Summary: The year 2022 saw democracy protected from tyrants in the US and abroad through the determined action of visionary leaders. That struggle continues. The struggle for health justice in the US is similar: facing growing threats and anti-democratic opposition, it requires persistent vision, strategy, and resolve.

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‘Clowns And Thugs’: Jan 6th Evidence Broken Down, CNN, December 23, 2022

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Ari Melber interview with David Remnick of The New Yorker (9 min).

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The Brutal Alternate World in Which the U.S. Abandoned Ukraine, The Atlantic, December 2022, by Anne Applebaum

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Ukrainian resistance and American support prevented a wide range of horrors.

[Had the Russian invasion proceeded as planned,] Russian soldiers, strengthened by their stunning victory, would already be on the borders of Poland … NATO would be in chaos; the entire alliance would be forced to spend billions to prepare for the inevitable invasion of Warsaw, Vilnius, or Berlin. …

This disaster would not have been confined to Europe. … Chinese plans to invade Taiwan would be well under way, because Beijing would assume that an America unwilling to defend a European ally, and now totally bogged down in a long-term battle against an emboldened Russia, would never go out of its way to help an island in the Pacific. The Iranian mullahs, equally cheered by Russia’s success and Ukraine’s defeat, would have boldly announced that they had finally acquired nuclear weapons. From Venezuela to Zimbabwe to Myanmar, dictatorships around the world would have tightened their regimes and stepped up the persecution of their opponents, now certain that the old rules—the conventions on human rights and genocide, the laws of war, the taboo against changing borders by force—no longer applied. …

But none of this happened. Because Zelensky stayed in Kyiv, declaring that he needed “ammunition, not a ride”; because Ukrainian soldiers repulsed the first Russian attack on their capital; because Ukrainian society pulled together to support its army; …

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Comment:

By Jim Kahn, M.D., M.P.H.

Many of us entered 2022 with deep concerns about the future of US democracy, with Biden’s popularity low and the looming midterm election expected to yield big gains for the MAGA GOP. The Russian invasion of Ukraine in February stoked fear of the global weakening of democracy. In a remarkable moment, Ukrainian president Zelensky declined a US offer to be airlifted to safety, instead leading a stunningly effective resistance, buoyed by US and NATO military supplies and political support. The January 6 House Select Committee convened compelling hearings, offering powerful evidence of seditious conspiracy. President Biden gave two major speeches highlighting the current GOP’s threats to US democracy. A midterm thrashing was averted, though vote margins were often precariously slim. The year ends with the huge relief of disasters averted, and cautious optimism that the tide has persistently turned in favor of democracy.

The 2022 news about US health justice is less upbeat, mainly because negative prior trends continue. Tens of millions remain uninsured, under-insurance via huge deductibles and copays is widespread, nearly half experience financial barriers to care, and medical indebtedness burdens 40%. [In a few days: a full and cited review of HJM 2022 content.] Meanwhile, private insurer profits are at record highs, boosted mainly by public programs such as Medicare and Medicaid. An effort to privatize traditional Medicare is proceeding. Private equity is buying up providers. Longevity has dropped nearly three years in two years, in substantial part due to the lack of insurance amidst the COVID pandemic.

There is also good news. Public support for federal government responsibility for insurance remains above 60% (making it the democratic choice!). Various local (including California) commissions and votes have endorsed universal and unified insurance – aka, single payer. National Democrats finally coalesced on the Inflation Reduction Act, with symbolic if limited controls on drug pricing and out-of-pocket costs. The abuses of private insurers and negative consequences of for-profit providers are receiving critical scrutiny.

On balance, where are we? The for-profit healthcare system has never been more firmly entrenched. Associated problems – and the futility of following the for-profit free market model – have never been clearer.

Nor have the links with the fight for democracy ever been more evident. A government role for universal unified health insurance is the popular will. A single payer, improved Medicare-for-All would extend and improve life; foster liberty to choose providers and jobs; and support the pursuit of happiness through reduced worry and improved health care. It would brilliantly support our founding notion that all are created equal. Other values align too.

Let’s remember the three essential elements of eventually winning the fight for single payer:

Vision: As shown around the world, the best way to pay for health care is identical comprehensive coverage. It saves money & lives. That’s the vision. We will not accept minor and inadequate tweaks to our fundamentally dysfunctional fragmented approach.

Strategy: Marshall the growing consensus that our system is thoroughly broken, recruit disenchanted stakeholders (such as physicians), and build the irresistible majority. It’s a challenging social change movement, linked with other powerful social change movements.

Resolve: We are told, repeatedly, that it’s not politically practical to achieve single payer. But we will relentlessly pursue its unique and powerful benefits as the only path to health justice.

All the best for the New Year!

http://healthjusticemonitor.org…

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Summary: Yet again, cogent review of the failings of absurdly complex US health insurance, reducing medical access for vulnerable populations and indeed, almost all of us. Yet again, acceptance of the dysfunctional patchwork and a call for “new reforms.” Yet again, we say: adopt the only sensible solution, single payer.

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U.S. Health Insurance Coverage and Financing, New England Journal of Medicine, December 22, 2022, by Sabrina Corlette, J.D. and Christine H. Monahan, J.D.

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The United States has a patchwork system of health insurance coverage, in which people’s access to services and level of financial protection — not to mention whether they have coverage at all — varies depending on their birthplace, age, job, income, location, and health status. If you are 65 years of age or older or have a disability, you might be eligible for Medicare. If you work full time for a company that chooses to offer benefits, you might be eligible for employer-sponsored insurance. Depending on your income, state of residence, and other factors, you might qualify for Medicaid. You could also fall through the cracks: 12 years after the enactment of the ACA, more than 9% of Americans remain uninsured.

Many people in the United States work for employers that do not offer insurance or do not sufficiently subsidize it, making it unaffordable for lower-income workers. Most documented immigrants must wait 5 years to qualify for Medicare or Medicaid; those who are undocumented may never be eligible for any type of government insurance. And immigration status aside, millions of people live in states where eligibility rules mean they are actually too poor to qualify for subsidized coverage.

No one would purposefully design the system we have. Unlike many of our peer countries, the United States has never had a centrally planned, cohesive system to help its citizens obtain and pay for health care services. Ours is a system built on happenstance, unintended consequences, and gap filling.

The United States has made sporadic efforts at creating a national system of health coverage… (the article provides a brief history of these attempts with which we are all too familiar).

Among the people still most at risk for falling through the cracks are historically marginalized populations.

Americans who have “good” insurance today may be surprised to learn that they, too, are vulnerable.

Our patchwork system of health coverage is not going away anytime soon. However, the primary reason millions of Americans remain uninsured or have insurance coverage that leaves them financially exposed is the high costs in our health care system. Constraining the growth of costs while reducing inequities in access and outcomes will require new but difficult reforms.

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Comment:

By Don McCanne. M.D.

Can you believe it? We are entering yet another new year with the same old problem:  We have the most expensive health care system on earth, and yet we continue to perpetuate the inequities in health care access and outcomes that we know would be dramatically reduced or eliminated with enactment and implementation of a single payer version of an improved Medicare that is designed to serve all of us.

Let’s resolve to make this the year of health care justice for all: Single Payer!

http://healthjusticemonitor.org…

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Summary: The Center for Medicare and Medicaid Services (CMS) just released 957 pages of proposed regulations for Medicare Advantage (MA). Despite the massive verbiage, and purported reflection of public comments, they fail to remedy the fundamental dynamics that make MA so lucrative for private insurers and so inadequate for sick enrollees.

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U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans, The New York Times, December 17, 2022, by Reed Abelson and Margot Sanger-Katz

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Federal health officials are proposing an extensive set of tougher rules governing private Medicare Advantage health plans, in response to wide-scale complaints that too many patients’ medical claims have been wrongly denied and that marketing of the plans is deceptive.

Despite their popularity, the plans have been the subject of considerable scrutiny and criticism lately. A recent report by the inspector general of the U.S. Department of Health and Human Services found that several plans might be inappropriately denying care to patients. And nearly every large insurance company in the program, including UnitedHealth Group, Elevance Health, Kaiser Permanente and Cigna, has been sued by the Justice Department for fraudulently overcharging the government.

The period leading up to this year’s enrollment deadline, Dec. 7, amplified widespread criticism about the deceptive tactics some brokers and insurers had used to entice people to switch plans. In November, Senate Democrats issued a scathing report detailing some of the worst practices, including ads that appeared to represent federal agencies and ubiquitous television commercials featuring celebrities.

Federal Medicare officials had said they would review television advertising before it aired, and the new rule targets some of the practices identified in the Senate report that caused some consumers to confuse the companies with the government Medicare program. A proposed regulation would ban the plans from using the Medicare logo and require that the company behind the ad be identified.

Federal Medicare officials had said they would review television advertising before it aired, and the new rule targets some of the practices identified in the Senate report that caused some consumers to confuse the companies with the government Medicare program. A proposed regulation would ban the plans from using the Medicare logo and require that the company behind the ad be identified.

The new proposal would require plans to disclose the medical basis for denials and rely more heavily on specialists familiar with a patient’s care to be involved in the decision-making.

Dr. Meena Seshamani, the director of the Center for Medicare and a deputy administrator at the Center for Medicare and Medicaid Services, said the changes had been influenced by thousands of public comments solicited by the agency and by lawmakers.

“The proposals in this rule we feel would really meaningfully improve people in Medicare’s timely access to the care they need,” she said.

Hospitals, which have been pushing for changes that would address their concerns that insurers were abusing prior authorization, applauded the proposals.

The proposed regulations are not yet final. Health officials are soliciting comments from the public and may make changes.

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Comment:

By Don McCanne, M.D.

The Feds are finally listening to the uproar against the privatized Medicare Advantage plans and all of their abuses. Or are they?

Let’s see. CMS proposed a 957 page set of rules which you can read and respond to by February 13, 2023. Actually reviewing the first 72 pages should be adequate since it contains the Executive Summary.  Therein you will find that our bureaucrats are attacking issues such as warning insurers that if they use the Medicare logo we will tell on them, though using the term “Medicare” is still acceptable.

Addressing evidently more significant problems, as an example Medicare will mandate that prior authorization reveal clinical justifications and incorporate expert review. But this is a micro-fix; the real issue is that insurers don’t want patients who need expensive health care and will continue to make getting care difficult so that patients switch to other coverage. The lawsuits they face for denying coverage are a drop in the bucket compared to the billions they rake in by avoiding expensive care. Most private Medicare Advantage patients are relatively healthy and thus not dissuaded by limited provider panels or lack of access to centers of excellence that they don’t need right now, if they can have their teeth cleaned or join an exercise club. It really isn’t their concern that extra taxpayer dollars are diverted to enrich these private plans.

Sorry, burying us in 957 pages of rules is not going to cut it. The privatization of Medicare, as a wealth-creating business model, has significantly damaged the program and these rules are only camouflage for perpetuating it. Our traditional Medicare program has some real problems that need to be addressed, and that is where the effort should have been directed. As a public program the traditional program is designed to serve all of us well, whereas the private Medicare Advantage model is designed primarily to serve business interests.

Sadly, our government is going to use this proposed rule to try to convince us that they are addressing the Medicare privatization issue. They clearly are not. They have been listening to us but not acting on what we say. We need to turn the volume up even higher. Let’s throw out the privatizers and enact a single payer Medicare for All system. Then we can have Health Justice for All!

http://healthjusticemonitor.org…

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Summary: A study of cancer surgery finds higher mortality in Medicare Advantage than in Traditional Medicare. The apparent reason? Less use of prestigious and highly experienced hospitals for complex cancer surgeries.

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Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients, Journal of Clinical Oncology, November 10, 2022, by Mustafa Raoof, et al.

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From the Discussion:

Medicare Advantage (MA) plans cut health care utilization by restricting beneficiary options to certain in-network providers or hospitals. Similarly, MA plans save cost by regulating the use of specialists through utilization-management techniques such as prior authorization. In this study, we sought to assess the outcomes of complex cancer surgery among Traditional Medicare (TM) and MA beneficiaries. We reasoned that utilization-management techniques used by MA plans may restrict access of the beneficiaries to high-volume specialists and hospitals.

The main finding of the study is that MA beneficiaries have significant barriers in accessing optimal surgical cancer care. For instance, except for pancreatic operations, MA beneficiaries were more likely to wait longer between diagnosis and therapy compared with TM beneficiaries. Furthermore, MA beneficiaries were significantly less likely to receive care at teaching hospitals, CoC-accredited hospitals, or NCI-designated centers. …

For liver, pancreas, or stomach operations, limited access of MA beneficiaries to high-volume hospitals likely contributed to worse 30-day mortality.

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Comment:

By Isabel Ostrer, M.D.

Nearly half of Medicare beneficiaries are enrolled in privatized Medicare Advantage (MA) plans as older Americans are increasingly siphoned away from Traditional Medicare (TM). A new study by Raoof et al. examines how costs and outcomes compare for complex cancer surgery patients in MA vs TM. Costs were significantly lower for MA compared with TM.

But monetary savings come at a serious health cost. Compared with TM beneficiaries, MA beneficiaries had significant delays from diagnosis to surgery. Those with stomach, pancreas, and liver cancer had much higher 30-day mortality rates – because they were less likely to receive care in hospitals with extensive experience (“high volume”) for the relevant complex surgeries.

MA plans are able to cut costs by restricting access to life-saving care, for example, by using prior authorization and narrow networks. It’s no surprise that MA beneficiaries have to wait longer for therapy. It’s unacceptable that they receive care at less experienced hospitals, resulting in added deaths. This adds to a recent study on MA finding no mortality benefit (at best) for acute myocardial infarction despite known higher MA costs to CMS.

Controlling health care costs should not come at the expense of patient well-being. Single payer does both: saves money and improves health.

http://healthjusticemonitor.org…

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Summary: Donald Berwick, a visionary leader in the pursuit of quality medical care, said at a forum that our health system’s focus on profits is damaging, wrong, and demoralizing. It blocks improvements in quality. He said, “I remain an advocate of a globally budgeted, single-payer system.”

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IHI Forum: Berwick Says ‘One of the Problems in Healthcare Is Greed’, Healthleaders, December 9, 2022, by Christopher Cheney

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The focus on profits in U.S. healthcare is “damaging,” Institute for Healthcare Improvement President Emeritus and Senior Fellow Donald Berwick, MD, said during this week’s IHI Forum in Orlando, Florida.

Berwick is one of the country’s leading authorities on healthcare quality and improvement. The co-founder of IHI served as administrator of the Centers for Medicare & Medicaid Services during the Obama administration.

In a meeting with journalists during the IHI Forum, Berwick criticized the financial model of U.S. healthcare. “One of the problems in healthcare is greed. We must address the degree to which the pursuit of profit and the acquisition of money and high valuations and investor-oriented business models has taken over healthcare. It is damaging. It is wrong.”

Individual patients are being harmed, Berwick said. “At the individual level, this is leading to higher and higher out-of-pocket costs, more and more insurance benefit structures where people have to pay more, and disadvantages to people with lower incomes.”

The emphasis on profits limits the ability of healthcare organizations to improve quality, he said. “This is affecting the context in which quality plays out. Our work on improvement depends on a basic foundational structure that can invest in improvement.

The distortion in behaviors and the demoralization that results from profit-driven excess is hurting our ability to improve.”

Other countries have established a better business model for healthcare, Berwick said. “I work in many systems around the world, which include single-payer systems in which there is a much stronger sense of collective duty. In many countries, the ministry of health feels responsible for making sure that resources are allocated in a way that will help the population. There is no minister of health in the United States. There is nobody thinking about whether the healthcare system is making sense for people. I remain an advocate of a globally budgeted, single-payer system.”

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Comment:

By Don McCanne, M.D.

Which is better for our health? Greed-driven healthcare? Or single payer? The answer is obvious, as Donald Berwick explains.

Which do we have? Why? Well let’s change that, for our health! Now!

http://healthjusticemonitor.org…

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Summary: A national study of 2.2 million Medicare hospital admissions for heart attacks finds no clinical differences between Medicare Advantage and Traditional Medicare by 2018. At best, Medicare Advantage is providing equal outcomes at higher cost.

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Association of Medicare Advantage vs Traditional Medicare With 30-Day Mortality Among Patients With Acute Myocardial Infarction, JAMA, December 6, 2022, by Bruce E. Landon, et al.

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Abstract:

OBJECTIVE: To compare 30-day mortality and treatment for Medicare Advantage and traditional Medicare patients presenting with acute myocardial infarction (MI) from 2009 to 2018.

RESULTS: [statistical detail removed for clarity]

[Clinical] Enrollment in Medicare Advantage vs traditional Medicare was associated with significantly lower adjusted 30-day mortality rates in 2009 (19.1% vs 20.6%). By 2018, mortality had declined in all groups, and there were no longer statically significant differences between Medicare Advantage (17.7%) and traditional Medicare (17.8%) … By 2018, there was no … significant difference in standardized 90-day revascularization rates between Medicare Advantage and traditional Medicare.

[Utilization] Rates of guideline-recommended medication prescriptions were … higher in Medicare Advantage (91.7%) vs traditional Medicare patients (89.0%)…. Medicare Advantage patients were … less likely to be admitted to an ICU than traditional Medicare patients (50.3% vs 51.2%) and more likely to be discharged to home rather than to a postacute facility (71.5% vs 70.2%). Adjusted 30-day readmission rates were lower in Medicare Advantage than in traditional Medicare (13.8% vs 15.2% and 11.2%vs 11.9%).

CONCLUSIONS AND RELEVANCE: Among Medicare beneficiaries with acute MI, enrollment in Medicare Advantage, compared with traditional Medicare, was significantly associated with modestly lower rates of 30-day mortality in 2009, and the difference was no longer statistically significant by 2018.

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Comment:

By Jim Kahn, M.D., M.P.H.

This impressive comparison of Medicare Advantage [MA] and Traditional Medicare [TM] in the management of acute myocardial infarctions (aka heart attacks) finds no differences in clinical outcomes and small differences in utilization. What are we to learn from this?

I’m not terribly interested in the utilization differences. They’re small, and may reflect MA plan cost control goals instead of clinical quality.

I prefer to focus on health results, as the authors did. Let’s look at these closely.

1) Clinical outcomes for heart attacks appear similar for MA and TM overall, by 2018. Thus, MA is not providing meaningful health advantages for this clinical situation. That leads to the question, why pay more, as MA forces us to?

2) An apparent MA advantage for 30-day mortality disappeared from 2009-2018. This makes sense, since the MA population evolved from very much healthier than TM to close in health status. However, there may still be a statistical bias making MA care look better than it is.

Geek detour: We know that MA plans aggressively upcode certain diagnoses to increase capitation rates. Once these clinical diagnoses are in the electronic health record, hospital doctors have the opportunity, and indeed a medical obligation, to assess and manage them. As a result, hospitalization summaries may list the added diagnoses as comorbidities. The TM patient doesn’t have this upcoding. In the analysis of clinical outcomes, it could look like the hospital did as well with similar MA and TM patients, when in fact the MA patients are a bit healthier than similarly coded TM patients. This introduces a bias that favors MA.

Summary in nearly normal speak: Small differences in hospital comorbidities due to diagnostic upcoding may make MA care look better than it is.

Summary in fully normal speak: MA care may not be as good as it appears.

3) Even if MA outcomes are about as good as TM overall, this doesn’t capture significant variation across MA plans. Beneficiaries have no way to determine which plans provide better care. It’s a crap shoot.

4) P.S., why are we using data that are four years old? Our healthcare data system is kludgy, due largely to the kludginess of our health care payment system. Single payer data would be streamlined and current.

Takeaway: It’s good that MA appears similar to TM in clinical outcomes, at least for heart attacks. I’m worried that the analysis is still biased. But even if MA is close on clinical outcomes, why is that good enough? We know that MA creates big cost problems – for CMS and for sick beneficiaries. Why would we pay more for something that’s not better?

With single payer, we’d pay less for medical care that’s superior.

http://healthjusticemonitor.org…

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Summary: Economist Thomas Piketty alerted us to accelerating economic inequality over the last 40 years. Now he proposes the solution: a revived socialism that embraces public-spirited investment in health and education for all, while adopting modern equity and ecological values.

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Time for Socialism, Yale University Press, 2022, by Thomas Piketty

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Born in 1971, I belong to a generation that did not have time to be tempted by communism, and which became adult when the absolute failure of sovietism was already obvious. I was more liberal than socialist in the 1990s. I could not stand those who obstinately refused to see that the market economy and private property were part of the solution.

But now, thirty years later, in 2020, hypercapitalism has gone much too far, and I am now convinced that we need to think about a new way of going beyond captalism, a new form of socialism, participative and decentralized, federal and democratic, ecological, multiracial, and feminist.

History will decide whether the word “socialism” is definitively dead and must be replaced. For my part, I think that it can be saved, and even that it remains the most appropriate term to describe the idea of an alternative economic system to capitalism. In any case, one cannot be just “against” capitalism or neoliberalism: one must also and above all be “for” something else, which requires precisely designating the ideal economic system that one wishes to set up, the just society that one has in mind, whatever name one finally decides to give it. …

Between 1930 and 1980, the (tax) rate applied on the highest incomes was on average 81% in the United States, and the rate applied to the highest inherited estates was 74%. Clearly, this did not destroy American capitalism, far from it. It made it more egalitarian and more productive, at a time when the voters in the United States had not forgotten that it was their level of educational advancement and their investment in training and skills that was the backbone of their prosperity, and not the religion of property and inequality.

Reagan, then Bush and Trump subsequently endeavored to destroy this heritage. They turned their backs on the egalitarian origins of the country, by counting on historical amnesia by fueling identity-based divisions. With the hindsight we have today, it is obvious that the outcome of this policy is disastrous. …

The challenge of global warming and the international awareness of the growing inequalities do act as leverage for change, but we are still far from that goal. The Organisation for Economic Co-operation and Development (OECD) projects for the taxation of the profits of multinationals only concerns a small fraction of the latter, and the scale of the contribution proposed is much more favorable to the rich countries than to the poor ones. “The Triumph of Injustice,” a book published in the United States by Emmanuel Saez and Gabriel Zucman, demonstrates that there are more ambitious solutions with the key element being financial transparency and the return to fiscal progressivity in order to finance health and education for all, and the ecological transition. The success of these ideas among the American Democrats (in particular, Warren and Sanders) does allow for optimism. …

Let it be said at once: The treatment received by Bernie Sanders in the leading media in the United States and in Europe is unjust and dangerous. Everywhere on the main networks and in the major daily papers we read that Sanders is an “extremist” and that only a “centrist”candidate like Biden could triumph over Trump. This biased and somewhat unscrupulous treatment is particularly regrettable when a closer examination of the facts actually suggests that only a full-scale reorientation of the type proposed by Sanders would eventually rid American democracy of the inegalitarian practices which undermine it and would deal with the electoral disaffection of the working classes.

To say emphatically, as Sanders does, that a public, universal health insurance would enable the American population to be cared for more efficiently and more cheaply than the present private and extremely unequal system is not an “extremist” statement. It is on the contrary a declaration perfectly well documented by many research studies and International comparisons. In these difficult times when everyone deplores the rise of “fake news,” it is right and proper for some candidates to rely on established facts and not resort to obscure language and complex tactics.

Similarly, Sanders is right when he proposes large-scale public investment in favor of education and public universities. Historically, the prosperity of the United States has relied in the twentieth century on the educational advance of the country over Europe and on a degree of equality in this field, and definitely not on the sacralization of inequality and the unlimited accumulation of fortunes which Reagan wished to impose as an alternative model in the 1980s. The failure of this Reagan-style rupture is evident today with the growth of national income per capita being halved and an unprecedented rise in inequality. Sanders simply proposed a return to the sources of the country’s model for development: a very wide diffusion of education. …

If the Democrats [DM: choose your own nonpartisan label] want to regain the socially disadvantaged vote, whatever its origin, then more needs to be done in terms of social justice and redistribution. The road ahead will be long and arduous. All the more reason to get started now.

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Comment:

By Don McCanne, M.D.

Just think of what a great society we could have if we all joined together in support of a government designed to serve all of the people. In the excerpts from his book, Thomas Piketty describes accessible and affordable health care for all of us. He also describes large scale investment in education and public universities that have been shown to be the source of a prosperous society as opposed to policies that are merely designed to accumulate greater fortunes for the wealthy.

Yet at election time, what happens? Some of us seem to get hung up on… what shall we say? Rhetoric? One term that seems to turn off many voters is “socialism,” when that term basically means that we are joining together to make this a better place for all of us. Yet when it comes time to vote, roughly half of us vote the Reaganesque or Trumpist ticket. What is their rhetoric? Freedom? What does that mean? Freedom to have the wealthy take even more of our assets and leave much of society in a compromised state without high performance health care or education systems that would be designed to serve all of us well?

Piketty tells us that we don’t have to use the term “socialism” but that we have to acknowledge an alternative economic system to capitalism and not merely be against capitalism or neoliberalism. Shall we name our system “utopia”? It would probably not take long for “utopia” to come to define the luxurious retreats for the wealthy that lock out the rest of us.

The other day I was looking at a photograph of participants in a panel discussion in San Francisco several years ago. I was standing next to Milton Friedman and I couldn’t help but notice how true it was that he was not a giant in economics – his small physical stature (5’0”) reminded me of his small intellectual perspective, fixated on markets as the antithesis to, not ally of, government.

But then, whether or not we use the word “socialism,” Piketty reminds us that we do need to do more in terms of social justice and redistribution, and WE NEED TO GET STARTED NOW!

http://healthjusticemonitor.org…

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