Monday, November 30, 2009

I'm Mad as Hell. Thank you Kim

Thank you Kim. I write this because I'm mad as hell. I'm with the Mad as Hell Doctors, who went to Washington D.C., in support of single payer health care for the U.S. I'm mad as hell at the Wall Street boys whose only concern is next quarter's profit report. And I'm really mad as hell at how the cash register politics our current crop of legislators and corporate-amerika have subverted the explicit intent of the founding fathers and pony up the current version as a faithful constitutional political system.

God, what a parody; it makes the Capitol Steps & The Onion look like kindergarten rehearsals. I'm mad as hell at what corporate-amerika is doing to our people and our jobs for the sake of the sacred quarterly reports and CEO bonuses; 10% of total corporate profits go to the top 5 executives of that corporation. At the same time the workers make less today than before Reagen began dismantling FDR's return to the founding fathers economic vision for America.

I'm mad as hell that people die every day because they have no health insurance, or can't meet the co-pays or some insurance twit sits in an office and denies a claim due to a fabricated "pre-existing" condition. All to save and improve the "bottom line".

I'm mad as hell that we're #1 in bombs, #1 planes, #1 in war, #2 in brains and #37 in health care (thank you Paul Hipp). Our babies die; our people lose their homes and discover street-level poverty because our health care system is worse than Andora's.

I'm mad as hell as hell that General McChrystal has the audacity to suggest that we need to send an additional of our fellow citizens to secure Afghanis-nam - for what? Our security? Give me a break. If we're so impotent at protecting our borders against all comers, what makes us think building the fence someplace in the Middle East will make us safer? Bin-Laden? Idiot Bush allowed the one clear opportunity to grab him, slip through his fingers, simply through inaction at the opportune moment - you can read about it. What did the Taliban ever do to us?

On Afghanis-nam: the U.S. lost the one time we really had to perhaps make a difference when the Russians admitted defeat, largely due to "Charlie Wilson's War". As mentioned at the end of the book, Wilson saw and understood the humanitarian needs we could fulfill as the Russians departed. But as soon as the perceived "cold war victory" and associated male breast pounding were done, Afghanistan and Bin Laden were forgotten until 9/11. And then idiot-Bush bungled our next best chance.

I'm just mad as hell. God dammit, we need those folks and the trillions of debt that idiot-Bush started the spending for, right here at home. We need those dollars for our infrastructure, health care, education and jobs. We need a whole lot of nation building right here at home.
God, we're so blind. Just look at how Denmark lives. Or Norway. Or Sweden. Or... or France who has the #1 health care delivery/results in the world.

When was the last time you read Patrick Henry's "The Rights of Man" and contextualized it for today. The way "we the people" are allowing the economic powerful to gain control of our nation today would have Paul Revere riding days and nights until he collapsed from exhaustion.

The "takers" are back and if we don't get mad as hell and quit pretending that somehow things will turn out OK, well then, perhaps you'll believe me when I tell you that the moon landing was just a Hollywood stunt, filmed in a back lot studio.

I'm mad as hell at you; my feckless fellow citizens for sitting like a bunch of frogs in the ever warming water. Have you so totally succumbed to the Orwellian and wandered into Huxley's drug-hazed “Brave new World" that you've forgotten the roots of this nation? And the price our founding fathers paid for the principles espoused in the Declaration and the Bill of Rights? Not to mention the Constitution?

We fill our minds like we fill our stomachs and do nothing more than sit – the boiling frog generation. The gen-boilers! Somehow thinking because we know a thing, then we've done all we need to do. But it's like so much of the garbage we put into our mouths and think it is nutrition for our bodies; until we discover too late that what we thought was "food" is really crap that just made us fat and started to feed the cancers, etc that are so endemic in our culture.

All the while, "we the people" scurry about mindlessly and faithfully follow the propaganda Madison Avenue spews at us. We've become like geese, with funnels down our throats, the corporate world eagerly awaiting the foie gras nickels we crap into their coffers. Like grease through a goose our gold flows into their off-shore, tax-evading accounts.

And we think we're happy - just look at us. The "Robber Barons" have returned. History demonstrates once again that it repeats itself; and the only fools are us, who fail to take its lessons - this is the third cycle for the U.S.

When are you going to get mad as hell? The social networks provide a great opportunity to promote a return to our constitutional roots as united citizens; but it means we'll have to expand our use of them to more than the martinis and lattes I spoke of earlier. It will take more souls the likes of Kim who sent me the tweet:

Watch it. Think about it. Think about our current situation. Understand how we got here and the thinking and ideas that got us here; and who promoted those ideas. Use your brains; they are there for more than ESPN and Twitter (both of which have their place - like maybe #38 & #39).

Sunday, November 29, 2009

Food Reform Must Go Hand in Hand w/Health Care Reform

Food writer Michael Pollan thinks food industry reform goes hand in hand with health care reform. Host Guy Raz talks to Pollan about how to improve America's eating habits and wean the country away from the cheap, unhealthy food produced by big agribusiness.
Copyright © 2009 National Public Radio®. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.
GUY RAZ, NPR host:
Welcome back to ALL THINGS CONSIDERED from NPR News. I'm Guy Raz.
In an opinion piece this week in the New York Times, Michael Pollan writes:
Professor MICHAEL POLLAN (Journalism, University of California Berkeley; Author, "In Defense of Food: An Eater's Manifesto"): The American way of eating has become the elephant in the room in the debate over health care.
RAZ; That's Michael Pollan, author of "In Defense of Food."
The Centers for Disease Control and Prevention now says most health care spending in America goes to treat preventable diseases, many of them linked to diet. And according to Pollan, one of the leading products of the American food industry has become patients for the American health care industry.
Michael Pollan, how does the food industry create business for the health care industry?
Prof. POLLAN: Well, as you suggest in your intro, we've got an epidemic of chronic disease linked to diet. It represents a significant part of the money we're spending on health care. We're talking about type 2 diabetes, cardiovascular disease, many types of cancer. And right now the one that is really threatening to bankrupt the health care system is type 2 diabetes, which the CDC estimates that one in three Americans born after the year 2000 may well get, and that's really expensive to treat. You know, the government's about to put itself on the hook to pay a lot of these costs and they could well swamp the new health care system.
RAZ; Michael Pollan, President Obama was in Minnesota today to stump for his health care reform plan. Minnesota, of course, is a big agribusiness state. It's one of the country's largest corn producers. You target high fructose corn syrup in particular and you talk about how the government both subsidizes this product and the treatment of type 2 diabetes caused in part by the consumption of this product.
Prof. POLLAN: Yeah, that's the big contradiction of our system. And we have a set of agricultural subsidies that are designed in such a way that they encourage farmers to overproduce things like corn, and that big corn crop gets turned into soda in the form of high fructose corn syrup and other sweetened beverages.
We know that adolescents are getting about 15 percent of their calories from these drinks. One of the reasons that soda is so popular is it's cheap, and the reason for that is that the high fructose corn syrup is so cheap, and then we're also paying for the cost, the damage that all that cheap sugar is doing to our health.
RAZ; You write that the health care industry actually gets more profit from, for example, amputating a diabetic's leg rather than preventing that person from getting diabetes in the first place. How is that?
Prof. POLLAN: Well, it's one of the perverse incentives we have. You know, much money is made in treatments and very little money is made in prevention. When you're doing prevention, you're addressing everybody. You know, you're counseling a lot of people who are never going to get diabetes.
So one of the things that happens, I think, under the rules changes that are being proposed, in even the weakest of the health care bills on offer right now, would change those incentives I think in a very positive way. At least on part of the health insurers, they would be on the hook in a way they're not now. They will have a direct financial interest in preventing every new case of Type 2 diabetes or obesity or heart disease.
RAZ; Large agribusinesses do make food cheaper. There's no question about that. How do you make your case particularly when we're in the middle of an economic crisis?
Prof. POLLAN: You know, nobody likes food to get more expensive and everybody likes cheap food. But it's important to understand the real cost of cheap food. You pay one way or another. The food may be cheap to the consumer, but the cost to your health and the cost to the system, when you add that together, it's not so cheap.
RAZ; What do you propose to do for people who don't have easy access to fresh produce, to high quality food?
Prof. POLLAN: Sure. Well, there are many different levers we can pull. I mean, we can look at food assistance. What if all those food stamps recipients also got a $20 or a $30 monthly coupon that allowed them to buy fresh produce or go to the farmers' market? That would suddenly draw farmers' markets into the inner cities to reap all that cash.
RAZ; What if health care is overhauled and it doesn't change the American diet in any way?
Prof. POLLAN: We'll go broke. If we don't get a handle on these health care costs, the new system or the old system, we'll go broke. And that's why I think that really food is the elephant in the room when we're talking about health care.
RAZ; Michael Pollan is knight professor of journalism at UC Berkeley and the author of several books, including "In Defense of Food: An Eater's Manifesto." He joined us from Berkeley.
Michael Pollan, thanks so much.
Prof. POLLAN: Thank you, Guy.

Sunday, November 22, 2009

Advice From Grandma

Published: November 21, 2009

President Obama’s visit to China this week inevitably invites comparisons between the world’s two leading powers. You know what they say: Britain owned the 19th century, America owned the 20th century, and, it’s all but certain that China will own the 21st century. Maybe, but I’m not ready to cede the 21st century to China just yet.

Why not? It has to do with the fact that we are moving into a hyperintegrated world in which all aspects of production — raw materials, design, manufacturing, distribution, fulfillment, financing and branding — have become commodities that can be accessed from anywhere by anyone. But there are still two really important things that can’t be commoditized. Fortunately, America still has one of them: imagination.

What your citizens imagine now matters more than ever because they can act on their own imaginations farther, faster, deeper and cheaper than ever before — as individuals. In such a world, societies that can nurture people with the ability to imagine and spin off new ideas will thrive. The Apple iPod may be made in China, but it was dreamed up in America, and that’s where most of the profits go. America — with its open, free, no-limits, immigrant-friendly society — is still the world’s greatest dream machine.

Who would cede a century in which imagination will have such a high value to an authoritarian society that controls its Internet and jails political prisoners? Remember what Grandma used to say: Never cede a century to a country that censors Google.

But while our culture of imagination is still vibrant, the other critical factor that still differentiates countries today — and is not a commodity — is good governance, which can harness creativity. And that we may be losing. I am talking about the ability of a society’s leaders to think long term, address their problems with the optimal legislation and attract capable people into government. What I increasingly fear today is that America is only able to produce “suboptimal” responses to its biggest problems — education, debt, financial regulation, health care, energy and environment.

Why? Because at least six things have come together to fracture our public space and paralyze our ability to forge optimal solutions: 1) Money in politics has become so pervasive that lawmakers have to spend most of their time raising it, selling their souls to those who have it or defending themselves from the smallest interest groups with deep pockets that can trump the national interest.

2) The gerrymandering of political districts means politicians of each party can now choose their own voters and never have to appeal to the center.

3) The cable TV culture encourages shouting and segregating people into their own political echo chambers.

4) A permanent presidential campaign leaves little time for governing.

5) The Internet, which, at its best, provides a check on elites and establishments and opens the way for new voices and, which, at its worst provides a home for every extreme view and spawns digital lynch mobs from across the political spectrum that attack anyone who departs from their specific orthodoxy.

6) A U.S. business community that has become so globalized that it only comes to Washington to lobby for its own narrow interests; it rarely speaks out anymore in defense of national issues like health care, education and open markets.

These six factors are pushing our system, which was designed to have divided powers and to force compromises, into the realm of paralysis. To get anything big done now, we have to generate so many compromises — couched in 1,000-plus-page bills — with so many different interest groups that the solutions are totally suboptimal. We just get the sum of all interest groups.

The miniversion of this is California, which, as others have noted, is becoming America’s biggest “failed state.” Californians had hoped they could overcome their dysfunctional system by electing an outsider, a former movie star, Arnold Schwarzenegger. He would slay the system, like the Terminator. But he couldn’t.

Mr. Obama was elected for similar reasons. People had hoped that his unique story, personality and speaking skills could bring the country together, overcome paralysis and deliver nation-building at home. A lot of the disappointment settling in among Obama voters today is prompted by their dawning realization that maybe, like Arnold, he can’t.

China’s leaders, using authoritarian means, still can. They don’t have to always settle for suboptimal. So what do we do?

The standard answer is that we need better leaders. The real answer is that we need better citizens. We need citizens who will convey to their leaders that they are ready to sacrifice, even pay, yes, higher taxes, and will not punish politicians who ask them to do the hard things. Otherwise, folks, we’re in trouble. A great power that can only produce suboptimal responses to its biggest challenges will, in time, fade from being a great power — no matter how much imagination it generates.

Grandma said that, too.

The Revolutionary Association of the Women of Afghanistan (RAWA)

VT Edition: The Revolutionary Association of the Women of Afghanistan

In the years since the fall of the Taliban, Zoya has risked her life to continue to fight for the dignity of women in Afghanistan.

Interview by Steve Zind

Listen to interview: zoya_nov9_09_vpr_radio.mp3

Zoya's Book
The 2002 book "Zoya's Story: An Afghan Woman's Struggle for Freedom" describes a life under the Taliban where women were largely confined to their homes and barred from working or going to school.

Zoya is a pseudonym used to protect the identity of the book's author, whose parents disappeared when she was in her early 20s - victims of a ruthless crackdown on opponents of the Taliban's fundamentalist government.

In the years since the fall of the Taliban, Zoya has risked her life to continue to fight for the dignity of women in Afghanistan. She's part of a self-described radical women's group. They're radical, she says because of their anti-fundamentalist views - and also their belief that the presence of the American military in their country is an obstacle to progress. The group is called RAWA: The Revolutionary Association of the Women of Afghanistan.

Recently Zoya was in our area and VPR's Steve Zind spoke with her. He began by asking her about the situation for women in Afghanistan today.

Afghan Women Speak Out Against U.S. Occupation

Afghan Women Speak Out Against U.S. Occupation

Thousand of troops and billions of dollars have not achieved any positive change.

By Code Pink, Women For Peace

The women of Afghanistan, after eight years of occupation, offer conflicting advice, depending on their position in society. If the women are in Kabul, are educated and affluent, and have family members in office or are part of the government, they sometimes say, “our safety is in danger if U.S. troops leave." If the women are in the countryside (and 90% are) they say, “get the troops out now. Our rights, our freedoms, our safety have not improved in eight years of occupation — and the occupation fuels the insurgency.” In this complex war-torn nation, both opinions are valid. But according to MP Dr. Roshnak Wardak, all women in Afghanistan still lack basic rights except on paper, and all women in Afghanistan live in an ever-escalating war zone. As another brutal winter approaches, the humanitarian crisis of Afghanistan worsens—people resort to eating grass and they shiver in canvas tents.

During October, RAWA (the Revolutionary Association of the Women of Afghanistan) sponsored a speaking tour of the U.S. RAWA is the oldest women’s organization in Afghanistan, founded in 1977 to work for women’s rights and education, and is a very credible source. Their members risk personal safety and dedicate their lives to improving conditions for all Afghan women; many have been assassinated, included RAWA’s founder, Meena.

Although our robotic killer drones strike wedding parties and funerals, crossing into Pakistan freely, the insurgency grows. We are creating terrorists faster than we can kill them. But maybe that’s the real goal?
Opposing Views, Nov.11, 2009
Zoya is a RAWA member whose parents were killed by extremists in Afghanistan when she was in her teens. She honors her mother’s work for women’s rights by continuing in her footsteps. Education of women, often in refugee camps and orphanages, has produced a generation of women like Zoya who are able in turn to educate us about conditions in their country. On an October 25 conference call, Zoya said, “It’s the same now as RAWA was saying eight years ago. It is impossible to import democracy. Democracy must be achieved by the people. Thousand of troops and billions of dollars have not achieved any positive change. Democracy cannot be practiced in a country ruled by warlords and drug lords.” She has seen the U.S. supporting the war criminals of the Northern Alliance against the Taliban, but “the Northern Alliance are also terrorists, and so they are happy with the presence of the Taliban. They may even be helping to arm the Taliban. We are tired of this deception.” She added more on this topic during a speech at Boston’s Oct 17 antiwar rally in Copley Square.

Zoya thanked antiwar activists for speaking out and supporting self-determination for Afghanistan. She said she has met many Americans who are not aware of the true situation because “the media misled them.” Her call? “Educate! Organize! Expose the truth of the occupation!”

Malalai Joya is an Afghan woman who rocketed to fame when she was ejected from Afghanistan’s constitutional assembly in 2003, silenced for complaining that there were war criminals among her fellow delegates. She was later elected to Parliament and then thrown out in 2005 for making the same statement. On tour in the U.S. during October, in an interview with Laura Flanders on GritTV, Malalai had this advice for antiwar Americans: “First you should raise your voice very strongly against occupation in Afghanistan, against the war crimes of your government. Support the democratic kind of people in my country…morally support them, financially support them, and support education. And, why not put Bush in the International Criminal Court?”

Both Zoya and Malalai must live in safe houses and move frequently, as their truth-telling has resulted in death threats against them. Yet asked what she fears, Malalai said: “I don’t fear death. I fear political silence against injustice.” And from her website this statement, echoes fears raised during the rise of fascism in 20th century Europe: “The silence of good people is worse than the actions of bad people.”

In January, 1980 during the first month of what would be a decade of Soviet occupation, an Afghan man in Kabul told me fiercely: “As long as there is ONE Afghan still alive, the Russians will NEVER rule our country!” Empires that have failed to subdue Afghanistan include the Macedonians under Alexander, the Safavid Persians, the Romans, the British, the Russians, and now, the U.S. Although our robotic killer drones strike wedding parties and funerals, crossing into Pakistan freely, the insurgency grows. We are creating terrorists faster than we can kill them. But maybe that’s the real goal?

Speak up and expose the so-called war on terror for what it really is: a marketing strategy for corporate profits.

Call on your government to ground the drones and bring the troops home now!

Category: English, RAWA in Media

Thursday, November 19, 2009

Enough Reform to Succeed?

The Affordable Health Care For America Act (HR 3962): Enough Reform To Succeed?
Posted by John Geyman MD on Wednesday, Nov 18, 2009
As we know, the House passed its health care reform bill on October 29, 2009 after many months of contentious debate. By a narrow margin, 220-215, the 1,990 page, almost 20 pound bill was passed. It laid out the most liberal health care reform that might be expected out of Congress this year, since any bill that may clear the Senate will certainly be more restrictive.
In order to answer our question as to the value of the House bill, we need to re-state the original major goals of reform: (1) contain skyrocketing costs of health care and health insurance; (2) expand access to care by including everyone; and (3) improve the quality of care.

At a gross cost of $1.055 trillion over ten years, the House bill would do some good things, including reduction of the uninsured by up to 30 million; helping many Americans to pay for insurance through government subsidies; helping small business to provide coverage to their employees; expanding Medicaid and community health centers; establishing a new Center for Comparative Effectiveness Research to study and recommend the most effective treatments; initiating limited reforms of the health insurance industry, such as termination (four years hence) of its common practice of denying coverage based on health status and pre-existing conditions; phasing out government overpayments to private Medicare Advantage plans; revoking a decade-old anti-trust exemption for insurance companies; and creating a new long-term care program (CLASS ACT) to supplement Medicaid and/or private long-term care insurance.

However, the negatives far outweigh the positives, and adopting this bill would delay real reform for years to come. Despite a chorus of accolades about the bill by its supporters, even comparing it with the historic importance of Social Security and Medicare, this monster bill instead bears the heavy imprint of corporate stakeholders who themselves are largely responsible for out-of-control health care costs. After months of lobbying and campaign contributions to legislators crafting the legislation, their multiple conflicts of interest and political compromises, this bill ends up being a bailout for the insurance industry and a bonanza for stakeholders in the medical industrial complex.
Here are some of the major problems with the bill:

• It will not “bend the cost curve” for many reasons—with the exception of a provision that the government negotiate drug prices with manufacturers (as the VA does so effectively), there are no real restraints on the prices of health insurance or health care services; insurers have already warned that premiums will continue to surge in future years; perverse incentives would remain in the system to continue providing large amounts of inappropriate and unnecessary services, especially by specialists in more highly reimbursed areas; and recommendations based on studies by the new Center for Comparative Effectiveness Research could not be used to mandate coverage or reimbursement policies.

• As the crisis in declining access to care only grows (with already 46 million uninsured and at least another 30 million underinsured), expansion of Medicaid, subsidies, and limited restrictions on insurers would not take place for four more years. And as many states struggle with their deficits during the recession, access and benefit levels available to patients on Medicaid will be seriously jeopardized in many parts of the country. Meanwhile 45,000 Americans are dying each year as a result of being uninsured—one every 12 minutes.

• Because of a number of small-print provisions in the bill, bought by industry interests and crafted by their representatives, we would see a growing epidemic of underinsurance among the newly insured. These are some of the reasons: low requirements for actuarial value, the proportion of health care costs that insurers are required to pay for care (probably ending up as low as 65 or 70 percent when further compromises are made with the Senate); restricted levels of benefits to be covered (the minimal essential benefits package would be in four tiers, has yet to be developed, and we can expect that it will fall far short of all necessary care); in a last-ditch effort to pass the bill and assuage pro-life legislators, new anti-choice language was added by the Stupak amendment that would deny coverage of abortion care to millions of women; and coverage shortcomings of private plans already in force will be grandfathered in without reform.

• Even after the expenditure of more than $1 trillion, the bill would still leave some 18 million Americans uninsured.

• The public option, diminished as it has been to the point where it could only include 2 percent of Americans by 2019, would not have enough market clout to “keep the insurers honest.” The Congressional Budget Office (CBO) has already concluded that the public option would not offer real competition to private insurers, and that its premiums would even have to be higher than private premiums. It would not be available until 2013 through the new Health Insurance Exchange, and then only to the uninsured and some employees of small businesses without coverage. Moreover, such Exchanges have no track record of success. After 15 years of experience in California, that Exchange failed, mostly due to lack of pricing power and adverse selection by attracting sicker enrollees.

• The CBO has projected that rising insurance costs could mean that middle-income families would spend 15 to 18 percent of their income on premiums and co-payments.

• This bill would not reverse the unraveling of the employer-sponsored insurance system because of rising health care costs that outpace the rest of our economy; despite subsidies to small business, employer-sponsored insurance would remain unsustainable.

• This bill would only add to the already large burden of complexity and bureaucracy, together with their additional costs. At the same time, it would forego savings of some $400 billion a year that could otherwise be achieved through a simplified, more efficient single-payer system.

So in sum, this bill, while well intentioned, is fatally flawed. It would not effectively address the three major system problems demanding urgent reform, and would delay real reform by letting much of our population falsely think that reform is at hand. It would leave in place an inefficient, exploitive insurance industry that is dying by its own hand, even as it props it up with enormous future profits through often subsidized individual and employer mandates.

The most fundamental single question about how to reform our health care system should be whether or not we abandon our multi-payer, mostly investor-owned financing system or move to a not-for-profit single-payer system, Medicare for All, which this year’s political process has carefully kept off the table. The lesson of history in this country tells us that, as long as we retain private health insurance at the core of our health care system, we can never achieve universal access to affordable, comprehensive high-quality care.

Dr. John Geyman is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, a past president of Physicians for a National Health Program and author of “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It.”

Buy John Geyman’s Books at:

Health Deform

Published on Monday, November 16, 2009 by The Alburquerque Journal
Health Deform
by Carol Miller
A very complex, mandatory private insurance scheme recently passed the U.S. House. The public is being overwhelmed by sound bites on one hand about how great it is, on the other, how terrible. We are hearing few of the details that are actually in the bill. Having read the bill, it is clear now that what started as health reform has emerged from the political process as health "deform," building on the worst, not the best of the current system.

It is still a toss-up as to whether the Senate will pass any bill this year. However, due to intense political pressure, the Senate is likely to pass a bill that will make some House provisions better and others worse. What actually comes out in the final conference-committee bill is anyone's guess at this point - so little time, so many deals still to be made, so many political funders to be appeased.

A careful analysis of the bill shows that it is designed more for political goals than to eliminate financial barriers to health care. For example, the actual coverage doesn't even begin until 2013, opportunistically after the next presidential election, in 2012. Run on having accomplished "historic reform" but before anyone actually experiences how bad it is? How cynical is that?

Yes, there are some good provisions. The best relate to improving existing programs like the Indian Health Service, community health centers, and health professionals education and training; all are important for New Mexico.

But there bad provisions, which comprise most of the 1,990 pages of the bill. Five key reasons this legislation must be stopped:

• If passed, this law will move the U.S. farther from universal health care, making it harder than ever to accomplish health care justice in the future. If Congress does not have the courage to stand up to the private insurance industry now, it will be even more difficult in the future, especially after giving the industry trillions of new dollars through this terrible legislation. Let's call this what it is: another corporate bailout on the backs of working people.

Pay attention to your federal representatives as they carefully talk about "health insurance reform." They aren't talking about health reform any more. Congress could have defended and built up a system based on popular, high-quality government-run health programs like the military and veterans fully socialized health systems or Medicare, a single-payer program. Instead, the president and Congress let the corporations and government-haters take control of the agenda.

• The legislation institutionalizes permanent inequality in health care. Unlike Medicare where all beneficiaries have a single plan, this bill further divides the U.S. system into tiers based on ability to pay. It creates basic, enhanced, premium and premium-plus plans. A basic plan will provide only 70 percent of the coverage of a "reference benefit package," one that includes even fewer services than most insured people have today. The bill doesn't even mention coverage for essential services like vision and adult dental care except in the most costly premium-plus plan.

• Out-of-pocket costs remain sky high. Everyone will be required to pay monthly insurance premiums. Some low-wage workers will receive taxpayer subsidies on a sliding scale. The lowest income people will have full subsidies. But remember, this is not money for care, it is support only to buy insurance.

Almost everyone will have to meet a deductible, capped in the bill at $1,500 a year, higher than most insurance-plan deductibles today. On top of this, insurance companies can charge even more under various "cost sharing" schemes for items like co-pays and co-insurance.
The bill puts a cap on cost sharing, but the total amount is obscene. The cap for an individual is $5,000 a year and for a family it is $10,000 before the plan must cover everything. Well, not exactly everything. Even after paying this huge amount of money, the legislation still allows the corporations to make us pay, billing for non-network providers and, since it is not a comprehensive benefit package, we are still on our own to pay for health care that the plans refuse to cover.

The legislation creates a law to let these corporations increase what they charge people as they get older. In fact, they can be charged up to twice as much as younger people for identical coverage.

• The legislation makes it illegal to not buy health insurance. The penalties are described in a section of the legislation called "Shared Responsibility." This will let the IRS impose a tax of up to 2.5 percent of modified adjusted gross income for not having health insurance. People on the financial edge, people fighting foreclosure to stay in their homes or people who are unemployed all or part of a year will not be able to afford the insurance premiums or the penalties for not having insurance.

• We will all be drowning in paperwork, which will continue to drive up administrative costs. Right now, insurance administrative waste is about 30 percent of every health care dollar- or about $1 billion a day. Adding more people to an insurance-based system will result in even more money going into this bottomless pit.

As if this isn't bad enough, the government will be setting up many new agencies to oversee the whole process including, at the top, the Orwellian Health Choices Administration, headed by the Health Choices Commissioner. This is not an agency to help us make health care choices, but to choose a health insurance company. The IRS will play a very large role in everything from certifying our income for subsidies to monitoring and taxing people who don't buy insurance.

Health Insurance Exchanges will be created across the country with at least one in every state offering both Web sites and telephone assistance. This is where we will go every year to pick our insurance plan in an open enrollment period of at least 30 days between September and November. We can add this unpleasant task to all of our other fall chores.

It is hard to imagine the chaos and wasted resources with the entire country picking insurance plans at the same time, attended by marketing, billboards, advertising and misinformation. We will gamble as we choose a plan, decide which corporation will be the best for us, hoping we pick one that is not dominated by corporate bureaucrats focused on rationing care to maximize their profits. It is not an easy task and if a wrong plan is selected, we are stuck for a year, until the next national open enrollment cycle.

The United States can do better. We can build on a strengthened and well-funded Medicare program. In Medicare, when a person reached the age of eligibility or is determined to qualify because they have a permanent disability, they are in, and there is no re-enrollment.

Imagine real reform, as simple as adding people ages 55 to 65 years old to Medicare in 2010, 35-55 in 2011, and so on until everyone is included by 2013. The bills that promote this kind of reform are under 200 pages, they are simple to implement, cost effective and equitable. Choose a doctor, choose a hospital when needed and let the government pay the bills. Everyone in one system.
That is what real health reform would look like.

© 2009 The Alburquerque Journal
Miller is a long-time public health professional and health care advocate. She lives in Ojo Sarco.

Tuesday, November 17, 2009

If you want the truth to stand clear before you, never be for or against.

"If you want the truth to stand clear before you, never be for or against. The struggle between 'for and against' is the mind's worst disease." (Sent-ts'an, c. 700 C.E.)

Monday, November 16, 2009

NO TROOP SURGE IN AFGHANISTAN! How about some peace with that Nobel Prize?!

PROTEST: Tuesday, December 1, 2009
RALLY: 11:45 AM, WWU Red Square
MARCH: 12:45 PM

Initiated by the Bellingham Socialist Alternative, co-sponsored by Whatcom
Peace & Justice Center, and endorsed by Food Not Bombs.

President Obama will be awarded the Nobel Peace Prize on December 10th --
he is leaning toward sending more troops to Afghanistan, escalating the war!
After 8 years of war, $228 billion has been sunk into Afghanistan, 920 U.S.
soldiers have been killed and thousands wounded, and thousands of Afghan
civilians have been killed or permanently disabled.

--Do NOT send more troops into an unjust, unwinnable war!
--Bring all the troops home from Iraq and Afghanistan NOW!
--Money for jobs and education, not war!

* Please forward this email widely! * Go to and click on
ACTIONS to find out what else you can do TODAY.

For more information, contact Ramy Khalil of the Bellingham Socialist
Alternative at, or Marie at the Whatcom Peace &
Justice Center at (360) 734-0217. Other organizations are invited to be
co-sponsors of this event-- just contact us.

Sunday, November 15, 2009

My Near Death Panel Experience (The Inside Truth)

Published: November 14, 2009, NYT

I DIDN’T mean to kill Grandma. I didn’t even mean to create death panels.

But now that I and my fellow lawmakers in the House have passed a health care bill, I’m finally free to explain what I learned as the author of the now-famous end-of-life provisions. My experiences during the bizarre controversies of the summer should provide a note of caution about what potential troubles and political distortions might lie ahead as health care legislation moves forward in the Senate, through the reconciliation process and toward a final bill.

This proposal was not even my top health-care priority. During my 13 years in the House, I have written and co-sponsored numerous provisions to change the way the government pays for health care. I am much more interested in extending coverage to the uninsured and moving away from “fee for service” Medicare, which rewards volume over value.

In this context, I found it perverse that Medicare would pay for almost any medical procedure, yet not reimburse doctors for having a thoughtful conversation to prepare patients and families for the delicate, complex and emotionally demanding decisions surrounding the end of life. So when I was working on the health care bill, I included language directing Medicare to cover a voluntary discussion with a doctor once every five years about living wills, power of attorney and end-of-life treatment preferences.

I was especially committed to this issue because helping patients and their families clarify what they want and need is not only good for all Americans, but also a rare common denominator of health care politics. Indeed, the majority of Congressional Republicans supported the similar provisions for terminally ill elderly patients that were part of the 2003 prescription drug bill. In the spring of 2008, Gov. Sarah Palin of Alaska issued a proclamation that stated the importance of end-of-life planning.

With this history in mind, I reached out to Republicans, including conservative members of Congress who often expressed support for the concept, and worked with national experts in palliative care and advocacy groups in devising the end-of-life provision. My Republican co-sponsor, Charles Boustany of Louisiana, told me he had many end-of-life conversations as a cardiovascular surgeon but unfortunately they often were too late. He wished that he could have spoken to patients and their families when they could have reflected properly, not when surgery was just hours away.

While continuing to work on other important health care reform provisions, I was confident that in this area, we had made a contribution that would ultimately be in the final bill. It might even serve as a bridge for bipartisan compromise as we entered the frustratingly contentious end game of finishing the overall legislation.

But the battle lines were being drawn. Little did I know how deep the trenches would be dug, nor how truth would be one of the first, and most obvious, casualties.

The House Ways and Means Committee “mark-up session” of the health care bill, on July 16, lasted all day and into the night. Republican colleagues offered dozens of amendments aimed at numerous provisions. Nowhere was there a single proposal to change the end-of-life language, nor a word spoken in opposition. Not a single word.

Then Betsy McCaughey entered the fray. A former lieutenant governor of New York, Ms. McCaughey had gained notoriety in the 1990s by attacking the Clinton health plan. In a radio interview, she attacked the end-of-life provisions in the health care legislation, claiming it “would make it mandatory, absolutely require, that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” The St. Petersburg Times’s fact-checking Web site PolitiFact quickly excoriated her: “McCaughey isn’t just wrong; she’s spreading a ridiculous falsehood.”

But in today’s vicious news cycle, lies take on lives of their own on Web sites, blogs and e-mail chains and go viral in seconds. Ms. McCaughey’s claims were soon widely circulated in the thirst for ammunition against the Democrats’ health care reform plan. “Mandatory counseling for all seniors at a minimum of every five years, more often if the seasoned citizen is sick or in a nursing home,” was how Rush Limbaugh described the provision a week later. “We can’t have counseling for mothers who are thinking of terminating their pregnancy, but we can go in there and counsel people about to die,” he added.

Two days later, the lie found its way into Republican politicians’ statements. “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law,” declared the House Republican leader, John Boehner of Ohio, and Thaddeus McCotter of Michigan. I was shocked. This really struck at the heart of what I was trying to do — to build consensus.

Still, nothing could prepare me for what came next. As luck would have it, on July 28 I was presiding over the House of Representatives when my Republican colleagues decided to have a filibuster of one-minute speeches attacking the Democratic health care reform proposals, or rather, the proposals as seen through their skewed vision.

Representative Virginia Foxx of North Carolina made the singularly outrageous claim that the Republican version of health care reform “is pro-life because it will not put seniors in a position of being put to death by their government.” More groups and politicians repeated and exaggerated the claims.

The most bizarre moment came on Aug. 7 when Sarah Palin used the term “death panels” on her Facebook page. She wrote: “The America I know and love is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

There is, of course, nothing even remotely like this in the bill, yet other politicians joined the death panel chorus. On “This Week With George Stephanopoulos,” the former Republican House speaker, Newt Gingrich, refused an opportunity to set the record straight. Instead, Mr. Gingrich noted “the bill’s 1,000 pages,” as if the number of pages was an excuse for his misrepresentation, and then declared, “You’re asking us to trust turning power over to the government, when there clearly are people in America who believe in establishing euthanasia.” The Speaker Gingrich I served with a decade ago would have been appalled at the blatant and repeated falsehoods of the Newt Gingrich of 2009.

Such behavior is a graphic example of how the issue of health care was hijacked. Town hall meetings became dominated by people shouting down their opponents and yelling misinformation. Some town hall participants even told politicians to keep government out of their Medicare — something that would be difficult to pull off since Medicare is a government program.

To be fair, some sincerely believed what they were saying to be true, but that only made them more indignant when others challenged them or tried to give them correct information.

The news media was a particular culprit in this drama. This was not just Fox News; seemingly all the national news organizations monitored any meetings they could find between lawmakers and constituents, looking for flare-ups, for YouTube moments. The meetings that involved thoughtful exchanges or even support for the proposals would never find their way on air; coverage was given only to the most outrageous behavior, furthering distorting the true picture.

My office quickly produced testimonials from 300 respected professionals and organizations to set the record straight. Articles followed about how Republicans themselves had supported such provisions. Sites like PolitiFact and as well as national organizations like the AARP pushed back on the lies.

It didn’t matter. The “death panel” episode shows how the news media, after aiding and abetting falsehood, were unable to perform their traditional role of reporting the facts. By lavishing uncritical attention on the most exaggerated claims and extreme behavior, they unleashed something that the truth could not dispel.

There was a troubling new dynamic: People like Senator Chuck Grassley, a Iowa Republican, were now parroting these falsehoods in their town meetings and letting it drive their policy decisions. (Mr. Grassley: “We should not have a government program that determines if you’re going to pull the plug on Grandma.”) When the most extreme elements peddling false information can cow senior members of Congress into embracing their claims, it does not bode well for either policymaking or for the Republican Party.

ON Sept. 9, President Obama spoke about the health care reform plan to Congress. Although his speech was more thoughtful and less partisan than much of what I’ve seen from presidents in my years in Congress, it was greeted by the call of “You lie!” from a backbencher from South Carolina, Joe Wilson. The accusation came as President Obama was attempting to debunk the many myths about the health care bill; Mr. Wilson’s outburst was the culmination of the summer’s frenzy, of everything that my end-of-life provisions had unwittingly set in motion.

The resulting support from the right wing and the inability of Republican leadership to acknowledge Mr. Wilson’s behavior as crude, unprecedented and inappropriate is telling. The Republican Party has been taken captive by these tactics, the extremists and their own rhetoric.

In a curious way, however, Joe Wilson’s eruption helped turn this particular debate full circle. Energized reform advocates began to push back. Support for the measure increased, and I began to hear, beneath the anger, some honest skepticism, along with an accurate complaint from fellow lawmakers that the language in the provisions was not as clear as it could be. The end-of-life provisions, I am proud to say, are in the bill that the House approved and sent to the Senate, where there is a reasonable chance of passage.

The inability to protect even the smallest element of bipartisan consensus from being used as a savage weapon of political attack makes lawmakers’ tasks harder, and the American public even more disillusioned. But perhaps the troubles of the summer and the success of the fall will provide a road map that leads to members of Congress finally enacting health care reform — and working together again on the long list of America’s unfinished business.

Saturday, November 14, 2009

R U Up?

Congressional Reform Act of 2009

1. Term Limits: 12 years only, one of the possible options below.

A. Two Six-year Senate terms
B. Six Two-year House terms
C. One Six-year Senate term and three Two-Year House terms

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

2. No Tenure / No Pension:

A congressman collects a salary while in office and receives no pay when they are out of office.

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

3. Congress (past, present & future) participates in Social Security:
All funds in the Congressional retirement fund moves to the Social Security system immediately. All future funds flow into the Social Security system, Congress participates with the American people.

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, server your term(s), then go home and back to work.

4. Congress can purchase their own retirement plan just as all Americans..

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

5. Congress will no longer vote themselves a pay raise. Congressional pay will rise by the lower of CPI or 3%.

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

6. Congress loses their current health care system and participates in the same health care system as the American people.

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

7. Congress must equally abide in all laws they impose on the American people.

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

8. All contracts with past and present congressmen are void effective 1/1/10.

The American people did not make this contract with congressmen, congressmen made all these contracts for themselves.

Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, serve your term(s), then go home and back to work.

Thursday, November 12, 2009

NPR: Listen to the Afghan Women. Support Ambassador Eikenberry's Position - No Surge

Instead of more troops, the women clearly state the need for more educational, farming and humanitarian help. Watch "Motherland Afghanistan" and do something.

Wednesday, November 11, 2009

Veterans to Obama: Do Not Escalate

Here's the link to the petition:

Tuesday, November 10, 2009

Meet the New Health Care Reform, Same as the Old Health Care Reform

By Aaron E. Carroll
Associate Professor of Pediatrics, Indiana University School of Medicine
The Huffington Post
October 26, 2009

We’re so close to health care reform! Even Paul Krugman is starting to talk about what comes next. Me? I’ve been thinking about what comes next for a long time. I think this bill will pass. We will get the incremental reforms we were promised. Things will likely get better in the short term. Then, since we didn’t contain costs, we’ll need to enact real reform. Or, things will go right back to the status quo.

How do I know that? We’ve been here before.

President Obama said, in his address to Congress, that he was determined to be the last president to deal with health care reform. That’s not going to happen. He should have read his history. At least, he should have read the New York Times.

Governor Romney thought the same thing in Massachusetts in 2006. I saw it – right there in the New York Times:

The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.
“This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone.”
But wait. I’d heard that before. In the New York Times. In 1988:

Massachusetts last week ventured where no state had gone before: It guaranteed health insurance for every resident.
The plan requires that by 1992 every employer of six or more pay $1,680 per worker per year for insurance. The employer may buy the insurance directly for his workers and their dependents, thereby earning a tax credit…The Massachusetts plan recognizes the value of an employer-based approach, which it would expand by forcing more businesses either to insure or pay.
That time was under Governor Dukakis. He was going to be the last one to deal with health care reform, too. Just so you know, the rate of uninsurance in Massachusetts was 8.4% in 1998 around the time of the first “unique” reform and 5.5% in 2008, after two times they said they were going to achieve universal coverage. I don’t think they understood the concept of “fixed”.

And that’s just Massachusetts. Look at Tennessee. They went all out with incremental reform in 1994. There’s that New York Times again:

The Tennessee program, which went into effect last Jan. 1, covers 803,800 people who were formerly on Medicaid and 335,300 who had no health insurance. Gov. Ned McWherter, a Democrat, said that 94 percent of the state’s residents were now insured. He predicted, “Tennessee will cover at least 95 percent of its citizens with health insurance by the end of 1994, seven years faster than the most aggressive goal set for the nation under legislation being debated in Congress.”
Tennessee’s rate of uninsurance was 10.2% in 1994 and 15.1% in 2008.

Governor Dean, no stranger to the cause of health care reform, “fixed” the problem of health care reform way back in 1992. Per the New York Times:

Gov. Howard Dean, the only Governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal health care by 1995.
The Vermont law creates a state agency, the Health Care Authority, that will have the power to bargain for health insurance for the state’s residents, using what Governor Dean called “enormous leverage” to gain better coverage at lower rates.
Wow. That sounds like… a public option! Let’s go to the scoreboard: Vermont’s rate of uninsurance was 9.5% in 1992 and 9.3% in 2008.

Minnesota tried this, too, in 1992. Of course, how would anyone know about that? It was only in the New York Times:

Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it.
The legislation, called HealthRight, provides state-subsidized insurance coverage for people of modest income, a provision that is expected to cost Minnesota $250 million a year, along with steps to control the health-care industry’s steeply rising charges.
Subsidies to buy insurance. That must have worked, right? Minnesota’s rate of uninsurance was 8.1% in 1992 and 8.7% in 2008.

Washington State? 1993. New York Times:

Washington will have one of the most aggressive health-care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state and try to control costs through a cap on insurance premiums.
The plan would require all employers to pay at least half the cost of health insurance premiums for their employees… “We weren’t going to create some huge new government bureaucracy, so we took that away from the critics.”
God forbid! A government system might actually… I don’t know… do something. Anyway, Washington’s rate of uninsurance was 12.6% in 1993 and 12.4% in 2008.

Since the administration has put Senator Snowe somewhat in charge of health care reform, you would think they would at least know about efforts in Maine. Right? To the New York Times, please!

The Maine Legislature today passed a comprehensive health insurance plan that will make low-cost coverage available to all state residents by 2009.
The legislation will create a semiprivate agency that provides private coverage to the state’s 180,000 uninsured residents, businesses and municipalities with fewer than 50 employees and the self-employed. Employers would pay up to 60 percent of an employee’s premium.
That looks like it could have come right out of HR 3200. You’d never know if was from 2003. How did that pledge to achieve universal coverage by 2009 go? Maine’s rate of uninsurance was 10.4% in 2003 and 10.4% in 2008.

We pretend these problems are new; we pretend that these solutions are new. Subsidies have been done. Community ratings are old news. “Public plans” have been around for a while. Mandates, both individual and employer, weren’t invented this year.

In 1988, before the first of these plans went into effect, 13.4% of Americans were uninsured. In 2008, it was 15.4% of Americans. They don’t work. Not in the long run.

We need comprehensive reform. This plan will pass; it won’t be enough. President Obama will not be the last President to deal with this problem.

We keep doing the same thing and expecting a different outcome. What does that signify?

Read more about health care policy and get your questions answered at Rational Arguments.

What's Missing In The Pending Legislation

Is the House Health Care Bill Better than Nothing?

By Marcia Angell, M.D.
Physician, Author, Senior Lecturer, Harvard Medical School
The Huffington Post
November 8, 2009

Well, the House health reform bill — known to Republicans as the Government Takeover — finally passed after one of Congress’s longer, less enlightening debates. Two stalwarts of the single-payer movement split their votes; John Conyers voted for it; Dennis Kucinich against. Kucinich was right.

Conservative rhetoric notwithstanding, the House bill is not a “government takeover.” I wish it were. Instead, it enshrines and subsidizes the “takeover” by the investor-owned insurance industry that occurred after the failure of the Clinton reform effort in 1994. To be sure, the bill has a few good provisions (expansion of Medicaid, for example), but they are marginal. It also provides for some regulation of the industry (no denial of coverage because of pre-existing conditions, for example), but since it doesn’t regulate premiums, the industry can respond to any regulation that threatens its profits by simply raising its rates. The bill also does very little to curb the perverse incentives that lead doctors to over-treat the well-insured. And quite apart from its content, the bill is so complicated and convoluted that it would take a staggering apparatus to administer it and try to enforce its regulations.

What does the insurance industry get out of it? Tens of millions of new customers, courtesy of the mandate and taxpayer subsidies. And not just any kind of customer, but the youngest, healthiest customers — those least likely to use their insurance. The bill permits insurers to charge twice as much for older people as for younger ones. So older under-65’s will be more likely to go without insurance, even if they have to pay fines. That’s OK with the industry, since these would be among their sickest customers. (Shouldn’t age be considered a pre-existing condition?)

Insurers also won’t have to cover those younger people most likely to get sick, because they will tend to use the public option (which is not an “option” at all, but a program projected to cover only 6 million uninsured Americans). So instead of the public option providing competition for the insurance industry, as originally envisioned, it’s been turned into a dumping ground for a small number of people whom private insurers would rather not have to cover anyway.

If a similar bill emerges from the Senate and the reconciliation process, and is ultimately passed, what will happen?

First, health costs will continue to skyrocket, even faster than they are now, as taxpayer dollars are pumped into the private sector. The response of payers — government and employers — will be to shrink benefits and increase deductibles and co-payments. Yes, more people will have insurance, but it will cover less and less, and be more expensive to use.

But, you say, the Congressional Budget Office has said the House bill will be a little better than budget-neutral over ten years. That may be, although the assumptions are arguable. Note, though, that the CBO is not concerned with total health costs, only with costs to the government. And it is particularly concerned with Medicare, the biggest contributor to federal deficits. The House bill would take money out of Medicare, and divert it to the private sector and, to some extent, to Medicaid. The remaining costs of the legislation would be paid for by taxes on the wealthy. But although the bill might pay for itself, it does nothing to solve the problem of runaway inflation in the system as a whole. It’s a shell game in which money is moved from one part of our fragmented system to another.

Here is my program for real reform:

Recommendation #1: Drop the Medicare eligibility age from 65 to 55. This should be an expansion of traditional Medicare, not a new program. Gradually, over several years, drop the age decade by decade, until everyone is covered by Medicare. Costs: Obviously, this would increase Medicare costs, but it would help decrease costs to the health system as a whole, because Medicare is so much more efficient (overhead of about 3% vs. 20% for private insurance). And it’s a better program, because it ensures that everyone has access to a uniform package of benefits.

Recommendation #2: Increase Medicare fees for primary care doctors and reduce them for procedure-oriented specialists. Specialists such as cardiologists and gastroenterologists are now excessively rewarded for doing tests and procedures, many of which, in the opinion of experts, are not medically indicated. Not surprisingly, we have too many specialists, and they perform too many tests and procedures. Costs: This would greatly reduce costs to Medicare, and the reform would almost certainly be adopted throughout the wider health system.

Recommendation #3: Medicare should monitor doctors’ practice patterns for evidence of excess, and gradually reduce fees of doctors who habitually order significantly more tests and procedures than the average for the specialty. Costs: Again, this would greatly reduce costs, and probably be widely adopted.

Recommendation #4: Provide generous subsidies to medical students entering primary care, with higher subsidies for those who practice in underserved areas of the country for at least two years. Costs: This initial, rather modest investment in ending our shortage of primary care doctors would have long-term benefits, in terms of both costs and quality of care.

Recommendation #5: Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices. (The House bill calls for this.) That prohibition has been a bonanza for the pharmaceutical industry. For negotiations to be meaningful, there must be a list (formulary) of drugs deemed cost-effective. This is how the Veterans Affairs System obtains some of the lowest drug prices of any insurer in the country. Costs: If Medicare paid the same prices as the Veterans Affairs System, its expenditures on brand-name drugs would be a small fraction of what they are now.

Is the House bill better than nothing? I don’t think so. It simply throws more money into a dysfunctional and unsustainable system, with only a few improvements at the edges, and it augments the central role of the investor-owned insurance industry. The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

Sunday, November 08, 2009

Call White House, Ask for Barack: Friedman On Middle East Peace Non-process

The only thing I would add to Friedman's position is we must do everything we can to provide much greater humanitarian aid to the Palestinians and hold each side accountable for the atrocities of the last round of military operations.

Published: November 7, 2009, NYT

The Israeli-Palestinian peace process has become a bad play. It is obvious that all the parties are just acting out the same old scenes, with the same old tired clichés — and that no one believes any of it anymore. There is no romance, no sex, no excitement, no urgency — not even a sense of importance anymore. The only thing driving the peace process today is inertia and diplomatic habit. Yes, the Israeli-Palestinian peace process has left the realm of diplomacy. It is now more of a calisthenic, like weight-lifting or sit-ups, something diplomats do to stay in shape, but not because they believe anything is going to happen. And yet, as much as we, the audience, know this to be true, we can never quite abandon hope for peace in the Holy Land. It is our habit. Indeed, as I ranted about this to a Jordanian friend the other day, he said it all reminded him of an old story.

“These two guys are watching a cowboy and Indian movie. And in the opening scene, an Indian is hiding behind a rock about to ambush the handsome cowboy,” he explained. “ ‘I bet that Indian is going to kill that cowboy,’ one guy says to the other. ‘Never happen,’ his friend answers. ‘The cowboy is not going to be killed in the opening scene.’ ‘I’ll bet you $10 he gets killed,’ the guy says. ‘I’ll take that bet,’ says his friend.

“Sure enough, a few minutes later, the cowboy is killed and the friend pays the $10. After the movie is over the guy says to his friend, ‘Look, I have to give you back your $10. I’d actually seen this movie before. I knew what was going to happen.’ His friend answers: ‘No, you can keep the $10. I’d seen the movie, too. I just thought it would end differently this time.’ ”

This peace process movie is not going to end differently just because we keep playing the same reel. It is time for a radically new approach. And I mean radical. I mean something no U.S. administration has ever dared to do: Take down our “Peace-Processing-Is-Us” sign and just go home.

Right now we want it more than the parties. They all have other priorities today. And by constantly injecting ourselves we’ve become their Novocain. We relieve all the political pain from the Arab and Israeli decision-makers by creating the impression in the minds of their publics that something serious is happening. “Look, the U.S. secretary of state is here. Look, she’s standing by my side. Look, I’m doing something important! Take our picture. Put it on the news. We’re on the verge of something really big and I am indispensable to it.” This enables the respective leaders to continue with their real priorities — which are all about holding power or pursuing ideological obsessions — while pretending to advance peace, without paying any political price.

Let’s just get out of the picture. Let all these leaders stand in front of their own people and tell them the truth: “My fellow citizens: Nothing is happening; nothing is going to happen. It’s just you and me and the problem we own.”

Indeed, it’s time for us to dust off James Baker’s line: “When you’re serious, give us a call: 202-456-1414. Ask for Barack. Otherwise, stay out of our lives. We have our own country to fix.”

The fact is, the only time America has been able to advance peace — post-Yom Kippur War, Camp David, post-Lebanon war, Madrid and Oslo — has been when the parties felt enough pain for different reasons that they invited our diplomacy, and we had statesmen — Henry Kissinger, Jimmy Carter, George Shultz, James Baker and Bill Clinton — savvy enough to seize those moments.

Today, the Arabs, Israel and the Palestinians are clearly not feeling enough pain to do anything hard for peace with each other — a mood best summed up by a phrase making the rounds at the State Department: The Palestinian leadership “wants a deal with Israel without any negotiations” and Israel’s leadership “wants negotiations with the Palestinians without any deal.”

It is obvious that this Israeli government believes it can have peace with the Palestinians and keep the West Bank, this Palestinian Authority still can’t decide whether to reconcile with the Jewish state or criminalize it and this Hamas leadership would rather let Palestinians live forever in the hellish squalor that is Gaza than give up its crazy fantasy of an Islamic Republic in Palestine.

If we are still begging Israel to stop building settlements, which is so manifestly idiotic, and the Palestinians to come to negotiations, which is so manifestly in their interest, and the Saudis to just give Israel a wink, which is so manifestly pathetic, we are in the wrong place. It’s time to call a halt to this dysfunctional “peace process,” which is only damaging the Obama team’s credibility.

If the status quo is this tolerable for the parties, then I say, let them enjoy it. I just don’t want to subsidize it or anesthetize it anymore. We need to fix America. If and when they get serious, they’ll find us. And when they do, we should put a detailed U.S. plan for a two-state solution, with borders, on the table. Let’s fight about something big.

Friday, November 06, 2009

The reform that's missing

By Rhonda Swan, Palm Beach Post
Thursday, November 05, 2009

Perhaps "death panels" weren't such a bad idea.

For private health insurance companies.

If ever there was a useless entity, it's a business that earns profits for doing nothing.

Wait. I take that back. They do something. They decide who lives and who dies. Paper-pushers with no medical training choose what is and isn't medically necessary for millions of people on whom they've never laid eyes. And for that, their employers rake it in.

United Health Group reported net income of nearly $3 billion in 2008; Aetna Inc. reported $1.3 billion, Humana Inc. came in at $647 million. Their CEOs had total compensation of $3.2 million, $24.3 million and $4.7 million, respectively. Their profits were down sharply compared with 2007 because of the recession. Still, it's not a bad haul for being nothing more than middlemen.

"What product does this industry sell?" Dr. Howard A. Green, director of the dermatology division at St. Mary's Medical Center in West Palm Beach, asked in an interview. "They don't do health care, they don't do access to health care because we have so many uninsured and underinsured. They remove too much money from health care, and therefore make it inefficient and ineffective."

In an article for On Call: The Journal of Palm Beach County Medical Society, Dr. Green maintains that shutting down private health insurance corporations is the first step to creating comprehensive quality health care. "Without the inefficiencies and burden to productivity of private insurance corporations," he wrote, "we can deliver efficient and effective comprehensive health care with great savings and no sacrifice of jobs."

The U.S. House is expected today to take up the 2,032-page health reform bill proposed by Democrats. A national insurance plan is a key element, though this version is far from the single-payer Medicare for All program that Dr. Green and Physicians for a National Health Program endorse.

Such a plan, which eliminates private profits, would be real reform. Yet it hasn't even come up for discussion, not this year or in 1994 under President Clinton, the last administration to attempt reform. No one in the White House or Congress has had the guts to take on private insurers, even though they clearly are the problem.

The major reform proposals focus more on private insurers than actual health care delivery. Forcing insurers to cover sick people. Getting insurers to compete and lower costs. Doling out subsidies to insurers so we can afford their high prices.

Why not just get rid of them? All they do is take our money and then show us the hand when we expect something in return like … medical treatment.

Opponents of the so-called public option say they fear a "government takeover" of health care that would put private insurers out of business. So what!

The fact that we are the very government that would "take over" our health care system under which doctors and hospitals would remain private gets lost.

As does the fact that we are a capitalist society where businesses that can't compete go out of business every day. And for-profit insurers just can't compete.

A Harvard Medical School and Public Citizen study found that health insurance bureaucracy - billing, sales and marketing, profits and executive pay, which have nothing to do with health care - costs $399.4 billion a year. Money that could insure every American.

Insurers also spend millions legally bribing Congress and the White House to protect their profits. But who is protecting us from them? Harvard researchers found that medical problems caused 62 percent of all personal bankruptcies in 2007. Of those, 60 percent had private medical insurance. "It's unethical," said Dr. Green. "It's a crime to bankrupt someone because they're sick."

It should be. Private insurance companies are too big, too inefficient and too heartless not to fail.

Thursday, November 05, 2009

Health Care Reform 2009: No Bill is Better Than a Bad Bill

By John Geyman MD on Thursday, Nov 5, 2009. Dr. John Geyman is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, a past president of Physicians for a National Health Program and author of “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It.”

The new House bill for health care reform (HR 3962), unveiled by Speaker Nancy Pelosi on October 29th, will not fundamentally reform U. S. health care. If you would believe the hype that accompanied its release, you might think that it would be as important as Medicare and Social Security. The New York Times concluded that “This bill will take a long stride toward universal coverage while remaining fiscally responsible.” Nobel laureate economist Paul Krugman added: “The political environment is as favorable for reform as it’s likely to get. The legislation on the table isn’t perfect, but it’s as good as anyone could reasonably have expected.”

But this bill is not good enough to pass. It will not make a big enough difference in addressing the three main problems requiring reform—containing the spiraling costs of health care, providing universal access to affordable health care, and improving its quality. If we look at the provisions of this 1,990-page bill concerning just the first two of these three goals, we see that it will fail to deliver real reform.

After all of the political compromises along the way that have led to the introduction of the new bill (HR 3962), on the positive side we can say that it will introduce some reforms to the health insurance market, expand coverage by about 36 million to health insurance by several means (especially through government subsidies to individuals and small employers and expansion of Medicaid), and help to address some other major system problems, such as the growing shortage of primary care providers.

But the negative side far outweighs the positive:

• There are no effective cost containment mechanisms built into the bill, either
for the costs of health insurance or for health care itself. As it whines about
loosening of the individual mandate that will likely limit some of its big increase
in the insurance market, the health insurance industry is already warning that
sharp premium increases will result. The most the bill will do is to require
disclosure and review of premium increases, without any regulatory teeth.
Although the bill would set up a Health Benefits Advisory Committee to
recommend a minimal essential benefits package (with four tiers), insurance
industry lobbyists will argue for the most minimal levels of coverage, and we can
anticipate an exponential growth in underinsurance. Moreover, there are no price
controls to be applied anywhere in the system, except perhaps in authorizing the
government to negotiate drug prices with manufacturers. But that provision will
almost certainly not clear the Senate, where we can expect even less concern for
affordability and prices.

• Although the public option has been the target of intense controversy, it will
play a negligible role in health care reform. The CBO has concluded that it would
cover no more than 6 million Americans, just two percent of the population, in
2013, and will cost more than private programs, mostly due to adverse selection in
attracting sicker individuals and its inability to set reimbursement rates for
physicians and hospitals as is done by Medicare. Moreover, middle-income
families may be required to spend 15 to 18 percent of their income on insurance
premiums and co-payments.

• HR 3962 will not result in making health care more affordable, despite
allocating some $605 billion over ten years for subsidies to low- and middle-
income Americans to buy insurance on Exchanges. We can count on continued
increases in the cost of health insurance as far as the eye can see, together with
less actuarial value of coverage.

• Buried in the fine print of this monster bill are many provisions that will benefit
corporate stakeholders in the medical industrial complex on the backs of patients
and their families. These examples make the point:

• Although medical loss ratios (MLR) (the proportion of premium
revenue actually spent on medical care) are specified at a minimum of 85
percent, this loophole has been added—“while making sure that such a
change doesn’t further destabilize the current individual health insurance
market.” By way of comparison, the Senate Commerce Committee has
found that the average MLR for the largest insurers in the individual
market is only 74 percent, with 26 percent of premium revenue going to
marketing, administrative overhead and profits.

• Although the bill would create a much-needed Center for Comparative
Effectiveness Research, it would have no say over reimbursement and
coverage policies. As the bill says, it “contains protections to ensure that
research findings are not construed to mandate coverage, reimbursement
or other policies to any public or private payer.”

In sum, this $1.055 trillion plan over ten years will not fix the major problems of cost and affordable access to health care in our deteriorating system, will add new layers of bureaucracy and complexity to the present system, is not fiscally responsible, and is not sustainable.

What to do now? Rather than accept an unworkable bill that is politically
expedient, we would be better off to make a major course change. The best first option would be to call for a floor vote, as originally promised by the House Speaker Pelosi, for
the amendment proposed by Anthony Weiner (D-NY) to substitute HR 676, a single-payer proposal, for HR 3962. If that fails, shelving this bill would be the best option, but if that is not possible, lawmakers should be pressed to retain the amendment proposed by Dennis Kucinich (D-OH) to allow states to experiment with single-payer plans, as a number of states would like to do (eg. California, Colorado, Illinois, Maine, New Mexico, New York and Pennsylvania). That amendment has already been passed by a rare bipartisan vote of 27-19 in the House Education and Labor Committee.

Whether a health care bill survives the end game in both chambers of Congress in this session is still up in the air. If a bill is finally enacted into law, however, it will be ineffective in remedying the big problems of cost and access to health care. We should be gearing up for an intense effort in 2010 to push for real health care reform—Medicare for All.

Wednesday, November 04, 2009

Obama One Year Later: The Audacity of Winning vs. The Timidity of Governing

I had arranged to meet David Plouffe on Saturday afternoon at a Starbucks on Wisconsin Avenue in Washington. The night before, a copy of his new book, The Audacity to Win: The Inside Story and Lessons of Barack Obama's Historic Victory, was waiting for me when I checked into my hotel at midnight. I flipped it open, read a few lines and was hooked. I spent the rest of the night reading it.

Plouffe has written the most important political book of the year (for reasons I'll get to in a moment). It's also completely gripping. It reads like a thriller. Even though you know how it ends, you quickly get caught up in every twist and turn of perhaps the most remarkable campaign in American history.

Along the way, I found myself tearing up when I read about the campaign volunteer who had scrimped and saved ("Grabbed some ramen on the weekends... Didn't take the girl to a movie") so he could donate ten dollars to Obama, and laughed at the funny-in-retrospect tales from the trail (like David Axelrod's BlackBerry crashing at a crucial moment because of glazed donut getting stuck in the trackwheel.)

But it's not the insider look at the past that makes the book so important. It's what it shows us about the present -- and the effect it could have on the future.

Plouffe's book arrives at a crossroads moment for the administration -- exactly one year after the election, and one year before the 2010 midterms. A lot has happened in that year, as the audacity of winning has given way to the timidity of governing. But in recounting how the campaign team -- and the candidate -- not only had the audacity to win but was able to keep that audacity alive, day in and day out over the long nearly-two-year slog of the campaign, Plouffe has also shown the Obama White House the way forward.

The book is a powerful reminder of what the country voted for last year -- and could serve as the trigger for Obama and his team to refocus and remember why the election mattered so much.

Most of the attention the book has gotten so far has focused on the so-called "sexy" parts -- the saga of Reverend Wright, the furor over Bittergate, how Obama came to pick Biden over Hillary for VP. All of which is serving to obscure the key takeaway from the book: the fact that everything in the campaign flowed, as Plouffe puts it, from Obama's conviction that "the country needed deep, fundamental change; Washington wasn't thinking long-term... the special interests and lobbyists had too much power, and the American people needed to once again trust and engage in their democracy."

Plouffe hits this theme again and again in the book. And it's the first thing we talked about when we met (me looking bleary-eyed from my night of reading and underlining and writing in the margins; Plouffe looking relaxed and refreshed, a far-cry from the profoundly exhausted look he had the last time I saw him, in the midst of the presidential run).

The book is "not a victory lap," he tells me. "It's a reminder of how and why we won. We never forgot why we were running. That was our North Star. And we held that North Star in our sights at all times. We made many mistakes along the way, but we always remembered that we were running because, as Barack put it, the dream so many generations had fought for was slipping away."

Axelrod -- or "Ax" as Plouffe refers to him throughout the book -- summed up at the beginning of the campaign the core elements of the message that would guide them: "change versus a broken status quo; people versus the special interests; a politics that would lift people and the country up; and a president who would not forget the middle class."

Running a different kind of campaign became "shorthand" for the campaign. Whenever they found themselves drifting towards standard political behavior, they'd ask themselves: "If we do this, how is that running a different kind of campaign?"

As Plouffe told me: "We made sure that everyone we hired internalized our core message and defaulted to those touch points when making decisions. For our break-the-rules strategy to work, we all had to remain faithful to its principles all the time."

Plouffe kept returning to the mistakes they made, but only to highlight the campaign's saving grace -- its ability to course-correct, a vital survival mechanism for any successful campaign. Or successful White House.

Early in the book, Plouffe describes a tense meeting with the candidate in April 2007, after it became clear that Obama was having a hard time connecting with voters turning out to see him. Ax, Plouffe, and Peter Rouse were brutally honest with him. And the candidate agreed about the need "to find his authentic voice and reconnect with the fundamental concerns that drew him into the race in the first place. He had run to challenge the bankrupt and conventional politics of Washington, not master it."

Then there was the senior staff meeting after their dismal showing in Pennsylvania, where Obama announced: "I want us to get our mojo back. We've got to remember who we are."

Plouffe also mentions the difficult decision made right before the Iowa primary to decline John Kerry's offer to endorse Obama -- a move campaign insiders felt was the wrong message to send to voters looking for change. "In the end," writes Plouffe, "the tough decision we made was unquestionably the correct one. Just about every time we took the road less traveled, we benefited."

That included the decision, which Plouffe fought hard for, to have the campaign headquartered in Chicago because "D.C. is a swamp of conventional wisdom and insiders that can suck a campaign down, and we needed to think differently." Maybe the answer to the last nine months is to move the White House to Chicago.

Indeed, reading the book, I often found myself wondering what Candidate Obama would think of President Obama. Would he look at what the White House is doing and say, "that's what I and my supporters worked so hard for?"

How did the candidate who got into the race because he'd decided that "the core leadership had turned rotten" and that "the people were getting hosed" become the president who has decided that the American people can only have as much change as Olympia Snowe will allow?

How did the candidate who told a stadium of supporters in Denver that "the greatest risk we can take is to try the same old politics with the same old players and expect a different result" become the president who has surrounded himself with the same old players trying the same old politics, expecting a different result?

How could a president whose North Star as a candidate was that he "would not forget the middle class" choose as his chief economic advisor a man who recently argued against extending unemployment benefits in the middle of the worst economic times since the Great Depression?

I'm referring, of course, to Larry Summers. According to a White House official I spoke with -- later confirmed by sources in the White House and on the Hill -- Summers was against the extension. And it took a lot of Congressional pushing back behind the scenes for the president to overrule him.

And, according to another senior White House official, when foreclosures or job numbers come up at the regular White House morning meeting, Summers' response is that nothing can be done. Nothing can be done about skyrocketing foreclosures or lost jobs.

Nothing can be done -- pretty much the opposite of "Yes we can," isn't it?
According to Plouffe, "reform is in Obama's DNA." Then how do you have in your inner circle a man who has "nothing can be done" in his DNA? Unless, of course, the problem on the table has to do with Wall Street, in which case "everything can be done, has been done, and will be done."

Obviously, an administration needs to hire people who weren't part of the campaign. But the danger comes in hiring those who don't even share the goals of the campaign. That's why The Audacity to Win is so desperately needed right now.

It reminds us that, not that long ago, the conventional wisdom was that Candidate Obama didn't have a chance and that Hillary Clinton's nomination was inevitable. That's the same conventional wisdom that tells us that President Obama doesn't have a chance at really changing things and that the ultimate victory of the entrenched special interests is inevitable.

But the Obama campaign didn't buy into the conventional wisdom then: "We had a mountain named Hillary Clinton in our path that we had to find some way to scale, get around, or blow a hole through," writes Plouffe. And the Obama White House doesn't have to give into the conventional wisdom now. It just has to get its mojo back.

One way the White House can do this is to have everyone there read Plouffe's book, filled as it is with page after page after page of reminders of who put Barack Obama in the Oval Office.

"We knew who we were," writes Plouffe, "a grassroots campaign to the core. We started with our supporters on the ground and they led us to victory." This grassroots effort "was a prime motivator for Obama to run, the belief that the American people needed to reengage in their civic life... Obama felt in his gut that if properly motivated, a committed grassroots army could be a powerful force. Over time, the volunteers became the pillars that held the whole
enterprise aloft."

I asked Plouffe what happened to the 13 million people on the campaign's email list -- a list he compares to having "our own television network, only better, because we communicated directly with no filter to what would amount to about 20 percent of the total number of votes we would need to win."

"Volunteers have made 300,000 calls to Congress to support the president's health care plan, and held thousands of events around the country," he told me. "But it's hard to maintain the intensity of the engagement."

Of course it's hard. But, as he puts it in the book, "Obama had ignited something very powerful in young people throughout the country. If that spark could be preserved, I was convinced we'd be a much stronger country for it."

And no amount of rationalizing and sugarcoating can change the fact that the spark has not been preserved. And that we are a less strong country for it.

One of the reasons Plouffe gives in the book for the campaign deciding to forgo public funding was that, as he writes, "most painfully, taking the federal funds meant losing control of our secret weapon: we would have to largely outsource our entire grassroots ground campaign to the DNC." Which is exactly where the grassroots list -- rebranded as Organization for America -- is housed now. Painfully.

Plouffe talks about how the Obama team knew that in order to win, it would have to "attain the holy grail of politics -- a fundamentally altered electorate. We had to expand the electorate or we were cooked." With the help of their grassroots army, they did just that. Among people who had never voted before -- or who hadn't voted for a long time -- 71 percent voted for Obama.

Plouffe feels genuinely connected to the movement he helped unleash. "So many of the people," he told me, "who gave their heart and soul to the campaign were people who had given up on the system because they no longer believed they could trust politicians to deliver or really change anything. It is imperative for our democracy that these people are not disappointed. If they become disillusioned, they won't be coming back for a long while."

"I feel such an obligation to them," Obama told Plouffe during the campaign. "They believe in me. In us. In themselves. What keeps me going day after day? Besides a clear sense of why I am running for president, it's them, our volunteers. It is a special thing we've built here and I don't want to let them down."

I asked Plouffe if the president had read the book. "He read a couple of sections in it," he replied, "and even discovered a couple of things he didn't know."

Well, if the president wants to make sure he doesn't let down the millions who believed he really would change the rotten system, he should read the The Audacity to Win from beginning to end -- and rediscover a whole host of things he knows, but seems to have forgotten.
Then he can complete the journey from The Audacity of Hope and The Audacity To Win to The Audacity to Govern.

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