SocialistWorker.org
The U.S. spends more per capita on healthcare, but ranks last among developed countries in terms of quality, access, coordination, efficiency, equity, patient safety and healthy lives. The Obama health plan does little or nothing to deal with most of these problems and, in particular, does nothing to stop health costs in the U.S. from continuing to spiral out of control. --PG
U.S. scores dead last again in healthcare study
Source: Reuters
Wed, Jun 23 2010
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system, according to a report released on Wednesday.
The United States ranked last when compared to six other countries -- Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.
"As an American it just bothers me that with all of our know-how, all of our wealth, that we are not assuring that people who need healthcare can get it," Commonwealth Fund president Karen Davis told reporters in a telephone briefing.
Previous reports by the nonprofit fund, which conducts research into healthcare performance and promotes changes in the U.S. system, have been heavily used by policymakers and politicians pressing for healthcare reform.
Davis said she hoped health reform legislation passed in March would lead to improvements.
The current report uses data from nationally representative patient and physician surveys in seven countries in 2007, 2008, and 2009. It is available here
In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.
Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.
This is a big rise from the Fund's last similar survey, in 2007, which found Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product.
"We rank last on safety and do poorly on several dimensions of quality," Schoen told reporters. "We do particularly poorly on going without care because of cost. And we also do surprisingly poorly on access to primary care and after-hours care."
NETHERLANDS RANKED FIRST OVERALL
The report looks at five measures of healthcare -- quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.
Britain, whose nationalized healthcare system was widely derided by opponents of U.S. healthcare reform, ranks first in quality while the Netherlands ranked first overall on all scores, the Commonwealth team found.
U.S. patients with chronic conditions were the most likely to say they gotten the wrong drug or had to wait to learn of abnormal test results.
"The findings demonstrate the need to quickly implement provisions in the new health reform law," the report reads.
Critics of reports that show Europeans or Australians are healthier than Americans point to the U.S. lifestyle as a bigger factor than healthcare. Americans have higher rates of obesity than other developed countries, for instance.
"On the other hand, the other countries have higher rates of smoking," Davis countered. And Germany, for instance, has a much older population more prone to chronic disease.
Every other system covers all its citizens, the report noted and said the U.S. system, which leaves 46 million Americans or 15 percent of the population without health insurance, is the most unfair.
"The lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen," the report reads.
Sunday, June 27, 2010
Saturday, June 26, 2010
As I awake each morning in Detroit… I Can See Healthcare From Here
Via Healthcare-NOW!
DETROIT – As I wake each morning here in Detroit at the US Social Forum, I glance just a few hundred yards across the way, and I know people have healthcare without regard to financial or other barriers. And it hurts like hell to see the cars “over there” winding along the river inside Canada and know that as I sit here in my own nation, I am without the basic human right to healthcare just because I am an American.
The feeling I get every time I glance that direction is the same one I had when I was a patient in Cuba during the filming of SiCKO. I feel sick to my stomach with anger and sadness and wonder why I have spent the past 25 years of my life fighting for healthcare that in other nations – other rich nations and other poor nations – is long accepted as what people in a civilized society extend to and protect for one another.
I am gut-punched all over again. I want to curl up in a ball on the floor of my room and weep. I want to rage at the top of my lungs until the pain pours out somewhere else. I want to grab my husband and my kitty and a few of my old family photos and go where my life is valued enough to allow me to seek and receive care when we need it. Yes, I admit it. I am sick to death of the excuses for why we cannot extend healthcare to all without bankrupting folks, and I sometime dream of escape from it all.
At the US Social Forum, the potential to gather many voices and many forces together to move toward healthcare justice in this nation may or may not fully materialize. Sometimes the voices at the microphone calling for transformative health reform are as controlling and power-hungry as those who run the for-profit, medical-industrial complex. The loudest voices speak with officious verbiage and self-righteous certainty that can squeeze out the meek or those without the required activist pedigrees. In many movements for social change, there is an intricate power structure that can be hard to understand and even harder to accept.
Those of us who believe that the for-profit health care system – not just the for-profit health insurance industry – must be broken apart to save lives, to save homes, to save families and to save this nation, must get to the point where swimming to the other side of this profit-powered river of healthcare delivery and finally changing this awful, brutal mess means so much to us that we are willing to let it be a people’s movement not its own hierarchical system of political ineffectiveness. The mission must be getting to healthcare for everyone and not who gets us there. We have to throw it all in together if we are ever to change it.
The power of the medical-industrial complex in this nation is that the thieves stay in bed with each other against all forces that would break up their game. Providers simultaneously speak ill of insurance giants but then court the best contracts with them. Even providers who claim to want to see transformative change in the system sue patients into bankruptcy to collect deductibles after those lucrative contracts negotiated with insurance carriers leave some portion of the bill unpaid. It isn’t just their money and raw greed that buys influence over the system of political power, it’s also their intense loyalty to one another and codependence on the sources of their profit margins — not unlike how the mob operates. Break out of the fold, and they’ll break your knees.
And, sadly, thousands and thousands of those who even support single-payer reform in their non-working hours are beholden to the system for their healthy incomes and lifestyles many patients will never attain. It’s hard to trust someone whose collection agency is garnishing your wages when they try to say they aren’t an inside player in this mess with a vested interest in making changes that protect the money they must have to protect the style of living to which they have become so accustomed.
Too often in movements for huge social change – like the health reform movement – we get tied up in the process and who is running the show, which expert is expert enough and who is at the microphone speaking to the lowly, less articulate minions instead of hanging together against the forces that we seek to overthrow. This tragedy is a people’s tragedy, a patients’ tragedy, a least-among-us tragedy. If we won’t even value those voices in the process – if we believe the stories and the pain no longer matters – then we do not believe in the basic human right to anything.
I am not sure we can transform the healthcare system in this nation unless we first stand at the edge of the river looking over to healthcare as a basic human right on the other side and share deeply enough the rage and the pain and the frustration of our sisters and our brothers who have been hurting for so long. We must then become united against all forces that would divide us against the primary goal of achieving healthcare for all. We have to rage together against a system that has ravaged so many lives and robbed us of so much human potential along the way – and we must not rage against one another for not having the perfect approach or the perfect pedigree or the perfect PhD or MD or JD.
The river and a bridge are all that physically separate me today from healthcare as a basic human right and the travesty of healthcare as a privilege of the sufficiently privileged. But the river of social and political change that separates me from healthcare as a basic human right is potentially much more difficult to bridge, unless we embrace and lift all voices. Raising millions of voices for change requires valuing what those voices have to offer to the chorus. All voices in, no voices out.
I am sick to death of fighting this terrible system to secure healthcare for my husband and myself. That struggle has consumed much beyond our health and our meager wealth. I don’t ever again want to glance across the way and see relief and know it could have been ours in this nation if only we’d fought the right enemy.
DETROIT – As I wake each morning here in Detroit at the US Social Forum, I glance just a few hundred yards across the way, and I know people have healthcare without regard to financial or other barriers. And it hurts like hell to see the cars “over there” winding along the river inside Canada and know that as I sit here in my own nation, I am without the basic human right to healthcare just because I am an American.
The feeling I get every time I glance that direction is the same one I had when I was a patient in Cuba during the filming of SiCKO. I feel sick to my stomach with anger and sadness and wonder why I have spent the past 25 years of my life fighting for healthcare that in other nations – other rich nations and other poor nations – is long accepted as what people in a civilized society extend to and protect for one another.
I am gut-punched all over again. I want to curl up in a ball on the floor of my room and weep. I want to rage at the top of my lungs until the pain pours out somewhere else. I want to grab my husband and my kitty and a few of my old family photos and go where my life is valued enough to allow me to seek and receive care when we need it. Yes, I admit it. I am sick to death of the excuses for why we cannot extend healthcare to all without bankrupting folks, and I sometime dream of escape from it all.
At the US Social Forum, the potential to gather many voices and many forces together to move toward healthcare justice in this nation may or may not fully materialize. Sometimes the voices at the microphone calling for transformative health reform are as controlling and power-hungry as those who run the for-profit, medical-industrial complex. The loudest voices speak with officious verbiage and self-righteous certainty that can squeeze out the meek or those without the required activist pedigrees. In many movements for social change, there is an intricate power structure that can be hard to understand and even harder to accept.
Those of us who believe that the for-profit health care system – not just the for-profit health insurance industry – must be broken apart to save lives, to save homes, to save families and to save this nation, must get to the point where swimming to the other side of this profit-powered river of healthcare delivery and finally changing this awful, brutal mess means so much to us that we are willing to let it be a people’s movement not its own hierarchical system of political ineffectiveness. The mission must be getting to healthcare for everyone and not who gets us there. We have to throw it all in together if we are ever to change it.
The power of the medical-industrial complex in this nation is that the thieves stay in bed with each other against all forces that would break up their game. Providers simultaneously speak ill of insurance giants but then court the best contracts with them. Even providers who claim to want to see transformative change in the system sue patients into bankruptcy to collect deductibles after those lucrative contracts negotiated with insurance carriers leave some portion of the bill unpaid. It isn’t just their money and raw greed that buys influence over the system of political power, it’s also their intense loyalty to one another and codependence on the sources of their profit margins — not unlike how the mob operates. Break out of the fold, and they’ll break your knees.
And, sadly, thousands and thousands of those who even support single-payer reform in their non-working hours are beholden to the system for their healthy incomes and lifestyles many patients will never attain. It’s hard to trust someone whose collection agency is garnishing your wages when they try to say they aren’t an inside player in this mess with a vested interest in making changes that protect the money they must have to protect the style of living to which they have become so accustomed.
Too often in movements for huge social change – like the health reform movement – we get tied up in the process and who is running the show, which expert is expert enough and who is at the microphone speaking to the lowly, less articulate minions instead of hanging together against the forces that we seek to overthrow. This tragedy is a people’s tragedy, a patients’ tragedy, a least-among-us tragedy. If we won’t even value those voices in the process – if we believe the stories and the pain no longer matters – then we do not believe in the basic human right to anything.
I am not sure we can transform the healthcare system in this nation unless we first stand at the edge of the river looking over to healthcare as a basic human right on the other side and share deeply enough the rage and the pain and the frustration of our sisters and our brothers who have been hurting for so long. We must then become united against all forces that would divide us against the primary goal of achieving healthcare for all. We have to rage together against a system that has ravaged so many lives and robbed us of so much human potential along the way – and we must not rage against one another for not having the perfect approach or the perfect pedigree or the perfect PhD or MD or JD.
The river and a bridge are all that physically separate me today from healthcare as a basic human right and the travesty of healthcare as a privilege of the sufficiently privileged. But the river of social and political change that separates me from healthcare as a basic human right is potentially much more difficult to bridge, unless we embrace and lift all voices. Raising millions of voices for change requires valuing what those voices have to offer to the chorus. All voices in, no voices out.
I am sick to death of fighting this terrible system to secure healthcare for my husband and myself. That struggle has consumed much beyond our health and our meager wealth. I don’t ever again want to glance across the way and see relief and know it could have been ours in this nation if only we’d fought the right enemy.
Tuesday, June 22, 2010
Nader Wants Conyers, Kucinich to Move on Single Payer: #SinglePayer #HR676 #Solidarity
Single Payer News
Ralph Nader wants movement on single payer national health insurance.
And now.
Nader said that weeks ago, Congressmen John Conyers (D-Michigan) and Dennis Kucinich (D-Ohio) personally assured him that they would bring together the more than 80 professed House supporters of single payer and jump start the movement for HR 676 — the single payer bill in the House.
But so far, nothing.
Zippo.
Nada.
So, last week, a clearly irritated Nader wrote a letter to Conyers and Kucinich.
“In individual telephone conversations with each of you, I was given to understand that you responded clearly and affirmatively to my request that you relaunch the single payer movement in Congress at a news conference that you would sponsor with other House supporters of HR 676 and leading citizen group advocates of full Medicare for all with free choice of doctor and hospital—a much more efficient and humane system,” Nader wrote.
“These assurances were made several weeks ago, shortly after the vote to fix a broken system with a broken piece of legislation was sent to the White House.”
“You may recall I took note of the utter dismay of many people and groups who supported HR 676 only to be abandoned by all 80+ supporters. If you want to rescue withdrawal and political cynicism, you need to restart what you believe in.”
“Are you going to announce this news conference, since both of you assured me that you would be in touch with one another about so doing?” Nader asked.
Ralph Nader wants movement on single payer national health insurance.
And now.
Nader said that weeks ago, Congressmen John Conyers (D-Michigan) and Dennis Kucinich (D-Ohio) personally assured him that they would bring together the more than 80 professed House supporters of single payer and jump start the movement for HR 676 — the single payer bill in the House.
But so far, nothing.
Zippo.
Nada.
So, last week, a clearly irritated Nader wrote a letter to Conyers and Kucinich.
“In individual telephone conversations with each of you, I was given to understand that you responded clearly and affirmatively to my request that you relaunch the single payer movement in Congress at a news conference that you would sponsor with other House supporters of HR 676 and leading citizen group advocates of full Medicare for all with free choice of doctor and hospital—a much more efficient and humane system,” Nader wrote.
“These assurances were made several weeks ago, shortly after the vote to fix a broken system with a broken piece of legislation was sent to the White House.”
“You may recall I took note of the utter dismay of many people and groups who supported HR 676 only to be abandoned by all 80+ supporters. If you want to rescue withdrawal and political cynicism, you need to restart what you believe in.”
“Are you going to announce this news conference, since both of you assured me that you would be in touch with one another about so doing?” Nader asked.
Saturday, June 19, 2010
Humiliation and Shame: Part of Being Insured in America
By Donna Smith
Oh, the things we did not fix in the healthcare bill are shocking. Just as seniors falling into the Medicare drug benefit donut hole begin to get the $250 checks meant to calm their fears about our new healthcare legislation, the rest of us would do well to remember the abuses of the for-profit healthcare system that will continue and even accelerate in the coming years.
Health insurance is not health care. Health insurance is a financial product marketed and sold to protect health and wealth which may do neither thing very well. I view it as a defective product. Yet, very soon we will be buying more of it and helping more of our fellow Americans buy more of it with the subsidies that support the great health insurance bailout that is being called “patient protection.”
Yesterday, I went to the doctor for an appointment I waited weeks to secure. I am insured. I have what some would say is fairly good insurance from one of the for-profit insurance giants. I waited patiently in the waiting room, and then was escorted to the exam room. There was a flurry of activity around me. A thorough history was taken. X-rays were taken. The nurse said, “Oh, honey, are you in pain? Those X-rays show some pretty awful deformity.” I said I have been hurting for years but that I have waited until I could stand no more to seek treatment. Most of the time I take large amounts of OTC anti-inflammatory medication and muddle through. It’s the American way. It’s the insured American’s way. It’s the working, insured American’s way.
The doctor buzzed in rather quickly and began discussing a treatment plan with me. Some immediate care to relieve some of the pain, and some longer term non-invasive care to see if we could avoid surgery. I was hopeful and thrilled though a bit worried about how it would feel to get shots in the joints of my feet to help the heel spurs and the bone pain. I’ve had shots in my knees, and it isn’t fun.
Suddenly, as quickly as I had felt the anticipation of some relief, the flurry of activity ground to a halt. The doctor left the room. Another office person came in. She said, “I’m sorry Ms. Smith. Your insurance will not cover what the doctor wants to try.” Matter of fact. She’s said these words before – many times. I ask how much it would cost to pay for it myself. She answers. I cannot pay that much. The visit is ending. The hope is shriveling.
I could feel the muscles in my face tense as the humiliation spread through my body. This body, just moments ago worthy of plans to relieve pain and head for some better health, now was deemed unworthy of care. Shame. All that old shame I used to feel before our medical bankruptcy was rising in my gut. It hurt so badly. But I was determined not to show my anger or my sadness.
The doctor wandered by the room and saw me. He stepped in and gave me some soft inserts for my shoes. He said they won’t help much or for long, but that maybe it would be a little relief. He must have seen the look on my face and felt at least a little compassion. A little. I thanked him. But I could say little else, and I could not look him in the eye. I felt so ashamed, and I don’t even really understand why I’ve been so conditioned as a patient to feel it is my failure when these things happen.
On the way home, I alternated between sadness and anger. Clearly someone wasn’t being honest with me. Either the treatments this doctor was suggesting really aren’t a good idea (as the insurance company’s denial to pay would lead one to believe) and therefore are not approved for coverage or the insurance company just wants to push those costs onto patients who cannot usually afford them. Either way, I didn’t get the care I needed. Either way, I left hurting. Either way, I lose. The doctor made some money on the office visit and my co-pay at least. The insurance company avoided paying for anything beyond that.
My husband sat beside me in the car, sad and angry for me. As a person covered under one of our nation’s single-payer programs and a supplemental private policy, he has never heard the words I heard – he has never been denied care. He felt helpless for me. As I cried tears of rage, he sat silently.
And, so, how will any of this change under the new healthcare bill? It won’t. In fact, the pressure for insurance companies to deny more care will grow as they are compelled by law to take more people who have pre-existing conditions like having feet. Cherry picking the healthiest folks will require a bit more skillful contortions for the for-profit insurance companies, and doctors will leave more patients sitting on the edge of exam tables like naughty little children who do not deserve to be treated.
Healthcare is a basic human right in most of the rest of the modern world. Only in this nation do we believe that only the richest people deserve the best of care. It’s a wild twist on the old Bible lesson about it being tougher for a rich man to get to heaven than for a camel to get through the eye of a needle. We’ve made it harder for a working person or a poor person to get healthcare in America than for a rich man to get to heaven. We are a sick society indeed. No Golden Rule values herein.
Only when we finally decide that we believe in a compassionate and just healthcare system for all will we ever have the courage to change it. Right now we just don’t believe in that sort of system at all. As a patient, I am fodder. At least this morning I was able to turn my outrage back on the system that left me in that exam room alone and sucking back tears of anger. No one should go to a doctor to seek care and leave less well. That’s cruel and unusual.
I was raised to have more compassion than this for my fellow human beings, and I think most Americans were raised with similar values. How in the world did we get to a place where we participate in doing this to one another? Is this the system we want to leave to our children? Do you want to leave your child lacking care when he or she needs it? Your grandchild? Then, for heaven’s sake — for heaven’s sake — stand up and let’s get back to work to fix this mess. There is much to be done.
Oh, the things we did not fix in the healthcare bill are shocking. Just as seniors falling into the Medicare drug benefit donut hole begin to get the $250 checks meant to calm their fears about our new healthcare legislation, the rest of us would do well to remember the abuses of the for-profit healthcare system that will continue and even accelerate in the coming years.
Health insurance is not health care. Health insurance is a financial product marketed and sold to protect health and wealth which may do neither thing very well. I view it as a defective product. Yet, very soon we will be buying more of it and helping more of our fellow Americans buy more of it with the subsidies that support the great health insurance bailout that is being called “patient protection.”
Yesterday, I went to the doctor for an appointment I waited weeks to secure. I am insured. I have what some would say is fairly good insurance from one of the for-profit insurance giants. I waited patiently in the waiting room, and then was escorted to the exam room. There was a flurry of activity around me. A thorough history was taken. X-rays were taken. The nurse said, “Oh, honey, are you in pain? Those X-rays show some pretty awful deformity.” I said I have been hurting for years but that I have waited until I could stand no more to seek treatment. Most of the time I take large amounts of OTC anti-inflammatory medication and muddle through. It’s the American way. It’s the insured American’s way. It’s the working, insured American’s way.
The doctor buzzed in rather quickly and began discussing a treatment plan with me. Some immediate care to relieve some of the pain, and some longer term non-invasive care to see if we could avoid surgery. I was hopeful and thrilled though a bit worried about how it would feel to get shots in the joints of my feet to help the heel spurs and the bone pain. I’ve had shots in my knees, and it isn’t fun.
Suddenly, as quickly as I had felt the anticipation of some relief, the flurry of activity ground to a halt. The doctor left the room. Another office person came in. She said, “I’m sorry Ms. Smith. Your insurance will not cover what the doctor wants to try.” Matter of fact. She’s said these words before – many times. I ask how much it would cost to pay for it myself. She answers. I cannot pay that much. The visit is ending. The hope is shriveling.
I could feel the muscles in my face tense as the humiliation spread through my body. This body, just moments ago worthy of plans to relieve pain and head for some better health, now was deemed unworthy of care. Shame. All that old shame I used to feel before our medical bankruptcy was rising in my gut. It hurt so badly. But I was determined not to show my anger or my sadness.
The doctor wandered by the room and saw me. He stepped in and gave me some soft inserts for my shoes. He said they won’t help much or for long, but that maybe it would be a little relief. He must have seen the look on my face and felt at least a little compassion. A little. I thanked him. But I could say little else, and I could not look him in the eye. I felt so ashamed, and I don’t even really understand why I’ve been so conditioned as a patient to feel it is my failure when these things happen.
On the way home, I alternated between sadness and anger. Clearly someone wasn’t being honest with me. Either the treatments this doctor was suggesting really aren’t a good idea (as the insurance company’s denial to pay would lead one to believe) and therefore are not approved for coverage or the insurance company just wants to push those costs onto patients who cannot usually afford them. Either way, I didn’t get the care I needed. Either way, I left hurting. Either way, I lose. The doctor made some money on the office visit and my co-pay at least. The insurance company avoided paying for anything beyond that.
My husband sat beside me in the car, sad and angry for me. As a person covered under one of our nation’s single-payer programs and a supplemental private policy, he has never heard the words I heard – he has never been denied care. He felt helpless for me. As I cried tears of rage, he sat silently.
And, so, how will any of this change under the new healthcare bill? It won’t. In fact, the pressure for insurance companies to deny more care will grow as they are compelled by law to take more people who have pre-existing conditions like having feet. Cherry picking the healthiest folks will require a bit more skillful contortions for the for-profit insurance companies, and doctors will leave more patients sitting on the edge of exam tables like naughty little children who do not deserve to be treated.
Healthcare is a basic human right in most of the rest of the modern world. Only in this nation do we believe that only the richest people deserve the best of care. It’s a wild twist on the old Bible lesson about it being tougher for a rich man to get to heaven than for a camel to get through the eye of a needle. We’ve made it harder for a working person or a poor person to get healthcare in America than for a rich man to get to heaven. We are a sick society indeed. No Golden Rule values herein.
Only when we finally decide that we believe in a compassionate and just healthcare system for all will we ever have the courage to change it. Right now we just don’t believe in that sort of system at all. As a patient, I am fodder. At least this morning I was able to turn my outrage back on the system that left me in that exam room alone and sucking back tears of anger. No one should go to a doctor to seek care and leave less well. That’s cruel and unusual.
I was raised to have more compassion than this for my fellow human beings, and I think most Americans were raised with similar values. How in the world did we get to a place where we participate in doing this to one another? Is this the system we want to leave to our children? Do you want to leave your child lacking care when he or she needs it? Your grandchild? Then, for heaven’s sake — for heaven’s sake — stand up and let’s get back to work to fix this mess. There is much to be done.
Sunday, June 13, 2010
(ESRA): The Environmental and Social Responsibility Amendment to the U.S. Constitution
(as proposed by Rabbi Michael Lerner and Peter Gabel and advanced through the work of The Network of Spiritual Progressives)
The intent of the framers of this Amendment is to:
a. Protect the planet and its inhabitants from environmentally destructive behavior and economic arrangements, and to increase environmental responsibility on the part of all corporations and government bodies.
b. Increase U.S. citizens’ democratic control over American economic and political institutions and ensure that all people, regardless of income, have the same electoral clout and power to shape policies and programs.
c. Promote the well-being of citizens of the United States by recognizing that our well-being depends on the well-being of the planet and all its inhabitants, which in turn requires an end to poverty, wars, and violence, and the rise of a new global ethic of genuine caring and interdependence.
Article One: The Pro-Democracy Clause
A. The First & Fourteenth Amendment to the U.S. Constitution shall apply only to human beings, and not corporations, limited liability associations, and other artificial entities created by the laws of the United States.
B. Money or other currency shall not be considered a form of speech within the meaning of the First Amendment to the Constitution, and its expenditure is subject to egulation by the Congress and by the legislatures of the several States.
C. Congress shall regulate the amount of money used to disseminate ideas or shape public opinion in any federal election in order to assure that all major points of view regarding issues and candidates receive equal exposure to the greatest extent possible. Congress shall fund all major candidates for the House, Senate and Presidency in all major elections.
D. In the three months prior to any election for a federal position, all media or any other means of mass communication reaching more than 300,000 people shall provide equal time to all major presidential candidates to present their views for at least an hour at least once a week, and equal time once every two weeks for congressional candidates during that media agency’s prime time. The candidates shall determine the form and content of that communication. During the three months prior to an election, no candidate, no political party, and no organization seeking to influence public policy may buy time in any media or form of mass communication or any other form of mass advertising including on the Internet. Major candidates shall be defined as:
a. those who have at least 5% of support as judged by the average of at least ten independent polling firms, at least two of which are selected by the candidates deemed "not major," 3 months before any given election,
b. or any candidate who can collect the signatures of 5% of the number of people who voted in the election for that office the last time that office was contestedin an election. These petitions can only be signed by people eligible to vote in the relevant electoral districts. Every state shall be instructed to develop similar provisions aimed at allowing candidates for the governor and state legislatures to be freed from their dependence on wealthy donors.
Article Two: Corporate Environmental and Social Responsibility
A. Every citizen of the United States and every organization chartered by the U.S. or any of its several states shall have a responsibility to promote the ethical, environmental, and social well-being of all life on the planet Earth. This being so, corporations chartered by the Congress and by the several States shall demonstrate the ethical, environmental, and social impact of their proposed activities at the time they seek permission to operate. In addition, any corporation with gross receipts in excess of $100 million shall obtain a new corporate charter every five years, and this charter shall be granted only if the corporation can prove a satisfactory history of environmental, social, and ethical responsibility to a grand jury of ordinary citizens. Factors to be considered by the grand jury in determining whether a corporation will be granted a charter shall include but not be limited to:
1. The degree to which the products produced or services provided are beneficial rather than destructive to the planet and its oceans, forests, water supplies, land, and air, and the degree to which its decisions help ensure that the resources of the earth are available to future generations.
2. The degree to which it pays a living wage to all and arranges its pay scale such that none of its employees or contractors earn more than ten times the wages of its lowest full-time wage earners; the degree to which it provides equal benefits including health care, child care, retirement pensions, sick pay, and vacation time to all employees; and the degree to which its employees enjoy satisfactory safety and health conditions.
3. The degree to which it supports the needs of the communities in which it operates and in which its employees live, including the degree to which it resists the temptation to move assets or jobs to other locations where it can pay workers less or provide weaker environmental and worker protections.
4. The degree to which it encourages significant democratic participation by all its employees in corporate decision making; the degree to which it discloses to its employees and investors and the public its economic situation, the factors shaping its past decisions, and its attempts to influence public discourse, and the degree to which it follows democratic procedures internally
5. The degree to which it treats its employees, its customers, and the people and communities in which it operates with adequate respect and genuine caring for their well-being, and rewards its employees to the extent that they engage in behaviors that manifest genuine caring, respect, kindness, generosity, and ethical and environ-mentally sensitive practices.
6. The degree to which its investment decisions enhance and promote the economic, social, and ethical welfare of the communities in which its products may be produced, sold, or advertised and/or the communities from which it draws raw materials.
If the grand jury is not satisfied with the level of environmental, social, and ethical responsibility, it may put the corporation on probation and prescribe specific changes needed. If after three more years the jury is not satisfied that those changes have been adequately implemented, the jury may assign control of the board and officers of the corporation to non-management employees of the corporation and/or to its public stakeholders and/or to another group of corporate directors and managers who seem most likely to successfully implement the changes required by the jury, but with the condition that this new board must immediately implement the changes called for by the jury within two years time.
B Any government office or project receiving government funds that seeks to engage ln a contract (with any other corporation or limited liability entity) involving the expenditure of over $100,000 (adjusted annually for inflation) shall require that those who apply to fulfill that contract submit an Environmental and Social Responsibility Impact Report to assess the applicant’s corporate behavior in regard to the factors listed above in point A of Article II. Community stakeholders and non-supervisory employees may also submit their own assessment by filling out the Environment and Social Responsibility Impact Report. Contracts shall be rewarded to the applicant with the best record of environmental and social responsibility that can also satisfactorily fulfill the other terms of the contract.
Article Three: The Positive Requirement to Enhance Human Community and Environmental Sustainability
A. Earth being the natural and sacred home of all its peoples, Congress shall develop legislation to enhance the environmental sustainability of human communities and the planet Earth, and shall present a report annually to the American people on progress made during the previous year in ameliorating any conditions deemed by an independent group of scientists to be adverse to the planet’s long-term environmental welfare. The objectives of such legislation shall include but not be limited to alleviating global warming, reducing all forms of pollution, restoring the ecological balance of the oceans, and assuring the well-being of all forests and animal life. The President of the United States shall have the obligation to enforce such legislation and to develop executive policies to assure the carrying out of its objectives.
B. In order to prepare the people of the United States to live as environmentally and socially responsible citizens of the world, and to recognize that our own well being as citizens of the United States depends upon the well being of everyone else on Earth and the well being of this planet itself, every educational institution receiving federal funds whether directly or through the several states, shall provide education in reading, writing and basic arithmetic, and appropriate instruction including at least one required course per year per grade level from kindergarten through 12th grade, to all of its students in:
1. the skills and capacities necessary to develop a caring society manifesting love, generosity, kindness, joy, rational and scientific thinking, non-violence, celebration, thanksgiving, forgiveness, humility, ethical and ecological sensivity, appreciation of humanity’s rich multicultural heritage as expressed in literature, art, music, religion, and philosophy
2. the appropriate scientific, ethical, and behavioral knowledge and skills required to assure the long term environmental sustainability of the planet Earth, and to do so in ways that enhance the well being of everyone on the planet, and
3. The measurement of student progress in the areas covered by sections 1 and 2 being, like artistic and musical skills, difficult or impossible to measure by quantitative criteria, educational institutions supported directly or indirectly by public funds shall develop subtle and appropriate qualitative ways of evaluating adequate progress on the part of students in the areas specified, ways that contribute to and not detract from students’ ability to love learning and to enhance their capacities to cooperate rather than compete ith their fellow students in the process of intellectual and emotional growth. Teachers shall be funded to learn the skills described in points A and B and the methods of evaluation
appropriate to this kind of values-oriented subject matter.
The intent of the framers of this Amendment is to:
a. Protect the planet and its inhabitants from environmentally destructive behavior and economic arrangements, and to increase environmental responsibility on the part of all corporations and government bodies.
b. Increase U.S. citizens’ democratic control over American economic and political institutions and ensure that all people, regardless of income, have the same electoral clout and power to shape policies and programs.
c. Promote the well-being of citizens of the United States by recognizing that our well-being depends on the well-being of the planet and all its inhabitants, which in turn requires an end to poverty, wars, and violence, and the rise of a new global ethic of genuine caring and interdependence.
Article One: The Pro-Democracy Clause
A. The First & Fourteenth Amendment to the U.S. Constitution shall apply only to human beings, and not corporations, limited liability associations, and other artificial entities created by the laws of the United States.
B. Money or other currency shall not be considered a form of speech within the meaning of the First Amendment to the Constitution, and its expenditure is subject to egulation by the Congress and by the legislatures of the several States.
C. Congress shall regulate the amount of money used to disseminate ideas or shape public opinion in any federal election in order to assure that all major points of view regarding issues and candidates receive equal exposure to the greatest extent possible. Congress shall fund all major candidates for the House, Senate and Presidency in all major elections.
D. In the three months prior to any election for a federal position, all media or any other means of mass communication reaching more than 300,000 people shall provide equal time to all major presidential candidates to present their views for at least an hour at least once a week, and equal time once every two weeks for congressional candidates during that media agency’s prime time. The candidates shall determine the form and content of that communication. During the three months prior to an election, no candidate, no political party, and no organization seeking to influence public policy may buy time in any media or form of mass communication or any other form of mass advertising including on the Internet. Major candidates shall be defined as:
a. those who have at least 5% of support as judged by the average of at least ten independent polling firms, at least two of which are selected by the candidates deemed "not major," 3 months before any given election,
b. or any candidate who can collect the signatures of 5% of the number of people who voted in the election for that office the last time that office was contestedin an election. These petitions can only be signed by people eligible to vote in the relevant electoral districts. Every state shall be instructed to develop similar provisions aimed at allowing candidates for the governor and state legislatures to be freed from their dependence on wealthy donors.
Article Two: Corporate Environmental and Social Responsibility
A. Every citizen of the United States and every organization chartered by the U.S. or any of its several states shall have a responsibility to promote the ethical, environmental, and social well-being of all life on the planet Earth. This being so, corporations chartered by the Congress and by the several States shall demonstrate the ethical, environmental, and social impact of their proposed activities at the time they seek permission to operate. In addition, any corporation with gross receipts in excess of $100 million shall obtain a new corporate charter every five years, and this charter shall be granted only if the corporation can prove a satisfactory history of environmental, social, and ethical responsibility to a grand jury of ordinary citizens. Factors to be considered by the grand jury in determining whether a corporation will be granted a charter shall include but not be limited to:
1. The degree to which the products produced or services provided are beneficial rather than destructive to the planet and its oceans, forests, water supplies, land, and air, and the degree to which its decisions help ensure that the resources of the earth are available to future generations.
2. The degree to which it pays a living wage to all and arranges its pay scale such that none of its employees or contractors earn more than ten times the wages of its lowest full-time wage earners; the degree to which it provides equal benefits including health care, child care, retirement pensions, sick pay, and vacation time to all employees; and the degree to which its employees enjoy satisfactory safety and health conditions.
3. The degree to which it supports the needs of the communities in which it operates and in which its employees live, including the degree to which it resists the temptation to move assets or jobs to other locations where it can pay workers less or provide weaker environmental and worker protections.
4. The degree to which it encourages significant democratic participation by all its employees in corporate decision making; the degree to which it discloses to its employees and investors and the public its economic situation, the factors shaping its past decisions, and its attempts to influence public discourse, and the degree to which it follows democratic procedures internally
5. The degree to which it treats its employees, its customers, and the people and communities in which it operates with adequate respect and genuine caring for their well-being, and rewards its employees to the extent that they engage in behaviors that manifest genuine caring, respect, kindness, generosity, and ethical and environ-mentally sensitive practices.
6. The degree to which its investment decisions enhance and promote the economic, social, and ethical welfare of the communities in which its products may be produced, sold, or advertised and/or the communities from which it draws raw materials.
If the grand jury is not satisfied with the level of environmental, social, and ethical responsibility, it may put the corporation on probation and prescribe specific changes needed. If after three more years the jury is not satisfied that those changes have been adequately implemented, the jury may assign control of the board and officers of the corporation to non-management employees of the corporation and/or to its public stakeholders and/or to another group of corporate directors and managers who seem most likely to successfully implement the changes required by the jury, but with the condition that this new board must immediately implement the changes called for by the jury within two years time.
B Any government office or project receiving government funds that seeks to engage ln a contract (with any other corporation or limited liability entity) involving the expenditure of over $100,000 (adjusted annually for inflation) shall require that those who apply to fulfill that contract submit an Environmental and Social Responsibility Impact Report to assess the applicant’s corporate behavior in regard to the factors listed above in point A of Article II. Community stakeholders and non-supervisory employees may also submit their own assessment by filling out the Environment and Social Responsibility Impact Report. Contracts shall be rewarded to the applicant with the best record of environmental and social responsibility that can also satisfactorily fulfill the other terms of the contract.
Article Three: The Positive Requirement to Enhance Human Community and Environmental Sustainability
A. Earth being the natural and sacred home of all its peoples, Congress shall develop legislation to enhance the environmental sustainability of human communities and the planet Earth, and shall present a report annually to the American people on progress made during the previous year in ameliorating any conditions deemed by an independent group of scientists to be adverse to the planet’s long-term environmental welfare. The objectives of such legislation shall include but not be limited to alleviating global warming, reducing all forms of pollution, restoring the ecological balance of the oceans, and assuring the well-being of all forests and animal life. The President of the United States shall have the obligation to enforce such legislation and to develop executive policies to assure the carrying out of its objectives.
B. In order to prepare the people of the United States to live as environmentally and socially responsible citizens of the world, and to recognize that our own well being as citizens of the United States depends upon the well being of everyone else on Earth and the well being of this planet itself, every educational institution receiving federal funds whether directly or through the several states, shall provide education in reading, writing and basic arithmetic, and appropriate instruction including at least one required course per year per grade level from kindergarten through 12th grade, to all of its students in:
1. the skills and capacities necessary to develop a caring society manifesting love, generosity, kindness, joy, rational and scientific thinking, non-violence, celebration, thanksgiving, forgiveness, humility, ethical and ecological sensivity, appreciation of humanity’s rich multicultural heritage as expressed in literature, art, music, religion, and philosophy
2. the appropriate scientific, ethical, and behavioral knowledge and skills required to assure the long term environmental sustainability of the planet Earth, and to do so in ways that enhance the well being of everyone on the planet, and
3. The measurement of student progress in the areas covered by sections 1 and 2 being, like artistic and musical skills, difficult or impossible to measure by quantitative criteria, educational institutions supported directly or indirectly by public funds shall develop subtle and appropriate qualitative ways of evaluating adequate progress on the part of students in the areas specified, ways that contribute to and not detract from students’ ability to love learning and to enhance their capacities to cooperate rather than compete ith their fellow students in the process of intellectual and emotional growth. Teachers shall be funded to learn the skills described in points A and B and the methods of evaluation
appropriate to this kind of values-oriented subject matter.
Saturday, June 5, 2010
In Canada: Public health care as sustainable as we want it to be
Claim that medicare is too costly to maintain is based on economic and political myths
There are stark and unpalatable choices that we face with respect to health care, but there is no magic solution. We absolutely must have an adult debate about how we deal with this.” That’s what David Dodge, former governor of the Bank of Canada and former deputy finance minister, told the Liberal policy conference last March.
Dodge joined a list of economists and other pundits who predict that public health care will be financially unsustainable in coming years as Canada faces an aging population and escalating costs for scientific advances in care and treatment. But an “adult debate” on the sustainability of public health care must start from who and what drives health-care spending.
It’s true that total health-care spending in Canada has risen in recent years, taking larger shares of both government revenues and budget allocations. This has led to accusations of “crowding out” other public programs by those favouring further privatization of health care.
The data tell a much more nuanced story. The central fact is that, recession years apart, medicare spending — hospitals and physicians’ services — has fluctuated between 4 per cent and 5 per cent of gross domestic product since 1975. After the introduction of medicare in the late 1960s these costs stabilized because universal, comprehensive coverage consolidated expenditures in the hands of a single payer. The cost of health services not covered by medicare has risen from 3 per cent of GDP in 1975 to 7 per cent in 2009.
Today, Canada’s expenditures on health care match those by other OECD countries. The public share of overall health costs in Canada is relatively low for high-income OECD countries, around 70 per cent. Private insurance, primarily for prescription drugs and dentistry, now accounts for 12.7 per cent of Canadian health spending, 14th highest in the world. The OECD outlier is the United States, where extensive private finance supports uncontrollable cost escalation (now over 16 per cent of GDP). Getting these costs under control will be the major task facing Obama’s health-care reform.
Provincial governments’ spending on health care over the past 15 years has taken increasingly larger bites out of their expenditure budgets. But this is a simple consequence of large cuts in non-health programs, not of out-of-control medicare spending. These cuts in non-health spending are traceable to substantial cuts in personal and corporate income taxes by the federal and most provincial governments, particularly since 1997. Between 1997 and 2004, these tax cuts removed an estimated $170.8 billion from public sector revenues. Total provincial revenues are by now roughly $35 billion per year less, or about half provincial spending on medicare. Cumulative federal cuts are at least as large.
The provinces’ revenue shortfalls were not all self-inflicted. The federal government’s large cuts in financial transfers since the mid-1990s also left big holes in provincial budgets. Subsequent increases have not fully made up the loss.
What are the real motives behind the claims of financial unsustainability? Two, I think. First, under Canada’s universal tax-financed medicare, higher-income people contribute proportionately more to supporting the health-care system, without receiving preferred access or a higher standard of care. Any shift to more private financing would reduce the relative burden on those with higher incomes and offer (real or perceived) better or more timely care for those willing and able to pay.
Second, every dollar of health-care expenditures is also a dollar of someone’s income. The Ontario government’s recent change in reimbursement for generic drugs made this clear: the shares of Shoppers’ Drug Mart fell 10 per cent overnight. Privatization is a way to avoid cost containment, reopening greater income opportunities for providers of care (and private insurers) outside public control. Expenditures would accordingly rise, as in the United States, but public budgets might (in the short term) be contained. “Unsustainable” public spending magically becomes sustainable when shifted from taxpayers to patients.
It is time, long past time, for an “adult conversation” about these motivations, and for a clear identification of the winners and losers from eroding or dismantling medicare. (Economists who evade this issue should be shamed.)
But it is also time for an adult conversation about the real drivers of cost escalation. Researchers have known for decades that population aging is a real but a minor factor. Its impact will certainly increase, but it will remain secondary to increases in intensity and costliness of care. This is the real issue. Where is the money going, both public and private, and are we getting value? Again the Ontario generic drug initiative makes the point. Rising expenditures are not a law of nature; several hundred millions will be cut at a stroke. The real issue is political; those millions are also cut from pharmacy’ incomes.
Are there other opportunities? Yes. Medical imaging and laboratory testing are currently the major sources of cost escalation. What are the benefits? No one knows. Ultrasound for low-risk pregnancies is up 50 per cent in 10 years. Why? Patterns of medical practice and hospital use vary widely across the country, for no apparent reason. Toronto’s Institute for Clinical Evaluative Science, among others, has tracked some of these large unexplained variations, but they are largely ignored. These are what we need to discuss, not “stark choices” about relieving the burdens on and improving the benefits for high-income taxpayers — and, incidentally, opening new markets for private insurers. Panic-mongering about a “grey tsunami” is simply a distraction.
Canadians consistently show that they support public health care. In May, a national poll by Nanos Research confirmed that 90 per cent of Canadians feel that health care is the most important national issue, and almost 90 per cent support public solutions to problems in the health-care system. They are right. Canada’s health-care system is as sustainable as we want it to be.
Robert G. Evans is a member of UBC’s university’s Centre for Health Services and Policy Research. He is an officer of the Order of Canada, and a fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences.
There are stark and unpalatable choices that we face with respect to health care, but there is no magic solution. We absolutely must have an adult debate about how we deal with this.” That’s what David Dodge, former governor of the Bank of Canada and former deputy finance minister, told the Liberal policy conference last March.
Dodge joined a list of economists and other pundits who predict that public health care will be financially unsustainable in coming years as Canada faces an aging population and escalating costs for scientific advances in care and treatment. But an “adult debate” on the sustainability of public health care must start from who and what drives health-care spending.
It’s true that total health-care spending in Canada has risen in recent years, taking larger shares of both government revenues and budget allocations. This has led to accusations of “crowding out” other public programs by those favouring further privatization of health care.
The data tell a much more nuanced story. The central fact is that, recession years apart, medicare spending — hospitals and physicians’ services — has fluctuated between 4 per cent and 5 per cent of gross domestic product since 1975. After the introduction of medicare in the late 1960s these costs stabilized because universal, comprehensive coverage consolidated expenditures in the hands of a single payer. The cost of health services not covered by medicare has risen from 3 per cent of GDP in 1975 to 7 per cent in 2009.
Today, Canada’s expenditures on health care match those by other OECD countries. The public share of overall health costs in Canada is relatively low for high-income OECD countries, around 70 per cent. Private insurance, primarily for prescription drugs and dentistry, now accounts for 12.7 per cent of Canadian health spending, 14th highest in the world. The OECD outlier is the United States, where extensive private finance supports uncontrollable cost escalation (now over 16 per cent of GDP). Getting these costs under control will be the major task facing Obama’s health-care reform.
Provincial governments’ spending on health care over the past 15 years has taken increasingly larger bites out of their expenditure budgets. But this is a simple consequence of large cuts in non-health programs, not of out-of-control medicare spending. These cuts in non-health spending are traceable to substantial cuts in personal and corporate income taxes by the federal and most provincial governments, particularly since 1997. Between 1997 and 2004, these tax cuts removed an estimated $170.8 billion from public sector revenues. Total provincial revenues are by now roughly $35 billion per year less, or about half provincial spending on medicare. Cumulative federal cuts are at least as large.
The provinces’ revenue shortfalls were not all self-inflicted. The federal government’s large cuts in financial transfers since the mid-1990s also left big holes in provincial budgets. Subsequent increases have not fully made up the loss.
What are the real motives behind the claims of financial unsustainability? Two, I think. First, under Canada’s universal tax-financed medicare, higher-income people contribute proportionately more to supporting the health-care system, without receiving preferred access or a higher standard of care. Any shift to more private financing would reduce the relative burden on those with higher incomes and offer (real or perceived) better or more timely care for those willing and able to pay.
Second, every dollar of health-care expenditures is also a dollar of someone’s income. The Ontario government’s recent change in reimbursement for generic drugs made this clear: the shares of Shoppers’ Drug Mart fell 10 per cent overnight. Privatization is a way to avoid cost containment, reopening greater income opportunities for providers of care (and private insurers) outside public control. Expenditures would accordingly rise, as in the United States, but public budgets might (in the short term) be contained. “Unsustainable” public spending magically becomes sustainable when shifted from taxpayers to patients.
It is time, long past time, for an “adult conversation” about these motivations, and for a clear identification of the winners and losers from eroding or dismantling medicare. (Economists who evade this issue should be shamed.)
But it is also time for an adult conversation about the real drivers of cost escalation. Researchers have known for decades that population aging is a real but a minor factor. Its impact will certainly increase, but it will remain secondary to increases in intensity and costliness of care. This is the real issue. Where is the money going, both public and private, and are we getting value? Again the Ontario generic drug initiative makes the point. Rising expenditures are not a law of nature; several hundred millions will be cut at a stroke. The real issue is political; those millions are also cut from pharmacy’ incomes.
Are there other opportunities? Yes. Medical imaging and laboratory testing are currently the major sources of cost escalation. What are the benefits? No one knows. Ultrasound for low-risk pregnancies is up 50 per cent in 10 years. Why? Patterns of medical practice and hospital use vary widely across the country, for no apparent reason. Toronto’s Institute for Clinical Evaluative Science, among others, has tracked some of these large unexplained variations, but they are largely ignored. These are what we need to discuss, not “stark choices” about relieving the burdens on and improving the benefits for high-income taxpayers — and, incidentally, opening new markets for private insurers. Panic-mongering about a “grey tsunami” is simply a distraction.
Canadians consistently show that they support public health care. In May, a national poll by Nanos Research confirmed that 90 per cent of Canadians feel that health care is the most important national issue, and almost 90 per cent support public solutions to problems in the health-care system. They are right. Canada’s health-care system is as sustainable as we want it to be.
Robert G. Evans is a member of UBC’s university’s Centre for Health Services and Policy Research. He is an officer of the Order of Canada, and a fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences.
Tuesday, June 1, 2010
After the Reform: Aiming High for Health Justice
By Margaret Flowers, M.D. for Tikkun Magazine
As we sit here on the other side of the recent health reform process, we have an opportunity for reflection. There were many times during the past year and a half when passage of a health bill seemed unlikely. However, in the end, the White House and Democratic leadership joined forces and converted the last holdouts with scare tactics of electoral turnovers and even a trip on Air Force One in order to muscle a bill over the final hurdles. The mere fact that any bill was passed at all was hailed as the great accomplishment, because no honest proponent of health reform could call the final product a solution to our nation’s serious health care crisis.
This entire health reform process occurred under the shadow of the previous attempt to pass significant health legislation. President Obama made this his signature issue, and so for his administration failure was not an option. He surrounded himself with many of those who were traumatized by their participation in the last go-round. Thus, the resulting strategy was based more on fear of the opposition than on sound health policy. An opportunity for an honest debate about the needs of our people was squandered for backroom deals with industry giants and the photo ops so reminiscent of the previous administration. And for the most part, the resulting legislation benefits the very industries that profit most from our current situation more than it benefits the people of America.
Pros and Cons of the Legislation
There are some provisions within the bill that are positive steps: comparative effectiveness research; funding for demonstration projects to improve care; a new emphasis on prevention, wellness, and public health; increased funding for community health centers; and incentives for primary care providers. These are all necessary provisions, but they do not offset the harm done by other provisions in the bill, such as the individual mandate to purchase private insurance with penalties for noncompliance and the $447 billion in public dollars being used to subsidize such purchases. The bill will omit at least 23 million people from having any coverage. And the requirement to accept people with pre-existing conditions will most certainly increase premiums such that they become unaffordable, or people will purchase policies with skimpier coverage. This will likely result in a larger population of underinsured people—those who risk bankruptcy from medical debt should they develop health problems.
And none of the positive steps turn us in the direction of creating a national health system such as there is in every other advanced nation. Rather, on the whole, this legislation, which was written with heavy input from private health insurance and pharmaceutical lobbyists, further privatizes the financing of our health care and further enriches and empowers the very industries that are the problem. We know from experience both in the United States and abroad that market-based financing of health care is both the most expensive model and the most unjust, providing only as much health care as the patient can afford.
The Public Option Was Ruled Out at the Start
From the beginning of this process, it was clear that the administration and leadership had developed a strategy based on an outcome they believed they could achieve. The path was predetermined. All of the steps along the way, from the house parties that started during the winter of 2008 to the hearings, to the media spin, were planned so that the resulting “debate” was a drawn out performance of political theater. In order to disarm the corporate interests, the health industries that had opposed previous reforms were included on the inside. In order to disarm the Right, bipartisanship was at the forefront. In order to disarm the supporters of a single-payer plan, who are the majority, a campaign was developed around a promised “compromise,” the public option, and given tens of millions of dollars for organizing and advertising. The public option succeeded in splitting the single payer movement and confusing and distracting it with endless discussion about what type of public option would be effective.
Despite all of the attention, the public option was never meant to be part of the final legislation. As early as March 2009, Senator Baucus admitted that the public option existed as a bargaining chip to convince private insurers to accept increased regulation. And a year later, Glenn Greenwald and others confirmed that the public option had been privately negotiated away, although members of Congress continued the charade and “fought” for it.
Toward the final vote, supporters of the public option were hearing the same excuses that single-payer advocates have heard for decades. We are always told that single-payer is not politically feasible. However, we know that political feasibility can change. We are told to be pragmatic, yet we know that the reform being passed was not practical, in that it failed to guarantee health care to everyone and to be financially sustainable. We are told we are asking for too much and should accept incremental change. However, we know that the smallest effective step we can take in health reform is the creation of a publicly funded health system. Beyond that, there is much more to do in order to create a health system that raises us into the top ten in the world.
Profit-Driven Insurers Cannot Prioritize Care
While politicians claim that we have finally achieved comprehensive health reform and that now all Americans will have guaranteed affordable health care, we in the single-payer movement experience a sense of déjà vu. We have seen the same scenario occur at the state level from Oregon to Maine to Tennessee, and most recently in Massachusetts. Every state that has passed a health reform package has made these claims, only to find that within a few years they were unable to cover the number of people they had hoped to cover and that their health care costs exceeded their budget. The reason for this is that every state, and now our federal government, ignored the data showing that we cannot achieve universal and affordable health care as long as we retain private insurers as an integral part of health care financing. This truth has been documented both in practice and in numerous economic studies.
We cannot control health care costs, without severe rationing, as long as we retain multiple private insurers, because this model wastes at least a third of our health care dollars on areas that have nothing to do with direct health care: marketing, high CEO salaries, profits, and administration. We cannot guarantee that patients will be able to afford needed care using private insurers because the private insurance model is profit driven. These corporations profit by avoiding the sick and denying and restricting payment for care. Their bottom line is profit, not improved health. And no amount of industry regulation to date has been successful in changing that bottom line. Likewise, the new federal legislation is full of loopholes that will allow private insurers to continue to skirt the regulations.
The White House and Congress claimed throughout the process that we must retain private insurance because Americans desire choice, and this has been framed as choice of insurance. However, this is a false concept. No person can anticipate what their health care needs will be or which insurance will be best. Health care needs change the day a patient has a serious accident or is diagnosed with a serious illness. We all need the same health insurance: one that covers all medically necessary care when and where we need it. Those of us who travel and listen find that people in America desire choice of health care provider and choice of treatment: the two choices that private health insurers restrict.
So what are the White House and Congress really saying when they claim that we must retain a private insurance model? That they are unwilling to take on these powerful industries, and so we, the people, must be willing to compromise and work within their framework. Mohandas Gandhi said:
All compromise is based on give and take, but there can be no give and take on fundamentals. Any compromise on mere fundamentals is a surrender. For it is all give and no take.
When it comes to health reform, compromise on the fundamentals is unacceptable because the human costs are continued preventable deaths, continued suffering as patients fight for needed care, and continued bankruptcy from medical debt as families struggle to pay for deductibles and uncovered services. In a study published in Health Affairs in January 2008 that looked at the top nineteen industrialized nations, the United States ranked the worst—we have the highest number of preventable deaths (101,000 each year) because we lack a health system. All of the other industrialized nations have health systems based on the principles of health care as a human right: universality, equity, and accountability.
Why We Failed
Why have the American people been denied this same right? As I look back at the health reform process, I see three serious errors: a willingness to compromise, a lack of clarity about what we require, and a fear that failure to pass reform will have electoral consequences. These are the areas we must address as a people if we want to see real change in this nation, not just in health care but also in many areas that affect our ability to survive on this planet.
The willingness to compromise has occurred repeatedly at the state level. As a result, fewer people have access to care, and health care costs continue to rise; the fundamental problems are not corrected. This willingness to compromise is based on a real sense of desperation. We see real suffering. We want to do something. We are told that this reform, whatever it is, is the best we can get this time. We accept that and tell ourselves that it is something, it is a step.
As the congressional fellow of Physicians for a National Health Program, I saw this desperate attempt to pass something, anything, rise to the surface in the final weeks of the reform process. Patients and their families were brought into Congress to tell their stories of abuse at the hands of private insurers. Well-meaning legislators looked them in the eye and told them that this reform would change that. When I challenged the truth of that response, I was told, often in heated tones, that they (the legislators) had to do something and that at least this reform would help some people. I could only think of those who would not be helped. What about them?
The lack of clarity was grounded in the belief that if we simply advocated based on principles such as access and affordability, then the legislation would meet those principles. Legislators and pro-reform groups were content to speak based on principles as long as they were not challenged about whether those principles were being met. We must go beneath the surface of simple principles, educate ourselves, and define what is acceptable and what isn’t. If we don’t know exactly what we are asking for, we won’t get it. And we mustn’t be afraid to ask for what we require. As a people, we have become willing to accept crumbs when we require so much more than crumbs.
The final mistake was to pin the results of the upcoming elections to the success or failure of passing reform. Those who were reluctant to support the legislation were forced to support it in the end or risk being blamed for possible electoral consequences. As has often happened in past campaigns, people were forced to vote for the lesser of two evils instead of for what they truly wanted.
We Can Still Create a National Health Program!
So what do we do now that a health bill has been signed? Now that the clamor has quieted, it is time for a civilized discussion of what our health needs are and how best to meet them. This discussion is unlikely to occur in a mainstream media dominated by advertising dollars from health insurance and pharmaceutical corporations. We will need to have this discussion at a more personal level and through independent sources of media. We must educate ourselves and those around us about what is possible to achieve in this nation.
It is possible to create a national health program in which every person living in this country is able to receive the same high standard of medical care whenever and wherever they need it, without fear of financial consequences. We call this health security. Other advanced nations have achieved this goal. The United States has not, and is currently ranked thirty-seventh in the world for health outcomes. We spend more per capita on health care than every advanced nation, yet leave a third of our population either completely on the outside or vulnerable to financial ruin should they have a serious health problem.
Physicians for a National Health Program, founded in 1987, educates and advocates for a health system that will improve our health outcomes and provide health security based on the evidence of what has worked in our nation and what is effective in other advanced nations. We envision a lifelong universal health system—much like traditional Medicare—that is nationwide. We envision a system that allows patients to choose where they receive their care, permits caregivers and patients to determine the best course of treatment with assistance from evidence-based data, controls costs in a rational way through simplified administration and negotiation of fair prices, and is progressively financed. Its publicly funded nature would make it transparent and accountable. Because it would be privately delivered, it would allow caregivers to compete based on quality of care provided. Private health insurers would be relegated to a position of offering supplemental plans and possibly providing administrative support.
The Rev. Dr. Martin Luther King Jr. taught us that to witness an injustice and not work to correct it is in itself an act of violence. As a physician and an advocate for nonviolence, I cannot ignore the injustice of the great health inequality that exists in our nation or ignore those in need who cannot afford medical treatment. We have delayed this struggle for too long. Alice Walker said, “We are the ones we have been waiting for.” So, let’s do it. We have the resources. Now we must create the political will. Together, we can create a health justice movement, educate ourselves, speak with clarity, and organize independently of any political party. Please join us. You can learn more at www.pnhp.org or join the grassroots movement at www.healthcare-now.org.
Dr.Margaret Flowers is a pediatrician who serves as the congressional fellow for Physicians for a National Health Program and is on the board of Healthcare-NOW! She is one of the “Baucus 8.”
As we sit here on the other side of the recent health reform process, we have an opportunity for reflection. There were many times during the past year and a half when passage of a health bill seemed unlikely. However, in the end, the White House and Democratic leadership joined forces and converted the last holdouts with scare tactics of electoral turnovers and even a trip on Air Force One in order to muscle a bill over the final hurdles. The mere fact that any bill was passed at all was hailed as the great accomplishment, because no honest proponent of health reform could call the final product a solution to our nation’s serious health care crisis.
This entire health reform process occurred under the shadow of the previous attempt to pass significant health legislation. President Obama made this his signature issue, and so for his administration failure was not an option. He surrounded himself with many of those who were traumatized by their participation in the last go-round. Thus, the resulting strategy was based more on fear of the opposition than on sound health policy. An opportunity for an honest debate about the needs of our people was squandered for backroom deals with industry giants and the photo ops so reminiscent of the previous administration. And for the most part, the resulting legislation benefits the very industries that profit most from our current situation more than it benefits the people of America.
Pros and Cons of the Legislation
There are some provisions within the bill that are positive steps: comparative effectiveness research; funding for demonstration projects to improve care; a new emphasis on prevention, wellness, and public health; increased funding for community health centers; and incentives for primary care providers. These are all necessary provisions, but they do not offset the harm done by other provisions in the bill, such as the individual mandate to purchase private insurance with penalties for noncompliance and the $447 billion in public dollars being used to subsidize such purchases. The bill will omit at least 23 million people from having any coverage. And the requirement to accept people with pre-existing conditions will most certainly increase premiums such that they become unaffordable, or people will purchase policies with skimpier coverage. This will likely result in a larger population of underinsured people—those who risk bankruptcy from medical debt should they develop health problems.
And none of the positive steps turn us in the direction of creating a national health system such as there is in every other advanced nation. Rather, on the whole, this legislation, which was written with heavy input from private health insurance and pharmaceutical lobbyists, further privatizes the financing of our health care and further enriches and empowers the very industries that are the problem. We know from experience both in the United States and abroad that market-based financing of health care is both the most expensive model and the most unjust, providing only as much health care as the patient can afford.
The Public Option Was Ruled Out at the Start
From the beginning of this process, it was clear that the administration and leadership had developed a strategy based on an outcome they believed they could achieve. The path was predetermined. All of the steps along the way, from the house parties that started during the winter of 2008 to the hearings, to the media spin, were planned so that the resulting “debate” was a drawn out performance of political theater. In order to disarm the corporate interests, the health industries that had opposed previous reforms were included on the inside. In order to disarm the Right, bipartisanship was at the forefront. In order to disarm the supporters of a single-payer plan, who are the majority, a campaign was developed around a promised “compromise,” the public option, and given tens of millions of dollars for organizing and advertising. The public option succeeded in splitting the single payer movement and confusing and distracting it with endless discussion about what type of public option would be effective.
Despite all of the attention, the public option was never meant to be part of the final legislation. As early as March 2009, Senator Baucus admitted that the public option existed as a bargaining chip to convince private insurers to accept increased regulation. And a year later, Glenn Greenwald and others confirmed that the public option had been privately negotiated away, although members of Congress continued the charade and “fought” for it.
Toward the final vote, supporters of the public option were hearing the same excuses that single-payer advocates have heard for decades. We are always told that single-payer is not politically feasible. However, we know that political feasibility can change. We are told to be pragmatic, yet we know that the reform being passed was not practical, in that it failed to guarantee health care to everyone and to be financially sustainable. We are told we are asking for too much and should accept incremental change. However, we know that the smallest effective step we can take in health reform is the creation of a publicly funded health system. Beyond that, there is much more to do in order to create a health system that raises us into the top ten in the world.
Profit-Driven Insurers Cannot Prioritize Care
While politicians claim that we have finally achieved comprehensive health reform and that now all Americans will have guaranteed affordable health care, we in the single-payer movement experience a sense of déjà vu. We have seen the same scenario occur at the state level from Oregon to Maine to Tennessee, and most recently in Massachusetts. Every state that has passed a health reform package has made these claims, only to find that within a few years they were unable to cover the number of people they had hoped to cover and that their health care costs exceeded their budget. The reason for this is that every state, and now our federal government, ignored the data showing that we cannot achieve universal and affordable health care as long as we retain private insurers as an integral part of health care financing. This truth has been documented both in practice and in numerous economic studies.
We cannot control health care costs, without severe rationing, as long as we retain multiple private insurers, because this model wastes at least a third of our health care dollars on areas that have nothing to do with direct health care: marketing, high CEO salaries, profits, and administration. We cannot guarantee that patients will be able to afford needed care using private insurers because the private insurance model is profit driven. These corporations profit by avoiding the sick and denying and restricting payment for care. Their bottom line is profit, not improved health. And no amount of industry regulation to date has been successful in changing that bottom line. Likewise, the new federal legislation is full of loopholes that will allow private insurers to continue to skirt the regulations.
The White House and Congress claimed throughout the process that we must retain private insurance because Americans desire choice, and this has been framed as choice of insurance. However, this is a false concept. No person can anticipate what their health care needs will be or which insurance will be best. Health care needs change the day a patient has a serious accident or is diagnosed with a serious illness. We all need the same health insurance: one that covers all medically necessary care when and where we need it. Those of us who travel and listen find that people in America desire choice of health care provider and choice of treatment: the two choices that private health insurers restrict.
So what are the White House and Congress really saying when they claim that we must retain a private insurance model? That they are unwilling to take on these powerful industries, and so we, the people, must be willing to compromise and work within their framework. Mohandas Gandhi said:
All compromise is based on give and take, but there can be no give and take on fundamentals. Any compromise on mere fundamentals is a surrender. For it is all give and no take.
When it comes to health reform, compromise on the fundamentals is unacceptable because the human costs are continued preventable deaths, continued suffering as patients fight for needed care, and continued bankruptcy from medical debt as families struggle to pay for deductibles and uncovered services. In a study published in Health Affairs in January 2008 that looked at the top nineteen industrialized nations, the United States ranked the worst—we have the highest number of preventable deaths (101,000 each year) because we lack a health system. All of the other industrialized nations have health systems based on the principles of health care as a human right: universality, equity, and accountability.
Why We Failed
Why have the American people been denied this same right? As I look back at the health reform process, I see three serious errors: a willingness to compromise, a lack of clarity about what we require, and a fear that failure to pass reform will have electoral consequences. These are the areas we must address as a people if we want to see real change in this nation, not just in health care but also in many areas that affect our ability to survive on this planet.
The willingness to compromise has occurred repeatedly at the state level. As a result, fewer people have access to care, and health care costs continue to rise; the fundamental problems are not corrected. This willingness to compromise is based on a real sense of desperation. We see real suffering. We want to do something. We are told that this reform, whatever it is, is the best we can get this time. We accept that and tell ourselves that it is something, it is a step.
As the congressional fellow of Physicians for a National Health Program, I saw this desperate attempt to pass something, anything, rise to the surface in the final weeks of the reform process. Patients and their families were brought into Congress to tell their stories of abuse at the hands of private insurers. Well-meaning legislators looked them in the eye and told them that this reform would change that. When I challenged the truth of that response, I was told, often in heated tones, that they (the legislators) had to do something and that at least this reform would help some people. I could only think of those who would not be helped. What about them?
The lack of clarity was grounded in the belief that if we simply advocated based on principles such as access and affordability, then the legislation would meet those principles. Legislators and pro-reform groups were content to speak based on principles as long as they were not challenged about whether those principles were being met. We must go beneath the surface of simple principles, educate ourselves, and define what is acceptable and what isn’t. If we don’t know exactly what we are asking for, we won’t get it. And we mustn’t be afraid to ask for what we require. As a people, we have become willing to accept crumbs when we require so much more than crumbs.
The final mistake was to pin the results of the upcoming elections to the success or failure of passing reform. Those who were reluctant to support the legislation were forced to support it in the end or risk being blamed for possible electoral consequences. As has often happened in past campaigns, people were forced to vote for the lesser of two evils instead of for what they truly wanted.
We Can Still Create a National Health Program!
So what do we do now that a health bill has been signed? Now that the clamor has quieted, it is time for a civilized discussion of what our health needs are and how best to meet them. This discussion is unlikely to occur in a mainstream media dominated by advertising dollars from health insurance and pharmaceutical corporations. We will need to have this discussion at a more personal level and through independent sources of media. We must educate ourselves and those around us about what is possible to achieve in this nation.
It is possible to create a national health program in which every person living in this country is able to receive the same high standard of medical care whenever and wherever they need it, without fear of financial consequences. We call this health security. Other advanced nations have achieved this goal. The United States has not, and is currently ranked thirty-seventh in the world for health outcomes. We spend more per capita on health care than every advanced nation, yet leave a third of our population either completely on the outside or vulnerable to financial ruin should they have a serious health problem.
Physicians for a National Health Program, founded in 1987, educates and advocates for a health system that will improve our health outcomes and provide health security based on the evidence of what has worked in our nation and what is effective in other advanced nations. We envision a lifelong universal health system—much like traditional Medicare—that is nationwide. We envision a system that allows patients to choose where they receive their care, permits caregivers and patients to determine the best course of treatment with assistance from evidence-based data, controls costs in a rational way through simplified administration and negotiation of fair prices, and is progressively financed. Its publicly funded nature would make it transparent and accountable. Because it would be privately delivered, it would allow caregivers to compete based on quality of care provided. Private health insurers would be relegated to a position of offering supplemental plans and possibly providing administrative support.
The Rev. Dr. Martin Luther King Jr. taught us that to witness an injustice and not work to correct it is in itself an act of violence. As a physician and an advocate for nonviolence, I cannot ignore the injustice of the great health inequality that exists in our nation or ignore those in need who cannot afford medical treatment. We have delayed this struggle for too long. Alice Walker said, “We are the ones we have been waiting for.” So, let’s do it. We have the resources. Now we must create the political will. Together, we can create a health justice movement, educate ourselves, speak with clarity, and organize independently of any political party. Please join us. You can learn more at www.pnhp.org or join the grassroots movement at www.healthcare-now.org.
Dr.Margaret Flowers is a pediatrician who serves as the congressional fellow for Physicians for a National Health Program and is on the board of Healthcare-NOW! She is one of the “Baucus 8.”
3rd Largest Labor Council in Ohio Endorses HR 676
HCNOW
On April 27, 2010, the Tri-County Regional Labor Council, the third largest labor council in the state of Ohio, endorsed HR 676, national single payer health care legislation sponsored by Congressman John Conyers (D-MI).
John Wagner, Executive Secretary Treasurer, stated that the council supports single payer “Because we believe that it’s the real solution to health care in this country. It is first and foremost the best option for America.” Wagner is from Local 219 of the United Association of Plumbers and Pipefitters.
This regional labor council with headquarters in Akron represents over 46,000 active and retired members in Medina, Summit, and Portage Counties.
Tri-County is the 136th central labor council to endorse HR 676 and the 9th Ohio CLC to endorse. CLC’s in Cleveland, Lorain, Ashtabula, Toledo, Mansfield, Cincinnati, Columbus, and Dayton have previously passed resolutions for HR 676.
On April 27, 2010, the Tri-County Regional Labor Council, the third largest labor council in the state of Ohio, endorsed HR 676, national single payer health care legislation sponsored by Congressman John Conyers (D-MI).
John Wagner, Executive Secretary Treasurer, stated that the council supports single payer “Because we believe that it’s the real solution to health care in this country. It is first and foremost the best option for America.” Wagner is from Local 219 of the United Association of Plumbers and Pipefitters.
This regional labor council with headquarters in Akron represents over 46,000 active and retired members in Medina, Summit, and Portage Counties.
Tri-County is the 136th central labor council to endorse HR 676 and the 9th Ohio CLC to endorse. CLC’s in Cleveland, Lorain, Ashtabula, Toledo, Mansfield, Cincinnati, Columbus, and Dayton have previously passed resolutions for HR 676.
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