Think again if you think being insured = security

Americans love to believe things that are demonstrably untrue - tax cuts equaling increased government revenue and a stronger economy, for starters. Oh, and the whole idea of for-profit insurance companies being an efficient way to finance our health care being another.

So I'm just passing this along - it's not going to make a whit of difference in the debate. The University of Arizona has found that being insured doesn't affect whether you have medical debt.

According to a study published online June 16 by the American Journal of Public Health, after taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications....

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt. From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

That's according to University of Arizona College of Pharmacy research scientist Patricia M. Herman.

But don't expect the Americans who are swayed by the big-business money that preaches anti-government ideology to take note. (Hell, the mainstream media didn't even take note.)

They're busy admiring Michele Bachmann's poll numbers in Florida, leaving the fact that she's a delusional liar to, at best, the papers' online blogs, to be read by the choir.

Social darwinist Bachmann is quite concerned about a mythical $105 billion "hidden" mandatory spending in the health care reform bill passed last year. That would be the most-debated bill ever passed. Right, Michele.

And the shot heard round the world was fired in New Hampshire. Uh huh. Obviously memory fails us all now and then. But when a third or so of Americans begin to channel the single-minded Walter Sobchak (You're goddamn right I'm living in the fucking past!") from The Big Lebowski, it's hard to know where to begin. As The Dude says, "Walter, I love you, but sooner or later, you're going to have to face the fact you're a goddamn moron."

The scary thing is that these folks aren't just channeling film rage, they and their leaders are unwittingly channeling mass murderers. Bachmann again: “But what I want them to know is just like John Wayne, who is from Waterloo, Iowa – that’s the kind of spirit that I have too.”

As one L.A. Times commenter wrote, "I don't think she was mistaken, she was just speaking in secret code to her minions. She well intends to rape the nation like [John Wayne] Gacy [who was from Waterloo] did to his victims..."

Another commenter offered a SOP right-wing solution: "Let's go to John Wayne's Wikipedia page and change it so that she is right."

Death as a Rorschach Test

After a post at Slate I realize, once again, that Paul's death is a kind of Rorschach Test.

Usually people who are in favor of healthcare reform get it, immediately - how the U.S. healthcare system failed him in a far bigger way than misdiagnosing his appendicitis.

Physicians almost always get it immediately.

People who are afraid of change, and who don't understand that our health care system is a kind of ever widening net of dysfunction - not so much. For them it's all about misdiagnosis - if they've gotten past the point where it must have been Paul's fault, because the U.S. healthcare system is the best in the world (maybe needs a slight tune-up, but nothing major) - that being the case because we're the best.

And once a group starts thinking it's the best despite all evidence to the contrary, that's the beginning of the end, whether it's a sports team, an automaker, an army or an entire nation.

The United States does a lousy job of protecting what it claims is its most precious asset - its people.

Soft Support for Reform

Back when politicians thought all healthcare reform could be was adding a few more kids to the SCHIP program, just like every other single-payer supporter I know I liked to point to polls showing that a majority of Americans knew we needed to overhaul our system, that government needed to guarantee healthcare, that it was the dastardly insurance industry's grip on our politicians that was to blame and so on.

All along there were the Celinda Lakes warning that public support for healthcare reform has always been soft, and easily manipulated by fear-based campaigns.

Like this, you think?

RX FOR DISASTER
83 MILLION OF US WON'T KEEP OUR INSURANCE

And for those who do manage to keep their current insurance -- well, it won't cost $2,500 less, as Obama promised. Lewin estimates it will cost $460 a year more because of new cost-shifting from the government-run plan to private health plans.

That's right. The $1.3 trillion House health-care bill would cause millions of Americans to lose the insurance they have now -- while the rest of us would pay even more than we do now.

It's times like this when you truly appreciate the smart analysts out there, like Paul Krugman and Ezra Klein - who quoted Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

They say that people deserve the governments they endure - a pretty hardhearted assessment of, say the Cambodians under Pol Pot. But when it's a democracy, and when there's every opportunity to become educated, wouldn't it be true to say that a people deserves the health care system they're too afraid to change?

I'm feeling like picking fights about this - pretty unproductive I admit.

Americans: OK with Inequality

Jacob Weisberg has a nice piece at Slate on the reform package. What really caught my attention, however, was this commenter:

Weisberg writes: "[The British system] doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s..."

The PSA is more likely evidence of what's wrong with the US system, not what's wrong with the British. It has become a standard even though there is little, if any, evidence it saves lives. Yesterday's NY Times ran a story that pointed out, "the federal Centers for Disease Control makes it clear on its Web site: there is no medical proof yet that routine screening for lung, ovarian, prostate and skin cancer reduces deaths from those cancers." But many men will suffer wretched complications from treatments in response to the screening.

But that's my minor quibble with Weisberg. The major one is this: "Morally speaking, Americans are surely more accepting of economic inequality than their European brethren. But the random unfairness that condemns the uninsured to bad health and the risk of untimely death offends the social conscience."

If only it were true that the bad health, disabilities and deaths that result from the lack of access to health care really offended Americans. Sure, there are some who are really outraged, some who are disturbed, and others who just can't be bothered to think about it. But there is also a group (large or not?) who are really satisfied knowing that there are winners and losers in American life and they are only too happy to be on the winning side. If we acted to create a more equitable system, how would they know who the winners and losers are and which side of that line they're on? Knowing that others are suffering, and believing that everyone in life pretty much gets what they deserve to get, they oppose any change that would bring relief to the suffering or make life "fairer."

Those who are passionate about universal care aren't large enough in numbers to bring about a change. Those who aren't passionate are too disturbed at the thought that reform may bring some change to what they already have to support it. And those who are happy with the way things are aren't going to support any change at all. If any reform bill passes it will have to be diluted too much to avoid imposing real change on health care providers or the currently insured. We're going to fall short again.

No doubt we'll fall short for just those reasons, although I sure hope that Obama gets us on track to a solution.

This comment makes me think about hearing some asinine Republican representative on C-Span last night pontificating on how every American has access to health care - it's just that not all of us have health insurance - two very different things, he wisely noted.

Right. Tell it to my brother. Tell it to all the American parents and children who've died because they did not have health insurance - and because they did not have health insurance they did not go to the doctor in time, and because they did not have health insurance the hospital treated them differently than had they been insured.

And I think about some commenter on a radio station saying that he sure did expect to have better health care - far better health care - because he was insured - otherwise what the hell was he paying for?

Lincoln was for govt-financed health care

James Nowlan, a Republican at the University of Chicago, has a column in today's Chicago Tribune. It's notable both for what it says and what it doesn't say.

"Abraham Lincoln declared that government should do only that which the people cannot do so well for themselves -- defense, highways, public safety, education. And government has done a good job of fulfilling this compact with the public. In recent decades, we have been adding health care to the compact, in increments: first the elderly with Medicare, then the poor, and more recently, children, both through Medicaid. If you're not in one of these categories, you scramble for health care. Everyone in my rural area hustles to find the shelter of health-care coverage. Farmers' wives take jobs at the school in town -- for health coverage for the family. Whenever a job change is contemplated, the biggest question is: 'Will there be benefits [health coverage]?'"

Nowlan addresses the irreconcilable tension between Americans believing that their taxes are too high and at the same time believing that the government should make sure everyone has health care.

Then, as if he can't quite help himself, he points out that Medicaid and Medicare are the biggest chunk of government expenditures on health care - something that is misleading because it doesn't note the other government expenditures on health care, such as the tax breaks for companies that provide health insurance and the cost of paying for private insurance for all municipal, county, state, and federal workers, including the military.

He notes that the cost of Medicare and Medicaid have gone up 7 percent a year, "far outstripping inflation," without noting that the rate of increase of private insurance puts Medicare and Medicaid increases in the dust.

Even so, the quote from Lincoln was nice. The experience of other industrialized democracies fairly proves that government does a better job of managing health care financing than does the private sector. (If, of course, you factor in health of the population as being at all important. If you're willing to write off a substantial portion of your work force - the Darwinian cost of doing business - then our system clearly is more profitable and therefore better, capitalistically speaking.)

Then again the right has so vilified the competence of the American government that it's possible that people think that whereas the Swedish or German or Taiwanese government can competently manage health care financing, our own government cannot.

The question then becomes "Why does the right wing hate America?"

Medicare Meets Mephistopheles

That's the title of a 2006 Cato Institute rip on Medicare. Here's the spin, via Amazon: "Let's say you're the devil, and you want to corrupt the American republic. How would you go about it? According to David Hyman, you might create something like Medicare, the federal health care program for the elderly. Hyman submits that Medicare may be the greatest trick the devil ever played. Medicare feeds on the avarice of doctors and other providers, turns seniors into health care gluttons, and makes regions of the United States green with envy over the dollars showered on other regions... With epic political battles over Medicare and the future of limited government looming just over the horizon, Hyman uses satire to cast a critical eye on this mediocre government program."

You can pick upMedicare Meets Mephistopheles, for $1.40 from Amazon or $14.95 from Cato. Your choice as a consumer in a market that actually works - unlike the free-market healthcare biz. The New England Journal of Medicine had a January 2007 review:

Hyman is surely correct that current financial trends in Medicare funding are unsustainable and will eventually erode public support. But in focusing on Medicare's inadequacies and mocking the system as an intergenerational scam (my word, not his), Hyman overlooks the reason why Medicare was enacted in the first place and why it retains considerable public support. At its inception, Medicare addressed the palpable medical needs of the elderly and the failure of the private insurance market to meet those needs. The program reflected a set of values and social commitments that included universalism, government responsibility for social welfare, and public accountability.

More important, Hyman ignores the reality that many of Medicare's flaws are at least rivaled, and perhaps exceeded, in the private sector. It is doubtful that the private sector would match Medicare's considerable strengths in providing access to health care that was unavailable before the program was introduced. Whatever its failures, there is evidence that the program has clearly improved the lives of its intended beneficiaries. As J. Lubitz and colleagues wrote in Health Affairs ("Three Decades of Health Care Use by the Elderly, 1965–1998") in 2001, "Our findings are consistent with the idea that Medicare-funded services have improved the health of the elderly." Is there any legitimate nonideological reason to believe that consumer-driven health care will better serve the elderly than Medicare? I am dubious.

Still, Hyman's bracing critique reflects the fact that neither Medicare's problems nor the ascendancy of market-based approaches to solving them can be ignored any longer. In an era of rampant individualism, the attempt to defend Medicare's collective ethos has the aura of a reactionary battle waged to save an old order in the midst of its last throes. Those who support the social obligations underlying Medicare must demonstrate anew why market-based solutions are unappealing and why governmental investment in health care is morally justified.

Here's hoping that Obama means new hope for social obligations.

Coincidence? I think not...

There's an unintentionally funny post at a blog I stumbled over this a.m. regarding Scott McClellan's new book, What Happened. The guy saw a correlation between Bush's falling approval ratings and Scott McClellan's competence as a press secretary. (As if the Bush administration would put an incompetent in a position of importance because of cronyism....) "Even Tony Snow couldn’t reverse the trend," this person wrote.

Somehow I think White House won't go with that. Looks like they've settled on disgruntled former employee sells out for book advance - same as McClellan himself used on Richard Clarke.

A bit of basic logic at Wikpedia gives some other examples of "Correlation does not imply causation":

The more firemen fighting a fire, the more damage there is going to be.
Therefore firemen cause damage.


With a decrease in the number of pirates we have seen an increase in global warming over the same time period.
Therefore, global warming is caused by a lack of pirates.


Since the 1950s, both the atmospheric CO2 level and crime levels have increased sharply.
Hence, atmospheric CO2 causes crime.

What ever happened to states' rights?

The Republicans have been so amazingly nimble politically from - what would you say? - 1995 to 2005? - that books will be written a hundred years from now on what they wrought during this crucial time. If, of course, their anti-family-planning, anti-environmental, pro-sprawl, pro-greed, you're-on-your-own polarizing policies haven't precluded publishing.

A NYT opinion piece on states rights offers a chapter of examples on how the right wing, that mighty protector of states rights, has been studiously and quietly stripping the states of their right to protect their citizens.

In February, the day after his infamous encounter at Washington’s Mayflower Hotel, Eliot Spitzer, then the governor of New York, published a remarkable opinion piece in The Washington Post.

He wrote that several years earlier, state attorneys general noticed a spike in predatory lending that the federal government was doing nothing about. When the states tried to rein in abusive mortgage lenders, the Bush administration finally did something. The Office of the Comptroller of the Currency issued rules nullifying state predatory lending laws over the objection of all 50 state banking superintendents.

The clampdown, which paved the way for the subprime mortgage crisis, was done by “pre-emption,” a little-understood doctrine that allows the federal government to wipe away state laws. The Constitution’s supremacy clause says federal law can trump state law. But the federal rule should be a floor, not a ceiling. It should set a minimum level of rights, not stop states from doing more to protect their citizens.

That's just one of 50 examples in an Associated Press report that also includes safety rules for chemical plants, head restraints in autos, abusive Medicare marketing, and curbing greenhouse gases.

One would assume the current makeup of the Supreme Court backs these new rules. That's a Supreme Court John McCain has said he'd strengthen.

The Republican corporate prescription

All is revealed with the GOP's new slogan: "The change you deserve," borrowed, we now know, from the antidepressant drug Effexor.

The difference, of course, is that the Republicans don't have to reveal side effects to potential consumers.

"Are depression symptoms keeping you from where you want to be?" Effexor's maker, Wyeth Pharmaceuticals, asks in its promotions. "Not feeling as good as you used to?"
House Majority Leader Steny Hoyer (D-Md.) told reporters today that a safer remedy would "Democrats, not drugs, is what the American people need," he said. He flashed the Effexor side effects on a large flat-screen television. "Nausea, up to 58 percent," Hoyer said. "Actually it's higher than that for Republicans."
Hoyer didn't even mention the warning label, which states that patients should be watched to see if they are "becoming agitated, irritable, hostile, aggressive, impulsive, or restless."

All so true.

Also in the news today was the sad fact that relentless for-profit marketing has turned Americans into a bunch of pill-poppers. More than half of all insured Americans are taking prescription medicines regularly for chronic health problems. The causes are worse public health, better meds, and advertising. The biggest jump in use of chronic medications was in the 20- to 44-year-old age group where it was up 20 percent over six years. The chronic conditions served are mainly depression, diabetes, asthma, attention-deficit disorder and seizures.

There are some good books out on the pharmaceutical industry's success in the United States. Here are four, with their descriptions from Amazon:

Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, by Shannon Brownlee
Award-winning health and medicine writer Brownlee notes that Americans spend between one-fifth and one-third of health-care dollars on unnecessary treatments, medications, devices, and tests. What's worse, there are an estimated 30,000 deaths per annum caused by this unnecessary care. The reason for what amounts to a national delusion that more care is better care is rooted, she says, in a build-it-and-they-will-come paradigm that rewards doctors and hospitals for how much care they deliver rather than how effective it is.

Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs, by Melody Petersen
Much of what [former New York Times reporter Petersen] recounts — such as the glut of copycat drugs like antacids, and marketers' lavish wining and dining of doctors—has been covered in books by others, like Marcia Angell. But Petersen fleshes out these issues and names prominent doctors who, she says, are on the take. She is particularly strong on the ghostwriting of medical journal articles by advertising agencies. She also covers less familiar matters, like the environmental impact of drug residues in water.

Before You Take that Pill: Why the Drug Industry May Be Bad for Your Health," by J. Douglas Bremner
Recent scandals involving diabetes drugs, Vioxx, and many other medications reveal the serious and undisclosed risks of some of the most commonly used prescription drugs in this country. Dr. Bremner, a researcher and clinician at Emory University whose study on Accutane and depression made headlines, offers an inside look at the pharmaceutical industry, as well as a scientifically backed assessment of the risks of more than three hundred prescribed medications, vitamins, and supplements.

The Truth About the Drug Companies: How They Deceive Us and What to Do About It, by Marcia Angell
The pharmaceutical industry, according to former New England Journal of Medicine editor Angell, is fraught with corruption and doing a disservice to customers, the federal government, and to the medical establishment itself. She explains how a huge portion of the revenue generated by "Big Pharma" goes not into research and development but into aggressive marketing campaigns to sell their product. She describes how, even though the drug companies claim that it costs them an average of $802 million per drug to develop new medicines, that figure is obscenely inflated since it factors in marketing as well as expected interest the company would have received had they invested the money in the open market. Meanwhile, most of the R & D work is done by colleges and universities funded by the government. There are also problems with the drugs themselves, since a majority are "me-too drugs", slightly modified versions of existing products which meant to address concerns of consumers most likely to spend money on pharmaceuticals. Thus, the market is filled with remarkably similar drugs to treat depression and high cholesterol while potentially life-saving medicines for diseases afflicting third-world countries are discontinued because they aren't profitable.

Nader as a (damaged) single-payer mirror

Slate's Timothy Noah wants people to lay off Ralph Nader.

Fine.

I actually haven't heard much about Nader in recent weeks. There was the wince and shake of the head when I heard he was running, maybe one cynical comment from CLJ, and that was it. OK. I guess I did also wonder aloud how much the Republicans had paid him in order to get him to run again.

We've mostly gotten over Nader. We're part of that common wisdom that sees Nader as part of the reason that Gore didn't win in 2000, yes. Along with blatant cheating on the part of the Bushies, and a disinclination on Gore's part to fight as dirty.

And because Gore didn't win, we got an addled born-again wannabe cowboy for a president who didn't pay attention to frantic warnings that we were about to be attacked. 9/11 happened and the Bushies immediately used the tragedy to their partisan advantage, whipping up fear and using it to get questionable legislation passed. Worse, they played off it to put us in a pointless war that has killed hundreds of thousands of people.

It is impossible to say whether 9/11 would have happened if Gore were president. It is possible to say that Bush wasn't paying attention and did not raise the alert level as Richard Clark and so many others advised. It is also reasonable to suppose that Gore would not have chosen to take us into Iraq.

So thanks, Ralph.

It wouldn't have come to mind except that Nader's running again. Even then, had he acknowledged that yes, turns out there is a difference between Republicans and Democrats, we could have seen him in a better light. It would also help for him to be able to see that he did play a role in the 2000 debacle.

Noah differs.

In the current election, Nader is the sole presidential candidate you're likely to hear about (now that Dennis Kucinich has dropped out) who stands forthrightly for adopting a single-payer solution to the health-care crisis, a stance universally regarded as politically impractical. But single payer is the only solution of much practical value in the real world, as evidenced by the experience of nearly all advanced democracies. If Nader does no more in the 2008 election than oblige major-party candidates to consider that stubborn reality for five minutes, he'll have done us all a big favor.

OK.

Immigrants and health care

What kind of people are we?

At the Un- and Underinsured Congress in December, Celinda Lake presented on the results of her focus groups.

She has found that when you ask Americans about their values in health care -- getting away from ideology and instead towards things like security and affordability -- she has found that in fact most Americans do support universal health care -- or, as she prefers, guaranteed, affordable choice.

However, she warned that she and her staff have in encountered a growing and ugly meanness towards immigrants when it comes to health care.

USA Today has a story today on that intersection between immigration and health care.

On a national level, an effort to add legal immigrant children to the State Children's Health Insurance Program was blocked in the Senate last year. Instead, lawmakers added language to ensure that illegal immigrants were excluded.

"The phrase 'illegal immigrant' is just radioactive at the moment," says Leighton Ku, a health analyst at the liberal Center on Budget and Policy Priorities. "Efforts to provide additional benefits for the undocumented would be essentially perceived as adding fuel to the fire."

You don't suppose Romney, Tancredo & Co. would exploit this, do you? Pander to people's ugliest sentiments of fear and hatred, rather than call them to their best?

Here's a clue from the story: "In a special election to fill the seat of the late Rep. Paul Gillmor, R-Ohio, last month, the National Republican Congressional Committee attacked Democrat Robin Weirauch for backing universal health insurance because it could extend taxpayer-funded health care to illegal immigrants. She lost the race."

Mandates won't help these families.

The sweeping overhauls of the nation's health care system proposed by Democrats Hillary Rodham Clinton, Barack Obama and John Edwards would not provide coverage for illegal immigrants. "Because the issue is so politically hot, people are staying away from it," says Cecilia Munoz, senior vice president at the National Council of La Raza, the nation's largest Hispanic advocacy group. Only Dennis Kucinich of Ohio, a Democratic long shot, proposes covering them.

That's likely to mean little change in undocumented immigrants' health care status, already the worst in the nation. Even among children, 53% are uninsured, according to Jeffrey Passel of the Pew Hispanic Center. That compares with 9% of U.S. citizens' children.

In North Carolina's rural Duplin County, more than one in four people are uninsured. The area's job growth is in low-wage agribusiness — "plucking chickens and gutting hogs," says Greg Bounds, chief executive officer of Goshen Medical Center, the area's largest group of community health centers. Businesses need the influx of illegal immigrants to take hard-to-fill jobs, but hospitals lose money when the workers need emergency care.

Until recently, most illegal immigrants here had one health care strategy. "They just weren't getting care before," Bounds says. "They were just suffering and dying."

McCain's short circuit

John McCain's column on U.S. health care begins so well:

WE HAVE AN approaching perfect storm in health care, and no one seems to be watching the clouds gather.

More families are without health insurance as premiums increase beyond the affordability of our citizens and their employers. Our safety net programs of Medicare and Medicaid are headed to financial meltdown and draining dollars from critical programs such as education. Our companies cannot continue to compete outside the country because health care costs are so much higher in the United States.

Leave out that bit about Medicare and Medicaid, and you've got some truths (and of course, with the Big Pharma giveaway that is Medicare Part D — no negotiating with pharmaceutical companies over the cost of drugs for Medicare recipients — the Republicans did manage to make Medicare unsustainable). McCain then attacks the Democratic candidates for their "same old" solution of universal coverage, which really means, he writes, "massive tax increases, mandates and government regulation, and no solution to rising costs."

Fair enough, since that is indeed the truth to mandates — unless mandates are a back-door route to single-payer. That seems unlikely, given the dominance of the organized money behind insurance. What he calls instead is almost unintelligible. If I hadn't heard McCain's policy guy in D.C. earlier this month I would come away wondering if McCain might not be the Nixon to China conservative on single-payer.

Here's why. McCain writes:

I offer a genuinely conservative vision for health care reform, which preserves the most essential value of American lives -- freedom.

We should not attempt to substitute government coercion for the right of individuals to decide what is best for them. Our citizens should not pay for the collective sins of a failed health care system. We must use the tools that have served us so well in the past -- competition, American ingenuity and personal responsibility.

Exactly what we in the single-payer movement are calling for, and exactly what Canadians, the Japanese, French, Greeks, Brits, etc. all have: freedom (aka choice of physician and hospital; and the freedom to be treated for medical ailments), which leads to competition amongst the docs and hospitals, with a strong element of personal responsibility injected. We are each responsible for our health. It's our government's role to empower us to do that better, however, not to punish us for not doing it well enough.

What kind of society do we want to be, an empowering one or a punitive one?

McCain also sings the single-payer tune when he notes that we should all have to "pay for the collective sins of a failed health care system." So well put.

Unfortunately, he then turns to gobbledygook, advocating tax credits so that more people can pay premiums to the insurance industry protection racket. Too bad. Ideology and a long career in Washington have blinded McCain to the real way forward — the conservative solition, since it fosters freedom, competition and fiscal sanity.

p.s. McCain has taken a page from Bush, whose image guys have long stood him in front of graphics that make it appear as though he has a halo. McCain's is more like a victorious Roman general's armored head-dress. Appropriate — he's not depending on the Christian fundamentalists hoping for end-times.

Divide and conquer

The Atlantic Monthly continues its downward spiral with a new writer, Megan McArdle, who fits their criteria for clever writing that leaves aside those quaint notions of morality, as Alberto Gonzolez has said. Entertaining!

The benchmark for this kind of dross ran a few years back, positing that the earth could easily support 30, 50, who knows how many billions of humans! and that our human population could vary by huge amounts — 30 billion to 3 billion! — within a few generations, without problems.

Right. Unless, I suppose, you consider starvation, war, pestilence and economic dislocations problematic.

Megan performs this trick on a smaller scale in "The Morality of Health Care Finance," by accusing those of us who see single-payer financing as a way out of the immoral and deadly morass in which healthcare is now mired in the United States. We are, she thinks, simply in love with government, and would be in favor of single-payer even if it could be proven that private health insurance could do a better, cheaper, more efficient job — "as long as a substantial population remained uninsured."

What?

Huh?

Megan. How is a system better if it leaves "substantial" numbers uninsured? How could that be cheaper in the long run? How more efficient? You've been reading too much Ayn Rand.

That's like accusing progressives of being against torture, even if it could be proven that torture does a better, cheaper, more effective job — "as long as a substantial amount of the information gathered turned out to be false."

See, the fact is that torture is wrong because it's immoral AND it doesn't work. Same as our private health insurance system.

Megan's argument that single-payer is a way to transfer money from the young and healthy to the old and infirm sounds like a trial balloon from the health insurance industry. Will we learn in a few years that she was lavishly compensated by that industry for this bit of "journalism"?

The fact is that our current system transfers money from the young and healthy to the old and infirm without benefit to the young and healthy. A single-payer system does collect from everyone, but its efficiency and appeal lie in the fact that there is benefit for the young and healthy. They have the security of knowing that if they hit a tree snowboarding next winter, they'll be cared for. They have the satisfaction of knowing that if they're one of the unlucky few who wake up tomorrow morning suddenly transformed by a diagnosis of cancer, suddenly no long one of the healthy but one of the stricken, that their children will continue to have a parent, and they can concentrate on recovery, not the consequences of bankruptcy.

Shame on you, Megan, for working to divide people, to set the young against the old, and suggest to them that their interests are served by turning their backs on others. She complains that liberals have been calling her "evil," but in fact, to work to divide people, one from the other, is an evil action.

First they came for the Socialists, and I did not speak out -
because I was not a Socialist.

Then they came for the Trade Unionists, and I did not speak out -
because I was not a Trade Unionist.

Then they came for the Jews, and I did not speak out -
because I was not a Jew.

Then they came for me - and there was no one left to speak for me.

Shame. We're in this together, Megan. Because it's moral, and because it's what works.

Private Beauchamp & the dogs

The New Republic found itself in the middle of a right-wing assault after editor Franklin Foer published a GI's story about how some of our young and immature soldiers have acted in Iraq. The right evidently thinks that all 170,000 of our soldiers there, dropped into hell with an unclear moral purpose, always channeled St. Francis when they weren't killing insurgents.

Army Private Scott Thomas Beauchamp, "the discredited soldier" who sent those reports to the magazine, has been widely reviled on the right-wing media sites. His three stories — of kids making fun of a disfigured Iraqi woman; of soldiers' finding children's bones; and of soldiers killing dogs for sport — were ridiculed. How could anyone think our boys would do such a thing?

Now comes this, in today's Denver Post:

A young man recently returned from Iraq sat in Barfield's chair while she applied a memorial tattoo.

She'd seen him in her shop before, just a regular kid. But now he told her a disturbing story about a lull between firefights. With no enemy in sight, the soldiers turned their weapons on a dog.

They fired a few rounds, but the dog didn't die. So they fired a few more. Then they ran over it with their armored vehicle, just to hear the bones crunch.

"They had programmed themselves to be hard," Barfield recalls. "The whole thing was about not losing the programming. But he was laughing when he told the story, and it kind of scared us.

Huh. War can harden hearts and damage a person inside as well as outside. Who knew?

Three talking points

David Welch of Chico wrote such a good letter to the editor of the Chico Enterprise-Record that you don't really need to see the piece he's reacting to. His three points are great talking points:

Sandra Pooley's attack on Michael Moore, single-payer health care and the California Nurses Association shares a notable common feature with all right-wing attacks of single payer in that it's completely fact free.

Anyone who examines actual facts, as opposed to slogans, innuendo and rumors, has to conclude that single payer is the only solution for fixing the failed American system.

Single-payer systems around the world vary quite a lot — different financing mechanisms, different administrative structures, larger or smaller roles for the private sector. Despite that variation, they all have three things in common:

1. They cover everyone in their country. You'll never see anyone in Canada, France or Britain holding a yard sale to cover someone's medical costs.

2. They achieve population health results and specific health care outcomes comparable to the U.S. or a bit better — sometimes a lot better.

3. They do it for about half what the U.S. currently spends, or less — often a lot less.

Of course the right-wing strategy for dealing with those facts is not to confront them but to just pretend they don't exist.

Business Week magazine — a rather conservative business journal — has a new article in their July 9 issue on the French system. I would recommend it to anyone who still imagines that the U.S. has "the best health care in the world."

— David Welch, Chico

White House responds to citizens group

Michael Leavitt, Secretary of Health and Human Services, has responded to the Citizens Health Care Working Group and its proposal to bring universal healthcare to the United States.

"Well isn't that nice for you?" he said. Or words to that effect.

The working group was a massive, cross-country effort to collect input from Americans about what kind of healthcare system they'd like to see. The group did not originally offer the choice of single-payer universal healthcare, didn't include it in discussions — but people wouldn't shut up about it, and so single-payer got through the door after all.

According to Leavitt, in a letter reporting to Cheney regarding the administration response to the group: "The Working Group chose an approach based on mandates and government intervention rather than an approach emphasizing consumer choice and options."

"The major areas of disagreement," wrote Leavitt "include the establishment of a national commission to define a core health benefit — an idea that the Federal Government can choose the best set of benefits for all Americans."

Leavitt returns to this several times — the insurance industry and their political toadies evidently think it's a good talking point. "The Administration believes it would be impossible for a federally appointed board to define a single benefit package that is able to address the diverse needs of Americans in their different income, family, geography, and health circumstances."

What does that mean? Could it be that Congressmen in Washington, D.C., after the birth of, say, a child with hemophilia, would expect his baby to be cared for, but that a poor father in Montana wouldn't want the same thing?

Or does it mean that a healthy, married Virginia socialite, after suffering major injuries in a car accident, would prefer to have all her medical needs seen to, but that a diabetic single mom wouldn't want the same?

"It would be impossible for a federally appointed board to define a single benefit package that is able to address the diverse needs of Americans in their different income, family, geography, and health circumstances."

I find it difficult to come up with the words that can express my outrage at that idea.

Where's the profit motive?

One of the best parts of working for a Catholic paper, which I did for about 16 years, was hearing stories of people doing good. The profit motive was rarely involved.

OK. Never.


I remember marveling about the farmers who would give so much time and treasure to build churches — and hospitals, as in this corny Canadian promo for universal healthcare being part of their traditional values — their heritage.

In any case, I'd look at how magnificent Mount Angel's church was, for instance, and I could see that although communities working together was also part of our heritage, we, their descendants, weren't likely to give so much.

Why?

Could the conservatives be right? Has there been a disintegration of values? What did happen to our community values? Our "We're in this together," golden rule values?

Now here's another question. Could it be that the Right is actually more to blame than the Left for this? Did they get so scared of communism that they tossed the baby right out with the bathwater?

Fox Attacks

Go to Fox Attacks to check out what you can do to help bring accountability back to the media. Fox has its place in the virtual universe, no doubt, but they've got less business hosting a Democratic debate than Air America would have hosting a Republican debate.

The Democratic Party of Nevada has cancelled Fox's deal to host that debate — what the hell were they thinking? — but more is warranted. Fox Attacks urges people contact Fox advertisers and let them know what they think.

We love California nurses

Wish they were in charge.

Huff Post turns hard right

It’s disappointing to see a piece of anti-single-payer propaganda on Huffington Post, one of the premiere progressive sites on the internet.

I say propaganda because it weaves in so many misstatements, false analogies, and because it is intended to inspire fear.

R.J. Eskow writes that there’s “no reason to believe” that "if we snapped our fingers and covered every person in the country today with Medicare, it would cost us way less than 20 percent of GDP," as Kevin Drum says.

There are actually dozens of reasons to believe that.

Every other industrialized country in the world has universal healthcare, most using
a single-payer system, and all of them see a smaller percentage of GDP — an average of 11 percent — go to healthcare than we do.

Why isn’t that reason to believe we could do the same?

For Eskow to then claim that Medicare and Medicaid are inexpensive only because private healthcare subsidizes them is also gratuitous. Is that also the reason why European universal healthcare is so (comparatively) inexpensive?

Or could their cost-efficiencies actually be in large part because they’ve eliminated that giant, sucking black hole of hundreds of insurance plans, all with competing profit margins, paperwork and duplicated administration?

Is it because they actually spend a far greater percentage of their healthcare dollars on… (drumroll followed by trumpets)
Healthcare!

We could do there here, too. Single-payer healthcare transitions include retraining the people who now prevent care to instead give care.

Eskow frets that a single-payer system would bring hospital rates down and force closures.

He doesn’t mention that’s exactly what has been happening in American markets, driven by relentless downwards pressure from insurance companies. Also known as competition for profit — not for providing health.

He also doesn’t mention that European countries have more hospital beds per capita than we do.

Then Eskow makes the ridiculous assertion that prices under a single-payer system would eventually surge upwards. Just like they HAVEN’T done Europe?

This is pure fear-mongering speculation, similar to the Bush administration urging people to buy duck-tape and the need to go after Saddam’s WMDs.

This article, in fact, reveals that Eskow might simply be a plant from the right. He’s a guy with a long-term association with the health insurance industry, supposedly now feeling the need to now “give back.”

Great gift, R.J.

His plan for vouchers to buy private insurance, abetting the private health insurance industry’s bottom line, is nothing more than a last-gasp raking in of a few more billion dollars.

The industry’s own greed has painted it into this corner. Its situation isn’t that different from the effects of a virulent new virus. On the one hand, such a vigorous virus could be seen as being spectacularly successful, as it has thrived by completely colonizing its host. On the other hand, it’s unsuccessful, because it dies when its host dies.

Eskow is wrong to say that we don’t know how a single-payer system would work. They work very well in a variety of styles around the world. Everywhere but here, actually.

Transitioning to a single-payer in the United States would have been easier in the early part of the twentieth century, when it was first proposed. It would have been easier under Roosevelt, — or any of the other times its obvious benefits were championed.

Powerful special interests have always been able to drum up fear against it, though, and put off the day of reckoning, leaving too many people dead, crippled, widowed, orphaned, bankrupted and homeless in its hardhearted, inefficient wake.

That’s not hyperbole. The rationalists just don’t like being reminded of it. Collateral damage, you know.

Eskow's nonsensical theories about the healthcare system potentially becoming more “two-tiered” under a single-payer system (what on earth does Eskow think we have now?) are almost obscene.

The past five years have proved that we are easily led into fearing the wrong things.

Eskow’s argument is exactly the same as the one that says we shouldn’t do anything about global warming, because it might disrupt the economy.

Both changes — for an efficient, equitable, and sustainable healthcare system, and for an efficient, equitable, and sustainable energy policy — would invigorate the economy.

Staying the course is what’s deadly.