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/).

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. ”

Blue Shield, Kaiser among state insurers fined

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.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/11/30/BUSR1GJ01V.DTL

1. Insurers are no longer permitted to rescind coverage for technical mistakes made on patient applications
2. Lifetime monetary limits on insurance coverage will end
3. Adult children will be allowed to remain on their parents’ plan until age 26
4. Insurers will be required to provide certain no-cost preventive services, such as colonoscopies, immunizations and mammograms
5. 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.

Indeed, in a less cheerful mood just yesterday, New York Times reporter Robert Pear wrote that  “state insurance regulators told the White House…that health insurance markets in some states would be disrupted unless President Obama gave insurers a temporary dispensation from one major provision of the new health care law” – remarkably, that which requires that insurers spend no more than 20 or 30 cents of every premium dollar on paper shuffling or profit rather than on health care (For the record, the Robert Wood Johnson Foundation estimated that insurers’ expenses on physicians and clinical services amount to a mere 21.2%, so insurers are complaining about having to spend no more than roughly the same amount for “administering” our money).

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.

And to their credit, Frontline did a terrific job of documenting the countless back-room deals struck by the White House and Congress with Big Pharma and Big Insurance. As the production illustrated, these deals chipped away whatever progressive features the Act may have initially had, and turned it into a weapon of mass destruction of the pockets of ordinary folks who already barely make ends meet, and into an extraordinary sweet deal that will substantially increase the political and economic power of for-profit insurers for years to come. Unsurprisingly of course, given that the Act was almost literally dictated by WellPoint Inc., as the Frontline production pointed out.

Disappointingly, however, Frontline did not live up to its promise. While it did reveal some of the “realities of American politics, the power of special interest groups and the role of money in policy making”, it omitted showing viewers just what “Obama’s deal” had sacrificed, and what single payer advocates were being dragged to jail for, as they entered the meetings of the Senate Finance Committee chaired by health care czar Max Baucus. Rather, it merely portrayed them as yet another disaffected group within “President Obama’s liberal base”, which had to be appeased so that our president could move on with the serious stuff — “reforming” healthcare.

But it is precisely what the deal sacrificed that matters. Because single payer advocates, including many doctors such as Margaret Flowers, risked arrest, and were arrested, for standing up for a right to health care, through a publicly-financed and publicly delivered single payer system, that was being sacrificed at the altar of special interests, even as President Obama asserted, with a straight face, that “all options (for health care reform) are on the table”.

Now, could the reason for sacrificing a right to health care be that our charismatic president received at least ten times the money that his designated health care czar, Max Baucus, received from the very industries they were supposed to rein in? We don’t know, but the hypothesis is not implausible, and Frontline producers would have done their viewers a service had they explored this or any other plausible and alternative to the mainstream hypothesis further. In so doing they would have spoken truth to power, the least we can expect from progressive mass media.

Americans have by now gotten used to having the best Congress (and Presidency) “that money can buy”. Let us not be forced to put the progressive media into an equivalent category — “it’s the best media money can buy”.

Not that there is anything to be surprised about, given how close these folks are to major policy decisions in US health care. As the Firedoglake website pointed out last year, it is not even a secret that the original Senate Finance Committee bill, a descendant of which was recently signed into law with the ambitious name of Patient Protection and Affordable Care Act, was authored by a former Wellpoint VP, so these guys know what they are doing. And since Congress released the first of its health care bills on October 30 of the past year, health care stocks have risen by almost 30%.

But it gets better (for private insurers, that is…). So take a big sip of that morning coffee, and read on!

WellPoint CEO Receives 51 Percent Salary Increase

It appears that 2009 was a good year for the CEO of the private health insurance company WellPoint. Angela Braly’s compensation package soared by 51 percent last year. She earned $13.1 million, up from $8.7 million in 2008 At least three other WellPoint executives received compensation increases of as much as 75%.

Single payer anyone?

By Kate Randall (originally posted here).
29 March 2010

In keeping with its campaign in support of Obama’s recently passed health care legislation and its agenda of cost cutting, the New York Times carried an article Saturday by Lesley Alderman headlined, “Doctors Offer Thoughts on Cutting Health Care Costs.”

The article takes as a given that the health care overhaul is a genuine social reform, whose effect will be to provide “substantial” benefits to the general population. It bemoans the fact, however, that the new legislation “does not tackle head-on the staggering cost of health care in the United States.”

In fact, the Obama-promoted legislation is aimed first and foremost at cutting costs for corporations and the government. It will slash hundreds of billions from the Medicare program for the elderly, and contains numerous cost-cutting mechanisms to ration and reduce care for ordinary Americans. This is well known by the Times editors. However, these cuts are seen as only a first step in a campaign to limit testing and treatments for the majority of Americans.

The entire framework of the health care “reform” is not to be challenged. Nor is the fact that insurance company and health care industry profits will by all accounts be boosted by the plan. But the ultimate question for patients, the author argues, is “How can the country reduce health care costs while not compromising quality?”

Alderman is not speaking here about reducing premiums, co-pays and deductibles for working families. There are no restrictions in Obama’s plan on what insurers can charge for coverage—and numerous studies have shown that these payments will actually increase.

No, the Times’ aim here is to promote the cost-reducing features of the health care bill for big business and the government and offer advice on how they might be strengthened. The author cynically attempts to palm off the suggestions of a select group of “doctors on the medical front lines” as a balanced cross-section of medical professionals.

It is notable that in the (“edited and condensed”) comments quoted, none of these doctors openly oppose the health care legislation; none openly promote nationalized health care, a single-payer system or even a government-run “public option.” Where appropriate, Alderman also helpfully notes how the Obama plan will advance the generally regressive proposals presented by this selection of physicians.

Jacques Moritz, M.D., director of gynecology at St. Luke’s-Roosevelt Hospital Center in New York, offers the first suggestion: insuring for catastrophes only. Dr. Moritz states, “When you buy auto insurance, you don’t insure yourself for every dent and nick—you insure yourself for serious accidents. This is the way the health system should work.”

He says that the current insurance model “doesn’t reward patients for being healthy, it rewards them for being sick”—as if patients now are getting sick on purpose just so they can take advantage of insurance payouts. Likening the health of a human being to dings on an auto body is a poor analogy, but one that serves a definite purpose. Patients should be discouraged from seeking treatments for supposedly non-catastrophic medical conditions, and the insurers would be rewarded by not paying out for them.

In health care, however, it is generally impossible to determine beforehand what is “catastrophic” and what is not. Is a chest pain an early signal of heart problems or is it simply a muscle ache? Is a persistent headache the result of stress or a brain tumor? The impact of the doctor’s suggestion, enthusiastically promoted by the Times, would be to prevent those who cannot afford to pay from getting tests and consultations aimed at answering these and many similar questions.

Next, James A. Reiffel, M.D., professor of clinical medicine and director, electrocardiography laboratory, Columbia University Medical Center, New York, argues for tort reform, something long campaigned for by Congressional Republicans and supported by Obama. Dr. Reiffel says, “Some doctors often order tests to confirm a suspected diagnosis—even when the suspected diagnosis is likely correct with a high degree of certainty—out of concerns regarding the potential for malpractice suits in our current litigious climate.”

The effect would be to prevent patients and their families from seeking legal and financial redress for injuries and deaths caused by medical errors. Alderman notes that the Obama plan already makes a step in that direction, including a provision awarding “five-year grants to selected states to develop alternatives to current tort litigation.” Again, the impact is to encourage doctors to stop giving supposedly “unnecessary” tests.

Dr. Lisa Bernstein, internist and associate professor in the department of medicine at Emory University School of Medicine in Atlanta, Georgia, advocates “spending adequate time gathering information and using actual research data to guide judicious ordering of tests and prescribing of treatments.” This is known in the medical community as utilization of “comparative effectiveness research.”

The Times notes that the new legislation calls for the creation of the Patient Centered Outcomes Research Institute. The goal of this panel is to identify treatments that have not been shown to provide adequate levels of positive patient outcome—i.e., they may have benefited what they consider an insignificant number of patients.

While the function of this body is clearly aimed at targeting treatments and services for rationing, the Times laments the fact the “institute’s findings could not be construed as mandates though, or used to deny coverage.”

Under the subheading “Stop Overtreating,” the article quotes Dr. H. Gilbert Welch, who says, “There are some people who would benefit from more medical care, but there are many more who are getting too much.” Dr. Welsh is a professor of medicine at the Dartmouth Institute of Health Policy and Clinical Practice in Lebanon, New Hampshire, publisher of the Dartmouth Atlas of Health Care.

The WSWS has analyzed the Dartmouth Atlas study in depth. (See “The Dartmouth Atlas of Health Care study: Shoddy science in support of health care cuts” ) Its methodology has been promoted by the Obama administration as a justification for reducing and rationing care.

Among those who are “overtreated,” according to Welch, are those who are dying (“for whom our aggressive care can be inhuman”) and the healthy, “in whom we feel increasingly compelled to look hard for things to be wrong.” Welch bemoans the fact that “screening scans, for instance, find more small cancers and early heart disease.” Presumably, it would be better if cancer and heart disease were only discovered in its late stages.

Welch also worries that “contracted definitions of what’s normal label more people as having disease, such as hypertension and diabetes.” These people should be denied treatment, Welch implies, even if doing so can improve their living conditions and potentially save their lives.

In a September 2008 speech, Obama budget director Peter Orszag, then director of the Congressional Budget Office, hailed Dartmouth Atlas, asserted there is “little evidence that extra spending gets us anything in terms of reduced mortality rates or higher quality.” There is nothing accidental in the Times dropping in this quote from Dr. Welch, and it also gives the lie to the suggestion that this is an ordinary cross section of doctors.

Finally, Ms. Alderman quotes Edward Hallowell, a psychiatrist practicing in New York City and Massachusetts, who states, “What’s in jeopardy in medicine—for a host of reasons—is the human connection between doctor and patient.”

Dr. Hallowell’s sentiments undoubtedly reflect a widespread concern among health professionals who experience firsthand strains between doctors and their patients. He says, “Doctors, patients and insurers alike should work together to recreate the familiarity, the warmth, the trust and the friendly alliances that used to define patient-caregiver relationships.”

Under the for-profit system of medical care in the United States, however, which is upheld and enshrined by the Obama health care legislation, these relationships are assured to erode even further, as patient costs rise and services are limited on the basis that life-saving treatments are “unnecessary” or have not been proven “cost-effective.”

It may help to read, and ponder about, the op-ed below by Barry Grey. And if words like “socialism”, “class struggle”, etc., make the reader uncomfortable, my suggestion is to go beyond word choices and focus on the argument instead.

It is well worth examining in some detail, because it does a good job of pulling apart the campaign of deception about health care reform led by the corporate media, and it highlights features of the recent “health care overhaul” that there are strong reasons to be concerned about, and are likely to have huge implications, and not necessarily positive, for the welfare of Main Street.

Assuming one agrees with Grey’s analysis of this campaign of deception, one has to admit that it still requires a stroke of genius to lead millions to believe that an individual obligation to buy a private product, a for-profit health insurance policy, with subsidies if necessary from your own money and with vague promises to rein on the manufacturer’s “worst practices”, is  something that would have made Karl Marx jealous.

Yet this is precisely what New York Times reporters Robert Pear and David Leonhardt argue that the bill signed today by President Obama is all about: it is no less than  “the most sweeping social legislation in decades” and “the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago”.

It is even more concerning that the next step towards “greater social equality”  may be an attack on Social Security. This program, announces the New York Times, “now stands as the likeliest source of the sort of large savings needed to bring projected annual deficits to sustainable levels, many budget analysts agree.”

And these “savings” are necessary because, as Times reporter Jackie Calmes suggests,  they would “immediately reassure global markets fretful that the United States’ debt is already its highest since World War II...[sending] “a very important signal to the world.”

Savings? To whom? Global markets and important signals? Of what sort? How does this euphoria translate into any intelligible improvement in the much eroded quality of life of millions of America is hard to say, but worth asking about.

Obama health bill sets the stage for assault on Medicare and Social Security

Barry Grey

24 March 2010

The passage of the Obama administration’s health care bill has been greeted with a wave of media commentary hailing the measure as a milestone in progressive social reform and a political triumph for Barack Obama.

“A historic first step,” editorialized the Los Angeles Times. “Health Care Reform, at Last” was the headline of the New York Times’ editorial. As always, the revving up of the American media to overwhelm and manipulate popular consciousness has been impressive.

If anything, the major organs of international finance capital have been even more effusive. Financial Times columnist Gideon Rachman published a commentary in which he writes, “By pushing through a social reform that eluded generations of presidents from Teddy Roosevelt to Bill Clinton, Mr. Obama can now point to a genuinely historic achievement.” The Financial Times editorial board published a similar piece, under the headline “Obama secures his place in history.”

Behind the celebrations of the health care overhaul lies a definite perspective. The authors of these commentaries see the legislation as a major step in confronting profound problems facing American and world capitalism. They are hailing what they consider a breakthrough in reining in massive US deficits that are destabilizing the world financial system.

It has for decades been deemed politically impossible to attack basic entitlement programs in the US, such as Social Security and Medicare, which account for an enormous and rising portion of the federal budget. Now, with Obama’s health care plan, the stage has been set for slashing these programs. This is the reason for the general jubilation in media and financial circles.

The claim that a genuinely progressive social reform has been dispensed as a gift from above flies in the face of the whole of American history. This is a country where every significant social reform has been the outcome of decades of the most bitter and bloody struggles against a ruling class that savagely resists social progress.

The enactment of such reforms has always followed brutal state repression and been associated with martyrs to the cause who were hunted down, jailed or murdered.

Slavery was abolished only by a Civil War that raged for four years and cost the lives of 620,000 soldiers and an undetermined number of civilians.

The eight-hour day was the result of mass strikes in the 1870s and 1880s that culminated in the Haymarket Massacre and the hanging of key leaders of the eight-hour movement.

The suffragettes endured repeated beatings and jailings in their battle for the right of women to vote.

Official recognition of the right to form industrial unions in America was the outcome of a 60-year struggle that began in the 1870s and continued even after Franklin Roosevelt recognized the right in 1934. It involved general strikes in major US cities, including the 1934 strikes in Toledo, Minneapolis and San Francisco.

In struggles such as the Flint sit-down strike, workers occupied factories and faced off against police and troops in industrial battles that verged on civil war. Ten workers were gunned down in cold blood and many others were wounded by Chicago police in the 1937 Memorial Day massacre.

It was in the context of such mass working class struggles fueled by the Great Depression that Roosevelt enacted Social Security.

The enactment of Medicare in the 1960s was the byproduct of the mass mobilization of African-Americans and their allies in the civil rights movement of the 1950s and 1960s, in which hundreds of thousands marched in the face of killings and terror by vigilantes backed by the state. By the time of the passage of Medicare, the civil rights struggle had been joined by an upsurge of militant labor struggles and the initial eruption of the most oppressed sections of the working class in urban uprisings.

The right of 18-year-olds to vote was secured as a result of the mass movement against the Vietnam War.

In every case, the victories for social reform represented the frightened response of the ruling class to mass movements from below. And in every case, these victories were partial and limited, diluted with all sorts of caveats, and containing the seeds of their eventual undoing—due to the limited political perspective imposed on the insurgent movements by their reformist leaderships.

The moment the working class relaxed its pressure, the gains were watered down or eliminated.

In stark contrast to this historical experience, Obama’s health care plan has been enacted in the absence of a mass movement—indeed, in the face of mounting popular distrust and hostility. The final push for the bill came after the Democratic candidate was massively defeated in January’s special Senate election to fill the seat vacated by the late Edward Kennedy in Massachusetts.

That defeat was the result of growing disillusionment with Obama and the Democratic-led Congress, which have done nothing while millions have been thrown out of their homes, millions more have had their light and heat turned off, personal bankruptcies have broken all previous records, and wage-cutting—encouraged by the government’s Auto Task Force—has become epidemic.

The same administration whose policies have encouraged a further growth in social inequality and the continued erosion of existing social programs has now, it is claimed, handed down a historic piece of progressive legislation.

Amidst the official jubilation, no one has asked an obvious question: If the Obama administration dropped all of those provisions deemed “progressive” and “liberal”—such as the public option—in order to gain Republican support, why were they not restored when it became clear that the Republicans would offer no support and the final bill would be a purely Democratic measure?

There is another question. In what, precisely, does Obama’s success in passing health care “reform” consist? Why has he succeeded where previous Democratic administrations failed?

The basic answer is that discussions of health care reform previously assumed either some form of nationalization or significant provisions to rein in the power of the health care industry. Obama, however, has not only rejected any such measures, he has worked out his overhaul in the closest consultation with the insurance, pharmaceutical and hospital companies. The same corporate giants will continue to exert unfettered control over the health care system.

Far from the health care bill being an exception to the historical rule, it could be enacted only because of the absence of a mass movement of working people and under conditions of the collapse of the old organizations such as the trade unions. It is the product of a political system in which broad sections of the population have been effectively disenfranchised and become alienated from the entire political establishment.

Neither of the two big business parties has any substantial base of popular support. Politics has become little more than the artificial creation of public opinion, involving an unprecedented level of media manipulation.

This social and political vacuum gives the ruling class a degree of latitude it would otherwise not have to impose legislation that in the past would have been considered unacceptable. Immense resources have been devoted to pushing through Obama’s health care bill, but there has been nothing approaching a serious public discussion in which the details of the measure are examined. The people have had no say and do not know what this legislation will mean for them.

In the form of the current administration, the American people have become the victims of a colossal fraud, in which Obama, capitalizing on his carefully crafted popular image, is carrying out policies that previously would have been deemed unfeasible.

The US ruling class is playing the long game. It is seeking to impose a regime of economic rationalization that has been worked out between the White House, Congress and big business.

The dire consequences of this overhaul for the broad masses of the population will become clear over time. They are indicated, however, in some of the commentaries by supporters of the legislation. The Washington Post, for example, speaks openly in its editorial of the “opportunity” to slash costs by rationing care to the general population.

“It means,” the newspaper writes, “establishing pilot programs to reward quality over quantity—keeping people healthy rather than administering more tests. It means holding hospitals, doctors and others accountable… to minimize unnecessary or conflicting care.”

The repeated claims that those who are satisfied with their existing health plans have nothing to fear are not believable. In the first place, existing plans are constantly being cut back by employers, private insurers or both, a process that will only be accelerated under the health care bill. More and more people will be forced into plans that provide far fewer services, under which they will be compelled to pay out of pocket for drugs, tests and procedures beyond a bare-bones minimum.

The overall strategy underlying the health care bill is indicated by the New York Times, which writes in a front-page article published Tuesday that “central to the health care changes are hundreds of billions of dollars in reductions in Medicare spending over time.” The newspaper goes on the declare that the victory on health care sets the stage for an assault on Social Security, the bedrock social program that currently provides (highly inadequate) pension benefits to 51 million Americans over the age of 65.

“Proponents of acting soon,” writes the Times, “also argue that changes to benefits or taxes… would immediately reassure global markets fretful that the United States’ debt is already its highest since World War II. An agreement on Social Security ‘would send an important signal to the world,’ said Robert D. Reischauer, a former Congressional Budget Office director.”

As the consequences of these policies become more clear, the disgust and anger of working people will deepen. They will resist in ever growing social struggles. What is critical is that these struggles be guided by a new political perspective.

The entire experience of Obama’s health care overhaul demonstrates once again the critical importance of the development of a Marxist leadership in the working class and the fight for a socialist perspective. Universal, quality health care as with any other social advance is possible only on the basis of the building of a mass socialist movement of the working class.

The New York Times and the Obama health care plan

By Kate Randall
23 March 2010

The New York Times weighed in predictably on Monday with praise for passage of the Obama health care plan. The editorial appearing the morning after the US House vote—titled “Health Care Reform, at Last”—caps a yearlong campaign by the newspaper to promote the legislation.

In keeping with that effort, the piece gushes, “Barack Obama put his presidency on the line for an accomplishment of historic proportions.” The newspaper’s editors argue that the legislation is “a triumph for countless Americans who have been victimized or neglected by their dysfunctional health care system.”

The piece provides misinformation and half-truths about what is actually contained in the bill in a cynical attempt to portray it as a monumental reform crafted with the interests of working families in mind. The analysis is deliberately vague on details, while making sweeping generalizations as to the expected impact of the legislation.

As the representatives of what passes for the liberal establishment in the United States, the New York Times has played a key role in promoting Obama’s health care agenda and characterizing it as a progressive reform. In fact, the Times represents those privileged sections of the ruling elite who stand to profit most from its cost-cutting features and the gutting of health care for ordinary Americans.

In this latest piece lauding passage of the bill, they take their cue from Barack Obama, who stated Sunday night that the legislation represents “another stone firmly laid in the foundation of the American Dream.” The Times argues dramatically, “Over time the reforms could bring about sweeping changes in the way medical care is delivered and paid for. They could ultimately rival Social Security and Medicare in historic importance.”

When the editorial begins to break down the features of the plan, however, even on the basis of the Times’ timeworn brand of convoluted reasoning, it is apparent that the bill has nothing in common with these genuine pieces of reform legislation. While significant tangible benefits were gained through these federally funded programs, the new health care legislation will cut government spending and reduce care and services for the vast majority of Americans.

Social Security and Medicare were wrested from the ruling establishment as a result of great social struggles on the part of working men and women. But the Obama health care plan is being imposed from above by that very ruling elite, with no input from the American people. Its features bear no relation to genuine reform, but in fact comprise a retrograde package of cutbacks and rationing that will serve to boost the profits of the health care industry.

The Times hails the plan for providing what it describes as “near-universal coverage.” After noting that the “United States is the only advanced industrial nation that does not provide or guarantee health care coverage for virtually all of its citizens,” they intone, “It is a moral obligation to end this indefensible neglect of hard-working Americans.”

The reality is that the bill has nothing in common with universal health care, something Obama pledged to fight for in his presidential bid. An estimated 23 million people will be left uninsured by 2019, including about a third who are undocumented immigrants and barred from coverage.

About 16 million of those newly insured will be dumped into the cash-starved Medicaid program. Another 24 million will obtain coverage through purchasing it on the insurance “exchanges.” These exchanges will not include even a fig leaf of reform in the shape of a public option, a feature ditched long ago by Obama in a backroom deal with the private insurance companies. As the president was at pains to emphasize last night, the bill “is not the government-run system some feared.”

Under the subheading “Insurance Reforms,” the editorial asserts, “The legislation would rein in many of the insurance industry’s worst practices.” The practices listed include rejecting applicants for pre-existing conditions, dropping sick people from coverage, and capping annual or lifetime benefits.

The Times then notes that reform of these insurance practices “cannot be achieved unless nearly all Americans are required to have coverage, so the costs can be spread among the healthy and the sick.” Precisely. This patient mandate will require individuals and families to purchase insurance or pay a penalty, funneling billions of dollars into the insurance industry’s coffers, in effect forcing the insured to finance the insurers’ reform of their own “worst practices.”

It is notable that the editorial fails to mention that the Health Insurance Rate Authority—a proposal floated by Obama before his bipartisan health care summit as a potential brake on skyrocketing premiums—has been eliminated from the bill. While the Times suggests that the plan will stop insurers from charging “exorbitant rates,” it provides no evidence of any mechanism in the bill that would actually do this because none exists.

The section of the editorial titled “A Start at Cost Control” gets down to the real meat of why the Times has been a consistent cheerleader of the Obama health care overhaul. It concerns the proposed tax on so-called Cadillac insurance plans, and is valuable to quote at some length:

“The legislation will impose an excise tax in 2018 designed to drive employers and their workers away from the highest-cost insurance policies, which typically provide generous benefits at little out-of-pocket cost to the workers. Health economists consider the excise tax a very strong cost-control measure, because if workers have to pay more of the cost themselves, they and their doctors are apt to think more carefully about whether a test or procedure is really needed” (emphasis added).

In other words, millions of workers, including a large number of unionized workers who receive insurance under company-sponsored plans, will see their benefits cut and the out-of-pocket expenses increased. In the drive to cut corporate costs, a crackdown is to be initiated against plans that provide such “generous benefits” and that encourage people to seek “unnecessary” tests and procedures.

The editorial then goes on to allude vaguely to a major cost-cutting component of the Obama plan, which the newspaper endorses, noting, “The reform measure will establish an independent board to push approaches that work into widespread use in Medicare and ultimately, by force of example, the private sector.”

The board to which they so favorably refer is the “Independent Payment Advisory Board,” an unelected body of presidential appointees that will wield sweeping powers to reduce costs and services and rewrite Medicare regulations. Changes proposed by this panel can only be overruled by a super-majority vote in Congress.

While chiding Republican leaders “who see opportunities to gain seats in the elections,” the Times makes no analysis of why the Republicans hope to make political gain by opposing legislation that supposedly benefits the majority of the population. In fact, the Republicans are seeking to capitalize on growing opposition to the plan among significant sections of the population who rightly view the legislation with mistrust, a skepticism that is bound to grow as the real implications of the bill become clearer in the coming period.

The Times, which claims to be a staunch defender of abortion rights, also fails to mention the wretched deal reached with the most right-wing sections of the Democratic Party in the final push to get the votes needed in the House to pass the legislation. Despite the already severe restrictions in the bill placed on the legally protected right to abortion, Obama agreed to sign a last-minute executive order confirming that no federal funds would be used for abortions under the terms of the legislation.

While the editorial characterizes the health care legislation as a triumph for “hard-working Americans” that will have the effect of reining in the “worst practices” of the insurance companies, another take on the situation was provided in the paper’s Business section.

An article headlined, “In Health Care Reform, Boons for Hospitals and Drug Makers,” explains that the plan would result in “millions more Americans buying private health insurance” who would be “better able to pay for their hospital stays, doctor’s visits, prescription drugs and medical devices.”

Drug makers, the article notes, “have the most clear reason to celebrate the legislation … they can look forward to tens of billions of dollars in additional revenue as more people with insurance visit doctors and fill prescriptions.”

Indeed, US stocks rebounded on Monday following the health care vote, hitting fresh 17-month highs lifted by health care-related stocks. Pharmaceutical shares surged, with Pfizer leaping 1.42 percent to $17.15 and Merck adding 0.63 percent to hit $38.30.

Among the insurers, Aetna gained 0.52 percent, hitting $34.64, and Cigna was up 0.54 percent at $37.28.

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