NYTimes Book Review Misses Major Points About US Healthcare

Jacob S. Hacker, Yale professor and author of many books and article critiquing the American political system, economy, and the fate of the poor and middle classes, reviewed a new book, AN AMERICAN SICKNESS: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal (NY: Penguin Press, 2017). Most of the review takes up the question of why healthcare is not like other commodities and does not fit into the “let the market solve the problem” ideology of the last 40 years. If you are unpersuaded now, this is useful territory. towards the end of the review Hacker turns to our developed country competitors’ approaches to healthcare.

“The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. ….. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.”

This is a great summary statement. Using a variety of tools and institutional arrangements every other government controls prices and healthcare budgets. They do not allow a one-sided market to focus on delivering as many procedures and prescriptions as possible without any systematic focus on health. My criticism is that Hacker should have provided two further data points to put the outrage of American healthcare in its true global setting: US healthcare spending compared to other developed countries and health outcomes relative to other developed countries. As the chart below demonstrates, the US spends more than 25% more than our closest competitor, Switzerland, and twice as much as most including japan, France, Australia and Canada. The health outcomes are woeful. We rank 42 in the world for longevity and 56th for infant mortality.  ((see https://www.cia.gov/library/publications/resources/the-world-factbook/)) These facts need to be front and center in our thinking about healthcare. The developed world is filled with universal healthcare systems with many different structures and approaches, all with several decades of experience at delivering better healthcare at much less expense. The only question is how will poor and middle class people in the united states gain enough political power to end this great rip-off??

https://ourworldindata.org/financing-healthcare/

Affordable Healthcare Act (Obamacare) Review – Rob Bujan

Dan Udell videotaped a presentation on the US healthcare system by Rob Bujan on 3/25/17. I could not attend so I watched Dan’s YouTube video – 

 The discussions towards the end of this presentation (about minute 50) concerning single-payer systems would have been more vigorous and perhaps useful with a little international context. We live in a world where every other developed country has universal healthcare and has had for decades. So, there is plenty of experience with a range of different structures to deliver healthcare to every person as a right. Continue reading

Congressman Faso and the proposed American Health Care Act

Congressman Faso

Today I received an email from my Congressman, John Faso, concerning the proposed American Health Care Act. It included a link to a Republican website that speaks to their proposed legislation and a link to the the actual legislation. Asking me to read the legislation is insulting because though I am fairly literate it is well known that the language of legislation is a swamp of references to other pieces of legislation frequently calling for comprehensive knowledge of the topic to even begin understanding its implications. 

The site also spends a lot of time bad-mouthing Obamacare. I get it. Republicans don’t like Obamacare. The question is how will they improve upon it??

Continue reading

Job (Business) Killing Regulations

Ever since Ronald Reagan told us in his 1981 Inaugural Address, “Government is not the solution to our problem; government is the problem.” government bashing by right-wingers, Republicans and many Democrats has been a constant drumbeat of political rhetoric. Now we have Trump with his “Kill 2 regulations for every new one” and a government dominated by Republicans for whom destroying government has been an objective for decades. We are faced with the probable destruction of many government agencies whose job it is to protect us from capitalism.

Someone Else Will Pay – A Basic Feature of the Capitalist Economy

One of the basic features of capitalism is the requirement that businesses avoid any costs that they can. Basically they are required by the rules of the competitive game to get someone else to pay for anything they can shirk off. Without countervailing forces, the government, unions, and other social organizations, stepping in, capitalists will externalize any cost they can. This results in capitalist firms destroying the environment by unsustainable exploitation of the earth (see mines, forests, rivers, oceans); polluting the environment (air, water, landscape); maintaining unsafe working conditions; paying wages below that required for people to have a sustainable life; engaging in speculative risky gambling (see our financial sector for the most recent egregious examples of this); creating and marketing products and services based on manipulating demand through false, misleading and manipulative advertising.

None of this being done because capitalists are evil people.

This happens because the rules of the capitalist game require it to happen. If another firm, lets say a paper mill, is avoiding the costs of cleaning the water used in production before returning it to the river, the competitor paper mill must do the same. Otherwise, their paper would cost much more and they would not survive in the marketplace. Without government, unions, and social groups setting the rules of the game with regard to “external costs” capitalist firms must cast off as many costs as possible. This is the simple inescapable law of capitalist competition.

The EPA is a favorite target of government bashing. Let’s look back to why the EPA was formed in 1970 by Republican President Nixon. Many readers are too young to have first hand knowledge of how widespread environmental pollution used to be.

From the Empire St building – photo by Neil Boenzi originally published in NYTimes.

New York City looked like this in 1966. That’s not fog, that is smog, a noxious pall of automobile exhaust and emissions from power plants, petro/chemical plants and others. These days you have to travel to Beijing and other places without an EPA to experience this first hand

Another example

Here is a comparative shot from Los Angeles – 1968 – 2005.

From: http://geoprojectgrp7.blogspot.com/2015/03/air-pollution-in-los-angeles-location.html

Rivers on Fire

Industry polluted water so badly that some burned. Here is a short documentary on the Cuyahoga River in Cleveland. It begins with a snip from Randy Newman’s song “Burn On”1 :

The catalog of capitalism’s inevitable sins is way too long for this brief piece. The breadth of the costs of this central feature is quite astonishing and in some perverse way, inventive. In recent years we have seen new forms of externalized costs unthought of earlier. Do a search on “farm waste pollution” or “chemical pollution” for more examples from our current situation.

You Eat the Next Cost Avoidance Every Day

Another cost that capitalists seek to reduce, or eliminate, is labor, wages and salaries. The food industry is a good example of where non-union, minority workers are exploited because no one will protect them from the cost avoiding behavior of the capitalist system. Without government protections capitalists will pay as low a wage as possible regardless of whether the wage allows workers to live a reasonable life, raise their families and educate their children. Capitalism is not concerned with how the human resources of society survive and reproduce the next generation of workers.

The food we eat every day is plentiful and comparatively inexpensive because the farms that grow it are largely outside the protections of fair labor and minimum wage laws. Many farm workers are undocumented migrant workers from Mexico and other countries to our South. “Annually, the average income of crop workers is between $10,000 to $12,499 for individuals and $15,000 to $17,499 for a family. To give you an idea, the federal poverty line is $10,830 for an individual or $22,050 for a family of four (in 2009). Thus, according to NAWS, 30% of all farm workers had total family incomes below the poverty line.”2 Many are migrants and therefore their children do not have stable school lives. 

This is not a new story. In 1960 Edward R. Morrow reported on this exploitation in one of the most famous documentaries of the TV history, Harvest of Shame. The facts today are only marginally better than 57 years ago.

Externalized costs, cost avoidance and shirking wherever possible are structural features of capitalism that people can and must control. Capitalism is structurally unable to control these outcomes. It has no capacity to see or react to the consequences of the actions of it participants. It requires perpetual mindless growth with no regard to any needs outside of its own needs. People and nature be damned.  With the present weakness of unions and other social forces, government is the tool. We must take the government back from the rich and corporations. Capitalism was created through the joint action of government and private entrepreneurs. It is not some ideal system, rather the result of struggle between various elements in society.  Its present structure is the result of more than forty years of political action by the rich and corporations furthering their ends. Time now for the vast majority to assert their needs to be expressed in the economy.

  1. audio of song here: https://youtu.be/VtW8RkI3-c4 []
  2. http://nfwm.org/education-center/farm-worker-issues/low-wages/ []

Congressman Faso’s Challenge

Today I received an email from Congressman Faso’s campaign committee. It read in part:

Friend,

The Democratic Congressional Campaign Committee (DCCC) today released a memo claiming Democrats are “starting the 2018 election cycle on offense.” This is an alarming statement on many levels. For one, they really do see the future of our nation as nothing more than a political game. They are also choosing to completely ignore the American people by not acknowledging the sweeping Republican victories from just two months ago.

The most worrisome item in the memo is that the DCCC listed my seat as a “Round One Target.” I was sworn in less than a month ago and already the Washington Establishment is targeting my district as one to pour hundreds of thousands of dollars into in order to install the liberal candidate of their choice.

The email then went on asking me to donate to his re-election campaign!

Here is my reply: Continue reading

Our Longest War – The War on Drugs – more data on its futility

I have noted here several times earlier about America’s longest war – the War on Drugs. Here is a graphic that displays the complete failure of our policies:1

drug-spending-v-addiction from Atlantic Monthly

 

  1. source: http://m.theatlanticwire.com/national/2012/10/chart-says-war-drugs-isnt-working/57913/ – this graphic came to my attemtion via the Colbert Report http://www.colbertnation.com/the-colbert-report-videos/425397/april-11-2013/america-s-pot-astrophe  []

The Health Care Debate Is About The Wrong Issues

The rhetoric about our health care system continues to center around market religions of one sort or another. For all of the blathering about “Obamacare” taking us over the edge into the territory of socialized medicine, it remains, like it’s progenitor dreamed up by Romney while governor of Massachusetts, a market focused policy. Even now Massachusetts is struggling to come up with policies to restrain the growth of costs to the rate of inflation plus 1%. At the national level it will be years before Obamacare can begin such considerations in real terms.

What is missing is a willingness by the political system to engage the undeniable truths about our health care system. Continue reading

America’s Longest War – a socio-political-military disaster – indicted by Global Commission on Drug Policy

Report of the Global Commission on Drug Policy

Last week this commission released its report,  “War on Drugs“. This once again brings into focus our longest war, Nixon’s War on Drugs. Here are the first two paragraphs from the executive summary:

The global war on drugs has failed, with devastating consequences for individuals and societies around the world. Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and 40 years after President Nixon launched the US government’s war on drugs, fundamental reforms in national and global drug control policies are urgently needed.

Vast expenditures on criminalization and repressive measures directed at producers, traffickers and consumers of illegal drugs have clearly failed to effectively curtail supply or consumption. Apparent victories in eliminating one source or trafficking organization are negated almost instantly by the emergence of other sources and traffickers. Repressive efforts directed at consumers impede public health measures to reduce HIV/AIDS, overdose fatalities and other harmful consequences of drug use. Government expenditures on futile supply reduction strategies and incarceration displace more cost-effective and evidence-based investments in demand and harm reduction.

Meanwhile the US War on Drugs grinds on and total Federal and state spending on this disaster will lurch over $35 Billion this year.

Extending Eisenhower’s Language

in his last speech as President, Eisenhower pointed to the “military-industrial complex” as a threat to the nation’s security and health. Since then, hisotry has added new layers of meaning and expanded the scope of this phrase. Today, we are in the thrall if not control of the Military-Industrial-Congressional-Executive-Spying-DrugWar-Complex. The War on Drugs has a record of failure and destructive outcomes now over 40 years old. Nevertheless, this behemoth roles along, getting bigger and more global in its reach every year. No Republicans or Democrats are willing to abandon the policies and rhetoric so cynically initiated by Nixon. Even this year of the so-called deficit debate, when Republicans and Democrats are willing to throw every bit of discretionary social or infrastructure spending under the bus, the War on Drugs (and every other element of the Military-Industrial-Congressional-Executive-Spying-DrugWar-Complex) is off limits.

Global Commission Recommendations

The executive summary continues(my highlighting):

Our principles and recommendations can be summarized as follows:

End the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others. Challenge rather than reinforce common misconceptions about drug markets, drug use and drug dependence.

Encourage experimentation by governments with models of legal regulation of drugs to undermine the power of organized crime and safeguard the health and security of their citizens. This recommendation applies especially to cannabis, but we also encourage other experiments in decriminalization and legal regulation that can accomplish these objectives and provide models for others.

Offer health and treatment services to those in need. Ensure that a variety of treatment modalities are available, including not just methadone and buprenorphine treatment but also the heroin-assisted treatment programs that have proven successful in many European countries and Canada. Implement syringe access and other harm reduction measures that have proven effective in reducing transmission of HIV and other blood-borne infections as well as fatal overdoses. Respect the human rights of people who use drugs. Abolish abusive practices carried out in the name of treatment – such as forced detention, forced labor, and physical or psychological abuse – that contravene human rights standards and norms or that remove the right to self-determination.

Apply much the same principles and policies stated above to people involved in the lower ends of illegal drug markets, such as farmers, couriers and petty sellers. Many are themselves victims of violence and intimidation or are drug dependent. Arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations. There appears to be almost no limit to the number of people willing to engage in such activities to better their lives, provide for their families, or otherwise escape poverty. Drug control resources are better directed elsewhere.

Invest in activities that can both prevent young people from taking drugs in the first place and also prevent those who do use drugs from developing more serious problems. Eschew simplistic ‘just say no’ messages and ‘zero tolerance’ policies in favor of educational efforts grounded in credible information and prevention programs that focus on social skills and peer influences. The most successful prevention efforts may be those targeted at specific at-risk groups.

Focus repressive actions on violent criminal organizations, but do so in ways that undermine their power and reach while prioritizing the reduction of violence and intimidation. Law enforcement efforts should focus not on reducing drug markets per se but rather on reducing their harms to individuals, communities and national security.

Begin the transformation of the global drug prohibition regime. Replace drug policies and strategies driven by ideology and political convenience with fiscally responsible policies and strategies grounded in science, health, security and human rights – and adopt appropriate criteria for their evaluation. Review the scheduling of drugs that has resulted in obvious anomalies like the flawed categorization of cannabis, coca leaf and MDMA. Ensure that the international conventions are interpreted and/or revised to accommodate robust experimentation with harm reduction, decriminalization and legal regulatory policies.

Break the taboo on debate and reform. The time for action is now.

Go to the website and read further. They provide case studies from around the world to illustrate their case for these principles and policies.

Charles M. Blow wrote an op-ed piece in the New York Times (6/11/2011) “Drug Bust“. It included the following graphics:

Einstein (Rita Mae Brown) Had Something To Say About This

Insanity: doing the same thing over and over again and expecting different results.

 

The Future of Healthcare??

I don’t generally pause long over the editorials in the NY Times. This morning’s caught my eye. As a recent state resident I watched the debate closely and supported the single payer approach. Since then the results have been interesting and as noted in the Time’s editorial generally good.

Here us the editorial:

Health Reform in Massachusetts
Last Updated: 11:18 PM EDT

Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.

Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.

Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Other significant accomplishments:

The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.

The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.

The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.

Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.

There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.

Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.

What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.

Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.

The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.

Just Another Cost of Doing Business? – Pfizer's $2.3 billion penalty and fine

Is $2.3 billion really a lot of money?

The Obama administration is touting the action taken this week against Pfizer for illegal promotion of several of its drugs. The $2.3 billion sounds like a lot of money to me, and I suspect most people. Is it really a lot of money or just an annoyance to a large company, just another cost of doing business?

Take a look at Pfizer’s Income and Balance Sheets (see their 2008 Financial Reports ) and a very clear picture appears. Pfizer had net incomes of $8.1 billion in 2008 and 2007 and a whopping $19.3 billion in 2006. They also have cash and short term investments (these are your well-known “quick assets” – meaning they are cash or near cash) on their balance sheets of $26 billion at the end of 2008. Now, look again at the $2.3 billion and the number looks quite different. To those who have watched the stream of pharmaceutical company ethical and legal transgressions over the years, this looks like a very manageable cost of doing business.