Category Archives: Capitalism

Healthcare Lobbying Group Double-Crossing Democratic Voters

For nearly a year now, I have been advocating single payer health care ever since I was diagnosed with end-stage renal disease. BTW, I am doing fine, even if I have been rejected twice for access to transplant centers due to personal reasons I won’t go into here.

Today, I found an article on The Intercept.com that reported that several candidates for Congress and other offices in Hawaii and other states have secretly secured opposition to “Medicare for All” single payer healthcare, even though they have told their voters that they support it.

According to the article, the candidates in Hawaii’s 1st Congressional District, former state Sen. Donna Mercado Kim, Hawaii Lt. Gov. Doug Chin, and Honolulu City Council Member Ernest Martin are taking heat from opponents for talking to an industry-friendly group, the Healthcare Leadership Council (HLC).

The Healthcare Leadership Council seeks to advance the goals of the largest players in the private health care industry. These candidates are talking to the HLC even as public opinion is moving towards positions opposed by giant health care companies.

Kaniela Ing, a state lawmaker running for the seat on a democratic socialist platform stated that, “Democrats running in a primary election will say they support ‘Medicare for All,” but what do they say to lobbyists behind the scenes?”

In fact, the article reports, one leading candidate has campaigned on a pledge to crack down on over-priced pharmaceuticals and promote single payer, but told the consultant sent from the HLC that he would maintain drug industry friendly pricing policies and views Medicare for All with skepticism.

HLC spends over $5 million a year on industry advocacy and brings together chief executives of major health corporations, and represents an array of health industries — from insurers, hospitals, drugmakers, medical device manufacturers, pharmacies, health product distributers, and information technology companies.

HLC’s outreach in Hawaii began in January. The group told candidates, in an email obtained by The Intercept, that it was in the process of forming a coalition to “jointly develop policies, plans, and programs to achieve their vision of a 21st century system that makes affordable, high-quality care accessible to all Americans.”

This language obscures their national campaign to monitor and blunt the energy behind progressive policy reform. In an email to The Intercept, Michael Freeman, executive vice president of HLC said that they survey “congressional candidates every election cycle regarding their views on a wide range of healthcare issues.”

Former state Sen. Kim’s dossier profile said she is very pro-market, opposes any attempt at single payer, does not support price controls on pharmaceuticals and agrees that Medicare and Medicaid need to be managed by the private market.

It would seem that besides the opposition from the insurance companies and the pharmaceutical industry, single payer, Medicare for All, is under assault below the radar of most voters, if not most Democratic voters during the primaries.

Despite alleged strong support for bills such as the one Bernie Sanders introduced, lobbyists for the medical-industrial complex are fighting hard to defeat health care reform for all Americans, and no matter what the public attitude is, they will prevent at all costs, the transition to single payer.

HLC also keeps tabs on candidates who could be a threat to their agenda, such as Ing, stating that she vocally supports a single payer, public health care system.

Lobbyists have told executives in the health care industry to be vigilant about the threat of single payer.

“It would be a mistake for us to overlook the growing number of lawmakers who are supportive of measures to expand significantly government’s role in healthcare,” according to a report HLC published at the end of last year. The report went on to say that while these ideas do not have the political support to pass at the moment, the “momentum on the Democratic side of the aisle is undeniable,” They have dispatched teams of lobbyists to keep tabs on rising candidates.

So, even if you vote for a Democrat in November, chances are, that they will double-cross you when it comes to supporting Medicare for All. Which is wrong-headed on their part, especially the hospitals and pharmaceutical companies.

If more people are covered, and the government pays for their health care, hospitals will get more patients covered under the plan and thus more revenue, even if they charge lower prices than for private insurance, and drug companies will sell more drugs to these patients, even if the prices are brought under control.

What difference does it make if a patient gets their health are from a government plan like Medicare or Medicaid, as many already do, or if they get it through private insurance? The hospitals and drug companies still make money, just a smaller amount. The number of newly insured will offset any assumed loss of profit, thereby increasing profit, and just not from a select group of people who can afford health care on their own.

Advocates for single payer need to be vigilant also. Don’t buy a pig in a poke. Confront these and other candidates for office to see if they really believe in single payer, or are pigs with lipstick.

 

 

 

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Baby Formula Battle Redux


In the mid-1970’s, a boycott was launched to protest the promotion of baby formula in the Third World by the Nestlé Company of Switzerland. I remember it well, because I researched it while in college.

At the crux of the boycott was that due to poor water quality, and the high cost of the infant formula which was in powder form and had to be mixed with the water, babies were not getting sufficient nutrition from the formula because of contaminated water and because their mothers only used less than the recommended amount of formula to make it last longer.

The worldwide boycott was promoted by a documentary that explained how Nestlé promoted the formula in countries mainly in Africa, and how the contaminated water supply, plus the watered down formula led to various diseases in infants.

The boycott has, according to Wikipedia, been cancelled and renewed because of business practices of Nestlé and other manufacturers.

The New York Times reported yesterday, that earlier this spring, in Geneva, a resolution regarding breast-feeding was expected to pass quickly and easily, was opposed by the American delegation to the World Health Assembly, a UN-affiliated organization.

According to the Times, American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

The American effort failed, so in keeping with the current regime’s bullying tactics against friends and allies and trading partners, the Times reported that they turned to threats, according to diplomats and government officials who took part in the discussions.

One of the countries they threatened was Ecuador. Ecuador had planned to introduce the measure. The fascist regime told the Ecuadoreans that if they refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.

Research has proven that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes, the Times went on to say. A 2016 Lancet study found that universal breast-feeding would prevent 800,000 deaths a year around the world, and yield $300 billion in savings from reduced health care costs, and improved economic outcomes for those reared on breast milk.

But owing to its slavish devotion to corporate America and the pursuit of profit at any cost, the fascist regime in Washington has embraced the interests of the infant formula manufacturers.

Thus, the battle to protect the health and safety of infants and children in the developing world has been renewed. However, this time with the threat of economic blackmail, countries that dare to introduce this resolution or enact its recommendations to promote breast-feeding over that of breast milk substitutes, may not be able to defend themselves, and represents a threat not only to the health and welfare of children in developing nations, but to the health and stability of their home countries as well.

Advocates for health scrambled to find another sponsor for the resolution, but a dozen countries, mostly in Africa and Latin America, backed off citing fears of US retaliation.

The Russians stepped in to introduce the measure, but the Americans did not threaten them. Of course not, the Orangutan takes his orders from Moscow.

The Russian delegate said, “We’re not trying to be a hero here, but we feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world.”

Oh, so I guess we can forget the over forty years the Soviet Union pushed around the smaller nations in Eastern Europe, as well as their allies in the third world? What would you call the invasions of Hungary and Czechoslovakia? Simple misunderstandings?

But getting back to the issue, it is sickening that the US, being more concerned with the financial health of some multinational formula manufacturers, would prevent mothers from getting information about how beneficial breast-feeding is for their babies, which would go along way to moving them out of poverty, and improve the overall health of people in those countries. Then maybe they wouldn’t need to rush towards our southern border to escape violence, drugs, hunger, poverty and despair. Profits before people, that’s the real American motto and values.

 

More doctors become hospital employees, facing noncompetes | Healthcare Dive

The proletarianization of physicians marches on. As you recall from my reviews of “Health Care under the Knife”, there has been a steady movement towards making physicians into employees of hospitals, or rather their proletarianization. Now it seems they are up against noncompetes, as the article below reports.

Here is the link to the article:

Legal experts say noncompete agreements are common practice for hospitals, and are usually enforceable. But physicians, and in some cases the courts, are pushing back.

Source: More doctors become hospital employees, facing noncompetes | Healthcare Dive

Some Final Thoughts On “Health Care under the Knife”

Last month, I wrote two articles about the book by Howard Waitzkin et al. entitled, “Health Care under the Knife: Moving Beyond Capitalism for Our Health.

The first article was a review of the Introduction to the book. The second article examined the Affordable Care Act (ACA), also known as “Obamacare”, as the last stage of neoliberal health care reform.

In this article, I will critique the overall message of the book and give some reasons as to why I believe radical change in American health care and radical change in American society in general cannot take place until one key condition is met for that change.

This will also apply to the rest of the world where neoliberal policies have taken root. But since much of the impetus of these policies comes from the US and institutions the US created after World War II such as the International Monetary Fund (IMF), the World Bank, and the United Nations’ World Health Organization (WHO), as well as many international financial institutions and the Gates Foundation, it will be difficult, but not impossible to turn back those policies and effect the necessary change to secure universal health care for their citizens. Some have already done so.

The authors have made a very convincing case for their argument that the failure to achieve universal health care is a result of neoliberal policies enacted over thirty years ago both here in the US and in the UK under both Republican and Democratic administrations, and under the various Conservative Party Prime Ministers, from Thatcher, Major, Cameron, and now Theresa May, and Labour PMs, Blair and Brown.

However, their prescription for how we overcome these policies assumes that social change is necessary before there can be change in health care. While technically correct, their understanding of the conditions necessary for that change is flawed.

Economic determinism, the socioeconomic theory that underpins much of Marxist thought about Capitalism and the relationship between workers and owners of the means of production is central to the thesis in “Health Care under the Knife.” But can economic determinism really explain why the central thesis of Marxism has not materialized, since Marx predicted that the contradictions inherent in Capitalism would bring about the revolution that would free the working class.

The truth is more complicated than that, because Capitalism has a nasty habit of reinventing itself, or in the case of the New Deal and the Great Society programs of the 20th century, reform the system to improve the lives of those most affected by the inequalities of the Capitalist system.

Many American families, mine included, benefitted from those reforms. Whether we are talking about Social Security, the GI Bill, student loans guaranteed by the federal government to cover the cost of college for those in the working and middle classes, job training programs, other forms aspects of the social safety net, millions of Americans have moved upward in social mobility.

Anecdotal evidence from friends and relatives, stories of celebrities rising from humble beginnings, and lately, the rise of a biracial male from the State of Hawaii, whose father was an African immigrant and whose mother was a White American, and reached the highest office of the nation, is indicative of this upward social mobility. He did it by working hard and proving that if he could do it, given his background and personal tragedy of losing his father early in his life, anyone can.

The long-predicted revolution, therefore did not happen because many working people, to use a euphemism, “made it”. Some have made it into the middle class, and some have made it into the upper middle class. And some others managed to make it into the lower strata of the upper class. They are not the proverbial “1%”, but nevertheless, they are wealthy. And happy, well-off people don’t make revolutions.

We are however, seeing a reversal among some of the middle class and working class, and that is most definitely due to neoliberalism. And the opioid crisis is decimating the White working class and economic dislocation is one reason for the increase in suicides among White males.

So, to base the argument for single payer solely based on economic determinism and the change the authors contend is necessary for that to occur, is only looking at one side.

After the ascendency of Ronald Reagan to the Presidency, I realized that there was something else besides his charm and ability to communicate effectively that made Americans vote for him overwhelmingly. But I was unable for many years to understand why beyond believing that they did not want to be poor, as many living in Socialist nations were.

However, in the evolution of my consciousness, I have discovered that a socioeconomic theory only tells part of the story. Some years ago, I learned of a biopsychosocial theory of development called Spiral Dynamics. I have written about it before in other posts.

Without going into detail, suffice it to say that Spiral Dynamics is the theory that explains how people think, either as individuals or as a collective. And the reason is it called Spiral Dynamics is because the adult human mind is an oscillating, dynamic spiral from lower order to higher orders of thinking.

Based on the research of Clare W. Graves, Don E. Beck and Christopher Cowan, patented their ideas into Spiral Dynamics. Spiral Dynamics is concerned with the life conditions and coping measures used to solve the problems life conditions present to individuals and collective societies. It also reveals the deep codes about how people think, and what they value.

Using Graves’ labels for the first six levels of existence, they borrowed the term “meme” from Richard Dawkins, the British biologist, and color coded them for better mnemonic effect, as shown in the table below. Beck and Cowan labeled their version of memes, vMemes, or value systems, as they are concerned with the values individuals and collectives manifest at any given time in their development. Individuals and collectives can exist at more than one level at any time.

The table illustrates the last three levels as they currently are represented in the American population, along with the percentage of the world population at each, and the percentage of social power they have. The US is included in these figures, and only at Green do we see what percentage of Americans are at Green. But we can use them nonetheless for our purposes here.

By adding the percentage of population at both Blue and Orange, which in today’s America represents the Republican Party’s bases’, we notice that Blue/Orange has 70% of the population. Conversely, adding the percentage of power for each gives us 80% of the power, meaning that 70% of the American population controls 80% of the social power. Given that fact, to effect any change, either in society in general, or in health care, those percentages must change.

Blue has throughout history viewed the delivery of health care as a form of charity. The word hospital comes from the Knights of the Hospital of St. John, who provided care for poor, sick, or injured pilgrims coming to the Holy Land. And more recently, several Christian denominations have established hospitals for the same purpose. Catholic, Baptist, Methodist, and Presbyterians are but a few of the Christian churches that have built hospitals in cities across the country. Jews also have built hospitals, even the one this writer was born in.

Orange, on the other hand, sees the delivery of health care as a commodity that can be purchased for a price through the instrument of an insurance policy issued by a for-profit insurance company. If one can pay for it, then health care is easily accessible, and available when needed. But if one is not able to do so, then they should have planned accordingly. It is not their responsibility to provide them with health care by using their hard-earned income for such care, is their reasoning.

Green, therefore believes that health care is a right, and that is how it should be. It should be no surprise that one of the areas where the Green meme is seen is in Canadian health care. Many progressives point to Canada’s system as a model for the US.

But what prevents the US from moving forward towards that model is exactly how both Blue/Orange sees health care delivery. And since Orange has most of the power between the two, it is Orange’s Capitalism and Neoliberal policies that dictate how health care is delivered, paid for, and who can get it.

Thus, the one flaw in the argument the authors of “Health Care under the Knife” have is not understanding the value systems that underpin opposition to universal health care. It is not enough to discuss the economic reasons, as they have so successfully done, but to examine the psychosocial aspects as well. Taken together, economic determinism and Spiral Dynamics, in my opinion, explains in greater detail why change cannot happen as the authors would wish, until most of the US population evolves up the spiral.

One of the outgrowths of Spiral Dynamics as theory has been its merger with economics which Said Dawlabani has termed, MEMEnomics. MEMEnomics has been defined as a new branch of social science that studies patterns of economic policies and practices by taking an integral, whole-systems approach to economic sustainability.

According to Dawlabani, the US has entered what he called the Third MEMEnomic Cycle and it is expressed as the “Only Money Matters” Meme. This period began in the 1980s, the same time when neoliberal policies began. It led to what Dawlabani called the perfect Memetic storm. It is at this juncture where we find ourselves, and it his belief that a new paradigm is needed to move into the next cycle.

So, despite polling favoring single payer health care, as the authors rightly note, powerful interests will block any movement towards single payer. Until Orange has diminished in its social power and Green’s has increased, nothing will change. And the radical change they prescribe for this to occur will not, so long as social mobility for some prevents it, and profit can be squeezed out of the system.

Nevertheless, I highly recommend this book as a significant resource for understanding the dysfunction of our broken health care system despite its one flaw of being only one part of the story.

The Disruptors are Coming: The New Health Economy and the Medical-Industrial Complex

A big shout out to Dr. Don MCanne for his Quote of the Day post Friday for today’s topic, and a belated shout out to him for his post last Tuesday about the gains from the ACA being reversed. See my post, ACA Gains Reversing.

This time, Don alerts us to the impact the new health economy disruptors will have and what it might mean for the push towards single payer health care.

Last month, the PwC Health Research Institute (HRI) released a report analyzing the new health economy landscape as more and more companies pursue acquisitions of companies in the insurance, pharmacy benefit management, health care services and retail spaces.
In the last six months, the report states, there has been an explosion of unusual deals between companies such as CVS Health buying Aetna, Cigna buying Express Scripts, UnitedHealth’s Optum buying DaVita Medical Group (Kidney disease and dialysis), Albertsons agreeing to merge with Rite Aid, as well as the much highly publicized partnership between Amazon, JP Morgan, and Berkshire Hathaway.

Naturally, these aren’t the only deals that have occurred. Last year, 67 deals occurred in the US health services market, including payers and providers, the report adds.

The value of these deals increased 146% over those in 2016. The US health care industry, the report states, is undergoing seismic changes generated by a collision of forces: the shift from volume to value, rising consumerism, and the decentralization of care.
The HRI identified four new archetypes of companies engaged in this new health care economy:

• Vertical integrators — CVS & Aetna, Optum & DaVita, Cigna & Express Scripts
• Employer activists — February 2016, 20 US companies form Health Transformation Alliance (HTA) and developed tools to help its members cut employee healthcare costs. In January, Amazon, JP Morgan and Berkshire Hathaway partnered to lower costs and improve employee satisfaction
• Technology invaders — Amazon selling over-the-counter medical products, offering discounted access to Prime service, Apple’s newest operating system allows users to access parts of their EHRs on their phones
• Health retailers — CVS, Walgreens, Walmart, Albertsons and others using their network of store locations, consumer insights, national and global supply chains, and national (and sometimes global) branding to attract consumers looking for affordable, convenient care and goods

The HRI report recommends that all healthcare companies should make the following moves:

• Invest in customer experience
• Plan for a broader workforce
• Focus on price

This is how Don McCanne commented on this report. He wrote that Arnold Relman, like Dwight Eisenhower did about the military-industrial complex, warned us about the medical-industrial complex, but did not realize how intense the disruption would be in health care that the HRI report discusses.

According to Don, we are about to see a takeover by the disruptors who “have a leg up on many established health players in understanding consumers and tailoring experiences for them.”
The disruptors are “positioned to address price through greater scale, ownership of middlemen and a wider grip on the US health system value chain.”

If you don’t believe Don, then read what Jamie Dimon, the CEO of JP Morgan said, “To attack these issues, we will be using top management, big data, virtual technology, better customer engagement and the improved creation of customer choice (high deductibles have barely worked). This effort is just beginning.”

This is exactly what the Waitzkin et al. book describes when explaining the methods used by the medical-industrial complex to control and direct the American health care system for power and profit of the members of the complex.

Dr. McCanne observes that it is almost as if the physicians, nurses and other health care professionals and the hospitals and clinics in which they provide their services have become a peripheral, albeit necessary, appendage to their wellness-industrial complex that is displacing our traditional health care delivery system and its more recent iteration of the medical-industrial complex.

In other words, the physicians and nurses and other professionals have become proletarianized, and the hospitals and clinics merely the places where the medical-industrial complex derives its power and profit from.

Dr. McCanne posits the following questions as to what the health care system would look like once the transformation is well along:

• Once the silos of the health care system are flattened, how will health care be financed?
• Will there still be networks?
• Cost sharing barriers such as high deductibles?
• Will it be possible to fund this expansive model of the wellness-industrial complex through anything remotely resembling an insurance product, especially when the insurers are being amalgamated into what was formerly the health care delivery system?
• And now that the plutocracy is in control, how could we ever remove the passive investors that extract humongous rents through the wellness-industrial complex?
• And what about the patients? Did we forget about them?

It is obvious from his comments that this new health economy is going to be more problematic for providing universal health care to all Americans and will only make things worse. His Rx is to begin now to move to a single payer, Medicare for All program, and not worry about what has passed.

Smart diagnosis and prescription.

ACA Gains Reversing

The Commonwealth Fund reported today that the marked gains in health insurance coverage made since the passage of the Affordable Care Act (ACA) in 2010 are beginning to reverse.

This is according to new findings from the latest Commonwealth Fund ACA Tracking Survey.

According to the survey, the coverage declines are likely the result of two major factors:

1) lack of federal legislative actions to improve specific weaknesses in the ACA and

2) actions by the current administration that have exacerbated those weaknesses. These include the administration’s deep cuts in advertising and outreach during the marketplace open-enrollment periods, a shorter open enrollment period, and other actions that collectively may have left people with a general sense of confusion about the status of the law.

Here are the key findings:

*  About 4 million working-age people have lost insurance coverage since 2016
*  The uninsured rates among lower-income adults rose from 20.9 percent in 2016 to 25.7 percent in March 2018
*  The uninsured rate among working-age adults increased to 15.5 percent
*  The uninsured rate among adults in states that did not expand Medicaid rose to 21.9 percent
*  The uninsured rate increased among adults age 35 and older
*  The uninsured rate among adults who identify as Republicans is higher compared to 2016
*  The uninsured rate remains highest in southern states
*  Five percent of insured adults plan to drop insurance because of the individual mandate repeal
What are the policy implications of this reversal?
The absence of bipartisan support for federal action has seen legislative activity shifted to the states.
Broadly, the leaving of policy innovation to states will lead to a patchwork quilt of coverage and access to health care across the country. It will fuel inequity in overall health, productivity, and well-being.
Folks, as I wrote about in What’s Really Wrong With Health Care? and Obamacare: The Last Stage of Neoliberal Health Reform, until we see a change in the consciousness of both the American people, their representatives in Congress, and in Corporate America, especially within the financial industry to radically alter the direction health care is heading, the situation will only get worse.
We need to get the money and the greed and the corporations out of health care altogether. We need a single payer system that does not proletarianize physicians, does not turn health care into a commodity, does not financialize it, commercialize it, and compromise it for the benefit of a few, and to the detriment to the many.
As this is May Day, the international workers’ day, wouldn’t it be nice if we could start moving in that direction, as so many other nations have already done?

CMS’s Price Transparency Trick

Shoutout to Promed Costa Rica for the following article posted today on Facebook.

http://www.modernhealthcare.com/article/20180425/NEWS/180429939?utm_source=modernhealthcare&utm_medium=email&utm_content=20180425-NEWS-180429939&utm_campaign=am

CMS has been for decades the crux of the problem with the American health care system, Every model, program and scheme they have implemented addresses only the symptoms, but not the cause of the disease the patient is suffering from.

As I wrote yesterday, and the week before in my review of Health Care under the Knife, the real cause of the complexity, confusion, dysfunction and overall failures of the health care system is the system itself — meaning the economic system that has proletarianized physicians, commodified, corporatized, financialized, and monopolized health care in this country.

So now, this talk of price transparency, when the cost of care is already too high compared to other Western nations, is just a placebo being administered to a dying patient — the American health care system.

Remember these words:

“America’s health care system is neither healthy, caring, nor a system.”

Walter Cronkite