Ted McLaughlin : Are We Moving Towards Single-Payer?

Photo by Glyn Lowe Photoworks / Flickr. Image from OtherWords.
The pressures moving the U.S. closer
to a single-payer health care system

There will be a huge pressure to reform Medicaid -- and the only way to reform it adequately is to make it a federally-administered program.

By Ted McLaughlin / The Rag Blog / July 3, 2012

It looks like the Affordable Care Act (Obamacare) is here to stay. After last week's Supreme Court decision, the only way it can be overturned now is for the Republicans to win the White House and both houses of Congress in the coming election (which is very unlikely) -- and even then, they might find public pressure would prevent its repeal.

Right now, a slight majority of people don't like Obamacare. Some have projected this to mean that a majority of Americans would like to see it repealed. That is just not true. One recent poll showed that 79% of Americans like most of the reforms and don't want it all repealed.

The only part they're not crazy about is the individual mandate. But as the program kicks in fully in the next couple of years, people will begin to realize that the individual mandate only applies to between 2% and 5% of the population -- and the program will become more and more popular.

Another fact commonly overlooked is that among those who are against Obamacare, about 22% don't want it repealed but made stronger. These people would like to see a public option at a minimum (and really want a single-payer system like those in other developed countries). When the program was first passed, I was among those opposing it because it didn't go far enough. I was afraid that all it really did was to delay the United States from going to a single-payer health insurance system.

But after a lot of thinking about it, and a few facts coming to light, I'm starting to change my opinion. I now believe that Obamacare might actually hasten America's progress toward a single-payer system, instead of delaying it. That's because the program is responsible for creating (or increasing) three pressures on the health care system as a whole to move toward a single-payer system. These three pressures are:

1. Forcing private insurance companies to pay a bigger percentage of their premiums for real medical care.
2. The continuing decline in employer-based insurance coverage.
3. The refusal of many states to increase Medicaid coverage for the poor.

Let me take these in order. First, in the past the insurance companies have not been required to spend the money they get for real medical care. While government-run Medicare has an overhead expense of 3% to 4%, many of the private insurance companies were putting 30% to 40% of their premiums toward "overhead."

And the more they put into this area (and the less into medical costs for consumers), the more profit they had. This was a primary reason for the record-breaking profits those companies were showing.

Obamacare ended that. A private insurance company must now put at least 80% of its premium income toward actual medical costs of its consumers (and the giant companies must spend at least 85% on medical costs).

The companies tried to get around this by declaring some administrative costs as medical costs (like the money spent paying their salesmen to sell the policies), but the government didn't go for it. They demanded medical costs be actual medical costs (rather than hidden administrative costs). And if an insurance company fails to spend the proper percentage on medical costs, then they must refund a big enough part of premiums received to get them down to the proper percentage (and the first refunds are currently being issued).

While this still allows the insurance companies to make a decent profit, it has put a serious crimp in the outrageous profits they were making (by denying claims and raising premiums). Now if they raise premiums, they must also increase the amount they spend for medical costs (or wind up refunding the raise).

In other words, the large insurance companies no longer have a license to steal -- and they don't like that. Forbes Magazine reports that some insurance companies are already getting out and searching for other, more lucrative, ways to do business -- and this movement out of insurance to other things will probably just continue to grow.

Second, is the move away from employer-based insurance for workers. This started before Obamacare was created (or the recession hit). As the chart above shows, the percentage of Americans covered by employer-based insurance fell from 69.2% in 2000 to about 58.6% in 2010 -- and the trend continues to move downward. If 2010 had the same percentage of coverage as 2000, then 28 million more people would have employer-based insurance than currently have it.

The hope of the writers of Obama's reform program was that the law would stop this decline in employer-based insurance coverage (through tax breaks for businesses, creation of health insurance exchanges, and a penalty charged for companies that don't provide insurance). I think that's mostly wishful thinking. Any business with less than 50 workers will be exempt, which means there is no incentive for small businesses to provide insurance. And as medical costs (and therefore insurance premiums) rise, many other businesses may decide it is cheaper to pay the penalty than to provide insurance coverage.

And those companies choosing the penalty over insurance coverage will just be a short step away from approving of single-payer insurance (which would most likely be funded by employee/employer contributions just like Social Security), as they realize it would be cheaper for them than providing their employees with ever-rising private insurance.

Third, and perhaps the biggest pressure for single-payer insurance, is the Republican state governments refusing to institute the Medicaid reforms called for in the program. The red states in the map above (from ThinkProgress ) are those with Republican leadership. The 10 states in dark red have already said they will not adopt the Medicaid reforms to cover most of the poor (even though the federal government would pay all of the cost for three years and then pay 90% of the cost). And it is extremely likely that the lighter red states will soon follow suit.

That means many millions of Americans who thought they would be getting insurance coverage because of the reforms, will be denied it because the Republicans will just continue the current inadequate Medicaid programs. They will do this because they don't consider medical care to be a right, but only a privilege available to people who can afford it.

For them, their ideology is more important than the lives and health of many millions of their fellow citizens. And they can get away with this because the Supreme Court killed the provision that would have forced the states to reform Medicaid.

Now one of the primary reasons Obamacare was passed was that there are 50 million people in this country without any kind of medical insurance. Some of these will now be able to get private insurance because of the health insurance exchanges and government subsidies. But a large part of this 50 million (the poor and the working-poor) were meant to be covered through Medicaid.

If this doesn't happen, there will be a huge pressure to reform Medicaid -- and the only way to reform it adequately is to make it a federally-administered program (like Medicare). And the easiest way to do that is to let those making less than a certain salary qualify for Medicare (and do away with Medicaid).

This huge swell in Medicare, combined with decreasing employer-based insurance and insurance companies leaving the business, will bring great pressure to go to a government-run single-payer insurance system.

The experience of other countries has shown us that the money spent on medical care overall will then decrease (since we spend much more per capita than any single-payer country). It will also decrease premium costs for both individuals and businesses (since high overhead and huge profits will be eliminated).

The way I see it, Obamacare did not delay going to a single-payer system. In fact, it has probably created (or increased) the pressures propelling us to adopt a single-payer system much sooner. It has to happen. There is no other real solution to our current broken health care system. Obamacare made some improvements, but it didn't fix the broken system. But maybe it is pushing us much closer to the real solution.

[Ted McLaughlin, a regular contributor to The Rag Blog, also posts at jobsanger. Read more articles by Ted McLaughlin on The Rag Blog.]

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Thorne Webb Dreyer and Sarito Carol Neiman : Bon Voyage, Doctor Keister

Dr. Stephen R. Keister, 1921-2012.
Dr. Stephen R. Keister, 1921-2012:
Bon Voyage, Doctor Keister

By Thorne Webb Dreyer and Sarito Carol Neiman / The Rag Blog / April 12, 2012

It seems the cancer always wins! Tomorrow I go to the Manchester Presbyterian Lodge for final care by Great Lakes Hospice. I am beginning to hear the splash of Old Charon's oars in the waters of the Styx. It ain't all that bad with the memories of all of you fine folks to take along.” – Steve Keister, in a message to his friends and his colleagues at The Rag Blog, February 2, 2012

Dr. Stephen R. Keister left us late Friday night, April 6, 2012, after a long-running bout with prostate cancer. He died in hospice care in his longtime home, Erie, Pennsylvania, at the age of 90.

The cancer may have won but we seriously doubt that Old Charon, the ferryman of Greek mythology (who carried souls of the newly deceased into the world of the dead) succeeded in transporting Steve all the way to Hades.

Steve, ever the philosopher and the reformer, probably recruited the wizened old seaman to his own cause of universal health care and they’re out there now, organizing for a single-payer system in the Afterlife.

Steve Keister, who turned 90 last October, was a retired physician who practiced internal medicine in Erie, PA, from 1950 until 1991, specializing in rheumatology; he was the region’s first practicing rheumatologist.

He attended Duke University where he became interested in the writings and philosophy of Moses ben Miamon, Voltaire, and Sir William Osler. He obtained his M.D. from the University of Maryland and did his postgraduate training at the Mercy Hospital in Pittsburgh and Hamot Medical Center in Erie.

His medical honors were many and after retirement he remained active in scholarship and volunteer work. And Steve found a second passion late in life, dedicating himself to progressive social change, and especially to the cause of universal health care, working with Physicians for a National Health Plan and other activist groups, and writing about health care reform for The Rag Blog.

According to his daughter, Cindy Hepfer, "Steve has always been a voracious reader, continued to play tennis until his 60s when he took up golf instead, and enjoyed having friends in in the evening for drinks and conversation."

And, “after retirement,” Cindy said, “Steve continued his family’s tradition of trying to preserve the tenets of the nation’s Founding Fathers by active membership in People for the American Way, Americans United for the Separation of Church and State, and Amnesty International.”

In a eulogy, Steve's friend Don Swift said that Keister was not only a "gentleman scholar," but that he was also "a mensch, a person of integrity and honor," and that he was "all about trying to heal a broken world."

Fellow Pennsylvania activist and writer Carl Davidson said, “We knew him well here in Western Pennsylvania, especially as an unwavering voice for Medicare for All, and then some. He supported PDA's [Progressive Democrats of America’s] efforts here, but his own views were with the socialist left. Raise a fist and a red rose for him this May Day. He will be missed.”

About her father’s involvement with The Rag Blog, Cindy Hepfer said, “You have certainly given him a mission in these latter years of his life! I thank you for giving Dad a creative outlet and a way to share his goodness and intelligence with others.”

Keister's heavily-researched opinion pieces published by The Rag Blog were rich with personal reference and backed up with facts, figures, and links. They were erudite, yet peppered with wonderful colloquialisms reminiscent of an earlier era, and always filled with quotes and observations from great thinkers, scientists, and philosophers ranging from Rabelais, Pliny the Younger, and Confucius, to Aldous Huxley, Sir William Osler, John Ruskin, and Will Rogers.

And, if you read a column by Dr. Stephen R. Keister, you never had any doubt about where the author stood on the subject.

Though always full of hope personally, Steve became increasingly disillusioned with the medical system in this country and the growing dominance of the pharmaceutical and health insurance companies.

In his writing, he often reflected on the lessons of a lifetime in medicine.

“I entered the practice of medicine in 1950, an idealist, believing in the lesson of the Good Samaritan,” he wrote. “I believed that all persons should be provided with medical care…”

But, “Somewhere in the 1980s medical care, with great planning and premeditation, was usurped by the health insurance cartel in collusion with the pharmaceutical industry. Medicine was changed from a proud profession to a business, and the physician degraded to a ‘health care provider.'"

In his final column for The Rag Blog, entitled “I Cry for My Country,” Dr. Keister wrote:

Having passed the age of 90 I wish that my final days could be days of happiness and good wishes for those about me; however, it appears that fate has ordained otherwise. It would be a great course of satisfaction to see an enlightened, progressive United States as a homeland for my grandchildren. Instead we find a nation that is descending into quasi-feudalism and subservience of the many to the few.

At the time Steve submitted his final column, we at The Rag Blog were aware of his worsening physical condition. We included the following introduction to his piece:

Our dear friend, Dr. Stephen R. Keister, turned 90 on Sunday, October 9. For the last three years Steve has written -- with a unique and singular voice -- dozens of columns about the sad state of our health care system. And in that time he has become the heart and soul of The Rag Blog. He claims this is his last column, but we promise not to hold him to that commitment! We hope he will continue to share his wisdom with us for many months to come.

But we knew it wasn’t likely.


Steve Keister approached death much as he handled life, with vigor, intellectual curiosity, and an open mind. According to his daughter, “He was analyzing the dying process for as long as he could and communicating his thoughts to those around him.”

“He had observed repeatedly to several of us that he was not afraid… and that he always liked to sleep.” Cindy said. "I told him how brave I thought he was and that he shouldn't be afraid to reach out for the sleep that he wasn't afraid of.”

We communicated with Steve during his final weeks and he shared his feelings and observations about the process of dying.


Saying goodbye

"Death is someone you see very clearly with eyes in the center of your heart: eyes that see not by reacting to light, but by reacting to a kind of a chill from within the marrow of your own life." -- Thomas Merton

"The greatest challenge of the day is: how to bring about a revolution of the heart, a revolution which has to start with each one of us?" -- Dorothea Day

How do you say goodbye to a friend? We mean really goodbye -- not “so long, see you later.” Saying goodbye, really, is an opportunity one doesn’t have often or early in life.

When we are young and a friend dies it is usually sudden, unexpected. One day the person is here, the next day that person is gone. And even when we know that death is coming, our culture as a whole does not tend to support the ceremony of saying our goodbyes while that person is still alive. Instead we are supported to remain in denial -- “you can beat this thing, I know you can!”

We are encouraged in so many ways, subtle and not so subtle, to save our goodbyes for when it’s too late for the person who’s leaving to hear them. And by the time we are old enough to see (if we dare to look) the glimmer of our own departure on the horizon, we have no practice in saying goodbye, either as one who is leaving or as one who will remain.

Stephen Keister was a friend. His contributions to The Rag Blog over the past three years have been rooted in a rich lifetime of experience as a physician and proud “secular humanist” and, as such, his insights have been invaluable as we have collectively wrestled with all the implications of the crisis in health care that has plagued the United States now for decades.

His passion for his subject was not abstract or ideological; it was his very life. In his first Rag Blog column, published on Nov. 17, 2008, Dr. Keister was clear where he stood on the question of healthcare reform:

To take the burden off future generations this country must get in step with Western Europe in quality and extent of health care for all. According to the Commonwealth Fund our health care rates 26th in the world and as of Nov. 13 [2008] … U.S. patients, compared to seven other countries, suffer the highest number of medical errors. 44% of chronically ill patients did not get recommended care, fill a prescription, or see a doctor when sick because of costs. 41% of U.S. patients spent more than $1000 in the past year on out of pocket costs, compared to 4% in Britain or 8% in the Netherlands.

We must make sure our elected representatives are not taking baksheesh from the pharmaceutical and insurance industries and support single payer, universal health care devoid of insurance company participation. The nation and your family depend on you not sitting idly on your butt. Call, E-mail, demonstrate!

We lost that battle, obviously. But the war is not yet over, as the sad compromise that became “Obamacare” now finds itself in the Supreme Court. Steve Keister did not live to see the outcome of the current scuffle. But it’s clear, no matter what the outcome, there is still no cause for sitting idly by.


When we heard that it was time to say goodbye to our friend Stephen Keister, we wanted to find a way to honor the occasion. Not to respond with denial, nor to save all our tributes till after he was gone.

So we did what anybody might do if they just found out that a wise and beautiful friend was about to leave for good. We sent him a list of questions, hoping it would offer the opportunity to share what is happening with him now. True to form, he responded both as a scientist and as a humanitarian, the rare combination that has made it such an honor and privilege to publish him over the years.

Here is his response, in his own words. In a sense, this is Steve Keister’s final column. We would like to thank writer and educator -- and Steve's close friend -- Don Swift, for facilitating our final communication with Steve Keister.

Recently I’ve received a request from Thorne Dreyer and his many friends at The Rag Blog, to give him some insight into the situation in which I am involved -- that is, terminal cancer of the prostate, under the care of the good people at the local hospice organization.

Initially, I think we’d better discuss what hospice exactly covers. In my last article in The Rag Blog, entitled “I Cry for My Country,” I refer to several instances of hospices run purely for the financial benefit of the folks in charge. In other words, once again we are faced with the terrible American attitude of money above all else. Therefore, I would suggest that anybody who is interested in legitimate hospice care get a copy of the pamphlet entitled, “When Death Is Near: A Caregiver’s Guide.”

Hospice in the United States is a reasonably new organization, and the hospice in Erie was one of those founded on the basis of charitable giving. Some 25 years ago, Dr. David Dunn, a very capable general surgeon who had spent time in Great Britain during the war, became interested in the hospice movement and spent several months studying the technique as utilized in the U.K. Subsequently he came back to the United States and established a purely volunteer movement, which was soon overburdened, and ultimately taken over by his son, Dr. Geoffrey Dunn at the Great Lakes Hospice, where it remains today.

I became involved in this personally, having been diagnosed with carcinoma of the prostate some 12 years ago. This was treated initially by irradiation and subsequently hormone therapy. Approximately mid-2011, bone scans showed spread of the cancer to the various bones of my body. I tended to ignore this, which was possibly a mistake on my part, because of several factors. At the age of 90 I was enjoying the company of both the Edinboro University retired faculty group, and an 89-year-old lady, who was the best of companions, on the 8th floor of my building.

The question arises, why did I resort to hospice care?

I was not fully aware of the signs of the deteriorating effects of metastatic cancer. I was aware of the fact that we develop painful areas in the bones, but I completely ignored the systemic symptoms of the disease, which are: 1) increased fatigue; one will sleep up to 18 hours a night; 2) complete loss of appetite; one desires nothing, even a glass of milk, for a meal; 3) desire for solitude and lack of interest in things of everyday origin.

These taken together mean something to an alert physician and, happily, Dr. Jeffrey Dunn of hospice stopped by one evening to discuss books, and I discussed my symptoms with him. He said, “Gee, Steve, you’re a candidate for hospice care -- your cancer is spreading.” So the next day I was a hospice patient, and have never regretted it to this day.

Hospice nationally will provide 90 days of care under Medicare. They do not provide inpatient care in a convalescent or nursing home, but otherwise, medicine, equipment, medical care, etc., is provided by the program. I currently am in the Presbyterian Lodge in Erie, and everything is going according to program. I realize I have not long to live, but realize too that I have much to be thankful for throughout my 90 years.

I am also asked how I have rationalized the facing of death, and the question mentions that Socrates, the Zen masters, Jesus, Buddha have all offered alternatives. However, I have somehow avoided these alternatives and looked at this as a purely biological process. We are born in pain, we live largely in pain, and hopefully we can avoid dying in pain.

I’ve been assured by several of the hospice workers that the easiest people to care for are those that are the “secular humanists” who approach each stage of life as a natural event and do not interfere or complicate matters with various philosophical pictures.

While is it true that good hospice care professionals, if possible, provide a role of helping family and friends come to terms with the impending loss of a loved one, some of us are beyond that stage. At the age of 90 we have few living relatives and depend entirely on friends. Happily, I have been blessed with many, many friends in my recent lifetime -- perhaps more so than earlier in my life.

The final question in the submitted list is very interesting and very apropos to the present time. It is: If you could make a new Hippocratic Oath for the 21st century to be given to every student graduating from medical school, what would it be?

This I have given much thought, and do not feel intellectually qualified to answer this at the present time. But I do feel that certain factors should enter into the situation. I do think the philosophy of Dorothea Day and Thomas Merton should play a big part, and within their thinking, we who allegedly feel we are Christians should remember the Sermon on the Mount and the Beatitudes.

In addition to that, from the ethical standpoint we should remember the teachings of two physicians of the last century: Sir William Osler and Dr. W.W.G Maclaclhan of Pittsburgh, both of whom treated people of prominence, the well-known, but at the same time never turned their backs on the poor, the underprivileged or the disabled.

I once again wish to thank my friends in Austin, Texas, my friends in my retired professors' group in Edinboro University, my children, including my daughter Cindy and son-in-law Will (both librarians), and my grandson Jonathan and his wife Alice (both modern musicians with a technique I do not understand but in which apparently they are doing great work). And finally, my dear friend on the eighth floor at 1324 South Shore Drive.

Peace. Peace to all. Thank you.

More of Stephen Keister’s last words can be found in his last columns for the Rag Blog. His final column ended with a challenge for us all to carry on the work of birthing a better world:

I cry for my country, and while asleep I hear in my dreams the mass gatherings of my youth singing, "Arise ye prisoners of starvation, arise thee wretched of the earth, for justice thunders condemnation, a better world's in birth."

Bon voyage, Doctor Keister. You will be missed.

[Thorne Dreyer edits The Rag Blog, hosts Rag Radio, and is a director of the New Journalism Project. He lives in Austin. Sarito Carol Neiman is a freelance editor, author, and actress who lives in Junction, Texas. Together they edited Austin's Sixties underground newspaper, The Rag.]

Find articles by Dr. Stephen R. Keister on The Rag Blog.

Images courtesy of Cindy Hepfer.
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Dr. Stephen R. Keister : Poverty and Public Health in America

The picture of poverty in America. Image from Bay View.
Poverty and public health:
The social causes of death in America

By Dr. Stephen R. Keister / The Rag Blog / June 29, 2011

"[The] incredible absolute size and commanding market positions [of a few immense corporations] make them the most exceptional manmade creatures of the twentieth century... In terms of the size of their constituency, volume of receipts and expenditures, effective power, and prestige, they are more akin to nation-states than business enterprises of the classic variety." -- Richard Barber, from the book Friendly Fascism by Bertrand Gross.

These days we are always on the lookout for a bit of encouraging news. But the final analysis of the Vermont health care plan comes as a bitter disappointment. The online organization Single Payer Action on June 21 provided us with the sad news: the much-touted Vermont plan is not single payer, not even close.

It seems that the phrase "single payer" was stripped out during the final negotiations, and the implementation of the legislation is dependent on federal approval. It also appears that agencies in Washington will not grant needed waivers. The bill permits the private insurers to operate in Vermont indefinitely.

ScienceDaily reports on a study done at the Columbia University School of Public Health that brings home once again the great failings of the healthcare system in the United States. The study “found that poverty, low levels of education, poor social support and other social factors contribute about as many deaths in the U.S. as such familiar causes as heart attacks, strokes, and lung cancer.”

The investigators found that approximately 245,000 deaths in the year 2000 could be attributed to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual poverty, 119,000 to income inequality, and 39,000 to area-level poverty.

Overall, 4.5% of U.S. deaths were found to be attributable to poverty -- midway between previous estimates of 6% and 2.3%. However, the risks associated with both poverty and low education were higher for individuals ages 25-64 than for those of 65 or older. The authors’ findings for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations.

Meanwhile, our elected representatives continue their budget negotiations in Washington with an eye on further cutting an already inadequate Medicaid program and "revising" Medicare benefits, continuing the downward spiral of health care for the poor, the disabled, our returning servicemen/women, and the emotionally ill.

Happily, there is some galvanizing opposition, as witnessed by a massive protest by National Nurses United in Lafayette Square demanding a tax revenue increase from corporations in order to prevent such cuts in Medicaid and Medicare.

I am encouraged by the rare occasions that a group of dedicated Americans will gather in public to speak up against injustice. But I also wonder about the lack of public militancy against injustice here that we see demonstrated by the citizens in our fellow democracies in Europe, especially in Greece, Spain, France, and the United Kingdom.

It would seem that there is an answer, a disturbing answer, contained in an article by Harriet Fraad, published in Tikkun and distributed by AlterNet. The title: "Why Are Americans Passive as Millions Lose Their Homes, Jobs, Families, and the American Dream?" While Dr. Fraad offers some suggestions, one hopes that they do not come too late.

Noam Chomsky peripherally addressed this matter in a 1995 essay when he wrote:

A final point, something I've written about elsewhere (e.g., in a discussion in Z papers and in the last chapter of Year 501). There has been a striking change in the behavior of the intellectual class in recent years. The left intellectuals who... years ago would have been teaching in working-class schools, writing books like Mathematics for the Million, participating in and speaking for popular organizations, etc., are now largely disengaged from such activities, and although quick to tell us that they are far more radical than thou, they are not to be found, it seems, when there is an obvious and growing need and even explicit request for the work they could do out there in the world of people with live problems and concerns. That's not a small problem. This country right now is in a very strange and ominous state.

People are frightened, angry, disillusioned, skeptical, confused. That's an organizer’s dream... It’s also fertile ground for demagogues and fanatics who can (and, in fact, already do) rally substantial popular support with messages that are not unfamiliar from their predecessors in somewhat similar circumstances. We know where it has led in the past; it could again. There's a huge gap that once was at least partially filled by left intellectuals willing to engage with the general public and their problems. It has ominous implications, in my opinion.

A few bright lights in the darkness: Senator Bernie Sanders is facing down the pharmaceutical industry. He has introduced a bill in the Senate authorizing government expenditures of some $80 billion per year to buy up the patents that were awarded to the drug companies for "carrying out research."

These patents, in essence, provide government-granted patent monopolies, thus providing the pharmaceutical companies the right to price drugs at hundreds of dollars per prescription and sometimes several thousand dollars per prescription in the United States.

The money would come from a tax on public and private insurers. The savings from lower-cost drugs would immediately repay more than 100 per cent of the tax.

The country is projected to spend almost $300 billion on prescription drugs this year. Prices would fall to roughly one-tenth the amount in the absence of patent monopolies, leading to a savings of more than $250,000 billion. The savings on lower drug prices should easily exceed the size of the tax, leaving a substantial net reduction in costs to the government and private insurers. For more details about the legislation, see "The Drug Market Scam" by Dean Baker on AlterNet.

The other side of the coin involves a decision by the Supreme Court on June 23, 2011, freeing the generic drug makers from providing consumers with the specific dangers of using a drug. The court, at the same time, gave the pharmaceutical industry access to prescriptions written by physicians for their patients. So much for “patient-physician confidentiality”!

The other bit of good news came in a June 16 New York Times op-ed by President Jimmy Carter, when he joined the chorus of those asking the government to call off the Global War on Drugs. Thus he added his voice to those of Richard Branson, George Shultz, and Paul Volker. President Carter pointed out that this legislation has increased our prison population from 500,000 people in 1980 to 2.3 million in 2009. The increase mostly is for crimes that are non-violent and related to drug possession. There are 743 people in prison for every 100,000 Americans, a higher proportion than in any other country and seven times as great as in Europe. Some 7.2 million people are either in prison, on probation, or on parole -- more than 3% of all American adults.

The cost? California in 1980 spent 10% of the state's budget on higher education and 3% on prisons. In 2010, almost 11% went to prisons and only 7.5% to higher education.

Of course, the fight for enlightened drug policy, as seen in most European nations, will be fought tooth and nail by those who are financially rewarded by the so-called war on drugs — the crime cartels and those receiving baksheesh from the criminal enterprises (corrupt law enforcement officers, politicians, judges, and the operators of our uniquely American private prisons).

One final personal thought: The Republicans keep repeating the mantra that if we increase the taxes on the wealthy, they will not have the funds to create jobs. Of course, this is pure and simple poppycock. Their wealth is not used to produce employment. In the autumn of 2008 at the time of the financial crash, I was talking to a Swiss banker who works for a typical big Swiss bank. In the autumn of 2008, he said, the bank’s below-street-level gold vault, encased in concrete, cracked open under the weight of the gold bullion being shipped in from the U.S.A.

Create jobs!?! Maybe for Swiss concrete workers...

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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David P. Hamilton : French Healthcare is the World's Best

Image from Yale Journal of Medicine and Law.

CLICK ON IMAGE TO ENLARGE.

Letters from France III:
The French healthcare system
is the best in the world

By David P. Hamilton / The Rag Blog / June 1, 2011

“There are no uninsured in France. That’s completely unheard of. There is no case of anybody going broke over their health costs.” -- Victor Rodwin, New York University

[This is the third in a series of dispatches from France by The Rag Blog's David P. Hamilton.]

PARIS -- President Obama dropped the healthcare “public option” like a hot potato at the very onset of last year’s debate in the U.S. over reforming healthcare. Despite polls of average citizens to the contrary, Obama asserted there wasn’t enough support for it, meaning that there wasn’t enough support among the economic elite, health insurance corporations, pharmaceutical manufacturers, doctors, and other medical capitalists, and hence, not enough support among members of Congress beholden to those interests. Let’s take a look at what they’re so afraid of.

The World Health Organization (WHO) ranks the French health care system as the best in the world. The U.S. system ranks 37th. The complex details of the procedures used to determine these rankings are available on the WHO website. The WHO has hundreds of rankings on health related topics as specific as beer consumption by country. The U.S. fails to distinguish itself favorably in any of them.

Of particular note is the ranking by total health care expenditures as a percentage of the GNP where the U.S. at 15.4% leads the world, only exceeded by the Marshall Islands and far ahead of any other major industrialized nation.

Hence, while the U.S. health care system produces mediocre results, it is the most expensive. For France, with a system rightists consider far too expensive to maintain, the corresponding figure is 11.4%. Different studies show this disparity even greater, at 16% and 10.7%. In the U.S., $6,400 is spent annually per capita on health care costs while the average French person spends barely over half that amount, $3,300.

Other health care assessments tell much the same story. Infant mortality is a principal indicator of the quality of health care. In France, it is 3.9 per 1,000 live births. In the U.S., the rate is nearly 80% higher at 7.0. Life expectancy is 79.4 years in France, two years more than in the U.S. Death from respiratory disease, often preventable, is 31.2 per 100,000 in France while in the US it is 61.5, despite the fact that nearly twice the percentage of French adults smoke tobacco compared to the U.S.

France also has many more hospital beds and doctors per capita than the U.S. A more recent study by researchers at the London School of Hygiene and Tropical Medicine measured “amenable mortality,” a measure of deaths that could have been prevented with good health care, in 19 industrialized nations. France again came in first. The U.S. was last. Not surprisingly, French citizens’ satisfaction with their system is 65%, the highest level among all European countries, compared to 40% in the U.S.

The French pay for their healthcare primarily by paying taxes that cover medical services. These taxes are high. Americans don’t pay as much in taxes, but pay much more when one counts insurance costs and their expenses for medicines, doctors, and hospitals.

The French system offers universal coverage and everyone is required to participate. In the U.S, 15.4% (46.3 million people) have no coverage at all and about twice that many are underinsured. Hence, there are roughly twice as many Americans with inadequate coverage as there are people in France.

The French system doesn’t cover everything. Co-payments in France range from 10 to 40% for most medical services. Hence, 92% of the French have complementary private insurance. This private health insurance makes up 12.7% of French health care expenditures. All private health insurance in France is required to offer guaranteed renewability, so you cannot be dropped if you get sick.

Most private health insurance is provided by non-profit organizations and their “modest” premiums are usually paid by employers. Furthermore, the more sick one is, the higher percentage is paid by the insurance system, 100% for 30 serious and chronic illnesses such as cancer and diabetes.

This feature is known as “solidarity,” a consciousness of community almost altogether absent in the hyper-individualistic U.S. Victor Rodwin, a professor of health polity at New York University states, “There are no uninsured in France. That’s completely unheard of. There is no case of anybody going broke over their health costs.”

How are the French able to accomplish this? First, the insurance system is run by quasi-public, non-profit agencies that cover different sectors of French society. These agencies directly negotiate prices for medicines with manufacturers, homeopathic medicines included. They also negotiate compensation schedules with doctors. Doctors are free to charge whatever they want, but the amount the system will reimburse is fixed.

Another reason for the lower costs is that, in the words of Kerry Capell in Business Week, “France reimburses its doctors at a far lower rate than U.S physicians would accept.” French doctors earn about a third as much as their American counterparts who are the best-paid group of professionals in the world. But French doctors have no student loans to pay since their medical training was paid for by the state.

In addition, France is not tort-friendly, so malpractice insurance is negligible. The French government also pays two-thirds of relatively high social security taxes for doctors. In France, general practitioners are specifically mandated to be concerned with prevention, public health education, and epidemiology.

In France, unlike in the U.S., getting rich is not the principal motive for pursuing a career in medicine. (I have as much education as a typical doctor, but the most I ever earned as a public school teacher in the U.S. was less than $45,000 a year. Stupid me.)

The French health system is financed primarily by a 13.55% payroll tax on income, of which almost 95% is paid by employers. In addition, there is a 5.25% “general social contribution tax” on all forms of income that contributes to health care. This tax is reduced to 3.95% on pensions. Special taxes on alcohol and tobacco also support the health care system.

Most Americans assume that universal coverage means losing one’s choice of doctors. This is not the case in France where one can go to any doctor one chooses. A patient can even go directly to specialists without referral, although the level of government compensation is higher if one goes through a general practitioner to get a referral. Furthermore, there are no lengthy delays in getting an appointment.

Recent cost-cutting “reforms” in France now require mandatory co-pays; 1 euro ($1.42 at today’s exchange rate) for a doctor visit, .5 euro ($.71) for prescriptions, and 16-18 euros ($24) a day for hospital stays. I pay several times more than that at the VA.

According to Joseph Shapiro on NPR, “the French live longer and healthier lives... because good care starts at birth. There are months of paid job leave for mothers [and now fathers] who work. New mothers get a child allowance. There are neighborhood health clinics for new mothers and their babies, home visits from nurses, and subsidized day care.”

How did the French achieve the creation of this system? The simple answer is that they elected governments led by socialists and communists who advocated these programs.

In 1930 the CGT (Confederation Generale du Travail), the largest labor union confederation, began to press for a healthcare program for workers. The CGT was then controlled by the French Communist Party. In 1934, the Communist and Socialist Parties formed the “Popular Front” and two years later won the national elections leading to the presidency of Leon Blum, first socialist and first Jewish president of France.

The Popular Front government instituted a program of healthcare coverage similar to Medicare, but for workers, not the elderly. This system was abolished during the Nazi occupation, but the Free French in London developed plans for an expanded system in the postwar period. Those involved included many CGT leaders, principally communists.

(It is probably necessary to point out to the American reader that after its initial treasonous collaboration during the period of the Nazi/Soviet non-aggression pact, Communist Party members comprised the principal element in the French Resistance.)

In 1945, the provisional government established Securite Sociale, a program of health care and pension benefits. It was a compromise negotiated between Gaullist and Communist representatives in the new French National Assembly. The conservative Gaullists were opposed to a state-run healthcare system, while the communists favored a complete nationalization. The compromise laid the foundation for the current system. Subsequently, expansions in the system have principally occurred during Socialist Party-led governments.

In 1958, a survey of the French asked, “Should the healthy pay for the sick or should everyone get back only what they put into the system?” Eighty-six percent answered that the healthy should pay for the sick and 95% approved of the compulsory nature of health insurance.

This points to a central problem for the implementation of universal healthcare in the U.S. Americans lack social consciousness. Capitalist culture denigrates social solidarity and glorifies individualism. This, of course, favors the highly class conscious capitalists who are quite well organized and who exhibit admirable solidarity.

The “reforms” instituted by Obama represent what the healthcare industry was willing to accept in return for the mandate requiring everyone to buy their defective product. Those measures won’t budge the figures that clearly show the defects of the U.S. system where healthcare remains a commodity. In France, it is an inalienable right that no politician would dare to violate.

[David P. Hamilton has been a political activist in Austin since the late 1960s when he worked with SDS and wrote for The Rag, Austin's underground newspaper. Read more articles by David P. Hamilton on The Rag Blog.]

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Dr. Stephen R. Keister : Back from Break, Republicans Resume Assault on Poor and Infirm

The Republicans are back. Image from xrodgers / Flickr.
Renew attack on poor, elderly, infirm:
Republicans back from Easter break

By Dr. Stephen R. Keister / The Rag Blog / May 5, 2011

"Wherever there is great property, there is great inequality. For one very rich man, there must be at least five hundred poor, and the affluence of the few supposes the indigence of the many." -- Adam Smith

I pen this over the Easter Weekend, the most holy day on the Christian calendar, when devout believers retreat to consider the basic tenants of the faith, the Sermon on the Mount, and the Beatitudes.

It seems that many of the Republican legislators have lost the spirit of the occasion and more likely have attended a black mass in preparation for their return to Washington to resume their attack on the poor, the elderly, and those with little hope. And perhaps -- as part of their regressive anti-science ideology -- they will nullify the pardons of Galileo and Copernicus and perhaps initiate an assault on Pasteur's “germ theory.”

As Mark Twain, no great fan of Congress, noted, "Congressman is the trivialist distinction for a full grown man."

On April 13, the House of Representatives voted to repeal the Prevention and Public Health Fund by a vote of 236 for and 183 against. This negated legislation that over eight years would provide funds to states and communities for preventive health care programs.

The same day, voting 189 for and 234 against, the House voted to defeat a Democratic amendment to keep the health fund in operation for the benefit of senior citizens. And, on the same day the House voted 235-193 against approving a budget that would privatize Medicare and raise the Medicare eligibility age from 65 to 67 and convert Medicaid to a block grant program run by the states and permanently extend Bush era tax cuts.

That same day the House voted 241-185 to remove funding from Planned Parenthood from the fiscal 2011 budget.

This is the Republicans’ first step in Rep. Paul Ryan's plan to finally eliminate Medicare, Medicaid, and Social Security, projects started during the presidency of the “sainted” Ronald Reagan.

The demise of Social Security has temporarily been put on hold while they dismember and destroy the health entitlement programs. There are various estimates available about the potential cost to our senior citizens. The proposal to privatize Medicare would, once in effect, provide the Medicare patient with a proposed $15,000 in vouchers annually but would not address what the individual should do once the voucher runs out.

Remember that coronary bypass surgery can result in a bill of somewhere around $100,000 -- and there are available estimates (TPMDC) that it could cost $20,000 yearly to purchase private insurance! In addition, many of us forget that Medicaid not only pays for a degree of health care for those who cannot afford private insurance, but it pays for nursing home care for the elderly when their personal savings are depleted.

The alleged objective of all of this is to “balance the budget” -- while nothing is done about restoring a reasonable tax rate to the very wealthy nor significantly reducing the cost of fighting questionable foreign wars and maintaining several hundred foreign military bases, many with 18-hole golf courses.

As a matter of fact, the Republican budget would further decrease taxes for the most wealthy 1% of the population while withdrawing a great amount of help to the poor, the disabled, and the elderly.

The vote on Planned Parenthood continues an out-and-out lie that that organization is primarily an abortion provider. Nothing can be farther from the truth. This is merely a symptom of the Republicans’ bigoted attitude regarding women that dates back to the Middle Ages.

Anyone who has read Silvia Federici's Caliban and The Witch knows that in all this there is a deep-rooted feeling that the female is subservient to the male -- and the attack on Planned Parenthood attests to this inner loathing for women.

Planned Parenthood was founded to provide birth control information to women, thus helping to prevent unwanted pregnancies that at the time of the organization’s founding could have led to "back-alley" abortions. Its purpose was to prevent the birth of children that families could not afford to take care of, children who would end up living in poverty, being abused by the unwanting parents, or ending up as wards of the state.

Planned Parenthood’s services include cervical cancer screenings, HIV testing, general health care, and, on rare instances, referral for termination of pregnancy if medical indications dictate.

The nation stands on the edge of a return to medieval times, a time of the two-class society of the baron in his castle and the serfs in their hovels -- and the Republicans aspire to bring this about under the guise of national financial security. Perhaps the Republicans wish to be the Lord's tax collector, each year presenting themselves at the peon's farm, with swords drawn, to collect the baron's taxes.

This said, even we progressives are aware of the excessive cost of health care in the United States compared to that in other developed nations. We are, first off, the only nation where health care is dominated by unregulated health insurance companies, a fact that adds 30-40% to the nation’s overall health care costs.

Another problem we face is the new concept of "concierge medicine," where a physician limits his practice to several hundred patients a year, with a yearly membership fee of $1500. The concept is ideal, and takes us back to our own practices in the 1950s-60s, but we did not receive, let us say, $300,000 up-front! In those days there was no insurance and patients frequently left saying, “Doc, I will send you $10 a week."

We also have the hospital-endowed medical practices, which I alluded to in a prior article, that charge for the physician's visit and add an additional cost “for the hospital.” This, of course, does nothing to reduce health care costs.

I urge everyone to read this article on medical malpractice liability in Canada. It offers an excellent review of the often misunderstood Canadian health care system, and also shows how malpractice costs can be reduced for physicians.

Another reason that our costs are so high is the lack of primary care physicians. Let us look as how it was once was... I was a rheumatologist before I retired after 40 years of practice in 1999. When presented with a new patient with arthritis, of any of 20-30 varieties -- after an hour’s interview and examination -- I could have a correct diagnosis 90% of the time and was able to forgo a lot of expensive testing.

Our job then was to explain the condition to the patient, review treatment and its side effects, and obtain a minimum of lab work to appraise any side effects that might accompany the specific treatment to be used. From there on it was the patient and me -- united in facing the rheumatoid arthritis, lupus, psoriatic arthritis, or scleroderma – whichever might apply.

Today, the physician’s schedule is overloaded (and many now close their offices at noon Fridays, and over the weekend the answering service refers patients to the ER for intercurrent care). A frequent visit for a new patient begins with the receptionist demanding insurance cards and ID, and the completion of a three-page history form. This is followed by a 10-minute visit with a physician's assistant, a further 5-10 minutes with the doctor, and then referral for a plethora of lab studies, and very possibly one of a variety of scans that cost from $500-$1,000.

Instead of time, which if used correctly is reasonably inexpensive, we start with hundreds of dollars of testing that might well have been avoided. Then we are placed on absurdly expensive medications that cost two to three times more here in the USA than in Europe or Canada.

Of course, we must pay for the joy of seeing all of those pharmaceutical ads on TV. The United States and New Zealand are the only nations that provide their citizens with the joy of seeing all of this illuminating garbage. Further, we as patients, must indirectly pay for all of the often vulgar physicians’ ads in the yellow sections, on roadside sign boards, or in the local newspaper.

And we must carry the heavy costs of emergency room visits for ourselves, and for the multitude of those poor folks with no regular medical care who must resort to the very expensive ER care in time of need. The medical care system must pay the costs of palaces built by the for-profit nursing home industry to charge some $6,000 or more per month for our elders’ care when no other option exists.

Further, if one is sincere in adhering to the Hippocratic Oath, a physician is here to serve -- but not to belong to the extremely wealthy sector of the community. This I referred to in my last contribution to The Rag Blog. Should we ever adopt a system of universal, single payer health care we could arrive at a fair and equitable system of physician payment. Please check out the suggestions of National Nurses United.

I have been asked how, with the fear of malpractice hanging over their heads, physicians can omit doing "necessary" studies. I recall advice from an older family practitioner when I started practice in 1950 (when malpractice insurance cost $75 a year!). He advised me: "Keister, always take time with the patients, and before they leave your office, be sure all their questions and anxieties are put to rest. If you are aware that you have made an error in treatment or management, fess up and discuss the matter with your patient."

I listened, and practiced for 40 years without incident, and was amazed on occasion how forgiving folks could be. Malpractice costs, as many physicians argue, are partly caused by greedy lawyers. However, much of the cost is related to scams pulled off by the malpractice insurance companies, and by physicians who do not devote enough thought or time to patient care.

Instead of "cutting" reasonable costs, our leaders in Washington should start a government program of subsidizing the education of primary care physicians as is done in all other advanced nations. Perhaps, with an adequate supply of physicians, a reasonable reimbursement system, and a health care system akin to that in many European countries, and other nations like Japan and Korea, we can resolve this cost problem once and for all.

One final thought: Since the advent of medicine dictated by the insurance cartel in the 1990s, I have found it offensive that in their literature the physician is characterized as a "provider.” At the same time the patient is deemed a "consumer.” Dr. Paul Krugman addresses this issue in an article in The New York Times titled, “Patients Are Not Consumers."

It is perfectly clear that the insurance industry considers the Hippocratic Oath passe and believes that the profits of the free-market should reign supreme.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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David P. Hamilton : On My Retirement from Political Activism

David Hamilton at MDS anti-war vigil in Austin, December, 2008. Photo by Sally Hamilton / The Rag Blog.
On my retirement from political activism

By David P. Hamilton / The Rag Blog / March 30, 2010

Last Sunday, the “health care reform” bill passed in the House of Representatives with most Democrats voting in favor and all Republicans voting against. Did you notice that stocks in pharmaceuticals and the health insurance industries both climbed the next day?

This comprehensive health care reform is none of the above. The struggle for its passage was pure theater on several levels. Most Democrats really don't support it and most Republicans really don’t oppose it. Most Democrats would prefer a public option, Medicare being allowed to negotiate drug prices, re-importation of drugs from Canada and the like, but there aren’t enough votes independent of corporate lobbyists to pass any of that, so they opt for a charade with frills.

The Republicans know that the chief beneficiaries of this legislation are Big Pharma and the health insurance industry, but they don’t want their fingerprints on it for purely partisan political reasons. They do want another excuse to rally their legions by railing at Democrats, who in this case happen to be taking the lead as corporate lackeys.

It’s got plenty of passion, drama and irony, but it’s sound and furry signifying very little to do with better health care. The invective is primarily posturing to gain political advantage and the wealth and power associated with being the favored capitalist class toady of the moment.

Presidential candidate Barack Obama appeared before 20,000 in the rain in Austin, February 23, 2008. Photo from the Texas Observer.
Our president, who I worked hard to elect and who repeatedly called himself a “progressive” when he spoke to Austin rallies in 2008, is at least vastly exaggerating about what a great reform this is. Contrary to what you might hear, it does not significantly change the health care system in the one manner that matters most, shifting more of it into the public sector.

It does not establish health care as a right. Instead, buying private health insurance is established as a legal obligation. Meanwhile, Dennis Kucinich, after much pontification, does his usual roll over act in compliance with the party leadership.

The principal outrage is that now, thanks to Democrats, for the first time the federal government will mandate that you have to buy the products of the health insurance industry or face the wrath of the IRS. It will be illegal for you not to give 8% of your annual income to the insurance cartel in perpetuity.

In some countries, the government takes over corrupt and failing industries. In America, the corrupt and failing industrialists take over big slices of government. The Republicans are quite correct to question whether the mandate provision of the health care legislation is unconstitutional and the proto-fascist majority on the “Supreme” Court they created may rule in their favor, especially given that there seems to be very little precedent.

The overriding conclusion from all this is that our federal and state governments are almost totally in the pocket of the corporate capitalist ruling class, now more so than ever. U.S. politics has become a question about how one should relate to squabbles within the ruling class. Corporate ownership of the political system has expanded over our lifetimes and now its control is so complete that U.S. democracy is irretrievably corrupted.

It is profoundly naïve to expect the federal government to do anything truly progressive related to the country’s economic functioning within the confines of this hegemony. It is not realistic to think that you or any combination of non-ruling class individuals can have any serious impact on U.S. politics above a local level. Without access to major capital and status among the big bourgeoisie, you’re not a player.

With the recent Supreme Court decision allowing corporations to contribute unlimited amounts to political campaigns, U.S. democracy is dead as a doornail, the coffin is welded shut and buried deep. You can spend all your remaining days calling your congressional representative, demonstrating, donating to progressive candidates, and writing letters to the editor, but your efforts will have little positive effect except perhaps on yourself.

About all that could be realistically expected is to keep our intellectual tradition alive. You may counter that once we did make a significant difference. True or not, that was then and this is now.

Obama: fading hope. Photo by Steve Rhodes / Flickr.
There are some areas where there will be positive change because such changes are not contradictory to capitalist domination. Gay rights is a good example and hardly insignificant. Now that “health care reform” has passed, Obama may even take pen in hand and do what he promised to do and what he should have done already by signing an executive order ending “don’t ask, don’t tell." Thanks to the great coming out that we’ve seen over the past few decades, no attitudinal trend is more bullish than the growing acceptance of the gay/lesbian community.

Immigration reform will take place because the immigrants are coming anyway, capitalists like cheap labor, and both parties want the ever-growing Latino vote. The “drug war” will be diminished by the decriminalization of marijuana, because its continuation only fuels drug cartels, destabilizes nearby countries with piles of corpses, and deprives established capitalists the opportunity to reap profits legally.

Besides, in this brave new world, pot might fill the role of “soma." As Huxley fittingly said of soma, it has “All the advantages of Christianity and alcohol [with] none of their defects." Who cares if we live in a country where the government is a wholly owned subsidiary of the capitalist class and operates primarily in its service, at least we can get high.

In a tangentially related matter, the left in France just drubbed Sarkozy’s rightists in regional elections and then staged a nationwide strike in protest of his policies. This is occurring on the eve of my wife and I blowing years of savings by going to France for two months in celebration of my recovery from what medical authorities assured me was an incurable disease.

The question always arises when visiting France: why don’t we just stay there? It’s a question I’ve struggled with for years and the answer remains unchanged. Sally still has a rewarding career, but only here. We now have two darling grandchildren living here and our Guatemalan textile business is here and resists transplantation. In addition, there are the nearly 50 years of accumulated Austin friends. We could never be so much a part of another community.

The quandary is how to continue living in the increasingly repugnant U.S. and at the same time maintain one’s sanity and low blood pressure -- without being angry about one travesty or another on a daily basis. One element of my solution is to retire from political activism and diminish my focus on political concerns. Turn off the cable pundits. Stop reading leftist blogs (except this one!). No more demonstrations of less than 10,000. No more “organizing," my activism relegated to the occasional documentation of errant thoughts.

I used to think that political activism was the ideal existential raison d’etre. But with my growing awareness of its futility, for me if not for others, that will no longer suffice. I’m 66 and it’s time to pass the torch, which in my hands now only smolders.

I credit Barack Obama with bringing me to these conclusions. We worked hard for him. We helped lead his campaign in our suburban precinct in this southern state and he carried it by 2 to 1. We drank champagne with a house full of neighbors at his inauguration. It has been precipitously down hill ever since, illusions crashing right and left.

Number one on my list of expectations for his administration was health care reform; one that included an expanded public sector. Instead, we got an expanded private sector, with which our relationship is now obligatory. You can no longer be denied insurance because of a pre-existing condition. Instead, such individuals will be sent to high-risk pools where, between premiums and the attendant costs, “coverage” will be unaffordable for most eligible Americans.

Their version of universal health care is to universalize bad “coverage” by “mandating” people to make lifetime continuous payments to private insurance companies. Talk about your subsidized industry! This pro-capitalist, private sector fealty on Obama’s part is hardly new, his having begun his term by exceeding even Bush’s generosity to Wall Street.

And speaking of exceeding Bush, we now have more troops fighting in more (mostly Muslim) countries than we did during the Bush II administration. I naively expected some subtle diminution of American militarism. No such luck.

But how about his historic break with Israel’s Likud? Talk's cheap and Obama is mainly talk.

The fall of Obama has been the icing on the cake.

Some of us had lunch with Bill Ayers last week and, unlike Obama, we are all proud to call him our friend. He continues to have a thoughtful analysis of the historical situation. He observed that promising political activism was taking place among the rubble of Detroit. People are growing -- vegetables and community. They don’t focus on pleading for their bankrupt government to take action. They take action among themselves by building local collectives in food, transportation, and security.

However much potential this approach might have to prolong our survival, it also has its drawbacks. In Guatemala, when the police take a bribe and let some career criminal out of jail, the locals have been known to hang and/or incinerate the alleged miscreant in front of the police station along with a few police cars. So much for due process. But, it is only on these most basic levels that one can maintain a realistic political identity.

Because my incurable disease disappeared as mysteriously as it appeared and my VA doctor and debate partner says it might return, my motto has become “do it now.” It’s time for me to get to work on that “bucket list” with a vengeance. Political activism is notable in its absence. It does not remain self-actualizing enough and I’m a privileged white guy with pensions, socialist health care, and choices.

So I’m choosing grandchildren and gardening, Antigua, Guatemala and Lake Atitlán, classic literature and friends, Sally and Paris, and compliance with the dictates of my personal trainer, Birdie Poundpooch; indulgences that will have to suffice during my remaining years of kicking out the jams.

[David P. Hamilton has been a political activist in Austin since the early Seventies when he worked with SDS and wrote for The Rag, Austin's underground newspaper.]

Above, Sally and David Hamilton at "Bring out the Dogs" demonstration against U.S. Sen. John (Corn Dawg) Cornyn, Austin, February 15, 2008. Photo by Carlos Lowry / The Rag Blog. Below, Chicago Three (L-R): David Hamilton and The Rag Blog's Thorne Dreyer and Jim Retherford at the Chicago Art Institute, November 11, 2007, during MDS Convergence.
Also see "Alice Embree on Political Activism: Carry it On" by Alice Embree / The Rag Blog / April 6, 2010

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Health Care Reform : The End of the Beginning

Photo from Circlemp / treehugger.
The end of the beginning:
How 'historic' is this reform?

By Dr. Stephen R. Keister / The Rag Blog / March 27, 2010

Health care reform was finally passed by the House and Senate and many consider it an historic occasion. But let’s look at that "historic occasion" and view the legislation objectively. This is primarily health insurance reform and does not produce a sensible program of health care for all citizens on the level to those found in most countries of the civilized world.

We can address that a bit later; however, I am alarmed at the spin-off of a very disruptive right-wing populist movement in the United States, which has emerged out of reaction to the fight for health care reform.

Many of my progressive friends consider this to be a passing phenomenon; however, let us pause for a moment and remember the 9th-10th of November 1938 in Berlin or the 17th Century witch trials in Salem, Massachusetts. Perhaps at my advanced age, with lots of unpleasant memories, I am unduly alarmed; however, more than one social scientist feels that the tea bag movement, which is surreptitiously financed by extremely wealthy members of the financial elite, is of much more concern than many of my liberal friends believe.

I refer all to an article by Chip Berlet, of Political Research Associates, entitled "Right wing 'populist moment' could get worse. Message to the Left: stop whining and organize!"

I recall the writings of Eric Hoffer when he noted:

The impression that mass movements, and revolutions in particular, are born of the resolve of the masses to overthrow a corrupt and oppressive tyranny and win for themselves freedom of action, speech and conscience has its origin in the din of words let loose by the intellectual originators of the movement in their skirmishes with the prevailing order. The fact that mass movements as they arise often less individual freedom than the order they supplant, is usually ascribed to the trickery of a power-hungry clique that kidnaps the movement at a critical stage and cheats the masses of the freedom about to dawn.

Coverage on MSNBC last evening was largely dedicated to the proliferation of extreme threats of violence to members of Congress -- and their spouses and children -- who voted for the health care legislation. Not only are the threats based on misinformation, deceit, and out and out lies, but the foul language being used suggests serious paranoia. It has been estimated that 30% of the population is involved in the right-wing movements; but, considering that the population of the United States is something like 300 million, that’s a lot of crazies.

According to the Erie Times News, my local congressperson, Democrat Kathy Dahlkemper, is receiving extremely frightening messages directed at her and her family. This is a locale where folks line up at the Wal-Mart some mornings waiting for the doors to open so they can buy more ammunition, and where a local gun dealer has problems maintaining his stock in certain types of weapons.

I have disagreements with some of Ms. Dahlkemper's votes; however, she has given the citizens of her district much more input into matters of national importance than her Republican predecessor did, and she seems much more enlightened in matters of the public good than her likely Republican challengers. In a civilized nation she is deserving of our concern and protection.

I hope that the news media will rise to the occasion and present the news in a fair and honest fashion during the period leading up the elections this coming Autumn, and not give in to the influence of the waves of corporate baksheesh. Meanwhile, it is the responsibility of the Democrats in power to take a cue from the Republican voice machine and do a much better job of getting out the truth to the 70% of the American people who may pay attention to morality and reason

I have had the privilege of following the progress of health care reform on the pages of The Rag Blog for over a year now. This has been an invaluable experience in my final years, and I will forever be grateful to the editor for his forbearance and patience. I would anticipate that my participation will be at irregular intervals in the future, but before I close the current exposition, a few observations:

The current insurance reform legislation in no way resembles a government take over of health care. In fact, as E.J. Dionne of The Washington Post and Commonweal points out, we have a bill that the Republicans could well have passed. It is very similar to the health care legislation that was passed in Massachusetts when Mitt Romney was governor.

There is absolutely nothing in the legislation that resembles a single payer system or even a public option, Medicare for All.

There is nothing in the legislation that approximates the excellent German health system that is, in fact, run by private insurance companies with government oversight of costs and services. Nor is it anything like the Canadian system -- for which its driving force, Tommy Douglas, was voted by the people of Canada “the greatest Canadian of all time."

I notice that health insurance stocks are doing quite well on Wall Street! Unfortunately, in the new legislation there is no effort to control insurance prices or to eliminate the health insurance industry’s anti-trust exemption. I am concerned about the mandatory inclusion of citizens in the plan under threat of fine, and -- unlike the Swiss or German plans -- it doesn’t at the same time set standards to ensure that the insurance companies provide adequate coverage, and to prevent price-gouging.

I would have wished for less equivocal language regarding the rights of the states to establish honest, effective plans -- like that currently proposed in the Commonwealth of Pennsylvania. I would have hoped for the inclusion of community health clinics, as proposed by Sen Bernie Sanders, to be established on the European model. And that the establishment of medical dispensaries be expedited -- to address the crowding of emergency rooms and thus reduce the overall cost of medical care, while at the same time providing a reasonable option for follow-up care. These facilities are absolutely necessary considering the fact that the fees paid under Medicaid make it economically impossible for a physician to take many of these folks as ongoing patients and still be able to cover office overhead.

There was some encouraging language in the legislation regarding subsidies for medical education that should result in more physicians for underserved areas; however, this requires much more fine tuning. As has been repeatedly pointed out by the American College of Physicians, much more attention must be directed at the paucity of primary care physicians -- general internists, pediatricians, and family physicians -- throughout the nation.

This problem is largely due to the inequitable fee schedules for these fields when compared with those in the surgical subspecialists, who are very well rewarded despite spending no more time in training than the internist or pediatrician. This has become a societal problem, largely driven by misinformation on TV that creates the myth that it is only those in the highly publicized specialties who are really in the “life saving" business.

We should express thanks for the collective courage of the orders of Sisters throughout the nation who came out in support of universal health care, especially in the face of pressure from their ecclesiastical “superiors.” We must remember the dedication of the nuns in the areas of healing dating back to the great medieval hospitals they founded during the Middle Ages, including the Hotel-Dieu in Lyons in 542; the Santa Maria della Scala in Siena in 898; St. Bartholomew's in London in 1123; the Ospedale di Santa Mana degli Innocenti in Florence in 1421; and the Hotel-Dieu in Beaune in 1452.

These Sisters cared for the ill, the infirm, the dying, and the mentally ill without regard to pay or their own well-being as they administered to the dying during the plague. At the same time, the Papacy in Rome, influenced by the Borgia family, was pursuing other less spiritual interests!

In any event we have in hand a bill that according to the AP:

1. Within 90 days will provide access to high risk pools for people with no insurance because of preexisting conditions. (The politicians like to compare these pools to those provided for the members of Congress, neglecting to say that 80% of their premiums are paid by the government.)


2. Six months after enactment will bar insurers from denying coverage to children with preexisting conditions; will bar insurers from imposing lifetime caps on coverage; will require insurers to allow children to stay on their parents policies until they turn age 26.


3. In 2013 will increase the Medicare payroll tax and expand it to cover dividend interest and other unearned income for singles earning more than $200,000 or joint filers making more than $250,000.


4. In 2014 will provide subsidies for families earning up to 400 percent of the poverty level, currently about $88.000 a year, to purchase health insurance; will require most employers to provide coverage or face penalties; will require most people to obtain coverage or face penalties. (Nowhere, it seems, does the legislation provide assurance that the insurance companies will not triple the rates for those with preexisting conditions.)

We must congratulate the Congress, in a supplement to the health care legislation, for providing student loans directly to the students, and preventing the banking industry from gouging the program as has been the practice in years past.

[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform.]

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