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Entries for August 2009

August 31, 2009

The health care debate-17: Obama's choice

(For previous posts on the issue of health care, see here.)

In this last post in this series, I want to look at the way the health care 'debate' has progressed because it provides a classic example of how Congress and the president, supposedly meant to represent the 'will of the people' who elected them, maneuver to actually do the will of the business interests.

Polls have repeatedly shown that people are highly dissatisfied with the current system of employer-based health care in this country in which the private, profit-seeking insurance companies exert such a stranglehold. As Paul Street writes in the September 2009 issue of Z Magazine (not online), 73 percent feel that health care is either in a "state of crisis" or has "major problems" (Gallup, November 2007), and 71 percent feel that we need "fundamental changes" or have the US health system "completely re-built," compared to just 24 percent who wish only for "minor changes" (Pew Research Center, 2009).

Real reform would consist of introducing a single payer system along the lines of France or Canada or a socialized system along the lines of England. And Street points out that polls consistently show that a majority of people would support changes along those lines.

  • 64 percent would pay higher taxes to guarantee health care for all US citizens (CNN Opinion Research Poll, May 2009)
  • 69 percent think it is the responsibility of the federal government to provide health coverage to all US citizens (Gallup Poll, 2006)
  • 67 percent "think it is a good idea [for government] to guarantee health care for all US citizens, as Canada and Britain do, with just 27 percent dissenting" (Business Week, 2005)
  • 59 percent support a single-payer health insurance system (CBS/New York Times poll, January 2009)
  • 59 percent of doctors back a single-payer system (Annals of Internal Medicine, April 2008)

But of course the business lobby has enough clout to ensure that those options are not even discussed, let alone considered seriously. So the fight has been reduced to whether even a watered-down so called 'public option' should be introduced.

Political scientist and health policy analyst Jacob Hacker is the person who originally formulated the public option plan that Obama once acted as if he embraced but now seems to be trying to distance himself from. In a recent paper Hacker describes why a public option is essential for any meaningful reform, and the futility of the health-industry friendly alternatives like the health cooperatives that are being floated. He concludes:

That the two bills under consideration in the House and Senate contain a public health insurance option is considerable cause for celebration. Yet it is no cause for complacency, because the Senate Finance Committee appears unlikely to produce a bill that contains a true public plan. If, as expected, the Committee endorses federally promoted health cooperatives, they should be understood for what they are: an effort to kill the public plan and, with it, the prospect of an effective competitor to consolidated insurance companies that have too often failed to provide affordable health security.

What is interesting is that despite the concerted propaganda campaign against reform this year by the crazed 'deathers' supported by the health industry and backed by the Republicans and conservative Democrats and tacitly encouraged by the Obama administration, support for the public option remains strong. A new SurveyUSA poll released last week puts support for the public option at 77%, one point higher than it was in June. Another poll finds that 79% still support measures that constitute what is effectively the public option. The success of the propaganda campaign has been solely in confusing people as to what the phrase 'public option' implies, with only 37% being able to identify correctly what it means and 26% incorrectly thinking it refers to a British socialized system.

So Obama and conservative Democrats still have some way to go in implementing their sell-out plan to satisfy their corporate overlords while persuading the public they are true reformists. In the process they run a huge risk. Economist Paul Krugman warns Obama that the progressives who were so crucial to his electoral success are turning on him because of his subservience to the health industry.

A backlash in the progressive base — which pushed President Obama over the top in the Democratic primary and played a major role in his general election victory — has been building for months. The fight over the public option involves real policy substance, but it's also a proxy for broader questions about the president's priorities and overall approach.

And let's be clear: the supposed alternative, nonprofit co-ops, is a sham. That’s not just my opinion; it's what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers. (emphasis added)

Obama has a choice. He can go down in history as a footnote, the answer to a future trivia question as to who was the first person of color to become president of the US and as someone whose main accomplishment was to show that a president of color can be as subservient to the interests of the pro-war/pro-business one party ruling class as his white predecessors. Or he can decide to use his considerable clout and rhetorical skill to push for real health care reform and be remembered in history as one of the greatest US presidents of all time, the way that Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country, was chosen as the greatest Canadian of all time.

I fear that Obama's ambition does not match his soaring rhetoric. I hope I am wrong.

POST SCRIPT: Health reform information

Our local paper The Plain Dealer ran an informative series on the health care debate and provided some links to the major documents. The media has been focusing on the one that is still in the Senate Finance Committee led by reform opponent Democrat Max Baucus because that committee is the Obama Administration's best chance of avoiding real reform, which is why they have given that committee and its so-called "Gang of Six" reform opponents an effective veto over health reform legislation.

But there are other versions of health care legislation emanating from the various committees.

The 1,000 page House Bill HR 3200 can be seen here. The Congressional Budget Office (CBO) analysis of the bill can be seen here and a summary of the bill's provisions can be seen here. This site gives a detailed breakdown on what the bill would imply for each congressional district.

The Senate’s Health, Education, Labor and Pensions (HELP) Committee's proposal can be seen here. The CBO analysis of the HELP plan can be seen here.

We should also not overlook the important step that the House Committee on Education and Labor that is chaired by Dennis Kucinich took when, by a vote of 25-19, it "approved an amendment to the House's health-care reform bill allowing states to create single-payer health care systems if they so choose." After all, the Canadian single payer system began at the provincial level, and only later spread nationwide.

You can also view a side-by-side comparison of the various health reform proposals and a timeline of health reform.

Sam Smith has a good article on health care reform that asks some important questions.

August 28, 2009

The health care debate-16: Health reform Kabuki theater

(For previous posts on the issue of health care, see here.)

In this post in this series, I want to look at the political gamesmanship that is going on in health care.

As I have said repeatedly, the US is a pro-war/pro-business one party state with two factions that differ on some social issues. However, people would revolt if they realized the extent to which so many of their elected representatives of both parties are the servants of corporate interests. In order to disguise this fact, whenever an issue that involves corporate interests arises, one sees an elaborate Kabuki theater performance in which the elected officials play assigned roles, one of which involves pretending to have a major fight over some peripheral issue, while the final outcome is never in doubt.

The massive bailout to Wall Street interests was a case in point. Remember the big fuss over bonuses? Regulations? Corporate jets and other perks? That was pure Kabuki theater, the equivalent of the circuses that Roman emperors put on to amuse the people and appease their blood lust. Once a few executives had been excoriated in public and made their public penance, once the media spotlight shifted to other things, the looting of the public resumed. The big Wall Street banking interests were ultimately left alone to make huge profits and hand out big bonuses, which is exactly what is happening right now.

It is the same with health industry reform. Matt Taibbi of Rolling Stone argues persuasively that Obama was, from the beginning, in the tank with the health insurance/drug/physician/hospital industries and was never serious about making the kinds of far-ranging changes that would improve health care, if those measures went against the interests of those industries. Jonathan Cohn already had pointed out that Obama cut a deal with the drug industry not to seek lower prices. But he did want to create an image of himself as a serious reformer and use fixing the health care system, which is obviously broken, as a vote getter. So he played his Kabuki role.

Obama started out on the campaign trail talking about the virtues of the single-payer system and then falsely asserting, without any argument, that because the employer-based system was already in place, single payer cannot be implemented now in the US, despite evidence to the contrary. This enables him to rule out, right at the beginning, single payer systems as one among the mix of options to be discussed in his health care reform panels.

Then later he says that what is most important to him is not getting good health care reform passed but that it must be bipartisan. Why on earth should bipartisan acceptance be more important than good policy? That statement was the confirmation of my suspicions that Obama was not serious, because that appeal to bipartisanship immediately put him at the mercy of the Republican Party and those in his own party who were never interested in any reform, who then went on to play their Kabuki roles of objecting to any meaningful reform proposals. Obama of course had to know that they would do this. He is not stupid. This predictable opposition enables him to act as if he is being forced to compromise more than he wants to, thus preserving his reformist credentials while abjectly serving the interests of the health industry. As Glenn Greenwald says, "There is one principal reason that Blue Dogs and "centrists" exert such dominance within the Party: because the Party leadership, led by the Obama White House, wants it that way and works hard to ensure it continues."

Then Obama starts signaling that he is willing to abandon even the limited public option. All this is to lead up to the final scene of the Kabuki theater in which he finally agrees to a system that the health industry would love, such as mandating that everyone buy insurance from the private, profit-seeking health insurance industry with the government paying the premiums of those who can't afford it, while the insurance companies are given the freedom to continue the treatment-denying policies that is at the heart of their business model.

Greenwald continues:

White House threats that "you'll never hear from us again" are issued to defiant progressives only. Not only are such threats never issued to "centrists" and Blue Dogs who are supposedly impeding the President's health care agenda, but the White House does everything it can to protect those ostensible obstructionists and further entrench them in power. Isn't all of this fairly strong evidence that the White House knew, accepted and likely even desired from the start that -- despite the President's public assurances to progressives -- the "public option," understandably despised by the insurance industry, would be dropped from bill?

The very idea that Obama is valiantly struggling to cleanse the party of its corporate and centrist dominance, yet is just haplessly and helplessly unable to do so, is ludicrous beyond words.

Former insurance industry insider Wendell Potter also sees quite clearly how Obama playing his role in this Kabuki play.

Not only is Obama clearly ready to throw the public option overboard, he is embracing the requirement that we all be forced to buy insurance from private insurers. That means your tax dollars and mine will be used to pay subsidies to the big insurers to provide coverage to people who can't afford to buy their policies, because the big insurers charge far more than they should because Wall Street investors demand that they do.

During his speech in Montana, Obama talked a lot of trash about the insurance industry. Don't be fooled by that tough talk. It's all part of a strategy to try get us to believe we'll get the reform he promised during the campaign. Industry leaders are in fact delighted he's denouncing their behavior, because they believe most of his supporters -- who were hopeful the stars might finally have aligned for real reform -- will be fooled into thinking the reform bill that reaches his desk will benefit them more than the special interests with their armies of lobbyists.

That final scene hasn't been arrived at yet because there is one group that is not playing its designated role and is thus threatening to disrupt the performance. These are the progressives in Congress whose role is to be cheerleaders for Obama because he is allegedly one of them. There are hopeful signs that the progressive members of the public and Congress are seeing through this charade. They are getting angry at this sell-out on a fundamental campaign issue and they are warning Obama that they will revolt if he abandons meaningful reform.

I hope they are successful in pushing back against Obama's sell-out.

POST SCRIPT: The Onion on health reform deadlock

As usual, it is the comedians and parodists, not the news media, that sees through the Kabuki façade.

After months of committee meetings and hundreds of hours of heated debate, the United States Congress remained deadlocked this week over the best possible way to deny Americans health care.

"Both parties understand that the current system is broken," House Speaker Nancy Pelosi told reporters Monday. "But what we can't seem to agree upon is how to best keep it broken, while still ensuring that no elected official takes any political risk whatsoever. It’s a very complicated issue."

"Ultimately, though, it's our responsibility as lawmakers to put these differences aside and focus on refusing Americans the health care they deserve," Pelosi added.

The legislative stalemate largely stems from competing ideologies deeply rooted along party lines. Democrats want to create a government-run system for not providing health care, while Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible.

That is about as succinct a presentation of how the pro-business one party state in the US works as you will find anywhere.

August 27, 2009

The infantilization of religious faith

Once in a while I get private emails from readers of this blog who disagree with my atheistic stance. Recently I got one that said in its entirety:

Dear Sir, from your comments about the religious beliefs of scientists, I gather that you contend that, for the scientist, the greater the learning, the lesser the belief in God; and, conversely, the greater the belief in God, the lesser the knowledge of science. It never ceases to fascinate me, the adoring eyes of a child for the elderly, yet the grown up has little need for them, and, so, they confine them to a home and out of their way. By far, what the child has is greater than what the grown up has. Love never enters the equations of scientists, nor does faith; consequently, the eternal God is not in view of scientists, but only His temporal creation. Archeology has uncovered less than 1% of all the treasures of our past (just scratched the surface), yet, for many decades, archeologists, in their haughtiness, have spoken with authority against the Bible, as bulls from the chair. Many scientists today, and of the past, with their silver surfboard in hand, have yet to feel a wave flow by their ankles, as they have barely just stepped into the ocean. What the eye cannot see, and the ear cannot hear, and the mind cannot understand, the spirit (even of a child) can fathom.

This letter, in somewhat flowery language, illustrates some of the contradictory beliefs that religious people commonly express without them even realizing it.

For example, it says that a child's understanding of the world is superior to that of the adult. It says that in order to perceive god, we need to be like children in our ignorance, and listen to the voices in our head, rather than the concrete senses of sight and sound. In other words, deeper knowledge and greater learning undermine faith. I actually agree with the last sentence but view it as a good thing.

It amazes me that people think that ignorance is a good thing. When people sing the praises of childlike faith, I don't think they quite realize how insulting that is to their religion. It is saying that faith in god is on a par with faith in Santa Claus and the Easter Bunny, things that only a child would believe in. I agree with that last sentence too but am surprised that religious people advocate it as a virtue.

But the letter writer then promptly contradicts that position by implying that scientists know so little now and presumably that when we get to know more, evidence for god will emerge. So in order to perceive god should we be like children unburdened by knowledge or should we seek more knowledge? Religious people want to have it both ways, on the one hand saying that we see god only by faith and not by knowledge, and on the other hand that we are ignorant now and that more knowledge will provide the necessary evidence for what now must be accepted only on faith. What is interesting is that this contradiction never strikes them, providing another illustration of how religion undermines the ability to think rationally.

The contradictions go even deeper. After all, if god created us then he also created our unusually large brains and gave us the power to think and reason and use logic. As Hamlet says (Act II, Scene II), "What a piece of work is a man! how noble in reason! how infinite in faculty!" If so, then why would god not expect us to use the abilities he/she supposedly gave us to understand everything about the world, including religious beliefs? Why would he/she give us this extraordinary intellectual ability and then make it into a liability?

In the end, what religions want you to do simply boils down to this prescription: "You must believe in god. Anything that helps you believe is good. Anything that undermines belief is bad. Ignore any contradictions. Use your brain for everything except examining your religious beliefs to see if they make any sense."

In the great title song from the film O Lucky Man, singer Alan Price describes the qualities that a lucky man possesses. One of them is not being tempted by promises of heaven or made fearful by threats of hell but he also adds that, "If knowledge hangs around your neck like pearls instead of chains, you are a lucky man."

This phenomenon of religious people sacrificing knowledge and reasoning abilities in order to preserve beliefs for which there is no credible evidence whatsoever is sad, really. For religious people, knowledge is indeed like heavy chains, holding them back and burdening them because it contradicts their myths. Atheists, on the other hand, not being bound by dogma and religious texts, delight in discovering pearls of knowledge.

POST SCRIPT: Jesus and the dinosaurs

Many Christians are anxiously waiting for the promised second coming of Jesus when they will get their reward for being faithful believers. But what they don't realize is that the first coming of Jesus was not at the time described in the Gospels in the Bible but actually occurred much earlier, during the dinosaur age. Eddie Izzard recovers this lost history.

So the second coming of Jesus has already occurred. Sorry, Christians, the show is over, there is nothing more to wait for.

August 26, 2009

The health care debate-15: The ruthless science of health industry profits

(For previous posts on the issue of health care, see here.)

Some of the supporters of the current health system have a somewhat naïve view of capitalism. They seem to have bought into the myth that the 'invisible hand' of the market will always result in good quality goods and services being provided at lower costs. That model works in some situations when there is competition among many suppliers and when the consumer has the option of not buying a product at all if they are not satisfied with the price or quality of the offerings, say as with the purchase of specific foods or a new car or a washing machine.

But it ceases to be true when people are in dire need and their options are limited. This is why one finds price gouging in essential supplies like water, food, blankets, and power generators in the immediate aftermath of a disaster like a hurricane or earthquake, when callous merchants take advantage of the misery of people to rake in huge profits. It would be insane for the government not to intervene and provide people with necessary supplies and services at those times. Look at how George Bush got hammered for the government's slow response to Hurricane Katrina.

Since health care is one of those situations in which people do not have the option of not obtaining services, and usually have to seek it in emergency situations, it is closer to the hurricane situation than that of buying a new car, which is why a strong government role is essential.

But the private, profit-seeking health insurance industry wants to go in the opposite direction. As Wendell Potter, who used to be the head of corporate communications of CIGNA, the highest public relations position of one of the largest health insurance companies, says in an interview with Bill Moyers, "The industry doesn't want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don't want any more competition period. They certainly don't want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so", compared to the health insurance industry's 20%.

Potter explains to Moyers the brutal calculations that go into increasing profits by denying treatment.

WENDELL POTTER: …[T]here's a measure of profitability that investors look to, and it's called a medical loss ratio. And it's unique to the health insurance industry. And by medical loss ratio, I mean that it's a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry's been dominated by, or become dominated by for-profit insurance companies. Back in the early '90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they'll punish them. Investors will start leaving in droves.

I've seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street's expectations with this medical loss ratio.

For example, if one company's medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that's ridiculous. And it's horrible.

BILL MOYERS: That they're spending more money for medical claims.

WENDELL POTTER: Yeah.

BILL MOYERS: And less money on profits?

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that's what-- that is what happens, what these companies do, to make sure that they satisfy Wall Street's expectations with the medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That's one thing. And that was that issue in the Nataline Sarkisyan case.

Many of the people who oppose single-payer and other comprehensive attempts at health care reform may be doing so out of a sense of smug complacency. They may think they are healthy and have good coverage from their current employer and so life is good. Why mess with something what seems to be working so well for them? In fact, one of the most disgusting arguments that I have heard recently from opponents of health reform is that by adding the 40 million or so currently uninsured to the rolls, there would necessarily be increased waiting times to obtain medical services. In other words, in order to save a little time for them, they would like to see others have no access to health care.

The fact that so many other people suffer from either inadequate coverage or no coverage at all may not be sufficient to move those who think they have good coverage now to embrace reform. What they do not realize is that their seemingly comfortable situation could change practically overnight through no fault of their own. All it would take is for one or two of their fellow employees to get a serious illness for them to lose their own coverage. Potter explains how this happens as a result of deliberate policy by the health insurance companies:

But another way is to purge employer accounts, that-- if a small business has an employee, for example, who suddenly has [to] have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That'll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they'll say, "We need to jack up the rates here, because the experience was," when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they'll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They'll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes. (emphasis added)

Potter warns people who resist reform attempts that the very things they say they fear about single payer or socialized systems or even the public option are actually more likely to occur under the present employer-based system.

And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don't want the government to take away your choice of a health plan. It's more likely that your employer and your insurer is going to switch you from a plan that you're in now to one that you don't want. You might be in the plan you like now. But chances are, pretty soon, you're going to be enrolled in one of these high deductible plans in which you're going to find that much more of the cost is being shifted to you than you ever imagined. (my emphasis)

The private, profit-seeking health industry is a cold-blooded and ruthless business in which meeting the needs of sick people is at the very bottom of their list of priorities, while making profits for their shareholders and paying for their executives' luxurious lifestyles is right at the top. Why anybody would want to preserve that system can only be explained either by their ignorance of how it actually works or because the politicians have been bribed by the industry.

POST SCRIPT: Billionaires for Wealthcare speak out

"If god loved the poor people, he wouldn't let them get sick." So true.

August 25, 2009

College as a Disney World of Learning

(Talk given at Case Western Reserve University's Share the Vision program, Severance Hall, Friday, August 21, 2009 1:00 pm. This program is to welcome all incoming first year students. My comments centered on the common reading book selection Three Cups of Tea by Greg Mortenson and David Oliver Relin. Mortenson will be the speaker at the annual fall convocation to be held on Wednesday, August 26, 2009 in Severance Hall at 4:30 pm.)

As I read the book Three Cups of Tea, two stories struck me. One begins on page 202 and is that of the little boy Mohammed Aslam Khan who was sent by his father alone on a perilous journey downriver in frigid waters, all so that he might get a chance at an education. Despite all the odds against him, he not only survived the trip but got a good education and returned to the village to become an educational leader.

The other story is on page 31 where Mortenson describes his amazement when he saw eighty two children assemble by themselves and do their lessons on their own in the open, in the cold, some writing on the ground with sticks, since the village could only afford a teacher for three days a week, and on the other days they were on their own.

As Mortenson said, "Can you imagine a fourth-grade class in America, alone, without a teacher, sitting there quietly and working on their lessons?"

Why were the people in that remote region of Pakistan willing to go through so much in order to get an education? Compare the situation in the US where learning is often seen as something to be avoided, and the complaints that some teachers get when they cover too much ground. When schools are closed or lessons cancelled due to some emergency, it is usually a cause for cheering amongst students. As a colleague of mine here said recently, education may be the only thing in the US where people actually want less than what they pay for.

There are of course classes, teachers, and students in the US where learning for its own sake is valued. But these are unfortunately few. But I do not believe that there is any fundamental difference between the children in those remote villages of Pakistan and Afghanistan and those in the US that explains this difference in attitude.

What may be true is that America suffers, if that is the right word, from too easy access to education. Schooling is fairly easily available and, at least in the K-12 sector, is free. A good analogy is with food, which is also freely and cheaply available in the US, when compared with other countries. And we waste and throw away vast amounts of it. I am sure your mothers pleaded with you to eat your vegetables, invoking images of starving children in China who would gladly eat with relish the food that you want to dump in the trash. Actually given the economic crisis in the US and the rapidly rising economic power of China, soon Chinese mothers might be pleading with their spinach-rejecting children to think of poor starving children in the US.

Students in the US, because of the ease and abundance of educational opportunities, have to be exhorted to take advantage of these abundant resources, just like they have to be coaxed to eat their broccoli, and this may be devaluing education in students' eyes, because people tend to not value the things that are easily available.

This is why the story of the immense struggles and sacrifices made by the villagers that Mortenson worked with to build their schools is so inspiring. They realized that education is a precious gift to be cherished, not something whose availability can be taken for granted.

All of you are now embarking on four years of education here at Case Western Reserve University. Some people may tell you that college will be the happiest time in your lives. I disagree. In fact, it would be very sad if the happiest years of your life were over by the age of twenty-two. So I hope that you will have much happier times in the future.

But there is one aspect in which these four years will be a unique experience that you must take advantage of to the fullest. It is the one time in your life when you will be surrounded by people who want nothing else but to help you learn. The world-class faculty here, who are experts on all manner of things, will share their knowledge and expertise freely and willingly. Here you will get free access to incredible libraries full of books, journals, magazines, audio-visual materials, and newspapers, and to librarians who are positively eager to help you use them. And it is all available to you just for the asking. Once you graduate and go out, that opportunity is gone.

Of course, all this is not technically 'free' since you are paying tuition that, despite the extraordinary fund-raising abilities of our president, is still considerable. But the way to think of tuition fees is the way you would the admission price to Disney World or other amusement parks. It is not cheap to get in but once you are in, people try to get as much out of their time there as possible. It would be absurd to spend all your time sitting on a bench eating ice cream or surfing the web or sleeping.

You should have that attitude during the years you spend here. Think of Case Western Reserve University as the Disney World of learning. You have paid the admission fee in terms of grades and tuition. Now that you are in, rather than get by with minimal work, you should try to get in as much learning as possible, formally in classes, and informally in all the talks and seminars and casual discussions with teachers and fellow students. Once you develop that attitude towards learning, you will find that it is much more fun than roller coaster rides and with none of the accompanying motion sickness.

I am lucky in that I actually work here and take full advantage on a daily basis of the knowledge that is so freely available. And I would urge you to do the same. In fact, as soon as this program is over, and you have some free time, you should go over to the library and see what they offer, and you should go to all the museums that are right here in University Circle, as the first steps in a four-year adventure of learning.

Trust me, you will never regret it.

POST SCRIPT: The story of Genesis as told by Eddie Izzard

Much more interesting than the original. Makes more sense, too.

August 24, 2009

The health care debate-14: The 'death panels' of the insurance companies

(For previous posts on the issue of health care, see here.)

Wendell Potter used to be the head of corporate communications of CIGNA, the highest public relations position of one of the largest health insurance companies. That position gave him a special insight into how the health insurance industry actually works and the very different way they present themselves to the public. At some point the contradictions became unbearable for him. He could not take it anymore and left his position and since then he has been spilling the beans about how the insurance companies really operate, how they put profits before any other consideration, and make money from the misery of sick people by denying them care in their time of need.

Potter spoke to Amy Goodman of Democracy Now! about two cases. One was a California teenager, Nataline Sarkisyan, who in 2007 was denied coverage for a liver transplant, even though her doctors' recommended it and they had insurance and had done everything that was expected of them. The family was able to get media attention and force CIGNA to reverse itself, but the reversal decision came just two hours before she died. No doubt CIGNA views this outcome as a great success since they did not have to pay for the liver transplant after all, hence their costs went down and their profits went up. Their shareholders must have been pleased.

Then there was the case of Thomas Concannon, who in 2002 was suffering from multiple myeloma, a rare form of cancer. As Goodman reports "His doctors planned to perform a bone marrow transplant, but as Concannon lay on the operating table, his insurance company, CIGNA, announced it would not cover the operation." (my emphasis)

Potter remembered both those tragic cases because he had to try and mitigate the public relations damage. In a recent interview with Bill Moyers, Potter describes how he came to his epiphany about how rotten the current system is and his own sordid role in it. It occurred when he visited a 'health expedition' run by volunteer doctors at the Wise County fairground near his hometown when he was visiting his family. Such events are sprouting up all over the country and the huge crowds that turn up are a testimony to how many people lack access to basic primary medical care. Potter describes what he saw.

I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn't know what to expect. I just assumed that it would be, you know, like a health-- booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases-- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee-- all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. They could have been people who grew up at the house down the road, in the house down the road from me. And that made it real to me.

Potter says that the widely contrasting world that the insurance industry executives live in carefully insulates them from the harsh realities that most people face, so that the people they deny coverage to are never seen as real people but are merely statistics.

I had a great job. And I had a terrific office in a high-rise building in Philadelphia. I was insulated. I didn't really see what was going on. I saw the data. I knew that 47 million people were uninsured, but I didn't put faces with that number.

Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.

And I just thought that was a great way to travel. It is a great way to travel. You're sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies.

In the same interview, Moyers reveals the strategy of the opponents of health care reform, who are trying to scuttle it while saying they want it.

BILL MOYERS: I have a memo, from Frank Luntz. I have a memo written by Frank Luntz. He's the Republican strategist who we discovered, in the spring, has written the script for opponents of health care reform. "First," he says, "you have to pretend to support it. Then use phrases like, "government takeover," "delayed care is denied care," "consequences of rationing," "bureaucrats, not doctors prescribing medicine."

This came as no surprise to Potter: "They don't want a public plan. They want all the uninsured to have to be enrolled in a private insurance plan. They want-- they see those 50 million people as potentially 50 million new customers. So they're in favor of that."

It is a fascinating interview, giving a disturbing insider's look at the really evil practices of the health insurance industry. Moyers describes another case.

The day before she was scheduled to undergo a double mastectomy for invasive breast cancer, Robin Beaton's health insurance company informed her that she was "red flagged" and they wouldn't pay for her surgery. The hospital wanted a $30,000 deposit before they would move forward. Beaton had no choice but to forgo the life-saving surgery.

Southern Beale writes about her own experience:

You have no idea what it's like to be called into a sterile conference room with a hospital administrator you've never met before and be told that your mother's insurance policy will only pay for 30 days in ICU. You can't imagine what it's like to be advised that you need to "make some decisions," like whether your mother should be released "HTD" which is hospital parlance for "home to die," or if you want to pay out of pocket to keep her in the ICU another week. And when you ask how much that would cost you are given a number so impossibly large that you realize there really are no decisions to make. The decision has been made for you. "Living will" or no, it doesn't matter. The bank account and the insurance policy have trumped any legal document.

Such stories expose that the falsity of the fear mongering that in a single payer or socialized system, bureaucrats will come between doctor and patient and make life or death decisions. Such things only happen with the private, profit-seeking health insurance companies. So the closest things to the bureaucratic 'death panels' that emerged from the fevered imaginations of the deathers are actually run by the private, profit-seeking health insurance industries who, in conjunction with hospital administrators, callously consign people to death purely because of their desire for profits.

POST SCRIPT: Capitalism – A Love Story

Here is the trailer for Michael Moore's upcoming film which, like his others, should be well worth watching. His Sicko that dealt directly with the health system was great, and if you did not see it, you should rent it. But the problem with the health system is that is embedded in the capitalist mindset that values profit above all other things, and so this new film should give the bigger picture.

People will try and dismiss Moore as a 'mere' comedian in order to discredit his message. This is what the health industry and its shills in the media (I am looking at you Sanjay Gupta) tried to do with Sicko. In his interview with Moyers, Wendell Potter describes the industry's strategy of which he was a part.

Don't be fooled. His films are funny but Moore is smart and researches his material well. Try as they might, his detractors could not fault him on the facts.

August 21, 2009

The health care debate-13: The US falling further behind

(For previous posts on the issue of health care, see here.)

I have pointed out repeatedly that the US lags badly behind other developed countries in the quality and cost of the health care it provides its people. And all indications are that the US is going to fall further and further behind as other countries adopt universal health coverage based on the single-payer model.

President Obama keeps saying that if we were starting from scratch, a single payer system would be the best option, but that given the existing situation of an employer-based private health insurance system, it would be too disruptive. This is just an excuse for protecting the interests of the drug and insurance industries. After all, Medicare was introduced in 1965 and within one year, by July 1, 1966 19 million seniors were enrolled in it, almost all of the nearly 20 million people over the age of 65 at that time (see table 2-1, page 9), and there were no major problems in that transition.

Furthermore, as this article in the journal Health Affairs points out, other countries such as Taiwan made the transition from a US-style system to a single payer one quite easily. (Thanks to Heidi Nemeth for the link.)

Taiwan established a compulsory national health insurance program that provided universal coverage and a comprehensive benefit package to all of its residents. Besides providing more equal access to health care and financial risk protection, the single-payer NHI also provides tools to manage health spending increases. Our data show that Taiwan was able to adopt the NHI without using measurably more resources than what it would have spent without the program. It seems that the additional resources that had to be spent to cover the uninsured were largely offset by the savings resulting from reduced overcharges, duplication and overuse of health services and tests, transaction costs, and other costs. The total increase in national health spending between 1995 and 2000 was not more than the amount that Taiwan would have spent, based on historical trends.

Additionally, Taiwan did not experience any reported increase in queues or waiting time under the NHI. Meanwhile, the government has taken regular public opinion polls every three months to gauge the public’s satisfaction with the NHI. It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs. (emphasis added)

As Scott Hanley says:

In 1995, Taiwan began providing government-run health insurance for everyone; by the end of the year, almost everyone in the country had enrolled and abandoned their US-style system of mixed private and public hospitals and free market insurance. What happened to health care costs? In the first seven years they ... stayed about the same.

That's right. They went from 57% insured to 97% insured without increasing overall spending on health care. People liked it, used it, remained healthy, and it was just as affordable as the private system that had insured not much more than half the population.

A recent report says that China has decided to have universal health care by 2011, and will "take measures within three years to provide basic medical security to all Chinese in urban and rural areas, improve the quality of medical services and make medical services more accessible and affordable for ordinary people."

Obama and the Democrats seem to start their negotiating process with what they think that the most reactionary elements in congress will accept, instead of the one that the country needs, let alone a really good one like a single-payer system. Cartoonist Tom Tomorrow explains the futility of this strategy.

Veteran journalist Russell Mokhiber lists the top 10 enemies of the single payer system, in alphabetical order. One or two of the names on the list may surprise you and you need to read the article for Mokhiber's reasons.

American Association of Retired Persons (AARP)
America's Health Insurance Plans (AHIP)
American Medical Association
Barack Obama
Business Roundtable
Families USA
Health Care for America Now
Kaiser Family Foundation
The Lewin Group
Pharmaceutical Research and Manufacturers Association of America (PHRMA)

However far Obama goes to appease the reactionary elements, they will still oppose reform because they want to kill it altogether. They do not want to give the Democrats a signature victory on a major issue, and they are aided in their efforts by those Democrats in Congress who are in the pockets of the health industry.

POST SCRIPT: Nutters gone wild

We have seen many examples of nutter behavior recently and it is hard to determine who is the craziest. A strong contender must be this woman who shouts "Heil Hitler!" at a Jew who is originally from Israel who was speaking in favor of health reform and for the creation of a national health care system like they have in Israel. Not surprisingly, he goes ballistic. Also watch her behavior at the end when he tells her that he had to pay $8,000 for a two-hour visit to a US emergency room. Priceless.

David Waldman notes that, to add to the irony, she is wearing an IDF T-shirt, which she presumably thinks gives her the license to freely use Nazi allusions.

August 20, 2009

The crying game

On Tuesday, I wrote about my discussion with the Cleveland Freethinkers group. Today I want to spend some time on the issue of the Christian woman at the meeting who, right in the middle of a lively discussion on the relative merits of the accommodationist versus the new atheist positions, suddenly and tearfully interjected an extended statement about her strong belief in Jesus based on some unspecified personal experience.

While we were sympathetic with her and treated her outburst gently, it is precisely this kind of reaction that is used by religious believers to shut down criticisms of their beliefs. I am not suggesting that this was a devious plan of the woman in question. In fact, I think she was being genuine and spontaneous. But it is symptomatic of the problem of frankly discussing religion. Religious people have become so used to their views being given undue deference that they cannot deal with having them clinically analyzed and thus become upset.

When someone tearfully says in the midst of a rational discussion on science and religion that "I truly believe that Jesus is my savior" or gives as the basis of some crackpot belief (like the Earth is 6,000 years old) that this is what his faith tells him is true, and is clearly upset because the rest of us are not taking such beliefs seriously, what are we supposed to do? What has been expected of us in the past, and which is what I am afraid that the accommodationist position encourages, is to treat such outbursts as either a sensible contribution to the conversation and try and soothe the person's wounded feelings or change the subject to avoid having to contradict someone's sincerely held beliefs, thus effectively ending the discussion. This is precisely how religious beliefs have shielded themselves, by expecting us to accommodate the emotional beliefs and feelings of religious people, and treating them as things that cannot be directly challenged.

What we should really do when people say such things is say something like "Good for you! But what you sincerely believe in the absence of any credible evidence is not really pertinent to this discussion, so let's move on, shall we?" In essence that is what the Cleveland Freethinkers group eventually did, although they took some time to do so because initially it was taken aback and spent some time trying to cater to the feelings of the Christian and not hurt them

The philosopher Richard Rorty grappled with this same question in a 1994 essay titled Religion as Conversation-stopper that I wrote about earlier. Rorty says that the silence that usually accompanies someone's fervent statement about their religious beliefs "masks the group's inclination to say, 'So what? We weren't discussing your private life; we were discussing public policy. Don't bother us with matters that are not our concern.' This would be my own inclination in such a situation."

I think that is precisely what happened at the Freethinker's meeting. The Christian's outburst hijacked the discussion away from general policy to solicitousness for her feelings. Most of us clearly felt that the Christian woman's testimony was not relevant but struggled to find ways to tell her so without making her cry even more, thus taking time away from the main focus.

What happened is the religious equivalent of what has been sarcastically referred to within the feminist movement as the 'white woman's tears' phenomenon, "the tendency of race and gender discussions among feminists to be derailed by white women into the pain the discussion is causing non-POC [person of color]." It is elaborated on in this poem by Native American poet Chrystos in the context of internal struggles within the feminist community.

That is precisely the response that we new atheists get when we criticize all forms of religion, moderate and fundamentalist. When we do so, the feelings of religionists are hurt and they start to cry. Not literally of course in the case of sophisticated religious moderates, because that would look obviously whiny and pathetic. Instead they cry in a metaphorical sense, by leveling the charge that the new atheists are 'contemptuous' of other people's beliefs or 'militant' or 'rude' or 'extreme' or 'shrill' or 'strident' or 'obnoxious' or similar epithets.

These charges are rarely backed up with concrete examples of such alleged bad behavior or language, or that it is any more common than the disdain with which atheists are routinely portrayed by religious people. Their function is once again to seek to shift the discussion away from the credibility of religion and to soothing the wounded feelings of the person claiming to be aggrieved by the allegedly harsh rhetoric against religion, and to make the new atheists apologetic and on the defensive. The excellent comic strip Jesus and Mo has something to say about this.

jesusandmo2.jpg

Sorry, but new atheists have caught on to this crying game rhetorical gambit and it is not working any more. This does not mean that we will simply dismiss those who get upset but it is not going to mute us. The new atheists are here to stay and will continue to make their critiques of religion because the fact that science and religion are incompatible is backed by an overwhelming preponderance of evidence and logical arguments in its favor, while religious apologetics and theology is becoming increasingly desperate in its special pleading.

Religious moderates are just going to have to suck it up and deal with criticisms of their beliefs like adults.

POST SCRIPT: The Thinking Atheist gives us The Story of Suzie

(Thanks to onegoodmove.)

August 19, 2009

The health care debate-12: Money talks

(For previous posts on the issue of health care, see here.)

Despite all the manifest advantages of the single-payer system, why is it not even discussed seriously in the decision-making bodies of government? To pose the question is to answer it. It is because the current US system is so bad that its supporters must prevent public discussion of obviously better rivals if it is to survive. The current system is the emperor that has no clothes.

Rich and powerful people either benefit directly from money that they get from the private, profit-seeking health industry (like those who work in the industry or the politicians who get big contributions from them) or have the money to get good treatment. It is these same people who protect the interests of the drug and insurance companies by refusing to even consider a single-payer system. These people use fear to keep others in line, raising downright dishonest fears of shortages, queues, rationing, lack of choice, etc if any reform should occur. They have even started upping the ante on their craziness, saying that with health reform we will start killing all old and sick people.

Uwe Reinhardt, a professor of political economy at Princeton University explains who is behind the propaganda:

Most Americans, first of all, are bombarded with propaganda. You don't know how many think tanks are paid by certain industry — insurance, drug, organized medicine — to feed out negative stories about the Canadian health system. They do of course have mishaps, as do we, but there is a whole industry collecting them and beaming them out here. That is one.

Secondly, people are always more comfortable culturally with whatever they have than with some other system.

Third, people imagine having the worst illness, and if you are really very sick in the U.S., you generally do have more hope than in any other country if you are very sick, particularly if you are well insured. But if you sort of live the average life of Americans and have a Canadian system, they have better primary care, easier access to it. They would never go bankrupt over health care, because they don't do that up there. They would realize what they are missing here.

Bloomberg reports that there are 3,300 health care lobbyists who have spent $263.4 million on lobbying during the first six months of 2009, getting their data from the Center for Responsive Politics which is monitoring the spending.

Uber-statistician Nate Silver, who did such an incredible job during the last election of analyzing the polling data, has done a statistical analysis of where politicians stand with respect to the public option and how that correlates with the amount of support they get from the health industry. He finds (surprise!) that the more they get funded by those special interests, the less supportive they are of the public option.

publogit2.PNG.png

Take Democratic Senator Max Baucus from Montana, chair of the Senate Finance Committee and one who has fought strenuously to keep single-payer out of the debate and scuttle any genuine effort at reform. As NPR reports:

Paul Blumenthal, a writer for the nonpartisan watchdog the Sunlight Foundation, mapped Baucus' network of influence. (You can see the "Baucus influence map" at left).

"We have Max Baucus, who represents a single node, as the chairman of the Senate Finance Committee," Blumenthal explains. On his computer screen, lines radiate from Baucus to five of his former Senate staffers. Two of them served as chief of staff to Baucus, the top job in his Senate office.

All five now lobby Congress for various interests. Among their clients: drugmakers Wyeth, Merck, Amgen and AstraZeneca, plus the third-largest corporation in the world, Wal-Mart.
...
When Baucus ran for his sixth term last year, his campaign raised $11.6 million, according to the Center for Responsive Politics. Nearly half of the funds came from out-of-state donors, including millions from health care and other industries overseen by Finance and Baucus' other committees.

Just 5 percent of Baucus' re-election funds came from Montana donors."

Baucus courts these inside-the-Beltway donors by inviting them to Montana for weekend getaways — skis and snowmobiles in February, fly fishing and golf in June, and coming up on July 31, "Camp Baucus," which is billed as "a trip for the whole family."

Tickets start at $2,500.

So as Baucus and other lawmakers attempt to craft a bill that can smash through a virtual gridlock of interests, the awkward question lingers: To whom are they more attentive — their voting constituencies back home or the dollar constituencies who are at the Capitol every day?

That's an easy question to answer, isn't it? It appears that Baucus's Senate Finance Committee may not include a public option. See also this report.

Former Senate Democratic leader Tom Daschle's nomination to be Obama's secretary of Health and Human Services was scuttled by some tax and ethics questions. While I felt that his ethics problems were nowhere as severe as (say) Tim Geithner's who was approved because he was favored by Wall Street interests, I was glad that he did not get the position because I knew that he was totally in the pockets of the health industry lobby. Sure enough, he later came out against the public option.

Of all the presidential candidates in the Democratic and Republican primaries in the last election, only Dennis Kucinich supports single payer. The House Committee on Education and Labor that he chairs, by a vote of 25-19, has "approved an amendment to the House's health-care reform bill allowing states to create single-payer health care systems if they so choose." He is also one of the 86 co-sponsors of John Conyers' House Resolution 676 that seeks to expand Medicare coverage for all, and is a worthy step towards an eventual single-payer system. The summary of the legislation can be read here.

POST SCRIPT: Hypocrisy on health care

It is becoming increasingly clear that opponents of health care reform are willing to say anything at all, even if it means directly contradicting themselves.

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August 18, 2009

Dealing with religious believers

Last Friday I was invited to speak to a group of Cleveland Freethinkers. I chose to speak about the new phase of the science-religion war. The old phase dealt with opposition to the teaching of the theory of evolution in schools and ended (more or less) with the drubbing that the intelligent design creationism forces received in the Dover trial in 2005. (Shameless plug coming up! My new book God vs. Darwin: The War Between Evolution and Creationism in the Classroom deals with this war and will appear in September.)

The new war is between two groups who were on the same pro-evolution side in the old war, the so-called 'accommodationists' (those who either believe that science and moderate forms of religion are compatible or that even if incompatible, the incompatibility should not be pointed out for fear of offending the sensibilities of moderate religionists) and the so-called 'new atheists' (those who think that science and religion are incompatible and have no hesitation in saying so).

The accommodationist position is nicely satirized by the cartoon below from the website Jesus and Mo, a terrific comic strip that features Jesus, Mohammed, and Moses as buddies and roommates conniving to foist their religions on their respective believers, and sometimes engaging with an unseen atheist barmaid. You really should visit the site regularly because it wittily captures much of the absurdity of religious apologetics.

jesusandmo1.jpg

After speaking for about 20 minutes or so explaining what this science-religion war entailed and advocating for the new atheist approach, I opened up the floor for discussion and a lively one ensued, debating the merits of the two approaches with arguments given in favor of both sides.

Then, in the middle of the discussion, a woman who had hitherto been quiet spoke up and said that she had listened to everyone and that it was clear that most (if not all) those present were skeptics of some sort but that she herself was a devout Christian who had been through much personal trouble (she implied that some of that involved recovery from a serious illness) and that she believed in Jesus and the Bible and had been blessed by him, and that all of us too should realize that we too had been blessed by him. She was clearly emotionally invested in what she said because she started to cry and had to wipe away tears several times.

The group was taken aback by this unexpected turn of the conversation and gave her the floor to let her fully have her say. They did not challenge or contradict or even interrupt her. When she was done with her extended comments, several people gently said that they could understand where she was coming from but that she should realize that the kinds of personal experiences that were meaningful to her may not be equally so to others who sought more empirical evidence for their beliefs.

After some time, the conversation returned to its original focus of which approach one should take, the accommodationist or the new atheist, and in the process we discussed what light, if any, might be shed on this topic by scientific theories such as quantum mechanics and the indeterminancy principle.

Although I claim to be a new atheist, I too did not directly challenge the devout Christian's beliefs, which might seem to make me an accommodationist in practice. But there is really no contradiction. As I have explained before, there is a difference in the way that one deals with people's religious beliefs in the private sphere and in the public sphere. I have no hesitation in the public sphere, which includes public talks like my initial remarks to the Cleveland Freethinkers group, of saying that I think that there is no rational basis for believing in god. I can be, and often am, quite uncompromising in my critiques of religion, not indulging in the polite fiction that some religious beliefs are credible or that the beliefs of religious people have some sort of immunity from criticism. But in the private sphere, which is what the discussion became when the Christian spoke to me and the rest of the group about her deeply held personal beliefs, one has to handle things differently.

In this particular case, the public/private line was not easy to draw because the group was about 30 people seated in a room in an informal setting. But I think the group as a whole was able to navigate that line, which speaks well for their sensibilities. I think the devout Christian was made to feel at ease and even welcome, even as it was clear that most of the people did not share her beliefs. But there is a disturbing undercurrent to such emotional outbursts by religious people that I will address in a fresh post later this week.

The Cleveland Freethinkers is a lively and friendly group that, as you can see, welcomes and accepts people with all kinds of beliefs. You can learn more about their meetings here.

POST SCRIPT: Why are there four conflicting gospels?

God tries to explain to Jesus how there came to be four different scripts for the part Jesus is to play on Earth.

August 17, 2009

The health care debate-11: The Brits fight back

(For previous posts on the issue of health care, see here.)

I have written before of my direct personal experience with the British National Health Service (NHS) and can report that it was wonderful, helping me tremendously when I was seriously ill, entirely free of charge.

As people should know, the NHS is a truly socialized medical system in which people are treated free, doctors are government employees, and hospitals are directly run by the government, although there is a private system overlaid on top of it. It is like the VA hospital system in the US. But even though I think that the socialized model of the NHS is admirable, I think it would not be a suitable model for the US and that the single payer systems of France or Canada would be better.

Part of the strategy of the health care reform opponents has been to lie shamelessly about the systems in other countries in order to make the current terrible system in the US look good in comparison. They are helped in this effort by the fact that most people in the US have no idea what people in other countries have and so believe the distortions. In addition, the people in those countries are not bothered to combat this propaganda, even if they have heard of it. After all, what does is matter to them if foreigners malign their health care? Their attitude seems to be that they are quite happy with what they have and if Americans want to continue to wallow in ignorance, let them.

But once in a while, things get taken too far and the attacks o insultingly unfair that the people in those countries get riled up and rise to defend their system. This seems to be happening with the recent attacks on the British NHS.

One of the triggers was a recent editorial in the Investor Business Daily that tried to give support to the hallucinations of the deathers by suggesting that in the NHS people are ranked according to their usefulness when getting treatments. The editorial said:

The U.K.'s National Institute for Health and Clinical Excellence (NICE) basically figures out who deserves treatment by using a cost-utility analysis based on the "quality adjusted life year."

One year in perfect health gets you one point. Deductions are taken for blindness, for being in a wheelchair and so on.

The more points you have, the more your life is considered worth saving, and the likelier you are to get care.

In order to drive their point home, the editorial then went on to give what it clearly thought was a killer example of the ghastly results that ensue from such a system.

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

It was clear that the writers were under the impression that Hawking, easily the most famous living scientist and the victim of a degenerative motor neurone disease that has steadily eroded his abilities until now he can only move a finger or two, was American and was able to survive and even flourish as a productive scientist because he was being treated in America.

The truth of course is that Hawking is British, was born there, lives there, and has been treated by the NHS all his life so that even now at the age of 67 he continues to work. As Hawking himself responded, "I wouldn't be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived."

The ignorance of the editorial writers was greeted with hoots of derision both here and abroad and in response they have removed the offending sentence about Hawking claiming it was only a factual error about citizenship, without acknowledging that what was considered by them to be an example in their favor is actually a counterexample that destroys their case that the NHS is a soulless, uncaring, bean counting system.

Faced with this embarrassment, perhaps the deathers will take a cue from the birthers and challenge Hawking's British citizenship. After all, has anyone actually seen his original birth certificate? And shouldn't he also produce documentation that he lives in the UK and was treated by the NHS? The latter might be difficult since that system doesn't drown sick people with mountains of bills and other paperwork like the private, profit-seeking health insurance industry in the US.

As a result of the Hawking fiasco, more stories about the virtues of the NHS are emerging from people fed up with the lies. Read about how the NHS helped an American living in the UK with his tragic experience when his child was born with serious problems. And here's another story from someone recounting the way his father's kidney disease was treated was treated:

The National Health Service paid for the installation of a dialysis machine plus all the necessary plumbing and renovation of a room in his home so that he could use the machine three times a week rather than travel to the hospital in London. The cost was enormous and there is no way my parents could have afforded it. His quality of life for his last years was improved beyond recognition. I don't recall any bureaucracy or fuss: the entire decision was the doctor's. After he passed away the NHS paid for the disassembly and removal of everything too. (my emphasis)

And here's yet another another story about an American woman who was treated first in the US (where her case was dismissed as being purely psychosomatic) and then, since she later became a student in the UK, was correctly diagnosed and treated by the NHS for what turned out to be a serious illness that required chest surgery plus post-operative care. Her father continues:

Recently, we flew back to New York to consult with perhaps the world expert on Myasthenia. After reviewing her symptoms and treatment he declared that the doctors in Scotland were doing all the right things. He then asked how much this cost. He had a bit of a hard time understanding that the cost was exactly zero. By the way, I spent about two months paying various bills associated with that one visit to his office. Quite a contrast I'd say. (my emphasis)

Defenders of the NHS have also taken to Twitter to spread their message.

The British government has been hesitant to vigorously correct the falsehoods that are being spread here:

As myths and half-truths circulate, British diplomats in the US are treading a delicate line in correcting falsehoods while trying to stay out of a vicious domestic dogfight over the future of American health policy.

But others are stepping up:

The degree of misinformation is causing dismay in NHS circles. Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (Nice), pointed out that it was utterly false that [Senator Edward] Kennedy would be left untreated in Britain: "It is neither true nor is it anything you could extrapolate from anything we've ever recommended to the NHS."

Defenders of Britain's system point out that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain's healthcare as 18th in the world, while the US is in 37th place. The British Medical Association said a majority of Britain's doctors have consistently supported public provision of healthcare. A spokeswoman said the association's 140,000 members were sceptical about the US approach to medicine: "Doctors and the public here are appalled that there are so many people on the US who don't have proper access to healthcare. It's something we would find very, very shocking."

Again, it should be emphasized that the British NHS is far from perfect. But its shortcomings and the complaints about it stem not from the nature of the system itself but the fact that the British government does not put enough money into it. Many people do not realize that the per capita public health expenditure in the UK is less than the US public (not total) health expenditure alone (i.e., what the US government spends just on Medicare, Medicaid, and the VA).

POST SCRIPT: Stephen Colbert and Howard Dean discuss health care

Howard Dean is a good spokesperson for single payer systems and the public option.

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August 14, 2009

The deathers get routed in Cleveland

On Wednesday evening, Marcia L. Fudge, Ohio's congresswoman for District 11, held a town hall meeting for her constituents. These events, once staid and even boring exercises in democracy, have recently become notorious for the groups of vociferous opponents of health care reform who have stormed them, armed with a strategy formulated by the health care industry and its Republican Party allies to shut down meaningful discussion on this important issue, intimidate elected representatives, and give the impression that those who oppose reform are more numerous and care more deeply about their point of view than those who support reform efforts such as single-payer.

But at the Fudge event, they got their come-uppance, big time. Fudge not only represents a solidly Democratic district that spans the East side of Cleveland and some adjoining suburbs like Shaker Heights (where I live), it is also a very progressive one. Fudge is a strong single-payer supporter and one of the 86 co-sponsors of John Conyers' House Resolution 676 that seeks to expand Medicare coverage for all. Fudge claimed in her remarks that our district is the most diverse in the nation. I am not sure how such things are measured and if she has data to support it, but from first hand experience living there, I see no reason to doubt it.

Since the event was held at the place I work (Case Western Reserve University) in an auditorium in the very building my own office is in, I got a ringside view of the events. My corner office overlooks the two main streets that intersect at my building and I could see the demonstrators with placards gathering on the sidewalks from about 4:00 pm for the 6:00pm meeting. It was clear that the pro-reform forces had mobilized because on the streets they clearly outnumbered the anti-reform forces.

When I entered the auditorium shortly before 6:00 pm, it was full to its capacity of about 500. The chair of the session got loud applause when he asked that all people be given a respectful hearing. The first 45 minutes consisted of introductions and various people being recognized, especially ten young community leaders, each of whom spoke briefly.

The shape of things to come became clear when one of the honorees spoke briefly. He was Zac Ponsky from the nonprofit group MedWish, a group that works to provide free health services to those who need it, both home and abroad. He said that we needed action on health reform now, and we needed to do it on a national level. He got generous applause but then there came some boos and this generated much louder applause to drown out the boos. It was clear that the anti-reform groups were in for a tough time with this crowd, who were prepared and ready to combat them.

When Fudge spoke at 6:45 she covered some general ground before she got to health reform and she said that we are definitely going to get it this year. This was met with loud cheers, before some boos were heard which again were responded to with louder cheers for Fudge. From the relative loudness of the two sides, I estimated that the pro-reform forces outnumbered the anti-reformers by about 10 to 1.

Soon after Fudge began her remarks, the anti-reform groups, which seemed to be in three different clusters in the auditorium, went into the mode that those of us who have been following these events are familiar with. They started yelling out their slogans ("Why the rush?" "This bill will kill old people", "What about the cost?" etc.) and refusing to let Fudge speak, even though the crowd started yelling for them to keep quiet and let her go on. It was clear, though, that university security had prepared for this. An officer went up to two men yelling the loudest and spoke to them, presumably to ask them to stop preventing the speaker from continuing. When they did not, they were both force-marched out of the room. This seemed to deflate the protest groups and they quieted down. Later on, during the Q and A, when another man started yelling from his seat and interrupting Fudge's answer to a question from a person in the line, the head of the campus police, a genial but firm man, went and spoke quietly to him and he subsided.

At the end of Fudge's brief remarks, the anti-reform people knew the drill and quickly got in line for questions in greater percentage (about 50%) than their presence in the room (about 10%) warranted. This was actually a good thing since it enabled Fudge to challenge the misconceptions on which they work. Fudge was not at all rattled. She is sharp, articulate, personable, and quick-witted. She knew what to expect and was ready. The largely pro-reform audience listened quietly to the questions and comments of even those who opposed reform, except for a couple of questioners who refused to yield the microphone when they were done but started to harangue Fudge. At that point, officials took the microphone away from them and moved them aside to allow the next person up, to the cheers of the crowd.

As to the question "Why the rush?", she said that we were actually too slow, that health reform has been talked about for 60 years, and that nothing had been done at all during the Bush years.

As to the question as to whether the reform bill will euthanize old people, she said, to loud applause and laughter, that anyone who would even think such a thing has real problems. She said that all of us, including her, have elderly relatives whom we love. Why would we want to kill them? She then explained clearly what the bill says about end-of-life issues, a far cry from the 'death panels' that exist in the fantasy world of Sarah Palin and the nutters. ("Sarah and the Nutters" would make a good name for a music group, don't you think?).

Fudge was also challenged as to whether she had read the entire 1,000-page bill. When she said she had not, they was a triumphant "Aha!" sound from the protest groups, implying that this meant that she did not know what was in the bill that she was supporting. She then explained what should be obvious. No congressperson is going to read every line of every bill that they vote on. It is not humanly possible. That is why they have staffs to do that work and flag those things that she should focus her attention on.

The most moving moments during the Q and A came from two women who spoke about their personal situations. One was a middle-aged nurse who works three jobs but cannot get health insurance because of a family history of cancer, not for any reasons directly related to her. She has been turned down by 14 companies and had her coverage taken away by another two. Another woman spoke of her husband who fortunately gets free treatment from the (government run) VA that costs $43,000 per year, but she herself cannot afford to buy her own insurance and they are going to lose their home because of her health care costs. Both women pleaded for the adoption of an affordable public plan and they received warm and sympathetic applause.

Twice Fudge was asked why the single-payer option was off the table and she replied both times that it was because Obama had taken it off, which is true. But perhaps not wanting to sound too critical of the president, she qualified it the second time round by saying that in order to pass reform legislation, they needed some conservative Democratic and/or Republican votes and they felt that single-payer would not be able to get that support.

In summary, the crowd was overwhelmingly in favor of health care reform with a public option, with a sizeable chunk pushing for single payer. The anti-reform groups were completely routed.

POST SCRIPT: The Daily Show on boisterous town halls

I showed this yesterday, but it seems to fit today's post better.

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August 13, 2009

Here come the nutters!

Am I imagining it or does there seem to be a sudden upsurge in the number of people who seem to be disconnected with reality? To elaborate, is there an increasing number of vocal and visible people who are believe strongly in some crackpot idea despite the complete lack of plausible evidence in favor of their belief?

Into this category I put those who believe that the Earth is 6,000 years old and that evolution did not occur. Also included are the so-called 'truthers' (those who think that the events of 9/11 were planned and executed by the US government or that they had advance knowledge of it and yet allowed it to happen), and the 'birthers', those who think that Obama is not a natural born citizen of the US and is thus ineligible to be president. And then we have the 'gunners', those who are convinced that Obama is going to take away their guns and enslave them. They have been forming militias and stocking up on weapons and ammunition ever since the election, presumably to prevent the military takeover of the country under the orders of Generalissimo Obama.

It is not surprising that this kind of paranoid climate would encourage individual nutcases like the Baptist preacher who is asking god to put a hit on Obama. Some have even gone on murderous rampages as a result of their beliefs

The health care reform debate has spawned yet another group of crackpots, called the 'deathers', who roam town hall meetings and yell about how the health care reform plans currently under consideration will result in government bureaucrats deciding who will live and who will die, and that they seek to kill off old people and anyone with any defects. This is quite an amazing level of delusion

The fact that there exist a sizable number of people who believe in each of these things is not surprising. I have long felt that there is no proposition, however crazy, that you cannot persuade up to about 20% of Americans to take seriously, simply by using spurious arguments that seem to have a veneer of plausibility, along with 'evidence' consisting exclusively of vague references to 'they say' or 'I read somewhere', with the source never specified. For example, a survey finds that 23% say 'no' or 'not sure' to the question of whether they believe Obama was born in the US. (Among Republicans, the figure is an incredible 58%!)

It is quite likely that there is strong overlap amongst all these groups, given their common basis in irrationality, so that the total number of believers may not be that much larger than the number that believes in just one of them. But given the rapid proliferation of such groups, it may be useful to adopt an umbrella label of some sort that covers everyone. How about the 'nutters'? Tom Tomorrow describes the weirdness of these people in a recent cartoon.

These people are helped in their paranoia delusions by prominent politicians, who should know better, reinforcing their beliefs. A report says that Representative Paul Broun (R-GA) said "spoke of a “socialistic elite” – Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid – who might use a pandemic disease or natural disaster as an excuse to declare martial law."

Then there is the ever-reliable serial exaggerator Sarah Palin. On her Facebook page she says the following about health care reform: "And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. 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."

Her statement has no connection to reality. Can she really be so stupid and ignorant as to believe this? Can she really not know that the proposed health reform legislation does not say anything of the sort? Or is she cynically deceiving and exploiting her followers? In addition, she once again shamelessly uses her baby as a political prop when it suits her purposes, while whining that her family should be off limits.

(To make it worse, Palin uses for support Minnesota Republican congresswoman Michelle Bachman, a person with an Alan Keyes level of craziness. Deciding which of Bachmann's statements and actions is the loopiest is not easy, but my favorite was when she warned that Obama was thinking of abandoning the dollar as the US currency.)

Stephen Colbert gives his take on the death panels.

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As I said earlier, some greedy geezer seniors are prominent among the deathers who are trying to whip up anger against health care reform with their insanities, perhaps in order to preserve their own government-run Medicare health privileges. Christopher Beam writes: "To be sure, there are plenty of legitimate reasons for seniors to be concerned about reform. Seniors already have universal health care in the form of Medicare. There remains the possibility that a broader universal plan will drain resources from a program they like as it is, thank you very much."

The Daily Show has some thoughts on the motivation that drives these people.

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So what is making these people so unhinged? Is it the thought that any Democratic president must necessarily be evil, and that a black one has to be the anti-Christ? Could they be that unhinged? It is strange because Obama is not even a liberal. He has kept and even increased the secrecy practices of the Bush regime, he is not planning a total pull out of Iraq any time soon (if ever, which I doubt), he is rapidly escalating the US war in Afghanistan, he has done little to advance gay rights, he has refused to close down the torture prisons that the US runs in other countries or to forbid the policy of extraordinary renditions, he is not prosecuting the lawbreaking torturers of the Bush regime, he has continued policies friendly to Wall Street in general and Goldman Sachs in particular, he has undermined support for a single-payer health care system, he continues the violation of human and constitutional rights such as habeas corpus, and so on.

We should not be that surprised. As cartoonist Tom Tomorrow points out, Obama has made vague promises into an art form that enabled his starry-eyed followers to read into his speeches what they wanted to hear and thus believe he was far more liberal than he really is. As a reality check, this website keeps a scorecard on Obama's promises. Sam Smith also keeps tabs on Obama.

So why are these people so angry about his presidency when he is really not opposed to their interests in any fundamental way, just making changes in the margins? I do not believe that their anger is completely artificial, although powerful interest groups are definitely bankrolling and urging these groups on. Is it as simple as racism, that these people cannot stand the prospect of white people not having exclusive control of the power structure, even if the minorities who replace them pursue pretty much the same policies?

The Daily Show has some thoughts on the racial fears that seem to be driving at least some of these people batty.

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POST SCRIPT: The Daily Show on the level of current discourse

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August 12, 2009

YouTube nostalgia: Barney Miller

I hardly ever watch TV anymore, mainly because I cannot stand the constant commercial interruptions. This used to bother me less in the past and I used to watch a lot more when I was in graduate school and have fond memories of many shows: comedies such as M*A*S*H, Mary Tyler Moore, Soap, Newhart, Alice and dramas like Lou Grant and Trapper John

Recently I stumbled on another old favorite TV show on YouTube. Someone had posted clips of Barney Miller, and I have been enjoying them online. And the bonus is that there are no commercials, which more than compensates for the poor quality image.

Barney Miller was in many ways an unusual comedy that ran from 1975-1982 and although not a huge hit, it developed a loyal following. It was set in a police precinct in New York's Greenwich Village and featured the precinct captain Barney Miller and his team of around three or four detectives, and one uniformed officer constantly striving to be promoted to detective.

The show was different in that there was no glamour or action at all. Everything took place in the small and grungy squad room and the adjoining private office of Miller. All the main characters were male and there was little or no romantic or sexual comedy, although some of the characters had relationships that were occasionally referred to but remained off-camera. There was no slapstick or broad humor. It was all low-key. It also had an unusually long opening sequence before the credits kicked in.

In most comedies there are quirky characters with exaggerated and easily labeled characteristics (the dumb, the smart, the oblivious, the eccentric, the greedy, the ambitious, etc.), and the rest play the straight roles that the others get laughs off. But in Barney Miller none of the series regulars were particularly weird, although they each had distinctive personalities and were well-developed characters, and the interactions between them provided a lot of the humor. None of the characters had standard tics or mannerisms or tag lines. There were no obvious eccentrics (a la Kramer in Seinfeld) or doofuses (Joey or Phoebe in Friends) or exceptionally dim people (Coach or Woody in Cheers). In Barney Miller, all the regulars were normal and played, in effect, the straight part and were the foil for the oddball characters that wandered into the precinct room in each episode. These people were usually petty criminals, drunks, vagrants, neighborhood residents and shopkeepers, and so on, and how the detectives dealt with them provided the humor.

In many TV comedies, you get cued mirth (either in the form of a laugh track or a live audience) where there is uproarious laughter for even the lamest of jokes or when characters did some standard shtick they have done hundreds of times before. I find that really annoying. In Barney Miller, the show's writers did not insult the audience with exaggerated canned laughter. It was subdued and realistic, corresponding more closely to what was called for, sometimes just a chuckle.

Here is one episode, called "The Psychic", to get a taste of what the show is like.

Part 1:

Part 2:

Part 3:

Most sit-coms periodically fall victim to having a "special" episode where they get preachy about some issue and try to give a "message" full of "meaning", and in the process forget to be funny. Seinfeld was a notable exception. Barney Miller did not fully escape the temptation but when it did try to give a "message", it managed to do so briefly and with a light touch, as in this clip about bigotry.

August 11, 2009

The health care debate-10: More comparisons with Canada

(For previous posts on the issue of health care, see here.)

The Canadian system is a single-payer system in which the federal government sets certain baseline services that have to be provided and then the provinces have some flexibility in what they provide over and above that. This means that there can be variability from province to province in the quality of health services with currently Ontario seeming to have the most complaints. Thom Hartmann talks to Sarah Robinson, who explains how it works.

But as to the question as to whether Canadians would prefer the US system to what they have there, this is an easy one: No. When the Canadian Broadcasting System held a poll to select the greatest Canadian of all time, the winner was Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country.

Let's look at the comparisons.

This report quotes a multi-nation study that found that:

One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.

Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.

Four in 10 U.S. adults told researchers that they had gone without needed care because of the cost, including skipping prescriptions, avoiding going to the doctor, or skipping a recommended test or treatment. (my emphasis)

Michael Rachlis, a Canadian doctor, exposes more myths in an article in the Los Angeles Times of August 3, 2009, where he does a side-by-side comparison of the Canadian and US health systems:

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

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

He then draws some lessons:

  • Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
  • Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.
  • Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.
  • Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

And what about the bureaucracy? In an interview, Uwe Reinhardt, a professor of political economy at Princeton University compares the two countries:

Edie Magnus: We were in a hospital that was affiliated with McGill University [in Canada], and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You'd be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University [in the US] and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don't have to do it. But take Duke University, for example, has more than 500,000 and I believe it's 900 billing clerks for their system. (my emphasis)

It is time to put the lies about Canada to rest. My colleague Ross Duffin (whom I must thank for sending me several of the links in the posts about Canada) put it best in a blog post way back in 2005:

[D]on't talk to me about inferior medical care in Canada. Its low reputation here is based solely on scare-mongering, knee-jerk anti-socialism, and just plain ignorance. A lot of people make a heck of a lot of money in the health care industry in this country, and would hate to see the system change, no matter how much it would benefit Americans to change it. And they can afford to spend a lot of money on advertising and lobbying to keep things just they way they are, thank you very much.

That seems to me to be exactly right.

POST SCRIPT: Bill Maher on health insurance reform

Bill Maher's final segment on New Rules says what I have been saying all along, that the US is essentially a pro-business/pro-war one party state with two factions, which is why some Democrats are allying themselves with Republicans to block meaningful health care reform.

August 10, 2009

The health care debate-9: Oh, Canada!

(For previous posts on the issue of health care, see here.)

One has to feel sorry for Canada. There they are, this perfectly nice country to the north of us, just minding its own business. And yet, whenever there is talk of health care reform in the US, the most blatant lies are told about their health system, treating it as this awful, low-quality, bureaucratic nightmare, when by any objective measure they provide better service for all their people, with better outcomes, with little bureaucracy, and at lower cost.

There is almost reflexive lying about Canada's health system by apologists for the US's profit-seeking health system. We are told that Canadians are dissatisfied with their system, that they would love to have what the US has, and that they come over here in droves to seek high quality treatment. If you are a Canadian and want to become a political and media darling in the US, all you have to do is complain about the way you were treated in Canada, as was the case of a Canadian woman who got a lot of tearful mileage in the media here by exaggerating the seriousness of her condition and claiming that she would have died if she had not come to the US for treatment. And don't forget to mention that old standby, the supposedly long wait times for those hip replacements.

Recently US Republican senate leader Mitch McConnell gave a speech lambasting the Canadian system, in particular the hospital at Kingston, Ontario. His lies were promptly debunked by Kingston General Hospital chief of staff and also rebutted by Hugh Segal, one of the most conservative of Canadian politicians, as reported in an article by Gloria Galloway in the June 24, 2009 issue of Toronto's The Globe and Mail (unfortunately behind a firewall).

One thing should be made clear. The Canadian system is not perfect. No system is. In any single-payer system what you get depends on how much taxpayers are willing to spend on the system. If you have enough money and don't care if the insurance companies will cover you, then you can get high quality treatment in the US with little wait times. That is what a profit-based system health is biased towards. So it should be no surprise that well-to-do people from other countries can be found coming to the US for treatment that they would have to wait for back in their home countries. But the fact that money talks in the US is hardly an argument for the superiority of the system.

But what about not so well-to-do people from Canada also coming here for treatment? Rhonda Hackett, a Canadian clinical psychologist who has lived in the US for 17 years explains that phenomenon in the June 7, 2009 Denver Post:

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Can you imagine any US private profit-seeking health insurance company agreeing to pay to send someone to another country for treatment? In her article Hackett systematically addresses seven other common myths about Canadian health care, refuting the lies that are spread.

  • Myth: Taxes in Canada are extremely high, mostly because of national health care.
  • Myth: Canada's health care system is a cumbersome bureaucracy.
  • Myth: The Canadian system is significantly more expensive than that of the U.S.
  • Myth: Canada's government decides who gets health care and when they get it.
  • Myth: There are long waits for care, which compromise access to care.
  • Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.
  • Myth: There aren't enough doctors in Canada.

Hackett concludes:

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Read her excellent article to get a better understanding of how the Canadian health system works.

Next: More on Canada's system

POST SCRIPT: How to deal with lies about Canada

Ohio congressman Dennis Kucinich, one of the strongest champions of a single-payer system for the US, slaps down an analyst who works for the conservative Manhattan Institute who tries to peddle the usual distortions about Canada's system. As Kucinich points out, almost 100% of the people in Canada have insurance (in fact, the number of uninsured in the US is greater than the entire population of Canada) and nobody goes bankrupt in Canada because of health care costs. In addition, he destroys the myth of wait times, and points out that no one in Canada goes without treatment due to the inability to pay, compared with 25% of the US population. The Manhattan Institute witness is unable to respond so, like a child, he sulks and refuses to answer. Pathetic.

The witness David Gratzer's analyses have been excoriated elsewhere but his position is not surprising since the Manhattan Institute is supported by all the usual suspects who oppose health insurance reform.

August 07, 2009

The health care debate-8: Where the money goes in the US system

(For previous posts on the issue of health care, see here.)

The indisputable fact is that per capita costs for health care in the US is almost twice that of other developed countries, while producing worse outcomes. So where does the money go?

This study in the journal Health Affairs compares the US with those of OECD countries to identify what other factors are leading to the inflated costs in the US, while at the same time providing lower quality care.

In 2000 the United States spent considerably more on health care than any other country, whether measured per capita or as a percentage of GDP. At the same time, most measures of aggregate utilization such as physician visits per capita and hospital days per capita were below the OECD median. Since spending is a product of both the goods and services used and their prices, this implies that much higher prices are paid in the United States than in other countries. But U.S. policymakers need to reflect on what Americans are getting for their greater health spending. They could conclude: It’s the prices, stupid.

U.S. per capita health spending was $4,631 in 2000, an increase of 6.3 percent over 1999… The U.S. level was 44 percent higher than Switzerland’s, the country with the next-highest expenditure per capita; 83 percent higher than neighboring Canada; and 134 percent higher than the OECD median of $1,983… Measured in terms of share of GDP, the United States spent 13.0 percent on health care in 2000, Switzerland 10.7 percent, and Canada 9.1 percent. The OECD median was 8.0 percent.

People in the OECD countries can also purchase private insurance if they wish to supplement the single payer systems that most of them have.

The median country finances 26 percent of its health care from private sources. The range is as high as 56 percent in the United States and Korea to as low as 7 percent in Luxembourg and 9 percent in the Czech Republic. As a percentage of GDP, the OECD countries spent 0.4–7.2 percent of GDP on privately financed health care in 2000, with an OECD median of 2.0 percent. The United States was the highest at 7.2 percent. U.S. private spending per capita on health care was $2,580, more than five times the OECD median of $451.

What about the fear that people die in those other countries because of waiting for care for acute treatment (leaving aside the fact that people here also die because they do not have access to health care at all)?

The German and Swiss health systems appear particularly well endowed with physicians and acute care hospital beds compared with the United States. The two countries rank much higher than the United States does on hospital admissions per capita, average length-of-stay, and acute care beds per capita. The average cost per hospital admission and per patient day in these countries must be considerably lower than the comparable U.S. number, however, because both countries spend considerably less per capita and as a percentage of GDP on hospital care than the United States does. The average U.S. expenditure per hospital day was $1,850 in 1999—three times the OECD median.

The fact is that because of the profit-making emphasis in the US, health care services simply cost a lot more here.

First, the inputs used for providing hospital care in the United States—health care workers’ salaries, medical equipment, and pharmaceutical and other supplies—are more expensive than in other countries. Available OECD data show that health care workers’ salaries are higher in the United States than in other countries. Second, the average U.S. hospital stay could be more service-intensive than it is elsewhere. While this may be true, it should be noted that the average length-of-stay and number of admissions per capita in the United States are only slightly below the OECD median. Third, the U.S. health system could be less efficient in some ways than are those of other countries. The highly fragmented and complex U.S. payment system, for example, requires more administrative personnel in hospitals than would be needed in countries with simpler payment systems. Several comparisons of hospital care in the United States with care in other countries, most commonly Canada, have shown that all of these possibilities may be true: U.S. hospital services are more expensive, patients are treated more intensively, and hospitals may be less efficient.

The final argument that apologists give for the US system is that the US is unique in its ability to provide easy access to high-tech treatments. This is also not true.

Quite remarkable, and inviting further research, is the extraordinarily high endowment of Japan’s health system with CT and MRI scanners and its relatively high use of dialysis. These numbers are all the more remarkable because Japan’s health system is among the least expensive in the OECD.

On his show, Bill Moyers spoke about some of the other wasteful costs that occur in the form of bloated health insurance CEOs salaries:

Now meet H. Edward Hanway, the Chairman and CEO of Cigna, the country's fourth largest insurance company. At the beginning of the year, Cigna blamed hard economic times when it announced the layoff of 1,100 employees. But it reported first quarter profits of $208 million on revenues of $4 billion. Mr. Hanway has announced his retirement at the end of the year, and the living will be easy, financially at least. He made $11.4 million dollars in 2008, according to the Associated Press, and some years more than that.

That's a lot of oysters, although he lags behind Ron Williams, the CEO of Aetna Insurance, who made more than $17 million dollars last year, or John Hammergren, the head of McKesson, the biggest health care company in the world. His compensation was nearly $30 million.

As a CNN report says:

So, if Americans are paying so much and they're not getting as good or as much care, where is all the money going? "Overhead for most private health insurance plans range between 10 percent to 30 percent," says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.

"Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system," says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights.

The entire health system in Canada has fewer workers to serve its population of 27 million than Blue Cross requires to service less than one-tenth that population in New England alone! This is the much-vaunted efficiency of the private sector.

Let's face the facts. The US has the most expensive and yet the worst health care system in the developed world. And it is largely due to the presence of profit-making drug and insurance companies and extortionist pricing that is squeezing money out of the system at the cost of people's health.

This is why we need to eliminate the profit-seeking private health insurance companies and institute a single-payer system.

POST SCRIPT: Bill Moyers, Sidney Wolfe, and David Himmelstein discuss single payer

In this must-see discussion, Wolfe and Himmelstein brutally expose the dirty truth about the current US health system and why the health industry here is violently opposed to the single payer system being even discussed, because they will come out far worse in comparison. They point out that we cannot create a health system that works if the private profit-seeking health insurance industry continues to play the main role.

August 06, 2009

Film review: Woodstock

Next week marks the 40th anniversary of the Woodstock folk festival. I was not in the US at that time and my only encounter with it was reading about it in the newspapers and seeing the documentary when it came to Sri Lanka some time after 1970. Since Sri Lanka did not have TV until 1977 (we skipped the entire black-and-white age and went straight into color) documentaries like this were the only means by which we could see rock musicians playing, so the film was quite an experience.

Even if I had been living in the US I would not have gone to the festival. My parents would never have agreed to let me go, besides which I was too strait-laced and would not have relished the drug use and the thought of camping out in a muddy field with filthy toilets.

But the film was fun to watch then, both for the music and to vicariously experience hippies having a good time.

I watched the film again last week. There is a new director's cut that has added 40 minutes more so that the film, already long, now runs to almost four hours.

I did not enjoy the film that much the second time around. It seemed to drag. Some of the musical sets, especially the one by Jimi Hendrix, went on way too long for my tastes and I was never a fan of his style of guitar virtuosity to begin with. This is a common problem with 'director's cut' versions of films. They are too self-indulgent. My lowered enjoyment is also probably because the experience of rock concerts is not the same when you are old.

But I thought that that I would share those moments that still had magic.

Richie Havens got the festival off to an electrifying start with his Freedom/Motherless Child.

A favorite moment in the film was a very young Arlo Guthrie singing Coming into Los Angeles, and using the quaintly dated slang of that time when he talks to the concertgoers.

Country Joe McDonald and the Fish singing the Vietnam protest Feel like I'm fixing to die rag was also another high point.

One of the oddest acts was a very brief song by the 50's nostalgia group Sha Na Na, which seemed totally out of place.

Their campy performance reminded me strongly of the Village People who came along about a decade later.

I have posted this last clip before, of Joe Cocker's rendering of the Beatles' A little help from my friends, a gentle song sung by Ringo Starr, which Cocker turned into an over-the top, weird, air-guitar-playing, frenzied, incoherent performance that looked like he was having some kind of seizure. Throughout it, you kept wondering what the hell he was singing since the lyrics seemed to have only a passing resemblance to the original.

Some helpful soul has now provided captions for Cocker's words.

It all makes sense now. Or maybe not.

August 04, 2009

The health care debate-7: Why health care is so expensive in the US

(For previous posts on the issue of health care, see here.)

The current health system in the US is a disgrace. Let us take some indisputable facts.

  • Health care costs in the US are way higher than in any other country.
  • Despite this, close to 15% of the population is uninsured, with the only option for such people being to go to expensive emergency rooms if the situation is dire, while in every other developed country everyone has access to primary care.
  • Using almost any statistical measure of health (life expectancy, infant mortality, etc.), the US ranks way below other developed countries.

These facts are so obvious that even conservative and right wing publications that are not ideological to the point of willful blindness have to concede the problem. Take for example, The Economist. It says:

NO ONE will be astonished to hear that health care costs more in Indiana than in India. However, a few might be surprised to learn that Americans spend more than twice as much per person on health care as Swedes do. And many may be shocked to be told that in Miami people pay twice as much as in Minnesota, even for far worse care.

The American health-care system, which gobbles up about 16% of the country’s economic output, is by far the most expensive in the world.

Another magazine, Forbes which calls itself a 'capitalist tool' points out that the US is unique among developed countries in that people actually go bankrupt because of health needs.

In 2007, medical problems and expenses contributed to nearly two-thirds of all bankruptcies in the United States, a jump of nearly 50 percent from 2001, new research has found

They randomly surveyed 2,314 bankruptcy filers in early 2007 and found that 77.9 percent of those bankrupted by medical problems had health insurance at the start of the bankrupting illness, including 60 percent who had private coverage.

Most of those bankrupted by medical problems were "solidly middle class" before they suffered financial disaster -- two-thirds were homeowners and three-fifths had gone to college. In many cases, these people were hit at the same time by high medical bills and loss of income as illness forced breadwinners to take time off work. It was common for illness to lead to job loss and the disappearance of work-based health insurance.

When you read about the quality of health care that you get in countries with single payer systems like in France, the pathetic state of affairs in the US become readily apparent. As BusinessWeek points out:

[T]he French system is much more generous to its entire population than the U.S. is to its seniors. Unlike with Medicare, there are no deductibles, just modest co- payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care.

In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.'s (DNA) Avastin without charge. In the U.S., a patient may pay $48,000 a year.

France particularly excels in prenatal and early childhood care. Since 1945 the country has built a widespread network of thousands of health-care facilities, called Protection Maternelle et Infantile (PMI), to ensure that every mother and child in the country receives basic preventive care. Children are evaluated by a team of private-practice pediatricians, nurses, midwives, psychologists, and social workers. When parents fail to bring their children in for regular checkups, social workers are dispatched to the family home. Mothers even receive a financial incentive for attending their pre- and post-natal visits. (my italics)

This must mean that the French system is really expensive right? Wrong. In France, the cost per capita of health care is about half that in the US! And this is despite the fact that in France, every single person is covered, while in the US 15% of its population is without health insurance. So health care should become much cheaper if we adopt the French model.

So why do people claim that providing that level of quality will be expensive here? Because the policy-makers and the media who are subservient to the profit-seeking, money-driven health industry start with the assumption that you have to preserve the interests (and of course the profits) of that industry, and then add the presently uninsured and underinsured on top of it. Of course that will be more expensive.

The economics of the situation are simple. The only way to get a better health system at lower cost is to drive the profit-seeking elements out of the system and institute a single-payer system.

POST SCRIPT: William Shatner on Sarah Palin's farewell speech

Sarah Palin stepped down as governor of Alaska, presumably to devote her full attention to giving us early warning if Russian planes should invade American airspace via Alaska (because they haven't figured out that the great circle route over the pole is much shorter) or if Vladimir Putin should unexpectedly raise his head.

Her farewell speech was the work of art we have come to expect of her, disjointed phrases that consist of brazen pandering to the military and Alaskans, swipes at the media, petty personal grievances gussied up as high principle, non sequiturs, sentences that don’t seem to end, all interwoven with ghastly and mangled imagery in the grand style of Thomas Friedman.

Conan O’Brien tried to make sense of her speech and, after several viewings, it finally clicked. It was meant as a poem.

If you can't believe that Palin said this and think Shatner is making stuff up, watch her speech. The passage Shatner quoted verbatim comes very early on.

When lese majestes collide

By now everyone must have heard about the Henry Louis Gates Jr. flap, where the Harvard academic had a confrontation with a Cambridge police sergeant James Crowley, when he was seen by neighbors breaking into his own home when could not open his front door. What should have been a simple misunderstanding that was quickly settled ended up with Gates being arrested and even president Obama being dragged into it as well.

As might have been expected, people have focused on the race aspect of the incident (Gates is black, Crowley is white) and the class aspect of the town-gown divide (Gates being perceived as a member of the privileged Harvard faculty and Crowley as working class).

So were race and class factors? In America, any encounter between people of different races always carries with it a racial subtext. That is inevitable and unavoidable. Underlying this whole episode is the almost universal feeling among black people that police treat them far worse than they do white people. Black people are always conscious that actions that would be seen as innocent if done by white people are viewed with suspicion when done by blacks. This is because black people of whatever status in society have usually experienced an incident where they were personally treated negatively by the police and other security personnel, even though they were totally innocent. This feeling is so strong in the black community that it explains the rare verbal misstep that Obama made when, instead of keeping out of the fray because he did not have all the facts (and he should not feel obliged to comment on every incident anyway), he ventured the comment that the police acted 'stupidly' in this incident.

It is a rare white person who has had that kind of negative experience at the hands of the police. At the risk of over-generalizing, white people, especially those in the middle and upper classes, tend to look on the police as their friends and protectors, while black people tend to look on them as a necessary evil.

Class conflict is a trickier issue in the US, since it is less spoken of by the general public but, like race, is always present in any encounter between people of different classes. Police officers in general get infuriated when people try to intimidate them with the "Do you know who I am?" and the "I know important people and can make life hard for you" class-based rhetoric that some people try to use to intimidate officers who are merely doing their duty, in order to avoid being charged with some minor offense.

So while race and class had to be factors in the Gates-Crowley incident, the real question is whether race and class played a greater role than usual here. That is hard to say, without knowing more about the people involved and the details of the incident. And since much of the contentious elements of the exchange occurred when only Crowley and Gates were present, we might never know.

What I would guess is that over and above the race and class issues, what escalated the confrontation between Gates and Crowley is that for each person the encounter created a sense of lese majeste, which Merriam-Webster defines as originating as "an offense violating the dignity of a ruler as the representative of a sovereign power" but now is used more generally as "a detraction from or affront to dignity or importance."

Gates is an academic superstar and people outside academia may not be aware of how deferentially such people are treated in the normal course of their work lives. Although in any administrative flow chart of a university, faculty members like Gates are at the bottom of the hierarchy, ranking below their department heads, deans, provosts, and university presidents, in reality they are more famous, more powerful, and more valued by their institutions than their nominal superiors. They carry a lot of clout and every one around them treads very gingerly for fear of giving offense because such people will be quickly snapped up by rival institutions if they are not accorded the proper respect. So Gates is used to being treated like royalty and it must have been galling for him to be treated and talked to like just an ordinary person, let alone an ordinary black person.

Police officers are also used to people being very deferential to them. First of all, they are armed and can easily injure or even kill you. They also have the power to arrest, harass, taser, or otherwise make life very difficult for you. So most people, even if they are innocent and think that they have been wrongly stopped or questioned by the police, will talk to them politely, even obsequiously, so that they do not give the police an excuse to book them. When people do challenge police, the charge of 'disorderly conduct' can and is routinely invoked against them, as was done against Gates, since this is a very elastic term that gives a police officer wide latitude with which to arrest someone, even if the challenge consists of merely expressing annoyance or anger. The phrase 'disorderly conduct' is sometimes referred as being a euphemism for the crime of 'contempt of cop'.

See this Colbert Report clip of police tasering people, including a 72-year old great-grandmother, who did not show sufficient 'respect' to the police officer.

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Can anyone doubt that the feisty great-grandmother was being punished with a tasering purely because the police officer was offended by her act of lese majeste?

People who are routinely treated with excessive deference, such as Gates and Crowley, are the ones who are most likely to overreact to perceived affronts, unless they are highly self-controlled or have a well-developed self-deprecating sense of humor. It is very likely that what triggered Gates' outburst against Crowley was the thought that he, a famous academic, used to being kowtowed to, was being asked to show his identification in his own home by a lowly policeman, an act that, while not unreasonable under the circumstances under which the officer was summoned, he would have perceived as an act of lese majeste. It is very likely that what triggered Crowley's use of the disorderly conduct arrest charge was that Gates talked back at him and demanded his name and number, again an act that while not unreasonable, would have also been seen by him as an act of lese majeste.

What is surprising is that Gates, whose field of study is race, seems to have been taken by surprise by being treated the way other blacks are routinely treated. This may be because, as Ishmael Reed suggests, Gates has benefited professionally from being a leading proponent of the view that America is now a post-racial society, which is why he reacted so angrily to the way that most black men are used to being treated all the time. Reed says that Gates actually got off easy. "If a black man in an inner city neighborhood had hesitated to identify himself, or given the police some lip, the police would have called SWAT. When Oscar Grant, an apprentice butcher, talked back to a BART policeman in Oakland, he was shot!"

All in all, it is an unfortunate incident, symptomatic of what happens when two self-important people prick each others' ego balloons, resulting in an absurd situation in which the president ends up having to invite them both to the White House for a highly publicized beer, further feeding their already inflated sense of self-importance.

POST SCRIPT: Larry Wilmore on the Gates incident

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August 03, 2009

The health care debate-6: The curious case of the swine flu vaccine guidelines

(For previous posts on the issue of health care, see here.)

The US is preparing for an expected outbreak of the H1N1 ('swine') flu epidemic in the fall. Scientists are in the process of developing a vaccine that is due to be available in October. A federal advisory board to the Centers for Disease Control (CDC) issued guidelines on July 29 for who should get priority in vaccinations.

The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:

  • pregnant women,
  • people who live with or care for children younger than 6 months of age,
  • health care and emergency services personnel,
  • persons between the ages of 6 months through 24 years of age, and
  • people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

In a press release, the CDC says:

There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others:

  • pregnant women,
  • people who live with or care for children younger than 6 months of age,
  • health care and emergency services personnel with direct patient contact,
  • children 6 months through 4 years of age, and
  • children 5 through 18 years of age who have chronic medical conditions.

Stop for a moment and listen. Isn't there something strange? What you hear is silence. And yet look at what just happened. The very nightmare that anti-single payer and anti-socialized medicine zealots talk about the most has just come to pass: We are having "rationing of health care", with the decisions on who should get treatment and who should not being made by "government bureaucrats"!

So why is there not an uproar about the awful government making decisions about your health care? Because once you leave the rarefied air of generalizations about the glorious virtues of the free market and come down to concrete cases involving public health, this is obviously the way to make sensible decisions. After all, who would they like to see making decisions as to who should get the vaccines and who should not?

A team of health care professionals weighing the merits of the various options and coming to some consensus decisions about how to get the maximum benefit from limited resources, without the possibility of enriching themselves by their decisions?

Or profit-seeking private drug companies and insurance companies figuring out how to make the most money for themselves and their shareholders, presumably by giving the vaccines to those who can pay the most for it, decisions being made by people whose income and bonuses is related to how much they can make from the vaccines?

Would people like to see the flu vaccine being sold by the private sector to those who can pay the highest price, so that they can make the most profit? Isn't that how the glorious market forces should work?

The way the swine flu allocation decisions were made is exactly how, in a government-run single payer system, decisions about allocating medical resources will be made, by publicly accountable health care professionals weighing all the options and seeing how to obtain the maximum benefit.

Notice that in this specific swine flu situation, people over the age of 65 are told to go to the back of the line because the evidence suggests that they may have already developed an immunity to the swine flu from a variant from a long ago past flu. This is a switch from other flu vaccine situations where older people got priority. I would not be at all surprised if, as the news sinks in and the flu season approaches and promises to be serious, all the well-to-do seniors led by that greedy geezer lobbying group the American Association of Retired Persons (AARP), people who have long been pandered to at the expense of others because they vote in large numbers, will start pushing to get to the head of the line and demanding that they get the flu vaccine first, elbowing pregnant women and children aside.

Although I long ago qualified to join the AARP, I refuse to do so because it always seemed to me to have only the interests of better off older people in mind, especially when it comes to health care, at the expense of poor older people, children, and the rest of the general public. On health care reform, the AARP seems to want to protect the interests (and profits) of the health insurance industry and opposes single payer systems.

The AARP tries to scare its membership using fraudulent arguments. They know that their members love Medicare, and they suggest that single payer systems will eliminate it. Oh, the horror! The fact is that Medicare is a single payer system and what is being proposed by single payer advocates is to essentially expand Medicare to cover everyone, so that there will be no need for a separate program just for older people. But some greedy geezers have got so used to being treated better than everyone else that telling them that everyone will receive the same care as they do is enough to turn some of them away, fearing that they will not automatically be at the head of the line.

POST SCRIPT: The Daily Show on scared old people

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