By VICENTE NAVARRO
CounterPunch
September 7, 2009

Let me start by saying that I have never been a fan of Barack Obama. Early on, I warned many on the left that his slogan, “Yes, we can,” could not be read as a commitment to the major change this country needs (see “Yes, We Can. Can We? The Next Failure of Health Reform”). Still, I actively supported him against John McCain and was very pleased when he became president — for many reasons, encompassing a broad range of feelings. One reason was that Obama is African-American, and the country needed to have a black president. Another was that his election seemed to signal the end of the Bush era. But, the most important reason was that I saw him as a decent man, surrounded by some good people who could promote change from the center and open up some possibilities for progress, giving the left a chance to influence the administration’s policies. Well, after just over seven months of the Obama White House, I have no reason to doubt that he is a decent man, but I am dismayed by the bad judgment he has shown in the choice of some of his staff and advisors. I really doubt that he is going to be able to make the changes we need. As I said, I never had great expectations about him and his policies, but even the lowest of my expectations have not been met.

Some among the many skeptics on the left might add, “What did you expect?” Well, at least I expected Obama to show the same degree of astuteness that he and his team had shown during the campaign. He seemed to be a brilliant strategist, and his election proves this. But my greatest disappointment is the strategies he is now following in his proposals for health care reform — they could not be worse. I am really concerned that the fiasco of this reform may make Obama a one-term president.

Error number One

One of the two major objectives for health care reform, as emphasized by Obama, is the need to reduce medical care costs. The notion that “the economy cannot afford a medical care system so costly, with the annual increases of medical care running wild” has been repeated over and over — only the tone varies, depending on the audience. An element of this argument is Obama’s emphasis on eliminating the federal deficit. He stresses that most of the government deficit is due to the outrageous growth in costs in federal health programs. Thus, a crucial part of the message he is transmitting is the health care reform objective of reducing costs.

This message, as it reaches the average citizen, seems like a threat to achieve cost reductions by cutting existing benefits. This perception is particularly accentuated among elderly people — which is not unreasonable, given that the president indicates that the funds needed to provide health benefits coverage to the 48 million currently uncovered will come partially from existing programs, such as Medicare, with savings supposedly achieved by increasing efficiency. To the average citizen (who has developed an enormous skepticism about the political process), this call for savings by increasing efficiency sounds like a code for cutting benefits. Not surprisingly, then, one sector of the population most skeptical about health care reform is seniors — the beneficiaries of Medicare. The comment that “government should keep its hands off my Medicare,” as heard at some of the town hall meetings, is not as paradoxical or ridiculous as the liberal media paint it. It makes a lot of sense. An increasing number of elderly people feel that the uninsured are going to be insured at the expense of seniors’ benefits.

Error Number Two

The second major objective of health care reform as presented by Obama is to provide health benefits coverage for the uncovered: the 48 million people who don’t have any form of health benefits coverage. This is an important and urgently needed intervention. The U.S. cannot claim to be a civilized nation and a defender of human rights around the world unless this major human and moral problem at home is resolved once and for all. But, however important, this is not the largest problem we have in the health care sector. The most widespread problem is not being uninsured but underinsured: the majority of people in the U.S. — 168 million, to be precise — are underinsured. And many (32 per cent) are not even aware of this until they need their health insurance coverage. This undercoverage is an enormous human, social, and economic problem. Among people who are terminally ill, 42 per cent worry about how they or their family will pay for medical care. And most of these people are insured — but their insurance does not cover all of their conditions and necessary interventions. Co-payments, deductibles, and other extra expenses — besides the insurance premiums — can amount to 10 per cent or even higher proportion of disposable income.

During the presidential campaign, both Obama and Hillary Clinton, in discussing the need for health care reform, made frequent reference to heart-breaking stories — cases in which families and individuals suffer under our current system of medical care. But none of the proposals that the Obama administration is ready to support would address most of these cases. It will be an embarrassing and uncomfortable moment during the 2012 presidential campaign if someone asks candidate Obama about what has happened to some of the people whose stories he told in the 2008 campaign.

Error Number Three

Obama plans to cover the uninsured by increasing taxes on the rich (a very popular measure, as shown in all polls) and by transferring funds saved through increased efficiencies in existing programs, including Medicare (an unpopular measure, for the reasons I’ve mentioned). We see here the same problems we’ve seen with other programs targeted to specific, small sectors of the population, such as the poor. Programs that are not universal (i.e., do not benefit everyone) are intrinsically unpopular. This is why antipoverty programs are unpopular. People feel that they are paying, through taxation, for programs that do not benefit them. Compassion is not, and never has been, a successful motivation for public policy. Solidarity is. You support others with the understanding that they will support you when you need it most. The long history of social policy, in the U.S. and elsewhere, shows that universality is a better way to get popular support for a program than means-testing for programs targeted to specific vulnerable groups. The limited popularity of the welfare state in the U.S. is precisely due to the fact that most programs are not universal but means-tested. The history of social policy shows that the best way to resolve poverty is not by developing antipoverty programs, but by developing universal programs to which all people are entitled — for example, job and incomes programs. In the same way, the problem of noncoverage by health insurance will not be resolved without resolving the problem of undercoverage, because both result from the same failing: the absence of government power to ensure universal rights. There is no health care system in the world (including the fashionable Swiss model) that provides universal health benefits coverage without the government intervening, using its muscle to control prices and practices. The various proposals being put forward by the Obama administration are simply tinkering with, not resolving, the problem. You can call this government role “single-payer” or whatever, but our experience in the U.S. has already shown (what other countries have known and practiced for decades) that without government intervention, all the measures now being proposed by this administration will be handsome bailouts for the medical-insurance-pharmaceutical complex.

Error Number Four

I can understand that Obama does not want to advocate single-payer. But he has made a huge tactical mistake in excluding it as an option for study and consideration. He needs single-payer to be among the options under discussion. And he needs single-payer to make his own proposal “respectable.” (Keep in mind how Martin Luther King became the civil rights figure promoted by the establishment because, in the background, there was a Malcolm X threatening the establishment.) This was a major mistake made by Bill Clinton in 1993. When Clinton gave up on single-payer, his own proposal became the “left” proposal (unbelievable as that may seem) and was dead on arrival in Congress. The historical function of the left in this country has been to make the center “respectable.” If there is no left alternative, the Obama proposals will become the “left” proposal, and this will severely limit whatever reform he will finally be able to get.

But there’s another reason that Obama has erred in excluding single-payer. He has antagonized the left of his own party that supports single-payer, without which he cannot be reelected in 2012. He cannot win only with the left, of course, but he certainly cannot win without the mobilization of the left. His victory in 2008 is evidence of this. And today, the left is angry at him. It is a surprise to me, but Obama is going to pay the same price Clinton paid in 1994. Clinton antagonized the left by putting deficit reduction (under pressure from Wall Street) at the top of his policies and supporting NAFTA against the wishes of the AFL-CIO and the majority of Democrats. The Gingrich Republican Revolution of 1994 was due to a demobilization of the left. The Republicans got the same (I repeat the same) number of votes in the 1994 congressional election that they got in 1990 (the previous non-presidential election year). Large sectors of the grassroots of the Democratic Party that voted Democratic in 1990 stayed home in 1994. Something similar could happen in 2010 and in 2012. We could see a strong mobilization of the right and a very demoralized left. We are already seeing this. Why aren’t those on the left out in force at the town hall meetings on health care reform? Because the option they want — single-payer — has already been excluded from the debate by a president they fought to get elected.

This is my concern. The alternative to Obama is Sarah Palin or someone like her. Palin has a lot of support among the people who mobilized to support John McCain. And the ridicule heaped on her by the liberal media (which is despised by large sectors of the working class of this country) helps her, or her like, enormously. I am afraid we may have, in the near future, friendly fascism. And I do not use the term lightly. I grew up under fascism, in Franco’s Spain, and if nothing else, I recognize fascism when I see it. And we are seeing a growing fascism with a working-class base in the U.S. This is why we cannot afford to see Obama fail. But his staff and advisors are doing a remarkable job to achieve this. Ideologues such as chief-of-staff Rahm Emanuel (who, when a congressman, was the most highly funded by Wall Street) and his brother, Ezekiel Emanuel (who did indeed write that old people should have a lower priority for health care spending) are leading the country along a wrong path.

I don’t doubt that President Obama, a decent man, wants to provide universal health care to all citizens of this country. But his judgment in developing his strategy to reach that goal is profoundly flawed, and, as mentioned above, it may cost him the presidency — an outcome that would be extremely negative for the country. He should have called for a major mobilization against the medical-industrial complex, to ensure that everyone has the same benefits that their representatives in Congress have, broadening and improving Medicare for all. The emphasis of his strategy should have been on improving health benefits coverage for everyone, including those who are currently uncovered. And to achieve this goal — which the majority of the population supports — he should have stressed the need for government to ensure that this extension of benefits to everyone will occur.

That he has not chosen this strategy touches on the essence of U.S. democracy. The enormous power of the insurance and pharmaceutical industries corrupts the nature of our democracy and shapes the frontiers of what is possible in the U.S. Given this reality, it seems to me that the role of the left is to initiate a program of social political agitation and rebellion (I applaud the health professionals who disrupted the meetings of the Senate Finance Committee), following the tactics of the Civil Rights and anti-Vietnam War movements of the 1960s and 1970s. It is wrong to expect and hope that the Obama administration will change. Without pressure and agitation, not much will be done.

Vicente Navarro, M.D., Ph.D., professor of Health Policy at The Johns Hopkins University and editor-in-chief of the International Journal of Health Services. The opinions expressed here are those of the author and do not necessarily reflect the views of the institutions with which he is affiliated. Dr Navarro can be reached at vnavarro@jhsph.edu

Tikkun Daily
September 11, 2009

[Passage omitted] President Obama knows that a single-payer program — extending Medicare to everyone — is far more rational than what he has proposed to Congress, but he also believes that eliminating the insurance companies, hospital chains, and other medical profiteers would require a battle beyond his current capacities.

To address any of these problems fully would require a fundamental challenge to the old Bottom Line. Obama would have to call for a New Bottom Line — to advocate for defining governmental and private corporate policies as “rational,” “productive” or “efficient” not only to the extent that they maximize money and power, but also to the extent that they maximize love and caring, kindness and generosity, ethical and ecological sensitivity, enhance our capacities to respond to other human beings as embodiments of the sacred and our capacities to respond to the universe with awe, wonder and radical amazement at the grandeur mystery of the universe.

He actually reached in that direction momentarily at the end of his health care speech to Congress by seeming to endorse Senator Ted Kennedy’s “large-heartedness: a concern and regard for the plight of others” which he defined as “our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand.”

Yet over and over again in the details of his plan it was not this large-heartedness that he championed, but a belief in the positive outcomes of the competitive marketplace. What Obama omitted from mention is that the ethos of that marketplace, which rewards selfishness and materialism and “looking out for number one,” as the “common sense” that guides individual as well as governmental behavior, is a product of the fear that we cannot count on others, that there will be no one there to take care of us, and that we must therefore maximize our own advantage lest someone else do so for themselves in ways that will permanently hurt or undermine us.

Obama can’t help us overcome that fear until he does so himself. He has to allow himself to know, and then help Americans to understand, that most people actually do want to help each other, get delight in being caring and loving, feel fulfilled when they are able to improve the well-being of others. Most people already know this about themselves, but are unsure whether its true of their neighbors or others. Obama’s most important contribution would be to fight for policies based on this understanding and to challenge those who believe the world is filled with people who are primarily self-seeking and aggressive. Unfortunately, he can’t do that while remaining loyal to the centrist ideology and its insistence that the aggressiveness manifested in the current competitive marketplace, is what will produce the greatest good for the greatest number.[passage omitted]

Imagine, for instance, if Obama had started his speech with the idea of “we are all in this together” that he ended it with, and then applied that to each specific part of his program. Sadly, that was impossible precisely because his actual program is in conflict with this at several points. He won’t support health care reform that raises the deficit. How can that be justified by a President who raised the deficit to help bail out the people who caused the banks and investment companies to fail all of us! He promises not to give any benefits to immigrants-but then “we” are not “all in it together!” He is willing to use government to coerce people into his plan those who would not voluntarily join, but not to force insurance companies to lower the prices (for example, by regulating their prices at the expense of lowering their profit rates or simply by creating Medicare for All. He tries to make a public option plausible by comparing it to public community and state colleges, but also assures the insurance companies that they have nothing to worry about from his plan because “the public insurance option would have to be self-sufficient and rely on the premiums it collects.” Yet the public option will not be open to those of us who already have private health care insurance. These limitations guarantee that the public option will not achieve the goal of lowering prices or obscene levels of profits. Public universities and community colleges have never been able to sustain themselves on the tuitions of those who use them. If that had been the requirement from the start, tens of millions of Americans would never have obtained the benefits of a public education that enabled them to get better jobs and go on to make valuable contributions to society in turn. If the principle had been that these colleges could not contribute to state or federal deficits, they would long ago have folded. So where is the “we” who are “all in it together” when crippling the only part of his plan that really makes an attempt at a universal solidarity? [passage omitted]

Rabbi Michael Lerner is editor of Tikkun Magazine (www.tikkun.org) , chair of the interfaith Network of Spiritual Progressives (www.spiritualprogressives.org) and rabbi of Beyt Tikkun synagogue in San Francisco (www.beyttikkun.org).

By Lara Wright, M.D.
Guest Commentary
Contra Costa Times
09/12/2009

I AM a family physician who has firsthand experience about the need for health insurance reform. In 1999, after completing a residency in family practice, I was diagnosed with a brain tumor. Fortunately, I had use COBRA to continue my health benefits for 18 months. When my diagnosis was made, I still had health insurance, as well as supportive family, friends and colleagues who worked in health care.

Even with so much help, I experienced much difficulty navigating the health insurance system. As someone with a history of a brain tumor, my options for insurance after my COBRA coverage expired were minimal and expensive. Many of the options would cover all medical problems except those relating to the brain tumor.

The difficulties with health insurance compounded the stress for me and my family in dealing with treatment of and recovery from my brain tumor.

During the next few years, I worked as a patient advocate for a health insurance plan. In that job, I sometimes heard patients referred to as “product lines,” a surprising and disturbing experience.

Now, 10 years later, I again work as a doctor. The prognosis from my rehabilitation physician immediately after my surgery included a lifetime of permanent disability. Thankfully, I have far exceeded the prognosis of my physician. Instead of receiving benefits, I am able to work, treat patients and pay taxes.

I work in a county clinic, where I see patients who are faced with the difficult decision to pay for rent and food for their families, or pay for their health care. Many are unable to afford health insurance and risk running up hospital bills for emergency care that will drive them into debt and possibly into bankruptcy.

A recent study shows that more than half of personal bankruptcies are linked to medical bills, and 75 percent of people filing those bankruptcies had health insurance when they got sick.

The insight into my patients’ experiences with illness combined with my own experiences as a patient and patient advocate give me a unique perspective on our medical and insurance systems.

My experiences have led me to realize that the best solution is single-payer health care, an improved Medicare for All. This alternative has been largely neglected in the present health reform debate.

The California Senate and Assembly have twice passed a single-payer health insurance plan, but Gov. Arnold Schwarzenegger vetoed it both times. On the national front, HR 676 and SB 703 are two bills in the U.S. House and Senate that include single-payer health insurance plans, funded by the government but delivered through the existing private and public hospital system.

A recent study showed that 59 percent of physicians now support a national health insurance program. Such a system would meet their patients’ needs best, as well as eliminate many of the wasteful administrative costs with the current private health insurance industry. Moving to a single-payer system would enable our nation to save $400 billion annually, enough to provide comprehensive, quality care to all.

Critics say single-payer health insurance is socialized medicine. Not so, single-payer is insurance for everyone. A good example of socialized medicine is the Veterans Affairs: hospitals are owned by the government and doctors and nurses are on the federal payroll.

Under single-payer, however, doctors and hospitals remain largely private. You go to whichever doctor or hospital you choose. Instead of private insurers, a nonprofit government agency pays all the bills, similar to how traditional Medicare operates today. Private insurance includes wasteful administrative costs, sometimes up to 20-30 percent, a significant portion of which is spent to deny care that is not covered and decide who will make for a profitable consumer, or “product line.”

The United States is the only developed country without a national health insurance plan. The U.S. ranks number 29 in infant mortality and number 30 in expected life span among countries in the world, while far outspending all other countries.

We desperately need real health insurance reform. The best option is single-payer Medicare for All.

Wright is a member of Physicians for a National Health Program (www.pnhp.org), an organization of 17,000 doctors and health professionals who support single-payer national health insurance. She practices in Contra Costa County.

By Dr. Oliver Fein
The Progressive
September 10, 2009

President Obama sold single-payer health care short in his speech to Congress. It’s actually the only sensible solution to our health care crisis.

Obama said that a single-payer health care system would require us to “build an entirely new system from scratch.”

Not true.

We already have a working single-payer system.

For more than 40 years, single payer has served millions of American patients in the form of traditional Medicare. In essence, single payer is an improved Medicare for all.

Obama touted his plan as a way to reduce the escalating costs of health care in this country. But he’s exaggerating the amount of waste and inefficiency he can wring out of Medicare and Medicaid. And the Congressional Budget Office estimated that his plan would actually end up costing hundreds of billions of dollars.

But if we implemented single payer, the savings would be enormous. Medicare incurs approximately 3 percent in administrative overhead annually, compared to at least five times that figure in private insurance plans. If you factor in all the bureaucracy and paperwork inflicted on physicians and hospitals by the insurance industry, the administrative waste in our present system amounts to $400 billion annually.

By replacing the for-profit insurance companies with a streamlined Medicare for all, that $400 billion could be put back where it belongs: providing health care. The new system would basically pay for itself.

Insurance companies play no constructive role in providing health care. They do not give you a physical exam; they do not perform your surgery. What they do instead is fight claims, issue denials and screen out the sick, diverting huge sums away from much-needed care.

The savings rendered by cutting out private insurance companies and establishing a single-payer plan would be sufficient to cover everyone who lacks insurance now and to upgrade insurance for everyone else.

Our nation spends twice per person on health care as other industrialized countries do, but our health outcomes are significantly worse.

What gives? How can we spend more and get less than the rest of the world?

The answer is that most these countries have taken a fundamental step that we haven’t: the elimination of U.S.-style, for-profit private health insurance.

We should take that step.

Obama should have proposed a single-payer plan in the first place. Not that the path would have been politically easy. But single payer would have been easier to defend than the expensive, overly bureaucratic, patchwork mess that he is trying to sell to the American public.

It’s time for Congress acknowledge what patients and doctors across the country already know, that single-payer Medicare for all is the only way to achieve affordable and effective health care.

Dr. Oliver Fein is professor of clinical medicine and public health at Weill Cornell Medical College in New York. He is also president of Physicians for a National Health Program (www.pnhp.org).