I found it really interesting, during the election of 2004, to see everybody miss the entire point in the debate over prescription drug prices. The Bush administration had negotiated a deal with the drug companies, where seniors could get a card that would subsidize their drug costs, but the cost of the drugs was set by the manufacturers, and the deal stipulated that it was not negotiable. The Democrats derided this plan, saying that it didn't lower the cost sufficiently and that, like some individual states, the US ought to allow its citizens to import drugs from Canada where they cost much less.

The problem with the Bush plan was that it was so unbelievably complicated, with so many different organizations offering cards with slightly different benefits, and it didn't solve the basic problem of lowering prescription drug costs. These were private insurance companies, however, and that kept the Bush government happy because it meant that private enterprise was making money and doing its efficient, free-market thing, instead of the big bad bureaucracy of the federal government trying to run it.

The Bush administration first tried to maintain that Canadian drugs were suspect, that they didn't have the kinds of quality controls the US did, and that people would die if they used Canadian drugs. Then word got out that Canadian drugs were the same as US drugs—some manufactured in the US and some in other parts of the world. Even some of the drugs sold in the US by US manufacturers were made in other parts of the world, as it turned out. So it became harder to make the point that Canadian drugs were somehow inferior. Then in the early fall of 2004, when the US flu vaccine supply fell through, and some precious extra vaccine was made available by Canada, the Bush administration had to back off the scare-mongering and badmouthing of the Canadian product. OK, point made.

The real problem with the Democratic plan was that the US is a much, much bigger country than Canada, and Canadian pharmacies couldn't hope to fill the US market, particularly on a national scale. Even with only a handful of states allowing their citizens to purchase Canadian drugs—a loophole the US was working to close anyway—the supply of drugs in Canada was not going to be enough to meet demand. Why is that?

Well, it's because the drug manufacturers were squeezing the Canadian market, and limiting the supply, so there wouldn't be enough to export. In fact, even while the election was going on, the Canadian government knew about this and began talking about limiting drug exports to ensure that there would be enough for the domestic market. So the Democratic plan had no hope of succeeding—something I helpfully tried to point out, only to get on some email list and receive campaign updates several times a day. But the question that was never asked in all of this is still worth asking: why are drugs cheaper in Canada (and in many other countries) than they are in the US? I will get to that, but first, we need to know why drugs cost so much money in the US.

Drugs companies in the US set the prices of their prescription drugs according to the cost of manufacturing plus the cost of research & development (of current and future drugs) plus the cost of advertising, and so on. I would say that the profits the drug companies are making are obscene, but as long as the companies can convince the Federal Trade Commission that they are not colluding with other companies to fix the price at an artificially high level, they are acting within the law. It’s nice for them that they have a monopoly on new drugs, at least for a few years until the law allows other companies to make generic versions of the drugs (while still paying a royalty to the original manufacturer), but it's new drugs, especially, that make the money.

One part of this equation that has changed drastically over the last few years is the cost of advertising. It used to be that drug companies marketed prescription drugs to physicians, who were, after all, the only ones who could decide to prescribe them, and thus controled the market. But drug companies discovered that they could market directly to consumers—there was no law against it, after all—and while the cost was much greater in marketing to the general public, they could get huge results. Consumers couldn't purchase the drugs directly over the counter, like they can with non-prescription remedies, but they could "ask their doctors" about the drug, and put pressure on them to prescribe it. This direct marketing of prescription drugs became more and more effective, as ignorant consumers put pressure on doctors to prescribe drugs they had heard about on TV. Even watching the network news, there are sometimes two or three prescription drug ads in a row in a single commercial break! It must be working. The billions of dollars spent on direct marketing is selling more drugs than marketing to physicians ever did. But, of course, it costs a whole lot more, and that cost is getting passed along to the consumer, whether by the direct payment for the medication, or the payment of higher insurance premiums to cover the higher cost of the drugs.

One famous case where the benefits of this system to the consumer were dubious but the benefits to the drug company were enormous occurred with the drugs Prilosec and Nexium, which were made by the same manufacturer. Prilosec was a very effective product and got prescribed a tremendous amount by doctors. But the monopoly on the drug was running out, so the company was faced with drastic cuts in profits as generics became available and the price of Prilosec plummeted in response to the competition. So they made some very small adjustments to the Prilosec formula and got a new patent under the name Nexium. Well, if it's virtually the same, why wouldn't doctors and consumers just go on purchasing Prilosec at its new lower cost? Because the company mounted a HUGE campaign for Nexium, so that consumers would demand the newer drug over the old one, even though the benefits were marginal at best. Why did the drug company do this? Because they had a monopoly on Nexium and were losing the monopoly on Prilosec. Is this in the bests interests of Americans, particularly when the astronomical costs of marketing drugs like that are simply added on to the cost of the medicine? That question is supposed to be irrelevant, because it's a free market society, and the companies are simply charging what the market will bear and what the hospitals, insurance companies and, ultimately, the conumers will pay. But the drug companies are still making obscene profits, and this brings back to the question of lower drug prices in Canada.

Drug prices are lower in Canada because a panel of experts looks at the cost of research and development, and the cost of manufacturing, and decides what a fair price should be for the product. They tell this to the drug companies and the companies charge that amount for their product, or they don't sell it in Canada. The same thing happens in other countries too. It's called price controls. The drug companies don't like it, but they abide by it, because even at the lower price, they are still making lots of money, and they want to sell their products there. So that's why drug prices are lower in Canada. Why couldn't it work here too?

First of all, "price controls" smack of government interference in the free market, so it's not something that the US government would ever agree to, since it's not capitalism and therefore not the American way. What I suggest to achieve the same end is for the US government to negotiate a lower cost from the drug companies. This is something the Bush administration said it wouldn't do with its prescription drug plan of 2004, but it happens all the time already with drugs used in Veterans hospitals all over the country. A lower cost is negotiated by a large user and the companies sell the product at that price. The larger the user, the more clout they have in negotiating the lower price. So if the US government were to negotiate a lower price on behalf of all the users in the country, drug companies would have to abide by it. In fact, they would want to abide by it because they want access to that market. Great idea, huh? But let's not call it price controls, let's call negotiating a better business deal. That sounds so much more American, doesn't it?

Over Thanksgiving in 2004, I attended a reunion for my wife's family in Texas. Although I certainly didn't go looking for an argument, I found myself in a shouting match at the dinner table with one of her relatives (by marriage) over the health care system in the US and how it compares to the system in Canada. I grew up in Canada and my sister is a health care professional there, so I think I know something about it. The level of ignorance about the Canadian system among Americans is appalling, however.

He cited stories of people going to the emergency room and waiting days to be seen.

Doesn't happen, I said.

He touted the quality of American care as the best in the world.

The best that money can buy, I corrected him. If you don't have the money to buy it, you don't get it.

The fact is, the medical care in Canadian hospitals is on a par with that in many of the top facilities in the US. They have the same medicines, the same equipment, the same highly trained doctors and nurses. Yes, I allowed, if you need an MRI, you might have to wait until the day after tomorrow instead of tomorrow. But when you have it done, it will be free. It's paid for by the government health insurance plan.

Ah! he said, his eyes gleaming as if to say, I've got you now! That's socialism! That's a failed system! We showed the triumph of our system with the fall of the Berlin wall.

You're an idiot, I screamed. Have some dessert, my wife said.

If this guy is any indication, Americans don't know the difference between socialism and communism. All of the countries in the West (the ones on our side, remember) except for the US have medical systems that include government-sponsored health insurance: Canada, Britain, France, Germany—you name it. Are we superior just because everything we have is based on a free market? Some countries with high taxes and a huge social safety net, like Sweden, are perennially ranked among the top countries for overall standard of living, and Canada, meanwhile, socialized medicine and all, is perennially ranked at the top in the world for health care. How can this be? How do you measure something like that?

Let's start with the percentage of the population with access to top-notch medical care. We all know that about 40 million Americans have no health insurance at all, so they don't have access to care, much less top-notch care. A lot more Americans have minimal coverage, so they don't have access to top-notch care either. I remember when our youngest child needed surgery as an infant, we were devastated when the insurance company called the night before the surgery to say that we'd have to have it done at a different hospital, because the one where it was scheduled was too expensive. We were paying insurance and the company was making medical decisions for us on the basis of cost! In Canada, everyone is covered for everything that doctors decide is necessary. Their health insurance comes out of their paychecks, and goes into a government-run system. They don't have to worry about catastrophic medical costs, because they won't have to pay any.

It seems to me that there are two other questions to ask in comparing health care between countries. The first is, who lives longer? It may surprise Americans to learn that Canadian women live, on average, two years longer than American women, and Canadian men live, on average, three years longer than American men. That's two or three years longer in retirement, two or three years longer with the grandchildren. This kind of result does not happen if the medical care is inferior or access to it is limited.

The second question is, who is happier with their medical care? Ask Canadians if they would like to trade their socialized system for the American system. No way. For whatever imperfections it may have, Canadians would still prefer the kind of universal access and coverage that they enjoy. There is one group of Canadians, I should say, that has shown that it prefers the American system, namely, physicians who are more interested in making money than in serving the public. American doctors make a whole lot more money than Canadian doctors, so any Canadian physician who has that as a top priority has already come down here. That's their right, of course, but it's one of the reasons that American medical care is so much more expensive than Canadian medical care—that and higher prescription drug prices, higher health insurance premiums, higher malpractice insurance claims and, consequently, malpractice premiums—the list goes on.

But don't talk to me about inferior medical care in Canada. It's low reputation here is based solely on scare-mongering, knee-jerk anti-socialism, and just plain ignorance. A lot of people make a heck of a lot of money in the health care industry in this country, and would hate to see the system change, no matter how much it would benefit Americans to change it. And they can afford to spend a lot of money on advertising and lobbying to keep things just they way they are, thank you very much.

Liberal is not a dirty word. I blame Michael Dukakis for making it seem so. In 1988, George Bush, Sr. used the word liberal as an insult, telling the world that Dukakis fit that description and that it was a really bad thing. And Dukakis ran from it, damn him, effectively endorsing Bush, Sr.'s negative definition. And Democrats have been running from the label ever since. If you are a liberal, you are dead meat in an American election. It's time for that to change, I think.

Let's begin with a look at the term itself. The Oxford Reference Online gives the following definitions of "liberal":

• Respectful and accepting of behavior or opinions different from one's own. (of a society, law, etc.) favorable to individual rights and freedoms.

• Willing to respect or accept behavior or opinions different from one's own; open to new ideas: liberal views towards divorce.

• Favorable to or respectful of individual rights and freedoms: liberal citizenship laws given freely; ample; abundant.

• The values of a liberal society tolerant, unprejudiced, unbigoted, broad-minded, open-minded, enlightened.

I ask you, what is not to like about any of that? Respectful, tolerant, open to new ideas, favoring individual rights and freedoms, unprejudiced, unbigoted, etc. If you are not a liberal, does that make you disrespectful, intolerant, against individual rights, prejudiced, and bigoted? It would seem to. By definition. Oxford is an English publication, however, so let's see what an American dictionary has to say. This is from the American Heritage Dictionary Online (2000):

• Not limited to or by established, traditional, orthodox, or authoritarian attitudes, views, or dogmas; free from bigotry.

• Favoring proposals for reform, open to new ideas for progress, and tolerant of the ideas and behavior of others; broad-minded.

• Tending to give freely; generous: a liberal benefactor.

OK, I think I see the problem: although the general definition in both English and American dictionaries is full of things all Americans hold dear, like freedom of thought and freedom of action, the "give freely" part and the "benefactor" part smack of social programs and government give-aways. That's the part that rankles self-described conservatives. They don't want to be paying their taxes only to have the government give the money away to undeserving layabouts. Never mind that they themselves are the beneficiaries of government programs, like national security and defense, regulation for the safety of food and medications, oversight and maintenance of transportation—I could go on. It's the laying out of cash to people who don't have to work for it that makes conservatives mad.

A few days before I wrote this, a takeover was announced in the telecom industry, where SBC, the â"baby Bell" from San Antonio, was taking over the former "mother ship," AT&T. Business usually sees such mergers as good things, but about a day after the announcement, we heard that it would mean the loss of 12,000 jobs. Those people were not bad workers, but a merged company simply didn't need the redundancy of the work they were doing. So, it's great for the company: a leaner work force, consolidated administration, lower labor costs, higher profits, happier share-holders, bigger bonuses for the executives. Ooh, it gives me shivers just to think about it.

 It's all legal, of course, unless the government decides that a merged entity consolidates too much of a single industry under one management, leaving that company able to set prices and gouge consumers without competition. But the 12,000 downsized workers go on the unemployment rolls, and become those non-working layabouts who are receiving cash from the government. You think they want to be there? You think the government should just let them fend for themselves? I'm betting there are some conservatives among the 12,000: stands to reason, since half the country voted to re-elect George W. Bush. I wonder how those conservatives feel about government safety net social programs now.

This is what being a liberal is all about. It's about recognizing that some people, through no fault of their own, simply need help to get—or get back—on their feet. Some come from disadvantaged backgrounds; some are simply the victims of circumstance. But a liberal society cares for those people and tries to help them become contributing members. If they can get education, training, re-education, jobs, then they can begin to pay taxes and help those still stuck in poverty or unexpectedly "cut loose" from a job they were doing well.

Being a liberal also means respecting other people and their opinions, being willing to consider other points of view, and being open to new ideas for solving problems. There is nothing insulting about those things either. One would hope that everyone in Congress was a liberal in that sense but, sadly, it doesn't seem to be the case anymore. What's their excuse, I wonder? That they are so sure they're right, they don't have to listen to anyone else? That their constituents don't want to pay taxes, so they don't want anymore giveaways? That they have a "mandate" with 51% of the vote (by 55% of the electorate, making a whopping 28% of the country behind them)? There are no excuses. They should all aspire to be liberal.

Recently, George W. Bush gave the first State-of-the-Union address of his second term. Like his Inaugural address, it was full of "spreading freedom and democracy around the world." Freedom, he says, is the essence of America. It's what the terrorists hate about us. "They hate our freedom," he says. Well, the word liberal comes from the Latin word, liberalis meaning "pertaining to a free man," and the root of liberalis is liber, meaning "free." If George Bush and other conservatives consider freedom to be the essence of America, they sure as hell ought to start rehabilitating liberal as an acceptable word in American political discourse. Liberalism, by definition, is the essence of a free society.

Who gains? That's the question that needs to be asked again and again, and too frequently is not asked at all. In the case of election campaign finance reform, it has an easy answer.

Politics has become something only for the rich. Oh sure, there may be one or two principled but impoverished citizens serving in government at the national level, but most of the people there have plenty of money, are receiving plenty of money through sweetheart investments, and have the ability to raise lots and lots of money for re-election. And boy, do they need it! Over the last few years, the cost of getting elected—or re-elected—has gone through the roof. Federal House candidates are spending $20 million or more, Senate campaigners are spending many times that, and Presidential election coffers need $200 million just to get out of the gate.

Campaign finance reformers are concentrating on where that money comes from. Who pays? Will there be a quid pro quo? Will those that foot the bill expect something in return? Probably. Don't we deserve to know who is footing the bill so we can check to see that there is no quid pro quo? or at least, that the quid pro quo is a general patronage repayment, and not a cash transaction or an illegal contract? The answer is yes, and I hope that something is done to ensure that groups and individuals don't buy undue influence with their money. Keeping the lid on contributions is part of it. But how is that going to reduce the cost of campaigning? Why do elections cost so much anyway?

 The answer is television. When campaigns say they need this much money, it's because television networks and local stations make them buy airtime for broadcast advertising. That seems only fair. The networks and stations own the rights to what goes on their airwaves and they can simply charge what the market will bear. That is the essence of capitalism. So when election season comes, the rates go sky-high because there is a lot of demand. The more candidates advertise, the more their opponents feel the pressure to put their message before the public, and the more it costs. The more bitter the campaign, the more ads, the more competition for slots, the more money television is able to charge.

When people complain about the cost of elections, then, what are they saying? That campaign literature costs so much more these days? That really good campaign promises don't grow on trees? No, they're saying that television is charging more and more because it can. Who gets all the money that politicians spend? What happens to the $20 million, $50 million, $200 million and more? It doesn't just disappear—it goes into the pockets of the networks and the local stations. Who, then, has the most to gain from keeping the system the way it is?

How can this be fixed? One way, I believe, is for candidates to be responsible for bearing much more of their own message to the public. Debates require the candidates to articulate their own ideas, defend their policies, challenge their opponents in person, and be seen and heard by the electorate. I think there should be a lot more debates. A LOT more. And television stations and networks should be required to carry them without cost, as partial payment for the broadcast rights granted them by the government (AKA, the people), and for the revenues they receive during election season anyway. If this means that there is less advertising because candidates are getting their message across through debates, then that's OK. With me, anyway. I'm not so sure about the networks and local stations. But I'm sure they'll be right up there, reporting on this as a possible way of reducing the cost of elections.

This idea struck me as I was listening to a debate between Senator (and former Governor) George Voinovich (R) of Ohio and Democratic challenger Eric Fingerhut, during the campaign of 2004. Fingerhut was all over Voinovich. He was far more in command of the facts, far more articulate of his vision, far more able to answer the questions that were posed. All Voinovich could do was to say plaintively that he felt he deserved another six years because he had worked hard for the state of Ohio. And he didn't even say that with too much conviction. He sounded tired. And bored. But, ironically, not very worried. He knew—we all knew—that it was no contest. Voinovich had so much more campaign money than Fingerhut, that there was no hope of a close election, much less a defeat of the incumbent. Fingerhut had scored a knockout, and it might have had an effect on the election for the US Senate in the state of Ohio if it had been broadcast on primetime television, rather than on public radio around midnight, which is when I heard it. Instead, on primetime television, the people of Ohio got slickly produced, feel-good ads about Voinovich and how he cared for the people of Ohio. They got to see them a lot. And the networks and the local stations made a lot of money. But I doubt very much whether the people of Ohio were well served by the result.

 Maybe if we make debates a required part of election campaigns, we will see a lot more principled but impoverished people representing the people of America. Maybe their representatives will be a lot more representative of the demographic they represent (gosh, there's that word again!). But don't hold your breath. Incumbents don't want to put themselves in such a vulnerable position, where ignorance—or just being outclassed, or making some verbal gaffe—might lead to defeat at the polls. Much better to use the campaign chest to discredit the opponent. So don't expect encumbent politicians to embrace debates as a way to reform campaigns. And don't expect television networks and local stations to complain about their failure to act.

 It's cosy arrangement, and likely to last until the American electorate feels disenfranchised. I think that will happen one day, but I'm not sure when.

I first came to this country as a graduate student and got to enjoy the benefits of an education at an outstanding American university. Everything seemed great. But when I got a job and a family, I started paying attention to elementary and secondary education for the first time, and I couldn't believe how the public education system worked in Ohio. Maybe it's that way everywhere in the US.

Every single municipality (including incorporated suburbs) has its own school board. Of course, it has its own mayor, city council, police department, and fire department, too. (This unbelievable bureaucratic redundancy is something I should save for a later comment.) The US Constitution stipulates that education is a state responsibility. So individual states have the right to determine the curriculum to be pursued by students in that state—so long as the curriculum is acceptable according the US Constitution, of course. Those state mandates for curriculum are then passed down to the individual school boards, who determine how much it's going to cost to implement the state curriculum, then ask their city councils for sufficient funds to do so. The funds for education come from taxes on property, so if you have expensive homes in your neighborhood, or if you have some wealthy corporation operating in your municipality, then your district is likely to have plenty of money. But if more money is needed than has been budgeted, then municipalities must ask the citizenry if they are willing to increase their property taxes enough that there will be sufficient funds to implement the state curriculum.

Often, the answer is no. Incredibly, the answer is no. People who no longer have children in school, or who think they pay too much tax anyway, or have no more money to spare, or think they are not getting enough for the taxes they are already paying, vote no, and the levy, as it's called, is defeated, and the school board has to get by without the money. What this means is that municipalities that manage their money well, and have citizens that support their schools, have really, really good school systems. And the others have really bad systems. Not necessarily bad teachers or administrators, but bad systems because they don't have enough money to buy everything they need, or to pay competitive wages for the best teachers, or to maintain their facilities, or to implement the state curriculum.

It's incredible! Education is a state responsibility, and the state board sets the curriculum, but the individual municipalities get to decide if they want to pay enough money to fund it. If they don't, the state curriculum means nothing. How is this fair? How is this "state control of education"?

I grew up in Canada, where education is a provincial responsibility. Provinces are like states, of course, and they set the curriculum. But they also control the funding for public education. And the taxes that are used for education come from taxation at the provincial level. So there is no disparity between districts based on property values or the inclination or disinclination of the voters to pay for the latest educational needs.

Gosh, that seems democratic to me.

In Ohio, the Supreme Court has told the state it must reform the education funding system because it's unfair. It's said this several times, but still, nothing has been done. It's worth asking why.

Americans are so fixated on low taxes that they've completely lost sight of the reason for taxes in the first place. Taxes are to enable the government to provide services. It's not how much you pay, but what you get that should be the issue. Taxes are not bad in and of themselves—though try telling that to any candidate trying to get elected in America! There just needs to be some equitable formula for collecting the taxes necessary to run the education system in the state of Ohio. It isn't being done now in spite of court orders to do it. Somebody at the state level has to be held legally accountable.

 When our oldest child became old enough to go to kindergarten, my wife and I had a choice: we could send him to private school (of which there are several excellent ones in our area), or we could move to a municipality that has a good public education system. For family reasons, or for economic reasons, not everyone has that choice. They are stuck where they are with the public education system they've got. But private schools and moving shouldn't be necessary. The Constitution put education in the hands of the states. States have the right to set curriculum, but they also have the responsibility to see that every child has an equal opportunity to pursue that course of study. Right now, that isn't true in Ohio, and probably in lots of other states as well.

The bottom line is that people in Ohio, in general, are not well educated. How can this be allowed to continue? Who benefits from the status quo? Why has the government of Ohio not lived up to its legal and moral responsibility to improve public education? I believe the answer is because the Republicans, who have dominated state politics in Ohio for decades, are flourishing under the current system and don't want to see it change. How can that be? How can an under-educated electorate serve one party or another?

Every election, I watch the Republicans run ads to convince people to vote against their own economic best interests. They do it in a number of ways: by wrapping themselves in the flag, by scaring people, by smearing good candidates on the other side, and by preaching blindly against taxes and the opposing candidate who, for sure, will "raise your taxes" or has already done so "422 times." If people are not educated enough to see the flaws in these arguments, then they can more easily be persuaded to the point of view of the advertising, even if they would personally benefit so much more from the policies of the other side. A less educated electorate is a more easily swayed electorate. You can't buy elections, but you can buy advertising, and create a system where that sort of advertising works best.

That's why I think the Republicans in Columbus continue to do nothing about public education in this state. And if they disagree with me, then why don't Ohio State Representatives, Ohio State Senators, and the Ohio Governor get off their duffs and do something! The Ohio Supreme Court has been telling them to do it for years. They are contemptibly in contempt, and they've obviously decided it's in their best interests to do nothing. But as George W. Bush once said, "Fool me once, shame on you"—Or something like that.