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The Real Health Care Debate April 9, 2012

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Published on Monday, April 9, 2012 by Truthdig

  by  Chris Hedges

The debate surrounding the Patient Protection and Affordable Care Act illustrates the impoverishment of our political life. Here is a law that had its origin in the right-wing Heritage Foundation, was first put into practice in 2006 in Massachusetts by then-Gov. Mitt Romney and was solidified into federal law after corporate lobbyists wrote legislation with more than 2,000 pages. It is a law that forces American citizens to buy a deeply defective product from private insurance companies. It is a law that is the equivalent of the bank bailout bill—some $447 billion in subsidies for insurance interests alone—for the pharmaceutical and insurance industries. It is a law that is unconstitutional. And it is a law by which President Barack Obama, and his corporate backers, extinguished the possibilities of both the public option and Medicare for all Americans. There is no substantial difference between Obamacare and Romneycare. There is no substantial difference between Obama and Romney. They are abject servants of the corporate state. And if you vote for one you vote for the other.

 

But you would never know this by listening to the Democratic Party and the advocacy groups that purport to support universal health care but seem more intent on re-electing Obama. It is the very sad legacy of the liberal class that it proves in election cycle after election cycle that it espouses moral and political positions it will not pay a price to defend. And since we have no fight in us, since we will not punish politicians like Obama who betray our core beliefs, the corporate juggernaut rolls forward with its inexorable pace to cement into place our global neofeudalism.

Protesting outside the Supreme Court recently as it heard arguments on the constitutionality of the Affordable Care Act were both conservatives from Americans for Prosperity who denounced the president as a socialist and demonstrators from Democratic front groups such as the SEIU and the Families USA health care consumer group who chanted “Protect the law!” Lost between these two factions were a few stalwarts who hold quite different views, including public health care advocates Dr. Margaret Flowers, Dr. Carol Paris and attorneys Oliver Hall, Kevin Zeese and Russell Mokhiber. They displayed a banner that read: “Single Payer Now! Strike Down the Obama Mandate!” They, at least, have not relinquished the demand for single payer health care for all Americans. And I throw my lot in with these renegades, dismissed, no doubt, as cranks or dreamers or impractical by those who flee into the embrace of empty political theater and junk politics. These single payer advocates, joined by 50 doctors, filed a brief to the court that challenges, in the name of universal health care, the individual mandate.

“We have the solution, we have the resources and we have the money to provide lifelong, comprehensive, high-quality health care to every person,” Dr. Flowers said when we spoke a few days ago in Washington, D.C. Many Americans have not accepted the single payer approach “because people get confused by the politics,” she said. “People accept the Democratic argument that this [Obamacare] is all we can have or this is something we can build on.”

“If you are trying to meet the goal of universal health coverage and the only way to meet that goal is to force people to purchase private insurance, then you might consider that it is constitutional,” Flowers said. “Our argument is that the individual mandate does not meet the goal of universality. When you attempt to use the individual mandate and expansion of Medicaid for coverage, only about half of the uninsured gain coverage. This is what we have seen in Massachusetts. We do, however, have systems in the United States that could meet the goal of universality. That would be either a Veterans Administration type system, which is a socialized system run by the government, or a Medicare type system, a single payer, publicly financed health care system. If the U.S. Congress had considered an evidence-based approach to health reform instead of writing a bill that funnels more wealth to insurance companies that deny and restrict care, it would have been a no-brainer to adopt a single payer health system much like our own Medicare. We are already spending enough on health care in this country to provide high-quality, universal, comprehensive, lifelong health care. All the data point to a single payer system as the only way to accomplish this and control health care costs.”

Obamacare will, according to figures compiled by Physicians for a National Health Plan (PNHP), leave at least 23 million people without insurance, a figure that translates into an estimated 23,000 unnecessary deaths a year among people who cannot afford care. Costs will continue to climb. There are no caps on premiums, including for people with “pre-existing conditions.” The elderly can be charged three times the rates provided to the young. Companies with predominantly female workforces can be charged higher gender-based rates. Most of us will soon be paying about 10 percent of our annual incomes to buy commercial health insurance, although this coverage will pay for only about 70 percent of our medical expenses. And those of us who become seriously ill, lose our incomes and cannot pay the skyrocketing premiums are likely to be denied coverage. The dizzying array of loopholes in the law—written in by insurance and pharmaceutical lobbyists—means, in essence, that the healthy will receive insurance while the sick and chronically ill will be priced out of the market.

Medical bills already lead to 62 percent of personal bankruptcies, and nearly 80 percent of those declaring personal bankruptcy because of medical costs had insurance. The U.S. spends twice as much per capita on health care as other industrialized nations, $8,160. Private insurance bureaucracy and paperwork consume 31 percent of every health care dollar. Streamlining payment through a single, nonprofit payer would save more than $400 billion per year, enough, the PNHP estimates, to provide comprehensive, high-quality coverage for all Americans.

But as long as corporations determine policy, as long as they can use their money to determine who gets elected and what legislation gets passed, we remain hostages. It matters little in our corporate state that nearly two-thirds of the public wants single payer and that it is backed by 59 percent of doctors. Public debates on the Obama health care reform, controlled by corporate dollars, ruthlessly silence those who support single payer. The Senate Finance Committee, chaired by Max Baucus, a politician who gets more than 80 percent of his campaign contributions from outside his home state of Montana, locked out of the Affordable Care Act hearing a number of public health care advocates including Dr. Flowers and Dr. Paris; the two physicians and six other activists were arrested and taken away. Baucus had invited 41 people to testify. None backed single payer. Those who testified included contributors who had given a total of more than $3 million to committee members for their political campaigns.

“It is not necessary to force Americans to buy private health insurance to achieve universal coverage,” said Russell Mokhiber of Single Payer Action. “There is a proven alternative that Congress didn’t seriously consider, and that alternative is a single payer national health insurance system. Congress could have taken seriously evidence presented by these single payer medical doctors that a single payer system is the only way to both control costs and cover everyone.”

© 2012 Truthdig.com

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Chris Hedges

Chris Hedges writes a regular column for Truthdig.com. Hedges graduated from Harvard Divinity School and was for nearly two decades a foreign correspondent for The New York Times. He is the author of many books, including: War Is A Force That Gives Us Meaning, What Every Person Should Know About War, and American Fascists: The Christian Right and the War on America.  His most recent book is Empire of Illusion: The End of Literacy and the Triumph of Spectacle.

US Targeting Cuba’s Health-Care System June 4, 2011

Posted by rogerhollander in Cuba, Foreign Policy, Health, Latin America.
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Published on Saturday, June 4, 2011 by Consortiumnews.com

The U.S. government’s half-century campaign to discredit and destroy Cuba’s experiment with socialism has had many ruthless aspects, but perhaps none more so than efforts to disparage and damage the Caribbean island’s widely admired health-care system

  by  William Blum

In January, the government of the United States of America saw fit to seize $4.207 million in funds allocated to Cuba by the United Nations Global Fund to Fight AIDS, Tuberculosis and Malaria for the first quarter of 2011, Cuba has charged.

The UN Fund is a $22 billion a year program that works to combat the three deadly pandemics in 150 countries. [Prensa Latina (Cuba), March 12, 2011]

“This mean-spirited policy,” the Cuban government said, “aims to undermine the quality of service provided to the Cuban population and to obstruct the provision of medical assistance in over 100 countries by 40,000 Cuban health workers.”

Most of the funds are used to import expensive AIDS medication to Cuba, where antiretroviral treatment is provided free of charge to some 5,000 HIV patients. [The Militant (US, Socialist Workers Party), April 4, 2011]

The United States sees the Cuban health system and Havana’s sharing of such as a means of Cuba winning friends and allies in the Third World, particularly Latin America; a situation sharply in conflict with long-standing US policy to isolate Cuba.

The United States in recent years has attempted to counter the Cuban international success by dispatching the U.S. Naval Ship “Comfort” to the region.

With 12 operating rooms and a 1,000-bed hospital, the converted oil tanker has performed hundreds of thousands of free surgeries in places such as Belize, Guatemala, Panama, El Salvador, Peru, Ecuador, Colombia, Nicaragua and Haiti.

However, the Comfort’s port calls likely will not substantially enhance America’s influence in the hemisphere.

“It’s hard for the U.S. to compete with Cuba and Venezuela in this way,” said Peter Hakim, president of the Inter-American Dialogue, a pro-U.S. policy-research group in Washington. “It makes us look like we’re trying to imitate them. Cuba’s doctors aren’t docked at port for a couple days, but are in the country for years.” [Bloomberg News, Sept. 19, 2007]

The recent disclosure by WikiLeaks of U.S. State Department documents included this little item: A cable was sent by Michael Parmly from the U.S. Interests Section in Havana in July 2006, during the run-up to the Non-Aligned Movement conference.

Parmly notes that he is actively looking for “human interest stories and other news that shatters the myth of Cuban medical prowess.”

Michael Moore refers to another WikiLeaks State Department cable: “On Jan. 31, 2008, a State Department official stationed in Havana took a made-up story and sent it back to his headquarters in Washington. Here’s what they came up with: [The official] stated that Cuban authorities have banned Michael Moore’s documentary, ‘Sicko,’ as being subversive.

“Although the film’s intent is to discredit the U.S. healthcare system by highlighting the excellence of the Cuban system, the official said the regime knows the film is a myth and does not want to risk a popular backlash by showing to Cubans facilities that are clearly not available to the vast majority of them.”

Moore points out an Associated Press story of June 16, 2007 (seven months prior to the cable) with the headline: “Cuban health minister says Moore’s ‘Sicko’ shows ‘human values’ of communist system.”

Moore adds that the people of Cuba were shown the film on national television on April 25, 2008. “The Cubans embraced the film so much it became one of those rare American movies that received a theatrical distribution in Cuba. I personally ensured that a 35mm print got to the Film Institute in Havana. Screenings of Sicko were set up in towns all across the country.” [Huffington Post, Dec. 18, 2010]

The United States also bans the sale to Cuba of vital medical drugs and devices, such as the inhalant agent Sevoflurane which has become the pharmaceutical of excellence for applying general anesthesia to children; and the pharmaceutical Dexmetomidine, of particular usefulness in elderly patients who often must be subjected to extended surgical procedures.

Both of these are produced by the U.S. firm Abbot Laboratories.

Cuban children suffering from lymphoblastic leukemia cannot use Erwinia L-asparaginasa, a medicine commercially known as Elspar, since the U.S. pharmaceutical company Merck and Co. refuses to sell this product to Cuba. Washington has also prohibited the U.S.-based Pastors for Peace Caravan from donating three Ford ambulances to Cuba.

Cubans are moreover upset by the denial of visas requested to attend conferences in the field of Anesthesiology and Reanimation that take place in the United States. This creates further barriers for Cuba’s anesthesiologists to update themselves on state of the art anesthesiology, the care of severely ill patients, and the advances achieved in the treatment of pain.

Some of the foregoing are but a small sample of American warfare against the Cuban medical system presented in a Cuban report to the United Nations General Assembly on Oct. 28, 2009.

Finally, we have the Cuban Medical Professional Parole (CMPP) immigration program, which encourages Cuban doctors who are serving their government overseas to defect and enter the U.S. immediately as refugees.

The Wall Street Journal reported in January of this year that through Dec. 16, 2010, CMPP visas had been issued by U.S. consulates in 65 countries to 1,574 Cuban doctors whose education had been paid for by the financially-struggling Cuban government. [Wall Street Journal, "Cuban Doctors Come In From the Cold" (video), Jan. 14, 2011]

This program, oddly enough, was initiated by the U.S. Department of Homeland Security. Another victory over terrorism? Or socialism? Or same thing?

Wait until the American conservatives hear that Cuba is the only country in Latin America offering abortion on demand, and free.

© 2011 Consortiumnews.com

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William Blum

William Blum is an American author, historian, and critic of United States foreign policy. He studied accounting in college. Later he had a low-level computer-related position at the United States Department of State in the mid-1960s. Initially an anti-communist with dreams of becoming a foreign service officer, he said he became disillusioned by the Vietnam War. Blum can be reached at: BBlum6@aol.com

Health Reform Passes, But I Still Don’t Feel So Good March 23, 2010

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by Randall Amster

Published on Tuesday, March 23, 2010 by CommonDreams.org

Hurray! I mean, Boo! Or is it, What? Perhaps we should just go with Whatever. No matter how you slice it, something has happened that is either historically fabulous, monumentally stupid, perplexingly intricate, or ordinarily mundane. I suspect, in the end, it will wind up being all of this and more. Welcome to the brave new world of health insurance reform, with a little something for everyone and a lot for some.

Don’t get me wrong: health care is a really good thing, something that should be a universal human right and never treated like a for-profit commodity. The only options approaching this horizon were long ago deemed “fringe” in the popular debate, leaving progressives to huddle around a lukewarm “public option” that never had a prayer of making the final cut when it came time to pass the bill. Staunch legislative holdouts miraculously caved at the last minute to support a problematic law, and the only folks representing the “no” side of the argument in the end were the regressive wingnuts rattling congressional cages with thinly-veiled homophobia and racially-tinged expletives. You know things are bad when that cadre even starts to make a little bit of sense on the issues — although of course, their alternative health plan probably includes requirements that people first show their birth certificates and pass an English test before being handed a set of bootstraps and a grade school anatomy book that omits any images of private parts and excludes anti-American doctors like Seuss, Zhivago, Ruth, and Spock.

The best part of the new bill is where we all get to buy health insurance from Monopolies Unlimited, and if we can’t afford it there will be subsidies given to us that we can then give right to the same insurance companies who have of course served our interests so well up to this point. If we don’t purchase this coverage, then the IRS can levy fines on us, which in many cases will be cheaper than the required tithe; this will leave some folks in the awkward position of having to pay to remain uninsured, which would be ironic if it wasn’t so excruciatingly real. However, even those who do pay for coverage — top dollar, too, since viable price controls are a non-sequitur by now — will be receiving only insurance and not necessarily actual care, since many steps on the ladder to treatment must be traversed in between insurance provision and medical fruition. The apex of the perverse options will be embodied by those who refuse to pay the insurance companies for an inherently defective product and also refuse to pay the fine for their transgression, leading to a class of people perhaps to be deemed the “Uninsurables” who will be made to wear the letter “U” on their chests and will be legally prohibited from ever getting sick.

But wait! This new bill is only a first step in the direction of better and more universal health care, say the apologists. It’s the best we could get in this political climate, and represents the sort of compromise that marks both maturity and good sense. It emboldens the Democrats to be more progressive, and provides our fledgling young President with a much-needed momentum boost. It will save money, cover millions more people, rein in some of the worst insurance practices, and bring America into closer alignment with the rest of the nations of the civilized world. To oppose this bill at this critical time would indicate that one is either hopelessly partisan (Republicans), plain old wacko (Teabaggers), naively socialistic (Single Payer), deeply unrealistic (Public Option), or electorally useless (The Actual Left). At the end of the day, we have to get on board with this, since it’s the only game in town, right?

Hmm, I almost even convinced myself for a minute there (not really). Here’s another rendering of the game. Corporate lobbyists opposed the bill until they got the one they wanted, and indeed this one looks a lot like their model version proposed in 2008. Huge sums of money flowed to key congresspersons to purchase/influence their votes, and even the few still on the board who seem at times to display integrity reversed course and gave this one a thumbs up. The political landscape is now dominated by one party with no ideas except regressive anti-intellectualism, and another with no spine that is pretty well bought out by Corporate Persons who vote (and vote and vote) with their unlimited dollars. As for we the people, our triumph is that we now get to have more of us relegated to universal serfdom and also must (or else) pay fealty and tribute to the neo-Robber Barons who have generously expanded the realm of insurance coverage in a selfless act of noblesse oblige. The politics of “least worst” once again prevails, and our health is now totally owned by the company store. And as a final insult, people you like and admire are cheerleading for this, and to do otherwise renders one anathema (which is not covered under most policies, of course).

Suddenly, amidst the celebratory gaveling and laudatory reveling, despite the incessant and pervasive chatter about health this and health that, and notwithstanding the wire-services version of the good news about expanded coverage — suddenly, I’m not feeling all that well. Watching my country continue down a path of feudalism posing as democracy, where our choices are constrained by the machinations of the far right and the center-right, has left me with a damaged heart and an open wound. While my personal disillusionment is no doubt preexisting, its exacerbation is ongoing and I’m beginning to wonder if there’s any hope for a cure at this point. Indeed, I had tried to ignore this condition in the misguided belief that it would magically go away, but it only seemed to get worse in the process. Now I fear it’s become chronic.

But hey, we finally got health care, and hope is restored! Yes, this should effectively balance out perpetual wars, environmental toxification, Big Brother, Bigger Bailouts, mainstream media, rampant recession, and climate change. Whew! It felt good to list all that out. Maybe I won’t be needing that required checkup from my cold-handed health insurance provider after all.

Randall Amster, J.D., Ph.D., teaches Peace Studies at Prescott College, and is the Executive Director of the Peace & Justice Studies Association. His most recent book is Lost In Space: The Criminalization, Globalization, and Urban Ecology of Homelessness (LFB Scholarly 2008).

A Canadian doctor diagnoses U.S. healthcare August 6, 2009

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The caricature of ‘socialized medicine’ is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients’ health.
By Michael M. Rachlis
August 3, 2009
» Discuss Article    (360 Comments)

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.

On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.

These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn’t happen. And perverse incentives like fee-for-service make things even worse.

Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world’s best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?

American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.

Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

Michael M. Rachlis is a physician, health policy analyst and author in Toronto.

Stop Playing Politics with our Healthcare July 29, 2009

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Elena Dumas

www.opednews.com, July 29, 2009

“Fear concentrates on what can go wrong ["] it interferes
with one’s confidence in being able to do what is right.”
Donald DeMarco

It is time to stop playing politics with our health and our health care. We are caught in a political chess game in which we are held out as mere pawns by our politicians.

Our health, and the care of it, is being used by politicians in both parties, by the insurance companies and by the President, to advance their own hold on power, their money wealth, and their political greed.

Immobilized by fear, whether of Republicans using their pulpit to rail against them, or by the fear of losing the silver coins put in their pockets by the moneyed insurance companies, or by the fear of losing their stranglehold on power, not one democrat politician, not even the President, have the grace, the courage, the fortitude to act under pressure and do the right thing. For, we are not serfs and we are not pawns.

We are human beings whose lives, we thought at one time, no one could place a value on.

That belief has fallen by the wayside today. We either have tons of money to pay for our healthcare, or we are castaways.

The new Castaways of the 21st Century, who are, (according to Obama in his press conference on July 22nd the latest malaise, the worst cancer draining our economy):

Those of us on Medicare whose health and medical insurance benefits are of no consequence to the moneyed politicians, who, without blinking an eye will chop-off benefits to us, the silver haired population, regardless of the live or die consequences those cuts will have, or are already having on our health.

The working have nots. Those of us lucky enough to hold a job in the shambles of this economy. A job which barely helps us meet the obligations of paying rent, or mortgage, putting food on the table, owning a car and putting gas in it, but who are unable to purchase health insurance due to the extreme high cost of it, or carry an employer provided insurance which benefits have been cut to the bare minimum, or work for employers who refuse to, or can’t afford any longer, they say, to provide health insurance benefits for those of us working for them.

The people on welfare whose health care depends on the Medicaid system.

We are all the new Castaways of the 21st Century.

So, this whole health care reform thing is a sham to our politicians. It is a hoax, our politicians are self-absorbed shammers of major proportions who are playing a chess game with our lives.

They are like the fox and the cat in the Pinocchio tale. They are working hard to convince us (and convince themselves since they have the power to vote Yes or vote No) that we do not need, and they cannot give us, the healthcare that we really need: Single-Payer Universal Healthcare. A healthcare which would go a long ways into returning us to our status of human beings, away from the pawn and serfdom status that they now grant us.

These politicians, who, one and all, pride and honor themselves as highly moral, highly honorable, highly compassionate, cannot see that they are really tepid in their morality and their compassion, timid in really taking on the health care reform, highly sentimental when it comes to departing with the money deposited in their pockets, bank accounts or PAC accounts by the insurance companies.

They also suffer from a reckless fortitude which blinds them to the courage needed to stand up and do the right thing for we, the people …

 elena dumas is a fictional name. the real person behind the fictional name is a computer activist. She is a former mental health clinician. A poet and a freelance writer. Her work has been published in several online publications.

 

Britain’s National Health Service: Simple, Sensible and Civilized July 5, 2009

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Published on Sunday, July 5, 2009 by the Los Angeles Times

A former NHS patient has some advice for Americans skeptical of single-payer, government-run healthcare: You’ll get over it.

by Clancy Sigal

For the first couple of years I lived in Britain, I was an illegal immigrant from the United States, visaless with an expired passport and looking over my shoulder all the time. Even so, from the very first day I arrived at Victoria Station in London, suffering from bronchitis, I was accepted in the NHS — the national health scheme, we called it — no questions asked and no ID required.

After I’d become a legal resident, I asked my doctor why he had taken me, almost literally off the boat, with so little fuss. Weren’t foreigners a drain on his time and the National Health Service? He shrugged. “If you come here with a contagious disease, we don’t want you infecting the rest of us. So of course we give you medical care. Purely selfish on our part.”

For three decades I used and, being of a hypochondriacal nature, exploited the British medical system without paying a farthing except for the taxes taken out of my wages as a working journalist. And that single-payer, socialistic, government-run, bureaucratized, heavily used, nationalized health system served me — and 50 million others — very well. In need, I saw many doctors, with no money ever changing hands. There was nothing to sign, hardly any papers to shuffle. My primary-care physician ran his “surgery,” his office, with the help of only one receptionist whose job it was to arrange appointments.

My doctor’s waiting room in his storefront office was by American standards shockingly casual, even a trifle seedy. In what was then a rigid class society, the waiting room was also a lesson in democracy where duchesses and dustmen, old and young, rich and poor, waited their turn. It wasn’t perfect. There was the occasional misdiagnosis, crowded hospital ward, sleepy student nurse. But it worked.

It was all free, including specialists, and I came to believe that healthcare is a right, not an entitlement I had paid for. This “free” part sometimes puzzled my visiting American friends. When they got ill in London, I’d send them to my doctor, who would smile bemusedly when offered money. Did they appreciate this? Hardly. “Your doctors,” they’d say, “can’t be much good, can they?”

Is this too rosy a picture of single-payer, government-run healthcare? Maybe. Over the years, an underfunded, over-bureaucratized, increasingly privatized NHS has in some areas turned into a shadow of its former vibrant self.

Perhaps I was lucky to arrive so soon after World War II, when a traumatized, bomb-weary public was in no mood to revisit a prewar history of medical deprivation and the humiliation of means testing. Slowly, over time, by argument and debate, a consensus had been achieved, by Conservatives and Labor alike, that, in the words of Edward VIII as Prince of Wales when he first saw the grinding poverty of the unemployed, “something must be done.”

Recently, the American Medical Assn. responded with skepticism to President Obama’s plea for healthcare reform. In Britain, too, the massed ranks of the medical profession at first fought bitterly against a “socialized” service covering all from cradle to the grave. But Labor’s health minister, a firebrand from the mining valleys, Aneurin Bevan, brought them into line with a mixture of enticements and threats.

The NHS was, and is, a classically English compromise, in which individual doctors are independent contractors paid by the government according to the number of their patients. Doctors are free to remove patients from their list, and patients are free to go elsewhere. Once ideology was laid aside and the system got working, it was actually quite simple.

Once launched, in an astonishingly short time, a matter of a year or so, the NHS was accepted by even its worst enemies — the doctors and the Conservative Party — as indispensable and a civilized way of dealing with life, illness and death.

Does that sound so awful?

© 2009 Los Angeles Times

Clancy Sigal is a writer and former BBC broadcaster who lives in Los Angeles.

We’ve Been Trapped Inside a Bad Health Care System So Long, We Don’t Even Know How Much We’re Missing June 26, 2009

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By Sara Robinson, Campaign for America’s Future. Posted June 26, 2009.

www.alternet.org

Our current system has robbed us of the chance to save, educate ourselves, see the world and live to a robust old age.

Sometimes, when you’re up to your chin in alligators, it’s hard to focus on the fact that there’s a big, broad, alligator-free world waiting somewhere out there, beyond the edge of the swamp.

In this case, it’s hard for most Americans to even imagine that nobody in the rest of the developed world lives this way. We’ve been living inside the restrictions and making the trade-offs required to hang onto our all-important health care coverage for so long that we don’t even realize that we’re cutting those deals, or what we’re giving up, or how thoroughly those choices have come to dominate and limit our lives.

If you’re an American under 40, you can’t remember a time that the health care system didn’t work this way — or that keeping coverage wasn’t a dominant factor in making your life choices. If you’re older than that, the memory of another, happier era beyond the swamp is dim, and fading fast.

This was one of the things that struck me hardest when I arrived in Canada five years ago. The swamp-blindness was so dark and deep that it took a while to adjust to a world without alligators. It’s almost impossible to describe to folks back home how different life is when health insurance simply doesn’t factor at all into how you choose to live your life. There’s almost no language for it. Rather than even attempt it, I sometimes just ask my American friends and relatives to open up their imaginations, and answer the question for themselves:

  • How would your life be different if you never had to worry about getting, keeping, or affording health care again?
  • What other choices might you have made?
  • Where else would you be right now?
  • How would it change your plans for the future?

I’ve seen people reduced to tears of rage and frustration by these questions. When you really stop and think about it — pause for a few minutes to take it all in, past, present, and future — it becomes clear that the full absurdity and the sheer enormity of the sacrifices we have to make for an almighty health care card are the greatest obstacle to life, liberty and the pursuit of happiness that most of us are burdened with today.

Polls say most Americans who have health care are satisfied with it. But nobody ever asks them if they’re satisfied with what they’ve had to do to get it, keep it, or afford it.

What would you do differently? I watch my Canadian neighbors live their lives, and the world beyond the swamp comes into sharp and stunning focus.

My neighbors go to the doctor when they need to — and often, when they don’t. If they’re just feeling funky for a day or two, they go. If the splinter is too big to handle with a needle, they go. Anything goes a little bit sideways — they go.

By American standards, they’re probably overusing the system. (My husband once asked an employee who was nursing a cough, “Have you seen a doctor about that?” The guy just looked at him, confused. Of course he’d seen a doctor. Up here, only an American would ask such a stupid question.)

But the upshot is that the small symptoms of really big things — little lumps, creeping blood pressure, wounds that don’t heal right, coughs that don’t go away — are caught and diagnosed early in a GP’s office, instead of months or years down the road in a full-blown crisis at the ER, which is now the American way. And this is central to cost containment: getting emergent problems calmly headed off right away in a $30 office visit is a lot more cost-effective than having to deal with the full catastrophe later on in a $3,000 emergency-room drama scene. And it allows people to maintain their good health through the years, instead of delaying treatment until it’s too late to recover it and permanent damage is done.

My neighbors heal, recover, and go on with their lives. The U.S. disability rate last year was 19.1 percent, and rising fast. In Canada, it’s 14.3 percent — and Statistics Canada believes that the only reason their stats are creeping up these days is that people who once hid their disabilities are now more willing to admit them.

That disability rate affects the country’s economic competitiveness. Americans just don’t have the time or money to spend on a proper recovery after a major event, or get the full course of treatment that a chronic condition requires to be truly well-managed. Fearing for our income or our jobs, we hurry back to work too soon. Our insurance doesn’t cover necessary follow-up therapies, so things may not heal thoroughly or properly. We can’t afford the drugs, so we cut the pills in half, or stop taking them entirely.

The result is that too many of us end up far more impaired than we need to be — and may, in fact, never be quite right again. Deferred maintenance — which is what this is — takes a ferocious toll on the American workforce, which is now being forced to compete with workers around the world who get better care, make better recoveries, and are able to return to work at full strength.

My neighbors start small businesses. Americans routinely stay chained to jobs they hate because they can’t afford to lose coverage. Canada has an exuberant entrepreneurial culture, fueled by favorable tax structures for small business and a preference for Main Streets over malls. Canadians may bet the house and the kids’ college funds on a new venture; but they never think twice about whether or not they can afford to leave BigCo because they’ll lose their insurance, or what will happen to the new business if they get hit by a delivery truck, or how they’ll afford some kind of minimal coverage for their new employees. Unburdened by health care costs or concerns, their ventures are far more likely to thrive.

My neighbors go back to school. Low-cost government-subsidized universities combined with assured health care make it easy for people to make mid-course career adjustments, pursue their passions, and expand their horizons. The upshot is a better-educated, more capable workforce that’s constantly improving its skills.

My neighbors quit jobs they hate. “Take this job and shove it” is a lot easier — and sweeter — when your boss isn’t holding an almighty health care card over your head. Bosses know this, too, and working conditions are often better as a result.

My neighbors stay home with their kids. They can afford to do that, because they’re not wholly dependent on whichever breadwinner can manage to find a job with a decent health care plan.

My neighbors invest. They’ve got stable household budgets that aren’t being thrown off by surprise health events. Because Canada doesn’t have a mortgage interest deduction, most Canadians reduce interest costs by taking out 10- or 15-year mortgages. The payments really squeeze the family budget for that decade — but by their 40s a lot of them own their homes outright, something most Americans will never achieve. Home ownership, college savings and retirement funds are all big-money investments that you simply can’t commit to if you’re liable to be hit with five-figure medical bills at any moment.

My neighbors travel. Americans don’t get vacation time; and when they do get it, they tend to stay in-country. A lot of Canadians take three weeks off in the winter to go somewhere fabulous and warm (understandable, given the climate). The sheer variety of these escapes boggles me yet: They fly off to build schools in Guatemala, or take holiday jobs in New Zealand, or learn French in Morocco. Even the guy who paints my house can afford to do this, because he’s not spending half his annual income on health care premiums. That $15K-a-year savings will buy a whole lot of margaritas in Cancun.

The result is a population with broad global awareness, and extensive global ties — a necessary thing for a country whose economy depends completely on trade. And it may be an important factor in keeping Canada progressive. According to Diana Kerry, who ran her brother John’s overseas campaign in 2004, Americans who own passports vote Democratic three to one. So travel makes you liberal. Who knew?

My neighbors seldom go bankrupt. The Canadian bankruptcy rate has soared in the past year to 4.3 per thousand. In the U.S., it’s 11.1 per thousand. The entire difference between these two figures is accounted for by the fact that 62 percent of all U.S. bankruptcies were driven at least in part by medical expenses.

But tidy numbers like this elide a harder reality: Bankruptcy doesn’t just cost us financially. It also destroys the foundations of our social capital. When the house, the dreams, and the future are gone, very often the marriage is the next thing that goes, too. Bankruptcy travels in close company with domestic trouble, divorce, drug use, homelessness, and broken families. (After medical-bill refugees, the second most common people in bankruptcy courts are recently divorced women.) If, as conservatives like to remind us, the family is the basic unit of civilization, then our health care system is directly making its profits by pulling down our social foundations — and ultimately undermining our ability to hold our civilization together.

My neighbors have never seen anyone die because they didn’t have health care. With 22,000 Americans dying every year due to a lack of health insurance — that’s one every 24 minutes — there aren’t many of us who don’t know someone who lost a loved one because they couldn’t get the treatment they needed. (For me, it was my father.)

But when I share this factoid with Canadians, they invariably do a long double take. They lean back, squint, stare, and pause to reassess my credibility (if not my sanity). It’s literally unbelievable. They can’t even process it. I must be making it up, or at least exaggerating. It’s just beyond the realm of imagining that a rich nation like America would let that kind of thing happen — let alone let it happen sixty times a day, for years on end.

And yet, they know things are bad down here, because everybody who goes South buys travel insurance before they cross the border. Everybody has heard scary stories about people who got sick or hurt and ended up in an American ER with a five-figure bill to pay. It’s just a stupid risk, and they’re not willing to take it.

What would you have done differently if you’d never had to worry about health insurance? How would life be different now? How would it change your plans for the future?

Go ahead. Think about it. Let yourself get good and angry. The current system has robbed an entire generation of Americans of their full potential. It has made us serfs. It has narrowed our horizons. It has undermined our families and communities. It has deprived us of the chance to save, to own a home, to educate ourselves and our children, to see the world, to retire in comfort, and to live to a healthy and robust old age.

It has left us in this swamp, chin-deep in alligators. And the first step in getting back out is getting very clear in our own minds that there are other places where people don’t live this way — and then angry enough to lean on our leaders, and make it just as clear to them that we don’t intend to live like this any more, either.

Your representatives need to hear from you. Today.

Because your future is still out there — and the most important thing you need to get there is a health care plan nobody can ever take away.

 Sara Robinson is a Fellow at the Campaign for America’s Future, and a consulting partner with the Cognitive Policy Works in Seattle. One of the few trained social futurists in North America, she has blogged on authoritarian and extremist movements at Orcinus since 2006, and is a founding member of Group News Blog.

Obama Running Scared June 23, 2009

Posted by rogerhollander in Health.
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Published on Tuesday, June 23, 2009 by the Albany Times Union (New York) by Helen Thomas

A universal health care system based on the single-payer model appears to be a bridge too far for President Barack Obama.

A single-payer system, such as Medicare for everyone, would provide health care for all.

President Lyndon Johnson had the courage to weigh in with all his clout to win passage of Medicare and Medicaid.

President Roosevelt put all his chips on the table to win passage of the Social Security Act that makes the elderly more secure.

All around the world, governments have long made medical care available for their citizens. Why not us?

Obama clearly has no stomach for the political battle that any single-payer plan would ignite. So he’s endorsed a step that would allow the government to provide health insurance coverage — not health care — to eligible people. Such government-sponsored health insurance is being considered in Congress as it writes health care reform legislation.

While the public plan option gets full consideration in Congress, the single-payer model has been unwelcome at the White House or on Capitol Hill.

Obama said part of the fierce opposition to health care reform has been fueled “by some interest groups and lobbyists — opposition that has used fear tactics to paint any effort to achieve reform as an attempt to, yes, socialize medicine.”

He made it clear that his idea of health care reform would allow patients to choose their own doctors and keep their own health plans.

Somehow government bailouts have been more palatable for Wall Street plutocrats who happen to be needy.

Obama stressed in a speech to the AMA in Chicago last week that he does not favor socialized medicine.

Some 47 million Americans are uninsured — many because some employers have dropped coverage in the economic downturn. Others lack insurance because pre-existing illnesses deny them access to private insurance. There also are millions with no way to pay for soaring health insurance payments because they have lost their jobs.

Nearly all Republicans and some moderate Democrats oppose any public plan option. These are the same lawmakers who receive many government-provided perks including health insurance.

In his remarks to the AMA, Obama warned against “scare tactics” and “fear mongering” by opponents of the public plan option, which the President said should be available to those who have no health insurance.

Obama rejected the “illegitimate concern that’s being put forward by those who are claiming that a public option is somehow a Trojan horse for a single-payer system.”

Obama should tear a page out of LBJ’s vote-getting manual and shame the heartless opponents.

The health of all Americans is our business.

© 2009 Times Union

Helen Thomas is a columnist for Hearst Newspapers. E-mail: helent@hearstdc.com.  Among other books she is the author of Front Row at The White House: My Life and Times. 

Healthy Opinions About Health Care June 21, 2009

Posted by rogerhollander in A: Roger's Original Essays, About Health, Canada, Health.
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Roger Hollander, www.rogerhollander.com, June 21, 2009

We Canadians know a good thing when we see, and live it and enjoy it and depend on it.  I’m not talking about maple syrup, although that might come in a distant second.  It’s our national health plan.  In the forty one years I have lived in Canada I have never once heard any politician from any political party suggest its abolition (not that the Tories do not do their best to defund and attempt to erode it).  It would be political suicide.  A few years ago a CBC poll asked Canadians who in their estimation was the greatest Canadian of all times.  The hands down winner was Tommy Douglas, the man who, as Premier of the prairie Province of Saskatchewan, introduced universal health care to Canada (he also happened to be Donald Sutherland’s father-in-law).

 

What Canada has is NOT government health care.  It is rather universal health insurance with a single insurer, the government (organized province by province).  Contrary to myth, and unlike HMOs and other private health insurance in the States, Canadians have an absolute right to choose their own physicians.  Furthermore, in all my years living in Canada not once have I walked into a doctor’s office, clinic, laboratory or hospital and had to open my wallet (other than to produce my plastic health card).  When my father was visiting from the States and needed to see my primary care physician, the office staff had to fumble around trying to figure out how to take a cash payment from him.  It had never happened before.

 

The Canadian health care provider, be it a physician, laboratory, etc., simply fills out a form and sends it to the government for payment according to a scale that is negotiated between the government a provider organizations such as the Canadian Medical Association.  There are no blood-sucking private health insurers to send costs through the ceiling and squeeze out bigger profits with co-payments and by denying treatment.  The Canadian plan is funded by employer and employee contributions. 

 

Despite massive disinformation campaigns about the Canadian health care system that are funded and promoted by the health insurance industry, the pharmaceutical industry and the Republican Party, a majority of Americans favor what is referred to as a single-payer system over the existing Rube Goldberg system in the States that passes for health care, a system that costs more, yields poorer results, and leaves tens of millions without coverage.

A CBS News/New York Times poll that was published in today’s New York Times (http://www.nytimes.com/2009/06/21/health/policy/21poll.html?_r=1&hpw) showed that 72% of respondents supported government health insurance with only 20% opposed (the poll did not refer to a “single-payer” plan, but rather a public plan that would compete with private plans; other polls have shown a majority in favor of single-payer).

Surprisingly, the poll showed 50% of Republicans in favor with 30% opposed.  87% of registered Democrats approved and 73% of Independents.

50% of all respondents thought government would do a better job than private insurance companies in providing medical coverage against 34% who thought it would do a worse job.  59% thought government would do a better job of holding down health costs while 26% thought they would do worse.

But here is what for me is the most interesting and telling statistic that arises out of the poll.  Respondents were asked if they were willing to pay higher taxes so that all Americans have health insurance that they can’t loose no matter what.  57% said yes and 27 % said no.  That’s better than a two to one ratio.  And here’s the kicker: of those who earn less than $50.000 annually, 64% are willing to pay more so fellow Americans are not denied health care and 27% are not.  For those earning more than $50,000, 52% are willing and 44% are not.  

Look at those numbers carefully.  While only 27% of poorer Americans are not willing to help their fellow citizens, a whopping 44% of those with greater means don’t give a damn.

This is what I call compassionate conservatism.

Held Hostage by the Health System May 24, 2009

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by Dr. Marcia Angell

The Senate Finance Committee’s hearings on health reform earlier this month did not include testimony from any advocate for single-payer insurance. Physicians for a National Health Program, which represents 16,000 doctors, asked the committee to invite me to testify, but it chose not to. If I had been invited, this is what I would have said:

The reason our health system is in such trouble is that it is set up to generate profits, not to provide care. We rely on hundreds of investor-owned insurance companies that profit by refusing coverage to high-risk patients and limiting services to others. They also cream off about 20 percent of the premiums for profits and overhead.

In addition, we provide much of our medical care in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most physicians are paid fee-for-service, which gives them a similar incentive, particularly specialists who receive very high fees for performing expensive tests and procedures. Nonprofits behave much like for-profits, because they must compete with them. In sum, healthcare is directed toward maximizing income, not maximizing health. In economic terms, it’s a highly successful industry, but it’s a massive drain on the rest of the economy.

The reform proposals advocated by President Obama are meant to increase coverage for the uninsured. That is certainly a worthwhile goal, but the problem is that they leave the present profit-driven and highly inflationary system essentially unchanged, and simply pour more money into it – an unsustainable situation. That is what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are poor without cutting benefits and greatly increasing co-payments. Initiatives such as electronic records, case management, preventive care, and comparative effectiveness studies may improve care, but the Congressional Budget Office and most health economists agree that they are unlikely to save much money. Promises by for-profit insurers and providers to mend their ways voluntarily are not credible.

Nearly every other advanced country has a largely nonprofit national health system that provides universal and comprehensive care. Expenditures are on average about half as much per person, and health outcomes are generally much better. Moreover, these countries offer more basic services, not fewer. They have on average more doctors and nurses, more hospital beds, longer hospital stays, and there are more doctor visits. But they don’t do nearly as many tests and procedures, because there is little financial incentive to do so.

It is often argued that the first order of business should be to expand coverage, and then worry about costs later. But it is essential to deal with both together to stop the drain on the rest of the economy and the further fraying of healthcare. The only way to provide universal and comprehensive coverage and control costs is to adopt a nonprofit single-payer system. Medicare is a single-payer system, with low overhead costs, but it uses the same profit-oriented providers as the private system and also preferentially rewards specialists for tests and procedures. Consequently, its costs are rising almost as rapidly as those in the private sector. Representative John Conyers introduced an excellent bill that calls for extending Medicare to everyone in a nonprofit delivery system. That could be done gradually, by lowering the Medicare age a decade at a time.

A single-payer system is ignored by lawmakers because of the influence of the health industry lobbies. They raise the specter of rationing and long waits for care. There are indeed waits for some elective procedures in some countries with national health systems, such as the United Kingdom. But that’s because they spend far less on healthcare than we do. For them, the problem is not the system; it’s inadequate funding. For us, it’s not the funding; it’s the system. We spend more than enough.

I urge you to consider a nonprofit single-payer system. The economic interests of the health industry should not be permitted to hold the rest of the economy hostage and threaten the health and well-being of the public.

 © Copyright 2009 Globe Newspaper Company.

Dr. Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine.
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