Tag: health care

David Sirota caught something in today’s edition of The New York Times that backs up what those of us supporting single-payer healthcare have been saying for years: Private insurers ration care.

Here is a quotation from Cheryl Tidwell, 45, director of commercial sales training for Humana, the “country’s fourth-largtest insurer”:

“We believe there’s a better way to control costs by controlling utilization and getting people involved in their health care.”

Translation: We control costs by controlling access, by deciding what will be covered and what will not be. In a word: Rationing.

As Sirota points out, “we’re supposed to think that private for-profit health care companies don’t ration care, while government-run programs like Medicare do – but as the insurance industry admits right here for all to see, that’s just not the case.”

The obvious truth is that the health insurance industry works hard to “control utilization” – that is, it works hard to make sure that when you need a costly medical service, you are “controlled” (read: prevented) from getting it.

As I said in a recent post, anyone who thinks rationing will not be a part of a future healthcare system, whether administered publicly or privately, is fooling themselves. Triage is part of medicine — doctors make decisions every day based on need and effectiveness.

The difference is that private insurers make their decisions based on profit, while a public entity — at least in theory — would make its decisions based on the good of the patient and the good of society.

Free-marketers like to extol the virtues of the market, but the market — because it is profit-based — just doesn’t function well with these kinds of life-and-death questions. Insurance companies make their money, after all, by paying out less money than they take in — which creates a perverse disincentive. Remove the disincentive and maybe, just maybe, the healthcare system will start to behave in a more humane and rational manner.

Protesters are targeting Whole Foods because of comments made by company CEO John Mackey made in an op-ed in the Walls Street Journal earlier this month.

At first, the protests seemed unlikely to have much effect, unlikely to shift the debate much. In fact, there was the very real possibility that they could backfire.

But Whole Foods now appears to be the poster company in the current healthcare debate and, especially because the company’s reputation (upscale progressivism) is belied by its aggressive anti-unionism, Mackey’s comments could be creating the kind of momentum that has been lacking on the left side of the discussion.

Here is what Mackey had to say:

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care—to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America.

Someone should tell Mackey that the markets for food and shelter have massive flaws, that there are thousands — possibly millions — of hungry and homeless Americans and that food prices have been outpacing inflation for quite some time.

As World War II was winding down, Franklin Delano Roosevelt unveiled a new “Economic Bill of Rights” that included:

The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

The right to earn enough to provide adequate food and clothing and recreation;

The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;

The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

The right of every family to a decent home;

The right to adequate medical care and the opportunity to achieve and enjoy good health;

The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

The right to a good education.

Roosevelt said “these rights spell security” and would help move the nation toward “new goals of human happiness and well-being.” William Greider, in his new book Come Home, America (excerpted in May 6 edition of The Nation), described Roosevelt’s “Bill of Rights” as setting the agenda for the three decades that followed.

One important condition government can provide is the platform of “essential needs” that will give everyone more security and therefore more confidence to explore new and different choices. We could dust off Roosevelt’s “second Bill of Rights” and address its unmet goals. FDR recognized in early 1944 that Americans were weary of the sacrifices imposed by World War II and so he announced a broadly conceived promise. After the war is won, he said, the country must construct a new set of meaningful “rights” for all, everything from health and education to work with remunerative wages. His vision of the future became the postwar political agenda of the Democrats, and in large measure the promises were kept.

Greider says we are at a point in history where we need to return to Roosevelt’s construct and expand upon it — to finish what FDR started.

Which brings me back to health care and the market. Roosevelt, basically, was saying was that there are some things in life that are too important to be left to the market. Health care is one of those things.

That’s why I believe we need a single-payer healthcare system, one in which the federal government — or some independent agency created by the feds — acts as the funder of all care, with doctors and hospitals remaining independent. Care would be up to medical personnel without interference from insurance companies.

I won’t pretend that such a change won’t have its difficulties — but the reorganization of the system would be an improvement on what we currently deal with. Critics of reform raise the specter of tax hikes and rationing, but we’re already paying through the nose and having our care rationed — but instead of a rationing by triage, with decisions made based on effectiveness and need, the insurance companies base their decisions on profit and profit alone.

Mackey’s belief in the market probably wouldn’t have triggered such disdain, however, had he not also blamed the victim in the healthcare fiasco. He said that “many of our health-care problems are self-inflicted,” blaming the rising costs on obesity and diseases that he says “are mostly preventable through proper diet, exercise, not smoking, minimal alcohol consumption and other healthy lifestyle choices.” Making better lifestyle choices would help stem rising prices.

There is nothing wrong with better choices, but the issue here isn’t McDonald’s hamburgers and Krispy Kreme donoughts. It’s access and cost and it is offensive to say that the people who are forced to use emergency rooms for primary care have brought it on themselves.

Hence, the protests, which are a direct response to the callousness of Mackey’s piece and a desire, a need, to put single-payer on the table.

The conservative blogger, Ryan Sager, makes an interesting point in today’s New York Times. Why is it we call what has been happening at the town hall meetings on healthcare “astroturf,” but not what the Obama administration – or Move On — has been doing?

“Astroturf” — essentially, manufactured public opinion, generally created using the deep pockets of corporations, designed to convince legislators and regulators that the public is behind a particular agenda.

Sourcewatch, a project of the Center for Media and Democracy, distinguishes what it calls “genunine grassroots activism” from “astroturfing” this way:

Unlike genuine grassroots activism which tends to be money-poor but people-rich, astroturf campaigns are typically people-poor but cash-rich. Funded heavily by corporate largesse, they use sophisticated computer databases, telephone banks and hired organizers to rope less-informed activists into sending letters to their elected officials or engaging in other actions that create the appearance of grassroots support for their client’s cause.

The question is whether it is fair to describe opposition to the Obama health plan and the public option as “astrotruf.” The answer depends, I think, on your partisan beliefs — sort of like asking whether the chicken or the egg came first.

There always has been a significant portion of the public — even before the interference of the corporate interests — that were suspicious of Barack Obama on health care, even if skeptics had been a minority. The money and strategizing coming from the right, in particular the money coming in from the insurance lobby, has only increased the skepticism.

Does that mean that the current opponents, the ones shouting most loudly at the healthcare forums, represent a fake movement? I don’t think so.

Consider this from William Greider’s 1992 book, Who Will Tell the People, which outlined how various intersecting strands — campaign contributions, voter apathy, and what he called “democracy for hire” — were leaving our democracy weakened and ineffective.

“Democracy for hire” is similar to “astroturfing,” but encompasses a much greater phenomenon: not just the creation of fictional grassroots support, but manufactured facts and analysis. But it operates in the same way, by manipulating the debate.

Grieder describes a targeted, PR-industry-run campaign in 1990 designed to kill clean-air legislation. The PR firm, Bonner & Associates (yes, the same firm tied to the forged NAACP letters), “persuaded” an array of otherwise apolitical civic organizations in auto-industry states “to take a stand” against tougher fuel standards by convincing the group’s leaders that higher mileage requirements “would make it impossible to manufacture any vehicles larger than a Ford Escort or a Honda Civic.” (Greider, p. 37)

Greider writes that Bonner was paid “somewhere between $500,000 and $1 million” (in 1990) for “scouring six states for potential grassroots voices, coaching them on the ‘facts’ of the issue, paying for the phone calls and plane fares to Washington and hiring the hall for a joint press conference.” (Greider, p. 37)

The groups lend a different look to the argument, putting a human face on what otherwise is a corporate campaign.

Bonner told Greider (pp. 37-38) that

“It’s farm groups worrying about small trucks. It’s people who need station wagons to drive kids to Little-League games. These are the groups with political juice and they’re white hot.”

Greider, however, does view this as truly democratic. (p. 38)

In actuality, earnest citizens are being skillfully manipulated by powerful interests — using “facts” that are debatable at best — in a context designed to serve narrow corporate lobbying strategies, not free debate.

The problem with using this concept to describe the shouters at the town halls is that — even with the concerted corporate effort behind it — the shouters appear to have come before the corporate money and they also appear to be plugging into some real concerns about the Obama health plan (even if it based on some ugly lies and distortions).

The reality, I think, is that progressives have allowed themselves to be out-organized by the right at a time when progressives should have had the ear of the people in power.

Basically, what the right has done on health care is what the left should have been doing. More from Sager:

One reason the town hall protesters are called Astroturf is that they have ties to groups with corporate financing like FreedomWorks, run by Dick Armey the former House majority leader. But the Obama administration has been doing its own stage managing. At a town hall in Virginia last month, the president took questions from members of organizations with close ties to the administration, including the Service Employees International Union and Organizing for America, which is a part of the Democratic National Committee. The Web site of another liberal group, Health Care for America Now, instructs counter-protesters to “bring enough people to drown” out the Tea Partiers.

What’s the difference?

Not much, really. Sager:

Organizing isn’t cheating. Doing everything in your power to get your people to show up is basic politics. If they believe what they’re saying, no matter who helped organize them, they’re citizens and activists.

The left — or a portion of it, anyway — allowed Obama too long of a honeymoon period, which left a political vacuum. Obama and Congress have seen little pressure from his left, and much from his right, creating an imbalance that plays into the outmoded political narrative that the newsmedia has had difficulty moving beyond.

The reality is that the Democrats have spent the better part of the last six months backpedaling on healthcare reform, trying to appease Republicans and conservatives with a weak and likely ineffectual plan that the GOP is not going to support anyway. That’s a sucker’s bet.

If Democrats were serious about reform, they’d follow the example of U.S. Rep. Anthony Weiner (D-N.Y.) and be bold and unapologetic in their support for a competing public insurance plan, even if they refuse to go all the way to single-payer.