WHO ARE YOU TRYING TO FOOL, NANCY?

Will the April 30 Hearing on Medicare For All Be Little More Than a Farce?

That may well be the case according to an April 26th article in the Huffington Post:

Single-Payer Advocates Worry 'Medicare For All' Hearing Could Be A Farce

PLEASE READ THIS. When you do, you'll see that not only did the Rules Committee reject as a witness Adam Gaffney,  the President of the Physicians for a National Health Program (PNHP), but a dozen other suggested witnesses. According to the Post,  sources involved with the planning of the hearing say three criteria were applied to potential witnesses: (1) Is this person a leader of a single payer group? If so, that person could not testify -- meaning  Gaffney was out. (2) Is this person an activist? If so, they couldn't testify.  That meant that people like Dr. Sanjeev Sriram, who has repeatedly advocated for Medicare For All, were ruled out. And (3) Has this person said anything negative about the Affordable Care Act? Especially involved in this last requirement was Wendell Primus, Pelosi's top healthcare staffer.

Rules committee chairman Jim McGovern (D-Mass) stoutly denied any such criteria, and insisted that the committee was "free" to choose anyone they wanted -- claims echoed by Henry Connelly, a Pelosi spokesman. But, according to the Post,  sources close to the process insist Primus was intimately involved. It goes on to say: Single-payer groups and activists are reflexively suspicious of Primus after The Intercept revealed that he had spoken to insurance executives and laid out his own objections to Medicare for All. Primus also did himself no favors in a March 25 meeting with staff from a number of congressional committees that have health care jurisdiction. He reportedly said the Medicare for All hearing was a “check the box and move on type of thing.”

At the time of the Huffington Post article, the only witness allowed who had in fact spoken positively about M4A was an emergency room doctor whose testimony was to be limited to "patient experience."

Subsequently, it was revealed that a patient dying of ALS would be allowed to testify in favor of Single-Payer. (Not being able even to speak, he was to be equipped with special technology tracking his eye movements.) Doubtless, it had been decided that not only would the "optics" of denying a person at death's door be very bad, but it could be spun that allowing him to testify would make the committee look "compassionate."

But the truth is that the committee is attempting to rig the hearing so that there will be nobody allowed to argue strongly in favor of M4A's superiority to other suggestions on the table. How is this "show trial" superior to the behavior of strong-arm regimes to which we are supposed to be superior?

Who is Pelosi trying to fool? My friends, if you are NOT fooled, you can contact Nancy Pelosi here: https://www.speaker.gov/contact/ Please consider doing it now.

And please forward this everyone you know who might be affected by this sham hearing -- which, in my opinion, is everyone interested in giving M4A a fair shot.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

WILL THE HOSPITALS SHUT DOWN?

NO, THEY WON'T.

Today, I was going to post my thoughts on The Soul of Republicanism, but I changed my mind when I saw Don McCanne's latest post:

US Hospitals Will Thrive Under Medicare For All

When you read it, you'll see that on April 4th of this years, a JAMA article, dated April 4th of this year, supposed that under Single Payer or Medicare For All,  hospitals would suffer grievously. Their income would be markedly reduced due to the lower reimbursement rates currently being paid by Medicare and Medicaid -- rates that hospitals are now able to recoup by charging private patients more -- a strategy which would be unavailable to them under Single Payer. Its conclusion is dire:

In the absence of exceptional public-mindedness among hospital leaders, supporters of Medicare for all should anticipate strong hospital political opposition, especially from leaders who have pursued strategies less focused on efficiency than on extracting ever-increasing payment rates from private payers.

Never particularly friendly to M4A, the New York Times, on April 21st, jumped on the bandwagon with an article whose headline was: Hospitals Stand to Lose Billions Under ‘Medicare for All'. Though the article did close with Dr. Adam Gaffney's assurance that decreased income would be offset by greater efficiencies, that assurance seemed, to this reader at least, not quite able to dispel the gloom of the Times' pessimistic headline.

On April 20th. The Huffington Post observed that hospitals ... alone account for roughly one-third of the nation’s health care spending. No other sector, not even pharmaceuticals, rivals it. Under the Medicare for All proposals from Sanders as well as some other potential reforms getting attention these days, the federal government would limit payments to hospitals, quite possibly reducing their incomes significantly.  Consequently, the hospitals have become part of an industry-wide lobbying effort to defeat any expansion of government-run health insurance, even relatively modest ones that wouldn’t do much to affect their revenue.

To clear the air, Matt Breunig, writing for the People's Policy Project,

Hospitals Will Do Fine Under Medicare For All

points out that in the U.S., 25% of hospital revenue is spent on administrative expenses, whereas hospitals in the Canadian Single Payer system spend only 12% of revenue on administration. What this means, Breunig continues,  is that the administrative efficiencies available under a Medicare for All system allow hospitals to offset 13 points of the 16-point revenue cut without digging into the actual cost of care. The remaining 3 points could come out of hospital profit margin (bringing the margin from 7 percent to 4 percent).

But there's more to it than that. Check out Woolhandler and Himmelstein's

Importance of Aligning House and-Senate Single Payer Bills The Right Way

which I present in my post, "Why Is American Healthcare So Expensive: Part Two." There  I discuss their analysis of the high cost of healthcare facilities like hospitals, dialysis centers, etc.  Woolhandler and Himmelstein write:

At present, hospitals’ success, and even survival, depends on generating profits (“surpluses” in non-profit facilities). Hospitals with a favorable bottom line can invest and add new buildings and programs, while unprofitable ones can’t modernize or expand, risking a downward spiral toward takeover or closure....It’s this profit imperative that drives hospitals’ financial gaming, e.g. upcoding, and concentration on the most lucrative services, such as elective cardiac and orthopedic services, rather than money losers like mental health. This payment mechanism ... also leaves the door open to investor-owned providers.

The answer to this, they write, is adopt the strategy used by some European countries, like Scotland, where the hospitals are paid not by procedure, but globally, with one payment intended to cover all  operating expenses. It's the way we in this country pay for firehouses, which, like hospitals, are resources for the public good. And if the firehouse needs to get a new fire engine, the firehouse applies to the municipality that governs it. No government is likely to last if it holds back on improvements the public sees is for its good. It would be the same with our hospitals. They would be expected not to show any profits at all. They could concentrate on their business -- which would not be making money, but healing.

In his discussion of all this, McCanne concludes:
Right now the two major hospital associations are partnering with other members of the medical-industrial complex to publicize [the notion] that hospitals will have to shut down if we enact and implement a single payer Medicare for All program. NOT TRUE! You should be prepared with your response when this comes up:


"Single Payer Medicare for All not only recovers a tremendous amount of administrative waste, but it also uses regional planning, global hospital budgets - like fire departments have - and separate budgeting of capital improvements to ensure that we will always have adequate capacity in our hospital system."

Amen.

The Soul of Republicanism is for our next post.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

NOBODY IS COMING TO SAVE US.

A scary article appeared in the New York Times, yesterday. 

How a Chicago Woman Fell Victim to Candida Auris, a Drug-Resistant Fungus

The fungus that killed her, Candida Auris, has a frightening ability to mutate and develop resistance to any drug deployed against it. The Times wrote:  According to the Centers for Disease Control and Prevention, nearly half of people who contract the illness die within 90 days. 

This is scary enough.  Even scarier is the likelihood,  if we judge by Ezekiel J. Emanuel's  recent article in The Atlantic Monthly -- that Big Pharma doesn't intend to anything about it.

Big Pharma’s Go-To Defense of Soaring Drug Prices Doesn’t Add Up 

Why? According to Emanuel, Pharmaceutical manufacturers would rather concentrate on anti-cancer medications, which make much more money for them -- even though they may extend life only for a few weeks:

Consider antibiotics. The Centers for Disease Control and Prevention ranks antibiotic-resistant infections as one of the nation’s top health threats. An estimated 2 million Americans become infected with such bacteria each year, and 23,000 die. A superbug that is resistant to all known antibiotics is an imminent threat. Yet because antibiotics are generally cheap, for most pharmaceutical and biotechnology companies they are not a primary focus. The Pew Charitable Trusts reports that only about 41 new antibiotics with the potential to treat serious bacterial infections were in clinical development for the U.S. market in March 2017.

If disease resistant microbes do not present as rosy a profit picture as cancer drugs, what chance have we to expect development of a drug to combat a disease resistant fungus whose main victims seem to be the aged, and those with compromised immune systems?

Once again, the possibilities for big profits trump -- forgive the expression -- the public good. Big Pharma is sitting in the catbird seat -- granted monopolistic rights by our government, which has ruled that Medicare may NOT negotiate prices with drug makers. They can charge whatever they want -- and they do.  An indecent number of our legislators have been bought and paid for by the medical-industrial establishment. Do you suppose that these bought-and-paid-for lawmakers want to harm the geese that lay for them so many golden eggs? Don't hold your breath waiting.

Speaking of eggs, the time is coming for Easter and Passover, when we recall the miraculous events heralding salvation -- the Hebrew people being rescued from a cruel despot who thinks he's God, and -- millennia later -- Jesus' rising from the tomb. I know more about the former tradition, being raised in it. What interests me is that God remembered His promise to the Israelites only when they, as one person, cried out to Him because of their pain. Before that, apparently, they thought that their enslavement was the natural order of things, just as many of us today are content to put up with the chancy corporate insurance that makes us afraid to leave our current employment -- making us, in effect, wage slaves.

What can free our healthcare from the cruel tyranny of profits?  I wouldn't count on any supernatural occurrences. But if we all, every man, woman, and child, could rise up and cry out as one person: ENOUGH OF THIS SHIT -- WE WON'T TAKE IT ANY MORE! -- that would be miracle enough, and it just might do it.

I wish a sweet Passover to those for whom, like me, it is meaningful, and to my Christian friends, a happy Easter. May all our deeds bring blessing.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

IT'S ALL OUR FAULT!

No, Debbie Stabenow did not say that it's all our fault. All she was trying to do was de-politicize the debate about healthcare. So she invited a bunch of industry executives to what was supposed to be a non-political discussion of her idea: Rather than setting up a Medicare for All plan, we should allow people 50-65 to buy into Medicare. You would think that this was -- politically speaking -- fairly tame, right?  Apparently not so. In the Modern Healthcare March 30 issue...

Healthcare's mission smothered in politics

...we read what went on at the meeting. We read of the assertion of Rick Pollack -- CEO of the American Hospital Association -- that there wasn't enough money in M4A to cover the cost of treating patients, some of whom would be denied care as a result of it.  

Chip Kahn, CEO of the Federation of American Hospitals, said that the ACA shouldn't be abolished entirely, and asked,  “Why do we want to turn everything upside down when we know we then open ourselves up to a whole new set of problems?” 

The businessmen agreed that policy reforms could only go so far. Banner Health CEO Peter Fine said. “I don’t know how you manage cost in healthcare until you manage usage.”

Anthony Barrueta, senior vice president of government relations for Kaiser Health Foundation Health Plan. said "Countries like Australia and New Zealand are essentially willing to say no to manufacturers of exorbitantly priced drugs. “The question is whether we can build that kind of dynamic into the American system … or is it impossible because of our culture because people are never willing to say no? Healthcare’s problem is related to behavior, Fine said. Everyone wants what they want instantaneously. You can change a business model, but changing a culture is way more difficult,” he said.

In other words, according to them the high expense in healthcare is not because of the profit motive driving eight-figure salaries of the CEOs, and it's not  because they have to keep shareholder dividends competitive to attract investors, not because of the inflated bureaucratic overhead or the costly TV advertising, certainly not because of all the money spent on bribing legislators to vote their way,  -- no no! It is because too many people want healthcare. And those pesky people want it whenever they get sick! That can cut into profits drastically!  The solution is to "manage usage," or in plain English, ration it, make it less accessible to people, so they'll be "encouraged" to seek medical care less often, resulting in less healthcare for them, and more money for the shareholders, the CEOs, and others high on the food chain who would like to feed on us undisturbed by the higher taxes which would surely result from every sick person being treated.

You see, dear reader,  as these corporate big-wigs see it, the problem is not their greed.

The problem is us.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

MODIFIED RAPTURE?!

In Gilbert & Sullivan's MIKADO, seen above in Jonathan Miller's famous version, Nanki-Poo (in the striped jacket) says to Yum Yum, "At last we are alone! I have sought you night and day for three weeks in the belief that your guardian was beheaded, and I find that you are to be married to him this afternoon!"

"Alas, yes!" replies the demure Yum Yum.

"But you do not love him?"

"Alas, no!"

"Modified rapture!" cries Nanki-Poo.

I wonder if that is what I am expected to cry now that I've learned that three congressman -- including Antonio Delgado -- the one from my own CD19 -- have re-introduced something called Medicare X. Delgado touted it as "a practical, robust way to achieve universal health care" in America. This is the "public option ,,,,available to all Americans" he campaigned on.  

Unlike Medicare for All, which would replace most of private insurance with a single payer (the government)  this plan would allow those who like their employer-sponsored insurance to keep it,  and it would give anyone of any age the option of buying into a Medicare-like plan which would use the doctors and hospitals currently accepting medicare, but would be funded not by the current Medicare Trust fund but by premiums being paid by those choosing it, with the aid of  government subsidies -- at least for the first 3 years -- and the aid of tax rebates to anyone whose premiums for health insurance exceed 13% of their total income. Coverage would be expanded to include obstetrics and pediatrics. It would first be rolled out in rural areas in which there is only one ACA provider or none at all, and it would be available to everyone by 2024.

Tim Kaine, a co-sponsor of the Senate version of the bill. extols what he says is the practicality of the proposal, the fact that “we preserve everything about the existing system. And we just put one additional element into it,”  But this micro-incremental approach did not go over well with a major nurses' union:

 A Major Nurses Union Calls Medicare X Plan 'Sub-Par and Wholly Inadequate to Address the Healthcare Crisis'

As far as the nurses union was concerned, this plan was merely a "Band-Aid" that does little to correct the huge systemic sickness in the current, profit-driven system, "which has left 30 million Americans uninsured and over 80 million more underinsured" and which,  "according to a Gallup report, forced Americans to borrow $88 billion to cover their healthcare expenses in 2018."

I just finished watching a recent video of Delgado explaining the proposal to Emily Burkhard on WNYT.  
                                          Delgado interviewed on WNYT
I was struck  by his passion -- which is to his credit. But when he said that the proposal would provide a "baseline" of care which would be less expensive, my ears pricked up. The suggestion I heard was that the more expensive private insurance might provide more than the baseline -- but you had to pay for it. I was also struck by the care he took to distance this proposal -- and himself -- from Ms Burkhard's asking if Medicare X would lead to single-payer. "What it will lead to," he said, "is universal health care."  I wondered if he was attempting to side step any suggestion of Medicare X being a slippery slope to socialized medicine.  

He kept saying that we needed "some form" of universal health care. All this left me wondering if the "some form" he was envisioning was two-tiered: There'd be the upper tier -- the premium tier -- for those who could afford it, and Medicare X -- the lower tier -- which would provide a "baseline."  What a contrast to the New York Health Act, the motto of which is "Everybody in, nobody out." 

Medicare X would divide the population of the country into two pools: One would be able-bodied and employed by companies who offer insurance, and the other -- by and large -- older and less healthy. My guess is that the Medicare X pool -- despite Delgado's grandiose projections -- would not, by itself, be able to afford what it cost to keep them healthy, and that the government would have to subsidize those expenses, causing the Medical/Industrial Establishment to fight even more fiercely against their competition -- not by lowering prices (heaven forbid!) but through their deep pockets, to buy enough legislators to crush it outright.  

Even if  not, my guess is that in order to make the Medicare X program self sustaining, premium prices would have to be raised to a point where there would be some unable to afford them. It would be Medicare for some. Yet Delgado optimistically projected a future in which so many people would flood into  Medicare X, that the Medicare doctors would be glad to treat them despite their somewhat lower rate of  pay. My own less rosy hunch is that the network of doctors willing to see Medicare X patients would shrink, and patients in this lower tier would have to put up with spending less time with their doctors, who all too often would turn out to  be second rate. 

And meanwhile our fragmented system would go on wasting billions, a substantial share of which would be the obscene profits made by reducing access to care, or denying it altogether.

I read somewhere that Medicare X is a lot like Medicare for America -- and, for sure, it does share some of the problems cited above. But at least it had a provision that every new-born would be enrolled into it, thus enabling its promoters to claim that it was a path to single-payer.  But Medicare preserves the status-quo: a two-tiered system where the upper tier gets better treatment -- and what the lower tier gets is...better than nothing.

Now that Medicare X has been re-introduced, should I cry, "rapture"? Hardly.

How about "modified rapture"?  Less than that, I fear.

Much less.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

Isn't our health care system so expensive because people don't take care of themselves? Why should I have to pay for those couch potatoes who smoke, eat junk food, etc.? What about personal responsibility?

Phew -- a tough and possibly hostile question! Let's see if we can answer it -- one point at a time. 

The first point is easy: The high prices we pay are not because of improvident people's lifestyles, but because of the obscene profiteering of the medical/industrial establishment, which includes Big Pharma, Private Health Insurance Companies, and Hospitals.

Yes, people do get sick, but to what extent, if any, are they to be blamed for their illness? It's an ancient question, and the answer, carried forward by artists and writers, is that, to some extent, people do cause their own illnesses.  For example, in  William Blake's The Sick Rose, we read:

Oh rose, thou art sick!

The invisible worm

That flies in the night

In the howling storm:

Has found out thy bed

Of crimson joy:

And his dark secret love

Does the life destroy.

In other words, as Blake would have it, the rose is sick because she is too beautiful, too seductive -- it's her own fault -- she has nobody to blame but herself! In addition to invoking the age-old trope of the woman being the cause of her own hurt, this poem not only lets us direct our prurient gaze at her, it also lets us distance ourselves from her suffering: We would never act like that, we think, so what happened to her is unlikely to happen to us.  When beholding suffering, our primal impulse is to see whether the sufferers brought it on themselves, so we can comfort ourselves with strategies to avoid the same fate. It's not a very attractive trait, but many of our primal traits are less than attractive. But they are human.

Also human is the resentment we feel when we are told, by such well-meaning people as Dr. Bernie Siegel that we have brought it all on ourselves. In an attempt to be helpful, he asks, "How did you need this illness....what was your body trying to tell you?"

Personally, I find such an approach distinctly unhelpful, but it doesn't help matters to see, in real life, what seems to be the result of very unhealthy behaviors. If people smoke a pack of cigarettes a day, does it surprise us if many of them contract cancer? Yes,  these people's behavior did seem to cause their illness, but does that mean that they are to blame for it?  What about the inveterate efforts of Big Tobacco to hook youngsters onto nicotine before they reach the age of discretion? It took years before this country was able to see through the cigarette industry's smoke screen of lies, and see that smoking was a matter of public health. We the people started to see that smokers deserved more to be helped than demonized. Their addiction was partly the result of a social ill, and to the extent that we acquiesced to this ill, the blame for it was partly ours -- so the expense of treating those afflicted by it should be partly ours -- including the cigarette industry, which promoted it in the first place!

A similar example of a public malady is soft drinks. It is sometimes forgotten that the brand name of Coca-cola was derived from one of its salient ingredients at the time of its creation -- cocaine. It was there to addict the drinkers. Cocaine is no longer there now, but a lot of addictive caffeine is, not to mention so much sugar that soft drinks are now considered one of the chief causes of obesity, and thus of diabetes, and all its attendant ills. Sugar, it turns out, is at least as dangerous cause of disease as is fat. In 2016, an NPR article stated that

50 years ago sugar industry quietly paid scientists to point blame at fat

Do the thousands of drinkers addicted to caffeinated sugary beverages deserve more blame for their ills than the industry which, knowing the ill effect of all that sugar, to this day still tries to addict them with the promise, conveyed through multi-million dollar advertising campaigns, that these drinks will make them appear -- and feel -- cool? 

New York has a law whose public health aim is to limit the consumption of such drinks in public places. The same aggrieved people who decry these laws as attacks on personal liberty -- folks, they claim, should be free to drink as much coke as they want! -- these same aggrieved people are the ones who are affronted when they are asked to to contribute to the treatment of those afflicted with the results of this social ill.

Yes, there are plenty of people afflicted with results of public policy allowing -- and nowadays even encouraging -- the pollution of air and water, and the consumption of ingredients tardily recognized as carcinogenic; people whose sickness is caused by medical treatments too late designated dangerous by the authorities -- or not yet designated dangerous at all! Should those victimized by such public failures be held responsible for their illnesses?

And there are those whose illness cannot be shown to be in any way linked to the environment, and whose only misfortune is that they have been born to parents carrying genetic predispositions to disease. If they become ill with these diseases, are they to blame? Of course not! In these cases, and in the cases where the physical or social environment encourages disease, folks can't be blamed for what happens to them.

But surely there must be people whose illness seems not at all attributable  to the social or physical environment, nor to genetic predisposition. Let's imagine one -- say that supine gentleman in the illustration above. Let's say he has plenty of money to eat right, and plenty of education to know the dangers of not exercising, and let's say that everyone he encounters is setting a good example for him, and let's say that at work his boss is very understanding and does not put too much pressure on him (I know this last requires a leap of imagination), so that mentally he is in reasonable health, and let's say his family loves him, and yet, despite all this, HE INSISTS ON BEING A COUCH POTATO! If he gets sick, must we contribute to his health care?

My answer is yes we must, for who is to judge him? Or put it another way, if you -- God forbid -- should get sick, wouldn't you want to be treated with compassion, and not abandoned because someone judged you as unworthy of care?

We humans are all in the same boat. And if someone falls into the water, do we let them drown? No, we help them, because they are human beings -- and so are we. If we don't help them, we are less than human. 

"But I am not less than human," I hear someone say, "I just want to keep from falling into the water myself."

"But if you did fall into the water," I reply, "wouldn't you want to be helped back into the boat?"

"Of course, I'm human."

I tell this person, and everyone: "Remember that."

Dio 

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

"The Republican Party will soon be known as the party of health care – you watch."

In George Orwell's 1984,  the term "wordfact" is used to describe a government pronouncement which is demonstrably false, yet accepted as true by an abject populace which has to swear allegiance not only to the beloved leader, but also to whatever comes out of his mouth. To such a state do we seem to be descending when the leader of the GOP asks us to believe that his party will generate any healthcare program at all -- let alone a serviceable one. 

Putting it charitably, anybody -- other than White House sycophants -- who would endorse that fiction simply hasn't been paying attention. The GOP is the party of providing no meaningful healthcare whatsoever. So fiercely have they opposed healthcare that Paul Krugman, in today's New York Times,  describes their hatred of it as "pathological." I prefer to think of it as a natural consequence of their chief credo -- that entitlement to life, liberty, and the pursuit of happiness can be quantified in dollars: the more of them you have, the more entitled you become, and the less of them you have, the less deserving apparently, you must be of any good thing in life. From which it follows that to require the rich to help the poor is unutterably wrong -- "confiscatory," to use one of their favorite words.  Redistributing wealth downward in anathema to them, whereas redistributing upward is natural and right, the inevitable triumph of the stronger -- celebrated, they suppose, by Darwin.

Indeed, in today's corporate world, Cain's question, "am I my brother's keeper?" has developed a sinister answer, for our corporate masters do "keep" us, the way corporate  agribusiness keeps the sheep or cows it owns -- for their wool and their milk. And when we are no longer worth the shearing, or the milking, our owners dispose of us as efficiently as possible.

Thus our Republican overlords either approve of, or acquiesce in the abolition of ACA, and the gutting of Medicare and Social Security.  To them, it makes perfect sense: We are, from their point of view, simply not worth the money -- their money. For it is, increasingly, becoming all theirs.  According to an article in the Washington Post dated February of this year,  the top .1 percent own more than the bottom 80 percent.

Wealth Concentration Returning to Levels Last Seen During the Roaring Twenties

Arguably, the super-rich already own our government. Pfizer Pharmaceuticals alone devotes three lobbyists to each Senator and Representative; doubtless the rest of Big Pharma is similarly devoted: One of the results is that Medicare is forbidden to negotiate drug prices. And the only way Obama could get ACA passed was  to agree to the parameters stipulated by the Medical/Industrial establishment. It was imperfect to begin with, and Trump's continual weakening of it made it even less satisfactory,  But we should be grateful for it, wobbly as it is, for 20 million people are insured by it, and it's the only thing standing between many thousands and certain death.  And if in the courts Trump succeeds where he couldn't in the legislature the results will be catastrophic.

And as if that weren't enough,  I've just received a post from Don McCanne, who quotes an economic report signed by Trump. Its bottom line is there is no reason why Healthcare cannot operate in a market governed by free choice  -- thus dismissing the work of eminent economists asserting that the unique features and conditions of healthcare make it impossible to function effectively in a free market system. (One of many reasons: To lower costs, the risk must be spread as wide as possible. Competing systems divide the pool and thus raise the rates. In addition, many people who need medical care are in no position to "shop  around" for the best value, nor have they the information to make an informed choice. This is no time for ideology. ) McCanne says with breathtaking understatement "we can conclude that our health care financing system is not in good hands. We have to do something about that."

Oh yes we do, friends, yes we do. We live in a country which is not only in thrall to corporate interests, it has seemingly become hypnotized by its propaganda.  There are people who actually believe that National Socialists (Nazis) and Democratic Socialists (Progressive Democrats) are equivalent. And there are people who think that taking the profit motive out of medicine is an attack on our Capitalistic system. If they mean the Capitalism of unrestrained and unregulated greed, they are right.

What can we do?  We must each of us contact our representatives -- on the federal level -- and insist that only Medicare For All will satisfy us, and that we don't buy the Trumpian free market bulls**t.  And on the State level we must contact our State Assembly Members and State Senators, and tell them that the New York Health Act is what we need and what we insist on. For more info on NYHA you can click on:

New York Health Act Campaign

They've got everything from a brief, entertaining animation (see it!) longer videos with  more wonky explanations -- and everything in between. And it will have more suggestions about what you can DO.

And we must do all the above not only forcefully, but repeatedly. Don't rely on your friend or your neighbor to do it -- do it yourself.  Make time for it. Do it.  The revolution begins with us.

Everybody gets sick now and then. And when it's your turn, whose policies do you want  in place -- the Republicans (who really don't care what happens to you so long as their beloved free market is allowed to fly unconstrained) or the Democrats, whose guiding principle is EVERYBODY HAS A RIGHT TO  HEALTHCARE -- NO MATTER WHAT THEIR STATION IN LIFE.

Tell others how you feel.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

PAUL KRUGMAN VS. WHO?

Anyone who has read the New York Times will likely recognize the gentleman on the right: He's Paul Krugman, Nobel Prize winning Economist and Columnist for the Times. It would be hard to be more distinguished than he. 

I'd be surprised if many of my readers recognized the gentleman in the left: He's Don McCanne, MD, who in addition to being a physician, has been all his life a student of health policy.  He currently serves as Chief Policy Fellow for the Physicians for a National Health Plan PHNP), a body in which he served as President in 2002 and 2003. There is no more passionate advocate for Single-Payer than Dr. McCanne, and I read his daily blog with the deepest respect.  

On Sunday, March 17, the Texas Tribune published Patrick Sviteck's story about Beto O'Rourke's pivoting on his healthcare plan preference:

In Iowa, Beto O'Rourke works to find his footing on health care

Sviteck explains that O'Rourke, never more than luke-warm towards the notion of Single-Payer, seemed more comfortable embracing a policy considerably to the right of  it -- Medicare for America.  Sviteck quotes him:

"It responds to the fact that so many Americans have said, ‘I like my employer-based insurance. I want to keep it. I like the network I’m in. I like the doctor that I see,'" O'Rourke said. "It complements what already exists with the need that we have for millions of Americans who do not have insurance and ensures that each of them can enroll in Medicare. It then suggests additional investments in that program so it becomes the program of choice, and people who have private insurance migrate over to the Medicare system."

Someone questioned him:"So the greed has to stay in the insurance industry in your opinion?"

Beto paused, then said that he didn't see it as a function of greed. "I think I have to be respectful to people who just shared with me what I shared with you: They like the program they’re in, they like the insurance that they have," O'Rourke said. "If we become too ideological or too prescribed in the solution, we may allow the perfect to become the enemy of the good. And there are fellow American human lives depending on us finding a solution."

Upon reading this,  Dr. McCanne posted a very passionate statement about 

The-Fallacy That You Can Keep The Insurance You Have

He says that virtually nobody in this country does. "The obvious point" he writes, "is that people do not have stable health care coverage throughout their lives." And as he makes clear, there are too many reasons why the insurance companies change, or their policies do, or the networks do.  I suggest you read his article I've linked above: I never knew there were so many reasons why the insurance you have can and will change, but I can testify that in my lifetime that has been my experience.  

And as for that shibboleth "freedom of choice," you have to go along with whatever your employer chooses to give you -- if he chooses anything. You get the doctors and the network that your employer chooses. But as McCanne says, with Single-Payer, you don't have to worry about doctors being in your network; You can choose any doctor, any hospital you want: they're all in the same network!  (This would be very much unlike Medicare for America, if it devolves into a two-tiered system -- one more pricey than the other -- those who belong to the medicare tier might find themselves priced out of the tier whose pricier doctors might not want to treat them. That sort of thing is happening as I write this. There is a physician in Kingston, well thought of,  whose receptionist told me: "Of course Doctor doesn't take Medicare. That's what you have? You should have told me from the get-go, and not wasted my time!" Luckily for Carol and me, we could find quite a few other good doctors in Kingston who do take Medicare.)

Thus this argument for Medicare for America -- that you can keep the insurance you have -- is, in McCanne's opinion, based upon a fallacy. And, as I said in my most recent post, Medicare for America, in my opinion, would be unlikely to last long, if for no other reason that no billion dollar company is going to sit quietly by while it is being put out of business -- however slowly. They'll deploy every dollar they have to lie, distort, and bribe.

Despite all this, Paul Krugman believes that eventually most of the Democratic candidates will be persuaded to move rightward and and embrace Medicare for America. In  his recent opinion piece,

Don't Make Health Care a Purity Test

Krugman asks, 

But even if optimistic claims about Medicare for All are true, will people believe them? And even if most people do, if a significant minority of voters doesn’t trust the promises of single-payer advocates, that could easily either doom Democrats in the general election or at least make it impossible to get their plan through Congress.

And he points out that -- just as there is more than one way to skin a cat -- there are in the world many ways proven successful in providing universal healthcare. "Every two years," he says,  "the Commonwealth Fund provides an invaluable survey of major nations’ health care systems. America always comes in last; in the latest edition, the three leaders are Britain, Australia and the Netherlands. 

"What’s remarkable about those top three is that they have radically different systems. Britain has true socialized medicine — direct government provision of health care. Australia has single-payer — it’s basically Bernie down under. But the Dutch rely on private insurance companies — heavily regulated, with lots of subsidies, but looking more like a better-funded version of Obamacare than like Medicare for All. And the Netherlands actually tops the Commonwealth Fund rankings."

Krugman then asks,  "So which system should Democrats advocate? The answer, I’d argue, is the system we’re most likely actually to create — the one that will play best in the general election, and is then most likely to pass Congress if the Democrat wins." 

He concludes, "To me, then, Medicare for America — which lets people keep employment-based insurance — looks like a much better bet for actually getting universal coverage than Medicare for All. But I could be wrong! And it’s fine to spend the next few months arguing the issue. What won’t be fine will be if activists make a no-private-insurance position a litmus test, declaring that anyone advocating a more incrementalist approach is no true progressive, or maybe a corrupt shill for the medical/industrial complex. As you might guess, my concerns aren’t drawn out of thin air; they’re things I’m already hearing."

So the next few months will be anything but boring! And the thing is: I'm really not 100% sure of where I am on all this.  In the readers comments section -- which I strongly urge you to read -- readers give their views about Krugman's opinions. In the first New York Times Pick, you can read:

"Private insurance is mostly there to say No, you can’t have that, but if you do, we’re not going to pay for it. And we currently pay through the nose for these companies to tell us that. Who in their right mind is “satisfied” w that? Only stupid people or people w ties to the health insurance industry. No, private health insurance, w the possible exception of “boutique” brands for the wealthy, should be abolished. I don’t often disagree w Mr. Krugman, but this time I do. Wholeheartedly. Is my view impractical? Let’s forget the polls and vote on it."

After reading this, I thought, "yes, yes! Those !*#@*! [the healthcare companies] should not be rewarded for what they've put us through! I agree 100 percent! But then I read:

"One of the problems that Progressives will have in selling Medicare for All is that they have made a compelling case for the utter corruptibility of politicians due to money in politics. The GOP over the years has made a much less honest but electorial effective case that "liberal elites" cannot be trusted. And Trump has demonstrated the weaknesses in oversight, check and balances, and the value of facts in our system of government in the face of extreme partisanship and the conservative media ecosystem. "So how do you convince the rightfully skeptical, currently insured but potentially persuadable, to let OUR Federal government take this much control over health care NOW? "Explaining all the positives of Medicare for All is easy relative to the challenge of explaining how THIS government, that will without question still be highly partisan in 2020 and still awash in big donor money, is capable of pulling this off. "Have a robust debate. If Medicare for All resonates with a solid majority of voters across a majority of states that's great. I hope it goes that way. "But if not, keep in mind that our democracy may not survive another 4 years of Trump and McConnell. Medicare for All is not the hill to die on. [Emphasis added]

After reading this, I think, OMG, of course, of course! This makes sense!

Let our good doctor, the esteemed Don McCanne -- only one year younger than I -- have the last word about what we activists for Single-Payer must bear in mind:

This is a time for PASSION. We have to get this message out there.

As with everything else, he is so right about this, too.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!

BETO O'ROURKE CHOOSES "MEDICARE FOR AMERICA" (NOT MEDICARE FOR ALL)

What does he know that we don't?

Although Medicare for All  has been the rallying cry of most of the progressive Democrats in the presidential race,  Beto chooses another, seemingly more "moderate" plan. What is this "Medicare For America" that Beto should go for it? You can check it out in this link:

Medicare for America -- Beto's Favorite Healthcare plan -- Explained

It's very much influenced by a plan cooked up the Center for American Progress (CAP) last year, and presented in my blog post "Various Flavors of Healthcare Reform" (12/15).  The new plan would allow all who like the insurance offered by their employer the opportunity to keep it. Everyone else -- those who don't like their employer's plans, or who do not have employer-offered insurance, or who have either private insurance, ACA, Medicare or Medicaid, or no health insurance whatsoever -- get Medicare for America. In addition, every new-born automatically gets enrolled in Medicare for America, whose required contributions  are graduated by ability to pay, and whose benefits would be at least equal to the remaining Private Employer's Insurance which would theoretically be strictly regulated, and would cover at least 80% of the expenses incurred by the employee. But any time the employee became dissatisfied with his employer's plan, or any time his employer wanted to move him or her off it, that employee would transfer into Medicare for America.

Thus, so the story goes, as more and more newborns are enrolled into Medicare for America, and more and more currently employed people retire, gradually everyone would be covered by Medicare for America, and Private Health Insurance would just fade away, so to speak. What's not to like?

WELL!

I can't imagine anyone so naive as to suppose that during the decades-long process of conversion to Single-Payer, Private Insurance would go gently into that Good Night. No, it would fight with every dollar at its disposal, and it would exploit the public's dissatisfaction with the new system. And there would be plenty to complain about! For one thing, all the disadvantages of our badly fragmented system would be kept, with the loss of much of the savings in administrative overhead that would have helped pay for Single-Payer, thus raising the costs higher than necessary.  And with the pool of risk essentially halved, the required payments to Medicare for America would be even higher than if  all the population were paying into it. 

Moreover, medical providers, who currently spend a fifth of their time wrestling with Private Insurance, would be denied the relief that Single-Payer would have provided. And since the Private insurance folks could drop coverage for anyone too sick or frail to be profitable (they're doing it now), we'd have a two-tiered system -- one for the rich and healthy, and one everyone else, with costs spiraling out of control.  And within the first two years -- five at the most -- the public would cry out to go back to what it had before -- the Medical Industrial Establishment would make sure of that!

Truly, the only thing Beto's plan has going for it is what he may suppose is the public's unwariness that might lead it to believe two things:

1. This "incremental" approach is a good thing, and
2. Private Insurance can be trusted not to find ways -- even with "strict" regulation -- to game the system to their advantage, and to the disadvantage of everything else.

I should make it clear that even with Single-Payer, there are bound to remain a few private insurance companies, to deal with things NOT covered by Medicare for All -- aesthetic plastic surgery for example.  And there may be others.

But Howard Schultz, the ex-CEO of Starbucks, supposes that the entire Health Insurance Industry would be destroyed. "Destroy a whole industry?" he says, "that's un-American! What will they destroy next -- coffee?"  My point is that the privatization -- indeed the financialization -- of all industries is so in-grown within the body of our American life,  that there is a benefit in making the excision of this toxic mass as surgically swift as possible.  Yes, we must plan for dealing with the displacement of many of the insurance workers -- they count, too!  In this I do NOT include the hugely salaried CEOs and their ilk. They have the resources to take care of themselves. 

They also have the resources to find ways to hold on to their jobs -- at the expense and pain of everyone else.

We must fight them, opposing all their culture of greed. Despite Schultz's protestations, that is NOT the American way.

Dio

PS: If you'd like to leave a comment -- and I encourage you to do so -- simply click on the "number of comments" area, and share your thoughts in the "comment rectangle" that appears.

PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!