Posts Tagged ‘health care’

Tomorrow’s Vote. Will We Step Back From the Precipice?

Monday, November 5th, 2012

Tomorrow’s vote is first about an immediate threat to our democracy.  This threat comes primarily from the domination of large, mostly multi-national, corporations who wish to lock in their dominance by using government to limit competition.  The US Supreme Court’s Citizens United decision accelerated this effort because it unleashed a flood of corporate cash, much of it provided in secret, into our political campaign system.

This multi-billion dollar effort is causing another, longer term problem:  We as a nation are not addressing our real needs and this means we are innocently taking massive and unnecessary risks.   What are those risks?

  •  We are running larger deficits and debt than is necessary.  Yet we are being pandered to, again, with more tax cuts that are guaranteed to further increase deficits and debt.
  •  We are much too dependent on fossil fuel energy.  Billions of people are climbing out of poverty worldwide and demanding a larger share of fossil fuel energy, which guarantees the price of these fuels will climb.  Yet we have no national program to install sustainable, clean energy systems which would insulate our country from the increasing cost of fossil fuels.   Importantly, this dependence threatens our national security as we are in danger of being in continual wars overseas protecting our fossil fuel sources.
  • We are over using chemicals and hormones in our food industry.  This is not only degrading our environment but is also creating an epidemic of ill health outcomes, like diabetes, that are taxing our health care system and costing us hundreds of billions of dollars in unnecessary spending annually.
  • Our weather is very likely to become increasingly more severe due to global warming.  Yet we have not begun national programs, such as those for sustainable energy or more robust infrastructures, to prepare for dealing with these probable weather challenges.
  • Our financial system is lopsided, favoring very large banking conglomerates that are shielded from competition and the dangers of their risk taking.    We have, so far, continued to socialize their losses which has removed their caution to risk taking.
  • Our tax structure too much favors the incomes of the wealthy over the incomes of a majority of Americans.  Privileged rates are applied to wealthy incomes from dividends, capital gains and carried interest.  The tax laws are shot full of tax avoidance schemes designed for the wealthy like unified charitable trusts, irrevocable trusts, offshore accounts and trusts and estate taxes that avoid capital gains taxes altogether.   Combined with broad based tax cuts, these schemes guarantee high deficits and debt and the underfunding of necessary government programs like social security, medicare and medicaid.
  • Our regulatory structures are too weak.  From bank risk taking, to environmental abuse, to a medical system focused on the more profitable business of treating symptoms rather than creating cures, regulators all too often look the other way or become enablers of corporations only concerned with the most profitable activity irrespective of the activity’s bad outcomes for individuals and the nation.

Beezer here.  Unfortunately one of our two political parties, the Republican party, is ‘all in’ supporting the efforts of multi-nationals.  They enable all these bad outcomes.  They support unlimited corporate campaign spending that dominates our national discussions and hides the real risks we are taking.  They favor a tax system tilted heavily in favor wealthy incomes, which in turn aggravates income inequality and suppresses both job creation and income gains for the majority of working Americans.   They pander to our want of lower taxes while endangering our needs for a safer, healthier and more competitive economy.   This is the precipice we face in tomorrow’s national elections.  If Republicans win tomorrow, then our needs will never be addressed without encountering some massive disaster of epic scale.  It’s that important.  We need to regain our ability to self-govern. 

When People Say “Free Markets,” What They Really Mean Is “Competitive Markets.”

Monday, May 17th, 2010

The first thing you need to understand is that there is no such thing as “free markets” in the real world.

All market participants, in truth, fight like mad to eliminate competition.  What they want is domination.  Overtime, domination occurs.  The losers leave the field of competition and the winners are left, larger and more concentrated.  By the way, this process happens under Communism or Capitalism: The first being domination by one political regime; the second domination by one, or just a few, large corporations.

In either circumstance the public eventually loses its freedom and the affected economies suffer.  Wealth and power flow up the income pyramid, mirroring the same upward flow in the political or market economy as the concentrations merge and become one:  Master of both the political and economic realms.

The only defense is competition.  In what could be viewed as a supreme irony, the only body that can force competition is the public one–government.

Ergo, the public must understand that concentrated centers of power need to be periodically broken up.  Real competition must be re-installed. 

Right now such an effort is being made by the US government, and some state attorneys general, against the concentration of financial power that’s been building up for years in the banking/investment industries.  Financial reform is underway in Congress.  Federal regulators and a few powerful state attorney generals are beginning investigations of alleged abuse by the few remaining bank holding companies, the markets themselves, and other major participants like hedge funds.

In a capitalist based economy, domination of an industry by a few corporations is called an Oligopoly.  Oligopolies seek to insure their domination by influencing government to pass laws and regulations inhibiting competition.  The agents in the government who have the responsibility of protecting Oligopolist and inhibiting competition are called Plutocrats.

Plutocrats aren’t necessarily just government regulators.  They can be elected officials too.  Powerfully wealthy corporations can funnel millions of dollars into key Congressional campaigns to help elect people who will pass the laws, and influence their regulations to favor the Oligopolists.

The main lesson in this brief essay is that the public needs to understand that their government is the best bulwark against this very natural progression.  If the government is allowed to be captured, then retracing the steps in this corrosive progression can become almost impossible.

Such is the place we now find ourselves in the United States where Oligopolies have been building up in several key industries, including finance/investment, agriculture, energy and health care.  After 30 years of not paying any attention to this natural progression, we find ourselves fighting for a return to competition in several vital industries.

Will the nation succeed in restoring competition?  Not until the public understands that what they really desire is not “free markets,” but competitive ones.

We’re Not Stupid. We Just Act That Way.

Friday, September 4th, 2009

Call it “cognitive dissonance” or whatever you like, but one clear lesson of the health care debate is that people can often state a conclusion and then cite as proof evidence that, in fact, obviously contradicts the conclusion. 

On CSPAN the other day, a caller said he didn’t want the government to have anything to do with health care.  He said, in clear libertarian language, that people must be held responsible for their choices, and if they are uninsured, or underinsured, that was their “choice.”

So where did this libertarian get his insurance?  From the Veteran’s Administration, which is the purest form of socialized medicine.  Asked what he would “choose” had there been no VA to protect his health, he responded “I probably wouldn’t have any insurance.  I can’t afford it.”

Huh?

You see and hear variations on this contradictory behaviour when seniors yell at Town Meetings that they want “the government” to keep its hands off their insurance, Medicare, which is the socialized, government run health plan for seniors.

Huh?

Anyway, here’s a NYT opinion piece by Nicholas Kristof entitled “Health Care That Works,” that appeared yesterday, Sept. 3.

“Here’s a paradox.

Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector.

Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.

So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.

The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care.

Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effective elements in the American medical establishment.

A study by the Rand Corporation concluded that compared with a national sample, Americans treated in veterans hospitals “received consistently better care across the board, including screening, diagnosis, treatment and follow-up.” The difference was particularly large in preventive medicine: veterans were nearly 50 percent more likely to receive recommended care than Americans as a whole.

“If other health care providers followed the V.A.’s lead, it would be a major step toward improving the quality of care across the U.S. health care system,” Rand reported.

As for the other big government-run health care system in the United States, Medicare spends perhaps one-sixth as much on administration as private health insurers, although the comparison is imperfect and controversial.

But the biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick — or, if they start out healthy and then get sick, to find a way to cancel their coverage.

A reader wrote in this week to tell me about a colleague of hers who had health insurance through her company. The woman received a cancer diagnosis a few weeks ago, and she now faces chemotherapy co-payments that she cannot afford. Worse, because she is now unable to work and has to focus on treatment, she has been shifted to short-term disability for 90 days — and after that, she will lose her employer health insurance.

She can keep her insurance if she makes Cobra payments on her own, but she can’t afford this. In her case, her company will voluntarily help her — but I just don’t understand why we may be about to reject health reform and stick with a dysfunctional system that takes away the health coverage of hard-working Americans when they become too sick with cancer to work.

On my blog, foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States.

Let’s hope we won’t miss this chance. A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.”

The Secret Other Rich Countries Know About Health Care: You Have To Eliminate Profits.

Sunday, August 23rd, 2009

From another article written by another author who actually knows what he’s talking when it comes to other countries’ health care plans comes this observation…

“The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.”

And this almost humorous observation about our health care system:

“In many ways, foreign health-care models are not really “foreign” to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we’re Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we’re Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we’re Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we’re Burundi or Burma: In the world’s poor nations, sick people pay out of pocket for medical care; those who can’t pay stay sick or die. ”

The article is called “Five Myths About Health Care Around The World,” and it appears in the Washinton Post online here.  The author is T.R. Reid, who has traveled around the world studying the health care systems of other developed, democratic nations.

The five myths he addresses are:

  • It’s all socialized medicine out there.
  • Overseas care is limited through limited choices or long lines.
  • Foreign health care systems are inefficient, bloated bureaucracies.
  • Cost controls stifle innovation.
  • Health Insurance has to be cruel.

On the “it’s all socialized medicine out there,” Reid points out: “In some ways, health care is less “socialized” overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet’s purest examples of government-run health care.”

On the myth about limiting benefits Reid notes:  “Generally, no. Germans can sign up for any of the nation’s 200 private health insurance plans — a broader choice than any American has. If a German doesn’t like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country…..As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations — Germany, Britain, Austria — outperform the United States on measures such as waiting times for appointments and for elective surgeries.”

And in Japan, we should be so lucky.   ”In Japan, waiting times are so short that most patients don’t bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. “Why don’t you just drop by?” the receptionist said. That same afternoon, I was in the surgeon’s office. Dr. Nakamichi recommended an operation. “When could we do it?” I asked. The doctor checked his computer and said, “Tomorrow would be pretty difficult. Perhaps some day next week?”

As to the foreign systems being bloated bureaucracies.  “U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

“The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.”

As for stifling innovation if you implement cost controls, Reid points out:  ”False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who’s had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)”

As for the cruelty myth there’s this:  ”Not really. American health insurance companies routinely reject applicants with a “preexisting condition” — precisely the people most likely to need the insurers’ service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer’s “rescission department” digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can’t cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. “Our customers love it,” the group’s chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.”

Thanks to economist’s view

Condensed Health Care Reform Flow Chart: Priceless.

Tuesday, August 18th, 2009

This flow chart is from a blog called donkeyliscious, cited in a blog by NYT economics columnist Paul Krugman, a Nobel prize winner.

It’s as clear a condensed representation of health care reform as you’ll get.  Click on the image to blow it up for easier reading.

 

What this points out, among other things, is that private health insurance is going to receive big, fat subsidies to offer policies to groups that are not otherwise profitable:  The unemployed, the poor, people with chronic health problems, those with pre-existing conditions, etc.

Without a public option that is.  With a public option there would be competition, and at least a first, baby step in building a non profit system to begin taking care of the growing number of folks who don’t qualify for Medicare (the existing, popular, public option for retired folks) and can’t get affordable, dependable health care policies from private insurance companies.

So instead of doing the common sense thing by providing direct services, we will be forced to insure profits for private companies.  Sound familiar?  Wall Street deja vu.  Socialism for the rich redux.

Obama’s Dance. The New Progressive In Action.

Wednesday, August 5th, 2009

As a progressive who agrees almost entirely with President Obama’s stated goals for America, watching his first 200 days has been fascinating.

Obama is an egalitarian, which is pretty much another word for progressive.  In the past such individuals from the left of the political spectrum never had much political success.  They would be Democrats, or independents, disjointed and ineffective in the main.

But Obama has changed the progressive dynamic, it’s calculus.  He has removed, almost single handedly, many of the negative, self defeating tendencies of the progressive, egalitarian left.

Take, for example, his outright embrace of free markets and Capitalism.  The liberal left would often ridicule free markets and capitalists, labeling them as “rent seekers” and “exploiters” of labor:  People who would destroy entire classes and trample on the Constitution in order to make more money.

There’s much to recommend this point of view.  But what of the alternative?  Liberals would be labeled “socialists” or even worse “communists” who would take away individual rights and trample the Constitution in the process as thoroughly as those out of control corporations.   Liberals had no answer to this justifiable concern.

Until Obama.  Here’s a portion of the insight into the President’s point of view, and the possibility that this new path may reconcile what has heretofore been an insoluble divide between progressives and much of America.

From an insightful article entitled “Who Rules America?” here.  The author is Prof. G. William Domhoff of the University of California, Santa Cruz.  Domhoff strikes right at the traditional liberal’s greatest weakness:  Promoting government alone as the only alternative to corporate conservatism.

“But non-market planning does not work economically and has strong authoritarian tendencies built into it that do not promote freedom. It first of all fails economically because no one has been able to design methods to analyze the tremendous amount of information necessary to manage a large-scale centrally planned economy that goes beyond a few core industries. It also fails economically and politically because the large bureaucratic system created to try to obtain and utilize this information becomes completely inefficient and corrupt in the way many such large organizations often do. The leaders use their positions to feather their own nests. They get into power struggles with each other that make the system even more unwieldy. They look out for their friends and relatives, which lowers the competence levels. Managers have to buy on the black market, cut corners, and cheat in order to meet their production quotas, which increases corruption, destroys morale, and dampens any desire to work better and harder for the sake of the collective good. Managers also adulterate goods and ignore the effects of their production processes on the environment, leading to greater pollution than in market systems. The more complex the economy becomes, the worse the planning problems become. Inefficiency, waste, corruption, lack of innovation, and environmental degradation were the hallmarks of the Soviet Union, China, and other efforts at central planning.”

So if free markets produce corporate conservatives who do exploit ordinary people even to the point of gaining huge taxpayer subsidies to bolster their incomes and profits, but government central planning is just as bad or worse, what is one to do?

Again Domhoff:

“The claims by free-market ideologues that any laws regulating the market hinder productivity, or that greater economic equality inevitably limits freedom, are without significant empirical support. Research shows that markets need guidance from government to operate well, and that there is no inevitable trade-off between equality and efficiency, or between equality and freedom, within a market system. More equality might even mean more efficiency, not less, and it can certainly mean more freedom for more people…

“Most importantly for our purposes, markets can be reconstructed to make it possible to plan for a more egalitarian economic future. It turns out it is possible for strong governments to use the market system for planning. Once it is realized that markets can be viewed from a governmental point of view as administrative instruments for planning, it can be seen that with a little reconfiguring they can serve collective purposes as well as the individual consumer preferences trumpeted by conservative free market economists. In this form of planning, the information is supplied by the price system that is so central to the considerable, but far from perfect, efficiency brought about by markets.

“There is thus no need for one big planning apparatus. Instead, the planning tools within a reconstructed market system are simply taxes, subsidies, government purchases, and regulation. This point may seem very mundane, but these well-known government powers can be potent when applied to markets. They make it possible to speak in terms of restructuring the market system. They make it possible for different agencies of the state to tinker with different parts of the economic system, and to change course quickly if the economy does not respond as projected. (This is exactly how the Federal Reserve Board operates now, but always in favor of using higher interest rates to control inflation by throwing people out of work, not to increase maximum employment in conjunction with tax and spending policies that could help constrain inflation.)

“Planning through the market is in effect the general strategy adopted by the environmental movement, and it has paid good dividends. Although most environmental programs actually increase the number of jobs, not decrease them, the plans developed by environmentalists can call for the government to subsidize any job losses or sudden dislocations through “just transition” programs. For example, in a 2002 plan developed for a green-blue alliance, which would reduce carbon emissions by half in 2020, the authors include a proposal for two years of income and up to four years of education for those who lose their jobs, along with $10,000 in community funds for each job lost. At the same time, they note that their plan to tax carbon and increase the use of renewable energy sources would increase the overall number of jobs. “Just transitions” would be financed by everyone through their taxes, which is a collective solution to a collective problem.”

While these are Domhoff’s words, the general approach to problem solving that harnesses progressive desires for a more equitable society with the power of free markets, seems to explain much of the approach used by President Obama. 

The truth is the Constitution is egalitarian in approach.  It provides the various tools Domhoff’s vision requires, from the policy making ability of Congress, to the various government regulators, tax authorities and other levers of government that can influence the direction capitalism will take.  And do so without trying to substitute some big, unwieldy central planner.

Free markets and capitalism, in other words, can become a more efficient planning system for egalitarian pursuits if given direction from government.  The people’s will and benefit can be enhanced without imposing central government planning.

This seems to be the Obama way too.  Of course he’s opposed by corporate conservatives, who long ago jettisoned free competitive markets in favor of government subsidies and government protection from competition:  Socialism for the Rich. 

There’s another intriquing aspect of this thinking.  A competitor can be created by government to force competition in an oligopoly created by corporate conservatives.

Public option in health care anyone?




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