Health Care 'Reform' : Just Say No to Traitor Joe!

Don't Surrender to Senator Joe
Vote "No" on the health care joke

By Ted McLaughlin / The Rag Blog / December 16, 2009

It looks like the United States Senate is going to cave in and surrender to Joe Lieberman. They first dumped the most important part of health care reform -- the public option. This was the part of the reform bill that would offer inexpensive and decent health care insurance to Americans, and would force the private insurance companies to lower their prices to compete. But Traitor Joe didn't like it, so it's gone.

But that wasn't enough. The Senate then tossed out a compromise idea -- the creation of a private non-profit insurance program that would be overseen by a federal government agency. Although not as good as a true public option, this would have also caused some downward pressure on insurance premiums and saved consumers a ton of money. But Traitor Joe didn't like it, so it's gone.

Still, that wasn't enough. Now the Senate is willing to toss out an expansion of Medicare to those between 55 and 64. At age 55, people are entering the years where they are much more prone to medical problems than younger Americans. This would have guaranteed they would be covered by a government insurance program that has been proven to work efficiently and effectively (just ask someone over 65 if they would give up their Medicare). But Traitor Joe didn't like it, so it's gone.

I'm beginning to think if Lieberman wanted Senate Democrats to kiss his scrawny ass, most of them would line up, get on their knees and pucker up. Are there any real Democrats left? Do any of them have even a remnant of a spine? Where are the progressives who promised us real health care reform?

All we are left with now is a bill that would force ordinary Americans to give the large private insurance companies a gigantic payday. And they would be forced to do it without getting lower costs or better health care. This bill would still leave medical decisions in the hands of insurance companies rather than doctors. Personally, I am appalled.

I think any Senate progressive with a functioning brain and a fully-developed conscience should vote against this travesty of a bill that is empty of any real health care reform. And it looks like Howard Dean agrees with me. He told Vermont Public Radio the following:

This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process where you only need 51 votes and it would be a much simpler bill.

I urge any remaining progressive senators -- don't check your conscience at the door to the Senate chamber. Vote against this bill. Kill it, then start over and do it right.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger.]

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Health Care 'Reform' : Tough Pill to Swallow

Best health care in the world?
A sad state of affairs

It is not only unfortunate that the health insurance industry plays on the fears of the elderly, but also that the Republican Party has become complicit in the deceit.

By Dr. Stephen R. Keister / The Rag Blog / December 5, 2009

If anyone is still under the illusion that the United States has "the best health care in the world" they should check out a recent incident in the Aria Health Hospital in Philadelphia.Under investigation is the death of one Joaquin Rivera, a musician and high school counselor, who lay on the floor of the hospital's waiting area for 50 minutes after losing consciousness and appearing to quit breathing.

The investigating officer reported that surveillance tapes showed Rivera going to the check-in window twice in 11 minutes complaining of chest pain before losing consciousness. While he was unconscious someone stole his watch! The thief was the only person shown on security video approaching the man after he clutched his chest and lost consciousness.

Aria Health Care is a for-profit hospital which is part of a conglomerate including Aria Home Health Care based in Dallas, Aria Colonic Hydrotherapy Clinics, Aria Breast Health Programs, Aria Physical and Occupational Therapy Clinics, and a provider of medical and nutritional supplies. The Philadelphia hospital is widely advertised as a resource for joint replacements, which is of special interest because of the investigation into and prosecution of joint replacement manufacturers for collusion with orthopedic surgeons throughout the nation, in some cases for using substandard appliances.

Meanwhile, have you seen the recent television advertising by the Humana HMOs? The ads are directed at the elderly, encouraging them to sign up for the Medicare Prescription Plan, but appear to be aimed at getting them to enroll in Humana's Medicare Advantage program. Humana is a corporation that manages private hospitals and is a major player in the Medicare Advantage business. The sad reality is that the majority of the elderly who enroll in Medicare Advantage do not realize that they are forfeiting the protection of the government Medicare program and consigning themselves to the tender care of the private health insurance industry. The con game has always been a feature of American society!

For another example of the "best health care in the world," read Michael J. Klag's article in the magazine of the Johns Hopkins Bloomberg School of Public Health. Klag writes: "I have to find a new doctor. Last month, my primary care physician wrote me a letter. He said he was leaving private practice. He's an outstanding physician -- a doctor's doctor who I've known since he was a medical student. His reason for closing up shop? The sheer frustration of getting paid by private insurance companies."

I retired from the medical profession in 1990, at the age of 70. It was then that the takeover of the American medical profession by the Health Insurance Cartel was complete. It was then that medicine ceased to be a healing profession and became a business where health care is rationed by the insurance companies and their oddly named HMO's. It was then that the judgment of a physician could be overruled by an insurance clerk, whose purpose was to maintain the profits of the carrier at the expense of what is best for the patient. It was then that the cost of health care began to accelerate toward today's outlandish levels.

I can understand the decision by Michael Klag's physician, who would appear to be a conscientious and honorable gentleman and an excellent doctor.

There is a very interesting exposition on health care in the December 12 New Yorker Magazine, by Jill Lepore, entitled "Pre-Existing Condition." The author begins: "'At present the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance,' the Yale economist Irving Fisher said in a speech in December. December of 1916, that is. More than nine decades ago, Fisher thought that universal health care coverage was just around the corner. 'Within another six months it will be a burning question' he predicted."

Nearly a century after Irving Fisher's discussion, our wise men/women in the Senate and House are continuing their health care kabuki dance. As we have noted in prior articles, since President Obama would not even consider universal/single payer health care -- Medicare for all -- the central issue revolves around including a true, unfettered, unencumbered public option in any legislation.

And this appears more and more unlikely as our more forward-looking representatives compromise time and time again with the Republicans and the Blue Dogs. By the time revisions and compromises are finally totaled up, the entire enterprise may once again be consigned to the dust heap of history. Robert Reich has addressed this in his usual lucid style in his blog: "Harry Reid, and What Happened to the Public Option?"

If Congress passes a bill without a "robust" public option while at the same time requires compulsory health insurance for all, the upshot will be the subsidization of the health insurance industry by the taxpayer. We will be passing the burden of health care costs to the illiterate and the poor. H. L. Mencken said: "Congress consists of one-third, more or less, scoundrels, two-thirds, more or less, idiots; and three-thirds, more or less, poltroons." He also said: "Democracy is the art of running the circus from the monkey cage."

Yet, this is very serious, as the public still has only a vague idea of what is transpiring in the debate. The mainstream media gives extensive accounts of Senator McCain's rants about the legislation cutting Medicare benefits -- when in fact it is not designed to cut payments to the elderly, but to eliminate waste such as the Medicare Advantage Plans and the terribly conceived Medicare Drug Plan -- and to do away with the outright theft of Medicare funds by criminal elements establishing medical supply and orthopedic supply outlets. (This issue was discussed on CBS' 60 Minutes several weeks ago.) It is not only unfortunate that the health insurance industry plays on the fears of the elderly, but also that the Republican Party has become complicit in the deceit.

As the Senate debate continues we watch the drug makers raise drug prices in anticipation of reform. The November 16 New York Times reported that the industry has raised the wholesale price of brand name prescription drugs by about 9%. This will add more than $10 billion to the nation's drug bill, which is already on track to exceed $300 billion this year. According to at least one analysis, it is the highest annual rate of inflation for drug prices since 1992. This flies in the face of the Consumer Price Index, which has fallen 1.3% in the last year.

The President was promised by the pharmaceutical industry, through his discussions with Billy Tauzin, that they would shave only $8 billion a year off the nation's drug costs after the legislation takes effect! The United States has the highest drug prices in the industrialized world, and is one of two nations that permit the advertising of prescription drugs on TV. I rarely watch television but last week I watched an hour-long program and 50% of the commercials were for pharmaceutical companies. Imagine the cost -- which in turn is passed on to the person getting a prescription filled.

An example, noted in The Times, is the cost of Singulair, an asthma medication produced by Merck, which now sells the 10 mg pills at a wholesale price of $1330 a year, $147 more than last year. Other brand name prescription drugs have seen a price increase from $2000 a year to $2200 per year. Unhappily brand name drugs account for 78% of the market. Why? Do the patients demand the drugs they see on TV and are then accommodated by physicians too busy to explain that generics, when available, are just as effective? Or are the physicians themselves influenced by the pharmaceutical industry? Or, for that matter, do physicians ignore information like that published in the New England Journal of Medicine reporting that Pfizer fudged it reports on studies of their epilepsy drug Neurontin and its use for off-label marketing practices.

We are faced what could be an even more difficult future as the Congress dallies regarding health care. The President commits the nation to an ongoing "war" in Afghanistan with poorly documented reasons for doing so and further burdening the citizens with an unconscionable national debt, originally run up by President Bush with his fruadulent war in Iraq, with money borrowed from China.

The most frightening aspect of all is the lack of knowledge and the lack of concern on the part of the American public, fed by the lackeys of the corporate interests that dominate our society.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

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The REAL Death Panel : Congress Gutting Reform

Photo by Mike Albans / AP.
The real death panel:
A requiem for true health care reform?

By Dr. Stephen R. Keister / The Rag Blog / November 22, 2009

It was ten years ago that I lost my wife who was my buddy and companion. The Lady succumbed to a particularly virulent type of malignancy after a year of intensive treatment which she had hoped would give her a few more years.

Happily, at the end we were blessed with excellent, compassionate hospice care (Sarah Palen's “death squad”) which allowed her to be free of unneeded machines, and permitted her to spend her last days in peace surrounded by her family and attended by dedicated hospice personnel.

The final night I had gone home for a few hours sleep and my always attentive daughter-in-law was with her mother. At 2 a.m. I received the call and was making my way back to the hospital when I turned on the car radio and was greeted with – how appropriate -- Mozart's “Requiem.”

The “Requiem” once again seems appropriate as I watch the demise of any meaningful health care legislation at the hands of our elected representatives. Thomas Jefferson's admonition echoes in my head: "The care of human life and happiness and not their destruction is the first and only legitimate object of good government.”

A recent e-mailing by Sen. Dick Durbin points to a poll where four out of five folks voiced full support for a 50 state public option and roughly three out of four respondents voiced little or no support for a public option bill that requires states to “opt-in” before they can participate. However there’s a rub as virtually all of the talking heads on TV stress that politics is the “art of compromise,” suggesting that if any bill is enacted it will have less than a “robust” public option, and indeed will include an opt-out provision.

Further, the public plan, such as it is, won’t be available until 2013 at the earliest. The single payer consideration is long gone. All of this doublespeak gives credence to Otto von Bismarck’s comment: "Laws are like sausages, it is better not to see them being made."

In Tikkun magazine, John Geyman M.D., from the University of Washington and past president of Physicians for a national Health Program, gives his opinion that, when all things are taken into account, the present approach to reform is worse than nothing.

He acknowledges that the bill will reduce the number of uninsured by up to 30 million over ten years; will help many Americans pay for insurance through government subsidies; will help small businesses provide coverage for their employees; will expand Medicaid and community health centers; will bring about limited reforms to the health care industry, like ending (four years hence)the common practice of denying coverage based on pre-existing conditions; will phase out government overpayment to private Medicare Advantage plans; and may revoke a decade old anti-trust exemption for insurance companies. (The last may be in dispute between the House and Senate and could be compromised away.)

But, Dr. Geyman believes that the negatives far outweigh the positives and that adopting the bill will delay real reform for years. After months of intensive lobbying and massive campaign contributions to legislators crafting the legislation, this bill ends up providing a bailout for the insurance industry and a bonanza for stakeholders in the medical industrial complex. There is no regulation of insurance industry costs, or costs in general, and many provisions will not take effect for at least four years.

Meanwhile 45,000 uninsured Americans are dying each year. This bill will leave 18 million uninsured, and the growing epidemic of underinsured Americans will continue. The public option may well be diminished by political compromise to the extent that only 2% more Americans would be covered by 2019. The bill will not reverse the unraveling of the employer-sponsored insurance system where rising health care costs outpace the rest of our economy; despite subsidies to small business, employer sponsored insurance would remain unsustainable. And health care reform, as currently envisioned, could dismantle the states’ consumer-protection laws.

Marcia Angell, M.D., writing in The Huffington Post, echos Dr. Geyman's concerns in an article, "Is the House Health Care Bill Better than Nothing?" She points out that the insurance industry will be the net gainer with millions of new customers subsidized by the taxpayer, and with the insurance companies able to charge twice as much for older people as for younger people who are less apt to use their insurance. Dr. Angell, who for 20 or more years has been crusading for universal health care, suggests the following:

1. Drop the Medicare eligibility age from 65 at 55;
2. Increase Medicare fees for primary care doctors;
3. Medicare should monitor doctor's practice for evidence of excess;
4. Provide generous subsidies to medical students entering primary care;
5. Repeal the provision of the Medicare drug benefit that prohibits Medicare from negotiating with drug companies for lower prices.

In the past several weeks we have discussed the Medicare Advantage plans that hopefully are under full review by the House and Senate. But allow me a few words about Medicare Part D prescription plans, which I am told are incorporated into the upcoming debate. In the spring of 2004 Congress passed the”'Medicare Prescription Drug and Modernization Act of 2003, P.L. 108-173.” This 681-page document was an effort by the Bush administration to "provide financial support to the elderly to aid in payment for prescription drugs.” The bill in its final form, as passed by two votes in The House at two in the morning, was about as easy to comprehend as a Kafka novel.

In reality it was a payoff to the corporations for “participation.” The pharmaceutical companies were to receive $139 billion in Medicare money over a ten year period, while the insurance companies -- the HMOs -- would receive $20 billion. Thus, the Medicare recipient was forced to pay a monthly fee to an insurance company, which was already being paid from the Medicare fund, and at the same time was being charged full price by the pharmaceutical companies for their prescriptions, while the drug company was already receiving Medicare money.

It should be noted that the bill did not permit negotiating drug prices with Medicare and attempted to prevent the consumer from getting pharmaceuticals from abroad, where they are available at perhaps half the price charged in the United States. It is my hope that Congress will repeal these laws that discriminate against the elderly.

Rep. Billy Tauzin, a Blue Dog Democrat turned Republican, was one of the leaders in enacting the Medicare Part D. legislation. Tauzin subsequently became a top lobbyist for the pharmaceutical cartel. This is the same gentleman who has had free run of the White House and has been negotiating with President Obama for the pharmaceutical industry. One wonders why PhARMA and the insurance cartel have had free access to the president while the nation’s physicians and nurses, who have a little something to do with health care in this country, have been kept at arm's length, save for photo ops, by both the White House and Congress. Indeed some physicians were arrested and shackled for speaking up before Senate Committees.

As our chief executive, Barack Obama has made enough mistakes with his Wall Street-dominated economic team, his apparant lack of concern about unemployment, his pursuit of the Bush "civil rights" doctrines, his cool reception to the employee rights legislation, his disdain for the legitimate government of Honduras, and his indecisiveness regarding health care.

Yet there is still a frightening hue and cry from the political right -- the Republicans and 'tea-baggers" who ominously call for physical harm, if not worse, for our president and his family. I may disagree with the administration regarding issues, but I am terrified of what I hear from a growing movement that is reminiscent of the brownshirts. We must support the President despite our philosophical and political disagreements.

A letter to the editor in my local paper today reads:

I watch Fox News. Why? Because: (1) They dress appropriately (2) They dig for truth (3) They use decent language (4) Their programs are uplifting -- and true (5) The clientele are church-reared and try not to be too "worldly" (decent attire) (6) Fox News seems to be the only network able to enlighten us as to the events and consequences evolving in the destructive behavior thrust upon our generation and impressionable youth.

Ouch! There are a lot of people out there looking for a man on a white horse to lead them. There are the folks with the guns, those who believe that once one puts on a military officer's uniform he becomes omnipotent -- for instance General McChrystal -- not recalling the history and very poor judgment exercized by General George McClelland, General George Custer, General Douglas MacArthur, and General William Westmoreland.

Carlos Ruiz Zafon envisioned a discussion between two educated people. One mentions that "people are evil.” The other replies,

Not evil, but moronic which is not quite the same thing. Evil presupposes a moral decision, intention or some forethought. A moron or a lout, however does not stop and think or reason. He acts on instinct, like a stable animal, convinced that he is doing good, that he's always right, and sanctimoniously proud to go fucking up anyone he perceives to be different from himself, be it because of skin color, creed, nationality, or leisure habits. What the world needs are more thoughtful evil people and fewer borderline pigheads,

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

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Divine Comedy : Joe Lieberman and the Hypocrites

The Hypocrites address Dante, from Canto XXIII of Divine Comedy, Inferno, by Dante Alighieri. Engraving by Gustave Doré from Pantheon Books edition / Wikimedia Commons.
The Eighth Circle of Hell:
Lieberman, Congress and health care reform

Of course, Sen. Lieberman does not stand alone as a hypocrite. In his company are all of those elected representatives in Congress and their families, who receive Federal Employment Health Benefit Programs, the Rolls Royce of health plans.

By Dr. Stephen R. Keister / The Rag Blog / October 31, 2009

Sen. Joe Lieberman's announcement of his complete and absolute opposition to health care for the poorest and sickest of all Americans took me back to when I was trying to understand Dante Alighieri in my early years. I do recall in his Inferno that Dante subdivided Hell into nine circles, the first circle being the widest and progressively the ninth and inner circle being the smallest and reserved for Lucifer.

Last evening I did a bit of research with Sen. Lieberman in mind and found within the eighth circle the hypocrites, and I quote Dante with a minor modification:

Here we see hypocrites, plodding forever around in their circle: And now we see a people decked with paint, who trod their circling away with fear and groan. And slow, slow steps, seemingly subdued and faint. They all wore cloaks, with deep hoods forward over their eyes, and shaped in fashion like the great cowls some monks wear; Outwardly they were gilded dazzling bright, But all within was lead and weighted thereby, an emperors cape would have seemed feather light. O weary mantle for eternity! Once more we turned to the left, and by their side Paced on, intent upon their mournful cry.

It would appear that Joe Lieberman has become the ultimate hypocrite within the modern American political establishment and that takes quite a bit of effort on his part. During the election that introduced Lieberman to most Americans he designated himself as a very "religious" man who didn’t campaign on The Sabbath. Nevertheless, he voted for every war appropriation designated by the Bush Administration, perhaps inspired, in part, by the two billion for each submarine produced in Connecticut and in part by his representation of Israel's Likud Party in The U.S. Senate.

He for all practical purposes defected to the Republican Party and actively supported Sen. John McCain for president. He accepted rehabilitation from a naive Sen. Harry Reid after the election, rejoined the Democratic caucus, and was granted chairmanship of the Homeland Security Committee.

Now, after voting for a $1.4 trillion dollar bailout of the insurance giant AIG, it turns out that he thinks the government cannot afford half that amount to provide the American people with decent health care, including health care for the returning veterans’ families, the families of the active military, and the unempowered average American. Once again he plunges a shiv into the back of the Democratic Party and the American people.

Of course, Sen. Lieberman does not stand alone as a hypocrite. In his company are all of those elected representatives in Congress and their families, who receive Federal Employment Health Benefit Programs, the Rolls Royce of health plans. Since this is government insurance, we the tax payers pay 75% of their premiums. Our representatives pay $503 per year for the coverage. Further, if they need an operation they have the option of having it done at a government hospital such as Walter Reed or Bethesda Naval Hospital.

These are the hypocrites who repeat and repeat that socialized medicine is an evil, that the government cannot and should not pay for it. They are protecting us from the government health care which they enjoy. We should also remember that the tax-payer continues to subsidize our elected representatives’ insurance after he/she leaves the congress.

On top of all this we now have Speaker Pelosi introducing health care legislation in the House with a far from "robust" public option. It seems that many of the progressives in the house want payment to physicians to be based on Medicare rates, while the Blue Dogs want these fees to be negotiated. I must admit that I have mixed feelings, as in many geographic areas, Medicare reimbursement is inadequate, and I note that under the Canadian National Health Plan that fees are negotiated yearly at the Provincial level.

It seems to me that the impasse could easily be settled by granting increased fees to primary care physicians -- who are in such short supply -- under the Medicare schedule. As we have noted previously, and as has been underlined by The American College of Physicians, this shortage will not be solved without making the fees of the general practitioner, the internist and for those in internal medicine subspecialties and pediatrics generally on a par with certain of those traditionally overpaid surgical subspecialties.

Any "public option" -- to be effective in reducing insurance costs and providing for the well-being of the public at large -- must provide (1) universal coverage, (2) the ability for any and all citizens to opt for the public plan without restrictions, thus reducing health care costs overall, and (3) must begin to provide coverage at the earliest possible time, and not await 2013, as many Americans will continue to die for lack of health insurance in that interval.

Granted, it will require time to provide a well managed, all inclusive program, but it should be instituted gradually over the next three years to start providing coverage for those without insurance. As Dr. Howard Dean pointed out on MSNBC, it is good politics looking forward to the elections of 2010 and 2012 to make the public aware that the government is exhibiting the ability and compassion to implement the program. As for the proposed right for states to "opt-out,” it is probably harmless to include that within a bill but it appears to be a bit of legislative absurdity.

Yesterday the progressives in Congress met with President Obama and the full context of the discussion has not been made public. The President has been a first class waffler relative to health care reform. It is up to the thinking progressives to keep the pressure on for the next several weeks and to try and offer him guidance. Without his leadership the dream of decent health insurance for all can never be achieved.

We must grant that the President has a full plate with both health care and Afghanastan; however, Mr. Obama is an intelligent human being, and was certainly aware of these problems prior to his election. In my opinion, the well being of the American people takes precedence over the umpiring of tribal feuds and pipe line building in a nation in central Asia that has historically, since the time of Alexander the Great, rejected foreign occupation.

On October 20, Robert Reich wrote on his blog,

Last January, as I understand it, the White House promised Big Pharma, big insurance, and the AMA the moral equivalent of what Joel Halderman allegedly demanded of David Letterman: hush money. The groups agreed to stay silent or even be supportive of health care reform, as long as they were paid off. But now it's time to collect, the bill is larger than the White House expected, and its going to fall like an avalanche on middle class Americans in coming years. That could mean an ugly 2012 election (read Sarah Palin). So the President has to do what Letterman did: refuse to pay.

On October 26 Reuters published an article indicating that our current health care system wastes up to $800 billion per year due to:

1. Unnecessary care such as overuse of antibiotics and lab tests to protect against malpractice exposure makes up to 37% of health care waste or $200 to $300 billion a year.
2. Fraud makes up to 22% of health care waste or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
3. Administrative inefficiency and redundant paper work account for 18% of health care waste.
4. Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year or 11% of the total.
5. Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

The same report indicates that the average U.S. hospital spends one quarter of its budget on billing and administration, nearly twice the average in Canada. American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada. Yet, primary care doctors are lacking, forcing wasteful use of emergency rooms.

Yet the On Line Journal reports that

United Health Care's 155% profits on Medicare Plans ("Medicare Advantage") must be a company record, especially in a down economy, and an embarrassing fact, particularly as the conservatives in the Senate Finance Committee fight to preserve the present payment structure of United Health Care and its fellow insurance companies. Private insurance plans in medicare cost up to 19% more than the cost to care for the same people under the public Medicare program.

In other words the taxpayers lost $2.7 billion in 2005 to private medicare advantage plans and their parent insurance companies. Yet the insurance industry and its prostitutes “keep telling innocent seniors that they will suffer (even more) if they lose their Medicare Advantage Plans.” This is not true. “Medicare Advantage Plans can hurt people with Medicare. Two studies found that people could end up actually paying out-of-pocket costs in a private plan than in straight Medicare.”

Congress, in the interest of preserving Medicare, must act on this issue, and must also redo the Medicare prescription plan, in the interest in saving the Medicare Plan for future generations.

I have previously warned the consumer about the purchase of insurance, medical devices, or pharmaceuticals advertised on TV. It does not require an Einstein to recognize that TV ads cost money, and that the consumer pays in the end. The current edition of Consumer Reports discusses Flomax, the highly advertised drug for an enlarged prostate. In 2008 the manufacturer spent $116 million advertising Flomax and racked up sales of $1.2 billion. Flomax can cost up to $246 monthly to the patient; however, one can obtain a generic equivalent, Doxazosin, for approximately $10 per month.

Always ask your doctor about generic equivalents, which are just as good as name brands, and are equally safe. If your physician refuses to discuss the matter, you should be concerned that he MIGHT be getting a kickback on the brand name version, or at the least is poorly informed. It is easy to look up this information in a book entitled the Physicians' Desk Reference.

Unhappily, true health care reform is in the hands of Congress, and that reminds me of a comment by Mary McCarthy:

The American, if he has a spark of national feeling, will be humiliated by the very prospect of a foreigner's visit to Congress -- these, for the most part, illiterate hacks whose fancy vestys are spotted with gravy, and whose speeches, hypocritical, unctuous and slovenly, are spotted with the gravy of political patronage, these persons are a reflection on the democratic process rather than of it; they expose it in its underwear.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform.]

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VERSE / Larry Piltz : In the Opt-Out States of America

Big digeridoo. Photo from Pihkva.com.

I pledge new legions to The Hague
and fresh new lesions to The Plague
for medicines to moan and beg
as Corporatocracy humps my leg
in the Opt-Out States of America
Re the Public Option's widget plans
for bleeding gums and swollen glands
with doctors singing oh yes we can
accompanied by Big Insurance plans
but not in the Opt-Out States of America

yet one new option that arises
fills with joy and great surprises
finally the notion's granted
militarism's been supplanted
if war's not what my state's about
my state can simply opt right out
in the Opt-Out States of America
with Quakers singing oh yes we do
accompanied by a big didgeridoo
yes in the Opt-Out States of America

In the Opt-Out States of America


Larry Piltz / The Rag Blog

Indian Cove
Austin, Texas
October 26, 2009
2:45 p.m. CST

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Dr. Stephen R. Keister : The Public Option and the Public Good

Graphic by patriotboy.
Honesty, honor and universal health care

We hear cries of woe about costs of universal care from the insurance-subsidized Republican members of Congress. Yet, these same folks have no problem with spending on foreign wars, of questionable need...

By Dr. Stephen R. Keister / The Rag Blog / October 25, 2009

The Machiavellian maneuvering in the United States Congress continues. As a keen observer of the complexities involved in health care legislation I am confused.

Granted there are a few forthright, honest elected representatives such as Rep. Alan Grayson on the scene; however, there is much conflicted double talk arising from our elected representatives in general. How can the general public ever understand? Just what is a "public option"? Hopefully, it would be a program akin to Medicare available to all. Apparently not. During a recent discussion on MSNBC it was pointed out the program may well be limited to those currently without insurance, or for employers to provide employee benefits when they find commercial insurance overly expensive.

It would seem that those who have found their insurance to be too expensive, or those who would turn to the public plan for more humane, more intensive, or more honest, coverage, may well be excluded. One still feels the evidence of Faustian arrangements between certain Democratic Senators and the insurance/pharmaceutical/medical equipment alliance.

The drumbeat of opposition to universal health care continues. Reasonably new on the scene is an organization interestingly named AmeriPac –- the American Political Action Committee -- whose motto is "No Obama Care!" These folks have amassed every lie, misrepresentation, and distortion into one central location, producing pamphlets, bumper-stickers, e-mailings, the works.

An interview with ex-senator Dr. Bill Frist on Fox News October 18, 2009, makes one appreciate the well funded efforts that the health insurance cartels employ to hoodwink the public. It brings to mind Josef Goebbels’ credo:

"There is no point in seeking to convert the intellectuals. For intellectuals would never be converted and would anyway yield to the stronger, and this will always be ‘the man on the street.’ Arguments must therefore be crude, clear, and forceable, and appeal to the emotions and instincts, not to the intellect. Truth is unimportant and entirely subordinate to tactics and psychology.

According to The Washington Post on October 10,

The Pharmaceutical Research and Manufacturers of America,. the drugmakers' main trade group, shattered records by spending nearly $7 million on lobbying July through September. The outlay brings PhARMA's total so far this year to nearly $20 million, just shy of the group’s entire lobbying budget for 2008. Other big spenders for the third quarter included Pfizer, Inc. ($5,42 million); the American Hospital Association ($3.8 million); the AMA ($3.95 million); Amgen, Inc. ($3,0 million; Bayer Corporation ($2.45 million) and Americas Health Insurance Plans ($2.4 million). Many of Washington's broader interest groups have also ramped up their lobbying efforts. The powerful U.S. Chamber of Commerce, which is at loggerheads with President Obama on health care, climate change and other key issues, spent a stunning $35 million on lobbying in the third quarter.

When we have a prescription filled at an outlandish price we are indirectly paying for the lobbies that are working to defeat efforts to establish price control on prescription drugs. The pharmaceutical industry spends much more on advertising than on research. It seems like every other commercial on television is for a pharmaceutical product.

Finally keep in mind that, when you are paying a health insurance premium, 40% of it will not go to pay your medical bills, but will provide for multimillion dollar executive salaries, lush stockholder dividends, and payments to your elected representatives aimed at defeating universal health care for you and your family. Universal health care would provide insurance without exclusions, high co-pays, and denials of preexisting conditions. Universal health care would be akin to Medicare, where you can choose your own physician, consultants, or out of town clinics, without the exclusions placed on HMO sponsors such as the Humana Corporation.

We hear cries of woe about costs of universal care from the insurance-subsidized Republican members of Congress. Yet, these same folks have no problem with spending on foreign wars, of questionable need, which have cost the American citizens $923,211,375,341 since 2001. The taxpayer has spent $693,457.283,717 in Iraq and $229,754,091,624 in Afghanastan, according to costofwar.com

Paul Craig Roberts, writing in Information Clearing House on October 21, 2009, notes: "According to reports the U.S. Marines in Afghanastan use 800,000 gallons of gasoline per day. At $400 per gallon that comes to a $320 million daily fuel bill for the Marines alone." Mr. Roberts also notes that it costs $750,000 per year for each soldier we have in Afghanastan. And we cannot pay for health care for the 45,000 Americans who die each year for lack of resources to pay for the fundamental right of having decent health car! Please check out Rep. Grayson's new website Names of the Dead.

Happily there is a bit of good news and that is the fact that both the House and Senate are working to include the health insurance industry under the antitrust laws, from which they and major league baseball have been the sole exemptions. Furthermore, there is legislation pending in both the House and Senate, the latter sponsored by Sen. Debbie Stabanow, as SB 1776, that would eliminate Medicare's Sustainable Growth Rate from the physician formula. This, plus a bill for health care reform, deemed necessary by the American College of Physicians, would provide a 10% bonus to primary care physicians for five years, establish a workforce Advisory Committee to develop and implement a national workforce strategy, redistribute unused graduate medical education funds to primary care, and create a CMS innovation center to test new payment models that support primary care.

In short we will begin to produce more family doctors, pay them a decent salary, and perhaps some day once again rediscover the house call, which is still available in many European nations. We have fewer primary care physicians than any Western nation. For no good reason some surgical specialists have an income 20 times that of a family doctor.

In the midst of all of this we again hear a cry from the highly paid specialties that Medicare discounts their usual fees. We who practiced prior to Medicare remember that that many of the elderly were able to pay only a token fee, and some could not pay at all; thus we who were in internal medicine, internal medicine subspecialties, or general practice were delighted to see, with the advent of Medicare, on time if discounted payment. I do believe that under a government sponsored program that a payment scheme like that of the Mayo Clinic or Cleveland Clinic should become the national standard.

I hope that Congress will pass a comprehensive public option and not the watered-down version noted in my first paragraph. In addition there must be some control of the insurance cartel concerning “pre-existing conditions.” It was noted in a 2008 study on law.com that women are discriminated against by the health insurance cartel, being charged as much as 48% more than men for health insurance. Of more than 3500 plans studied, 60% did not cover maternity care, and women are regularly denied coverage for “pre-existing conditions” which can include pregnancy or a previous C-section. In eight states and the District of Columbia, insurers are allowed to use a woman's status as a survivor of domestic violence to deny her health insurance.

It would appear that President Obama has rid himself of his idée fixe concerning Sen. Snow and the need for “bipartisanship.” It seems that he finally has come out from under the cloud of subservience to the insurance, pharmaceutical, and medical appliance industries and will take an active part in providing the 60% of the public and 65% of the physicians with a true, unencumbered public option.

It also appears that the House of Representatives is listening to the majority of the American people and their physicians. One can only hope that Sen. Reid throws off his jellyfish facade, stands up like a true leader, and demands that the Democrats in the Senate vote for cloture, thus avoiding a filibuster by the “death care” inspired Republicans. (What do we do with Sen. Lieberman?) In the meanwhile the majority of the American public must stand firm against the corporations and their political allies who put profit above morality and the negative image of American society in the civilized world.

I am still not sure that the American public understands the term “public option.” I have seen no polling on the matter. Hence, I conducted a brief survey of my own in a grocery store checkout line, talking to six people. Two middle aged ladies with breast cancer ribbons on their lapels were fully informed. One elderly lady feared it would in some way interfere with her Medicare. (I explained that it was merely a Medicare-like program for those under 65, and she was satisfied.)

One gentleman told me that he had General Electric health insurance and was not interested. Another gentleman was fearful of “socialized medicine,” but it turned out that he was a Korean War Vet and attended the V.A. Clinic; hence, it was easy to explain in terms of the V.A. and his wife's Medicare. The sixth, attired in hunter’s garb, assured me that any government program was "Communism," and took off in his Hummer with the NRA sticker on the bumper.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform.]

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Health Insurance : Does Baucus Bill Make Things Worse?

Cartoon by David Horsey / Seattle P.I.
Public option a necessity:
Baucus Bill protects insurance companies

By Ted McLaughlin / The Rag Blog / October 19, 2009

There are two especially devious ways that private health insurers use to keep their own profits high (and deny health care to consumers). The first is to cherry pick only healthy people to cover with insurance, and deny insurance to sick people or people with pre-existing conditions.

The second is to deny coverage for specific treatments to those with insurance. It is not uncommon for seriously ill people to find that their private insurance will not cover the treatment they need to get well. In many cases, these people die because they are unable to get the treatment their insurance company has refused to pay for.

The Baucus Bill, the health care reform bill approved by the Senate Finance Committee, would take care of the first problem. Private insurance companies would no longer be able to deny coverage to sick people or those with pre-existing conditions (or price that coverage out of the consumer's reach). But it does nothing to fix the second problem.

In fact, an excellent article by Lisa Girion in the Los Angeles Times makes the point that the Baucus Bill would only make the second problem worse, and leave consumers no better off than they are now. After all, what good is private insurance coverage if that coverage will not pay for needed treatment?

Since they could not exclude sick people or those with pre-existing conditions, the insurance companies would be left with two choices to maintain their exorbitantly high profits -- raise premiums or deny treatment. Of the two choices, the easiest option is to deny treatment -- a choice that could easily be hidden in the policy's fine print.

Considering the fact that private insurers already do this for many expensive procedures, is there any doubt that they would protect their profits by denying coverage even more often? I think that answer is self-evident. But there is a simple solution to this problem.

One might think the solution is to require coverage and payment of any treatment declared necessary by a doctor, but that won't work. That would just raise the premium cost of private insurance, and in the Baucus Bill there is nothing by private insurance.

The real solution is to include a public option for insurance in the bill. A public option would cover those with pre-existing conditions, cover all necessary treatments and it would keep premium costs low (by significantly lowering overhead among other things). This would force the private insurers to do the same, or lose consumers to the public option.

Senator John D. Rockefeller (D-W. Virginia) says, "We've seen all the insurance industry tricks -- hiding rules in fine print, cutting people off when they get sick, and refusing to pay for necessary treatment because of pre-existing conditions. This is why I am fighting for a public option -- we need an insurance option out there that puts people first, not profits. We need a real public option, one that competes with private insurance companies to keep them honest and accountable."

There are those who think the public option would drive private insurers out of the health insurance business. Personally, I don't care. There are plenty of other things they can insure.

It comes down to a choice. Which is more important -- protecting private insurers or providing necessary treatment for sick Americans? I choose the latter.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger.]

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Dems Who Voted Against Public Option : $19 Million in Healthcare Bucks

CLICK IMAGE TO ENLARGEMax Baucus Health Care Lobbyist Complex

Democrats who voted against public option
Got $19 million from healthcare firms

...compared to the profits the insurance industry will make if a public option is defeated... They got a great deal for that 19 million.

By Muriel Kane / September 30, 2009

Five Democratic members of the Senate Finance Committee who voted on Tuesday to shoot down a proposed public option for the health care reform bill -- a measure which polls show is favored by 81% of Democrats -- are coming under close scrutiny for their ties to the health care industry.

According to Intershame.com -- a site which aims to draw attention to misbehavior -- those five senators have collectively been the recipients of over $19 million in donations from health care, pharmaceutical, and health insurance companies over the course of their Congressional careers.

Finance Committee Chairman Max Baucus (D-MT) alone accounts for nearly $8 million of the total. In addition, five of his former staff members -- including two former chiefs of staff -- are now lobbyists representing organizations with a strong interest in the health care bill.

Joan Walsh of Salon took Baucus to task for his vote, writing, "So let's get this straight: Baucus admits the public option would 'hold insurance companies' feet to the fire,' but he voted against it? Is there any clearer evidence that Baucus is in the pocket of the health insurance industry?"

Blanche Lincoln (D-AR) comes in second on the Intershame list, with about $4 million in health industry donations, and Kent Conrad (D-ND) is third at around $3 million. Like Baucus, both Lincoln and Conrad have former chiefs of staff who are now health industry lobbyists.

Nate Silver of fivethirtyeight.com did some number-crunching last June which revealed the extent to which health insurance donations can influence Congressional voting. "Lobbying contributions appear to have the largest marginal impact on middle-of-the-road Democrats," Silver wrote. "Liberal Democrats are likely to hold firm to the public option unless they receive a lot of remuneration from health care PACs. Conservative Democrats may not support the public option in the first place for ideological reasons, although money can certainly push them more firmly against it. But the impact on mainline Democrats appears to be quite large."

Calls are already appearing at places like the liberal message board Democratic Underground for progressives to sponsor primary challenges to all three senators.

Bill Nelson (D-FL) at $2.5 million and Tom Carper (D-DE) at $1.5 million fill out the Intershame list. Both voted in favor of the weaker Schumer version of a public option, which would not include robust measure to control costs, but against the stronger version proposed by Sen. Jay Rockefeller. Carper has also been a prominent supporter of a "trigger," which would activate a public option only "if there is no meaningful competition after a couple of years."

"If money is the reason these five Democrats rejected the public option," Intershame concludes, "then it only took a little over 19 million dollars over 20 years to buy the five votes the health insurance industry needed to kill any meaningful reform to their industry. 19 million dollars is nothing compared to the profits the insurance industry will make if a public option is defeated. They got a great deal for that 19 million. The American people? Not so much.

Source / The Raw Story

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Hey Blue Dogs : Don't Make Me Vote Third Party!

Listen up Democrats! If you don't have or can't find enough backbone to give the American people substantial health care reform that contains a public health insurance option, then don't even bother asking for my support.

By Ted McLaughlin / The Rag Blog / September 9, 2009

I am a left-winger. I usually vote for the candidates on the Democratic ticket, but I don't have to. Along with millions of others, I have voted for third-parties in the past and I'm not afraid to do so again. When the real liberals and other left-wingers vote for third-party candidates, the Democrats do not win.

Once again, it looks like the Democrats are taking the left for granted. The Blue Dogs and others seem to think the left will have to support the Dems no matter what they do or fail to do. Those who believe this are badly mistaken.

I will be blunt. I have been disappointed with the Democrats since they regained power. But there is one issue that will determine how I vote in 2010 and 2012 -- health care. It should be obvious to anyone that our health care system is badly broken. If the Democrats don't pass real reform with the numerical advantage they currently hold, I cannot see any reason why I should continue to support them with my money, my blog and my vote (and I certainly won't participate in any GOTV effort).

And it looks like they are fast going to wuss out on real health care reform -- opting instead to enrich the insurance companies at the expense of the American people. Take the Baucus bill for example. This really bad bill would not have a public option, would require everyone to purchase private insurance, and would fine those who don't purchase private insurance.

Baucus says he will help those who can't afford health insurance by giving tax credits. I have to ask, how will getting a tax credit help the poor who don't pay taxes? And how will fining them help them to buy insurance or get out of poverty? The only real answer for these people is a cheap public option for health insurance.

Since my retirement a couple of months ago, I have joined the ranks of the poor (and with my age and the poor job market, I see little chance to change that anytime soon). I make slightly less that $1600 a month. That will take care of my rent and bills since I don't owe a lot, but how am I going to buy private health care insurance (especially with a pre-existing condition like diabetes)?

At current rates, private health insurance will cost me over half of my monthly income (if I can even get it at all). Then how am I going to pay rent, bills and eat? And don't try to tell me a "co-op" will drive down insurance costs with competition. I'm not stupid. I've seen how competition did nothing but allow prices to rise for electricity, car and home insurance, and many other things (especially if you are mandated by the government to purchase those things).

Listen up Democrats! If you don't have or can't find enough backbone to give the American people substantial health care reform that contains a public health insurance option, then don't even bother asking for my support. Real health care reform is your last chance to earn my support for the future (and I believe millions of others think the same).

I have never voted for a Republican (and never will), but I (and many others) are not afraid to vote for a third party. When we did it in the past, the Democrats fell from power. Don't force us to do it again!

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Health Care Blackjack : We Need an Ace from Obama

The Card Player by Pablo Picasso / MoMA Collection.
The stakes are high:
The President and health care reform

I have great concern about whether the President will take a principled stand in favor of a true and unfettered public option.

By Dr. Stephen R. Keister / The Rag Blog / September 5, 2009

In my younger days, in the days of the two dollar table, I would on rare occasion enter into a game of blackjack. In some odd way, these recollections entered my consciousness when I became aware that the President is going to address a joint session of Congress on the subject of health care.

I now am transported back to the table with two cards face up, both of them fives. The croupier awaits my decision to take a hit. If I get an ace, if the President unequivocally announces that he will fight for a decent public option, i.e. Medicare For All, I win. If I am dealt a six, the game is over, the President has conceded to the insurance cartel, the pharmaceutical companies, and the for profit nursing homes and hospitals.

The second option will force those of us who have stood by the nation, the welfare of the American people, the cause of reason, to fold our cards and depart, and hope that the progressive members of the House of Representatives will vote against a bill that is a farce and a concession to the corporations that appear to control both the President and the Congress.

Better the public, which in its lethargy and lack of inquisitiveness to find the truth, continues to suffer under the current system of health care rationed by the insurance industry, under a system where the insurance industry denies the physician his sacred duty to give appropriate care to the sick and injured, where a minimum of 18,000 Americans die each year for lack of health care.

It would seem overly optimistic to expect in the near future that the United States will rise from 26th place among nations of the world, and adopt a health care system approximating that of France, Germany, the Netherlands, or the Scandinavian countries. All these provide decent health care from cradle to grave, with free choice of physician, dentist and hospital and/or nursing home. Care is not rationed as the spokesmen for the corporations would have us believe. Indeed you may well have to wait 6-8 weeks for a total knee transplant for an arthritic knee that has been a burden for many years; however, for an acute illness, or an emergency, you receive immediate care without having to waste time to give a receptionist your insurance information.

Take the oft retold story of the Canadian woman who ostensibly was informed in Canada that she would have to wait a year and a half to have surgery for a brain tumor. She ended up at the Mayo Clinic in Jacksonville where the surgery was done shortly after arrival. The problem is that this lady did NOT have a brain tumor. Rather than a malignancy she had a small congenital cyst in the region of the pituitary gland which over a matter of years might impinge on the optic nerve and cause visual problems. Yet the American public was totally deceived and the media, save for rare instances, did not correct the distortions. Really! One wonders who indeed paid her bill at the Mayo Clinic.

I have great concern about whether the President will take a principled stand in favor of a true and unfettered public option. Thus far he has equivocated, dealt in secret with the pharmaceutical companies, and reportedly has arrived at a ten year arrangement with them. He has had extensive meetings with the health insurance industry, the AMA, AARP, and those who oppose a public option but are in favor of the nebulous bipartisan "health care reform.” By and large physicians groups, nurses organizations, labor unions, and medical academic organizations have been shut out of the discussions, save for a rare photo-op.

Physicians for A National Health Care Program has been developing a plan for a public insurance system -- not government managed, but managed by the physicians and representatives of their patients -- for the past 30 years. To date this group has been largely ignored, in spite of the fact that their plan would reduce national health care costs by 30-40%, and provide each and every person health care of their choice from cradle to grave. The reason this plan has been ignored? The insurance industry would suffer, thus depriving their executives of multimillion dollar incomes and bonuses, and reducing them to the level of normal profit making businesses. Still, they have had it quite good for the past 30 years.

President Obama has been compared on occasion to President Franklin D. Roosevelt. Absurd... FDR came to the presidency with a long history of public service in the family. His uncle, Teddy Roosevelt, as a Republican had been a "trust buster,” taking on the monopolistic corporations of that era. He broke with the Republican Party to stand with the people as a candidate for president from the Bull Moose Party.

FDR followed in his footsteps, serving in the Department of the Navy in World War I, being elected a state senator and later governor of New York. When he was elected president in 1932 he did not waver, he did not bow in supplication to his political opponents, he did what he felt was in the national interest. Sometimes the President won, other times he lost; however, he unequivocally did what he felt was in the interest of the citizens of the country, and did not bow to corporate power. President Obama appears to feel insecure, and panders to those who obviously dislike him intensely, accomplishing nothing, and leaving those progressive, thoughtful folks who supported him hanging out to dry.

Health care has become the ultimate test for Obama -- and we can be legitimately concerned after his visit to Montana where Governor Schweitzer, in his introduction, spoke up for single payer/universal care, and obviously nettled Obama, according to a report by the state coordinator of the Progressive Democrats of America. It seems the President was unhappy with the governor’s allusion to excellent health care in neighboring Saskatchewan.

One wonders if the President is following a pattern of concession to special interests as occurred with the Wall Street bailout, the apparent lack of concern about who was behind the so called CIA torture scandal (remember the Nuremberg Trials of 1945), the concessions to the Dole and United Fruit interests in the Honduran coup, the approval of continued snooping on domestic communications, and most of all, the continued support for an increasingly unpopular war in Afghanistan which lacks a well defined rationale and/or exit strategy. Does he remember President Eisenhower’s advice regarding the industrial/military complex?

I would like to see Mr. Obama disavow the Christian extremists interjecting the end-of-times foolishness into the debate -- as exemplified by "Pastor" Rick Joiner, a South Carolina evangelical who bases his spiritual authority, according to his website, on being transported to Heaven for an extended conversation with Jesus. (The Washington Spectator, September 1, 2009) "Pastor" Joiner has informed his believers, through his Liberty Council, that national health care would lead to euthanizing senior citizens as took place in Nazi Germany under Adolph Hitler.

This charlatan also has continued to inject the abortion issue into the debate. No bill in either house has mentioned abortion, which is prohibited in any event by The Hyde Amendment, passed some years ago, forbidding government funds to be used for abortions. This abortion thing is a fraudulent issue designed to mobilize the wingnuts. I am conversant with the PNHP suggestions for national health care and the issue of abortion has never been mentioned and in probability never thought of in their plans.

Obama must disavow these extremist folks, whose foolishness is subsidized by the insurance industries, and be forthright with the American people. He should know that the teabaggers, Birchers, etc., will never follow him, since their dislike has nothing to do with policy but with a deep seated hatred of an educated man of mixed race achieving the presidency. They dislike walking down the street hearing foreign languages spoken; they dislike the fact that Obama believes in sexual equality; they believe that Obama caused the financial depression, when in reality the neo-liberal economics of George Bush was responsible.

Mr. Obama must forget this foolishness regarding "bipartisanship.” The followers of Rush Limbaugh, Bill O’Reilly, Sean Hannity, and Glen Beck will never accept him nor believe him; however, the remaining 60-70% of the American public deserve a forthright discussion. It is time to face issues head on, as did FDR. Obama must show the courage to take on the Blue Dogs who in the last election cycle received $122,370 from their corporate contributors. He must face the fact that members of the Senate Finance Committee have received millions from the health care industries.

If President Obama cannot take up the mantel of leadership one can anticipate mass defections from his progressive base, and his being defined in advance as a one term president. (I have already removed my Obama bumper-sticker.) He must voice support for the House Progressive Caucus and back them in their goal of obtaining a true, undiluted, government option, as part of health care reform, We who desire single payer realize that no mere mortal can alone defeat the corporate interest.

Once again, it’s the special interests against the people. Thornstein Veblen addressed this in his "Theory of Business Enterprise" written in 1904, when he noted: "The big businessman, uninterested in anything but the amassing of money and the accumulation of power, was actually the enemy of his enterprise. He was concerned with earnings not with values, with prices rather than goods. Profit-hungry moguls sabotaged production and held the common man down by the harsh law of diminishing returns." Veblin as he continued, appealed for a new set of controls, for a society of engineers who recognize the social use of our machines.

Before signing off I would like to call the reader's attention to a piece in the summer 2009 Wilson Quarterly. There is a dichotomy in the thinking of the “religious” folks who oppose health care reform that has entranced me for some time. The Wilson Quarterly notes the following, in "Porn in the USA: Who subscribes to pornographic websites?”:

“Benjamin Edelman of Harvard Business School summarizes data from a major provider of online porn in The Journal of Economic Perspectives (Winter 2009). Per capita, Utah has the most subscriptions to porn sites, and West Virginia the fewest. Some religious attitudes correlate with subscription rates. Edelman reports: In states where more people agree that 'Even today miracles are performed by the power of God' and 'I never doubt the existence of God,’ there are more subscriptions. Residents of states with high rates of churchgoing prove to be about average in their appetites for porn -- the only difference is that fewer of them sign up on Sundays."

Think about it. The Religious Right rails against large government and "government interference,” yet continues to push for an anti-abortion amendment to the Constitution. These folks seem to have a continuing unnatural level of interest in human genitalia!

Our nation is indeed at a crossroads.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform.]

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