All healthcare practices, techniques, treatments, devices, and medications can be placed on a spectrum ranging from softest to hardest. At the soft end of the spectrum we find such approaches as massage, herbalism, diet, yoga, and emotional counseling. At the hard end of the spectrum we find most surgeries, most prescription drugs, acute and traumatic injury care, chemotherapy, radiation therapy, and extreme psychiatric practices, such as electroshock.

The basic premise of commonhealth is that to the extent that a community or nation has over-committed to hardcare approaches, its heathcare expenses rise precipitously, fewer community members have secure access to regular care, and overall outcomes — as measured in such areas as infant mortality, life expectancy, and iatrogenic illness — worsen.

Conversely, when we commit time, money, energy, and attention to softcare approaches, expenses fall, everybody has secure access to quality care, and medical outcomes improve.

While America’s healthcare crisis is in part due to its inane aversion to “socialized medicine,” even if we remove the insurance companies from the equation and adopt the single-payer system that works so well for other nations, many of our problems will remain. Indeed, the proponents of “anti-social medicine” may be proven right: there’s way too much hardcare in our current system to fund with a tax-based approach, so there would definitely be long waits and/or rationing for hardcare treatments.

Even as it shifts to a single-payer system, America must also undergo a total rethink of its medical practices. As we lessen our reliance on hardcare, and commit to a softcare lifestyle, we’ll all feel a whole lot better.

The debate over the State Children’s Health Insurance Program (Schip) — whether to continue it, and for how much money and how many kids — is providing a clear view into the ugliness of anti-government conservatism. Nobody contends that the program isn’t successfully providing much needed care to millions of children, or that providing the care via SCHIP is less expensive for the nation than having all of these uninsured children show up at emergency rooms when sick.

But Mr. Bush, with the blessings of many Republicans, promises to veto any legislation that attempts to expand the program. Not because we can’t afford it: the proposed expansions would amount to a couple months of the war in Iraq, and would be paid for by taxes on tobacco. No, Bush’s real objection is that if we do this, and it works, then we’ve opened the door to more government healthcare:

And there you have the core of Mr. Bush’s philosophy. He wants the public to believe that government is always the problem, never the solution. But it’s hard to convince people that government is always bad when they see it doing good things. So his philosophy says that the government must be prevented from solving problems, even if it can. In fact, the more good a proposed government program would do, the more fiercely it must be opposed.

This sounds like a caricature, but it isn’t. The truth is that this good-is-bad philosophy has always been at the core of Republican opposition to health care reform. Thus back in 1994, William Kristol warned against passage of the Clinton health care plan “in any form,” because “its success would signal the rebirth of centralized welfare-state policy at the very moment that such policy is being perceived as a failure in other areas.”

But it has taken the fight over children’s health insurance to bring the perversity of this philosophy fully into view.

There are arguments you can make against programs, like Social Security, that provide a safety net for adults. I can respect those arguments, even though I disagree. But denying basic health care to children whose parents lack the means to pay for it, simply because you’re afraid that success in insuring children might put big government in a good light, is just morally wrong

So, we will go on with our ridiculously bad healthcare system, refusing simple changes that have worked for so many other nations, because the men running our government are committed to proving that government can’t do anything right. Which explains the missing WMD, the bungled occupation, Katrina, and so on. Those who voted for Bush can hardly be surprised at the gross levels of criminal incompetence — it was the bottom line of his “government sucks” philosophy.

As a child I was sick a lot. I’d get three or four colds a year, always with a nasty strep throat. I missed most of fifth grade with mononucleosis. I’d been born with some sort of digestive difficulties (never diagnosed; I now believe I was allergic to baby formula) that persisted as chronic diarrhea. Then, around the age of nine, I started passing blood in my stools.

By that age I was already averse to doctors and especially terrified of needles. So as my condition developed I kept it secret from my parents. Somehow they missed the fact that I was going to the bathroom twenty times a day, and another two or three times at night, usually just to pass a dollop of mucusy blood. Nor were they aware of the belly cramps, so bad that I’d have to stop whatever I was doing for several minutes until they abated.

Thus I grew into a skinny, pale, chronically tired teenager. Finally, when I was fourteen, I was hospitalized and tests revealed an advanced case of ulcerative colitis — the interior wall of my large intestine was one open, bleeding sore.

When CNN was picking the YouTube questions for the recent Democratic debate it passed on an excellent challenge from Michael Moore:

I am calling on each presidential candidate to pledge to refuse their free government health care until every person in this country also has it. I want every candidate who said they’d work for the minimum wage as president to work uninsured, too, until health care is universal. And I want the other candidates to join them. (Yes, I’m looking at you, too, Republicans. I know you can afford to do it.)

To be really effective it would have to be extended to the full Congress also. And  the Judiciary. Just end the free government-run healthcare they and their families are all receiving and let them experience the joys of the free market system they never tire of praising and pushing on the rest of us.

A core principle of “commonhealth” holds that the health of individuals cannot be considered apart from the health of their surroundings, including family, workplace, community, and the environment. No body is an island. Individual health fluctuates relative to local inputs — we experience good or ill health in significant measure due to the good or ill health of the world we inhabit.

Michael Marmot, British epidemiologist and author of The Status Syndrome, has shown that individual health rises or falls with one’s high or low status in society. But this is not a simple matter of the wealthy having more money to buy better food and medical care:

As important as it is to move America to a single-payer heathcare system that eliminates the administrative costs of profit-driven insurance companies, it will do little good if we do not simultaneously change the way medicine is practiced in this country.

This flies in the face of a basic assumption in the current debate: that for all of its expense, and despite those millions of uninsured, the American medical system (AMS) is the best in the world. Saudi princes, we’re told, come here for their coronary bypass operations. Canadians eschew their long waits and slip over the border for hip replacements. Supposedly, every sick person in the world would prefer an American hospital over the second-class offerings of their government-controlled systems.

Makes for a patriotic narrative. If only it were true.

Between Michael Moore’s “Sicko,” and an election cycle in which the American people are naming healthcare as their number two issue (after the war in Iraq), American healthcare is about to undergo a long overdue and hopefully deep examination. If, however, all we do is focus on access to and payment for care — arguing, as Moore admirably does, for the elimination of private health insurance — then it is likely that the status quo will prevail, because the insurance companies will win that battle.

The insurance industry is a major contributor to and thus part-owner of the Congress. The men and women who make up the Senate and House are beholden to the industry for much of their financing yet, ironically enough, not for their own healthcare. Instead, all of the people who run the government (executive, legislative and judiciary) get their care through a government-run and -financed, single-payer, universal (for them) system.

We have to appreciate their conundrum when they get together to decide what to do about the rest of us — the fifty million who have no insurance at all, and many others who have the sort of tragically inadequate insurance that Moore highlights.

The only thing more depressing than listening to our political and pundit classes soundbite their ways around the subject of the war in Iraq without every addressing the core issue of America’s addiction to Middle Eastern oil, is listening to their plans to reform the American healthcare system. Blah, blah, yak, yak, nothing ever changes, and the core problem with healthcare in America is never mentioned:

And these health insurance companies are — they’re just — they’re the Halliburtons of the health industry. I mean, they really — they get away with murder. They charge whatever they want. There’s no government control. And frankly, we will not really fix our system until we remove these private insurance companies. I mean, they literally have to be eliminated. They cannot be allowed to exist in this