The deepest undercurrent of the election is assuredly the War in Iraq and its global consequences. These include those who have been killed, wounded, or displaced as a result of hostilities; the international political estrangement of the United States; the impact of its domestic economic costs; but most of all what the war suggests about the American sense of morality.

As the 2008 presidential campaign has evolved over the past few months certain issues have come to the fore: the economy, the environment, health care, and the War in Iraq. Their import seems not to be dictated by the candidates themselves but rather by the media pundits analyzing them.

The basic question of the 2008 election is “What Kind of Country are We?” Are we a country that accepts huge economic and social differences between rich and poor? Are we comfortable as one of the wealthiest and technologically developed countries with a dysfunctional health care system? Can we ignore pressing environmental problems?

Finally, how can we ignore the impact of the present on the future?

The impact of our cavalier bravado and paranoia will be felt by future generations. We ignore our immoral behavior at their peril and ours.

The results of the Democratic primaries and caucuses on Super Tuesday have raised an interesting conundrum for Hillary Clinton and Barack Obama during the six months before the National Convention.

They will likely be confronted with John McCain as the republican presidential candidate and thus it would behoove each of them to figure out how to balance their concerns about each other with their concerns about the Republican candidate. Castigating each other will ultimately be self-destructive and petty; the politics of personality get rapidly tedious.

Instead Both Obama and Clinton should focus both on the policies of the Bush administration and the potential Republican candidate hoping to replace it. Their personalities and differences will evolve as they make their ideological and practical arguments about how either of them will turn the country around with a forward looking Democratic administration.

I was incredulous that a Republican would actually try to give credibility to Palin's foreign policy experience by saying she was the governor of Alaska, the state most proximate to Russia. Such arguments are both insulting and stupid and an example, once again, of the proximity of the McCain campaign to the Bush administration.

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The recent flailing about the torture policies of the Bush Administration by former Vice-President George Cheney has been

overwhelming, disconcerting, and downright odd.

The former taciturn minion of an administration that left the Obama presidency with a number of confounding issues has been all over the media. He has been speaking in his self-righteous and smarmy tone about how he (and of course the rest of his cronies) kept the country safe for eight years as a result of their infernal policies.

Trying to understand Cheney’s motivation for going public is like trying to solve the riddle of the Sphinx. There are some clues from his quizzical past behavior.

In January of 2005 he attended the 60th Anniversary of the liberation of Auschwitz. Surrounded by world leaders dressed appropriately in black over-coats. Cheney, in contrast, was dressed, according to the Washington Post “in attire one typically wears to operate a snow blower”, an olive drab parka with a fur-trimmed hood, hiking boots, and ski cap.

More recently he attended the Inauguration in a wheel chair: The ostensible reason being that he had strained his back lifting boxes.

Perhaps he did not want to have to stand for Obama’s inauguration.

This is admittedly a cynical perspective righteously engendered by Cheney’s sardonic view of the world.

The health care morass is multifactorial and thus it is unlikely that all of its problems can be easily addressed at once. Providing a government alternative to private insurance will be one step and despite the AMA's antipathy to the notion would provide a necessary challenge to the monopoly of the health insurance industry.

But the system is broken and deeply problematic. Access is an issue: as a pediatrician I spend a significant portion of each day facilitating entree to some part of the system (e.g. a specialist's office or an MRI). If left on their own they would like have a difficult time getting past the front desk.

The problems with hospital care are legion. I always tell patients and friends to "make sure they ask the extra question." Both the patient and his family need to be vigilant for what happens in the hospital.

For most of my medical career I have had some antipathy to my chosen profession because the economic and political forces that determine its direction are neither patient nor primary care provider friendly. Now is the time to grapple once and for all with our dysfunctional health care system. Perhaps this needs to happen piece by piece, but we must make a dramatic beginning.