feat, crafting a literary and emotional work of art that pulls us out of our everyday experience (come on: nobody experiences heartbreak like that every day) and gives us a healthy dose of desperation and catharsis. They resurrect the thrill I felt when I first discovered good music on the radio.

And they know how to use a string section.

The Toxic Airborne Event plays Boulder, Omaha, and Des Moines in September. South Dakota fans will have to settle for Hyperion's refinery.

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September's coming soon... so get out and enjoy the weekend!

SD Peace &Justice: Single-Payer Best

The South Dakota Peace and Justice Center weighs on the side of socialists like Congressman Anthony Weiner and me: their August policy analysis calls for a single-payer health coverage system. SDPJC joins the myth-busting crew on three points:

1. You don't have choice under a private insurance system... unless you think "cling to my employer's health insurance or do without" is real choice.
2. You and your doctor don't have control with private insurance—ever hear of "managed care"?
3. Single-payer doesn't mean long waits... at least not any longer than you might wait now for care.

(On that third point, Erin and I have a friend who has a medical problem that could cause paralysis. This friend got a cursory interview with a surgeon, who said he'd do the surgery in six months and then didn't stick around long enough to answer questions about why that wait was acceptable. And folks say America has no waiting for health care? Riiiight.)

SDPJC holds its nose and says a strong public option—government insurance every American can buy—is an acceptable compromise. But let's remember: public option is an extreme compromise down from the successful standard of public health coverage in dozens of other countries.

Tell the Story, Mr. President: Back Facts with Narrative to Win Health Coverage Reform

From Berkeley linguist George Lakoff, via Rebecca Blood, an argument that even having all the facts on our side may not be enough to win the health care reform debate:

To many liberals, Policy Speak sounds like the high road: a rational, public discussion in the best tradition of liberal democracy. Convince the populace rationally on the objective policy merits. Give the facts and figures. Assume self-interest as the motivator of rational choice. Convince people by the logic of the policymakers that the policy is in their interest.

But to a cognitive scientist or neuroscientist, this sounds nuts. The view of human reason and language behind Policy Speak is just false. Certainly reason should be used. It's just that you should use real reason, the way people really think. Certainly the truth should be told. It's just that it should be told so it makes sense to people, resonates with them and inspires them to act. Certainly new media should be used. It's just that a system of communications should be constructed and used effectively [George Lakoff, "The Policy-Speak Disaster for Health Care," Truthout, 2009.08.20].

Now I'm more interested in discussing the actual plans for saving money and saving lives by reforming health coverage than the language we use to promote it. But Lakoff makes the unavoidable point that, in the democratic process, language matters. He really makes the same point as my debate coach friends do every year (and which I'll be making in my speech class at DSU this fall): point-by-point rebuttals are useful, but to win the round, debaters need to convey the truth of their argument in a "clear and powerful narrative."

And what is that clear and powerful narrative the President needs to tell America?

• The American Plan: Health care is a patriotic issue that we should all work together, through a public option, to solve.
• Doctor-Patient Care: The President's reforms are all about removing all the current practices that get between you and your doctor, like unaffordable insurance, exclusions for pre-existing conditions, and denails of coverage for preventive care and maternity and other basics.
• The Status Quo is private taxation, bureacracy, and control: Insurance companies tax you and profit from it. Insurance companies subject you to a bureaucracy more complicated and opaque than any government health coverage system. Insurance companies deny and ration care every day. And insurance executives don't have to answer to you at town halls or the ballot box. (Try calling your insurance agent or claims processor a letter and telling her she's a Nazi bent on killing your mother, see how well that goes over.) An American Plan gives you more bang for your buck, more coverage, and more control and accountability.

I suspect my conservative readers will brand Lakoff's recommendations as mere spin. But Lakoff isn't asking the President to take the socialism/fascism criers' tack and tell stories that could only be true on another planet. He's making the valid point that most Americans aren't policy wonks (they don't have time to be!). To bring out public support (support that poll after poll has shown is out there!), the President and all supporters of reform need to choose clear, powerful, and memorable language that conveys the truth.

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Update 08:45 CDT: But there are still plenty of myths to bust. Bulk up your narrative with this list 14(!) bogus arguments against health coverage reform from MediaMatters.org.

Update 13:27 CDT: Peggy Noonan makes a somewhat similar argument in the Wall Street Journal about the need for simple language to sell big legislation to "normal" people. Sounds a little elitist, but the point dovetails with Lakoff's.