The health care debate-17: Obama’s choice

(For previous posts on the issue of health care, see here.)

In this last post in this series, I want to look at the way the health care ‘debate’ has progressed because it provides a classic example of how Congress and the president, supposedly meant to represent the ‘will of the people’ who elected them, maneuver to actually do the will of the business interests.

Polls have repeatedly shown that people are highly dissatisfied with the current system of employer-based health care in this country in which the private, profit-seeking insurance companies exert such a stranglehold. As Paul Street writes in the September 2009 issue of Z Magazine (not online), 73 percent feel that health care is either in a “state of crisis” or has “major problems” (Gallup, November 2007), and 71 percent feel that we need “fundamental changes” or have the US health system “completely re-built,” compared to just 24 percent who wish only for “minor changes” (Pew Research Center, 2009).

Real reform would consist of introducing a single payer system along the lines of France or Canada or a socialized system along the lines of England. And Street points out that polls consistently show that a majority of people would support changes along those lines.

  • 64 percent would pay higher taxes to guarantee health care for all US citizens (CNN Opinion Research Poll, May 2009)
  • 69 percent think it is the responsibility of the federal government to provide health coverage to all US citizens (Gallup Poll, 2006)
  • 67 percent “think it is a good idea [for government] to guarantee health care for all US citizens, as Canada and Britain do, with just 27 percent dissenting” (Business Week, 2005)
  • 59 percent support a single-payer health insurance system (CBS/New York Times poll, January 2009)
  • 59 percent of doctors back a single-payer system (Annals of Internal Medicine, April 2008)

But of course the business lobby has enough clout to ensure that those options are not even discussed, let alone considered seriously. So the fight has been reduced to whether even a watered-down so called ‘public option’ should be introduced.

Political scientist and health policy analyst Jacob Hacker is the person who originally formulated the public option plan that Obama once acted as if he embraced but now seems to be trying to distance himself from. In a recent paper Hacker describes why a public option is essential for any meaningful reform, and the futility of the health-industry friendly alternatives like the health cooperatives that are being floated. He concludes:

That the two bills under consideration in the House and Senate contain a public health insurance option is considerable cause for celebration. Yet it is no cause for complacency, because the Senate Finance Committee appears unlikely to produce a bill that contains a true public plan. If, as expected, the Committee endorses federally promoted health cooperatives, they should be understood for what they are: an effort to kill the public plan and, with it, the prospect of an effective competitor to consolidated insurance companies that have too often failed to provide affordable health security.

What is interesting is that despite the concerted propaganda campaign against reform this year by the crazed ‘deathers’ supported by the health industry and backed by the Republicans and conservative Democrats and tacitly encouraged by the Obama administration, support for the public option remains strong. A new SurveyUSA poll released last week puts support for the public option at 77%, one point higher than it was in June. Another poll finds that 79% still support measures that constitute what is effectively the public option. The success of the propaganda campaign has been solely in confusing people as to what the phrase ‘public option’ implies, with only 37% being able to identify correctly what it means and 26% incorrectly thinking it refers to a British socialized system.

So Obama and conservative Democrats still have some way to go in implementing their sell-out plan to satisfy their corporate overlords while persuading the public they are true reformists. In the process they run a huge risk. Economist Paul Krugman warns Obama that the progressives who were so crucial to his electoral success are turning on him because of his subservience to the health industry.

A backlash in the progressive base — which pushed President Obama over the top in the Democratic primary and played a major role in his general election victory — has been building for months. The fight over the public option involves real policy substance, but it’s also a proxy for broader questions about the president’s priorities and overall approach.

And let’s be clear: the supposed alternative, nonprofit co-ops, is a sham. That’s not just my opinion; it’s what the market says: stocks of health insurance companies soared on news that the Gang of Six senators trying to negotiate a bipartisan approach to health reform were dropping the public plan. Clearly, investors believe that co-ops would offer little real competition to private insurers. (emphasis added)

Obama has a choice. He can go down in history as a footnote, the answer to a future trivia question as to who was the first person of color to become president of the US and as someone whose main accomplishment was to show that a president of color can be as subservient to the interests of the pro-war/pro-business one party ruling class as his white predecessors. Or he can decide to use his considerable clout and rhetorical skill to push for real health care reform and be remembered in history as one of the greatest US presidents of all time, the way that Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country, was chosen as the greatest Canadian of all time.

I fear that Obama’s ambition does not match his soaring rhetoric. I hope I am wrong.

POST SCRIPT: Health reform information

Our local paper The Plain Dealer ran an informative series on the health care debate and provided some links to the major documents. The media has been focusing on the one that is still in the Senate Finance Committee led by reform opponent Democrat Max Baucus because that committee is the Obama Administration’s best chance of avoiding real reform, which is why they have given that committee and its so-called “Gang of Six” reform opponents an effective veto over health reform legislation.

But there are other versions of health care legislation emanating from the various committees.

The 1,000 page House Bill HR 3200 can be seen here. The Congressional Budget Office (CBO) analysis of the bill can be seen here and a summary of the bill’s provisions can be seen here. This site gives a detailed breakdown on what the bill would imply for each congressional district.

The Senate’s Health, Education, Labor and Pensions (HELP) Committee’s proposal can be seen here. The CBO analysis of the HELP plan can be seen here.

We should also not overlook the important step that the House Committee on Education and Labor that is chaired by Dennis Kucinich took when, by a vote of 25-19, it “approved an amendment to the House’s health-care reform bill allowing states to create single-payer health care systems if they so choose.” After all, the Canadian single payer system began at the provincial level, and only later spread nationwide.

You can also view a side-by-side comparison of the various health reform proposals and a timeline of health reform.

Sam Smith has a good article on health care reform that asks some important questions.

The health care debate-16: Health reform Kabuki theater

(For previous posts on the issue of health care, see here.)

In this post in this series, I want to look at the political gamesmanship that is going on in health care.

As I have said repeatedly, the US is a pro-war/pro-business one party state with two factions that differ on some social issues. However, people would revolt if they realized the extent to which so many of their elected representatives of both parties are the servants of corporate interests. In order to disguise this fact, whenever an issue that involves corporate interests arises, one sees an elaborate Kabuki theater performance in which the elected officials play assigned roles, one of which involves pretending to have a major fight over some peripheral issue, while the final outcome is never in doubt.

The massive bailout to Wall Street interests was a case in point. Remember the big fuss over bonuses? Regulations? Corporate jets and other perks? That was pure Kabuki theater, the equivalent of the circuses that Roman emperors put on to amuse the people and appease their blood lust. Once a few executives had been excoriated in public and made their public penance, once the media spotlight shifted to other things, the looting of the public resumed. The big Wall Street banking interests were ultimately left alone to make huge profits and hand out big bonuses, which is exactly what is happening right now.

It is the same with health industry reform. Matt Taibbi of Rolling Stone argues persuasively that Obama was, from the beginning, in the tank with the health insurance/drug/physician/hospital industries and was never serious about making the kinds of far-ranging changes that would improve health care, if those measures went against the interests of those industries. Jonathan Cohn already had pointed out that Obama cut a deal with the drug industry not to seek lower prices. But he did want to create an image of himself as a serious reformer and use fixing the health care system, which is obviously broken, as a vote getter. So he played his Kabuki role.

Obama started out on the campaign trail talking about the virtues of the single-payer system and then falsely asserting, without any argument, that because the employer-based system was already in place, single payer cannot be implemented now in the US, despite evidence to the contrary. This enables him to rule out, right at the beginning, single payer systems as one among the mix of options to be discussed in his health care reform panels.

Then later he says that what is most important to him is not getting good health care reform passed but that it must be bipartisan. Why on earth should bipartisan acceptance be more important than good policy? That statement was the confirmation of my suspicions that Obama was not serious, because that appeal to bipartisanship immediately put him at the mercy of the Republican Party and those in his own party who were never interested in any reform, who then went on to play their Kabuki roles of objecting to any meaningful reform proposals. Obama of course had to know that they would do this. He is not stupid. This predictable opposition enables him to act as if he is being forced to compromise more than he wants to, thus preserving his reformist credentials while abjectly serving the interests of the health industry. As Glenn Greenwald says, “There is one principal reason that Blue Dogs and “centrists” exert such dominance within the Party: because the Party leadership, led by the Obama White House, wants it that way and works hard to ensure it continues.”

Then Obama starts signaling that he is willing to abandon even the limited public option. All this is to lead up to the final scene of the Kabuki theater in which he finally agrees to a system that the health industry would love, such as mandating that everyone buy insurance from the private, profit-seeking health insurance industry with the government paying the premiums of those who can’t afford it, while the insurance companies are given the freedom to continue the treatment-denying policies that is at the heart of their business model.

Greenwald continues:

White House threats that “you’ll never hear from us again” are issued to defiant progressives only. Not only are such threats never issued to “centrists” and Blue Dogs who are supposedly impeding the President’s health care agenda, but the White House does everything it can to protect those ostensible obstructionists and further entrench them in power. Isn’t all of this fairly strong evidence that the White House knew, accepted and likely even desired from the start that — despite the President’s public assurances to progressives — the “public option,” understandably despised by the insurance industry, would be dropped from bill?

The very idea that Obama is valiantly struggling to cleanse the party of its corporate and centrist dominance, yet is just haplessly and helplessly unable to do so, is ludicrous beyond words.

Former insurance industry insider Wendell Potter also sees quite clearly how Obama playing his role in this Kabuki play.

Not only is Obama clearly ready to throw the public option overboard, he is embracing the requirement that we all be forced to buy insurance from private insurers. That means your tax dollars and mine will be used to pay subsidies to the big insurers to provide coverage to people who can’t afford to buy their policies, because the big insurers charge far more than they should because Wall Street investors demand that they do.

During his speech in Montana, Obama talked a lot of trash about the insurance industry. Don’t be fooled by that tough talk. It’s all part of a strategy to try get us to believe we’ll get the reform he promised during the campaign. Industry leaders are in fact delighted he’s denouncing their behavior, because they believe most of his supporters — who were hopeful the stars might finally have aligned for real reform — will be fooled into thinking the reform bill that reaches his desk will benefit them more than the special interests with their armies of lobbyists.

That final scene hasn’t been arrived at yet because there is one group that is not playing its designated role and is thus threatening to disrupt the performance. These are the progressives in Congress whose role is to be cheerleaders for Obama because he is allegedly one of them. There are hopeful signs that the progressive members of the public and Congress are seeing through this charade. They are getting angry at this sell-out on a fundamental campaign issue and they are warning Obama that they will revolt if he abandons meaningful reform.

I hope they are successful in pushing back against Obama’s sell-out.

POST SCRIPT: The Onion on health reform deadlock

As usual, it is the comedians and parodists, not the news media, that sees through the Kabuki façade.

After months of committee meetings and hundreds of hours of heated debate, the United States Congress remained deadlocked this week over the best possible way to deny Americans health care.

“Both parties understand that the current system is broken,” House Speaker Nancy Pelosi told reporters Monday. “But what we can’t seem to agree upon is how to best keep it broken, while still ensuring that no elected official takes any political risk whatsoever. It’s a very complicated issue.”

“Ultimately, though, it’s our responsibility as lawmakers to put these differences aside and focus on refusing Americans the health care they deserve,” Pelosi added.

The legislative stalemate largely stems from competing ideologies deeply rooted along party lines. Democrats want to create a government-run system for not providing health care, while Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible.

That is about as succinct a presentation of how the pro-business one party state in the US works as you will find anywhere.

The infantilization of religious faith

Once in a while I get private emails from readers of this blog who disagree with my atheistic stance. Recently I got one that said in its entirety:

Dear Sir, from your comments about the religious beliefs of scientists, I gather that you contend that, for the scientist, the greater the learning, the lesser the belief in God; and, conversely, the greater the belief in God, the lesser the knowledge of science. It never ceases to fascinate me, the adoring eyes of a child for the elderly, yet the grown up has little need for them, and, so, they confine them to a home and out of their way. By far, what the child has is greater than what the grown up has. Love never enters the equations of scientists, nor does faith; consequently, the eternal God is not in view of scientists, but only His temporal creation. Archeology has uncovered less than 1% of all the treasures of our past (just scratched the surface), yet, for many decades, archeologists, in their haughtiness, have spoken with authority against the Bible, as bulls from the chair. Many scientists today, and of the past, with their silver surfboard in hand, have yet to feel a wave flow by their ankles, as they have barely just stepped into the ocean. What the eye cannot see, and the ear cannot hear, and the mind cannot understand, the spirit (even of a child) can fathom.

This letter, in somewhat flowery language, illustrates some of the contradictory beliefs that religious people commonly express without them even realizing it.

For example, it says that a child’s understanding of the world is superior to that of the adult. It says that in order to perceive god, we need to be like children in our ignorance, and listen to the voices in our head, rather than the concrete senses of sight and sound. In other words, deeper knowledge and greater learning undermine faith. I actually agree with the last sentence but view it as a good thing.

It amazes me that people think that ignorance is a good thing. When people sing the praises of childlike faith, I don’t think they quite realize how insulting that is to their religion. It is saying that faith in god is on a par with faith in Santa Claus and the Easter Bunny, things that only a child would believe in. I agree with that last sentence too but am surprised that religious people advocate it as a virtue.

But the letter writer then promptly contradicts that position by implying that scientists know so little now and presumably that when we get to know more, evidence for god will emerge. So in order to perceive god should we be like children unburdened by knowledge or should we seek more knowledge? Religious people want to have it both ways, on the one hand saying that we see god only by faith and not by knowledge, and on the other hand that we are ignorant now and that more knowledge will provide the necessary evidence for what now must be accepted only on faith. What is interesting is that this contradiction never strikes them, providing another illustration of how religion undermines the ability to think rationally.

The contradictions go even deeper. After all, if god created us then he also created our unusually large brains and gave us the power to think and reason and use logic. As Hamlet says (Act II, Scene II), “What a piece of work is a man! how noble in reason! how infinite in faculty!” If so, then why would god not expect us to use the abilities he/she supposedly gave us to understand everything about the world, including religious beliefs? Why would he/she give us this extraordinary intellectual ability and then make it into a liability?

In the end, what religions want you to do simply boils down to this prescription: “You must believe in god. Anything that helps you believe is good. Anything that undermines belief is bad. Ignore any contradictions. Use your brain for everything except examining your religious beliefs to see if they make any sense.”

In the great title song from the film O Lucky Man, singer Alan Price describes the qualities that a lucky man possesses. One of them is not being tempted by promises of heaven or made fearful by threats of hell but he also adds that, “If knowledge hangs around your neck like pearls instead of chains, you are a lucky man.”

This phenomenon of religious people sacrificing knowledge and reasoning abilities in order to preserve beliefs for which there is no credible evidence whatsoever is sad, really. For religious people, knowledge is indeed like heavy chains, holding them back and burdening them because it contradicts their myths. Atheists, on the other hand, not being bound by dogma and religious texts, delight in discovering pearls of knowledge.

POST SCRIPT: Jesus and the dinosaurs

Many Christians are anxiously waiting for the promised second coming of Jesus when they will get their reward for being faithful believers. But what they don’t realize is that the first coming of Jesus was not at the time described in the Gospels in the Bible but actually occurred much earlier, during the dinosaur age. Eddie Izzard recovers this lost history.

So the second coming of Jesus has already occurred. Sorry, Christians, the show is over, there is nothing more to wait for.

The health care debate-15: The ruthless science of health industry profits

(For previous posts on the issue of health care, see here.)

Some of the supporters of the current health system have a somewhat naïve view of capitalism. They seem to have bought into the myth that the ‘invisible hand’ of the market will always result in good quality goods and services being provided at lower costs. That model works in some situations when there is competition among many suppliers and when the consumer has the option of not buying a product at all if they are not satisfied with the price or quality of the offerings, say as with the purchase of specific foods or a new car or a washing machine.

But it ceases to be true when people are in dire need and their options are limited. This is why one finds price gouging in essential supplies like water, food, blankets, and power generators in the immediate aftermath of a disaster like a hurricane or earthquake, when callous merchants take advantage of the misery of people to rake in huge profits. It would be insane for the government not to intervene and provide people with necessary supplies and services at those times. Look at how George Bush got hammered for the government’s slow response to Hurricane Katrina.

Since health care is one of those situations in which people do not have the option of not obtaining services, and usually have to seek it in emergency situations, it is closer to the hurricane situation than that of buying a new car, which is why a strong government role is essential.

But the private, profit-seeking health insurance industry wants to go in the opposite direction. As Wendell Potter, who used to be the head of corporate communications of CIGNA, the highest public relations position of one of the largest health insurance companies, says in an interview with Bill Moyers, “The industry doesn’t want to have any competitor. In fact, over the course of the last few years, has been shrinking the number of competitors through a lot of acquisitions and mergers. So first of all, they don’t want any more competition period. They certainly don’t want it from a government plan that might be operating more efficiently than they are, that they operate. The Medicare program that we have here is a government-run program that has administrative expenses that are like three percent or so”, compared to the health insurance industry’s 20%.

Potter explains to Moyers the brutal calculations that go into increasing profits by denying treatment.

WENDELL POTTER: …[T]here’s a measure of profitability that investors look to, and it’s called a medical loss ratio. And it’s unique to the health insurance industry. And by medical loss ratio, I mean that it’s a measure that tells investors or anyone else how much of a premium dollar is used by the insurance company to actually pay medical claims. And that has been shrinking, over the years, since the industry’s been dominated by, or become dominated by for-profit insurance companies. Back in the early ’90s, or back during the time that the Clinton plan was being debated, 95 cents out of every dollar was sent, you know, on average was used by the insurance companies to pay claims. Last year, it was down to just slightly above 80 percent.

So, investors want that to keep shrinking. And if they see that an insurance company has not done what they think meets their expectations with the medical loss ratio, they’ll punish them. Investors will start leaving in droves.

I’ve seen a company stock price fall 20 percent in a single day, when it did not meet Wall Street’s expectations with this medical loss ratio.

For example, if one company’s medical loss ratio was 77.9 percent, for example, in one quarter, and the next quarter, it was 78.2 percent. It seems like a small movement. But investors will think that’s ridiculous. And it’s horrible.

BILL MOYERS: That they’re spending more money for medical claims.

WENDELL POTTER: Yeah.

BILL MOYERS: And less money on profits?

WENDELL POTTER: Exactly. And they think that this company has not done a good job of managing medical expenses. It has not denied enough claims. It has not kicked enough people off the rolls. And that’s what– that is what happens, what these companies do, to make sure that they satisfy Wall Street’s expectations with the medical loss ratio.

BILL MOYERS: And they do what to make sure that they keep diminishing the medical loss ratio?

WENDELL POTTER: Rescission is one thing. Denying claims is another. Being, you know, really careful as they review claims, particularly for things like liver transplants, to make sure, from their point of view, that it really is medically necessary and not experimental. That’s one thing. And that was that issue in the Nataline Sarkisyan case.

Many of the people who oppose single-payer and other comprehensive attempts at health care reform may be doing so out of a sense of smug complacency. They may think they are healthy and have good coverage from their current employer and so life is good. Why mess with something what seems to be working so well for them? In fact, one of the most disgusting arguments that I have heard recently from opponents of health reform is that by adding the 40 million or so currently uninsured to the rolls, there would necessarily be increased waiting times to obtain medical services. In other words, in order to save a little time for them, they would like to see others have no access to health care.

The fact that so many other people suffer from either inadequate coverage or no coverage at all may not be sufficient to move those who think they have good coverage now to embrace reform. What they do not realize is that their seemingly comfortable situation could change practically overnight through no fault of their own. All it would take is for one or two of their fellow employees to get a serious illness for them to lose their own coverage. Potter explains how this happens as a result of deliberate policy by the health insurance companies:

But another way is to purge employer accounts, that– if a small business has an employee, for example, who suddenly has [to] have a lot of treatment, or is in an accident. And medical bills are piling up, and this employee is filing claims with the insurance company. That’ll be noticed by the insurance company.

And when that business is up for renewal, and it typically is up, once a year, up for renewal, the underwriters will look at that. And they’ll say, “We need to jack up the rates here, because the experience was,” when I say experience, the claim experience, the number of claims filed was more than we anticipated. So we need to jack up the price. Jack up the premiums. Often they’ll do this, knowing that the employer will have no alternative but to leave. And that happens all the time.

They’ll resort to things like the rescissions that we saw earlier. Or dumping, actually dumping employer groups from the rolls. So the more of my premium that goes to my health claims, pays for my medical coverage, the less money the company makes. (emphasis added)

Potter warns people who resist reform attempts that the very things they say they fear about single payer or socialized systems or even the public option are actually more likely to occur under the present employer-based system.

And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don’t want the government to take away your choice of a health plan. It’s more likely that your employer and your insurer is going to switch you from a plan that you’re in now to one that you don’t want. You might be in the plan you like now. But chances are, pretty soon, you’re going to be enrolled in one of these high deductible plans in which you’re going to find that much more of the cost is being shifted to you than you ever imagined. (my emphasis)

The private, profit-seeking health industry is a cold-blooded and ruthless business in which meeting the needs of sick people is at the very bottom of their list of priorities, while making profits for their shareholders and paying for their executives’ luxurious lifestyles is right at the top. Why anybody would want to preserve that system can only be explained either by their ignorance of how it actually works or because the politicians have been bribed by the industry.

POST SCRIPT: Billionaires for Wealthcare speak out

“If god loved the poor people, he wouldn’t let them get sick.” So true.

College as a Disney World of Learning

(Talk given at Case Western Reserve University’s Share the Vision program, Severance Hall, Friday, August 21, 2009 1:00 pm. This program is to welcome all incoming first year students. My comments centered on the common reading book selection Three Cups of Tea by Greg Mortenson and David Oliver Relin. Mortenson will be the speaker at the annual fall convocation to be held on Wednesday, August 26, 2009 in Severance Hall at 4:30 pm.)

As I read the book Three Cups of Tea, two stories struck me. One begins on page 202 and is that of the little boy Mohammed Aslam Khan who was sent by his father alone on a perilous journey downriver in frigid waters, all so that he might get a chance at an education. Despite all the odds against him, he not only survived the trip but got a good education and returned to the village to become an educational leader.

The other story is on page 31 where Mortenson describes his amazement when he saw eighty two children assemble by themselves and do their lessons on their own in the open, in the cold, some writing on the ground with sticks, since the village could only afford a teacher for three days a week, and on the other days they were on their own.

As Mortenson said, “Can you imagine a fourth-grade class in America, alone, without a teacher, sitting there quietly and working on their lessons?”

Why were the people in that remote region of Pakistan willing to go through so much in order to get an education? Compare the situation in the US where learning is often seen as something to be avoided, and the complaints that some teachers get when they cover too much ground. When schools are closed or lessons cancelled due to some emergency, it is usually a cause for cheering amongst students. As a colleague of mine here said recently, education may be the only thing in the US where people actually want less than what they pay for.

There are of course classes, teachers, and students in the US where learning for its own sake is valued. But these are unfortunately few. But I do not believe that there is any fundamental difference between the children in those remote villages of Pakistan and Afghanistan and those in the US that explains this difference in attitude.

What may be true is that America suffers, if that is the right word, from too easy access to education. Schooling is fairly easily available and, at least in the K-12 sector, is free. A good analogy is with food, which is also freely and cheaply available in the US, when compared with other countries. And we waste and throw away vast amounts of it. I am sure your mothers pleaded with you to eat your vegetables, invoking images of starving children in China who would gladly eat with relish the food that you want to dump in the trash. Actually given the economic crisis in the US and the rapidly rising economic power of China, soon Chinese mothers might be pleading with their spinach-rejecting children to think of poor starving children in the US.

Students in the US, because of the ease and abundance of educational opportunities, have to be exhorted to take advantage of these abundant resources, just like they have to be coaxed to eat their broccoli, and this may be devaluing education in students’ eyes, because people tend to not value the things that are easily available.

This is why the story of the immense struggles and sacrifices made by the villagers that Mortenson worked with to build their schools is so inspiring. They realized that education is a precious gift to be cherished, not something whose availability can be taken for granted.

All of you are now embarking on four years of education here at Case Western Reserve University. Some people may tell you that college will be the happiest time in your lives. I disagree. In fact, it would be very sad if the happiest years of your life were over by the age of twenty-two. So I hope that you will have much happier times in the future.

But there is one aspect in which these four years will be a unique experience that you must take advantage of to the fullest. It is the one time in your life when you will be surrounded by people who want nothing else but to help you learn. The world-class faculty here, who are experts on all manner of things, will share their knowledge and expertise freely and willingly. Here you will get free access to incredible libraries full of books, journals, magazines, audio-visual materials, and newspapers, and to librarians who are positively eager to help you use them. And it is all available to you just for the asking. Once you graduate and go out, that opportunity is gone.

Of course, all this is not technically ‘free’ since you are paying tuition that, despite the extraordinary fund-raising abilities of our president, is still considerable. But the way to think of tuition fees is the way you would the admission price to Disney World or other amusement parks. It is not cheap to get in but once you are in, people try to get as much out of their time there as possible. It would be absurd to spend all your time sitting on a bench eating ice cream or surfing the web or sleeping.

You should have that attitude during the years you spend here. Think of Case Western Reserve University as the Disney World of learning. You have paid the admission fee in terms of grades and tuition. Now that you are in, rather than get by with minimal work, you should try to get in as much learning as possible, formally in classes, and informally in all the talks and seminars and casual discussions with teachers and fellow students. Once you develop that attitude towards learning, you will find that it is much more fun than roller coaster rides and with none of the accompanying motion sickness.

I am lucky in that I actually work here and take full advantage on a daily basis of the knowledge that is so freely available. And I would urge you to do the same. In fact, as soon as this program is over, and you have some free time, you should go over to the library and see what they offer, and you should go to all the museums that are right here in University Circle, as the first steps in a four-year adventure of learning.

Trust me, you will never regret it.

POST SCRIPT: The story of Genesis as told by Eddie Izzard

Much more interesting than the original. Makes more sense, too.

The health care debate-14: The ‘death panels’ of the insurance companies

(For previous posts on the issue of health care, see here.)

Wendell Potter used to be the head of corporate communications of CIGNA, the highest public relations position of one of the largest health insurance companies. That position gave him a special insight into how the health insurance industry actually works and the very different way they present themselves to the public. At some point the contradictions became unbearable for him. He could not take it anymore and left his position and since then he has been spilling the beans about how the insurance companies really operate, how they put profits before any other consideration, and make money from the misery of sick people by denying them care in their time of need.

Potter spoke to Amy Goodman of Democracy Now! about two cases. One was a California teenager, Nataline Sarkisyan, who in 2007 was denied coverage for a liver transplant, even though her doctors’ recommended it and they had insurance and had done everything that was expected of them. The family was able to get media attention and force CIGNA to reverse itself, but the reversal decision came just two hours before she died. No doubt CIGNA views this outcome as a great success since they did not have to pay for the liver transplant after all, hence their costs went down and their profits went up. Their shareholders must have been pleased.

Then there was the case of Thomas Concannon, who in 2002 was suffering from multiple myeloma, a rare form of cancer. As Goodman reports “His doctors planned to perform a bone marrow transplant, but as Concannon lay on the operating table, his insurance company, CIGNA, announced it would not cover the operation.” (my emphasis)

Potter remembered both those tragic cases because he had to try and mitigate the public relations damage. In a recent interview with Bill Moyers, Potter describes how he came to his epiphany about how rotten the current system is and his own sordid role in it. It occurred when he visited a ‘health expedition’ run by volunteer doctors at the Wise County fairground near his hometown when he was visiting his family. Such events are sprouting up all over the country and the huge crowds that turn up are a testimony to how many people lack access to basic primary medical care. Potter describes what he saw.

I took my camera. I took some pictures. It was a very cloudy, misty day, it was raining that day, and I walked through the fairground gates. And I didn’t know what to expect. I just assumed that it would be, you know, like a health– booths set up and people just getting their blood pressure checked and things like that.

But what I saw were doctors who were set up to provide care in animal stalls. Or they’d erected tents, to care for people. I mean, there was no privacy. In some cases– and I’ve got some pictures of people being treated on gurneys, on rain-soaked pavement.

And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. People drove from South Carolina and Georgia and Kentucky, Tennessee– all over the region, because they knew that this was being done. A lot of them heard about it from word of mouth.

There could have been people and probably were people that I had grown up with. They could have been people who grew up at the house down the road, in the house down the road from me. And that made it real to me.

Potter says that the widely contrasting world that the insurance industry executives live in carefully insulates them from the harsh realities that most people face, so that the people they deny coverage to are never seen as real people but are merely statistics.

I had a great job. And I had a terrific office in a high-rise building in Philadelphia. I was insulated. I didn’t really see what was going on. I saw the data. I knew that 47 million people were uninsured, but I didn’t put faces with that number.

Just a few weeks later though, I was back in Philadelphia and I would often fly on a corporate aircraft to go to meetings.

And I just thought that was a great way to travel. It is a great way to travel. You’re sitting in a luxurious corporate jet, leather seats, very spacious. And I was served my lunch by a flight attendant who brought my lunch on a gold-rimmed plate. And she handed me gold-plated silverware to eat it with. And then I remembered the people that I had seen in Wise County. Undoubtedly, they had no idea that this went on, at the corporate levels of health insurance companies.

In the same interview, Moyers reveals the strategy of the opponents of health care reform, who are trying to scuttle it while saying they want it.

BILL MOYERS: I have a memo, from Frank Luntz. I have a memo written by Frank Luntz. He’s the Republican strategist who we discovered, in the spring, has written the script for opponents of health care reform. “First,” he says, “you have to pretend to support it. Then use phrases like, “government takeover,” “delayed care is denied care,” “consequences of rationing,” “bureaucrats, not doctors prescribing medicine.”

This came as no surprise to Potter: “They don’t want a public plan. They want all the uninsured to have to be enrolled in a private insurance plan. They want– they see those 50 million people as potentially 50 million new customers. So they’re in favor of that.”

It is a fascinating interview, giving a disturbing insider’s look at the really evil practices of the health insurance industry. Moyers describes another case.

The day before she was scheduled to undergo a double mastectomy for invasive breast cancer, Robin Beaton’s health insurance company informed her that she was “red flagged” and they wouldn’t pay for her surgery. The hospital wanted a $30,000 deposit before they would move forward. Beaton had no choice but to forgo the life-saving surgery.

Southern Beale writes about her own experience:

You have no idea what it’s like to be called into a sterile conference room with a hospital administrator you’ve never met before and be told that your mother’s insurance policy will only pay for 30 days in ICU. You can’t imagine what it’s like to be advised that you need to “make some decisions,” like whether your mother should be released “HTD” which is hospital parlance for “home to die,” or if you want to pay out of pocket to keep her in the ICU another week. And when you ask how much that would cost you are given a number so impossibly large that you realize there really are no decisions to make. The decision has been made for you. “Living will” or no, it doesn’t matter. The bank account and the insurance policy have trumped any legal document.

Such stories expose that the falsity of the fear mongering that in a single payer or socialized system, bureaucrats will come between doctor and patient and make life or death decisions. Such things only happen with the private, profit-seeking health insurance companies. So the closest things to the bureaucratic ‘death panels’ that emerged from the fevered imaginations of the deathers are actually run by the private, profit-seeking health insurance industries who, in conjunction with hospital administrators, callously consign people to death purely because of their desire for profits.

POST SCRIPT: Capitalism – A Love Story

Here is the trailer for Michael Moore’s upcoming film which, like his others, should be well worth watching. His Sicko that dealt directly with the health system was great, and if you did not see it, you should rent it. But the problem with the health system is that is embedded in the capitalist mindset that values profit above all other things, and so this new film should give the bigger picture.

People will try and dismiss Moore as a ‘mere’ comedian in order to discredit his message. This is what the health industry and its shills in the media (I am looking at you Sanjay Gupta) tried to do with Sicko. In his interview with Moyers, Wendell Potter describes the industry’s strategy of which he was a part.

Don’t be fooled. His films are funny but Moore is smart and researches his material well. Try as they might, his detractors could not fault him on the facts.

The health care debate-13: The US falling further behind

(For previous posts on the issue of health care, see here.)

I have pointed out repeatedly that the US lags badly behind other developed countries in the quality and cost of the health care it provides its people. And all indications are that the US is going to fall further and further behind as other countries adopt universal health coverage based on the single-payer model.

President Obama keeps saying that if we were starting from scratch, a single payer system would be the best option, but that given the existing situation of an employer-based private health insurance system, it would be too disruptive. This is just an excuse for protecting the interests of the drug and insurance industries. After all, Medicare was introduced in 1965 and within one year, by July 1, 1966 19 million seniors were enrolled in it, almost all of the nearly 20 million people over the age of 65 at that time (see table 2-1, page 9), and there were no major problems in that transition.

Furthermore, as this article in the journal Health Affairs points out, other countries such as Taiwan made the transition from a US-style system to a single payer one quite easily. (Thanks to Heidi Nemeth for the link.)

Taiwan established a compulsory national health insurance program that provided universal coverage and a comprehensive benefit package to all of its residents. Besides providing more equal access to health care and financial risk protection, the single-payer NHI also provides tools to manage health spending increases. Our data show that Taiwan was able to adopt the NHI without using measurably more resources than what it would have spent without the program. It seems that the additional resources that had to be spent to cover the uninsured were largely offset by the savings resulting from reduced overcharges, duplication and overuse of health services and tests, transaction costs, and other costs. The total increase in national health spending between 1995 and 2000 was not more than the amount that Taiwan would have spent, based on historical trends.

Additionally, Taiwan did not experience any reported increase in queues or waiting time under the NHI. Meanwhile, the government has taken regular public opinion polls every three months to gauge the public’s satisfaction with the NHI. It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs. (emphasis added)

As Scott Hanley says:

In 1995, Taiwan began providing government-run health insurance for everyone; by the end of the year, almost everyone in the country had enrolled and abandoned their US-style system of mixed private and public hospitals and free market insurance. What happened to health care costs? In the first seven years they … stayed about the same.

That’s right. They went from 57% insured to 97% insured without increasing overall spending on health care. People liked it, used it, remained healthy, and it was just as affordable as the private system that had insured not much more than half the population.

A recent report says that China has decided to have universal health care by 2011, and will “take measures within three years to provide basic medical security to all Chinese in urban and rural areas, improve the quality of medical services and make medical services more accessible and affordable for ordinary people.”

Obama and the Democrats seem to start their negotiating process with what they think that the most reactionary elements in congress will accept, instead of the one that the country needs, let alone a really good one like a single-payer system. Cartoonist Tom Tomorrow explains the futility of this strategy.

Veteran journalist Russell Mokhiber lists the top 10 enemies of the single payer system, in alphabetical order. One or two of the names on the list may surprise you and you need to read the article for Mokhiber’s reasons.

American Association of Retired Persons (AARP)
America’s Health Insurance Plans (AHIP)
American Medical Association
Barack Obama
Business Roundtable
Families USA
Health Care for America Now
Kaiser Family Foundation
The Lewin Group
Pharmaceutical Research and Manufacturers Association of America (PHRMA)

However far Obama goes to appease the reactionary elements, they will still oppose reform because they want to kill it altogether. They do not want to give the Democrats a signature victory on a major issue, and they are aided in their efforts by those Democrats in Congress who are in the pockets of the health industry.

POST SCRIPT: Nutters gone wild

We have seen many examples of nutter behavior recently and it is hard to determine who is the craziest. A strong contender must be this woman who shouts “Heil Hitler!” at a Jew who is originally from Israel who was speaking in favor of health reform and for the creation of a national health care system like they have in Israel. Not surprisingly, he goes ballistic. Also watch her behavior at the end when he tells her that he had to pay $8,000 for a two-hour visit to a US emergency room. Priceless.

David Waldman notes that, to add to the irony, she is wearing an IDF T-shirt, which she presumably thinks gives her the license to freely use Nazi allusions.

The crying game

On Tuesday, I wrote about my discussion with the Cleveland Freethinkers group. Today I want to spend some time on the issue of the Christian woman at the meeting who, right in the middle of a lively discussion on the relative merits of the accommodationist versus the new atheist positions, suddenly and tearfully interjected an extended statement about her strong belief in Jesus based on some unspecified personal experience.

While we were sympathetic with her and treated her outburst gently, it is precisely this kind of reaction that is used by religious believers to shut down criticisms of their beliefs. I am not suggesting that this was a devious plan of the woman in question. In fact, I think she was being genuine and spontaneous. But it is symptomatic of the problem of frankly discussing religion. Religious people have become so used to their views being given undue deference that they cannot deal with having them clinically analyzed and thus become upset.

When someone tearfully says in the midst of a rational discussion on science and religion that “I truly believe that Jesus is my savior” or gives as the basis of some crackpot belief (like the Earth is 6,000 years old) that this is what his faith tells him is true, and is clearly upset because the rest of us are not taking such beliefs seriously, what are we supposed to do? What has been expected of us in the past, and which is what I am afraid that the accommodationist position encourages, is to treat such outbursts as either a sensible contribution to the conversation and try and soothe the person’s wounded feelings or change the subject to avoid having to contradict someone’s sincerely held beliefs, thus effectively ending the discussion. This is precisely how religious beliefs have shielded themselves, by expecting us to accommodate the emotional beliefs and feelings of religious people, and treating them as things that cannot be directly challenged.

What we should really do when people say such things is say something like “Good for you! But what you sincerely believe in the absence of any credible evidence is not really pertinent to this discussion, so let’s move on, shall we?” In essence that is what the Cleveland Freethinkers group eventually did, although they took some time to do so because initially it was taken aback and spent some time trying to cater to the feelings of the Christian and not hurt them

The philosopher Richard Rorty grappled with this same question in a 1994 essay titled Religion as Conversation-stopper that I wrote about earlier. Rorty says that the silence that usually accompanies someone’s fervent statement about their religious beliefs “masks the group’s inclination to say, ‘So what? We weren’t discussing your private life; we were discussing public policy. Don’t bother us with matters that are not our concern.’ This would be my own inclination in such a situation.”

I think that is precisely what happened at the Freethinker’s meeting. The Christian’s outburst hijacked the discussion away from general policy to solicitousness for her feelings. Most of us clearly felt that the Christian woman’s testimony was not relevant but struggled to find ways to tell her so without making her cry even more, thus taking time away from the main focus.

What happened is the religious equivalent of what has been sarcastically referred to within the feminist movement as the ‘white woman’s tears‘ phenomenon, “the tendency of race and gender discussions among feminists to be derailed by white women into the pain the discussion is causing non-POC [person of color].” It is elaborated on in this poem by Native American poet Chrystos in the context of internal struggles within the feminist community.

That is precisely the response that we new atheists get when we criticize all forms of religion, moderate and fundamentalist. When we do so, the feelings of religionists are hurt and they start to cry. Not literally of course in the case of sophisticated religious moderates, because that would look obviously whiny and pathetic. Instead they cry in a metaphorical sense, by leveling the charge that the new atheists are ‘contemptuous’ of other people’s beliefs or ‘militant’ or ‘rude’ or ‘extreme’ or ‘shrill’ or ‘strident’ or ‘obnoxious’ or similar epithets.

These charges are rarely backed up with concrete examples of such alleged bad behavior or language, or that it is any more common than the disdain with which atheists are routinely portrayed by religious people. Their function is once again to seek to shift the discussion away from the credibility of religion and to soothing the wounded feelings of the person claiming to be aggrieved by the allegedly harsh rhetoric against religion, and to make the new atheists apologetic and on the defensive. The excellent comic strip Jesus and Mo has something to say about this.

jesusandmo2.jpg

Sorry, but new atheists have caught on to this crying game rhetorical gambit and it is not working any more. This does not mean that we will simply dismiss those who get upset but it is not going to mute us. The new atheists are here to stay and will continue to make their critiques of religion because the fact that science and religion are incompatible is backed by an overwhelming preponderance of evidence and logical arguments in its favor, while religious apologetics and theology is becoming increasingly desperate in its special pleading.

Religious moderates are just going to have to suck it up and deal with criticisms of their beliefs like adults.

POST SCRIPT: The Thinking Atheist gives us The Story of Suzie

(Thanks to onegoodmove.)

The health care debate-12: Money talks

(For previous posts on the issue of health care, see here.)

Despite all the manifest advantages of the single-payer system, why is it not even discussed seriously in the decision-making bodies of government? To pose the question is to answer it. It is because the current US system is so bad that its supporters must prevent public discussion of obviously better rivals if it is to survive. The current system is the emperor that has no clothes.

Rich and powerful people either benefit directly from money that they get from the private, profit-seeking health industry (like those who work in the industry or the politicians who get big contributions from them) or have the money to get good treatment. It is these same people who protect the interests of the drug and insurance companies by refusing to even consider a single-payer system. These people use fear to keep others in line, raising downright dishonest fears of shortages, queues, rationing, lack of choice, etc if any reform should occur. They have even started upping the ante on their craziness, saying that with health reform we will start killing all old and sick people.

Uwe Reinhardt, a professor of political economy at Princeton University explains who is behind the propaganda:

Most Americans, first of all, are bombarded with propaganda. You don’t know how many think tanks are paid by certain industry — insurance, drug, organized medicine — to feed out negative stories about the Canadian health system. They do of course have mishaps, as do we, but there is a whole industry collecting them and beaming them out here. That is one.

Secondly, people are always more comfortable culturally with whatever they have than with some other system.

Third, people imagine having the worst illness, and if you are really very sick in the U.S., you generally do have more hope than in any other country if you are very sick, particularly if you are well insured. But if you sort of live the average life of Americans and have a Canadian system, they have better primary care, easier access to it. They would never go bankrupt over health care, because they don’t do that up there. They would realize what they are missing here.

Bloomberg reports that there are 3,300 health care lobbyists who have spent $263.4 million on lobbying during the first six months of 2009, getting their data from the Center for Responsive Politics which is monitoring the spending.

Uber-statistician Nate Silver, who did such an incredible job during the last election of analyzing the polling data, has done a statistical analysis of where politicians stand with respect to the public option and how that correlates with the amount of support they get from the health industry. He finds (surprise!) that the more they get funded by those special interests, the less supportive they are of the public option.

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Take Democratic Senator Max Baucus from Montana, chair of the Senate Finance Committee and one who has fought strenuously to keep single-payer out of the debate and scuttle any genuine effort at reform. As NPR reports:

Paul Blumenthal, a writer for the nonpartisan watchdog the Sunlight Foundation, mapped Baucus’ network of influence. (You can see the “Baucus influence map” at left).

“We have Max Baucus, who represents a single node, as the chairman of the Senate Finance Committee,” Blumenthal explains. On his computer screen, lines radiate from Baucus to five of his former Senate staffers. Two of them served as chief of staff to Baucus, the top job in his Senate office.

All five now lobby Congress for various interests. Among their clients: drugmakers Wyeth, Merck, Amgen and AstraZeneca, plus the third-largest corporation in the world, Wal-Mart.

When Baucus ran for his sixth term last year, his campaign raised $11.6 million, according to the Center for Responsive Politics. Nearly half of the funds came from out-of-state donors, including millions from health care and other industries overseen by Finance and Baucus’ other committees.

Just 5 percent of Baucus’ re-election funds came from Montana donors.”

Baucus courts these inside-the-Beltway donors by inviting them to Montana for weekend getaways — skis and snowmobiles in February, fly fishing and golf in June, and coming up on July 31, “Camp Baucus,” which is billed as “a trip for the whole family.”

Tickets start at $2,500.

So as Baucus and other lawmakers attempt to craft a bill that can smash through a virtual gridlock of interests, the awkward question lingers: To whom are they more attentive — their voting constituencies back home or the dollar constituencies who are at the Capitol every day?

That’s an easy question to answer, isn’t it? It appears that Baucus’s Senate Finance Committee may not include a public option. See also this report.

Former Senate Democratic leader Tom Daschle’s nomination to be Obama’s secretary of Health and Human Services was scuttled by some tax and ethics questions. While I felt that his ethics problems were nowhere as severe as (say) Tim Geithner’s who was approved because he was favored by Wall Street interests, I was glad that he did not get the position because I knew that he was totally in the pockets of the health industry lobby. Sure enough, he later came out against the public option.

Of all the presidential candidates in the Democratic and Republican primaries in the last election, only Dennis Kucinich supports single payer. The House Committee on Education and Labor that he chairs, by a vote of 25-19, has “approved an amendment to the House’s health-care reform bill allowing states to create single-payer health care systems if they so choose.” He is also one of the 86 co-sponsors of John Conyers’ House Resolution 676 that seeks to expand Medicare coverage for all, and is a worthy step towards an eventual single-payer system. The summary of the legislation can be read here.

POST SCRIPT: Hypocrisy on health care

It is becoming increasingly clear that opponents of health care reform are willing to say anything at all, even if it means directly contradicting themselves.

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Dealing with religious believers

Last Friday I was invited to speak to a group of Cleveland Freethinkers. I chose to speak about the new phase of the science-religion war. The old phase dealt with opposition to the teaching of the theory of evolution in schools and ended (more or less) with the drubbing that the intelligent design creationism forces received in the Dover trial in 2005. (Shameless plug coming up! My new book God vs. Darwin: The War Between Evolution and Creationism in the Classroom deals with this war and will appear in September.)

The new war is between two groups who were on the same pro-evolution side in the old war, the so-called ‘accommodationists’ (those who either believe that science and moderate forms of religion are compatible or that even if incompatible, the incompatibility should not be pointed out for fear of offending the sensibilities of moderate religionists) and the so-called ‘new atheists’ (those who think that science and religion are incompatible and have no hesitation in saying so).

The accommodationist position is nicely satirized by the cartoon below from the website Jesus and Mo, a terrific comic strip that features Jesus, Mohammed, and Moses as buddies and roommates conniving to foist their religions on their respective believers, and sometimes engaging with an unseen atheist barmaid. You really should visit the site regularly because it wittily captures much of the absurdity of religious apologetics.

jesusandmo1.jpg

After speaking for about 20 minutes or so explaining what this science-religion war entailed and advocating for the new atheist approach, I opened up the floor for discussion and a lively one ensued, debating the merits of the two approaches with arguments given in favor of both sides.

Then, in the middle of the discussion, a woman who had hitherto been quiet spoke up and said that she had listened to everyone and that it was clear that most (if not all) those present were skeptics of some sort but that she herself was a devout Christian who had been through much personal trouble (she implied that some of that involved recovery from a serious illness) and that she believed in Jesus and the Bible and had been blessed by him, and that all of us too should realize that we too had been blessed by him. She was clearly emotionally invested in what she said because she started to cry and had to wipe away tears several times.

The group was taken aback by this unexpected turn of the conversation and gave her the floor to let her fully have her say. They did not challenge or contradict or even interrupt her. When she was done with her extended comments, several people gently said that they could understand where she was coming from but that she should realize that the kinds of personal experiences that were meaningful to her may not be equally so to others who sought more empirical evidence for their beliefs.

After some time, the conversation returned to its original focus of which approach one should take, the accommodationist or the new atheist, and in the process we discussed what light, if any, might be shed on this topic by scientific theories such as quantum mechanics and the indeterminancy principle.

Although I claim to be a new atheist, I too did not directly challenge the devout Christian’s beliefs, which might seem to make me an accommodationist in practice. But there is really no contradiction. As I have explained before, there is a difference in the way that one deals with people’s religious beliefs in the private sphere and in the public sphere. I have no hesitation in the public sphere, which includes public talks like my initial remarks to the Cleveland Freethinkers group, of saying that I think that there is no rational basis for believing in god. I can be, and often am, quite uncompromising in my critiques of religion, not indulging in the polite fiction that some religious beliefs are credible or that the beliefs of religious people have some sort of immunity from criticism. But in the private sphere, which is what the discussion became when the Christian spoke to me and the rest of the group about her deeply held personal beliefs, one has to handle things differently.

In this particular case, the public/private line was not easy to draw because the group was about 30 people seated in a room in an informal setting. But I think the group as a whole was able to navigate that line, which speaks well for their sensibilities. I think the devout Christian was made to feel at ease and even welcome, even as it was clear that most of the people did not share her beliefs. But there is a disturbing undercurrent to such emotional outbursts by religious people that I will address in a fresh post later this week.

The Cleveland Freethinkers is a lively and friendly group that, as you can see, welcomes and accepts people with all kinds of beliefs. You can learn more about their meetings here.

POST SCRIPT: Why are there four conflicting gospels?

God tries to explain to Jesus how there came to be four different scripts for the part Jesus is to play on Earth.