I have been devoting my energies to writing about the ongoing health care debate and will continue to do so hereafter, but we are faced with a situation that so fundamentally changes the character of our Democracy, that I must digress to alert my readers.
As early as the 19th century Mark Twain said, “We have the best government that money can buy.”
This was dramatically illustrated when in 1896 the champion of the masses, of the debtor classes, William Jennings Bryan, ran against the champion of the entrenched business interests, corporations, and the banking industry, William McKinley. McKinley, who outspent Bryan by an estimated 10 to 1, won handily, proving Hanna’s famous dictum: “There are two things that are important in politics. The first is money, and I can’t remember what the second one is.” By 1904 the popular outcry was so great that the then losing Democratic candidate declared, “The greatest moral question which now confronts us is shall the trusts and corporations be prevented from contributing money to control or aid in controlling elections?” In 1907, Congress passed the Tillman Act, the first federal law barring corporate campaign contributions. States adopted similar laws. Since then, Congress has repeatedly ratified the federal ban. In 1925, it folded the Tillman Act into the Federal Corrupt Practices Act. In 1947, it made clear that the ban included not just corporate contributions, but corporate expenditures on campaigns — and that it also applied to labor unions. In the 2002 McCain-Feingold law, Congress once again underscored that corporations cannot contribute to campaigns. See here.
Thus this principle has stood the test of time, having been affirmed by the people’s elected representatives in Congress time and time again and by the Supreme Court as well.
But now with a court dominated by these same interests, it appears that they are getting ready to strike down these essential restrictions and open the floodgates to the domination of the political process by the billions upon billions contained in corporate treasuries.
The Los Angeles Times summarized potential result when they wrote: “If the justices were to issue such a ruling in the next few months, it could reshape American politics, beginning with the congressional campaign in 2010…
“For example, the health insurance industry would have a much greater ability to target for defeat lawmakers who supported a so-called public option for medical insurance. Banks and investment firms could oppose representatives who favored stricter regulation of the financial industry…And far more money could flow into elections. Last year, the political parties spent about $1.5 billion on campaigns, while corporations earned more than $600 billion in profits.” See here.
Justice Scalia and his brethren on the Right by their questions during argument suggested that in their view corporations are no different from individuals or association of individuals and are entitled to the same rights, but for one who claims to be an “originalist” he ignores that the constitution gives no such rights to “artificial persons” and that Jefferson in 1816 even expressed the hope to, “crush in its birth the aristocracy of our moneyed corporations, which dare already to challenge our government to a trial of strength and bid defiance to the laws of our country.” See here.
To suggest that corporations are no different from associations of individuals they would not have the many rights that are unique to them, such as limited liability or as the Solicitor General put it, “Corporations are artificial persons endowed by the government with significant special advantages that no natural person possesses,’’ or as the Boston Globe wrote, “publicly traded business corporation, driven to maximize profits by market competition and its own charter, can’t rise above that mission any more than it can dance nude. Corporations aren’t “voluntary associations’’ with republican intentions, as Justice Antonin Scalia claims; in a civic sense, they’re mindless, because their shareholders change with every stock-price fluctuation.” See here.
But last, but not least, corporations don’t even represent the views of their stockholders. As I wrote on my blog in another context, “Unfortunately, it is not shareholders who decide on compensation. It is the Board of Directors! And who chooses the Board of Directors? Usually the CEOs. To be sure Shareholders get a chance to vote at shareholder meetings for the Board, and whatever issues are placed before them, but the only choices they really have is to vote yes or no on whatever the management chooses to let them vote on. And increasingly, shareholder meetings are held at out of the way places so as to discourage shareholders from attending. God forbid, they might ask embarrassing questions. They are asked to send in their proxies to confirm what has already been decided. The Chinese communist voting system is not much different.” See here. Thus Corporate CEOs, a small select group would have the power to spend untold billions to further whatever their political predilections may be.
A few years ago in a dissenting opinion, Justice Antonin Scalia sought to counter concerns by reform advocates about the potential corrupting influence of money in politics. Justice Scalia alluded to the signers of the Declaration of Independence as pledging their "fortunes" as well as their "sacred honor."
The solicitor General commenting on this put it very well when she said, "John Hancock pledged his own fortune, …When the CEO of John Hancock Financial uses corporate-treasury funds for electoral advertising, he pledges someone else's."
The impending decision of the Supreme Court may well be the most important event of a century. It could well end Democracy in the US as we know it. Instead of “power to the people” we may have “power to a few oligarchs.”
Tuesday, September 29, 2009
Tuesday, September 22, 2009
Republican Talking Points on Health Care
In my series of posts on this blog, I have dealt with the crucial need for reform of our health care system, and have decried the inexcusable outright lies and libels deployed against the reform attempts.
While Republicans, their allies, and cohorts have brought all their energy into the attempt to block all meaningful change, they have on occasion pretended that they do want reform, but an examination of their “positive” proposals shows them to be sham.
Thus Senator McCain in addressing his Town Hall Meetings always begins with an attack on the Public Option, which as most of us know is a government sponsored insurance plan, like so many other government insurance plans such as Medicare, which are run much more efficiently than private insurance plans, but which unlike Medicare, which is a single payer plan, would be but one among many plans, and would compete on an equal footing with private plans. But McCain does not discuss the merits or demerits of the public option, he hold forth with “the Public option is the “government option” using a sound in his voice clearly intended to make it sound sinister. That is not discussion – that is not debate – that is in keeping with the attack line of innuendo and distortion.
But then McCain goes on to talk about “his plan” and I think it is necessary to examine what it is that purports to be “his plan.”
He starts by having a large poster on an easel that supposedly summarizes it as follows:
1.) Focus on what we can afford-don’t burden the future. 2.) Insurance Reform to improve access. 3.) Reform Medical Malpractice 4.) Tax Reforms/incentives to purchase insurance ($5,000 advanced, refundable tax credit) 5.) Increase freedom and real competition to choose the best plan in any state. 6.) Risk pools for those with difficult conditions. 7.) Address long term cost reductions 8.) Incentives for Wellness and fitness.
1.) I have listened again and again to McCain perorations and I have never heard him set forth what he thinks we can afford. What McCain forgets to tell us is that the one thing we cannot afford is the status quo.
2.) Insurance Reform – Again it is hard to fathom what this means to McCain. He apparently does not want to force insurance companies to stop discriminating against those with pre-conditions, or against women, or to have lifetime limits, or to drop people when they are become sick. It is only clear what he does not want. What he is for is a mystery.
3.) Reform Medical Malpractice. This is the only area where he is clear but he does not want to focus on preventing malpractice, which is rife in our medical system. Nor does he want to set up procedures to more effectively weed out non-meritorious claims. What he wants is to put limits on how much injured people can recover so that only those who have large incomes could recover significant amounts. What he want is to limit recoveries to economic damages, i.e. if someone who earned millions was injured and could not work for a year they could recover millions, but someone who earned $30,000 a year could recover only $30,000. He would disallow all non-economic damages. Thus if medical malpractice caused an unemployed person to lose his eyesight, or lose a leg, or become paralyzed, they could recover zilch. That is what is meant by Medical mal-practice reform.
4.) As for incentives to purchase insurance it is hard to understand how this would cover the uninsured. It would give a $2,500 tax credit to every person in the US ($5,000 per family) toward buying health insurance. The rich, who don’t need it, would get it. The poor, and indeed the middle class who still could not afford insurance with the $2,500 subsidy toward a $5,000 or $6,000 premium would get nothing and would continue without insurance. How this would move toward universal coverage is hard it envision but it would be another windfall for those who don’t need it.
5.) Increase freedom and real competition to choose the best plan in any state.” What does that mean. Well during the campaign he expressed it this way: “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products, less burdened by the worst excesses of state-based regulation.” McCain would actually bring the banking debacle to our health insurance system. Instead of regulating them – he would free them from regulation. He would make a bad situation worse. Has he learned nothing at all? But there is a reason why insurance companies can’t operate across state lines and it is explained in a post found here. It prevents a race to the bottom. It does not create better choice.
6.) And how would he deal with people who are sick and who now can’t get or can’t afford insurance. He would create “Risk pools.” In other words take all the ones who need health care and put them all in the same insurance pool where the cost of their insurance, rather than being spread over a diverse risk population, would contain only those with existing health problems. Can anybody imagination what the cost of such insurance would be. Only the very wealthy could afford it. People like McCain. This is reform?
7.) Address long term cost reductions. How would he do that? He opposes all attempts to rationalize health care so that only effective treatment would be reimbursed.
8.) And finally incentives for Wellness and fitness. How would he do this? Again he opposes all attempts to get people to lead healthier lives, such as a tax on high calorie beverages, which would go along way to reduce obesity and improve health outcomes,
But there is no substance to anything on the positive side of McCain or the other naysayers. All they really have in their bag of tricks is “NO” and lies intended to sow fear.
Why does the viciousness and deception never stop?
While Republicans, their allies, and cohorts have brought all their energy into the attempt to block all meaningful change, they have on occasion pretended that they do want reform, but an examination of their “positive” proposals shows them to be sham.
Thus Senator McCain in addressing his Town Hall Meetings always begins with an attack on the Public Option, which as most of us know is a government sponsored insurance plan, like so many other government insurance plans such as Medicare, which are run much more efficiently than private insurance plans, but which unlike Medicare, which is a single payer plan, would be but one among many plans, and would compete on an equal footing with private plans. But McCain does not discuss the merits or demerits of the public option, he hold forth with “the Public option is the “government option” using a sound in his voice clearly intended to make it sound sinister. That is not discussion – that is not debate – that is in keeping with the attack line of innuendo and distortion.
But then McCain goes on to talk about “his plan” and I think it is necessary to examine what it is that purports to be “his plan.”
He starts by having a large poster on an easel that supposedly summarizes it as follows:
1.) Focus on what we can afford-don’t burden the future. 2.) Insurance Reform to improve access. 3.) Reform Medical Malpractice 4.) Tax Reforms/incentives to purchase insurance ($5,000 advanced, refundable tax credit) 5.) Increase freedom and real competition to choose the best plan in any state. 6.) Risk pools for those with difficult conditions. 7.) Address long term cost reductions 8.) Incentives for Wellness and fitness.
1.) I have listened again and again to McCain perorations and I have never heard him set forth what he thinks we can afford. What McCain forgets to tell us is that the one thing we cannot afford is the status quo.
2.) Insurance Reform – Again it is hard to fathom what this means to McCain. He apparently does not want to force insurance companies to stop discriminating against those with pre-conditions, or against women, or to have lifetime limits, or to drop people when they are become sick. It is only clear what he does not want. What he is for is a mystery.
3.) Reform Medical Malpractice. This is the only area where he is clear but he does not want to focus on preventing malpractice, which is rife in our medical system. Nor does he want to set up procedures to more effectively weed out non-meritorious claims. What he wants is to put limits on how much injured people can recover so that only those who have large incomes could recover significant amounts. What he want is to limit recoveries to economic damages, i.e. if someone who earned millions was injured and could not work for a year they could recover millions, but someone who earned $30,000 a year could recover only $30,000. He would disallow all non-economic damages. Thus if medical malpractice caused an unemployed person to lose his eyesight, or lose a leg, or become paralyzed, they could recover zilch. That is what is meant by Medical mal-practice reform.
4.) As for incentives to purchase insurance it is hard to understand how this would cover the uninsured. It would give a $2,500 tax credit to every person in the US ($5,000 per family) toward buying health insurance. The rich, who don’t need it, would get it. The poor, and indeed the middle class who still could not afford insurance with the $2,500 subsidy toward a $5,000 or $6,000 premium would get nothing and would continue without insurance. How this would move toward universal coverage is hard it envision but it would be another windfall for those who don’t need it.
5.) Increase freedom and real competition to choose the best plan in any state.” What does that mean. Well during the campaign he expressed it this way: “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products, less burdened by the worst excesses of state-based regulation.” McCain would actually bring the banking debacle to our health insurance system. Instead of regulating them – he would free them from regulation. He would make a bad situation worse. Has he learned nothing at all? But there is a reason why insurance companies can’t operate across state lines and it is explained in a post found here. It prevents a race to the bottom. It does not create better choice.
6.) And how would he deal with people who are sick and who now can’t get or can’t afford insurance. He would create “Risk pools.” In other words take all the ones who need health care and put them all in the same insurance pool where the cost of their insurance, rather than being spread over a diverse risk population, would contain only those with existing health problems. Can anybody imagination what the cost of such insurance would be. Only the very wealthy could afford it. People like McCain. This is reform?
7.) Address long term cost reductions. How would he do that? He opposes all attempts to rationalize health care so that only effective treatment would be reimbursed.
8.) And finally incentives for Wellness and fitness. How would he do this? Again he opposes all attempts to get people to lead healthier lives, such as a tax on high calorie beverages, which would go along way to reduce obesity and improve health outcomes,
But there is no substance to anything on the positive side of McCain or the other naysayers. All they really have in their bag of tricks is “NO” and lies intended to sow fear.
Why does the viciousness and deception never stop?
Monday, September 14, 2009
Health Care Reform – Facts and Fiction
In a series of commentaries I have set forth the misconceptions, the distortions and the outright lies to which the American Public has been subjected.
It is difficult to understand why this is being done. There are some business groups that have a stake in the status quo and I can understand their struggle to protect their profits and increase them, even if it is at the expense of the Nation's needs.
The Republican Party stands opposed, as they oppose all Democratic initiatives, because they see obstruction and denunciation as the means to further their own political fortunes. These positions are unpatriotic for even a “loyal opposition” should put the Nation’s needs ahead of their parochial ambitions.
It is harder to understand the rank and file Republicans who write columns and who write Letters to the Editor distorting the facts, for they have no “horse in the race.” They remind me of the Communists of the ‘30s and even the ’40s who followed the party line no matter where it led them.
In my posting entitled “Health Insurance Reform” posted on August 11, 2009, I set forth unassailable facts and figures to show that we do not have the “best medical care in the world.” In fact dollar for dollar we have one of the worst.
In my commentary, “Health Insurance Reform - Lies and Damned Lies” posted on 8/19/09, I called attention to some of the lies being circulated and the viscous attacks being orchestrated against reform, running the gamut from unfounded claims of “death panels”, the use of swastikas and the word “Nazi”. I waited for some Republicans out of some sort of decency, some sort of honesty, some sort of responsibility to denounce these lies but instead found them using weasel words to defend them, and sadly this included that “maverick” John McCain. I looked for Republican columnists and Letter to the Editor writers to distance themselves from the worst of these outrages, but their loyalty apparently is to their party and not their country.
In my posting, “Health Reform - Reality” posted on August 25, 2009, I quoted at length from a major brokerage house that pointed out that if nothing is done about reforming our present system, we face economic disaster.
Among the commentaries to Health Reform Realities there are three particularly worth reading. Tanya Keith and her husband, professionals, and middle class earners who had insurance set forth the disasters that befell them because of our crazy quilt system.
Nicole Scheller, a recent mother, in another comment to Health Reform Realities related her horrific experiences with trying to gain coverage from her insurance company after she had her baby. No facts, no personal disasters, move these opponents. They keep inventing dangers from reform that must emanate from their own nightmares, or from the Right wing nut factory, for they have no basis in reality.
Roger Berkley is a small business man but with a business much larger than Tanya’s. He employs about 200 people. He tells at length what is happening to him under the present system. His is in the form of a podcast and I particularly commend the antepenultimate message entitled: Healthcare: The Great American Boondoggle, though the two following are also worth listening to.
One widely circulated e-mail about that the Democratic bill, claims that it “would cede vast powers to a “Health Choices Commissioner”. Where do they get such nonsense? I investigated these claims on the web. It appears that this one is just another one of the endless e-mails on all kinds of subjects that are circulated, and I have received many, that are out and out lies, but which naïve people are impressed with, and they hit the forward button. Snopes.com is a web site that specializes in exposing such e-mails. I suggest to the reader that they go here for the top 25. If nothing else it will be good for a laugh. But what about the “Health Choices Commissioner”? This one is dealt with at length by PolitiFact.com that won the Pulitzer Prize in 2009, and they point out that this lie originated in what may be the “longest chain e-mail ever received” filled completely with falsehoods about the bill pending in Congress.
The only part of this e-mail that is true is that the bill provides for the creation of a Health Choices Commissioner. This is part of the Health insurance exchange that is to be set up to create a market place for insurance shoppers. The bill says that a Health Choices Commissioner will run the exchange, and that he or she will make sure that insurers are offering basic benefits and adhering to the regulations. Individuals then choose their own plan from offerings on the exchange. To the extent that insurance plans have to meet basic requirements, those instructions are ultimately coming from Congress. See here for a discussion of this, and for those who want to really know what is and what is not in the bill.
But as usual the liars are ahead of the game. The truth has to always play catch-up, and for many people the truth never catches up with the fears engendered.
I have been wanting to discuss the merits and demerits of the few suggestions that have been offered by Republicans, but so much space has to be devoted to rebutting lies, that there is little left for an honest discussion.
Is a public option desirable? What are the true pros and cons? But even beyond this, if this is the Republican main concern, as it appears to be, let them say, “if you take this off the table we will join you in reform.” But if no concessions will bring them on board, then action must proceed without them, or with such few as allow patriotism to trump partisanship.
If medical malpractice reform is the hang-up, Obama has already met them more than halfway. But except for space limitations, I could show this to be a red herring. What we need to do away with is malpractice, not the right to recover for those injured. This is not a right of lawyers, though to be sure they benefit; it is a right of the injured. If a surgeon amputates the wrong leg am I to be denied an adequate remedy?
Are we all agreed that people with medical pre-conditions should not be discriminated against? If not, let’s debate that.
But stop the lies! Stop the smears! Stop the innuendo!
Debate is good. But opponents of reform don’t want to debate, they don’t want to discuss, they don’t want to compromise. They want delay till hell freezes over. They want the status quo, and the status quo is not sustainable. The status quo spells disaster for the country.
Finally, I commend to the reader the article by Hendrick Herzberg in the curreent issue of the New Yorker.
It is difficult to understand why this is being done. There are some business groups that have a stake in the status quo and I can understand their struggle to protect their profits and increase them, even if it is at the expense of the Nation's needs.
The Republican Party stands opposed, as they oppose all Democratic initiatives, because they see obstruction and denunciation as the means to further their own political fortunes. These positions are unpatriotic for even a “loyal opposition” should put the Nation’s needs ahead of their parochial ambitions.
It is harder to understand the rank and file Republicans who write columns and who write Letters to the Editor distorting the facts, for they have no “horse in the race.” They remind me of the Communists of the ‘30s and even the ’40s who followed the party line no matter where it led them.
In my posting entitled “Health Insurance Reform” posted on August 11, 2009, I set forth unassailable facts and figures to show that we do not have the “best medical care in the world.” In fact dollar for dollar we have one of the worst.
In my commentary, “Health Insurance Reform - Lies and Damned Lies” posted on 8/19/09, I called attention to some of the lies being circulated and the viscous attacks being orchestrated against reform, running the gamut from unfounded claims of “death panels”, the use of swastikas and the word “Nazi”. I waited for some Republicans out of some sort of decency, some sort of honesty, some sort of responsibility to denounce these lies but instead found them using weasel words to defend them, and sadly this included that “maverick” John McCain. I looked for Republican columnists and Letter to the Editor writers to distance themselves from the worst of these outrages, but their loyalty apparently is to their party and not their country.
In my posting, “Health Reform - Reality” posted on August 25, 2009, I quoted at length from a major brokerage house that pointed out that if nothing is done about reforming our present system, we face economic disaster.
Among the commentaries to Health Reform Realities there are three particularly worth reading. Tanya Keith and her husband, professionals, and middle class earners who had insurance set forth the disasters that befell them because of our crazy quilt system.
Nicole Scheller, a recent mother, in another comment to Health Reform Realities related her horrific experiences with trying to gain coverage from her insurance company after she had her baby. No facts, no personal disasters, move these opponents. They keep inventing dangers from reform that must emanate from their own nightmares, or from the Right wing nut factory, for they have no basis in reality.
Roger Berkley is a small business man but with a business much larger than Tanya’s. He employs about 200 people. He tells at length what is happening to him under the present system. His is in the form of a podcast and I particularly commend the antepenultimate message entitled: Healthcare: The Great American Boondoggle, though the two following are also worth listening to.
One widely circulated e-mail about that the Democratic bill, claims that it “would cede vast powers to a “Health Choices Commissioner”. Where do they get such nonsense? I investigated these claims on the web. It appears that this one is just another one of the endless e-mails on all kinds of subjects that are circulated, and I have received many, that are out and out lies, but which naïve people are impressed with, and they hit the forward button. Snopes.com is a web site that specializes in exposing such e-mails. I suggest to the reader that they go here for the top 25. If nothing else it will be good for a laugh. But what about the “Health Choices Commissioner”? This one is dealt with at length by PolitiFact.com that won the Pulitzer Prize in 2009, and they point out that this lie originated in what may be the “longest chain e-mail ever received” filled completely with falsehoods about the bill pending in Congress.
The only part of this e-mail that is true is that the bill provides for the creation of a Health Choices Commissioner. This is part of the Health insurance exchange that is to be set up to create a market place for insurance shoppers. The bill says that a Health Choices Commissioner will run the exchange, and that he or she will make sure that insurers are offering basic benefits and adhering to the regulations. Individuals then choose their own plan from offerings on the exchange. To the extent that insurance plans have to meet basic requirements, those instructions are ultimately coming from Congress. See here for a discussion of this, and for those who want to really know what is and what is not in the bill.
But as usual the liars are ahead of the game. The truth has to always play catch-up, and for many people the truth never catches up with the fears engendered.
I have been wanting to discuss the merits and demerits of the few suggestions that have been offered by Republicans, but so much space has to be devoted to rebutting lies, that there is little left for an honest discussion.
Is a public option desirable? What are the true pros and cons? But even beyond this, if this is the Republican main concern, as it appears to be, let them say, “if you take this off the table we will join you in reform.” But if no concessions will bring them on board, then action must proceed without them, or with such few as allow patriotism to trump partisanship.
If medical malpractice reform is the hang-up, Obama has already met them more than halfway. But except for space limitations, I could show this to be a red herring. What we need to do away with is malpractice, not the right to recover for those injured. This is not a right of lawyers, though to be sure they benefit; it is a right of the injured. If a surgeon amputates the wrong leg am I to be denied an adequate remedy?
Are we all agreed that people with medical pre-conditions should not be discriminated against? If not, let’s debate that.
But stop the lies! Stop the smears! Stop the innuendo!
Debate is good. But opponents of reform don’t want to debate, they don’t want to discuss, they don’t want to compromise. They want delay till hell freezes over. They want the status quo, and the status quo is not sustainable. The status quo spells disaster for the country.
Finally, I commend to the reader the article by Hendrick Herzberg in the curreent issue of the New Yorker.
Tuesday, August 25, 2009
Health Reform - Reality
In my previous commentaries I talked about Health Insurance Reform because I saw the problem as being primarily one of insurance. Too many people are uninsured. Those who are insured often don’t get coverage when they most need it. The expense of insurance is astronomical and going up.
But as I study the problem in ever greater depth I have begun to realize that I have been looking at the tip of the iceberg. Insurance is only a part of the problem and I have concluded not the major one.
I have concluded that the cost of our medical delivery system is astronomically expensive and going up and while the inefficiencies of the private insurance companies are contributing to the problem they are not the primary cause. But the situation has been a problem since the time of Teddy Roosevelt and has now become nothing short of a crisis, which unless dealt with endangers the economy of the United States. If nothing is done health care is on a path where in a relatively short time it will bankrupt the country.
Let me repeat: If nothing is done health care is on a path where in a relatively short time it will bankrupt the country.
This is truly not a Republican or a Democratic problem it is in words of our President “an American problem.”
Fidelity Investments, a brokerage and Mutual Fund company, is not a political organization and certainly not a Democratic or a liberal one. Its mutual funds total $1.57 trillion in assets.
They write on their web site:
“The rising cost of health care in the United States represents a significant threat to the competitiveness of U.S. businesses and the fiscal sustainability of government finances.
“Reform that reduces the rate of health care inflation is critical to the long-term prospects for the U.S. economy.”
They go on to say:
“Health care expenditures have risen at more than twice the pace of overall inflation since 1970, …the United States spends far and away more money on health care …than any other country in the world. Health care spending makes up 15.3% of GDP compared to an average 8.8% for developed countries.
“…aggregate health statistics, such as life expectancy or infant mortality, are worse in the United States than other developed countries despite the extra expenditure. This is the essence of the problem: health care costs are rising more quickly than GDP, tax revenues, business sales, employee wages or any other measure of national, public, or private incomes. At this pace, health care will continue to consume an ever larger share of public and private sector resources. …it represents a large expense with inflation rates that are unsustainable.”
For Republicans to oppose change is irresponsible. To oppose reform by the use distortions and lies is inexcusable. To resort to comparisons to the Nazis or to euthanasia is despicable.
We probably should consider one of the systems that work, whether the British, the Canadian or the Swiss or any other as long as it controls costs. For an article that debunks some of the lies and myths about these systems see here.
For reasons that are incomprehensible to me, that is politically impossible.
An American single payer system like Medicare is the next best solution! A public option follows close behind. But, and this is directed at my liberal friends, reform of some kind is essential and the proposal, which seems to have support in the Senate, that if state co-ops or other programs failed to meet certain cost and coverage goals in five years, the president could create a public plan on a fast track without threat of a Senate filibuster has a lot to commend it as a compromise.
It is not sensible to adopt the Republican approach of “My way or the highway.” Reform may have to be piecemeal, but we cannot forgo a start because it falls short. Time is short and neither inaction nor delay is an option.
The insurance companies, who have been the most effective entity in blocking reform in the past, make good villains. But they are doing what all business entities do in our capitalist system. They will fight to protect their profits and a review of their profits shows them not to be outrageously profitable. What they are is outrageously inefficient. According to Locker Gnome, Aetna, United Health and Tenet have profit margins of 3.85%, 4.1%, and 2.63% respectively, compared to e.g. Microsoft at 24.93%, Exxon 8.98% and Apple at 14.97%. But their inefficiency is most likely due to the huge amount spent cherry picking healthy people, denying insurance and claims to people with pre-conditions, and finding other causes for not paying claims. If the Health Reform legislation forbids these practices we will not only get people who are now uninsurable, insured, and get insured people reimbursed for their expenses, but we will have taken a huge step forward toward a better system.
It doesn’t solve all the problems, but a half loaf is better than none, and we must guard against the perfect being the enemy of the good. Fighting for a public option is one thing, but making it the sin qua non of health reform, serves only to strengthen the hand of the enemies of all reform. Sometime it is better to win a battle and live to fight another day, than to gloriously go down to defeat, and lose the best opportunity for reform we shall see for a very long time. Right now liberal forces in sniping at the President are doing a disservice not only to Health Reform, but to all the other reforms that will follow once this battle is behind us.
But as I study the problem in ever greater depth I have begun to realize that I have been looking at the tip of the iceberg. Insurance is only a part of the problem and I have concluded not the major one.
I have concluded that the cost of our medical delivery system is astronomically expensive and going up and while the inefficiencies of the private insurance companies are contributing to the problem they are not the primary cause. But the situation has been a problem since the time of Teddy Roosevelt and has now become nothing short of a crisis, which unless dealt with endangers the economy of the United States. If nothing is done health care is on a path where in a relatively short time it will bankrupt the country.
Let me repeat: If nothing is done health care is on a path where in a relatively short time it will bankrupt the country.
This is truly not a Republican or a Democratic problem it is in words of our President “an American problem.”
Fidelity Investments, a brokerage and Mutual Fund company, is not a political organization and certainly not a Democratic or a liberal one. Its mutual funds total $1.57 trillion in assets.
They write on their web site:
“The rising cost of health care in the United States represents a significant threat to the competitiveness of U.S. businesses and the fiscal sustainability of government finances.
“Reform that reduces the rate of health care inflation is critical to the long-term prospects for the U.S. economy.”
They go on to say:
“Health care expenditures have risen at more than twice the pace of overall inflation since 1970, …the United States spends far and away more money on health care …than any other country in the world. Health care spending makes up 15.3% of GDP compared to an average 8.8% for developed countries.
“…aggregate health statistics, such as life expectancy or infant mortality, are worse in the United States than other developed countries despite the extra expenditure. This is the essence of the problem: health care costs are rising more quickly than GDP, tax revenues, business sales, employee wages or any other measure of national, public, or private incomes. At this pace, health care will continue to consume an ever larger share of public and private sector resources. …it represents a large expense with inflation rates that are unsustainable.”
For Republicans to oppose change is irresponsible. To oppose reform by the use distortions and lies is inexcusable. To resort to comparisons to the Nazis or to euthanasia is despicable.
We probably should consider one of the systems that work, whether the British, the Canadian or the Swiss or any other as long as it controls costs. For an article that debunks some of the lies and myths about these systems see here.
For reasons that are incomprehensible to me, that is politically impossible.
An American single payer system like Medicare is the next best solution! A public option follows close behind. But, and this is directed at my liberal friends, reform of some kind is essential and the proposal, which seems to have support in the Senate, that if state co-ops or other programs failed to meet certain cost and coverage goals in five years, the president could create a public plan on a fast track without threat of a Senate filibuster has a lot to commend it as a compromise.
It is not sensible to adopt the Republican approach of “My way or the highway.” Reform may have to be piecemeal, but we cannot forgo a start because it falls short. Time is short and neither inaction nor delay is an option.
The insurance companies, who have been the most effective entity in blocking reform in the past, make good villains. But they are doing what all business entities do in our capitalist system. They will fight to protect their profits and a review of their profits shows them not to be outrageously profitable. What they are is outrageously inefficient. According to Locker Gnome, Aetna, United Health and Tenet have profit margins of 3.85%, 4.1%, and 2.63% respectively, compared to e.g. Microsoft at 24.93%, Exxon 8.98% and Apple at 14.97%. But their inefficiency is most likely due to the huge amount spent cherry picking healthy people, denying insurance and claims to people with pre-conditions, and finding other causes for not paying claims. If the Health Reform legislation forbids these practices we will not only get people who are now uninsurable, insured, and get insured people reimbursed for their expenses, but we will have taken a huge step forward toward a better system.
It doesn’t solve all the problems, but a half loaf is better than none, and we must guard against the perfect being the enemy of the good. Fighting for a public option is one thing, but making it the sin qua non of health reform, serves only to strengthen the hand of the enemies of all reform. Sometime it is better to win a battle and live to fight another day, than to gloriously go down to defeat, and lose the best opportunity for reform we shall see for a very long time. Right now liberal forces in sniping at the President are doing a disservice not only to Health Reform, but to all the other reforms that will follow once this battle is behind us.
Wednesday, August 19, 2009
Health Insurance Reform - Lies and Damned Lies
In my last commentary, entitled: ”Health Insurance Reform," I addressed some misconceptions about our health care. I pointed out that it is far from the best system in the world. Depending on the criterion we use it ranks 24th, 72nd and 30th according to our own CDC. Lately the UK system has come in for some bashing but it comes in 14th on life expectancy, a lot better than the US, but it is severely under funded.
According the conservative British newspaper, The Guardian that has a cross-reference under the heading, Data: health spending around the world the per capita expenditure on health in the UK is $ 2,784. For the US it is $6,714 and when measured by total expenditure on health as a percentage of gross domestic product, we find that the UK spends 8.4% while the US spends 15.3%. We spend two to three times what Britain spends and get poorer result and then critics of US reform bash the British. Nobody is proposing adopting the British system but we could do worst. It is certainly better than the one we have.
The bashing of the British system got to be such a sport that Investor's Business Daily wrote an editorial saying, “People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.” When Stephen Hawking, upon hearing of this, pointed out that he is British, and it is the British Health Service that has kept him alive, the paper pulled this nonsense from its pages and blog. But the right wing, Rupert Murdoch-owned NY Post, stuck to the lie by writing:
“One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."
Scary, and a boldface lie, despite the reference to page numbers in the bill. The section referred to according to the Associated Press was authored by Republican Reps. Charles Boustany of Louisiana, Geoff Davis of Kentucky and Patrick Tiberi of Ohio and would authorize Medicare to pay for counseling if desired in the preparation of Living Wills. The AP article goes on to point out that “just a year ago, Congress overwhelmingly approved legislation requiring doctors to discuss issues like living wills and advance directives with new Medicare enrollees. And the government already requires hospitals and nursing homes to help patients with those legal documents if they want support, under a 1992 law passed under Republican President George H.W. Bush.”
But just about any lie will do to stop reform because in the words Republican Senator Jim DeMint "If we are to stop Obama on this, (referring to Health Care Reform) it would be his Waterloo. It will break him."
What is good for the country doesn’t matter. What matters is “breaking Obama.” They wouldn’t debate on the merits. On the merits they lose. And we know they don’t have a case when they start putting out boldface outrageous lies. And so what used to be something they were for, now becomes something that is euthanasia. And they all jump on the bandwagon. It started with that sterling Republican leader Sarah Palin when she put on her Facebook page, “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.”
Such a system would be downright evil, but no such system is, was, or ever will be considered. What is evil is the lie. One might hope other Republicans would immediately repudiate it, but no, former House Speaker Newt Gingrich defended the bizarre claim by Palin.
Well, I don’t know if such outlandish lies will stop needed reform, but they have succeeded in killing the provision that would allow being reimbursed for the cost of getting advice from your physician on what provisions you want in a Living Will, that, by the way, can provide that you want to live no matter what the state of your health is. If you want to live in a vegetative state for decades you can provide for that in a Living Will. All it does is tell providers what your wishes are when you are not able to do so any more. It avoids the situation that occurred in the infamous Schiavo case.
But the outrageous get even worse, if that is possible. Glen Beck on Fox News actually went into detail on the Nazi extermination programs suggesting the Health reform mimics the Nazis and Rush Limbaugh proceeded to describe the ways Democrats are like Nazis -- a list that included their dedication to animal rights and their opposition to smoking and pollution.
Jewish groups including the Israeli lobby, AIPAC were outraged, but nothing seems to be too low for people whose only allegiance is to the insurance companies and the drug companies and who will use any tactics to defeat what is not an option but a necessity.
I have questions about the cost of the bill and how it will be paid for. We all have questions of one kind or another. Some, particularly the very rich, the insurance companies and the drug companies, may be better off without reform and they are entitled to be against it. But when outrageous lies are used, we know that the opposition is bankrupt. An honest and civil debate is called for. Lies, smears, and scare tactics have no place in a discussion of such a crucial subject.
According the conservative British newspaper, The Guardian that has a cross-reference under the heading, Data: health spending around the world the per capita expenditure on health in the UK is $ 2,784. For the US it is $6,714 and when measured by total expenditure on health as a percentage of gross domestic product, we find that the UK spends 8.4% while the US spends 15.3%. We spend two to three times what Britain spends and get poorer result and then critics of US reform bash the British. Nobody is proposing adopting the British system but we could do worst. It is certainly better than the one we have.
The bashing of the British system got to be such a sport that Investor's Business Daily wrote an editorial saying, “People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.” When Stephen Hawking, upon hearing of this, pointed out that he is British, and it is the British Health Service that has kept him alive, the paper pulled this nonsense from its pages and blog. But the right wing, Rupert Murdoch-owned NY Post, stuck to the lie by writing:
“One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."
Scary, and a boldface lie, despite the reference to page numbers in the bill. The section referred to according to the Associated Press was authored by Republican Reps. Charles Boustany of Louisiana, Geoff Davis of Kentucky and Patrick Tiberi of Ohio and would authorize Medicare to pay for counseling if desired in the preparation of Living Wills. The AP article goes on to point out that “just a year ago, Congress overwhelmingly approved legislation requiring doctors to discuss issues like living wills and advance directives with new Medicare enrollees. And the government already requires hospitals and nursing homes to help patients with those legal documents if they want support, under a 1992 law passed under Republican President George H.W. Bush.”
But just about any lie will do to stop reform because in the words Republican Senator Jim DeMint "If we are to stop Obama on this, (referring to Health Care Reform) it would be his Waterloo. It will break him."
What is good for the country doesn’t matter. What matters is “breaking Obama.” They wouldn’t debate on the merits. On the merits they lose. And we know they don’t have a case when they start putting out boldface outrageous lies. And so what used to be something they were for, now becomes something that is euthanasia. And they all jump on the bandwagon. It started with that sterling Republican leader Sarah Palin when she put on her Facebook page, “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's "death panel" so his bureaucrats can decide, based on a subjective judgment of their "level of productivity in society," whether they are worthy of health care. Such a system is downright evil.”
Such a system would be downright evil, but no such system is, was, or ever will be considered. What is evil is the lie. One might hope other Republicans would immediately repudiate it, but no, former House Speaker Newt Gingrich defended the bizarre claim by Palin.
Well, I don’t know if such outlandish lies will stop needed reform, but they have succeeded in killing the provision that would allow being reimbursed for the cost of getting advice from your physician on what provisions you want in a Living Will, that, by the way, can provide that you want to live no matter what the state of your health is. If you want to live in a vegetative state for decades you can provide for that in a Living Will. All it does is tell providers what your wishes are when you are not able to do so any more. It avoids the situation that occurred in the infamous Schiavo case.
But the outrageous get even worse, if that is possible. Glen Beck on Fox News actually went into detail on the Nazi extermination programs suggesting the Health reform mimics the Nazis and Rush Limbaugh proceeded to describe the ways Democrats are like Nazis -- a list that included their dedication to animal rights and their opposition to smoking and pollution.
Jewish groups including the Israeli lobby, AIPAC were outraged, but nothing seems to be too low for people whose only allegiance is to the insurance companies and the drug companies and who will use any tactics to defeat what is not an option but a necessity.
I have questions about the cost of the bill and how it will be paid for. We all have questions of one kind or another. Some, particularly the very rich, the insurance companies and the drug companies, may be better off without reform and they are entitled to be against it. But when outrageous lies are used, we know that the opposition is bankrupt. An honest and civil debate is called for. Lies, smears, and scare tactics have no place in a discussion of such a crucial subject.
Tuesday, August 11, 2009
Health Insurance Reform
Health Insurance Reform appears to be in trouble, or at least that is what the media is telling us.
Should we care? Or is the present system fine for most of us?
These are questions that are legitimate and should be asked by all. After all we are told we have the best medical care in the world. For example Senator Shelby (R-Ala.) told Chris Wallace in June on "Fox News Sunday" that President Barack Obama's proposed health care plan is the "first step in destroying the best health care system the world has ever known" and Senator Mitch McConnell on July 19 said on Meet the Press: “They don't seem to grant that we have the finest health care in the world now. We need to focus on the two problems that we have, cost and access, not sort of scrap the entire healthcare system of the United States.”
These comments are very important because they set up certain premises that if true should give us all pause. Do we have the best health care system in the world? We all would like to think so. We like to think the U.S. is Number I in everything. That is something we should strive for, but in a sense we all come from Missouri, we ask is it true?
Well the World Health Organization has stopped doing these studies, so the latest figures we have date to 1999, but there is no reason to think that much has changed. On the basis of life expectancy the U.S. ranks #24. Japan Ranks #1, France #3, Sweden #4, Canada #12, UK #14. When the rankings are by eight relevant measures the U.S. comes in – hold your breath – comes in at #72.
But many Americans don’t trust the statistics of these “foreigners.” Well the American CDC (Center for Disease Control and Prevention) does a ranking on infant mortality rates. The latest one done as of 2005 shows the U.S. in 30th place.
So much for the claim that we have the best medical care in the world.
It is true, as some Republicans have contended, that the rich, the prominent often come to the U.S. for treatment - the Shah of Iran, with terminal cancer, came to the U.S., but all that shows is that if you have unlimited money excellent care is available in the US. Very few come from Germany or Italy or Canada, etc. Only a very few of us have unlimited money and whether people know it or not, even the insured don’t have unlimited coverage as so many are discovering.
We keep hearing about the uninsured and their lot is indeed serious. But the same goes for most of the insured who don’t know that when they need their insurance most they will discover that they forgot to read the small print. It doesn’t cover the most expensive procedures or they find the condition is a pre-existent one, even though they didn’t know that, and their insurance exempts pre-existent conditions. And then there are the co-pays. They can bankrupt you if you need an expensive procedure even if the procedure is covered by private insurance.
But let us remember what else McConnell said: he doesn’t want to “sort of scrap the entire healthcare system of the United States.” Well who does? What an outrageous setting up of a straw man. The discussion revolves around the insurance system, not the medical delivery system. The most controversial part of the reform is whether to have a government insurance system alongside private insurance and they treat that as though it were the most outrageous idea in the world. Well, Senator McConnell has government run health insurance along with every member of Congress. They all love it. Every American over 65 has a government run health insurance. Its called Medicare. All are very happy with it. Children who are not insured in a private health insurance plan have access to a government health insurance plan. Its called SCHIP. Parents whose children are covered by this plan are very happy to have it. The poor have a government health insurance plan, its called Medicaid. They are grateful to have it even though in many states it is under funded. As for veterans who are insured under the Veterans Administration program, a government program, they wouldn’t exchange it for private insurance.
None of these American Health insurance plans has turned us into a Socialist state and the insurance companies are still in business.
But now they tell us that Medicare may look good but it under-reimburses doctors. It is true that Medicare pays doctors less than they charge their un-insured patients*, but so does every private insurance company. According to Ethical Health Partnerships, “No matter how much we pay for private insurance, their payment to physicians is either slightly above Medicare rates (for better insurance companies) or BELOW Medicare rates. It is not uncommon for some insurance companies to pay 10-20% LESS than Medicare.”
It is no wonder that I have yet to find a notice posted in a doctor’s office that says we no longer take Medicare, though undoubtedly some don't. However, I do frequently find notices, “We don’t take United Health Care” or some other carrier, anymore. That means you lose your choice of doctor, and your choices of doctors are limited, with most private insurance companies having in-plan and non-plan doctors.
But one of the scare tactics used by the opponents of reform, and don’t be fooled by the claim that they want reform but “only the right kind,” is that you will lose your choice of doctor. They turn the facts on their head. Your choice of doctor is limited by the private insurance industry - it is not likely to be limited under any government program.
I realize that there are other issues that are troubling. Most important is cost. I will try to address all of them, or as many of them as I can, in future presentations.
* who are not only subject to the burden of having to pay all their medical expenses out of pocket, but are charged at a substantially higher rate then the insurance companies, so that they end up subsidizing the insured.
Should we care? Or is the present system fine for most of us?
These are questions that are legitimate and should be asked by all. After all we are told we have the best medical care in the world. For example Senator Shelby (R-Ala.) told Chris Wallace in June on "Fox News Sunday" that President Barack Obama's proposed health care plan is the "first step in destroying the best health care system the world has ever known" and Senator Mitch McConnell on July 19 said on Meet the Press: “They don't seem to grant that we have the finest health care in the world now. We need to focus on the two problems that we have, cost and access, not sort of scrap the entire healthcare system of the United States.”
These comments are very important because they set up certain premises that if true should give us all pause. Do we have the best health care system in the world? We all would like to think so. We like to think the U.S. is Number I in everything. That is something we should strive for, but in a sense we all come from Missouri, we ask is it true?
Well the World Health Organization has stopped doing these studies, so the latest figures we have date to 1999, but there is no reason to think that much has changed. On the basis of life expectancy the U.S. ranks #24. Japan Ranks #1, France #3, Sweden #4, Canada #12, UK #14. When the rankings are by eight relevant measures the U.S. comes in – hold your breath – comes in at #72.
But many Americans don’t trust the statistics of these “foreigners.” Well the American CDC (Center for Disease Control and Prevention) does a ranking on infant mortality rates. The latest one done as of 2005 shows the U.S. in 30th place.
So much for the claim that we have the best medical care in the world.
It is true, as some Republicans have contended, that the rich, the prominent often come to the U.S. for treatment - the Shah of Iran, with terminal cancer, came to the U.S., but all that shows is that if you have unlimited money excellent care is available in the US. Very few come from Germany or Italy or Canada, etc. Only a very few of us have unlimited money and whether people know it or not, even the insured don’t have unlimited coverage as so many are discovering.
We keep hearing about the uninsured and their lot is indeed serious. But the same goes for most of the insured who don’t know that when they need their insurance most they will discover that they forgot to read the small print. It doesn’t cover the most expensive procedures or they find the condition is a pre-existent one, even though they didn’t know that, and their insurance exempts pre-existent conditions. And then there are the co-pays. They can bankrupt you if you need an expensive procedure even if the procedure is covered by private insurance.
But let us remember what else McConnell said: he doesn’t want to “sort of scrap the entire healthcare system of the United States.” Well who does? What an outrageous setting up of a straw man. The discussion revolves around the insurance system, not the medical delivery system. The most controversial part of the reform is whether to have a government insurance system alongside private insurance and they treat that as though it were the most outrageous idea in the world. Well, Senator McConnell has government run health insurance along with every member of Congress. They all love it. Every American over 65 has a government run health insurance. Its called Medicare. All are very happy with it. Children who are not insured in a private health insurance plan have access to a government health insurance plan. Its called SCHIP. Parents whose children are covered by this plan are very happy to have it. The poor have a government health insurance plan, its called Medicaid. They are grateful to have it even though in many states it is under funded. As for veterans who are insured under the Veterans Administration program, a government program, they wouldn’t exchange it for private insurance.
None of these American Health insurance plans has turned us into a Socialist state and the insurance companies are still in business.
But now they tell us that Medicare may look good but it under-reimburses doctors. It is true that Medicare pays doctors less than they charge their un-insured patients*, but so does every private insurance company. According to Ethical Health Partnerships, “No matter how much we pay for private insurance, their payment to physicians is either slightly above Medicare rates (for better insurance companies) or BELOW Medicare rates. It is not uncommon for some insurance companies to pay 10-20% LESS than Medicare.”
It is no wonder that I have yet to find a notice posted in a doctor’s office that says we no longer take Medicare, though undoubtedly some don't. However, I do frequently find notices, “We don’t take United Health Care” or some other carrier, anymore. That means you lose your choice of doctor, and your choices of doctors are limited, with most private insurance companies having in-plan and non-plan doctors.
But one of the scare tactics used by the opponents of reform, and don’t be fooled by the claim that they want reform but “only the right kind,” is that you will lose your choice of doctor. They turn the facts on their head. Your choice of doctor is limited by the private insurance industry - it is not likely to be limited under any government program.
I realize that there are other issues that are troubling. Most important is cost. I will try to address all of them, or as many of them as I can, in future presentations.
* who are not only subject to the burden of having to pay all their medical expenses out of pocket, but are charged at a substantially higher rate then the insurance companies, so that they end up subsidizing the insured.
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