Whether the debt ceiling is raised or not in the days ahead, Minnesotans and the nation have reason to celebrate this weekend. Saturday marked Medicare’s 46th birthday.

While we have a long way to go before our health care system works well for all patients, this anniversary gives us an opportunity to reflect on what we’ve done right.

Surprisingly, Medicare was born out of bitter controversy in 1965. It was condemned by some as “socialized medicine,” a threat to basic freedoms. As a physician, I’m embarrassed to say organized medicine was among its key opponents. It all seems silly today.

Since its inception, Medicare has afforded hundreds of millions of Americans access to high-quality health care. It has reduced poverty among seniors and improved the financial security of their families. It has become one of the most popular government programs in history.

Current political discourse is centered on spending cuts, including Medicare. But covering Americans via Medicare saves money. No, that is not a typo.

Medicare boasts far lower administrative costs than the leanest private insurance company. While it is true that Medicare spending has risen dramatically over time, its growth is far less than that of the private sector.

And remember that Medicare pays for the care of our sickest and oldest, while private insurers foot the bill for the young and healthier.

In fact, uninsured Americans in their late 50s and early 60s routinely delay needed care, only to become expensive Medicare recipients once they reach 65.

Medicare is not the cause of health care inflation; rather, it is a victim of our country’s sky-rocketing health care costs. Cuts to Medicare will not control these costs.

Rather, they will reduce access to care by the nation’s elderly, worsen their health status, and increase financial hardship among already-struggling Americans.

Not only is Medicare less expensive than private insurance, it provides superior service. An example is the free choice of doctor granted to patients under Medicare — a basic freedom many privately insured Americans are currently denied.

As a practicing internist, I can attest to the lower “hassle factor” doctors incur when dealing with Medicare rather than interacting with multiple private payers, each requiring different rules and regulations. Expecting us to treat patients differently because they have different or no insurance contradicts our professional responsibility.

Medicare is far from perfect, and it has some serious limitations. But for this weekend, let’s celebrate a government program that actually works incredibly well. Americans are proud of Medicare. It should be strengthened, expanded and improved to include all of us. A sustainable Medicare-for-all system is the reform our nation needs.

Ann Settgast is a primary care doctor practicing in the Twin Cities. She co-chairs the Minnesota chapter of Physicians for a National Health Program. This essay first appeared in the Twin Cities StarTribune.

Happy Birthday, Medicare! I should send you one of those gag cards that teases you about getting older—but at 46, you’re a year younger than I am, so I won’t go there. On your special day, a little reminiscing about your life…

You sure did have a hard time in the womb. Many times, your enemies—the ones we always have with us, those who believe man is an island entire of himself—tried to abort you. Even the doctors in the AMA worked like the dickens to get rid of you. They didn’t kill you, thank goodness, but they did succeed in maiming you. You were conceived as a public insurance for us all, but by the time you were born you had lost the limbs to care for those under age 65. And you were hobbled so that you could only cover limited services, leaving deductibles and co-pays.

Even with your birth injuries, you’ve managed to do a lot of good in your 46 years. I’m grateful for the service you’ve given to my grandparents, my father, and my in-laws. Without your help, my husband and I would have been bankrupt long ago trying to help pay for their medical care. Folks who worry about being in the “sandwich generation” now probably don’t realize how bad it would be with medical bills piled on top of that sandwich. Our finances would be panini, or maybe toast.

Your enemies have tried to poison you over the years. They force you to donate blood to something they call “Medicare Advantage”, private corporations who divert your precious transfusions toward their own profit instead of caring for patients. These same enemies put a gag over your mouth so you couldn’t negotiate with drug companies for fair prices. Even today, some are working to drain all your blood and give it to private corporate vampires.

These actions have weakened you, but there’s a way to restore you to health. We’ve got the technology to reattach the limbs you lost at birth, so you can become what you were always meant to be—Medicare for All. Not only that, but we can improve you—make you cheaper and stronger—by removing your burdensome co-pays and deductibles.

Some worry you’d be slower with all your limbs. We can plan ahead to solve that problem by training more doctors and other health workers. Once we remove all those bloodsucking insurance companies from you and the rest of us, you can get your strength back. Our healthcare system as a whole has had to operate on 2/3 power for decades, while private insurers and the associated administrative costs have siphoned off a third of our medical funds. Imagine what we can do when fully powered!

Happy Birthday, Medicare! I’ll quit talking about your enemies—after all, this is a day to celebrate. You also have friends. Friends who love you are working tirelessly to help you fulfill your dreams. Physicians for a National Health Program, Healthcare-Now!, and many other organizations, including labor unions and churches, continue to gain new members working for your cause. There’s great hope in the next generation of doctors—the largest medical student group, the American Medical Student Association, officially endorses Medicare for All. Even smart conservatives support you, because you are the most financially responsible way to address our health insurance needs.

So today, it’s all about you! We’re having parties and singing your song, all over the country. Happy Birthday, Dear Medicare. May you have many, many more.

Dr. Pippa Abston, a general pediatrician, sees patients and teaches medical students and residents in Huntsville, Alabama. She posted the essay above at Pippa Abston’s Blog: A Pediatrician’s Perspective on Healthcare Reform.

Dr. Abston has written many reflections, including blogging as she reads every word 2,400+ pages of the “Patient Protection and Affordable Care Act.” (33 installments so far!) Dr. Abston has also articulated beautifully the principles that guide her support for single-payer reform, most recently some thoughts on “faith-based health cost sharing.”

If you follow the link to her blog you can subscribe and read Dr. Abston’s latest when she sends it out. I wholeheartedly recommend it!

Here is today’s blogpost by Dr. Abston.

It Could Have Been Me
Pippa Abston MD, PhD, FAAP
May 2, 2011

I’m writing this on a beautiful spring afternoon in Huntsville, just 5 days after a series of horrific tornadoes tore through my state. Tuscaloosa, the town I grew up in, suffered a huge gash. I’m told I wouldn’t recognize the landscape I knew so well. So many people– even children– are suddenly, unexpectedly and heartbreakingly dead. The blog post I drafted last week and meant to post a few days ago seems inadequate to our shared shock and grief.

Last Wednesday, I woke up to sirens and wondered if I would be able to drive down to Destin as planned, to attend our annual Alabama pediatric meeting. During the gap between fronts at 8 am, I decided to make a run for the coast– I succeeded in outrunning the storm by a couple of hours all the way south. Around Montgomery, a radio announcer casually said “there’s a tornado on the ground in downtown Huntsville” and returned to the music– frightened and imagining my husband in his downtown office, I pulled off the road to call him. He was fine, in the basement of the courthouse, and the announcer was wrong. It wasn’t until I got to Florida that I found out about Tuscaloosa.

The pediatric meeting was wonderful, with many excellent speakers. I learned several new things that I hope will help my patients. But the whole time, between every talk and well into the night, I frantically tried to learn what had happened to my loved ones. My father and stepmother were fine. I was able to find many of my Tuscaloosa friends on Facebook, even those who had lost their homes. I clicked repeatedly on the hyperlinks titled “Names of the Dead,” dreading what I might find. I watched the news, and I cried.

The storms passed. Online, between images of the twisters and the damage, I began to see photos of people coming forward to help– rescuing the injured, comforting the newly homeless, bringing food and water. Even in surrounding areas with no damage, strangers seemed kinder. The hotel desk clerk hugged me. Drivers slowed to let me merge, instead of rushing forward at the sight of my turn signal. In the grocery store lines, many let others go ahead of them. We quit watering our lawns and washing our cars to save precious water for the thirsty. I expected this– we always seem to locate our better selves after disaster. After awhile of course, we forget. We get back to “normal.” Still, every time, I am grateful to find our ability to care for one another remains intact, despite being so often underused.

Here’s what I didn’t hear, not even once: I didn’t hear anyone say a victim of the tornado was undeserving of help. I didn’t hear anyone asked if they had heeded the warning sirens, before being pulled from the wreckage. I didn’t see anyone turned away from the food lines because they had chosen to live in a trailer or because they could have stockpiled food and didn’t. I didn’t hear anyone ask why these devastated people had lived in Alabama anyway, knowing tornadoes were possible. And I didn’t notice volunteers checking citizenship papers before offering help.

I heard only “how can I help?” and “it doesn’t matter that I lost my house/stuff/car when others lost their lives.’” I heard “it could have been me.”

Can you imagine what would happen if we treated each other with the same compassion when it comes to healthcare? More than 300 people died this week in the storms– more than 45,000 die every year because they can’t afford to go to the doctor. Sure, some of them could have gotten insurance and didn’t, just the way some of us keep making dinner upstairs when the sirens go off. We could choose to let that go, knowing we are human and thus prone to error.

Forget for a few minutes about the details of how we would do it– single payer, private insurance, whatever. It isn’t an impossible dream. We share our resources to educate our country’s children and to build safe highways for anyone to use. And other developed countries have even applied this principle to their healthcare systems. But first we have to decide we matter to each other– not just after bad weather but all the time.

What if we just quit asking or telling sick people what they had done to cause their own trouble? Let other people into the line ahead of us sometimes? Counted our blessings? Didn’t complain about sharing some of our stuff, to save others’ lives? Conserved our resources out of concern for others? What if we only said “how can I help?” What if we really understood that “it could have been me?”

When I was hired at my present position I welcomed the opportunity to join PEF. Our union provides an important way to stand up for our communities, our environment, our patients and each other. For example, thanks to unions, ours with others, registered nurses in New York are no longer subject to mandatory overtime, something proven to be vital for patient safety.

We need to nurture our society and our environment toward health and with science. This is the proper role for all public employees, from hospital caregiving to environmental conservation to engineering to taxation and finance to schools to the maintenance and development of our infrastructure.

With these things in mind I ran for union office, first as a steward. Then, when our Council Leader retired last year, I decided to seek the role of leader of the stewards for our division. This year I was also elected a member of the statewide Executive Board of PEF.

What a time to take up the union cause!

We now face the bared fangs of a major political offensive against public employees.

The offensive is really a defense. A defense of the indefensible.

It is a defense of three decades of tax cuts for the wealthy, with steep tax breaks and huge taxpayer subsidies for profitable corporations during a period of accelerating income inequality, a time of spectacular concentration of great wealth, a time in which the poor have grown even poorer.

Thirty years ago the wealthiest 1 percent of New Yorkers won about 10 percent of total income. Today the wealthiest 1 percent take more than 35 percent of the total income in New York state. In New York City they take 45 percent of the total.

In 1980 the “poorer” one half of New Yorkers had an average income of $16,074. By 2007 this figure declined to $14,045! (Both figures in 2007 dollars: see the report by economist James Parrott.)

Not only have the rich gotten richer and the poor poorer, such yawning income inequality leads to poor health for the state as a whole. Convincing epidemiology shows that states and nations with greater income inequality are less healthy and have more social problems than those with more income equality. (See The Equality Trust.)

This month Forbes reported that New York is home to 68 billionaires.

68 billionaires!

New York is NOT broke!

Yet to close the state budget deficit our elected leaders have taken aim not at billionaires but at public employees. They blame the public sector for a crisis it did not create and have launched an assault upon public education, safety and health.

Will cutbacks and layoffs nurture a better future? Layoffs in the public sector will cause layoffs in the private sector. Will layoffs, closures and cuts strengthen or weaken our frayed social safety net, our weather-beaten infrastructure, our schools, our already-weakened environmental protections and our beleaguered economy?

We have experienced a time when the rich have grown so much richer than ever, especially here in New York. During the same period the wealthy have received tax break after tax break after tax break, with billions and billions of dollars in state revenue forfeited annually.

It is now time to tax the rich. But alas, not for our leading politicians. Their mission is to defend the millionaires’ and billionaires’ money, the bankers’ bonuses and the corporations’ profits from taxation.

Against the defense of the indefensible, and in the interest of community health and social medicine, I’m sticking to the union.

Originally published at the Albany Times-Union.

To celebrate Martin Luther King Jr.’s birthday, January 15, Dr. Garrett Adams, president of Physicians for a National Health Program, invited Dr. Claudia Fegan to speak in Louisville, Kentucky.

Dr. Fegan is a prominent figure in Chicago’s medical community and a nationally recognized authority on single-payer health care systems. She currently serves as associate chief medical officer for the Ambulatory and Community Health Network for the Cook County Health and Hospital System, and is a past president of Physicians for a National Health Program (PNHP).

Dr. Fegan spoke at the Louisville Urban League at a Jan. 15 meeting to honor and celebrate Dr. King’s life and work. The text of her remarks, “‘The time is always right to do what’s right’: Dr. King and health reform,” has been posted at the Network of Spiritual Progressives.

During her visit to the city, Dr. Fegan also met with students and faculty at the Louisville Presbyterian Theological Seminary and with local physicians and medical students.

Dr. Adams, a specialist in infectious diseases of children, is the new president of PNHP. He has retired from full-time teaching at the University of Louisville School of Medicine. His previous duties included serving as medical director of communicable diseases at the Louisville Metro Health Department. He recently established a not-for-profit volunteer clinic on the Cumberland Plateau in Tennessee (www.beershebaclinic.org).

Thank you, Dr. Adams, for taking time to speak with us. To begin, would you please share with us some thoughts about how your recent efforts in Louisville connect with the overall effort for a national health program, and why you invited Dr. Fegan to speak?

One of the reasons that I was invited to be the new president of the Physicians for a National Health Program is because I am from Kentucky, a southern state. PNHP has recognized the contradiction that in the very areas of the United States where some of the worst health outcomes exist – areas that particularly would benefit from national health insurance – we have the lowest number of members. I have taken it upon myself to make an effort to expand the knowledge and understanding of the value of single-payer health reform in the South. I want especially to bring this message to African-American and Latino people who disproportionately suffer poor health results from the current system based on private health insurance.

So to answer your question, Dr. Fegan’s visit was targeted for Louisville’s African-American community, and it was a great success.

Before we get to the big meeting at the Urban League, please tell us about the discussion at the Louisville Presbyterian Theological Seminary.

Dr. Fegan was invited to speak at the Louisville Seminary by a seminary professor. Several faculty members with significant health concerns have had unfortunate personal experiences with private health insurance and are convinced of the moral imperative that health care is a right to which all are entitled. Last year the Presbyterian Church USA made a formal endorsement of publicly funded national health insurance, so the subject is not unfamiliar. Dr. Fegan’s presentation was the first in a new series of health care discussions at the seminary sponsored by two professors, one of whom happens to be African-American.

It was an informal meeting over lunch attended by a racially mixed audience of about 30 students and professors. Dr. Fegan had new slides specially prepared for this audience, and she engaged the audience from start to finish; there were lots of questions and interaction. Many stayed later to talk and to ask her more questions.

When you met with medical students and physicians, did they bring similar concerns to your dialogue?

This meeting was targeted to bring together PNHP-Kentucky members, medical students, and the membership of the Falls City Medical Society, the area’s association of African-American physicians. Once again, Dr. Fegan was right on target with her presentation, including a selected group of fresh slides for this audience. A surgeon member of the Falls City Medical Society described his experience with French medicine and the “carte vitale.” A resident physician, who had driven all the way from eastern Kentucky, and a medical student were especially interested in the discussion. There were several new faces at the meeting. Dr. Fegan’s talk was informative and inspiring, but the opportunity to meet and talk with colleagues from a broader spectrum of our community was a memorable aspect of this meeting.

What do you find doctors and medical students saying about the Affordable Care Act? The national news media refers to it “the health care overhaul” or sometimes “sweeping health care legislation.” Is that their sense of the president’s reform?

I did not meet anyone over this weekend of health reform discussions that thinks that the ACA will resolve America’s health care dilemmas. Most recognize the advantages that are coming from it and appreciate the fact that something has been done, but they know that it’s not enough. The people with whom I met like the prospect of a single-payer national health plan.

How did the meeting at the Urban League come about?

We chose the Louisville Urban League as the venue for our signature remembrance of Dr. Martin Luther King Jr. for several reasons. First, it is located in the section of the city where many African-Americans live; it is a building with which local residents are familiar. It was a logical place to hold an event celebrating the life and work of Dr. King because the Louisville Urban League’s mission is “to assist African-American and disadvantaged persons in the achievement of social and economic equality primarily through education, employment, housing, family development and community development.”

Can you describe the Urban League event for us? Who spoke besides Dr. Fegan?

My feeling about the meeting was that it was exciting and joyous. The participation of community leaders was incredible. There were over 100 attendees. The first welcome was by Mr. Ben Richmond, the president and CEO of the Louisville League.

Finally, before Dr. Fegan’s address, Triza Cox led us in singing together the Black national anthem, “Lift Every Voice and Sing.”

Would you like to say something about how celebrating the life of Martin Luther King Jr. connects with the struggle for national health insurance?

Dr. King understood 40 years ago that gross inequities in health care existed in America and that they were linked to poverty and racism. The subtitle of Dr. Fegan’s address was “Remembering Dr. King’s cry for justice in health care.” Dr. King said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” On this occasion, in Louisville, Kentucky, we responded to that declaration with a loud affirmative, that we demand justice in health care for all Americans, and we will not relent until it is a reality.

Shortly after Dr. Fegan’s visit to Louisville, the House of Representatives, with a new Republican majority, passed a symbolic bill that would repeal the Affordable Care Act. Did the events “inside the beltway” in Washington seem to be on the minds of the people at the Urban League?

Not much. The American people are amazingly prescient. They recognize political grandstanding for what it is. These audiences understand clearly that the recent health law is incomplete, but they appreciate the progress it represents, and they are very supportive of President Obama.

What do you think the significance of the Louisville meetings was for the future of our efforts to win single-payer national health insurance?

We took a giant step forward for single payer in Louisville on Dr. Martin Luther King’s birthday. Many discouraged people were informed and inspired by the single-payer message that Dr. Fegan and the members of PNHP-Kentucky and Kentuckians for Single Payer Healthcare brought.

Do you have any advice for people who might want to try to emulate your work in Louisville and reach out in other places around our country?

Yes. “Reach out” is the right phrase. That is exactly what we need to do. As Dr. Arthur Sutherland of Memphis has said, we need to replace charity with social justice. There is no better way to eliminate inequities in health care than with single-payer national health insurance, an improved Medicare for all.

These events were meant to reach African-Americans. It is necessary for those of us who are not African-American or members of minority groups to try to recognize the subtleties of racism in ourselves, so that we can connect and share the single-payer message of “Everybody In, Nobody Out.”

(Andrew D. Coates, MD, is an internist and professor at Albany Medical College (N.Y.) and a member of the national board of PNHP.)

Words matter. The insurance companies (as Wendell Potter will attest) have used that to their advantage and have tried to turn “single-payer” and “Medicare For All” into pejoratives, much as Ronald Reagan did with “socialized medicine” while in the pay of the AMA.

But there are really no other words to use and I find that “Medicare For All” and “single-payer” are labels that best describe what I am talking about.

When I encounter opposition to the words, I find that a small amount of education is in order, and usually works. Here is one example. A common response of the uninformed to the word “single-payer” is to mention Canada.

If I hear “Canadian health care” from my listener (as I did on a radio interview at 0200 this morning) then I tell the following story:

I live in Canada in the summertime. My friend there, Red, had to go to the hospital a year or two ago and was hospitalized for five days. It seems like he got every test and x-ray known to God and man while there, in addition to five days of IV medication.

A few days after he got out of the hospital, I saw him walking around town.

“How are you doing, Red?” I said.

“Pretty good”, he said, “but I’m pissed off at this hospital bill I got.”

I was dumbfounded. “Hospital bill? What are you talking about? You don’t have to pay for hospital care in Canada, I thought.”

He explained. “Yeah, I had a private room. I’m mad. I didn’t know it would cost me 240 bucks. That’s outrageous.”

I had to agree. Outraged is how I felt too.

When I told this story to 3 complete strangers on a plane recently, apropos of nothing, one said, “If they can do it in Canada, why can’t we do it here? The insurance companies are screwing us and have bought off the politicians.” The other two nodded in agreement.

Words matter, but they matter most when they are combined with ideas and stories.

Dr. Newhall is a physician and attorney in Salt Lake City, Utah. His website is health-justice.org.

Minnesota health CEOs taking a whack at Medicaid
A coalition of health CEOs released a plan to reshape spending in state’s huge Medicaid program.
By WARREN WOLFE, StarTribune
January 26, 2011

Concerned that the Legislature and governor might get it wrong, CEOs from seven major health plans and providers have drawn up their own plan to streamline Minnesota’s massive Medicaid program — and carve $1.8 billion from the projected $6.2 billion deficit.

The plan is sure to draw political fire. It suggests up to $170 million in cuts to state-funded services that help keep the elderly and disabled out of institutions, for example, and captures $280 million in higher taxes on tobacco and alcohol.

The proposal would also keep $800 million in federal subsidies by continuing Medicaid expansion, raise $400 million by taxing healthcare providers, push people with disabilities into managed care and establish an “institute” to design further cuts. Warren Wolfe’s report continued:

Some critics said Wednesday they wonder if the health plans are trying to enhance their profits by moving more people into managed care.

Together, the state’s 12 HMOs earned $103.1 million in net income in 2009 from the three Minnesota health care programs. Historically, Medicaid has been profitable for HMOs, with those earnings typically offset by losses from the MinnesotaCare and General Assistance Medical Care.

State government business is often more profitable than earnings from private insurance. In 2009, the average HMO profit margin for state health plans was 4.1 percent, compared with 1.6 percent for commercial business, according to a StarTribune analysis.

The next day the StarTribune published this letter to the editor by PNHP leader Dr. Lisa Nilles:

If HMOs want in, demand transparency

Not surprisingly, Minnesota’s health plans suggest that the state shift the administration of its public health programs for those with disabilities into a program administered by insurance companies (“Taking a whack at Medicaid,” Jan. 27).

Without evidence, they claim this will save the state up to $300 million annually. Shockingly, we let them get away with it.

Minnesotans hand over $3 billion of taxpayer money each year to Minnesota HMOs to manage most of our public health care programs and demand no auditing in return.

Historically, adding a middleman to “manage” health care delivery has added costs, not lowered them.

DR. LISA NILLES, MINNEAPOLIS

The writer is acting director of the Minnesota Universal Health Care Coalition.

Today the StarTribune’s editors took up the topic again. Their editorial, subtitled “Cost-cutting report didn’t disclose plans’ business interests,” explains and asks:

While the group offered up clear-eyed, if painful, prescriptions in a report last week – namely, benefit cuts and tax increases on tobacco and alcohol – it undermined its hard work by not addressing these important questions:

• How much would the health plans profit from their proposed shift of more Medicaid patients into insurer-run managed-care programs?

• Could the health plans themselves trim operational or administrative costs to provide savings to the state?

Comment by Dr. Lisa Nilles:

In 2005-2006, the Minnesota single-payer community supported legislation to remove the HMOs from the administration of our public programs. We offered testimony, supported by Kip Sullivan’s extensive research, that privatization of our public health care programs almost certainly increased costs, without any corresponding increase in quality of care or access to care. The legislation didn’t move.

Today’s StarTribune editorial, the fruit of Dave Feinwach’s courage as well as consistent advocacy by many voices, helps everyone see the folly of privatization of public health programs.

The measure reaffirmed the European ban on television and radio drug advertisements, and recommended that nations extend the ban to print media. Nevertheless the vote was greeted as a victory by the pharmaceutical companies. The European Federation of Pharmaceutical Industries and Associations called it a “constructive approach.” The Director General of that trade group called the vote “clearly a step in the right direction.”

In response, our friends at the International Association of Health Policy and the Federation of Associations for the Defense of Public Health issued this statement:

The advertising to users of medicines puts at risk the health and sustainability of health care systems

December 2, 2010

The European Parliament has just approved the possibility that the pharmaceutical industry to report directly to patients about medication on prescription.

This measure, which supposedly done to improve the information of the citizens, is really a major setback to the right of reliable information and quality.

There is much evidence that the information the industry provides to professionals contains numerous biases that magnify the effects of pharmaceuticals and minimizes or hides the health risks.

It turns out to be difficult therefore to think that the own industry that makes the products and it has direct interests to promote his sale could favour a ” objective and impartial ” information, and it is expected that this information is addressed to encourage inappropriate consumption of drugs and shoot up pharmaceutical cost (as has been demonstrated in countries like USA where there is direct advertising of medicines to “consumers”), which is particularly irresponsible and dangerous in a time of economic crisis and can lead to damage patients health.

The legislation leaves it to the EU member states the final regulation of this information, and obviously this way can establish control mechanisms to reduce the worst effects of this rule. Anyway, the experience of USA and Canada leaves room for little doubt about the negative health effects and costs of this measure.

Therefore we understand that the Council of the EU where their member states are present must veto this initiative that represents a step backwards on the current situation, an attack to public health and puts at risk the health of citizens and the sustainability of the European Union health systems.

International Association of Health Policy
Federation of Associations for the Defence of Public Health

Last week the proposal by the co-chairs of the president’s bipartisan National Commission on Fiscal Responsibility and Reform reverberated on down the mass media echo chamber. They called for substantial cuts in Social Security and Medicare benefits, among other things that would undermine our basic standard of living.

The media saturation was intense. Even for casual news-watchers it was like being herded into a “captive audience meeting,” one of those smarmy PR jobs that company bosses hire out to consultants, who tell the workers through a microphone why they don’t need a union.

The proposals of the co-chairs are ambitious. They would re-make the United States of America as a place not only without unions, but largely without a middle class: leaving on one side low-wage workers (who foot the bill for their own benefits), and on the other side the super-rich, with precious few in the middle.

The editors at our local paper, the Albany Times Union went ahead and amplified the message, accepting it rather than holding it up to scrutiny. Starting with the premise that “the country needs to confront what it would take to stabilize the accumulation of the federal debt,” they uncritically embraced the co-chairs’ proposal, concluding that “Every one of its provisions deserves serious consideration.” They even supported the messenger, although in a backhanded way:

Hardly an unreasonable plan, even as it’s advanced by the likes of Mr. Simpson, who’s previously likened Social Security to a giant mammary gland and called its recipients “greedy geezers.”

Republican co-chair of the president’s commission, Alan Simpson is a conservative Republican fossil. His counterpart, Erskine Bowles, is a conservative Democratic Party dinosaur. What they share, besides being millionaires whose “public service” helped to enhance their immense personal fortunes, are failed ideas that ought to remain extinct. But here they are, the president’s appointees.

What to say? Well, if you want fossilized, vengeful and smarmy at center stage, then Alan Simpson is your man, Mr. President.

*

Back in June Mr. Simpson unhinged upon Alex Lawson of Social Security Works with an expletive-laced rant. Simpson was full of personal insults yet vacant of facts, rambling on.

When economist James K. Galbraith, professor of government at The University of Texas, gave his must-read testimony to the deficit commission, he cited that rant as evidence of Simpson’s incompetence. Galbraith questioned the legitimacy of the commission and demanded that the body advance no proposals.

Then in September Simpson stuck his foot into his mouth again with the line the Times Union editors mentioned, calling Social Security – “a milk cow with 310 million -” … udders. (You can figure out the profanity Simpson used.)

The National Organization for Women immediately responded, saying that Simpson’s quip amounted to a crass insult “to those who depend on Social Security – many of them older women, children and people with disabilities.” Soon afterward NOW President Terry O’Neill delivered over 1,500 baby bottle nipples, sent by NOW members from across the country, to Mr. Simpson.

I love Terry O’Neill. She is so courageous and unflappable. You can see her with Simpson on YouTube. As she hands her “gift” to Mr. Simpson, she smiles and says it is given “in the spirit of hoping that you’ll have the decency to resign.” She then presses Simpson for a pledge not to cut Social Security benefits. He acquits himself badly. As he tries to dodge and dismiss Ms. O’Neill, Simpson seems ever more cadaveric and sarcastic and ultimately furious.

Last week as the media echoed Bowles and Simpson’s proposals, particular delight focused on Alan Simpson’s rhetoric. The Times Union editors joined in. Here’s their lead:

Leave it to Alan Simpson, so blunt and irreverent, to set the tone for the debate that America has avoided for far too long.

A particularly illuminating Simpson quote was noted in the Wall Street Journal (and elsewhere):

“We have harpooned every whale in the ocean and some of the minnows,” said co-chairman Alan Simpson, a retired Wyoming Republican senator. “No one has ever done that before.”

Who does Alan Simpson think he is? Captain Ahab?

Like the captain of The Pequod, the ship in Herman Melville’s classic novel Moby Dick, the retired Wyoming senator lusts after a monomaniacal purpose – in this case, to send the middle class to the bottom, by raising the retirement age, slashing social spending, further privatizing Medicare, privatizing Social Security, taxing health insurance benefits and lowering the tax rate for corporations.

With unemployment at nearly 10% officially – and unofficially twice that – with health care costs sinking us all, with two-income households the norm and two, even three jobs for many workers a necessity, an alternative vision stands in plain sight yet scarcely makes the news. Nicholas Kristof proved this rule with an exceptional column last week titled “A Hedge Fund Republic?” He reminded us that the poorer 90 percent of people in the United States own only 29 percent of the wealth, while the wealthiest 1 percent own an even greater share, 34 percent of the total.

When the top 10 percent possess more than two-thirds of total holdings, it is time to increase taxes on the rich. We could easily afford to shorten the workweek with no cut in pay and also lower the retirement age – and each of these would put millions of people to work. We can also extend and improve Medicare to cover all necessary care for everyone, from birth, something that would save hundreds of billions of dollars annually. Bringing the troops home from Iraq and Afghanistan would not only save trillions of dollars, but human lives.

As for Social Security, only the first $106,800 of income is taxed for the Social Security fund. Nancy Altman and Eric Kingson point out that if this cap were scrapped, and all income was taxed at the present rate, benefits could be raised across the board and Social Security would be assured solvency for 75 years to come. As it is, there is no immediate crisis in Social Security funding. Well, then, let’s scrap the cap!

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At the end of Moby Dick only the young sailor Ishmael survives, afloat on a coffin. But along the way the first mate, Starbuck, suggests to the revenge-crazed captain that he has got the great whale all wrong. Ironically, today “Starbucks” (named for Melville’s tragic character) has become a designer coffee-shop that symbolizes a middle-class lifestyle rich with lattes and car payments, i-Pods and consumer credit debts.

Although partisan differences loudly dominate when it comes to the TV, we have seen a bipartisan commitment to privatize profit and socialize risk, as President Bush and then President Obama both rushed to rescue Wall Street’s financiers and their insurers and bankers, instead of the debtors.

Now Alan Simpson, Mr. Obama’s appointee, wants “to harpoon every whale in the ocean” even if it means we all go down with the ship. For the co-captains of the deficit commission the credo is no longer E pluribus unum (“out of many, one”), but “I’ve got mine – you swim for it!”

Isn’t it simply absurd to hear retired millionaires like Simpson and Bowles, whose families grew wealthy at taxpayer expense, telling the people of the United States that they live too long to be allowed to retire at age 65? The very idea should be laughed off the stage, not championed and not echoed.

There is still hope, for in reality they have not harpooned any whales. All they’ve really done is issue a report and attend some press events. Yet as the media, including this newspaper, chooses to parrot Simpson’s maniacal ravings, we find ourselves like Starbuck and Ishmael, captive audience aboard The Pequod.

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Horrible old man! Who’s over him, he cries; —aye, he would be a democrat to all above; look, how he lords it over all below! Oh! I plainly see my miserable office,— to obey, rebelling; and worse yet, to hate with touch of pity! For in his eyes I read some lurid woe would shrivel me up, had I it. Yet is there hope. Time and tide flow wide.

– Starbuck, in Moby Dick by Herman Melville (1851).