Category Archives: United Kingdom

ACO’s Across the Pond: What Some Believe the US and England Can Learn From Each Other

It is amazing how experts in the field of health care are so wedded to ideas that are, with greater scrutiny, the real cause of the dysfunction and failures of providing health care to the citizens of a nation.

Such is the case with an article I found from the Commonwealth Fund, a well-respected organization in health care research, yet doubles down on the root causes of the crisis faced by the health care system in the US.

Late last month, Briggs, Alderwick, Shortell, and Fisher published the article entitled, “What Can the U.S. and England Learn from Each Other’s Health Care Reforms?

The focus of the article was on the idea of Affordable Care Organizations (ACO’s), which in the US were established in 2010 under the ACA. According to the authors, both countries are currently working toward better integrating health services, improving population health, and managing health care costs. They also said that both countries are developing their own versions of ACO’s to achieve these aims.

However, the authors point out, by way of listing previous links to articles they wrote, that results so far have been mixed, patient experience (you mean like having a great time at Disney World, that sort of experience?) and some quality measures have improved.

Yet, financial savings, they report, have been modest and data on outcomes is limited.

On the other hand, across the pond, the English NHS recently created 44 Sustainability and Transformation Partnerships (STPs) [Isn’t that what one puts in a motor car to make it run better?]

These STPs cover the entire country and are “place-based” partnerships of all NHS organizations and local government departments that purchase and provide health and long-term care services for a geographically defined population. They believe that organizations in STPs will work together to improve care and manage local budgets. Some payers are even considering American-style ACO contracting models.

Wait, if we are not having success with ACOs, what makes the Brits think they will do better? Interestingly enough, Himmelstein and Woolhandler, in “Health Care Under the Knife”, chapter 4, page 61, said the following when they were involved with drafting an new proposal for the Physicians for a National Health Program (PNHP):

“Recently, the emergence of huge integrated health systems incorporating multiple hospitals and thousands of physicians (so-called Accountable Care Organizations or ACOs), which dominate the care of entire regions, is causing us to again to talk about NHS models.”

So let me get this straight. We are not having much success with ACOs, yet, the Brits are moving in that direction. And the physician-led advocacy group in this country, the PNHP, that is pushing for single-payer, has been forced to consider models employed by the British NHS.

If that isn’t the definition of insanity, I don’t know what is.

Of course, the move towards ACOs in this country is due to the ACA and to the resurgence of 19th century economic liberalism, also known as neoliberalism, and its impact over the past thirty years on the American health care system. But in the UK, the move away from Labour Party socialism to the Conservative Party’s neoliberalism, is the reason why Britain is exploring the ACO model.

Maybe one day, both Anglo-oriented nations will wake up and stop believing in the fairy tale that the free market works for health care. It does for cars and other consumer goods, but health care is not a consumer good. It is a necessity of life.

Advertisements

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.

 

The “Curse” of For-Profit Health Care

Recently, Vermont Senator Bernie Sanders introduced a Medicare for All bill into the U.S. Senate, and many Democratic Senators signed on as co-sponsors of the bill.

Earlier yesterday morning, on his way to a photo-op in Naples, Florida to see the damage from Hurricane Irma (why didn’t he go to the Keys), the Orangeman tweeted that Senator Sanders’ bill would visit a curse on the U.S.

This from a man who said that he preferred the Canadian system, and told the Australian Prime Minister to his face, and the cameras, that they had a better health care system than the US.

What are we to make of someone who likes other countries health care systems as long as it is not our system? What do we do when the elected leaders of this country are dead set against providing the best health care system to their constituents, and in fact, are determined to take away what little health care they already have?

I find it rather odd, and callous that the Orangutan calls Sen. Sanders’ plan a curse, when millions of Americans are cursed everyday with not having any health care, or minimal care at best.

No, what is a curse are families going broke paying for medical care, individuals forgoing needed care because it costs too much, doctors and nurses burned out because they are overworked, underpaid (in some cases), and trying to work in a broken, bureaucratic, sclerotic, and byzantine system.

The American “health care” system is the curse. The cure, or rather the silver bullet for this vampiric monster, is single-payer. Maybe Sen. Sanders’ bill won’t pass this time, with this Congress and this President, but it or something like it should in the future.

Our curse as a nation is in our slavish devotion to making everything conform to the will and whim of the free market. We have seen that the free market is great for the production and selling of goods and services, but health care is not a consumer good. It is a right of every man, woman, and child.

The Canadians, the Australians, the British, and many other nations are not so slavishly devoted to the free market as we are when it comes to providing health care to all their citizens, and they cannot be called “Socialist” or “Communist” in any way, shape, or form.

Only because of the greed of a few insurance companies, Wall Street players and their investor clients, as well as very wealthy Libertarian brothers from the energy sector do we continue to be cursed with the worse system for providing health care.

Finally, the ultimate curse this nation has is the individual who said single-payer would be a curse. And like Dracula, only the light of day will stop him.

Despicable!

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

Karl Marx

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Winston Churchill

 

Here we have two quotes dealing with the same subject. The first quote is from the father of Scientific Socialism, i.e., Marxism and Communism, and the second quote is from the wartime Prime Minister of Great Britain, who was a staunch anti-Communist.

But what transpired today in Washington, is far from the view of Marx, or the view of Churchill. In other words, it is DESPICABLE!

Never before in the history of the United States, has the government of the people, by the people, and for the people ever taken away something the government gave them in the first place.

Not even the enactment of the 18th Amendment outlawing the sale and production of alcohol, stoops to the level of total disregard for the health and welfare of the American people. Alcohol was never something the government had to give to people, they produced it themselves. Our founding fathers were brewers and distillers of alcoholic beverages.

But the vote this afternoon represents a step towards a society this nation has not seen in many decades. You hear that Republicans want to take the country back. The obvious place they want to take us to is the 19th century, when no one had health care, there was no Medicare or Medicaid, or Social Security, Unemployment Insurance, and Workers’ Comp.

There are specific reasons for this, which I will discuss.

First, pure and simple, it is greed. They want the money dedicated for health care and the other medical plans for a huge tax cut for their wealthy friends.

Second, the health insurance companies can now get to pick and choose who they want to cover, what they will cover, and what they will charge you if you have a serious pre-existing condition or a life-threatening disease. We know this as adverse selection.

Third, they don’t believe in giving “entitlements” to anyone except the military and the wealthy.

Fourth, their libertarian, puritanical, Calvinism teaches them that the poor are undeserving of the benefits that money brings, so let them die, and who cares if they are poor, it is a sign of a moral failing.

Another quote from Churchill says that you can always trust the Americans to do the right thing after they have tried everything else.

Well, after today, we have tried everything else. We have given employers the right to offer health insurance to their employees, we have allowed private insurance companies to sell policies to individuals, and we have created separate health care plans for children, the elderly, the military and their families, members of Congress, and the poor.

But for all the reasons I have given above, and many more, this nation refuses to enact single payer health care, the only thing we haven’t tried, and the one form of universal health care every other Western nation provides its citizens.

One fellow blogger last year during the Democratic Primary, said that while he liked Bernie Sanders, he knew that the health insurance companies were not going to scrape their businesses and start from scratch.

But maybe they should. It is because the capitalist profit motive is at the heart of what, in the words of Walter Cronkite, our health care system really is. “America’s health care system is neither healthy, caring, nor a system.” Too many are profiting from other people’s misery, and driving many into poverty. This is the richest nation on Earth, and this is how we treat our fellow citizens.

It is strange that the Conservative Party of Great Britain believes in single payer, but the American Republican Party does not. The truth is, they are no longer the Republican Party but the Republican Libertarian Party.

Once upon a time, members of their right-wing decried the nation’s drift towards “Creeping Socialism.” With this vote, and with executive orders flowing from 1600 every day, we are witnessing “Creeping Fascism.’ The new Secretary of Labor comes from the fast food industry where workers were mistreated, and still are in some places.

Worker’s rights are being eroded with new overtime rules, wages are stagnant, unemployment is still too high despite what the government says.

One other reason for enacting single payer is that doing so will free employers from having to provide it to their employees, and workers over forty will not have to face losing their jobs and careers they spent their lives in.

We, as a nation, must decide; either we take away health care for millions of Americans, or we make sure everyone has it. There can be no half-measures. Many pundits have said the AHCA (Zombie Health Care Bill) will not pass the Senate, but that is what they said about the House of Representatives.

I hope the Senate will defeat this, but if they don’t, the only option left is single payer.

Damned If You Do, Damned If You Don’t

“You can always count on Americans to do the right thing – after they’ve tried everything else.”

Winston Churchill

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.

Winston Churchill

 

Veering away from the usual topics covered in this blog, I thought about some recent articles I saw about the attempt to repeal and replace, or to simply repeal the Affordable Care Act (ACA), which the current political regime wants to do.

The first article, in yesterday’s [failing] New York Times, warned that repealing the ACA would make it harder for people to retire early. Those who retire early, before reaching 65, can get retiree coverage from their former employers, but not many companies offer that coverage.

Those early retirees poor enough could turn to Medicaid, and everyone else would have to go to the individual market. Without the ACA, health care coverage would be more difficult to get, cost consumers more where available, and provide fewer benefits.

According to the article, if the ACA is repealed, retiring early would become less feasible for many Americans. This is called job-lock, or the need to maintain a job to get health insurance.

This is one of the concerns the ACA was supposed to address, in that it would reduce or eliminate job lock. Repealing the law could, according to the article, affect employment and retirement decisions.

The second article, from Joe Paduda, also from yesterday, reported that improving healthcare will hurt the economy, and Joe lays out the arguments for doing something or doing nothing to improve health care and what effect they would have on economic growth.

For example, Joe states that healthcare employs 15.5 million full time workers, or 1 out of every 9 job. In two years, this will surpass retail employment. As Joe rightly points out, those jobs are funded by employers and taxpayers. He suggests that some experts argue that healthcare is “crowding out” economic expansion in other sectors, thereby hurting growth overall.

But Joe also points out that by controlling health care costs, employment will be cut, and stock prices for pharmaceutical companies, margins for medical device firms, and bonuses at health plans will also be affected.

So, if cost control and increasing efficiency works, these lost jobs, reduced profits, and lower margins, Joe says, will hurt the economy. The economy will suffer if the health care sector is more efficient, and since healthcare is also a huge employment generator and an inefficient industry, fixing that inefficiency will reduce employment and growth.

Thus, the title of this article, “Damned if you do, damned if you don’t.”

But wait, there’s more.

Yesterday, a certain quote has been making the rounds through the media. It was uttered by Number 45. “Nobody knew health care could be so complicated.”

Yes, it is complicated and complex, but does it have to be so? If we consider the second Churchill quote above, and realize that the UK, France, Germany, Canada, and many other Western countries have some form of single payer, then one must conclude that it is only the US that has complicated and made too complex, the providing of health care to all of its citizens.

There are many reasons for this, which is beyond the scope of this article or blog, but there is one overriding reason for this complexity…GREED. Not the greed of wanting more of one thing, but the greed of profit, as one executive from an insurance company stated recently.

This brings me to the last of the articles I ran across yesterday. It was posted on LinkedIn by Dave Chase, founder of the Health Rosetta Institute. He cited a segment on the Fox News Channel’s Tucker Carlson program, in which Carlson interviewed a former hospital president who said that pricing was the main problem with the US healthcare system.

Mr. Chase does not solely rely on Carlson’s guest in his article, but cites other experts in the field as evidence that pricing failure is to blame.

If we are to except this as true, then it buttresses my point that the overriding problem is greed, for what else is the failure to control prices but a symptom of greed inherent in the American health care system, and something that does not exist elsewhere in the Western world.

Which brings me to Churchill’s first quote above. Since we Americans have tried the free market system of health care wanting, and have tried a reformed free market system, perhaps it is time to go all the way to a government-sponsored, Medicare for All, single payer system.

The bottom line is: we’re damned if we do, damned if we don’t. The question is, which is the lesser of two evils.

UPDATE: Here is Joe’s take on what will happen to the ACA in the next two years. I agree with his assessment.

RIP GLOBALIZATION?

From all the commentary this weekend and on Friday about the referendum to leave the European Union (EU) in the UK, it would seem that the dream of a handful of international bankers, multinational corporation heads and politicians of both the left and the right since the end of the Second World War have made a terrible and unforeseen error in pushing for a globalized world economy.

How did we get to this place? Simple, as a result of the economic policies of the 1920’s and 1930’s, Europe and her allies in North America, were plunged into a second global conflict. Near the end of the conflict, the economic leaders of the Allied nations gathered in Bretton Woods, NH to carve out the Bretton Woods Agreement, which established the World Bank and the International Monetary Fund.

Along with this, came the United Nations to deal with the political and military crises that would arise in the second half of the twentieth century. To provide greater perspective, we must go back to the First World War and recognize that here in the US, many Americans were woefully ignorant not only about world affairs, but of geography as well. In 1914, I doubt many Americans could point out just where Sarajevo or Serbia was, or where any of the other nations drawn up into that war were located.

Following on the heels of an earlier organization, the National Civic Federation, several prominent business, political, academic, labor and other leaders formed the Council on Foreign Relations. The Council promoted the study of geography and political science in colleges and universities, as well as promoting social studies in high schools and junior high schools.

The Council also published Foreign Affairs magazine, which became a forum for the discussion of world events and dissemination of political theories and policies from leading academics and business leaders. But there was one other thing that the Council did. It provided the US government with its future Secretaries of State, War, Treasury, and later Defense, among other lesser administration positions from the 1920’s onward.

My first major in college was political science, and more specifically, international relations and foreign policy. I also had a graduate course in American Foreign Policy at NYU as part of my History Masters degree.

After WWII, the Cold War forced many of the Western countries to realize that in order to defend against Communism, as they had against Fascism, they needed to have greater cooperation. So the North Atlantic Treaty Organization, or NATO was born, and within Western Europe, the idea of European cooperation led to the formation of the Common Market, of which the UK was a member.

In the 1950’s and 60’s, the European Coal and Steel Community (ECSC) and  was created, followed by the European Economic Community (EEC). These developments were spelled out in the Brussels Treaty of 1948, the Paris Treaty of 1951, the Modified Brussels Treaty of 1954, and the Rome Treaty of 1957.

In the 1960’s, the Merger Treaty of 1965 created the European Communities, made up of the European Atomic Energy Community (EURATOM), as well as the  ECSC and EEC.

The Maastrict Treaty of 1992 created the European Union, and its membership has grown steadily, especially after the fall of Communism in Eastern Europe and the breakup of the Soviet Union and Warsaw Pact.

Meanwhile, in other regions of the world, similar ideas were taking shape. In Asia, the Association of Southeast Asian Nations (ASEAN) was formed to do for Southeast Asia what NATO and the European Communities were doing for Europe.

To foster greater cooperation between North America, Western Europe and Japan, the three industrial regions of the world, David Rockefeller, Chairman of Chase Manhattan Bank and Zbigniew Brzezinski created the Trilateral Commission. In the next two decades, membership in the Commission was expanded to every other region of the world.

Like the Council on Foreign Relations, members of the Commission could be involved in politics in their respective countries, but once they achieved national office of any kind, they resigned from the Commission. Membership was recommended by current members, and the incoming Jimmy Carter Administration of 1977-1981 saw the following members leave the Commission: Jimmy Carter, Walter Mondale, Harold Brown, Zbigniew Brzezinski, Cyrus Vance, among many others.

It was in college that I studied global politics, or what would become known as Globalization, and with the expansion of the Commission’s member countries, and the fall of Communism, it seemed that globalization would continue.

Yet, they made one big mistake. Neglecting to replace the jobs lost to globalization from the 70’s to the present and thinking that “free trade” conducted through treaties such as NAFTA, CAFTA, TPP, and under the approval of the WTO would benefit both the developed and underdeveloped worlds. Hardly, as the Brexit vote and the rise of Trump in the US, as well as Bernie Sanders on the left can testify to.

Globalization has been mostly a one-way street out of the developed countries and into the undeveloped or developing countries. It has had the unintended consequences of stirring up racism, bigotry and resentment, as well as distrust in institutions and government. It has also favored the wealthy and those international players already in the game, but locks out those who are attempting to benefit from it, as many in the medical travel industry have tried and failed to do.

With other European nations threatening to leave the EU, and opposition here to TPP, and other trade deals (“I’m going to make better deals”), it would seem that globalization, far from dead yet, may at least be stopped in its tracks for the foreseeable future. That may happen if the US does the stupid too, and elects a moron.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

Share this article, or leave a comment below.