Category Archives: Republicans

Single Payer A Bargain

Another shout out to Don McCanne for the following.

On Friday, the Nation published an article by Steffie Woolhandler, David Himmelstein, and Adam Gaffney.

You may recall these folks from my book review, “Health Care Under the Knife,” and it’s conclusion, “Some Final Thoughts on ‘Health Care Under the Knife.'”

Rather than regurgitate it for you, I am letting you read it in its entirety. But before I do, let me bring to your attention, an issue that is flying under the radar and has serious consequences for the country, our rights, and for the future of health care and other social programs.

Those lovable brothers from the Midwest, Charles and David Koch, are funding a group called ALEC, the American Legislative Exchange Council. One of the goals of ALEC is to call an Article V (of the Constitution, for those of you not familiar with the document) that allows for the creation of a convention in the event the government gets too much power.

I recommend you read up on it because it will radically alter our system of government for the benefit of the corporations and wealthy. Say goodbye to Social Security, Medicare, Medicaid, and direct election of Senators, to name a few goals.

That brings me to a quote I must let you read from a man who has no clue what he is talking about, and is emblematic of the dysfunction of his party. That man is former Oklahoma Sen. Tom Coburn, himself a physician who said the following regarding a convention and why he and others feel it is necessary.

“We’re in a battle for the future of our country…We’re either going to become a socialist, Marxist country like western Europe, or we’re going to be free. As far as me and my family and my guns, I’m going to be free.”

In case you missed that, let me repeat it:

“We’re in a battle for the future of our country…We’re either going to become a socialist, Marxist country like western Europe, or we’re going to be free. As far as me and my family and my guns, I’m going to be free.” Violent, ain’t he?

Pray tell, what country in western Europe is Marxist? Last I heard, none. Folks, these guys not only want to take away health care, they are still fighting the Cold War and godless, Marxist Communism.  No, what they are really about is defending a system, both economic and health care-wise, that cannot be sustained.

Here is the article in full:

Last week, Charles Blahous at the Koch-funded Mercatus Center at George Mason University published a study suggesting that Bernie Sanders’s single-payer health-care plan would break the bank. But almost immediately, various observers—including Sanders himself—noted that according to Blahous’s own estimates, single payer would actually save Americans more than $2 trillion over a decade. Blahous doubled down on his argument in The Wall Street Journal, and on Tuesday, The Washington Post’s fact-checker accused Democrats of seizing “on one cherry-picked fact” in Blahous’s report to make it seem like a bargain.
The Post is wrong to call this a “cherry-picked fact”—it’s a central finding of the analysis—but it is probably right that single-payer supporters shouldn’t make too much of Blahous’s findings. After all, his analysis is riddled with errors that actually inflate the cost of single payer for taxpayers.
First, Blahous grossly underestimates the main source of savings from single payer: administrative efficiency. Health economist Austin Frakt aptly demonstrated the “bewildering complexity of health care financing in the United States” in The New York Times last month, citing evidence that billing costs primary-care doctors $100,000 apiece and consumes 25 percent of emergency-room revenues; that billing and administration accounts for one-quarter of US hospital expenditures, twice the level in single-payer nations; and that nearly one-third of all US health spending is eaten up by bureaucracy.
Overall, as two of us documented recently in the Annals of Internal Medicine, a single-payer system could cut administration by $500 billion annually, and redirect that money to care. Blahous, in contrast, credits single payer with a measly fraction of that—or $70 billion—in administrative savings.
Our profit-driven multi-payer system is the source for this outlandish administrative sprawl. Doctors and hospitals have to negotiate contracts and fight over bills with hundreds of insurance plans with differing payment rates, rules, and requirements. Simplifying the payment system would free up far more money than Blahous estimates to expand and improve coverage.
Next, Blahous lowballs the potential for savings on prescription drugs. He assumes that a single-payer system couldn’t use its negotiating clout to push down drug prices, ignoring the fact that European nations and the US Veterans Affairs system achieve roughly 50 percent discounts relative to the US private sector. (Single payer’s only drug savings, he argues, will come from shifting 15 percent of brand-name prescriptions to generics.) Hence Blahous foresees only $61 billion in drug savings in 2022, even though tough price negotiations would likely achieve threefold higher savings.
Third, Blahous underestimates how much the government is already spending on health care. For instance, he omits the $724 billion that federal agencies are expected to pay for employees’ health benefits over the 10 years covered by his analysis, which would simply be redirected to Medicare for All. He also leaves out the massive savings to state and local governments, which would save nearly $3.6 trillion on employee benefits and another $5.3 trillion on Medicaid and other health programs. Hence, much of the “new money” needed to fund Sanders’s reform is already being collected as taxes.
Yes, there will need to be some new taxes—albeit much less than Blahous estimates. But those new taxes would just replace—not add to—current spending on premiums, co-pays, and deductibles. Additionally, at least some of the new taxes would be virtually invisible. For instance, the $10 trillion that employers would otherwise pay for premiums could instead be collected as payroll taxes. Similarly, Medicare for All would relieve households of the $7.7 trillion they’d pay for premiums and $6.3 trillion in out-of-pocket costs under the current system.
It’s easy to get lost in the weeds here. But at the end of the day, even according to Blahous’s errant projections, Medicare for All would save the average American about $6,000 over a decade. Single payer, in other words, shifts how we pay for health care, but it doesn’t actually increase overall costs—even while providing first-dollar comprehensive coverage to everyone in the nation. The Post’s fact-checker is wrong: Single-payer supporters can and should trumpet this important fact.
Of course, the most important benefits of single payer are altogether invisible in economic analyses like the one performed by Blahous. No matter what injury or illness we faced, we would be forever freed from one great worry: the cost of our care. It’s hard to put a price tag on that kind of freedom. Yet, paradoxically, even the slanted analysis of a libertarian economist provides evidence that it would be fiscally responsible.
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Health Care, Immigration, and the Supreme Court

This week America underwent a shock of such magnitude that many believe that this is the end of the experiment begun in 1776, and the United States lost its standing as the “Shining City on a Hill.”

We have witnessed the cruelty of the Trump regime towards innocent children snatched from the arms of their parents, simply because their parents want to escape the violence and oppression of the drug gangs rampant in their home countries.

These parents want not only to secure for their children a life free from being recruited into these gangs, they also want to provide their children with a better life.

And most of them did so according to US immigration law. They presented themselves at legitimate border crossings, and were summarily arrested, had their children separated from them, the children, some as young as a few months old, put in cages, or transferred across the country, and placed in facilities where no press or Congressional observers are allowed to see for themselves, except on special guided tours where they cannot speak to the children.
Recently, a judge in California ordered the regime to re-unite the children with their parents and effectively ended the zero-tolerance policy.

Tomorrow, at 11 am, I, and many others around the nation will take part in a march to protest this cruel and un-American action. The march I will be attending will be held in West Palm Beach and will cross the Intracoastal Waterway by way of a bridge connecting the mainland with Palm Beach island. The march will terminate at Mar-a-Lago, the former home of Marjorie Merriweather Post, heiress to the Post cereal fortune, and that is now owned by the Orangutan.

Why am I writing this, and what does it have to do with health care? And what does the Supreme Court have to do with these other issues?

That is what this post will attempt to address.

To begin with, the immigration issue will have a profound effect on the health care system, as the older Americans get, the more home health and nurses’ aides they are going to need.

Preventing these unfortunate men, women and children, fleeing violence and drug gangs, and civil war and corruption at home, will mean that in the future there will be fewer workers to take these and many other jobs in health care and other industries.

In addition, the so-called “travel ban”, is really a cynical attempt to impose a Muslim ban without calling it one. The Supreme Court weighed in on this move this week, ignoring the racist comments made by the Orangutan, and gave him wide latitude to ban anyone he does not like.

This will have the chilling effect of preventing both medical students and physicians from coming to the US, not only from the countries on the list, but all other Muslim nations. The medical travel industry, also may feel some effect, as providers and facilitators from Gulf states, and other nations in the region, may be prevented from attending conferences and speaking engagements, and Americans who go to the UAE may be given greater scrutiny upon return to the US.

As a grandson of immigrants, this un-constitutional, un-American, and inhumane action by this regime is very disturbing and sickened me when I heard the cries of those children. But, according to recent polling on the issue, 58% of Republicans approved of the separation of children from their parents, while 92% of Democrats disapproved. The CNN poll results are here:

On top of the immigration debacle, and the “travel ban”, there was a third and more devastating blow to American democracy and to the Republic this week. The retirement of Justice Anthony Kennedy, a swing vote on many issues brought before the Court, portends that the Court will be radically altered once a replacement is chosen and confirmed by the Senate.

But unlike the Merritt Garland nomination, Mitch McConnell is vowing to confirm whatever nominee the Orangutan appoints, and the regime promises to appoint a strict Conservative justice. Several commentators have indicated that abortion, LGBTQ rights, and maybe even health care, could be overturned if one more current justice, most probably Ruth Bader Ginsberg, retires or like Scalia, dies in the next two years. She is 85.

Overturning Roe v. Wade and making abortion illegal once again, will force women to seek back alley abortions, and will severely impact their health and lives. Also, it is possible that birth control and access to it, may be denied to women, and that will have serious impacts on health care in the future. Some believe that Roe is settled law, but don’t count on them being right. The Religious Right is waiting for the day that women are forced to carry to term pregnancies they don’t want, and then have any neo-natal or post-natal care taken away, so that they and their babies suffer needlessly.

A strict Conservative on the bench also threatens gay marriage and LGBTQ rights, as it was Justice Kennedy who broke with the Conservatives and said that gay people had a constitutional right to marry. It may mean that more cases like the recent Colorado case may be decided in the plaintiff’s favor, albeit without the bias the state Commission showed to religion.

Lastly, health care could face enormous challenges ahead if the makeup of the Court swings radically to the right. The current Court ruled that the ACA was Constitutional, but since the coup of 2016, the GOP has steadily destroyed the law and a radical Supreme Court just might put the last nail in the coffin and deny millions of Americans health care. There is also a health care bill in Congress that will remove many diseases and pre-existing conditions from coverage.

This is especially disturbing to yours truly, as I have one of those pre-existing conditions: ESRD. Right now, I have Medicare only, but who knows what a radical Court may do to that and the other health care programs such as Medicaid, CHIP, etc.

In college, I was taught that the Court generally swings from liberal to conservative, but in my lifetime, it has gone from liberal to conservative, to radically conservative, so that now we may be headed for a judicial, corporate dictatorship where the people have little or no rights, and Corporate and religious interests have all the rights.

The following quote sums up our predicament:

“When fascism comes to America it will be wrapped in the flag and carrying a cross.”
Sinclair Lewis

So, what do we do?

Well, the march tomorrow morning is a start. I have been critical of those groups opposed to this regime sitting on their kiesters and doing nothing except marching once a year in January for two straight years in the Women’s Marches. This crisis is bigger than just one demographic group. This fight is for the soul of the nation and for the Republic as a democratic republic. A journalist heard this morning on MSNBC said she went to Minnesota recently when the Orangutan was there, and she said that the cab driver told her that he is a Republican, is against the Orangutan, and cannot speak to friends about him because they believe him 100% and think he is a god.

Great! Now we have a Caucasian version of Kim Jong Un.

We have to work together, because in the words of Pastor Niemoeller:

First, they came for the Socialists, and I did not speak out—
Because I was not a Socialist.
Then they came for the Trade Unionists, and I did not speak out—
Because I was not a Trade Unionist.
Then they came for the Jews, and I did not speak out—
Because I was not a Jew.
Then they came for me—and there was no one left to speak for me.

The Founding Fathers knew something like this would happen, but never thought that the Electoral College, created to prevent this, would actually make it a reality. We are living in scary times.

Have a good weekend everyone, and if I don’t write before Wednesday, have a safe and happy Fourth…it may be our last.

Mad Dog Attacks Public Transport

Tom Lynch of LynchRyan’s Workers’ Comp Insider blog, wrote an article this morning that follows on the heels of my post from yesterday about the Justice Department not defending portion of the Affordable Care Act (ACA).

According to Tom, the GOP finally figured out how to fight the ACA, and he discusses three events beginning with February of last year in which the GOP-led Congress attacked the ACA. The three events are:

February 2017 – tax cut law that zeroed out the penalty for not having insurance.

February 2018 – getting 20 states to sue the federal government and contend that repeal of the penalty obviates the individual mandate making the entirety of the ACA unconstitutional.

And just last month, as I wrote yesterday, got the Justice Department to not defend the government in the suit.

Tom continues to say that if the 20 states win, pre-existing conditions, which the ACA protects, goes out the window. There are about 133 million Americans under the age of 65 who fall into that category. I am one of them.

Insurance companies are not happy either, Tom reports, and the trade association for the health insurance companies, America’s Health Insurance Plans, supports the provision under the ACA, and is quoted thus: “Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” according to a statement released by AHIP.

Finally, Tom asks the question — what happens if the 20 states win their suit? His answer, the 1.25 million Americans with Type 1 diabetes are waiting for an answer.

Yet, they and others don’t really have to wait for an answer, because the answer is staring us right in the face, but we refuse to see it, or even acknowledge its presence. Instead, we keep doing the same things over and over again, thinking the free market has the answer.

That is patently not true. A real, comprehensive, universal single payer system or an improved Medicare for All system that does not force those who are ill and don’t have a lot of money to pay for parts of the coverage, either the medical portion, or the 20% not now covered by Medicare, is the answer. Anything less is just a dog chasing a bus, catching that bus, and the dog and bus getting hurt.

On the Job Injury Costs Rising

Turning back to the original subject of this blog, workers’ comp issues, two articles this week discusses two recent reports that examine the issue of workplace safety.

The first article highlights the fact that despite a drop in the number of workplace injuries, the cost of those injuries and illnesses continues to rise, according to the 2018 Liberty Mutual Workplace Safety Index.

According to the Safety Index, the number of most serious injuries and illnesses fell by 1.5%, yet their cost, including medical and lost-wage payments, rose by 2.9% between the 2017 and 2018 reports.

Total cost of the most disabling work-related injuries was $58.5 billion, with the 10 leading causes accounting for $51.4 billion of the total, the Index reported.

An earlier post in this blog has discussed this issue before.

The top cause of workplace injuries, according to the Index, was overexertion, costing employers $13.7 billion in 2015. Falls on the same level came after that at a cost of $11.2 billion, while falls at a lower level cost another $5.9 billion.

Finally, rounding out the top five causes, were struck by object or equipment at $5.3 billion, and other exertions or bodily reactions at nearly $4.2 billon, the Index reported.

The second article discusses a report issued by the AFL-CIO on making workplaces safer. The report outlines the state of safety and health protections for American workers, and includes state and national information on workplace fatalities, injuries, illnesses, the number and frequency of workplace inspections, penalties, funding, staffing and public employee coverage under OSHA (Occupational Safety and Health Act). It also has information on mine safety and health.

A side note here: On Tuesday, the voters in West Virginia defeated Don Blankenship, the former Chairman and CEO of Massey Energy Company, who was convicted and spent a year in prison for his role in a mine safety disaster, who ran for the Republican nomination for US Senator. Blankenship not only ran a lackluster campaign, but engaged in calling Senate Majority Leader McConnell a few choice names, and attacked his wife and father-in-law because they are Chinese. He chose to use racist language to attack McConnell’s family,

But back to the issue at hand.

In 2016, there were 5,190 workplace deaths due to traumatic injuries, which was an increase over the 4,836 deaths reported in 2015. The rate of fatalities in 2016 also increased from 3.4 per 100,000 in 2015 to 3.6 per 100,000 in 2016.

Since Congress enacted the OSH Act, more than 579,000 workers can claim that their lives have been saved. But the article states that too many workers remain at serious risk of injury, illness or death as a result of chemical plant explosions, major fires, construction collapses, and other preventable tragedies. Add to that, workplace violence is increasing.

Key points to consider:

  • An average of 14 workers die because of job injuries; does not include death from occupational diseases, estimated to be 50,000 – 60,000 each year
  • In 2016, nearly 3.7 million workers across all industries, plus state and local governments, had work-related injuries and illnesses; 2.9 million reported by employers in private industry
  • Due to limitations on current reporting system, true toll is estimated to be two or three times greater, or 7.4 – 11.1 million injuries and illnesses a year
  • Cost of these injuries and illnesses estimated at $250 billion to $360 billion

Key takeaways:

  • During eight years of Obama administration, a strong track record on worker safety and health was achieved. Dedicated pro-worker advocates appointed to lead job safety agencies, increase budget for job safety, stepped up enforcement and strengthened workers’ rights, landmark legislation protecting workers from silica and coal dust issued, long-overdue rules on other serious safety and health hazards, including beryllium and confined space entry in construction industry introduced
  • Opposition by business groups and Republican-led Congress thwarted action on a number of initiatives, but at end of eight years, Obama administration put in place protections, policies, and programs that made jobs safer, reduced injuries and illnesses, and saved workers’ lives

Compare that to what the current anti-worker, pro-business fascist regime in Washington is doing to not only roll back the work of the Obama administration, but to undo all the safeguards and protections workers had fought and died for over the past century.

There is even consideration of looking at the child labor laws. Instead of draining the swamp, the head of this regime has nominated a coal industry executive to head the Mine Safety and Health Administration.

Folks, this gang of corporate criminals wants to make America great again by not moving forward, but by moving backward. They want to take the country back, alright — right back to the 19th century when businesses did whatever they wanted, workers had no rights, and if you got injured or ill on the job, it was too bad. Or maybe it was your fault. That was the verdict in the civil case against the two owners of the Triangle Shirtwaist Company, whose factory went up in flames in March 1911, and led to enactment of workers’ compensation laws and fire codes.

And the sad thing is, there are many business professionals who support and defend this regime and its leader, especially on social media sites like LinkedIn. They are not CEOs or Presidents of companies, although some maybe, albeit small ones. They do have executive titles at the managerial, supervisory or vice presidential levels. They are not informed about the struggles workers endured during the last century to gain those rights and protections. And until the labor movement, and the union leadership regains their rightful place as defenders of those rights, these actions will continue until they are gone forever.

 

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?

What’s Really Wrong With Health Care?

Book Review

Health Care Under the Knife: Moving Beyond Capitalism for Our Health

by Howard Waitzkin and the Working Group on Health Beyond Capitalism

Monthly Review Press
e-book: $18.00
Paperback: $27.00
Hard cover: $45.00

Americans commemorated the assassination of Martin Luther King fifty years ago on Wednesday. Two years earlier, Dr. King, in March 1966, said the following during a press conference in Chicago at the second convention of the Medical Committee for Human Rights (MCHR):

“…Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”

The part of the quote up to the word ‘inhuman’ begins the Introduction of a new book I just began reading called, Health Care Under the Knife: Moving Beyond Capitalism for Our Health by Howard Waitzkin and the Working Group on Health Beyond Capitalism, published by Monthly Review Press, the publishing arm of the Monthly Review, an Independent Socialist magazine.

Those of you who know me, and those of you who have read many of my previous posts, know that my educational background is in the Social Sciences, as my B.A, is in Political Science and History, with Sociology and African-American Studies thrown in, along with some Humanities coursework. My M.A. is in History, with emphasis on American Social History, especially post-Civil War until the mid to late 20th century. In addition, I also have a Master’s degree in Health Administration (MHA).

But what you may not know is that my leanings have been to the far left, and I am still proudly and defiantly so, even if I have tempered my views with age and new insights. I think that is called wisdom.

So, as I set out to read this book, much of the material presented in it will not be new to me, but will be perhaps new to many of you, especially those of you who got their education in business schools, and were fed bourgeois nonsense about marketing, branding, and other capitalist terms that are more apropos for selling automobiles and appliances and such, but not for health care, as this book will prove.

In this book, there will be terms that many of you will either find annoying, depending on your own personal political leanings, or that you are unfamiliar with. Words such as alienation of labor, commodification, imperialism, neoliberalism, and proletarianization may make some of you see red. So be it. Change will not occur until many of you are shaken out of your lethargy and develop your class consciousness.

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.” Karl Marx

While the publisher of the book is an independent socialist foundation, it is no means a Marxist or Communist organization. And from my perusal of the names of the contributors to the chapters of the book, I have found that they are all health care professionals or academics, as well as activists.

Two of the contributors of one chapter, David Himmelstein and Steffie Woolhandler, are familiar to many in the health care industry, as they have co-authored many peer reviewed articles in health care journals that I have cited in my previous blog posts.

Be warned. This book may piss you off. Too bad. The future of health care is at stake, as is the health of every man, woman, and child in the U.S. and around the world.

This will probably be true no matter what part of the health care industry you work in. Physicians, insurance company personnel, pharmaceutical company executives, Wall Street investors and money managers, service providers, vendors, consultants and many others will discover inconvenient truths about the businesses that provide their livelihood. As stakeholders in the status quo, you will be resistant to the prescriptions the writers offer for correcting the mistakes of the past, and the recommendations they suggest for the future of health care.

This book will not only be relevant to the health care industry, but also to the workers’ compensation and medical travel industries, as each is a subset of health care.

And if you do get upset or angry at me for what I have to say about health care, then you are part of the problem as to why health care in the U.S. is broken. Those of you around the world will also learn that your own countries are moving in a direction that sooner or later will result in your health care system mirroring our own, as the authors will point out.

This is a book that will shake you to your core. So, sit back, relax, and keep an open mind. It’s about to be blown.

The book is divided into five parts, with each part containing at most five chapters, as in Part Five, or two chapters, as in Part Two. Parts Three and Four, each contain four chapters. Part One deals with Social Class and Medical Work, and focuses on doctors as workers, the deprofessionalization and emerging social class position of health professionals, the degradation of medical labor and the meaning of quality in health care, and finally, the political economy of health reform.

Throughout the book, they ask questions relating to the topics covered in each chapter, and in Part One, the following questions are asked:

  • How have the social-class positions of health workers, both professional and non-professional, changed along with changes in the capitalist global economy?
  • How has the process of health work transformed as control over the means of production and conditions of the workplace has shifted from professionals to corporations?

These questions are relevant since medicine has become more corporatized, privatized, and financialized. The author of the second chapter, Matt Anderson, analyzes the “sorry state of U.S. primary care” and critically examines such recently misleading innovations such as the “patient-centered medical home”, “pay for performance”, the electronic medical record, quantified metrics to measure quality including patient satisfaction (“we strive for five”), and conflicts of interest as professional associations and medical schools receive increasing financial support from for-profit corporations.

Part One is concludes with Himmelstein and Woolhandler responding to a series of questions put to them by Howard Waitzkin about the changing nature of medical work and how that relates to the struggle for a non-capitalist model of a national health program. Himmelstein and Woolhandler comment on the commodification of health care, the transformation that has occurred during the current stage of capitalism, the changing class position of health professionals, and the impact of computerization and electronic medical records.

Part Two focuses on the medical-industrial complex in the age of financialization. Previous posts of mine this year and last, reference the medical-industrial complex, so my readers will be familiar with its usage here. In this section, the authors tackle the following questions:

  • What are the characteristics of the current “medical industrial complex,” and how have these changed under financialization and deepening monopolization?

Two corollary questions are raised as follows:

  • Are such traditional categories as the private insurance industry and pharmaceutical industry separable from the financial sector?
  • How do the current operations of those industries reflect increasing financialization and investment practices?

Once again, Matt Anderson authors the first chapter in Part Two, this time with Robb Burlage, a political economist and activist. Anderson and Burlage analyze the growing similarities and overlaps between the for-profit and so-called not-for-profit sectors in health care, considering especially the conversion of previously not-for-profit corporations such as Blue Cross and Blue Shield to for-profit.

The second chapter in Part Two is authored by Joel Lexchin, an emergency care physician and health policy researcher in Canada and analyzes monopoly capital and the pharmaceutical industry from an international perspective.

Part Three looks at the relationships between neoliberalism, health care and health. Before I go any further, let me provide the reader with a definition of neoliberalism in case the authors assume that those who read this book understand what it is.

According to Wikipedia, Neoliberalism or neo-liberalism refers primarily to the 20th-century resurgence of 19th-century ideas associated with laissez-faire economic liberalism. Those ideas include economic liberalization policies such as privatization, austerity, deregulation, free trade and reductions in government spending in order to increase the role of the private sector in the economy and society. These market-based ideas and the policies they inspired constitute a paradigm shift away from the post-war Keynesian consensus which lasted from 1945 to 1980.

These neoliberal policies have been associated in the U.S. with the Republican Party and the Conservative movement since the election of Ronald Reagan. In the UK, the rise of Thatcherism ended the long dominance of the Labor Party’s left-wing until Tony Blair’s New Labor took over. Bill Clinton’s election in the U.S. in 1992, diminished some of these policies, and implemented others such as welfare reform, a goal Republicans had wanted to achieve for decades.

Returning to Part Three, the questions asked here are:

  • What is the impact of neoliberalism on health reforms, in the United States and in other countries?
  • What are the ideological assumptions of health reform proposals and how are they transmitted?
  • What are the effects of economic austerity policies on health reform and what are the eventual impacts on health outcomes?

In the next chapter, Howard Waitzkin and Ida Hellander, a leading health policy researcher and activist, trace the history of the Affordable Care Act initially developed by economists in the military during the Vietnam War. International financial institutions, the authors say, especially the World Bank, promoted a boilerplate for neoliberal health care reforms, which focused mainly on privatization of services previously based in the public sector and on shifting trust funds to private for-profit insurance companies.

Colombia’s health reform of 1994, Hillary Clinton’s in that year as well, Mitt Romney’s plan in Massachusetts in 2006, which led to the ACA, are examples cited by the authors. The chapter also clarifies the ideological underpinnings of the neoliberal model and shows that the model has failed to improve access and control costs, according to the authors.

Economic austerity is closely linked to neoliberalism and have led to drastic cutbacks in health services and public health infrastructure in many countries. As I have recently written in my post, Three Strategies for Improving Social Determinants of Health, economic austerity policies have also affected health outcomes through increased unemployment, food insecurity, unreliable water supplies (Flint, MI), and reduced educational opportunities. Recent teacher protests in West Virginia, Oklahoma and other states are examples of this.

In the second chapter in Part Three, Adam Gaffney and Carles Muntaner, focus on social epidemiology, especially the impacts of economic policies on health and mental health outcomes. They also document the devastating effects of austerity in Europe, focusing on Greece, Spain and England. The authors analyze four dimensions of austerity:

1) constriction of the public-sector health system, 2) retreat from universalism, 3) increased cost sharing, and 4) health system privatization.

This trend would seem to have a negative effect on medical travel from Europe and to Europe, as Europe’s health care systems, long touted as a less expensive alternative to medical care in the U.S., begins to suffer.

Part Four examines the connections between health and imperialism historically and as part of the current crises. The question in this part is:

  • What are the connections among health care, public health, and imperialism, and how have these connections changed as resistance to imperialism has grow in the Global South?

The authors are referring to those countries in the Southern hemisphere from Africa, Asia, and Latin America as the Global South. The Global North refers to Europe and North America, and some other industrialized and advanced countries in the Northern hemisphere.

The authors in Part Four focus on the forces and institutions that have imposed a top-down reform of health care in the Global South. Such organizations as the Carnegie, Rockefeller, and Gates foundations, the World Bank and International Monetary Fund, trade agreements such as NAFTA, CAFTA, TPP, TiSA, and health organizations as the World Health Organization (WHO) and the Pan American Health Organization (PAHO) are all termed “philanthrocapitalism” by the authors, and have implemented policies that have weakened public health standards and favored private corporations.

The final part, Part Five focuses on the road ahead, i.e., the contours of change the authors foresee and the concrete actions that can contribute to a progressive transformation of capitalist health care and society.

The authors address these questions:

  • What examples provide inspiration about resistance to neoliberalism and construction of positive alternative models in the Global South?
  • Because improvements in health do not necessarily follow from improvements in health care, how do we achieve change in the social and environmental determinants of health?
  • How does progressive health and mental health reform address the ambiguous role of the state?
  • What is to be done as Obamacare and its successor or lack of successor under Trump fail in the United States?

Howard Waitzkin and Rebeca Jasso-Aguilar analyze a series of popular struggles that focused on the privatization of health services in El Salvador, water in Bolivia, as well as the ongoing struggle to expand public health services in Mexico. These struggles are activities David and Rebeca participated in during the past decade.

These scenarios demonstrate an image of diminishing tolerance among the world’s people for the imperial public health policies of the Global North and a demand for public health systems grounded in solidarity rather than profit.

In the U.S., the road ahead will involve intensified organizing to achieve the single-payer model of a national health program, one that will provide universal access and control costs by eliminating or reducing administrative waste, profiteering, and corporate control.

Gaffney, Himmelstein, and Woolhandler present the most recent revision of the single-payer proposal developed by Physicians for a National Health Program (PNHP). They analyze the three main ways that the interests of capital have encroached on U.S. health care since the original proposal:

1) the rise of for-profit managed care organizations (MCOs); 2) the emergence of high-deductible (“consumer-directed”) health insurance, and 3) the entrenchment of corporate ownership.

The authors offer a critique of Obamacare, explain and demystify innovations as Accountable Care Organizations, the consolidation and integration of health systems, something yours truly has discussed in earlier posts as they relate to workers’ comp, and the increasing share of costs for patients.

The next two chapters concern overcoming pathological normalcy and confronting the social and environmental determinants of health, respectively. Carl Ratner argues, that mental health under capitalism entails “pathological normalcy.” Day-to-day economic insecurities, violence, and lack of social solidarity generates a kind of false consciousness in which disoriented mental processes become a necessary facet of survival, and emotional health becomes a deviant and marginalized condition.

Such conditions of life as a polluted natural environment, a corrupt political system, an unequal hierarchy of social stratification, an unjust criminal justice system, violent living conditions due to access of guns, dangerous working conditions, and so forth, Ratner dissects as the well-known crises of our age in terms of the pathologies that have become seen as normal conditions of life.

Next, Muntaner and evolutionary biologist Rob Wallace show how social and environmental conditions have become more important determinants of health than access to care. They emphasize struggles that confront social determinants through changes in broad societal polices, analyze some key environmental determinants of health including unsafe water (Flint again), capitalist agribusiness practices, and deforestation in addition to climate change. And they refer to the impact these have on emergent and re-emergent infectious diseases such as Ebola, Zika and yellow fever.

Lastly, Waitzkin and Gaffney try to tackle the question of “what is to be done.” They outline four main priorities for action in the U.S. and other countries affected by the neoliberal, corporatized, and commodified model of health care during the age of Trump:

  • a sustained, broad-based movement for a single-payer national health program that assures universal access to care and drastically reduces the role of corporations and private profit, 2) an activated labor movement that this time includes a well-organized sub-movement of health professionals such as physicians, whose deteriorated social-class position and proletarianized conditions of medical practice have made them ripe for activism and change, 3) more emphasis on local and regional organizing at the level of communal organizations…and attempted in multiple countries as a central component in the revolutionary process of moving “beyond capital”, and 4) carefully confronting the role of political parties while recognizing the importance of labor or otherwise leftist parties in every country that has constructed a national health program, and understanding that the importance of party building goes far beyond electoral campaigns to more fundamental social transformation.

In their book, the authors try to answer key and previously unresolved questions and to offer some guidance on strategy and political action in the years ahead. They aim to inform future struggles for the transformation of capitalist societies, as well as the progressive reconstruction of health services and public health systems in the post-capitalist world.

Throughout this review, I have attempted to highlight the strengths of the book by touching upon some of the key points in each chapter.

If there is a weakness to the book, it is that despite the impressive credentials of the authors, they like many other authors of left-of-center books, cling to an economic determinism as part of their analysis, which is based on theories that are more than one hundred years old.

As I stated in the beginning of this review, my views have been tempered by examining and incorporating other theories into my consciousness. One theory that is missing here is Spiral Dynamics.

Spiral Dynamics is a bio-psycho-social model of human and social development. It was developed by bringing together the field of developmental psychology with evolutionary psychology and combines them with biology and sociology.

In Spiral Dynamics, biology is concerned with the development of the pathways of the brain as the adult human moves from lower order thinking to higher order thinking. The social aspect is concerned with the organizational structure formed at each stage along the spiral. For example, when an individual or a society is at the Beige vMeme, or Archaic level, their organization structure is survival bands, as seen in the figure below.

At the Purple vMeme, or Mythic level, the organizational structure is tribal, and so on. There is, among the authors of the book, an evolutionary biologist, but it is not clear if he is familiar with this theory and what it can bring into the discussion at hand.

It would not only benefit the authors, but also the readers to acquaint themselves of this valuable theory which would present an even more cogent argument for better health care. As the book concludes with a look at the future of health care after capitalism, knowing the vMemes or levels beyond current levels will enhance the struggle.

As I continue reading the book, I hope to gain greater insight into the problems with privatized, corporatized, free-market capitalist health care. My writings to date in my blog has given me some understanding of the issues, but I hope that the authors will further my understanding.

I believe that anyone who truly wants to see the U.S. follow other Western nations who have created a national health program, whether they are politicians like Bernie Sanders, his supporters, progressives, liberals, and yes, even some conservatives who in light of the numerous attempts to repeal and replace the ACA, have recognized that the only option left is single-payer. Even some business leaders have come out and said so.

I recommend this book to all health care professionals, business persons, labor leaders, politicians, and voters interested in moving beyond capital and realizing truly universal health care and lower costs.

 

Gallup Poll Says Americans Equally Divided on Single-Payer

Don McCanne, former President of the Physicians for a National Health Plan posted a New York Times article that said that Americans are equally divided over support for single-payer versus private insurance.

The article also said that support for single-payer edged up 10-points from last year, and closed  a 27-point gap since 2010.

This year’s survey, conducted Nov. 2-8, indicated that 48% preferred the private health insurance system and 47% preferred the government-run system.

Here is the breakdown by party:

Favor government-run system
22%  Republicans/Leaners
67%  Democrats/Leaners

Favor system based on private insurance
76%  Republicans/Leaners
29%  Democrats/Leaners

When asked if they had an opinion on “Medicare for All”, the majority said they did not have enough information.
17%  Favor
21%  Oppose
61%  Don’t know enough to say

While private insurance is still favored, if only by a percentage point, time will tell as the GOP’s tax plan takes effect and wipes out the middle class, whether that poll changes in the direction of single-payer.