Notes from Justice in Health Care Forum in Rochester, NY 11-15-09

Notes from Forum on Justice in Health Care Held in Rochester on November 15, 2009

Panel: Jeff Cohen, Moderator; Congressman Eric Massa; Donna Smith of California Nurses Association; Political Strategist Steve Cobble; PNHP Member and working Physician Emily Queenan, Held in Dryden Theater of the George Eastman House Museum

A crowd of perhaps 200-250 people turned out. I did not get a head county. It was a very well organized event by the Genesee Valley Progressive Democrats, with a good supplemental packet ready for all attending. Jeff Cohen started off by reminding everyone that the recent House Health Care bill was not only written for the private health insurance industry, but was actually written by them. He pointed out that Max Baucus’ Chief Counsel for health care legislation is former Well Point V.P. of Public Policy Liz Fowler. He pointed out that Democrat Senator Evan Bayh’s wife sits on the Well Point Board. Given this kind of influence on our legislative process, Cohen wondered if “Democracy was still functional.” In regard to the House Health Care Bill he said it “started going wrong when liberal net roots groups started with a robust public option as their chief demand” instead of single payer. He then introduced New York 29^th Congressional District Representative Eric Massa, stating that Massa was the most courageous freshman Congressman since 1846, when Illinois Freshman Congressman Abraham Lincoln opposed the Mexican War. After a week of being unfairly chastised by self described Progressive Democrat Party hacks, Congressman Massa was greeted with the standing ovation he deserves.

 

Massa stated that he spent 14 hours on the House floor on November 7, watching as the drive grew to “pass anything.” He said he knew back when Obama took single payer off from the table, the fight was going to be to get a bill that would do the most good for the most people. He said: “This bill does tremendous good for a few health insurance industry CEOs.” He stated that the bill: “Intensifies what is wrong with the health care system—it strengthens the role of private insurance and heightens the role of employers in providing health care.” He noted that the bill contains “astronomical” cuts to Medicare and Medicaid, in order to put funds into the private insurers. He also noted that we are about to spend twice as much money in Afganistan in the next year as we are debating spending on health care over the next ten (for those who do not know, Massa, a retired Naval Commander, has also taken a lead role in opposing “Obama’s war” in the Congress).

 

Following Massa, Donna Smith of the California Nurses Association spoke. Fans of Michael Moore might remember her from Sicko. She is one of the most articulate bloggers on the web on behalf of single payer. She stated that she is still optimistic about the movement, based on her activism on the ground. She said she has been to 43 states now, and that “people get it.” She said we just have to keep building the pressure on the Congress to force them to follow along. She stated that this bill is terrible—said it was like “giving a cancer victim an aspirin.” She said it won’t guarantee people get the care they need and won’t guarantee that people don’t end up bankrupt from medical bills, so it is a failure. She made some very smart observations about how disingenuous so much of the debate is, how they tell you “You’ll be able to keep what you have” but that “14,000 Americans a day lose their jobs, and they can’t keep what they’ve got.” She pointed out that almost no American workers actually have any meaningful say over “what they’ve got” for health care. Their employers negotiate the policies, their health insurance companies negotiate rates and establish which doctors “are in the network.” She pointed out that keeping health care tied to employment by definition hurts women most, because as a group women are statistically employed at lower wages, at lower hours. She pointed out that a woman whose husband dies doesn’t get to “keep what she has.” She also spoke about the age-rated provisions in the house bill, which will allow insurance companies to charge up to 5 times as much based on age—totally destroying the concept of “affordability.” She concluded her introductory remarks by stating that activists need to support Bernie Sander’s S703 bill, the Senate version of single payer, and must keep educating: “We’re not done.”

 

Next up was political strategist Steve Cobble. He frankly gave the Democrats credit for being stupid where I would call them corrupt. He pointed out that voters are not “conservative” on heath care—that it is the beltway pundits and media types who are conservative on health care. He said that the Democrats should have made the Republicans vote against “Medicare for All” not a confusing “public option” contained in a 1900 page bill. He said “people know what Medicare is and they like it.”

 

Following Cobble was PNHP member Emily Queenan. She talked anecdotally about how private insurance undermines the entire system. She said that “everyday the heath insurance industry invades the space where I am trying to heal my patients.” She put a lot of emphasis on the fact that making people buy insurance won’t in any meaningful way guarantee them care, based on her experience working with underinsured patients—most people will be underinsured with the plans that they will be forced to buy.

 

The rest of the time was spent on audience questions. The first question was the obligatory “But don’t we have to start somewhere?” Massa stated that he would be happy to support a health care bill that did not go all the way towards establishing single payer, but only if it were a “step in the right direction” that would actually improve the health care situation for working and middle class Americans. He pointed out that this bill will cut 500 Billion from Medicare, which will force people in the future to buy supplemental plans from private insurers, when more and more doctors start refusing to take Medicare because of the lowered reimbursement rates—one more way in which the bill will benefit the insurance industry while hurting regular people. Donna Smith pointed out that while the bill expands eligibility for Medicaid, it cuts Medicaid funding, which will end up being a huge burden on already strapped counties and states. She also observed that by forcing so many more people to become customers of the health insurance industry, and by giving them so much more money from citizens and tax payers, we are ultimately strengthening the people who are causing all the problems. Cobble repeated Rahm Emanuels cynical comment that “the only non-negotiable part of the bill is whether it passes” as a sign of how little some in the Democrat party actually care about passing reform that will actually help people.

 

In response to another question on what the Medicaid/Medicare cuts will look like, Massa repeated a story about how Obama came to see him shortly after he had become a Congressman and told him “You will not raise taxes on people earning less than $250,000 a year!” But this bill will very likely force property taxes up on Americans across the country, regardless of their income, due to the expanded eligibility for Medicaid and corresponding cut in funding.

 

Donna Smith raised the issue of the much vaunted “pre-existing condition reform.” She pointed out what many have been saying—that forcing people to buy private insurance and forcing private insurers to sell it to people with pre-existing conditions is really a meaningless reform because the insurance industries will still be able to deny treatments.

 

Somebody wanted to know why the bill will take 4-5 years to phase in. Massa stated that “no living person can intelligently answer that question.” Somebody wanted to know why the AARP would support a bill that cuts funding for Medicare. Smith pointed out that the AARP has a strong relationship with United Healthcare and that they sell seniors supplemental insurance policies—so they will make a lot of money off from the Medicare cuts.

 

There was a question about Torte Reform. Massa pointed out that states with medical malpractice caps have seen no reduction in medical malpractice premiums. He stated that malpractice lawsuits mostly drive up rates due to the amount of defensive medicine they cause—excessive tests that probably might not be needed. He advocated for national standards of care, which would establish a framework to measure malpractice against. Dr. Queenan stated that financing for doctors must be altered so that doctors can spend enough time with patients so that they can actually determine what might be going on without having to rely on a battery of extensive tests.

 

The panel concluded with a discussion of what activists can do in the weeks ahead. Cobble said that we need to be calling the Senate to make sure Bernie Sanders can get his single payer for the states amendment into the Senate bill. He said to defend Massa and Kucinich on the blogs against the so-called progressives who think “anything is better than nothing.” He said in New York we need to seriously talk about passing it on the state level and inject it into the Governor’s race. Smith said to contact Schumer and Gillibrand and demand they support the Sanders amendment. She said get on the blogs and keep talking up single payer in local communities. She said we need to make single payer a “centrist issue.”

 

Massa strongly urged people to write letters for single payer to newspapers throughout the state and in his district (newslink.org will give you the homepage for most newspapers in New York State, and the rest of the country, too). He said the letters to the editors really have a strong impact on shaping public opinion. He really emphasized the fact that so-called progressives really haven’t been as vocal and public in supporting single-payer as the right-wing has been in shouting down “socialism.”

 

Massa finished his remarks with a very chilling story about a vocal right-winger in his district, who routinely calls his office and attacks him and his staff. He said the man called after the health care vote to congratulate him on being independent in his vote on the bill. He then started to tell the staffer in Massa’s office about how his daughter had recently been diagnosed with cancer, and does not have any insurance. “But I still don’t want Massa to vote for socialized medicine,” he said. The staffer asked “You mean that even though your daughter is sick and shut out of the system, you don’t want the system reformed?” The man replied that he would rather have his daughter “die an American than live as a socialist.”

The Health Care Betrayal II

The Game They Play in that Imperial City: Health Care Reform as Political Football

A year ago Barak Obama was the freshly elected 44^th President of these United States, swept into power by a wave of unprecedented popular enthusiasm. Our nation was worn down by two long, seemingly endless wars, still recoiling in shock from the financial collapse of October, but for so many Americans the election of Obama promised a new hope, breaking like sunrise across a dark horizon. A responsible new post-partisan future beckoned at last, when pragmatic approaches to the desperate problems facing us would finally replace the stupid ideological posturing that had been dragging us down for so long.

Alas, that is a future for which we shall continue to wait. The Health Care Bill passed in the House on November 8, 2009 is simply the most recent and graphic example yet that nothing in Washington has changed. Both political parties continue to play their cynical, orchestrated games, all of it so much cover for the continuing transfer of wealth and power into the grasping hands of an ever smaller economic elite. And the most tragic thing of all is that far too many of our citizens are still anxious as ever to herd themselves into competing flocks of ideological sheep. And Barak Obama, who so many looked to with hope, as a “transforming” president, has merely revealed himself to be a particularly adept and cynical politician, preternaturally skilled at the same old game.

On the right we see the Congressional Republicans and their followers bah-bah-bahing away about the “imminent government take over” of the health care industry. This is idiot talk, nothing less. The bill passed by the Congress last week is in no way a “government take over.” The puny pubic option it contains might, at best, cover as many as six million Americans by 2019—those are the Congressional Budget Office’s numbers. That will be less than 2% of the population. The insurance industry has made an art out of separating out the sickest members of our society and mostly only offering coverage to the healthy, so we can be certain that over the next decade they will make sure that only the sickest, least desirable patients get shuffled into the “public option,” guaranteeing that its premiums for the public option will be higher than for private plans (which will continue to rise steeply). The “public option” as written into the current house bill will not remotely compete with the private sector, and will likely be managed by private insurance firms, as well.

I have heard more than a few health care activists wonder aloud in the past week “Why are the Republicans even opposing this bill—it is almost exactly what they want.” But the reason they are opposing it is simple: That is the part they play in these charades. They stir up their base of near illiterate bigots by waving around the red meat of socialism, illegal aliens and abortion. They stamp their feet and carry on about the unfairness of getting anything less than 100% of what they want. And even when they get 100% of what they want, they still devote great energy to complaining about the fact that anybody even disagreed with them.

The running assumption from the start of the health care debate, echoed and magnified by the hair-dos on the cable “news” networks, has been that Republican support was absolutely crucial for any bill that ended up getting passed. This was somehow supposed to equate with “post-partisanship.” But post-partisanship and bi-partisanship are not even remotely the same thing. Post-partisanship means addressing large scale societal problem in the most economically responsible manner. Bi-partisanship means getting all the various elected crooks in Washington to go along with a particular bill. Post-partisanship would mean true, pragmatic solutions. Bi-partisanship, given that the various crooks in Washington only really agree that they want to keep getting corporate campaign dollars, can only means passing bills that will benefit the corporations.

Post-partisan policies are instituted by vigorously debating their merits in an open forum. Bi-partisan policies are reached through cynical backroom deals. The health care bill that passed last week was a bi-partisan bill, regardless of how many Republicans actually voted for it.

 

From a pragmatic standpoint, our current health care crisis has only one true solution: A single payer system. The other democratic industrial nations of the world all figured this out a long time ago and they all spend far less money on health care and enjoy far better results—their people live longer, their newborn die less frequently, their citizens are healthier. Forget whatever anecdotal horror stories you may have heard about “rationing” in the “socialist countries of Europe”—the statistically verifiable truth is that they all get a lot more for a lot less than our so-called fiscally conservative nation.

The liberal argument for single payer is generally presented in moral/ethical terms: “Health care is a right” or “In the richest nation in history, 45,000 people a year should not die because they can’t afford to see a doctor.” I appreciate the sentiment, but the best arguments for single payer are fiscally conservative. It is flat-out stupid for the U.S. to spend twice as much per capita as other nations in order to get much less in return. The Federal Government already spends 60% of the dollars that go for health care–more money per capita on health care than any other nation in the world spends total, except for Switzerland, Luxemburg and Norway. And then citizens and employers chip in another 40%. All so we can trail the rest of the first world in quality of care. It is fiscal irresponsibility taken to a dizzying height.

The effects of letting corporate privateers hold our health care system hostage can be seen across the economy. Rising premiums have been the leading cause of stagnating wages, which directly limits consumer spending, the engine of our economic system. Rising health care premiums have bloated city, county and state budgets across the nation. The quickest way to provide property tax relief from coast to coast would be to adopt a single payer health care system. Forty percent of auto insurance premiums goes to the medical liability portion of the policy.

But by extorting twice as much per capita out of the American people, a small percentage of health care industry CEOs are able to earn very lucrative incomes—in some cases, the salaries and bonuses in this field run into the hundreds of millions of dollars per year for single individuals. And on Wall Street, fortunes are made directly off from the misery that our for-profit health care system creates. And Wall Street runs Washington. Barak Obama and the Democrats work for them just as surely as the Republicans do. And so we did not get pragmatic reform that will save our economy hundreds of billions of dollars every year, that will guarantee health care for everybody. Instead we got a bill that will enslave American workers to the health care corporations—force them to buy a product that is ridiculously overpriced as compared to the world market, that has a proven record of poor performance. And the whole crooked deal will be subsidized by a potentially endless supply of tax dollars.

 

Of course, the fix has been in from the beginning of this whole debate. The first thing Barak Obama did was announce that “single payer is not on the table.” This despite the fact that Barak Obama built his early political career on supporting single payer, and despite the fact that his family doctor for over 20 years is a member of Physicians for a National Health Plan and a high profile, outspoken advocate of the single payer system. Despite the fact that 60% of the population already supports a single payer system—a number that continues to rise, and would rise rapidly if single payer were given a fair hearing by the corporate-owned Congress and media. Despite the fact that single payer has a proven track record of working far better than our for profit system in every other first world nation.

Despite this betrayal from Obama and the house Democrats, single payer forced its way back onto the table, throughout the debate, thanks to millions of single payer activists across the country who have been tireless in their lobbying and public education on the matter. Starting from a position of complete marginalization, we managed to get the “Kucinich amendment” attached to the bill, which would have given individual states the right to institute their own single payer systems, using the Federal funds that the bill would allocate.

A great deal was made in the media about the 2000 right-wingers who rallied outside of the Congress on November 7^th, but they totally ignored it when over 3000 single payer activists descended on the House to lobby last July 30^th. The next day Pelosi agreed that, prior to voting on a final bill, she would allow an amendment presented by Anthony Weiner, which would substitute the language of H.R. 676—the single payer bill—for the language in the House bill and allow it to be brought before the House for a straight up or down vote.

But more Democrat betrayal was on the way. In the days before the final vote, Pelosi yanked the Kucinich amendment. Her justification was that, if she allowed the Kucinich amendment, she might also have to allow amendments restricting abortion rights. The next day she added the anti-abortion Stupak amendment. Of course, the Stupak amendment fits very comfortably within the framework of the political football game that the Democrats and Republicans play. It is a single, diversionary issue that can be thrown out to distract single-minded, issue driven activists within the greater progressive movement.

Then, the very morning that the Weiner amendment was scheduled to come up for a vote, it was pulled back. This has been a great source of frustration for single payer activists. While we did not actually expect to win the day, the vote would have given us a very valuable, real-time assessment on how to proceed. We would have seen which legislatures supported it and which ones needed to be worked on. It would have given single payer activists across the country a position from which to strategize, from which to pressure Democrat representatives and possibly even vote them out in primaries. A lot of Democrat legislatures have told activists repeatedly that they know single payer is the best system, but that they can’t support it because it isn’t up for consideration. The Weiner amendment would have put it up for consideration—it would have been put up or shut up time for dozens, if not hundreds, of Democrat house members who have been balancing a top the fence throughout this debate. Ultimately, that was a corner the cowardly Democrat party was not willing to be backed into.

And so we got what we got—a corporate give away bill of unprecedented magnitude. The bill entrenches the predatory health insurance corporations more firmly than ever. It cuts reimbursement rates for Medicare and Medicaid, which will guarantee an even greater loss of medical services for low-income rural and urban areas. Many of the more Conservative Democrats from rural districts, such as Michael Arcuri from New York’s 24^th, have held this issue up throughout the debate as a primary concern, and it was a very valid and principled objection. But when the time came, many of them, like Arcuri, fell into lockstep with the corporate party bosses.

Much has been made of the fact that this new bill will prevent insurance companies from denying coverage for pre-existing conditions, but you don’t need a law degree to realize that this is much different than guaranteeing that the insurance corporations will have to pay for necessary treatment for pre-existing conditions. Nowhere in the 1900 page bill does it say “Health Insurance Corporations will be forced to pay for all medical treatments prescribed by authorized medical professionals” and given the lack of such straight forward language, you can be sure that there is a loophole in there somewhere that will be big enough to throw tens of thousands of corpses into annually.

The most depressing aspect of the aftermath has been the sight of so many loyal Democrat party sheep, falling all over themselves to bah-bah away with approval and gratitude. I have received at least half a dozen emails in the past week from so-called “progressive” organizations, urging me to thank the Democrats for instituting this perverse new form of “Taxation without Representation.”

This celebratory mood is the result of ignorance mixed with blind faith. Most of the Democrat party loyalists have not bothered to understand the health care system and the reform debate well enough to understand that the mere presence of the words “public option” in the bill is not enough to guarantee true, meaningful reform. Just as the sheep in the Republican party herd gnash and cry hysterically over the mere existence of the phrase “public option,” the Democrat sheep have been taught to accept that the mere existence of the phrase means that they have won. Then, Democrat-insider groups like Moveon.org send them emails telling them that they have won, and they are sure it must be true. If the Democrats are telling them that this bill will fix the system, who cares if they can’t point to anything specific in the bill that shows how. What matters is that the leaders are telling them that they won.

And for many of the Democrat sheep, the fact that their enemies on the right are currently so apoplectic “proves” that their team must have won. Indeed, for these political football fans, any bill that could so upset the other side is worth supporting as a matter of course. Other Democrat lackeys do realize that the bill is abysmal, but just can’t resist celebrating, anyway. “It’s a first step,” they assert, as if more firmly entrenching the corporate privateers is a good first step for removing them, as if embracing a lie could ever be a “good first step” for reaching the truth.

But probably the most idiotic statement of all that I have heard from the Democrat party loyalists is “Well, we have to do something!” From this line of reasoning, since the corporate hacks in the Democrat party are bought-off by the health care industry and unwilling to stand up to it, we much then accept whatever they are willing to give us and be thankful for it. As if that were any way that citizens of a nation that purports to have a government “by, for and of the People” should ever act.

The Health Care Betrayal

1776 Again: The Return of Taxation without Representation and the Betrayal of the Democrat Party

45,000 United States citizens die every year because they lack access to health care. That’s the number reached by a team of Harvard Medical School researchers, published in the peer-reviewed American Journal of Public Health on September 28, 2009.  45,000 people a year equals over 120 people every day—one every 12 minutes. Or consider the number this way: It is 15 times the body count in New York City on September 11, 2001.

Nothing remotely like this occurs in any other advanced industrial nation on the planet. In every other first world country, citizens take cradle to grave health care for granted. The citizens in all those other countries enjoy longer lives and lower rates of infant mortality. They average more doctors visits per year than we do and have much lower rates of chronic disease. And those other nations all spend far less money on health care. The United States spends nearly twice as much per capita on health care as other nations. Every other advanced nation on the planet spends a lot less money to get a lot better care, and the reason is simple: They all have some variety of a nationally administered, single payer system.

The reason 45,000 of our fellow citizens die each year is simple, too. Instead of treating access to health care as a basic element of necessary infrastructure in a functioning democracy, we have instead decided to let it become a for-profit commodity, administered by privately owned and traded health insurance corporations. So we spend far more money than all the other advanced nations of the earth, just so that a small cadre of CEOs can earn millions, or tens of millions, or even hundreds of millions, of dollars each year in salary and bonuses. And we pay all that extra money for extra administrative costs—the number of doctors has increased less than 200% in the past 30 years while the number of “health care administers” has increased 3000%; the average doctor’s office spends $70,000 a year on staff just to process all the paperwork created by the insurance company bureaucracy. We pay all that extra money every year, because, unlike all the other nations, ours declines to negotiate drug prices with the pharmaceutical companies.

And probably most important of all, we pay all that extra money so that the health care industry can afford to “lobby” (a better word would be “bribe”) our elected officials in Washington, to make sure no threat to their deadly wealth machine is ever allowed to emerge. During the 2008 election cycle they contributed more money than any other industry to national candidates. During the health care debates of this past summer and fall, the health insurance industry spent $2.4 million a day on lobbying in Washington.

As they watch Nancy Pelosi and her Democrats celebrate their “historic victory” today, the death merchants in the health insurance industry must certainly consider all that as money well spent. Because the bill that the Democrats in the House of Representatives decided to stake their party’s future upon yesterday will do pretty much nothing to solve this nation’s catastrophic health care crisis. It will merely enrich and entrench the very same health insurance industry that is responsible for all the misery.

The primary problem with our nation’s health care system is the reliance on over-priced, defective health insurance policies issued by private insurers. Instead of following the successful example of the rest of the first world and replacing this defective product with a cheaper, more efficient national plan, the Democrats courageous and brilliant response has instead been to pass a law making it mandatory for Americans to purchase these very same over-priced, defective products.

The Congressional Democrats and their apologists are hailing the “affordability” of their bill. According to this bill, a family that earns around $32,000 would “only” have to pay $1,300 a year for their plan and “only” up to $2000 in out of pocket costs. A family in the median household income range of $55,000 would “only” be expected to pay $4,300, plus the $2000 out of pocket expenses. It is quite interesting to see what the members of the House, over 260 of them millionaires, all of them earning nearly $160,000 a year, consider affordable. And those “affordable” numbers are all considerably higher in the Senate version of the bill, which is waiting in the wings. The difference between the $1,300 or $4,300, or whatever number our elected officials decide is appropriate for us to pay, and the $13,000 that an average family policy costs will be covered by “subsidies”—i.e., tax payer money going directly to the private insurance industry.

The Democrats are of course making the most noise today over the fact that this bill will force insurance corporations to “cover” pre-existing conditions. Given the slippery nature of legislative language, my first thought is to wonder “does selling coverage to people with pre-existing conditions actually mean the same thing as paying for their treatment?” I do not think I am being excessively cynical to doubt that the studied absence of the words: The insurance companies will be forced to pay for all physician prescribed treatments means that this bill retains a loop hole big enough to throw tens of thousands more dead bodies into each year.

And what of the much debated “public option”—that crucial element that the Progressive Caucus threatened to rebel over? Oh, there’s a public option all right. According to Congressional Budget Office, it might cover as much as 2% of the population by 2019. So much for giving the health insurance industry competition and holding them accountable.

The only thing truly historic about this bill is that, for the first time in our nation’s history, our government legislated the mandatory purchase of a private product as a condition for simply EXISTING. Whether you want to or not, fellow Americans, you are now forced to pay a percentage of your own personal wealth to a private corporation, an institution over which you have no democratic control and no recourse for petition. This is “taxation without representation” in every sense of the phrase. As a former soldier writing three days before Veteran’s day, I feel duty-bound to note: The founding generation of our nation went to war over the likes of this.

 

A Strategy Note for Single Payer Activists: Now is the Time to Take Control of the Language!

The momentum in favor of the “public option” has probably already achieved a critical mass—recent polls have 80% of physicians in favor, 65-70% of the general public. And these numbers have been on a steady upward trend, so we should expect to see them climb higher in the weeks and months ahead. Despite the blatant attempts of the Democrat party leadership and the corporate news media, the ranks of the single payer activists have continued to swell. Everyday, all over the country, we are reaching a lot of people and converting them over to our side. It is like we are a civic version of the white blood cell, multiplying in the body politic to drive out the virus of the corporate privateers. Every day, tens of thousands more Americans are realizing that a profit-driven health care delivery system ultimately endangers the health and financial well being of the entire society, for the benefit of a very small economic elite.

Although they embarrassingly trail behind public opinion, even the elected Democrats in Washington seem to realize that they will have to pass health care reform with at least the words “public option” written into the bill. A battle has been won and our side has seized a better tactical position from which to fight on.

Now begins the battle over just what, exactly, the bill will say. And this is a terrain where our enemies are well prepared to fight. The health insurance industry has 2700 full-time lobbyists in Washington D.C., and their dirty finger prints are smudged all over every single bit of health care legislation that has appeared to date.

For an example of what I am talking about I will turn to America’s Affordable Health Choices Act Implementation Timeline—a summary of H.R. 3200, the Democrat sponsored House Bill that stalled out on the floor in early August and which will likely reappear in some altered form for vote at some time in the near future. This was a document prepared by the Committees on Ways and Means, Energy and Commerce, and Education and Labor and was released on July 14, 2009. It is what the National Democrat Party leadership would have given our nation in the way of health care reform, had they gotten their way last summer session. One needs to look no further than the first sentence of this document to find a loophole big enough for an insurance-industry owned Mack truck. The very first claim the document makes is that America’s Affordable Health Choices Act: “Ends Health Insurance Rescissions: Prohibits abusive practices by health insurance companies rescinding existing health insurance policies as a way of avoiding covering the costs of enrollees’ health needs.”

Here is a rule of thumb when looking at any document prepared by lawyers: Be very wary of all modifying words and clauses. In other words, if you see an adjective or adverb, ask yourself:  “Why?”

In the sentence quoted above, why include the word “abusive?”

Why include the very clumsy phrase “as a way of avoiding covering the costs of enrollees’ health needs?”

Why not simply write “Prohibits health insurance companies from rescinding existing health insurance policies” and leave it at that?

You do not need to have graduated first in your class at Harvard Law to be able to look at a sentence like “Prohibits abusive practices by health insurance companies rescinding health insurance policies as a way of avoiding covering the costs of enrollees’ health needs” and realize that this will give the health insurance corporations all the legal wiggle room they need to continue rescinding policies, justifying that they have not done it in an “abusive” manner, or for the purpose of “avoiding covering the costs of enrollees’ health needs.”

Instead of a 1000 page long bill full of poorly written sentences and legal loopholes designed to protect health insurance industry profits, we need to be pushing hard on our representatives to write a straight forward piece of legislation which will establish a Medicare buy-in system as the public option. And it must be open to any United States citizen who wishes to participate.

Right now the Democrats are brandishing about the words “public option,” with no clear statement of what they really mean by it. Now is the time for us as activists to make sure they understand exactly what we, the members of the public, expect from a public option. We must seize the term and use it as our own weapon to drive the greed from our health care system.

What the Public Option Must Look Like

Strategy Note for Single Payer Activists: Make Sure “the Public Option” does not become the Insurance Industry’s Flanking Maneuver!

 

It has now become clear to a strong majority of American voters that meaningful healthcare reform will not happen unless the greed-driven health insurance corporations are forced to compete against a not-for-profit, publically administered plan. A New York Times poll released on September 25^th had 65% favoring a “public option” vrs. 26% against. Another recent poll puts support for public option at 77% (SurveyUSA, June 2009). Health care reform activists are achieving these results influencing voter opinion in spite of the way the mainstream media spent the summer inflating the phony populist right-wing backlash of the town-hall know-nothings. The reason we are achieving these results is simple: The health care crisis is too big to ignore or gloss over. Millions of Americans live with the results every day and they know that the profit hungry jackals in the insurance industry are to blame.

The Democratic Party, too, is learning that they face an uprising among the party rank and file. Support for a single payer plan continues to grow. In the meantime, the house Democrats realize they will not be able to face their constituents if they fail in delivering a “strong public plan.”

We have won some valuable ground in this battle, but victory still hangs in the balance. As activists we have to keep engaged on the ground. There are 2,700 health insurance lobbyists working full time in Washington D.C., and if they can’t outright defeat a “public option,” you can be certain that they will work day and night trying to make sure that legislation gets written that will protect their bloody-money profits.

A strong, viable public option must do several things. It must be open to ANYBODY who wants to buy into it. There is a significant danger that health-insurance owned legislators will write a bill that forces workers to accept whatever private plan is offered at their work, regardless of how bad it is. It is crucial that the public option be open for enrollment to ANYBODY so that the plan will have a big enough risk pool to be sustainable. If the public option is created merely to serve a relatively small, less healthy population than it will never have a financially viable risk pool.  It will face constant financial unsustainable, making it an easy target for an eventual right-wing backlash.

This leads to a second crucial point. The “public option” legislation must be written in a way that strengthens Medicare. For decades, Medicare has provided efficient, timely medical care to our highest risk pool, all the while suffering under the out-of-control inflation caused by the profit-driven American healthcare model. The best way to create a public option and strengthen Medicare at the same time is to demand a public option that is a Medicare buy-in. They must let everybody buy into Medicare. This will provide the Medicare risk pool with an infusion of younger, statistically healthier patients, strengthening the system for the long term future. Howard Dean used the term “Medicare buy in” immediately after Obama’s speech this month.

A “Medicare buy in” public option would of course be a death sentence for the health insurance industry. When they argue that they “can’t compete” against a strong government run plan, they are 100% right. If given the choice, what consumer would not opt for the plan that costs less, that has no out-of-pocket expenses, that has no profit-motivated desire to refuse care?

As single payer activists, we should keep pushing for single payer. We should demand our representatives vote for H.R. 676, “Medicare for All” when it comes up on the floor. We should demand that they support the Kucinich amendment to H.R. 3220, which will allow individual states to start single payer systems. But right now, we also need to be working tirelessly to make sure we don’t let the health insurance lobbyists use “the public option” to flank us. If we take over the debate and make “the public option” our own, we can instead use it at the lance point straight into the heart of the insurance industry.

Report from Michael Arcuri Town Hall Meeting

Report from Mike Arcuri Town Hall Meeting in Varna, 9.11.09

The entire Varna Community Center building on the side of route 366 was packed, with overflow parking graciously provided by the service station next door. Arcuri had to address the crowd by standing in a doorway between two rooms. A lot of credit should go to Martha Robinson and whoever else helped her put together the event. There were probably between two and three hundred in attendance.

There was strong pro-single payer sentiment expressed throughout the comments and questions, with even larger numbers momentarily bursting into applause for the invocation of single payer and single payer ideas. If the rather large crowd was not overwhelmingly single-payer, it was at least overwhelmingly in favor of the sort of public health system that can really only be delivered by a single payer system.

Arcuri gave his standard dismissal of single-payer: “It can’t get the votes to pass. It’s not practical.” But I suspect others who saw him in his office in D.C. on July 30^th, and a week or so later in Cortland, will agree with me that he was much less forceful in dismissing single payer yesterday. Within a sentence of saying it was not practical, he segued to discussing how the opposition to single-payer was very similar to the opposition to Medicare and now Medicare is extremely popular and politically untouchable now. He brought up single-payer himself, prior to anybody else asking about it or advocating for it, acknowledging it as popular with some people in the way Obama did in his speech. It is easy to be cynical and view that as them just patting us on the head after they sold us out at the bargaining table, but from a practical organizing standpoint, the more people hear the phrase “single payer” used, the more receptive those people will be to the very fiscally conservative, common sense logic of adopting a single payer system.

The first question Arcuri actually took on health care policy was about health saving accounts. Health savings accounts are very popular, and for obvious reasons. It a profit-driven, inhumane health care system, the health care savings accounts have made a big different for a lot of people with crappy, high deductible policies. Arcuri stated that he was generally against health care savings accounts because they inhibit the risk pool, but admitted that they were quite popular and may “fit in somehow” with an eventual health care bill.

He also invoked all the people who “like their plans and don’t want to see them changed.” But he also spent a lot of time throughout the meeting explaining that a lot of people who think they like their plans have never really had to rely on them under a true medical emergency, when the insurance corporations use all their various loopholes to deny care and save money. This was a very positive development since I last saw him in late July and early August. In those meetings, he would just insist “a lot of people really like their plan now” and we would have to point out that a high percentage of those people don’t really understand how their plans even work. Then he would say “it doesn’t matter why they think it, it’s what they think.” It was encouraging to see him now seeming to come around to the point of view that he should be willing educate his constituents if necessary. At several points throughout the meeting he was quite explicit about blaming the for profit health insurance corporations for creating misery, suffering and an economic burden for the society.

The question about health saving accounts was followed by a gentleman who made an eloquent denunciation of the private insurance industry. He stated that he preferred a single payer system and asked for at least a strong public option, legitimately open and big enough to succeed. He also asked Arcuri to at least cast a symbolic vote for H.R. 676, “Medicare for All,” when it comes up for up or down vote in the fall.

Some guy claimed Medicare is going to be broke in six years and asked Michael Arcuri, “for the sake of my two children”, to vote against any spending, ever again.

It should be noted here that the popular right-wing claim that “Medicare is broke” is absurd. Medicare pays for medical care for one of the most expensive demographics there is to treat, and in a medical system with out of control yearly increases in costs. So Medicare continually needs more money—just like the private insurers. The private insurers get more money from hiking rates—9 to 10% a year, 119% over the last decade. The whole thing should be turned around: “Why can’t the private insurers operate without doubling their rates every ten years? That’s supposed to be a practical business model?” If they weren’t selling something we need to survive—access to medical care—with no competition, they would have gone broke a long time ago.

Arcuri responded to the question from the “fiscal conservative” by invoking his own towering status as a fiscal conservative. He said he will not support any bill that adds to the deficit. He raised one of his favorite issues, the fact that the bill needs to make sure Medicare and Medicaid payment schedules will continue to rise sufficiently to allow the small rural hospitals like he has in his district to continue operating. This is a legitimate concern for rural areas throughout the country. I actually think that, although people associate single payer with urban liberals, it is much more likely to catch on in rural, traditionally conservative parts of the country first.

It was somewhere around this point in the meeting where Arcuri made his first reference to his recent televised encounter with somebody named “Chris Matthews.” This Matthews guy has apparently decided that the Democrats are going to lose some number of house seats if they can’t manage to pass a “health care bill.” Apparently according to this Matthews guy, it doesn’t matter how many people will actually end up covered under the bill or whether or not it will add to the deficit or how much citizen money the bill will end up funneling into the coffers of the health insurance corporations, the only really important thing is that the Democrats pass a bill, so that people with television shows like this Chris Matthewson will be extremely impressed by their organization skills. Arcuri apparently told him in no uncertain terms that it did matter whether or not the bill was a good bill. Obviously it is great that he thinks this way. He mentioned the show at least two other times, so it is clearly something he is proud of and anybody calling his office might consider mentioning that you “caught Mike on the Chris Mackelsen Show and thought he really let Chris have it!”—provided you really did see the show, of course.

A woman from the Teacher’s Association spoke very intelligently about how even people who seem to have great insurance find themselves out in the cold when they really need to get help. She said under the Teacher’s Association plan her mother was denied critical end-of-life care on the basis that “dying is not a medical emergency.” She gave other example of co-workers who have had their doctor-order chemo-therapy treatment denied (it is a sad fact that if you spend a month doing single payer activism, you will end up meeting more people than you would ever have thought possible who have had their insurance companies deny or cut off their chemo), examples of people denied payment for highly effective laser technologies to more safely remove cancer tumors because the treatment was “experimental.” She summed up her testimony very nicely by talking about the difference between having insurance and actually having access to care: “We think we have insurance. But we don’t, maybe.”

Arcuri responded to her by saying “Most people are happy with their insurance. Most people don’t actually need their insurance.” I have to say, I am a much bigger fan of Michael Arcuri when he is telling the truth about insurance corporations.

Some woman made a strong general statement of her disapproval of Michael Arcuri for his alliance with the Blue Dogs and his alliance with his business friends. She said he needed to stop listening to his business friends and listen to people like her, “experts on social and public policy.” She finished her comments by announcing that she had to leave immediately for a very important meeting she was attending in Cortland at the Center for Ethics, Peace and Social Justice—presumably some confederation of  other experts in public and social policy. She urged him to “check us out.” And then she was gone into the afternoon.

Arcuri was happy to take the opportunity to defend his association with the Blue Dogs, once more returning to the issue of Medicare payment schedules for small rural hospitals. He said he was proud to stand with the Blue Dogs when trying to make sure the bill will protect small rural health care networks.

The next speaker said he loved the free market, and also liberty. He identified himself as a Republican and said he was very proud of Arcuri for voting against the cap and trade bill. He called Arcuri a man of integrity no fewer than four times during the course of perhaps two minutes of talking. He urged Arcuri to be “fiscally conservative on health care.”

Arcuri again emphasized that he wanted to see a fiscally conservative bill. In the next breath he stated that it was very important to write a bill that would take out “the prejudice against pre-existing conditions.”

A woman from 212-HELP and the Tompkins Health Alliance gave a very strong front line report documenting the shocking rise in unmet health care needs in our own community over just the past six months. I plan to get a copy of the Health Alliance’s research and send them out in a future Water Cooler Wars Bullet pack.

Arcuri used this to segue into the argument that fixing the health care system is not only an ethical imperative, it is also an economic imperative. He said it is “not just the morally right thing to do, it is the economically necessary thing.” He also said “We need to make sure people who think they have good insurance understand they probably don’t.”  He was really making these sorts of arguments with a lot of enthusiasm. His fiscally conservative side is getting drawn into the debate. I think we can flip him to support single payer at some point.

Another guy complained about Medicare being broke, the government being inefficient because he had to wait in line at the Department of Motor Vehicles (apparently there are retail stores and private business office I have not been to, where the miracles of the Free Market have eliminated all waiting). He also invoked the commonly known rightwing opinion that the post office is no good. He spoke about how frustrating it is for him to not be able to buy health insurance policies from any state he wants; the phrasing of his question did not indicate that he had any awareness of the Sherman Anti-trust laws, and of the fact that the insurance corporations have a specially written exemption to them. He seemed to think that if only some non-existent government regulation were removed from place, the health insurance market would suddenly be transformed “by competition” that policies would suddenly appear that were both affordable and actually useful for when you get sick or injured. He finished by asking for “loser pays” torte reform—a brilliant idea for effectively denying the Constitutional right to due-process to any poor or working class person.

Arcuri managed to politely explain what a stupid idea “loser pays” torte reform would be. He then tackled the issue of “competition.” He explained how, by design, almost all the markets in the country are divided up between the various corporations and only two or three operate in most areas. He said that a strong public option was necessary in order to provide real competition. The guy who had just asked for “loser-pays” countered “But it’s not fair, because the private health insurance corporations have to make a profit.” Arcuri pointed out that private schools manage to flourish alongside the public school system, UPS and FedEx make money despite the completion from the Post Office, and that the Post Office keeps the private shippers’ fees down.

Really, we should pray that the right-wingers keep making this “But it’s not fair because the private insurers can’t compete” argument. That argument is check-mate for them. By raising it, they are admitting that the profit in the health care industry comes at the direct expense of the patients in the health care system—it is not something traded in exchange for added value, but is in fact something siphoned off in an exploitive manner. They are admitting that you can’t have huge corporate profits and still provide people the care they want and need. You can tell that they think they are making a “good point” when they bring this up, but the argument they are making is: “Hey, if the government starts letting people create a large public risk pool, where all of the money is only used to provide medical treatment, then nobody is going to want to go enter the privately managed risk pool, where so much of the money has to be filtered out of the pool to pay off investors and to pay CEO’s over a hundred thousand dollars an hour, at the continued expense of actual sick people who are denied treatment.”

A Doctor followed by saying that anybody who thinks the private insurance system is the best way to go has a “rich fantasy life.” He said that when he started practicing in 1970, he old needed one and half employees to manage billing and paperwork. Now he needs 10. He said that private insurance costs are making the entire system unsustainable. He also mentioned a patient who had his payments denied after he was shot in the face in a hunting accident because he “went outside the system.”

Another Doctor and Cornell professor stated that he had lived in Britain, Canada and the U.S. and that the U.S. health care system is far inferior. He stated that the only good solution was a single payer system. He said he also wanted a ban on drug advertising on television. Arcuri made a lame argument that he had “first amendment problems” with banning Drug Company advertising. I think we should at least be pushing him to help take away the tax write off that drug companies get for their advertising. According to Eric Massa at his town hall meeting last month, drug companies are able to deduct their advertising from their taxes—not their pre-tax burden, but their actual tax bill. That means that the tax payers are really paying for it.

A woman from Ulysses spoke about the difficulty of losing coverage while pregnant. She said her sister had a great job with insurance, and still had to fight her insurance company for treatment, right up to the day she died of cancer.

A woman from Ithaca challenged fiscal conservatives to justify opposing single payer when it is the only really fiscally conservative solution to the health care problem. She wanted to know why fiscal conservative are opposing reforms that will save money. Arcuri responded with a defense of fiscal conservatism and said that he and other fiscally conservative Blue Dogs were supporting the public option, because it would save money.

A Doctor from Trumansburg said that in 30 years he has seen the insurance companies become increasingly hostile to patients. He said he favored a single payer system. “You should really think about that,” he told Arcuri. “A lot of rural doctors support single payer.”

Arcuri at this point said a very interesting thing—he said he was going to support the amendment to force Congress to take the public option as their plan. This is something Massa mentioned at his town hall meeting in Erin. Let’s encourage him to keep this position.

A man invoked the moral imperative of providing health care and kept saying that he didn’t mind paying more in taxes to give more people coverage. He asked Arcuri what exactly Arcuri would or would not vote for. Arcuri said he would vote for anything that will “legitimately improve the situation.” He came back again to saying that the prejudice against pre-existing conditions had to be eliminated. He also spoke about closing the donut hole in Medicaid D—which means making the drug companies negotiate with Medicare for drug prices (like the rest of the world does). It is interesting he brought this up, because it is thought that Obama already bargained it away. I think this is one of those details we should force the issue on—Obama doesn’t have a right to bargain that away, for the sake of “support” from the drug companies for his bill. Any meaningful healthcare reform has to force drug companies to negotiate their prices.

In general, I think that the meeting showed Arcuri is in a good place on this issue—or as good of a place as we could hope to find him. He is making a lot of the arguments you would want to hear him making, and in his case, I think that means he is hearing those arguments from larger and larger numbers of his constituents. The idea that radical reform is necessary is gaining a lot of traction—so many people, from all walks of life and all backgrounds, find themselves dealing with the same cruel, unjust problems within the American healthcare system. Single payer is forcing its way into the conversation, and we can hope that it will reach a critical mass as more and more people come around to the undeniable fiscal and moral reality of our situation.

Really? This is the Best America Can Do?

Back in 2002 the Institute of Medicine released a study which estimated that 18,000 Americans had died during 2000, as a result of not having health care. More recently, the Urban Institute employed the IOM’s methodology, accounting for the rise in the ranks of the uninsured, and adjusted the number upwards: 22,000 in 2006 (urban.org). Let’s say we just split the difference and call it 20k, for the sake of convenience. Any way you count it, it works out to over a hundred thousand dead Americans since the 2003 invasion of Iraq. For over half a decade now, our federal government has been spending in excess of a billion dollars a week of tax payer money, much of it going to private corporations such as Halliburton and Black Water, all in the name of “protecting” our “national interests.” Meanwhile, enough people to fill a city the size of Allentown, Pennsylvania or Midlands, Texas bit the dust. In no other industrialized nation in the world would this happen.

By the way: During roughly that same time period, health insurance industry profits have risen 1000%  and premiums for workers’ policies have jumped five times the rate of wages (AFL-CIO). The strain of paying health insurance premiums is threatening to bust the budgets of nearly every city, county and state government across the nation; it went a very long way towards destroying the American auto industry. Somehow, the United States of America has managed to cobble together a healthcare delivery system which is simultaneously bankrupting industry and government, while killing off large numbers of the population.

Of course, a very small number of United States citizens make tens of millions of dollars a year working within this deadly health care delivery system. And for this reason alone, some people will actually maintain that our “uniquely American” health care system is a smashing success. Some people really and truly do believe that any enterprise which increases personal wealth is noble and just, no matter how many other people suffer or die as a matter of due course.

There is a kind of folk belief in the United States that “nobody goes without medical care if they really need it.” But that just isn’t true. If you are one of the 50 million Americans without health insurance coverage then you cannot simply make an appointment and go see a Doctor just because your stomach has hurt and your digestion has been haphazard for months. You can’t just waltz into the convenient care at the first sign of flu symptoms. You won’t get the routine physical and blood work that might detect a sudden, troubling rise in your blood sugar or a glitch in your organ functions.

Oh, sure, as things go on and your condition continues to degenerate, you can eventually look forward to receiving whatever medical attention will be needed to stabilize your condition at an emergency room, once you have contracted a full-blown case of influenza, or slipped into a diabetic coma, or progressed significantly far along with a case of stomach cancer to be shitting blood when you cough.

At that point, your condition will be extremely expensive to treat, and your options for procuring treatment severely limited by your uninsured status. Unless you have been sick sufficiently long enough to have slipped into the lowest levels of the economic underclass, you will not qualify for Medicaid or any other sort of government subsidized health plan. For an uninsured person with a serious medical condition, procuring any kind of medical care at all can become a full-time job by itself; simply keeping track of and servicing the ever rising debt, another.

And there just isn’t a lot about the situation to inspire even the smallest flicker of hope. Let’s suppose that, for instance, in spite of dealing with a serious medical condition, you manage to land a better job, one that offers health insurance. But you still won’t be able to get the medical care you need, because the insurance corporation that your new employers buy their policy from will deny you coverage the very first time you go sign up for those tests or treatments you’ve been waiting months, or even years, to get done.

Denying coverage for “pre-existing” conditions is the industry standard. It has to be. Insurance corporations are legally obligated to pursue maximum profits. They present themselves to the public as if their business was somehow providing health care services, but almost the exact opposite is in fact the case. They are instead a parasitic bureaucratic syndicate that has somehow managed to insert itself as a gatekeeper between sick Americans and their Doctors. Their only goal is to take more money from people in premiums than they pay out to medical care providers on those people’s behalf. If you are already sick, the “health care industry” is never going to let you through the door.

So as an uninsured person with a serious, chronic medical problem, your fate is now largely sealed. Under the United States’ for-profit model of health care delivery, a “pre-existing condition” equals lifetime banishment from full access and care. Your only hope is to somehow manage to make enough money to pay for tens of thousands of dollars worth of medical care up front. Or else wait until your condition deteriorates enough so that you are no longer productive and able to support yourself, at which time you will be able to get onto Medicaid. Or, if you are old enough you might cross your fingers and hope you can ride out a few tough years and hang in there long enough to qualify for Medicare. In the meantime, if things get desperate, maybe somebody will throw a fundraiser for you at an Eagle’s Hall or the VFW, and put up some collection cans for spare change at the checkouts of the local package stores.

But mostly you are just shut out of the system. And, frankly, there is a good chance it will kill you in the end. And I will repeat: In no other industrialized nation in the world would this happen to you. Only here in America, where we love freedom so goddamned much more than everybody else.

And where, apparently, no freedom is more sacredly entrenched than the freedom of health insurance CEOs to rig our health care delivery system, so that they can wring 50 million dollar a year salaries from figuring out ways to deny medical treatment to people who are not profitable to insure.

Why on earth is it like this? Why do we here in the home of the Brave opt for a private insurance system, instead of joining the other Democratic nations of the world in guaranteeing access to health care for all of our citizens? For some reason, we just accept as fact that the “free market” model of health care is more efficient than a publically managed program that covers everybody. We, apparently, believe it is some how more “efficient” to have a system that shuts out 50 million of our fellow citizens. Some of us, at least, seem to clearly believe that it is “efficient” to let tens of thousands of our citizens die each year, so long as a few other citizens get to make tens of millions of dollars in salary and profit, as a direct result.

I mean, that has to be what the insurance industry lobbyists and defenders mean when they rant and rave about how much more “efficient” the free-market, for-profit health care system is. They must mean that it “efficiently” allows a small number of well connected CEO’s to make billions in profit by directly exploiting our society’s sickest, hardest-suffering individuals.  That has to be what they mean by “efficient,” for in no other sense could the United States health care system be regarded as so.

Still I get the distinct impression that some of my fellow Americans naively believe “more efficient” might mean something else—like that it saves our nation money. In fact, the United States spends roughly twice as much per capita on health care as other industrialized nations spend through their various single-payer, non-profit systems. A study released two weeks ago by the state of New York found that the state would save 20 billion dollars a year under a single payer system. I honestly do not understand how fiscal conservatives can countenance it: our nation pays roughly twice as much as other nations, only to achieve verifiably inferior results.

Others perhaps imagine that the private insurance company model is more efficient because it somehow eliminates layers of complicated, inhumane bureaucracy that exists in a government managed, single payer system. Again, essentially the opposite is the case. Medicare, and the various single-payer models that are employed by other democracies average about 3% in administrative overhead costs. American, for-profit insurance corporations average about 30%. I recently heard an RN and office manager for a primary care physician quote a study that found the average doctor spends roughly 70 thousand dollars a year in staffing costs, simply to deal with the insurance companies.

Of course, health insurance corporations have overhead expenses that just do not accrue under the not-for profit, single-payer system. In the first place, they must pay much, much higher salaries, in order to attract that particularly successful brand of individual who is not morally troubled by generating wealth directly through the misery of others.

Secondly, the health insurance corporations must spend millions of dollars a year lobbying our elected representatives in Washington, in order to make sure their own, narrowly defined, selfish interests are given a dominant stake in any discussion of potential reform.

And perhaps most important of all, the health insurance industry must maintain an entire army of workers whose only job is to go over policies with a fine tooth comb, looking for reasons to disqualify a person from coverage, once they have become sick enough to actually need access to health coverage, often after they have spent years paying ever rising premiums.

Because in our free-market, for-profit health care system, you can spend years feeling confident and well covered, only to discover that was never really the case. Once you get sick and start costing the health insurance corporation money, there is an excellent chance they will figure out some “efficient” way to deny you care. Not only is it their legal right to do so, it is their responsibility. Very efficient, that.

On the front page of the August 5^th New York Times, insurance industry sophist (a sophist was a kind of professional liar in ancient Greece) Karen Ignagni whined that “not one single person is going to get coverage as a result of attacking our community.” As you would expect of a comment made by an insurance industry spokesperson, this one is completely untrue. To increase health care coverage to all Americans will not only require attacking Ignagni’s “community”—it will require putting them completely out of business. Remember, Ignagni’s “community” is the group of health insurance CEO’s who make billions of dollars in profits each years through collecting health insurance premiums and then denying care for any possible reason they can come up with. That “community” has no place in civil society. They prevent us from properly taking care of our citizens.

But naturally they are not going to quietly go away. The health insurance corporations are currently spending 1.4 million dollars every single day in congressional lobbying and media manipulation, in order to keep their death grip on our health care system. And they have pulled the necessary strings to fire up their “astro turf” organizations, those angry mobs of lunatic right wingers who have recently launched a strategy of shouting down and disrupting town hall meeting about health care reform.

These unfortunate individuals are allowing themselves to be turned into some of the greatest dupes in human history. In the great generational battle to win back liberty from the corporate-state leviathan, these passionately ignorant patriots are standing tall and true for the corporate elites fundamental right to exploit and privateer off from the rest of society. And somehow, in their minds it has gotten all twisted up into a kind of holy crusade, a battle to protect the American way of life against the menacing specter of socialism. That’s right, the Godless commies are coming to infringe upon our sacred right to pays hundreds of dollars a month in health insurance premiums to insure our families, just so we can run the strong risk of having them cut us off once we really need care.

It is, of course, ludicrous. The other countries which have single-payer health care systems are anything but “socialist.” In most cases, they have more robust economies than we do, when measured in terms of quality of life for the average citizen. Unencumbered by the idiosyncratic American habit of marrying health insurance to employment, the businesses in Canada and the European nation are free to focus their resources on production. Under a single payer system, entrepreneurship is more strongly encouraged, because bright and creative people are not obligated to stay in a job just to maintain their insurance.

A system for providing adequate and timely health care to all members of society is as important a part of the infrastructure as maintaining a system for responding to house fires or criminal attacks. Which is to say, decrying a single-payer health care system as “socialism” makes as little sense as ranting about the “socialist” fire and police departments. Carrying on about “socialism” and “government takeovers” is emotional dummy talk. The cold reality is that corporate interests took over our health care system long ago. It is time to use our government—the one that is of, for and by the people—to take it back.

This September, the Congress will take up for debate and vote H.R. 676, the “Medicare for All” bill by John Conyers of Michigan. This bill would reign in the out of control inflation of  medical costs while at long last providing coverage to all Americans. The bill can be read in summary or in its entirety at healthcare-now.org. Contact your congressional representative and ask them to sign on as a co-sponsor for H.R. 676. We can have a more cost effective and humane health care system in the United States, and we can even have it sooner rather than later. But we aren’t going to get it without demanding it.

Or maybe you just figure that 20 thousand dead Americans each year is good enough, or simply the best that can do.

Some More Reviews of my Summer Reading

Forecast: The Consequences of Climate Change, from the Amazon to the Arctic, from Darfur to Napa Valley by Stephan Faris, 2009

Unlike much of the writing on the topic of climate change, this book by Stephan Faris altogether avoids an alarmist tone. It is chilling nonetheless. That Faris is able to so thoroughly, accurately and unflinchingly detail the current and most likely effects of climate change without sounding like Henny Penny is a testament to his tremendous rhetorical skill as a journalist.  I will not even try to emulate him. If society does not adjust to the physical reality of our ecosystem, and quickly, we will all be fucked. Even in the best case scenario, we will be leaving a vastly different world to our children and grandchildren, with some very difficult problems to be solved.

Faris offers a brief but thorough catalogue of places around the world where climate change has already begun to place significant pressure upon human society. He begins in Darfur, where climate change has been responsible for one of the most catastrophic human conflicts in recent decades. For generations, the farmers and nomadic herdsmen of the Sudan existed together in some semblance of civil accord, managing to accommodate each other on the humble land they shared. The desert-expanding droughts that North Africa suffered under in the last decades of the 20^th century shattered this mutual tolerance; one side eventually adopted a policy of genocide against the other, to ensure their own continued access to the region’s dwindling natural resources.

Faris’ reporting dramatizes a cruel and bitter irony of climate change—although it has been driven by the frantic industrial growth and consumption of the world’s richest nations, it is mostly the poorer ones which are suffering the first, harshest brunt. Nowhere, perhaps, is this truer than in Bangladesh. Faris describes Bangladesh as a place where “a population half the size of…the United States crams into an area a little smaller than Louisiana…With floodplains stretching across roughly 70 percent of its territory…uniquely vulnerable to flooding, rising seas and storm surges. Most of the country lies within six yards of sea level.”

Rising seas have already begun to turn the ground water salty in parts of the country. Even under the most optimistic models for near-term climate change, significant portions of Bangladesh will become uninhabitable, potentially causing a refugee problem of a magnitude never seen in the history of humanity. Bangladesh, of course, was formally East Pakistan—meaning that the country is a focal point in the Indian/Pakistani rivalry, perhaps the world’s most volatile nuclear stand-off.

Rising water levels and hotter temperatures will turn large sections of the planet into ideal environments for all manner of diseases and viruses, such as malaria, staph infection, dysentery, Ebola, dengue and Lime disease. Flooded coastal regions and vanishing ground water in drought areas will push more hungry, desperate, and oftentimes, physically ill people into increasingly crowded land areas, to share finite resources.

The U.S., too, will almost certainly loose shoreline, even in the best case scenarios, with major disruptions to the economy as a result. Insurance corporations seem to harbor no doubts at all about the real, immediate threat of climate change, and in recent years they have bumped the premiums on wind and storm policies for hurricane plagued regions of the country by four to five hundred percent, where they will still even write them at all. Faris refers to an article published in Science magazine by U.S. Department of Energy scientist Evan Mills, just prior to Hurricane Katrina: “He predicted that property and business-interruption losses would continue to force rates up, while extreme temperatures, worsening water quality, and vector-borne diseases would add new costs to health and life insurance. Meanwhile, major insurers would begin to see lawsuits against their clients as victims of global warming turn their attention to the emitters of greenhouse gases. There would be more and more years when the industry isn’t profitable.”

At the same time, the vanishing ice of the Arctic region is already spurring a land boom, as shipping routes, oil fields, mineral and precious metal mines previously inaccessible beneath sheets of ice are now opening up. The result is a suddenly more contentious, confrontational assertion of national sovereignty from nations like Russia, Canada, the United States and the Scandinavian countries, in parts of the globe where less then a decade ago such matters were shrugged at for being irrelevant.

In his epilogue, Faris writes that he considers his book “an exercise in optimism.” He notes that the most ambitious proposals likely to be adopted by society aim at curbing warming “at about three and a half degrees Fahrenheit, enough to bring about most of the changes laid out in this book. In other words, the scenarios described in the preceding chapters could turn out to be the best we can expect under even the most rosy assumptions.”

He also warns that an increase of more than three and a half degrees “is the point beyond which global warming risks slipping out of our control. After that, the Earth starts to undergo changes that perpetuate the thermometer’s climb. Warm soils decompose faster, releasing carbon dioxide and methane. Hotter oceans absorb less. Melting permafrost unleashes millennia’s worth of methane trapped in frozen bogs. At the North Pole, white ice is already giving way to black water; the feedbacks pile up, the warming accelerates, and there’s little we can do to slow it down.”

It is important to note in a review of this book that the recent House Bill designed to implement a “Cap and Trade” policy will not do nearly enough to lower the rate of carbon dioxide being discharged into our atmosphere. It was primarily designed in order to provide Goldman Sachs, Obama’s largest contributor (look it up, Democrat partisans), with another trading bubble to manipulate. Still, it is scary to see how the mainstream corporate media is only allowing this bill to be criticized from the perspective of how “bad it will be for industry.” It is a simple matter of reality that adequately responding to man-made climate change is going to require a level of accommodation from human society.  And industry, after driving our planet to the brink of environmental collapse, will at long last need to be reigned in. The pursuit of “economic prosperity” at any environmental cost has produced a legacy of ecological crisis; our entire view on what constitutes “prosperity” has been erected on shifting sands, and it cannot withstand the angry waves waiting to crash over us in the days ahead.

Some Reviews of my Summer Reading, Part 2: The Big Necessity: The Unmentionable World of Human Waste and Why it Matters by Rose George, 2008

I spent this past Fourth of July Weekend at the Blue Heron Music festival, in far Western New York, where my wife was singing. As part of a band entourage, I had a backstage pass to the Hospitality Tent, where impressive meals were served three times a day, and free draft beer was dispensed in the evening. But for me, a 38 years old man with a typical 38 year old man’s digestive issues, spending three days camped out and drinking more cans of cheap beer than are healthy, the true attractions of the hospitality tent were the twin portapotties, far more gently used than the facilities available to the thousands of festival ticket buyers (although, even in the general public facilities, which I of course did need to use in a pinch, the Blue Heron festival does a fantastic job of providing timely sanitation.) So it was with a special appreciation that I returned home on Monday and began reading George’s journalistic investigation of sanitation practices around the world.

During my life I have spent time both as a low-ranking enlisted infantryman on lengthy deployment and as an off-the-grid homesteader, so I have had personal experience with the gritty realities of waste disposal. Nevertheless, most of my life has been spent in first world comfort, where such matters are easily dismissed from the mind with the casual whoosh of the modern flush.

Indeed, as George demonstrates, casual indifference is pretty much the default attitude most people adopt towards sanitation and waste disposal, which is portrayed in the book as a kind of Rodney Dangerfield in the area of third world development. But her first rate reporting clearly establishes that this issue is among the most critical facing humanity on this ever-more crowded earth.

George’s journalistic tour takes the reader from the sewers of such ultramodern cities as London and New York,  to the Indian subcontinent, where open defecation continues to be a standard practice in some of the world’s most crowded slums, and where women of the Dalit caste continue to have the wretched role of “public scavenging” forced upon them—a euphemism for cleaning human feces from shallow pits by hand and then hauling it away in leaky baskets balanced upon their heads, a task which pays them pennies a day, when they are lucky, and leaves them perpetually suffering from dysentery (a disease I myself caught after performing an improvised water crossing down stream from a sewage treatment plant one summer while stationed in Germany—the sickest I have ever been in my life, by far).

A recurring complaint George reports throughout her book is the inattention governments, aid agencies and the media around the world pay to this crucial matter: “Talk to anyone who is trying to improve the world’s sanitation, and this idea becomes a refrain. We need a champion. A Bono or Geldoff. A Nelson Mandela or Angelina Jolie. A film star or politician who has the courage to talk about toilets, when most people only want to talk about faucets.”

She contrasts this to the situation with drinking water, a popular (and worthy) issue with no shortage of champions. Matt Damon has launched his own NGO to “bring clean water to Africa.” Jay Z produced a three-part series on the issue for MTV.  But in a world where 2.6 billion people have no access to any kind of toilet facilities at all, talking about providing clean drinking water to the poor while ignoring the reality of how they dispose of their bodily waste really doesn’t help them in any meaningful way at all. Lack of adequate sanitation in a crowded area leads as a matter of course to contaminated drinking water and the miserable package of associated diseases. George quotes a 2006 Human Development Report from the United Nations: “The 1.8 million child deaths each year related to clean water and sanitation dwarf the casualties associated with violent conflict. No act of terrorism generates economic devastation on the scale of the crisis in water and sanitation. Yet the issue barely registers on the international agenda.”

George also does an excellent job of showing how this is not exclusively a third world problem. She refers to semi-regular reports issued by The American Society of Civil Engineers, grading the nation’s infrastructure: “In 2000, wastewater infrastructure got a D. By 2005, it was a D minus. In 2000, the U.S. Environmental Protection Agency estimated that a quarter of the nation’s sewer pipes were in poor or very poor condition. By 2020, the proportion of crumbling, dangerous sewer pipes will be 50 percent.” Our first-world privilege of flushing and forgetting might very well prove to be a luxury that vanishes in our lifetime.

Indeed, for many of our fellow citizens, those days have long passed. George devotes a substantial part of her chapter on “biosolids” (another euphemism, for sewer sludge) to the plight of nurse and activist Nancy Holt, and her rural North Carolina neighbors, whose community has been plagued by a staggering, statistically improbable, level of assorted cancers, auto-immune diseases and other assorted health crisis since the farmland in their area became the regular spreading sight for something like 9.75 million gallons of sewer sludge a year (a best guess estimate by Holt and her husband, since no records are available). This atrocity is a brought about by the EPA giving yet one more pass to corporate industry, allowing them to classify sewage as “fertilizer” before it has been properly treated. The result is a chilling array of heavy metals, PCBs and infectious diseases being spread over prime agricultural land across the nation.

I think most people realize, metaphorically, that the world is going to shit, and if humans are going to have any hope of changing that, they are going to have to get their shit together. And in the second to second world of daily reality, an important part of fixing a shattered world economy and restoring a level of dignity and equality to humans everywhere is going to require dealing with the problem of shit.

Some Reviews of My Summer Reading, Part 1: The Wrecking Crew: How Conservatives Rule

by Thomas Frank, 2008

Frank has been among my favorite writers since the late 90’s, when I was finishing up my dysfunctional graduate student years and embarking upon my tumultuous career as a radical adjunct writing professor. His journal The Baffler and his first book The Conquest of Cool played a decisive part in helping me to find a viable alternative to the college English department, dominated as it was in those days by the a-historical, anti-intellectual aestheticism of the academic creative writing world on the one hand and to the philosophically vapid, self-congratulatorially hip, cultural studies obsessed, self-described “Marxists” on the other. I most often see Frank described as a “cultural critic,” which he is, to an extent, though his real strength is as a philosopher of recent history. His work examines the way popular intellectual and aesthetic movements in post-World War II America have been manipulated and implemented for the systematic purpose of increasing wealth and power to the corporate class. In The Wrecking Crew he describes how this trend has reached its grand culmination in recent years, shattering our Democratic Republic’s ability to fulfill its obligation of protecting the common good, and in the process creating a disparity in wealth and power not seen since the Robber Barons.

Frank wrote this book during the last years of the Bush/Cheney regime, a period of American history that will forever after be known for jaw-dropping corruption and shameless cronyism: Hundreds of billions of dollars worth of no-bid contracts doled out to a corporation which the vice president was a former direct of, and in which he currently held (undisclosed amounts of) stock; party loyalty forced upon government employees in a manner not seen since the Soviet Union; a major American city left floundering in the wake of a devastating hurricane because the directorship of the Federal Emergency Management Agency had been turned over to an Arabian horse expert with absolutely no qualifications aside from his insider political connections; the lobbying scandals centering around Jack Abramoff and Tom Delay.

Abramoff, in fact, provides a kind of lynchpin character for Frank’s story of how the Republicans managed to go from being the party of “fiscal responsibility and good government” to the party of massive deficits and obscene corruption. He starts his narrative during the early Reagan years, when the young Abramoff took charge of the national chairmanship of the  College Republicans and transformed the group from what had primarily been an organization of goodtime  frat boys, marking years before returning home to Daddy’s firm and the country club, into a radical campus presence agitating on behalf of such causes as the Contra’s terror campaign in Nicaragua and the South African apartheid regime. By taking the playbook from campus radicals of the 1960’s and inverting it, they helped to establish the central myth of the contemporary right-wing worldview, that conservative activists are always rebellious outsiders struggling against the oppressive Federal Government leviathan and/or the international socialist conspiracy.

This myth has remained emotionally potent for going on three decades now, even as conservatives have most often controlled the Federal Government during that time. It is frankly pathological, a persecution complex that defies all rationality. But the most important thing to understand about the right-wing persecution complex is that the right wing political operatives employ it strategically. They use it to justify all the jaw dropping corruption and criminality they engage in. When Ollie North was taking it upon himself, as a Lt. Colonel, to subvert the Constitution of the United States to covertly fund an armed insurrection against a Democratically elected government in Nicaragua (in express violation of United States law)—well, old Ollie was being opposed by a vast Communist conspiracy of democratically elected United States Senators! To diehard rightwing Republicans, that totally justified it. Hell, to them, it justifies the fact that he was probably involved in putting crack onto the streets of South Central Las Angeles. And it justifies the lobbying scandals of politicians like Tom Delay—they are bravely standing up for the underdog cause of protecting the rights of the extremely wealthy, while pretending to give a shit about abortion and gay marriage in order to placate the poor white Christians who must be lured to the polls every two years. By any means necessary, my brother.

This underdog myth is foundational to the contemporary, far-rightwing Republican Party. It is what they are selling for hours every day on the a.m. radio. Belief in it seems to be shrinking, but the smaller it gets, the nastier it squeals. Nobody explains this phenomenon, and chronicles it more meticulously, than Thomas Frank.

From the College Republicans, The Wrecking Crew follows Abramoff and his pals as they discovered the unbelievably lucrative field of “political entrepreneurship”—i.e., establishing “think tanks” and lobbying firms dedicated to relentlessly pushing a pro-corporate, pro-industry agenda, even at the expense of truth and the common good, in exchange for millions of dollars in direct funding from international corporations and industry groups, even from rogue nations like Apartheid era South Africa.

The millions of dollars are a good investment for the economic elite. It allows them to set up shop in Washington D.C. in the most stylish of digs, where they can get down to the business of holding shady fundraisers for your Congressperson and mine, while they wine and dine the important people and write the very legislation that it supposed to protect the rest of us from their unrelenting greed and predatory excess. A chapter in The Wrecking Crew is devoted to detailing how the explosion of lobbying since 1980 has led to the Washington D.C. area transforming from a middle class city of civil servants into the wealthiest area in the nation, at a time when major cities across the countries were seeing their own economies, infrastructure and populations collapsing. They have gotten rich from stripping out our economy and government, rich beyond any poor man’s wildest dreams.

Conventional wisdom, as established in the corporate owned mainstream media, generally treats the important political divides in this country as social matters—those who favor abortion rights and gay marriage versus Christian fundamentalists; those who believe in “God, guns and guts” versus those who spend every spare moment sipping lattes and plotting out their next yoga retreat; those who attend the opera versus those who follow NASCAR. Something like this cultural rift does exist in the country, and it has been skillfully manipulated by political campaigners—it was, in fact, the topic of Frank’s last book What’s the Matter with Kansas? But in The Wrecking Crew, he makes a very convincing argument that the only truly meaningful political divide in contemporary America is between the economic elite and everybody else.

Viewed from this perspective, the rampant corruption and incompetence of the recent Bush administration was no accident. It was the grand culmination of a political strategy, designed to weaken and discredit, and ultimately destroy the ability of the Federal Government to function, leaving a power vacuum for the corporate elite to fill through more privatization, more transfers of wealth and control to the banks and the corporations. The staggering deficits have been an intentional plan to leave the government unable to fund its most basic responsibilities, even as we face the most challenging economic climate in over 70 years; the corruption scandals have had the simultaneous effect of both immediately enriching industry and of fomenting cynicism and apathy among the disgusted electorate, making the possibility of engaged, citizen led governance that much more unlikely.