Yesterday, when I was watching the CNN/YouTube Democratic debate I noticed that there was a significant number of Californian's questions that were selected to be asked of the candidates. Out of the 38 questions that were asked, eight came from Californians. No other state even came close to matching that total. Minnesota, Michigan, South Carolina and Pennsylvania had two each. The rest were single digits and two came from unknown locations.

Everyone in the country was eligible to submit a question. A state by state breakdown of the origin of all of the 2,000+ questioners is impossible to find, since we only know user names. However, during the debate they listed the hometown of almost all. So we can't know if this was a representative sample of the questions asked. Regardless, it is great to see so many Californians get a chance to ask the candidates questions during the debate. Wouldn't it be ironic if there were more CA questions asked during this debate than the one in LA?

Below the fold are the Californian questions and the name and hometown of the questioner.

Sometimes I find myself to the right of many of my fellow bloggers out here in California. Perhaps it is my East Coast roots, or my more direct experience working in politics. Health care reform is one of those issues where I diverge and stand with the political establishment.

See, I am pragmatic. I look at SB 840 (single payer bill) and SiCKO and think well gee wiz, it sure would be nice, but it just isn't politically practical right now. I see the statistics on all of the uninsured and know that we can do better than the status quo, even if it does keep in place the private insurance industry. It's why legislators like Shelia Keuhl, ever the fighter for single payer, votes for bills like AB 8 (the Nunez/Perata plan).

Similar dynamics are playing out on in the presidential campaign. The WaPo had an interesting article on the decision making that went into Edward's health care plan. He pulled in two leading academics, one who argued that our system was "so riddled with inefficiencies that it needs to be blown up and replaced by a plan in which people can buy coverage themselves." On the other side was a MIT economist, who argued for an incremental approach that would be politically viable.

A month later, when Edwards announced his health-care plan, he almost completely sided with Gruber. And he is not alone. For the first time since President Bill Clinton's plan for health-care reform, overseen by his wife, collapsed in 1994, the leading Democratic presidential candidates are campaigning in favor of universal health care. But in developing their specific plans, they are embracing the pragmatic steps advocated by the MIT professor and a group of similar-minded policy experts, many of whose ideas were shaped by their first exposure to the perils of health-care politics 13 years ago.

"Plans which minimize the disruption to the existing system are more likely to succeed than plans that rip up the existing system and start over," said Gruber, who has consulted with the three leading Democratic campaigns about their health plans. "It doesn't take a genius to see that. That's not to say that plans ripping it up wouldn't be better -- I just think they're political non-starters."

Politics is not the art of the possible, but rather the practical. That is not to say that what is a political non-starter today will be impractical a few years from now. Indeed, we have seen a great deal of shifting on the issue of reform in the last decade. Republicans are now much more willing to discuss significant changes to the system.

If a health care reform bill does make it through the legislature this year, it will not be perfect. Heck, it may not even be great, but more than likely it will be better than what we have got now. We are not talking about something abstract here. There are life and death matters at stake, not to mention quality of life issues. Millions of Californians do not have insurance and millions more are at risk of losing their coverage. Even more fight their insurance companies tooth and nail to get the coverage they paid for.

We can change this, at least partially. Something is better than nothing.

The desire for health care reform is so strong in the country that even the Republican Presidential candidates are promising massive changes to cover more of the 44.8 million uninsured and increase affordability for those who already have insurance. There is no one singular idea of how to reach those goals. Republicans are fearful to step into SiCKO territory and increase the numbers covered under governmental programs. The Democrats generally take the opposite tact. Here is a pretty decent NYT overview of the situation.

Their approaches are very different, reflecting longstanding divisions between the parties on the role of government versus the private market in addressing the affordability and availability of health insurance. Republicans, by and large, promise to expand coverage by using a variety of tax incentives to empower consumers to buy it themselves, from private insurers. Conservatives warn, repeatedly, of Democrats edging toward the slippery slope of “government-controlled health insurance,” as former Mayor Rudolph W. Giuliani of New York puts it, and promote the innovation and choice offered by private insurers.

The major Democratic candidates propose strengthening the private-employer-based system, through which most working families get their coverage. But many Democrats also see a strong role for government, including, in some plans, new requirements that individuals obtain insurance and that employers provide it, along with substantial new government spending to subsidize coverage for people who cannot afford it.

Still, while they argue over solutions, both parties acknowledge the problems and their political urgency. Republicans, whose primaries usually turn on other issues, often wait until the general election to roll out detailed health plans; this time they are plunging into the debate far earlier. Democrats are competing furiously among themselves over who has the bigger, better plan to control costs and to approach universal coverage, a striking change from the party’s wariness on the issue a decade ago after the collapse of the Clintons’ health care initiative.

Health care is not a partisan issue. All Americans have been hit hard by the 87% increase in premiums for families over the last seven years. Businesses are having a harder time providing coverage. Polls now show it is the top rated domestic issue among all voters, regardless of party affiliation. Americans are eager for change and the presidential contenders are hoping to be able gain supporters from their plans. It's unlikely that Congress will address the issue on a broad scale until there is a new president in office. However, especially with a Democrat in office it will be on the top of the priority list next session and Republicans would have a hard time resisting addressing the issue.

Obama released his first two ads of the cycle in Iowa today. It was a relatively modest buy, but he is getting a lot of earned media out of it. They are by and large bio pieces and pretty traditional political ads.

The first ad is called "Carry" and emphasizes his ability to work in a bi-partisan manner and highlights his work in the IL legislature on health care among other issues.

The second ad is titled "Choices" and focuses on his work as a community organizer.

Interesting move not to put them in YouTube, but brightcove configured this way let me grab the code. No real big difference from a user perspective.

This weekend I had the opportunity to join a few fellow bloggers and interview Elizabeth Edwards. I had written a post last week arguing that there was not a huge controversy between the advocacy of Michael Moore for single payer health care in SiCKO and the presidential contender plans that would by and large stay within the private health insurance industry. This was an opportunity to put that to the test. I opted to ask Elizabeth about the differences between single payer and John's plan and she immediately emphasized that they really were not that far apart.

They are not that different... And honestly single payer is not going to pass in this country. It is not going to happen. We may get to single payer, but we are not going to jump to single payer.

John is in favor of bold moves about a lot of things, but we have to be realistic and the point is to get people covered. So, John's program allows private insurers, if they bid and are willing to follow a pretty stringent set of rules to participate. But he also has a government option.

After a bit of back and forth, Elizabeth explicitly presented the Edwards plan as a transitional piece of legislation between the current system and single payer. She highlighted the support from Paul Krugman and another health policy expert at Princeton that John has the best plan.

It's got the specificity, got the capacity to pass and is actually is probably our most logical path for us to take, if we are ever going to get to single payer.

This is right in line with what I have been writing on these pages. The interview was the first time that I have seen a campaign argue along these lines. The country is not in a place to pass single payer right now. First people need to see that the government can provide affordable, more efficient health care, before there is support for a truly universal governmental program. It is fascinating to see this kind of progressive policy argument be made.

The LA Times works hard at creating a story around the Democratic presidential contenders not endorsing the message of SiCKO and the potential of that to upset liberal activists. The problem is that it is not happening. It is a manufactured story. One only needs to trundle over to recommended list on Daily Kos, which is as good as any temperature reading of the activist base of the Democratic party as anywhere. On it is a piece titled "LA Times Hit Piece on SiCKO and American People". The reaction to the article was not to go off on the candidates, but the paper itself for fanning the flames of a non-story.

Here is what the LAT said:

Rejecting Moore's prescription on healthcare could alienate liberal activists, who will play a big role in choosing the party's next standard-bearer. However, his proposal — wiping out private health insurance and replacing it with a massive federal program — could be political poison with the larger electorate.

It is a legitimate question to ask, but some digging, or heck even getting the authors to talk to their colleagues in Sacramento would have gotten them an answer. The Democratic base already supports single payer health care, however, the majority recognizes that it is not currently a viable option on the national scale. Indeed that is the purpose of SiCKO, to spread the message to the greater electorate. Michael Moore understands that dynamic, which is why he appeared with Fabian Nunez, despite the obvious disconnect between his message and the current path of the legislature.

The LAT goes way overboard with this:

If Moore's fire-breathing proposal catches on among party activists, who tend to be suspicious of the private sector and supportive of direct government action, the candidates' pragmatic, consensus-seeking ideas could look like weak-kneed temporizing — much the way their rejection of an immediate pullout from Iraq has drawn heated criticism from antiwar activists.

Their bias is clear in labeling SiCKO as a "fire-breathing proposal". They are framing single payer health care as something that is supported by the dirty f#**# hippies that want an immediate pullout from Iraq. They see no nuance.

Now, don't get me wrong. There will be a certain percentage of the activist left who does attack the presidential candidates on this. Just as there are those here in California attacking Democrats over their health care legislation. However, the overwhelming response has been supportive of both pushing the American public on single payer and the contenders health care plans that move us in that direction. They are not mutually exclusive.

The two are not an easy match, but the media is the one pressing the candidates on the issue, trying to stir up trouble where little exists. They will continue to press the candidates at their press conferences, because it makes a nice little story for them.

Last week, John Edwards fleshed out more details of his universal health care plan. The cost savings from his proposal would save the average family $2,000-2,500 a year and cut waste in the health care system by $130 billion. One of the biggest piece of his plan is the establishment of health markets to encourage competition among insurance companies. They will also have to compete against what Edward's calls "Medicare-plus", a government plan that all people can join. The new information mostly centered on the cost savings reaped by the potential implementation of Edward's plan.

Edwards would require that insurance companies spend 85% of their revenues on patient care, in contrast to the 70% they spend now. He also wants to add a new option for drug companies to forgo their long patents. Edwards would give them a cash prize on the front end for developing drugs that treat diseases like Alzheimer's and cancer. In exchange, they would drop their patent rights, so that the end result is a generic more affordable drug. He would also require chronic care management, with each patient having a doctor in charge of their coordinate care. Chronic disease treatment and preventative care would be required to be covered in all health care plans. He also encourages the adoption of electronic medical records. Edwards wants to create a central organization within the Institute of Medicine that tests new devices and drugs head-to-head, disseminates best practices nationally. He advocates for the creation of a health care Consumer Reports-type publication to help patients make better choices and encourage providers to offer better services for lower costs.

While, not technical a cost reduction piece of his plan, Edwards also did detail his plans to improve working conditions with the goal to lure back 50,000 nurses who have left the profession and bring in another 50,000 young people into nursing.

Here is is at his press conference:

For more information read this official campaign blog post.