Innovation is not a prerogative of the private sector.
More and more, we are seeing a process of outsourcing the international development agenda. The current trade and investment regimes are already favoring wealthy countries and corporations. And where has this led us? To the balance already being outrageously skewed in favor of private interests. (Look at WHO’s financing, for instance).
In this Reader, I have more questions than I have answers:
What track record do businesses really have for being part of the solution?
What is the incentive for TNCs to exert their enormous power and influence in any way beyond maintaining the status-quo that has delivered so many benefits to them? So, Who benefits from the current state of affairs?:
The gargantuan pharmaceutical and food and beverages industry, intent on protecting their profits?
Governments that now are increasingly elected on the back of private election finance?
Does all this imply that the incentive structure only operates in one direction –not the human rights direction?
Is the assumption such that we should have less confidence in the aptitudes of the public sector, so that it must do more to operate on business terms? …even when those are the same terms that have led to the current highly inequitable, unsustainable, human rights-violating patterns of development?
Since public and private incentives are currently so poorly aligned (a marriage in hell?), it is hard to imagine how public entities operating more and more along private lines will keep up with their primary public responsibilities, including as the main duty bearers for protecting sustainability, inclusiveness and human rights (HR). The question really is:
At what point should projects vital to human and environmental wellbeing happen regardless of a business take on the issue?
Many businesses (of course, not all –I am not a business basher…), encouraged by years of deregulation, think of themselves as existing outside any social contract–or as able to select the parts of such a contract useful to them— for instance picking deliberate strategies that reduce their tax bills even as they are underpaying workers who then have to rely on social protection schemes paid for by general taxation. As a privileged group, big corporations are able to set their own norms, mostly related to their own survival and profitability, and further expect the public sector not to stand in their way. Large transnational corporations have pushed this approach so far that some progressive governments at the United Nations have called (and are acting upon it) for a legally binding framework to regulate them so as to provide appropriate protection, justice and remedy to victims of corporate HR abuses. But if such a new social contract keeps gaping exemptions or exclusions, it is bound to collapse. Businesses have to understand that the new global contract will be binding, not optional; it will have to be upheld and enforced, and there can be no picking and choosing –no exceptions. (B. Adams and G. Luchsinger)
There is no such a thing as a developed and underdeveloped world; there is only a single, badly developed or maldeveloped world (CETIM)
Some like to call the current development model “an evidence-free zone”. (Steven Nissen)
Poor countries beware: Under the SDGs, more experts are coming! Not soldiers and bureaucrats to run your affairs like during colonialism, now it is an army of ‘experts’. (Note that, sometimes, experts are even more dangerous than soldiers). Experts come to tell you: “You cannot. The market will be irritated. The market will be angry”. It is as if the market is an unknown, but very active and cruel God punishing us, because we are trying to commit the cardinal sin of changing reality. I ask: Is recovering dignity a cardinal sin? (Eduardo Galeano)
Fittingly, long ago, Immanuel Kant was of the opinion that, whoever wills the end, wills also (so far as cold reasoning* decides his conduct) the means in his power which are indispensably necessary thereto.
*: Marcel Proust used to talk about the intermittences of the heart as he observed world development going from bad to worse. (as cited by Alfredo Bryce Echenique)
The narrative of progress in development is no longer sustainable –unless things change (Steven Smith)
The UN (and other development) agencies have, for decades, pitifully little to show in the implementation of actual actionable deliverables in the realm of the HR-based framework to development. It is evident that the power of interventions aimed at fulfilling HR principles and standards comes not from where they are ‘targeted’ top-down –when this power is rather to come from those who know (or suffer) how these interventions do not work to create positive change within the prevailing unfair economic and political system. This means that efforts targeted at government policy can have only limited effectiveness if they are aimed at changing relatively weak (or outright uninterested) leverage-points and individuals in the prevailing unfair system. (G. Carey)
Even if it has been more than twenty years since their re-emergence on the international agenda, economic, social and cultural rights still remain a rhetorical aspiration. …or is there some global evidence that there have been many real advances in how they are enjoyed, claimed and enforced? This is indeed a pressing question. In a way, the affirmation by UN member states in the Vienna Human Rights Declaration of 1992 that HR and development should be seen as ‘mutually reinforcing’ still has a hollow rhetorical ring twenty five years on. (Alicia Yamin)
On a less negative note, yes, some progress has been made on each front, particularly in the realm of discrimination, legal protection and judicial enforcement. Human rights are beginning to play a more prominent role in how we think, and how we act. But the economic and social rights of millions of people across the globe are still under systematic and renewed attacks as a result of a number of even current pervasive private/financial sector-dominated development trends. These include the imposition of regressive fiscal austerity measures and other policies fuelling economic inequality, the failure to take effective action against climate change, and the consolidated grip that unbridled corporate power now has on both national and international governance. (UN CESR) On the other hand, one of the most important innovations in human HR has been the increasing attention to economic policies such as the scrutiny of budgets, taxation, and social security systems. (Sakiko Fukuda-Parr)
As you can see, a mixed picture. …in need of a photoshop overhaul…
Claudio Schuftan, Ho Chi Minh City, January 14, 2017
-We are simply acting as the folk wisdom that says: “If we do not change direction, we are going to get where we are going.” This is equivalent to the cartoon Yogi Bear’s: “When you come to a fork in the road, take it.”
–Peace, more than any other word, represents the essence of our work in HR. (Anwar Fazal)
-Henri Bergson used to say: The future is not what ‘is coming’, but rather what we will be capable of doing and achieving. It makes no sense to wish ourselves a Happy 2017 if, like donkeys, we are going to continue accepting what is being imposed on us by a corrupt and out-of-reputation political class; wishing ourselves a Good Year of Struggles, that yes! (Politika)
Given what is happening in the world later this month, I cannot think of anything more pertinent to share with you than a visionary excerpt from Henry Miller’s 1933 Tropic of Cancer. He had this to say:
How many people and colleagues do we know that have no allegiance, no social responsibility, no hatred, no prejudices, no passion, being neither for nor against –claiming to be neutral. It is actually hard to talk to a man or woman when you have nothing in common with him or her; you betray yourself, even if you use only monosyllabic words with them.
The axis has shifted, the world is dying. The world is pooped out; there is not a dry fart left. Who, that has a desperate, hungry eye can have the slightest regard for existing governments, laws, codes, principles, ideals, ideas, totems and taboos? This crazy civilization looks like a crater. And the crater is obscene. But more obscene than anything is inertia, is paralysis.
Conversely, even as the world goes to smash, there are men and women who remain at the core, who remain combative as the process of the world’s downward spiral quickens. At the very hub of this downward spiral we must keep rolling; otherwise, the whole world will belch no more. The wheel is falling apart, but the revolution is intact. Ideas have now to be wedded to action; if there is no vitality in them, there is no action. Ideas cannot exist alone in the vacuum of the mind. I find it soothing and refreshing to move among the creatures with living, breathing pores whose ethical background is stable and solid. The task to throw ourselves into is to overthrow the existing values, to make the chaos about us a new order.
The wallpaper with which the men of science and technology have covered the world of reality is falling to tatters. The grand whorehouse that they have made of life requires no such wallpaper decoration. Beauty is finished. The world is still beautiful only in an old fashioned way; it is the same old world of wine and fornication.
It sounds nutty to me, all this palaver about things happening so fast. Nothing is happening that I can see, except the usual calamities on the front page: Love and hate, despair, pity, rage, disgust, war, disease, cruelty, terror, the evil, the sorrow, the discord, the rancor, the strife, the disorder, the violence, the hatred, the chaos, the confusion…
A new day is dawning. As the thermometer rises, the form of the world grows blurred; there still is articulation, but at the periphery the veins are all varicose and are starting to bleed. To fathom the new reality it is first necessary to dismantle the gangrened ducts of the system responsible for all the garbage we see and experience.
Once I thought that to be human was the highest aim we could have, but I see now that it was meant to deceive me. I see this other race of individuals ransacking the universe, turning everything upside down, always moving in blood and tears, slaying everything within reach. We are governed by counterfeit values; only the tiny part that is left is human, i.e., the rest that belongs to life. We simply have to act before a large portion of humanity is buried, wiped out forever. My world has overstepped its human bounds; what it is to be human is left to moralities and codes disregarded by those in power. Too much of what they feed us to read is mere literature, not reality. I know what they are really like. Underneath this fake morality all is dead, no feelings. They are selfish to the core. They think of nothing but money, money, money. And they look so goddammed respectable, so bourgeois. That is what drives me nuts.
We have got our faults, but we have got integrity and enthusiasm. It is better to make mistakes than not to do anything.
The 2015 Left Forum will take place on the weekend of May 29-May 31, 2015 at John Jay College in the Bronx. Readers of the Social Medicine Portal readers may be interested in the Health Track. (LF 2015 Health Track Flyer). We have a special reason to celebrate as the New York Assembly has just voted in favor of a Single Payer plan for New York State. This is a small but significant victory.
Please come to our session on Faultlines in the Medical Industrial Complex on Saturday at noon.
On Tuesday, November 11th, Dr. Dawn Belkin Martinez will be presenting at Social Medicine Rounds on: Social Justice in Clinical Practice. The venue will be 3544 Jerome Avenue and the session will run from 4:30 to 6PM.
What follows is a brief biosketch of Dr. Belkin Martinez:
Dawn Belkin Martinez, PhD, LICSW is a Lecturer in Clinical Practice at the Boston University School of Social Work and was formerly an instructor in psychiatry at the Harvard Medical School. Trained as a family therapist, Dawn worked as the senior social worker on the Inpatient Psychiatry Service at Children’s Hospital Boston for thirteen years and is the co-author of the book Social Justice in Clinical Practice: A Liberation Health Framework for Social Work. Dawn is one of the founding members of the Boston Liberation Health Group and gives presentations locally, nationally, and internationally about her work with immigrant families, liberation health theory and practice,
A chance encounter with a neighbor walking his dog, reminded me to post this short video by Dr. Mike Evans, a physician with an interest in Preventive Health. It discusses the health benefits of walking. This an activity that requires no special equipment, no special gym, no coach, and no particular training (past age 14 months). You can watch the video on his website at this link or watch it on You Tube screen below. (If you do watch it on You Tube please skip any creepy Pharma ads).
*Paraguayan 5th year student participating in primary care in Havana, Cuba. (2011,by Joanna Mae Souers)
In early 2007, I began studying medicine at the Latin American School of Medicine in Havana, Cuba. I entered the program not knowing much about the Cuban healthcare system, other than that it was universal and free. “Now that’s a system I want to learn from,” I thought to myself, “It’s a system we could all learn from.” Five years later, what have I learned?
There are many subtle and not so subtle differences between the Cuban and the U.S. health care systems which have allowed the Cubans to equal the U.S. with respect to their health statistics, but at a much lower cost and with better preventative and primary care. In this paper I analyze just one of the reasons for the differences between the two systems; Cuba produces more primary care practitioners per capita. How do they do it? Medical education in Cuba is free, all doctors interested in specializing must first serve two years working in primary care, and graduating doctors are not driven to specialize by salary incentives. This socialist approach towards medicine and medical education assures the human resources necessary to provide universal and preventative healthcare to all.
People marvel at how Cuba has “accomplished so much with so little.” And they marvel with good reason. According to the World Health Organization, Cuba spent only $503 per capita on healthcare in 2009, the U.S. spent almost 15 times that sum. In fact we in the US spent $421 per person just on the administration of the private healthcare insurance system, almost enough to fund the Cuban system.  Despite dramatically lower costs, Cuba has some of the best health statistics and health indicators of any country around the world.
Although people like to compare and contrast the health statistics of the U.S. and Cuba, I think this a bit preposterous. Cuba, a small island in the Caribbean, is being compared to one of the largest countries in the Americas with a very different history. So in the table below, I have shown some health statistics on Cuba and the U.S. as well as the Dominican Republic and Haiti. The Dominican Republic and Haiti are Cuba’s Caribbean neighbors; similar in size, history and geographic location.
*Statistical information provided by the World Health Statistics 2011 Report by the World Health Organization.
From this table, we can see that Cuba’s health indicators are more like those of the “first world” in the U.S. than its neighbors in the “third world.” The life expectancy of the U.S. and Cuba is almost identical. Cuba supersedes the U.S. in the categories highlighted. So we continue to ask, “How do they do it?” Could it have something to do with their philosophy that people need doctors? Hence, their solution is to offer a free medical education to develop young, quality doctors dedicated to serving those in need.
Per capita Cuba graduates roughly three times the number of doctors as the U.S. In 2005 Cuba had 70,594 doctors. Before the revolution in 1959, there were only an estimated 6,000 doctors; somewhere around half left the country after 1959. This means they must have graduated an average of 1,469 Cuban doctors per year, not including the some 5,000 international students who graduate each year from Cuban medical schools.  When we later compare these numbers to the U.S. we see that Cuba graduates 3 times the number of doctors per capita, and the U.S. must import graduating doctors from other countries just to fill the primary care residency positions.
Critics of the “Obama Plan” say that there will not be enough doctors in the U.S. to take care of all the patients if everyone has healthcare coverage. Obama encouraged the Association of American Medical Colleges to increase the number of graduating doctors by 30% in 2010. Ever since 1980, U.S. Medical schools have graduated 16,000 doctors a year. Meanwhile, the population of the U.S. has grown 50 million during the same period. A 30% increase would have meant we should have graduated 20,800 medical students in 2010, but we only graduated 16,838 according to the Kaiser Family Foundation. The number of residency programs at teaching hospitals in the U.S. has been frozen since 1997, funded by Medicare. There were 29,890 residency slots filled in 2009,positions not filled by American graduates are filled by International Medical Graduates.  This means we can estimate more than 1/3 of students in U.S. residency programs are International Medical Graduates (IMGs), students from another country or a U.S. citizen, like me, who studied in another country.
In the current scheme of things, International Medical Graduates are continuously brought in to the U.S. to meet the needs of the growing patient population. Unfortunately nothing bridges the gap, because there just are not enough residency positions and/or funding for teaching hospitals to produce enough doctors to satisfy the entire U.S. population. Taking International Medical Graduates to meet the needs of the U.S. population only adds to the “brain drain” of developing countries around the world. So as we produce fewer doctors, introduce more doctors from other countries; U.S. doctors work harder for less to meet the needs in the U.S. and a lot of the world remains catastrophically underserved.
Cuba leads the world with the lowest patient to doctor ratio, 155:1, while the U.S. trails way behind at 396:1. With a surplus of Cuban doctors, Cuba is able to help ailing nations around the world. They have medical missions in over 75 different countries lead by nearly 40,000 health professionals, almost half of them are doctors. The United States by contrast imports doctors from poorer countries, further contributing to the brain drain of professionals from poorer countries to rich ones.
In Cuba education is free. Room and board, books and amenities are included. Doctors are not burdened by student loans and live comfortably though not extravagantly. Harvard Medical School states in their admissions statement that an “un-married first year medical student” will spend approximately $73,000 for the 2011-2012 academic year. This includes tuition, room and board, books, etc. Now times that by four and you have a whopping $292,000 to shell out to become a Harvard doctor. With interest rates, loan deferments and default charges, you might end up like Michelle Bisutti. She graduated medical school in 2003 with a $250,000 debt, in which by 2010 had increased to $555,000. This may be an extreme case, but the Association of American Medical Colleges projected in their 2007 report that in 2033, students on a 10-year repayment program will only see half of their after-taxes salaries, the rest going to loan repayment.
The cost of medical education in the U.S. causes more and more medical school graduates to turn to higher paying specialties and subspecialties rather than primary care or family medicine. Dr. Thomas Bodenheimer writing for the New England Journal of Medicine, stated that “between 1997 and 2005, the number of U.S. graduates entering family practice residencies dropped by 50 percent,” based on data from the National Resident Matching Program.  In the U.S. specialists predominate at a ratio of 2:1 (the reverse of other Western countries) while half of all outpatient visits are made by primary care physicians.  This deficit of primary care physicians decreases people’s access to primary care and preventative medicine, causing increases in health disparities and healthcare costs. This is because preventative medicine benefits the patient as well as reduces the number of Emergency Department visits and hospital stays. If there are no primary care physicians to provide preventative care to the population, we see the population suffer as costs continue to rise.
* Family Medicine Residency Positions and Number Filled by U.S. Medical School Graduates. From the American Academy of Family Physicians, based on data from the National Resident Matching Program. 
According to a survey in 2008 by the American Academy of Family Physicians, family medicine graduates with less than 7 years of experience earn, on average, a yearly salary of $145,000. The difference in earnings between primary care physicians and specialists differed by only 30 percent in 1980, and dramatically rose up to 300 percent for some narrowly defined specialists by 2009. In the graph below, we show the dramatic difference between median compensation for selected specialties compared to that of primary care.[14,15]
*Median Compensation for Selected Medical Specialties. Data are from the Medical Group Management Association Physician Compensation and Production Survey, 1998 and 2005. 
When working in the U.S., almost every primary care physician I talk to has the same complaint, “Too many patients, and too little time.” They are forced to see 20 to 30 patients a day just to meet pay-incentives and “keep their doors open.” General/Family Practice physicians spend an average of 16.1 minutes with each patient per visit.  Meanwhile, 18%, or roughly 48.2 million of the U.S. population under the age of 64 is without healthcare insurance. They have no access to most GP’s or family practice physicians. 
We need to follow our Cuban role model, we need to be held socially accountable and produce more primary care physicians. This can be accomplished by providing an education at full scholarship to those interested in primary care, or by increasing the number of medical students going into primary care by closing the compensation gap between primary care and the higher paid specialties. These measures would ensure the population better access to quality primary care and preventative medicine. It would bring down the cost of healthcare while allowing primary care physicians to practice under less stressful conditions leading to quality affordable healthcare for all.
World Health Organization (WHO 2011); Countries. [www.who.int/countries/en]
“Healthcare Marketplace Project, Trends and Indicators in the Changing Marketplace (Exhibit 6.11: Private Health Insurance Admin Cost per Person Covered, 1986-2003),” Kaiser Family Foundation, Publication Number: 7031. [http://www.kff.org/insurance/7031/print-sec6.cfm]
“Cuba and the Global Health Workforce: Training Human Resources.” Salud! (Source Vice Ministery for Medical Education and Research, Ministry of Public Health) [http://www.saludthefilm.net/ns/elam.html]
Sullivan, Paul. “Discomfort at U.S. Medical Schools.” The New York Times; April 29, 2009.
“Total Number of Medical School Graduates, 2010.” The Kaiser Family Foundation. [http://www.statehealthfacts.org/comparemaptable.jsp?ind=434&cat=8]
“World Health Statistics 2011,” World Health Organization; WHO Press, Switzerland.
Brouwer, Steve. “The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity,” Monthly Review, 2009, vol 60, issue 8 (January).
Harvard Medical School Admissions, “Costs (Updated: 7/21/2011).” [http://hms.harvard.edu/admissions/default.asp?page=costs]
Pilon, Mary. “The $555,000 Student Loan Burden,” The Wall Street Journal, February 13, 2010.
Fuchs, Elissa. “With Debt on the Rise, Students Face an Uphill Battle.” The Association of American Medical Colleges, January 2008.
Bodenheimer, Dr. Thomas,“Primary Care – Will it Survive?” New England Journal of Medicine, vol 355;9. Pg 861-862.
Alper, Philip R. “Primary Care’s Dim Prognosis,” Hoover Institution, Stanford University, Policy Review No. 158 (December 1, 2009).
American Academy of Family Physicians, Income (2011). [http://www.aafp.org/online/en/home/publications/otherpubs/debtmgmt/graduation/income.html]
Alper, Philip R. “The Decline of the Family Doctor,” Hoover Institution, Stanford University, Policy Review No. 124 (April 1, 2004).
Woo, Dr. Beverly. “Primary Care – The Best Job in Medicine?” New England Journal of Medicine, vol 355;9. Pgs 864-866.
“Healthcare Marketplace Project , Trends and Indicators in Changing Healthcare Marketplace (Exhibit 6.5: Mean Time Spent with Physicians (in Minutes), 1989 – 2002),” Kaiser Family Foundation, Publication Number: 7031, Information Updated: 4/11/05. [http://www.kff.org/insurance/7031/print-sec6.cfm]
“2010 National Health Interview Survey (Tables 1.1A-B, 1.2 B)”, Center for Disease Control. [http://www.cdc.gov/nchs/fastats/hinsure.htm]
Today we came together on this first day of the IPHU from all over our small planet: Ghana, Guinea, Haiti, Kenya, Lebanon, Puerto Rico, Russia, Rwanda, Thailand and the United States. The day begins with introductions that are more than asking this group of inspiring and eloquent agitators the bland recitation of names, organizations and what are you interested in; we are asked to speak of ourselves through our personal and social mandates, or, what is the change you wish to see in the world and how do you see it? As brothers and sisters, we respond with a passion born of being fed up with a global system that perpetuates inequality and injustice at the cost of the health of our communities, and speak of our hopes and common threads of the need for advocacy, speaking truth to power, and alternative models and ways of thinking about health and health care that is people centered, not profit focused: “Health for all Now,” “Love Solidarity,” “Access,” “Health Activism,” “Meaningful Participation,” “Progressive Work,” “Mental Health,” “Englightening,” “Bright Future,” “Visual Healing,” “Cultivate Love,” “Health Education,” “Awakening,” “Education Action.”
Next, David Legge gives a comprehensive overview and history of the People’s Health Movement, International People’s Health University (IPHU) and the People’s Health Charter (PHC). We go over this radical document, a unifying, organizing vision that views health as a right for ALL. This profoundly simple understanding is so fundamental, that some of us in our small group discussions ask, “Why Not?” Not “Why Not” as this is a good idea, but “Why Not” as in why is this socially, economically and just idea not implemented and what do we as advocates and activists need to do to push this forward, use this in our work, and what do we need to include (LGBT rights, more emphasis on gender inequality, and a suggestion to create a handbook on how to use the PHC)?
Laura Turiano follows with a presentation on using a Human Rights based approach to advocate Health for All Now. Next follows participants’ big task: group work on our projects that advance the idea of Health for All in our communities. Our task at hand: present our projects with our compadres in small groups where, over the course of the week, we will support each other to: analyze, re-think, re-fine, conceptualize, strategize, and put into action our vision of the world and communities in which we wish to live.
The “formal day’s agenda” concludes with a brief introduction of the Theatre of the Oppressed by John Sullivan. Free form movement and human sculptures is what we are and mold ourselves into as we attempt to convey the fundamental values and concepts of the days proceedings: Hope, Inspiration, Thinking, Motivated…all conveyed through our bodies, expressions, and movements. The consensus over dinner discussions and late night debates, rabble rousing, getting to know you sessions, is: this is going to be a great, learning filled, intense, memorable week.
As the world celebrates Women’s History Month, the U.S. House of Representatives has just launched the most devastating assault on women’s health in the history of our nation – a real case of state terrorism, or use of violence on a civilian population to achieve political goals.
If the House-passed bill is approved by the Senate and is signed into law by President Obama, Title X will be eliminated.
Title X provides basic health services, including Pap smears, testing for sexually transmitted diseases, and cancer screenings to more than 5 million low-income people, disproportionately women, at a cost that is a fraction of the cost of waging at least two wars of aggression and funding over 700 overseas military bases and at least 6,000 such bases in the United States and its territories.
This bill would also cut $210 million from Maternal and Child Health Block Grants, that also serve poor women and children; the Centers for Disease Control and Prevention would see a major cut in its funding, of $755 million, that would undermine a host of public health efforts, such as confronting HIV/AIDS; and Community Health Centers would see a $1.3 billion dollar cut that would brutally curtail services in a network of health centers in cities and rural areas providing essential primary care — so much for the Patient Protection and Affordable Care Act (PPACA) expansion of funds for community clinics.
And it gets worse, and does not stop at our nation’s shores. The same legislation would also eliminate funding for the United Nations Population Fund (UNPF), the agency providing family planning, maternity care, and sexually transmitted diseases prevention services, among many other services essential to women’s wellbeing, in some 150 countries.
This onslaught against women joins the one against working people generally, as calls to “save” Social Security and Medicare by slashing these programs multiply, and an increasing number of state legislators attempt to gut the collective bargaining rights of unions with the spurious argument that public sector employees just “earn too much” and receive “too generous benefits”.
While the subtleties of the discourse differ, not only the right but also sectors of the “liberal left”, convey the same message: workers with “generous benefits” must give them up, because it is those “benefits” that caused “the deficit”.
But just what are these “generous benefits”?
The benefits of Wall Street we know well, even if they figure nowhere in these arguments. As President Obama noted (with a straight face) in this year’s State of the Union address, “the stock market has come roaring back and corporate profits are up.”
Yet the “benefits” of the US welfare state are paltry compared to those enjoyed by millions of individuals in similarly wealthy nations – in terms of public pensions, paid vacations, and maternity leave, to mention a few. And the United States stands alone in that it lacks guaranteed access to health care. The new federal law barely gave us an obligation to purchase an insurance policy from commercial insurers, under penalty of a fine, and would leave at least 23 million individuals (5% of the US population) with no coverage whatsoever ten years out of passing this law.
It would also leave a yet-to-be-estimated number of individuals burdened by medical bills that they cannot pay, as new “consumer–driven insurance products”, with actuarial values as low as 60%, huge co-pays, and deductibles, multiply.
As to the much trumpeted deficit, as Dean Baker at the Center for Economic and Policy Institute reminds us, before the latest economic downturn the federal budget deficit was relatively modest – just over 1% of GDP in 2007, even with the cost of fighting two wars and Bush’s tax cuts (that anti-deficit crusaders remain blissfully silent about). The size of the deficit then certainly posed no danger to the economy.
But then everything collapsed, as an $8 trillion housing bubble burst, a bubble caused by the policies endorsed or even legislated by the same individuals that the Obama Administration has now asked for advice on how to “save” the economy – Pete Peterson, Alan Simpson, Erskin Bowles, among many others. So where were these anti-deficit crusaders between 2002 and 2006? They were, of course, crying wolf against…the deficit caused by the “generous benefits” of US workers.
And now, with 25 million people unemployed or underemployed, ten million underwater in their mortgages, over 50 million uninsured, and 45,000 dying every year for lack of access to basic medical care, these same economic geniuses are warning us against the “impending catastrophe” wrought by the “generous” salaries of public employees, the “Cadillac services” of minimally decent health insurance policies, programs providing basic health care to poor women, men, children and the elderly, Social Security, or Medicare.
Yet Social Security poses no major problem – it is projected to be fully solvent for almost 30 years with no changes whatsoever. Whichever problems it may have could be easily fixed by simply raising the cap on taxable income, a move that would affect only the wealthy. Medicare and other publicly financed healthcare programs pose a problem only because the US health care system, pre and post PPACA, is built upon a losing proposition: for-profit health insurance for medically necessary services.
It needn’t be this way. From the Middle East to the US Midwest ordinary people are demanding greater political participation and a share in the national wealth that they and only they overwhelmingly produce. As we commemorate those 15,000 brave women who back in 1908 marched through New York City demanding shorter hours, better pay and voting rights, American women and working Americans generally must demand no less.
Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).
So what was it that we are paying insurers for? Processing claims, the wrong way at least one out of five times..? (see article below in the San Francisco Chronicle). And what is it we’re paying our legislators for? Locking us in a system which mandates us to purchase for-profit insurers’ products? (this is exactly what the “Patient Protection and Affordable Care Act”, signed into law this past March, does).
Yes, Dr. Don McCanne is right. “Let’s have the members of Congress fire the insurers and set up our own national health program – an improved Medicare that covers everyone. If they won’t do that then let’s fire them, replacing them with responsible elected stewards who will. ”
State regulators Monday fined seven of California’s largest health insurers nearly $5 million for systematically failing to pay doctors and hospitals fairly and on time.
The California Department of Managed Health Care issued the fines following an 18-month audit in which investigators looked at a small but statistically significant sample of claims. The investigation found the plans were paying on average about 80 percent of the claims correctly, far below the legal threshold of 95 percent.
“Our clear and consistent message is that California’s hospitals and physicians must be paid fairly and on time,” said Cindy Ehnes, director of the Department of Managed Health Care, which is charged with regulating the states’ health maintenance organizations, or HMOs.
Insurers are no longer permitted to rescind coverage for technical mistakes made on patient applications
Lifetime monetary limits on insurance coverage will end
Adult children will be allowed to remain on their parents’ plan until age 26
Insurers will be required to provide certain no-cost preventive services, such as colonoscopies, immunizations and mammograms
Consumers will be allowed to appeal claims decisions through an external review process.
These are only a few of the many provisions that take effect as of today, and that as it appears we are supposed to celebrate. But are we?
Not just yet. Let’s look at the “good news” through an alternative, and equally plausible, lens:
Number 1: While insurers may not be permitted to rescind coverage for technical mistakes made on patient applications, they will be able to do so based on other considerations. For instance, based on“intentional misrepresentation”, the number 1 reasons insurers allege to cancel policies.
Number 2: While lifetime monetary limits on insurance coverage will end, these limits apply only to covered services. Uncovered ones will be on patients, as they always have been. And as insurers are permitted to sell policies that cover as little as 60% of covered services (again, only covered services), patients will be extremely vulnerable to financial ruin if they become seriously ill.
Number 3: Yes, your “adult child” will be able to remain on your plan (assuming you have one and you or your “child” pay for the coverage) until age 26. And if you signed up to receive email alerts from Barak’s cheerleaders, Organizing for America, you may have read illustrative stories about the law’s goodness. For instance, you may have read that Kristin, a recent grad living in Scottsdale, Arizona, laments that health reform was not implemented last year, because it would have allowed her to remain on her mom’s plan, something that young folks now are able to do….until they turn 26, of course. But clearly this is only good news compared to the status quo, yet why should this be our standard? If Kristen lived in Canada, or in the UK, or anywhere else in the industrialized world, including Taiwan (and soon in China) she would not be hoping to remain forever young just to have access to her parents’ coverage – at least not for those reasons – because her health care needs would be covered as a matter of right, and for life.
Number 4: Yes, insurers will be required to provide certain no-cost preventive services, but, who do you think is going to foot the bill? You guessed it! All of us in the form of increased premiums — together with the bill for any other provision that affects insurers’ bottom line, such as the provision that insurers spend no more than 20% in administrative overhead.
Just getting a tad ahead of us (and of the law), as California Healthline noted earlier this week, Blue Shield of California has ended its “one-year rate guarantee”. This means that Blue Shield will be able to increase health plan rates throughout the year, instead of waiting for the annual renewal period. As a company spokesperson reported, Blue Shield opted to end the rate “because of forthcoming changes under the federal health reform law”. All which, according to the same source, has left Democrats and Republicans scratching their heads, seeking reasons behind hikes in premium costs (really???).
Ok. If depression has not prevented readers to read this far, let’s examine “reason for celebrating number 5”. As it appears, as of today “consumers” (we’re all consumers now) will be allowed to appeal claims decisions through an external review process. Now, assuming that it is good news that the bad guy will be still around yet now we are allowed to defend ourselves from him, the downside is that it is unclear who will be in charge of those appeals, or more importantly, who will pay for them. Indeed, just days ago, the same California Healthline announced that “state agencies have limited resources to implement reform law”.
Should we be surprised? Not at all. Indeed, the law was not passed to make ordinary Americans happy, although that was certainly the rhetoric. It was passed to satisfy the real constituency of the folks in Washington, a corporate lobby that has hijacked American democracy. In fact it was drafted by a member of that lobby, a WellPoint executive, himself. And they surely have reason to celebrate, now that they’ve been given at least $447 billion in taxpayer money to subsidize the compulsory purchase of their shoddy products.
Can we do something about it? Yes we can. We can, and must, demand a public single payer system that streamlines administration, stops wasting money in paper pushing or inflated prices, puts back medical decisions where they belong — in the hands of providers and patients — and allows us to make badly needed improvements in the health care delivery system – increasing the number of primary providers, emphasizing primary care, and so forth.
We need a new civil rights type movement. We need to demand health care justice for all.
For profit insurers put profits over health in more than one way, and now that the Patient Protection and Affordable Care Act has made all but a few American residents their captive audience they are in for a blast.
Just weeks after the passage of the Act, that will dramatically increase the number of Americans covered by private health insurers, Harvard researchers detailed the extent to which life and health insurance companies are major investors in the fast-food industry.
Although fast food can be consumed responsibly, research has shown that fast-food consumption is linked to obesity and cardiovascular disease, two leading causes of death, and contributes to the poor health of children. The evidence is so compelling that as part of the new law more than 200,000 fast-food and other chain restaurants will be required to include calorie counts on their menus, including their drive-through menus.
A new article on insurance company holdings, published online in the April 15 issue of the American Journal of Public Health, shows that U.S., Canadian and European-based insurance firms hold at least $1.88 billion of investments in fast-food companies.
“These data raise questions about the opening of vast new markets for private insurers at public expense, as is poised to happen throughout the United States as a result of the recent health care overhaul,” says lead author Dr. Arun Mohan.
Among the largest owners of fast-food stock are U.S.-based Prudential Financial, Northwestern Mutual and Massachusetts Mutual Life Insurance Company, and European-based ING.
U.S.-based Northwestern Mutual and Massachusetts Mutual Life Insurance Company both offer life insurance as well as disability and long-term care insurance. Northwestern Mutual owns $422.2 million of fast-food stock, with $318.1 million of McDonald’s. Mass Mutual owns $366.5 million of fast-food stock, including $267.2 in McDonald’s.
Holland-based ING, an investment firm that also offers life and disability insurance, has total fast-food holdings of $406.1 million, including $12.3 million in Jack in the Box, $311 million in McDonald’s, and $82.1 million in Yum! Brands (owner of Pizza Hut, KFC and Taco Bell) stock.
New Jersey-based Prudential Financial Inc. sells life insurance and long-term disability coverage. With total fast-food holdings of $355.5 million, Prudential Financial owns $197.2 of stock in McDonald’s and also has significant stakes in Burger King, Jack-in-the-Box, and Yum! Brands.
The researchers also itemize the fast-food holdings of London-based Prudential Plc, U.K.-based Standard Life, U.S.-based New York Life, Scotland-based Guardian Life, Canada-based Manulife and Canada-based Sun Life. (See table; all data current as of June 11, 2009.)
“Our data illustrate the extent to which the insurance industry seeks to turn a profit above all else,” says Dr. Wesley Boyd, senior author of the study. “Safeguarding people’s health and well-being take a back seat to making money.”
Mohan, Boyd and their co-authors, Drs. Danny McCormick, Steffie Woolhandler and David Himmelstein, all at the Cambridge Health Alliance and Harvard Medical School, culled their data from Icarus, a proprietary database of industrial, banking and insurance companies. Icarus draws upon Securities and Exchange Commission filings and news reports from providers like Dow Jones and Reuters. In addition, the authors obtained market capitalization data from Yahoo! Finance.
The authors write, “The health bill just enacted in the Washington will likely expand the reach of the insurance industry. Canada and Britain are also considering further privatization of health insurance. Our article highlights the tension between profit maximization and the public good these countries face in expanding the role of private health insurers. If insurers are to play a greater part in the health care delivery system they ought to be held to a higher standard of corporate responsibility.”
Several of these same researchers, all of whom are affiliated with Physicians for a National Health Program, have previously published data about the extent to which the insurance industry is invested in tobacco. They say that because private, for-profit insurers have repeatedly put their own financial gain over the public’s health, readers in the United States, Canada and Europe should be wary about insurance firms’ participation in care.