PNHP

Conservative leader David Cameron on the NHS

Conservative leader David Cameron on the NHS

We are proud of the NHS

By David Cameron
Conservatives
The Blue Blog
August 13, 2009

People still care about the issues they care about, and thanks to the internet they can voice their concerns whenever they want. Just look at all the support which the NHS (National Health Service) has received on Twitter over the last couple of days. It is a reminder – if one were needed – of how proud we in Britain are of the NHS.

Millions of people are grateful for the care they have received from the NHS – including my own family. One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.

That’s why we as a Party are so committed not just to the principles behind the NHS, but to doing all we can to improve the way it works in practice. So yes, we will spend more on the NHS, but we will also improve it so that it is more efficient and responsive to patients. People working on the frontline will actually be able get on with the job they signed up for, without getting tied up in a web of targets. And we will put more power in the hands of patients by giving them better information about the care they can expect to receive.

Underlying these reforms, and our whole approach to the NHS, will be one big ambition – that future generations will be even prouder of the NHS than we are today.

http://www.conservatives.com/News/Blogs/We_are_proud_of_the_NHS.aspx

Comment:

By Don McCanne, MD

The Right Honourable David Cameron MP is the leader of the Conservative Party in the United Kingdom. Many believe that he will replace Gordon Brown as Prime Minister.

For those of us in the United States who want to know more about the horrors of their government-run, socialist system of health care, Conservative David Cameron would be the first to expose how government ownership and management are a threat to the health of the people. But that is not his message.

As he says, “One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.” He has joined the people of his nation in supporting the NHS, in reaction to the outrageous distortions and lies being propagated in the United States.

Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP) recently stated, “As the American people have learned the facts, support for a government-run plan has plummeted.”(AHIP release, Aug 4)

What facts? Lies about the United Kingdom’s NHS? Lies about Canada’s medicare? Or lies about the consequences of providing all of us the benefits of our Medicare program which is working so well for our senior citizens and individuals with long-term disabilities?

The British and Canadians have identified the lies and are waging a campaign to set the record straight. We need to greatly intensify our efforts to do the same here.

Canadian health system has a fan in Schweitzer

By MIKE DENNISON
Billings Gazette
Friday, August 14, 2009

BELGRADE – As Gov. Brian Schweitzer warmed up the crowd Friday for President Barack Obama, he paid a lengthy compliment to a health care system that leading Democrats, including the president, have declared “off the table” as a reform here: the Canadian single-payer system.

“Did you know that, just 300 miles north of here, did you know they offered universal health care 62 years ago?” he said, referring to Canada’s system of providing government-funded health insurance for all citizens.

Schweitzer, a Democrat, said he sometimes mentions the Canadian system when he hears people say that universal health coverage is a radical, new idea being rushed through the political process.

Quoting a Canadian journalist, Schweitzer said it was said that “there’s more likelihood of a person in Canada being struck by lightning than there is a likelihood of a Canadian going to the United States for their health care.”

Most of the crowd of 1,300 in the Gallatin Field Airport hangar roared its approval.

Each Canadian province provides health insurance for all of its citizens, funded by the provincial and state governments. Canadian citizens see private physicians, who bill the province for the care they provide.

Canada’s government insurance covers most basic health care for all citizens, on an equal basis. This type of government-funded insurance is often called a single-payer system, because one “payer” – the government – covers basic medical care.

Minutes later, Obama made it clear that he does not favor adopting such a system in the United States.

“I’m not in favor of a Canadian system, I’m not in favor of a British system, I’m not in favor of a French system,” he said. “What we’ve said is let’s find a uniquely American system.”

Obama said the majority of people in America get health insurance through their employers, and “we want to build on that.”

“For us to completely change that, it would be too disruptive,” he said. “Max (Baucus) and I agree, that’s not the right way to go.”

Baucus, a Montana Democrat, who also spoke before Obama appeared, is chairman of the Senate Finance Committee, which is drawing up a key health-reform bill. Baucus has said from the beginning that considering a single-payer system for the United States is “off the table” because it’s not politically possible.

http://www.billingsgazette.com/news/state-and-regional/montana/article_02d665da-8955-11de-94f2-001cc4c002e0.html

Uwe Reinhardt on ethics and economics of end-of-life care

End-of-Life Care: Where Ethics Meet Economics

By Uwe Reinhardt
The New York Times
August 14, 2009
… the debate — really, shouting match — over health-care reform has focused on end-of-life care in recent weeks…
An earlier report in The Wall Street Journal had quoted physicians at Memorial Sloan-Kettering Canter Center in New York stating that “the standard treatment regimen for advanced colon cancer, which can include Erbitux [and Eloxatin and Avastin] in the mix, is close to $250,000 for 19-20 months of treatment. … And for that money, patients may get only a few months [of added life].”
And therein lies a dilemma increasingly faced by modern societies.
Readers are well advised to read Senator Isakson’s thoughtful comments on end-of-life planning, along with an equally thoughtful research brief “Advance Care Planning: Preferences for Care at the End of Life,” published in March 2003 by the Agency for Health Care Research and Quality.
The thrust of that research brief, as of the Senate bill and of Section 1233 of the House bill, was to enhance the probability that the end-of-life care actually received by a person should conform to his or her own preferences, rather than either the physician’s or the government’s preferences.
Health spending in the United States has doubled every 10 years during the past four decades. It may well do so again in the coming decade. As health spending grows year after year roughly twice as fast as the payroll that supports private health spending in this country, Americans sooner or later will have to confront the hard questions about access to expensive treatments, perhaps after a rational national conversation, if such can still be had in America.

Posted reader comment:
Ethics meets economics not only at the end of life, but throughout a lifetime of health care. Economics provides us with various alternatives on financing health care, and ethics provides us with the decency to do it the right way.
But the pervasive noise seems to be drowning reason out. For example, when a protester complained to Sen. Specter that he wasn’t listening to what they wanted, Sen. Specter asked him to tell him just that. The protester was flummoxed, and only after being prompted by several others in the audience, he said, “tort reform.”
It would be tragic if those crafting reform allow themselves to be influenced by those who understand neither the economics nor the ethics. Perhaps it would be even worse if they allow themselves to be influenced by the moneyed interests who understand very well the economics, but could care less about the ethics.
— Don McCanne, MD
http://economix.blogs.nytimes.com/2009/08/14/end-of-life-care-where-ethics-meet-economics/#more-26155

Uwe Reinhardt on ethics and economics of end-of-life care

End-of-Life Care: Where Ethics Meet Economics

By Uwe Reinhardt
The New York Times
August 14, 2009

… the debate — really, shouting match — over health-care reform has focused on end-of-life care in recent weeks…

An earlier report in The Wall Street Journal had quoted physicians at Memorial Sloan-Kettering Canter Center in New York stating that “the standard treatment regimen for advanced colon cancer, which can include Erbitux [and Eloxatin and Avastin] in the mix, is close to $250,000 for 19-20 months of treatment. … And for that money, patients may get only a few months [of added life].”

And therein lies a dilemma increasingly faced by modern societies.

Readers are well advised to read Senator Isakson’s thoughtful comments on end-of-life planning, along with an equally thoughtful research brief “Advance Care Planning: Preferences for Care at the End of Life,” published in March 2003 by the Agency for Health Care Research and Quality.

The thrust of that research brief, as of the Senate bill and of Section 1233 of the House bill, was to enhance the probability that the end-of-life care actually received by a person should conform to his or her own preferences, rather than either the physician’s or the government’s preferences.

Health spending in the United States has doubled every 10 years during the past four decades. It may well do so again in the coming decade. As health spending grows year after year roughly twice as fast as the payroll that supports private health spending in this country, Americans sooner or later will have to confront the hard questions about access to expensive treatments, perhaps after a rational national conversation, if such can still be had in America.

Posted reader comment:

Ethics meets economics not only at the end of life, but throughout a lifetime of health care. Economics provides us with various alternatives on financing health care, and ethics provides us with the decency to do it the right way.

But the pervasive noise seems to be drowning reason out. For example, when a protester complained to Sen. Specter that he wasn’t listening to what they wanted, Sen. Specter asked him to tell him just that. The protester was flummoxed, and only after being prompted by several others in the audience, he said, “tort reform.”

It would be tragic if those crafting reform allow themselves to be influenced by those who understand neither the economics nor the ethics. Perhaps it would be even worse if they allow themselves to be influenced by the moneyed interests who understand very well the economics, but could care less about the ethics.

— Don McCanne, MD

http://economix.blogs.nytimes.com/2009/08/14/end-of-life-care-where-ethics-meet-economics/#more-26155

Helen Thomas on single payer

Health care for all

By Helen Thomas
San Francisco Chronicle
Politics Blog
August 12, 2009
It’s all so sad. Well-organized conservatives have launched a full-scale attack on health care reform. And they appear to be winning — for now.
I covered the battle to create the Medicare system back in the 1960s. The cries of “socialized medicine” worked for years until President Johnson rammed Medicare through Congress in 1965.
What kind of a nation are we if we do not provide everyone with the excellent medical care that only some of us now receive?
I continue to think the so-called single-payer system is the only answer to the nation’s obligation to make sure that no one lacks health care. Yes, single payer means a government-run health insurance program for all — the prevailing system in Canada and in many nations in Europe.
President Obama is making a big mistake by ignoring the single-payer proposal.
In 2003 before he became a U.S. senator from Illinois, Obama actually called himself a single-payer “proponent.” But now that he is president, Obama has buckled to Republicans and conservative Blue Dog Democrats in pursuit of consensus. My question is if Congress passes a watered-down version of health care that doesn’t truly cover everyone, is the result worth it?
President Obama should lay down markers for real health care reform — meaning we all kick in to a national program instead of fattening the pocketbooks of the insurance financiers.
Instead, the president has given up on Medicare for all, calling single payer “impractical.”
He still has time to do the right thing and nothing to lose.
For the full article:
http://www.sfgate.com/cgi-bin/blogs/nov05election/detail?blogid=14&entry_id=45426

Helen Thomas doesn’t ever give up, thank goodness. As she writes, President Obama “still has time to do the right thing.”

Helen Thomas on single payer

Health care for all

By Helen Thomas
San Francisco Chronicle
Politics Blog
August 12, 2009

It’s all so sad. Well-organized conservatives have launched a full-scale attack on health care reform. And they appear to be winning — for now.

I covered the battle to create the Medicare system back in the 1960s. The cries of “socialized medicine” worked for years until President Johnson rammed Medicare through Congress in 1965.

What kind of a nation are we if we do not provide everyone with the excellent medical care that only some of us now receive?

I continue to think the so-called single-payer system is the only answer to the nation’s obligation to make sure that no one lacks health care. Yes, single payer means a government-run health insurance program for all — the prevailing system in Canada and in many nations in Europe.

President Obama is making a big mistake by ignoring the single-payer proposal.

In 2003 before he became a U.S. senator from Illinois, Obama actually called himself a single-payer “proponent.” But now that he is president, Obama has buckled to Republicans and conservative Blue Dog Democrats in pursuit of consensus. My question is if Congress passes a watered-down version of health care that doesn’t truly cover everyone, is the result worth it?

President Obama should lay down markers for real health care reform — meaning we all kick in to a national program instead of fattening the pocketbooks of the insurance financiers.

Instead, the president has given up on Medicare for all, calling single payer “impractical.”

He still has time to do the right thing and nothing to lose.

For the full article:
http://www.sfgate.com/cgi-bin/blogs/nov05election/detail?blogid=14&entry_id=45426

Comment:

By Don McCanne, MD

Helen Thomas doesn’t ever give up, thank goodness. As she writes, President Obama “still has time to do the right thing.”

Healthcare reform: Locum tenens perspective on single payer

By Daniella Grossman
Modern Medicine
August 15, 2009

This is the first in a series of reports analyzing various aspects of healthcare reform Congress is considering. –Ed.

Sixteen years after the late Democratic Sen. Paul Wellstone proposed the American Health Security Act of 1993, which would have created national health insurance and extended benefits to all Americans, lawmakers are once again considering a single-payer healthcare system.

On both sides of the ideological battle, policy makers, analysts, and healthcare providers agree that reform is needed. A shortage of primary care physicians, imbalanced coverage, and exorbitant costs that don’t always correspond with exorbitant care are just a few of the countless reasons why the healthcare status quo, which left more than 43 million people in the United States without insurance in 2007, is under attack.

“A single-payer system in theory can help control costs and help with patient outcomes,” says Kevin Pho, MD, an internist practicing primary care in Nashua, New Hampshire. “But a lot of physicians are against it, based on the idea of a Medicare-for-all system where the government will be the only payer. Politically, it’s very controversial.”

Several bills introduced in Congress isolate a clear culprit for the biggest failings of the healthcare system: insurance companies. “There’s no question that the private insurance companies would be most negatively affected,” Dr. Pho says. “They won’t exist in a single-payer system.”

Private insurance companies would be eliminated, in addition to current benefits through government programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP). States would operate their own health-security programs to cover all citizens, nationals, and legal residents.

In mid-July, the House Committee on Education and Labor approved an amendment to the national healthcare reform bill that would enable individual states to adopt single-payer, Medicare-for-all style reforms. Introduced by Rep. Dennis Kucinich (D-Ohio), the amendment would remove potential legal impediments for states to pass single-payer bills by waiving federal exemptions that apply to employer-sponsored health plans.

The amendment passed on a bipartisan vote of 25-19, with the support of both progressive, single-payer Democrats and many Republicans who endorsed the ability of individual states to pass their own versions of healthcare reform.

THE SUPPORT

For Anne Scheetz, MD, a single-payer healthcare system is both socially and financially sound. She’s one of 16,000 members with Physicians for a National Health Program (PNHP), she serves as the Chicago co-chair for the Illinois Single Payer Coalition, and she’s an ardent advocate of national health insurance. “We have two slogans,” Dr. Scheetz says of PNHP. “One is ‘everybody in, nobody out,’ and the other is ‘one nation, one plan.’ Although some people say it’s not politically feasible, it’s inevitable. We can’t survive without it, economically or as a citizenship that stands together.”

Dr. Scheetz makes house calls to her mostly elderly patients, all of whom are insured through Medicare. She says the fragmented network of multiple payers that most doctors, nurses, and technicians rely on takes critical time away from medical work. With one source of reimbursement, providers could spend more time caring for patients instead of arguing with insurers on the phone. “Right now, with private insurance companies you don’t know what’s covered until you don’t get paid for it, and you don’t know how they arrived at that decision,” she notes. “It’s not good for the patient-physician relationship [to say], ‘I know you need this, but your insurance company won’t pay for it.'”

A single healthcare payer could also mean major budget cuts and less paperwork at most doctors’ offices. Dr. Scheetz says national health insurance would be “a tremendous administrative relief.” Healthcare-NOW! campaign coordinator Tom Knoche says his friend, a primary care doctor in Camden, New Jersey, bills more than 200 insurance plans, each with its own regulations. “He has to have a staff just to figure out who’s responsible for what,” Knoche adds. “That’s incredibly cumbersome and adds a tremendous amount of overhead to his practice.”

Another case for single payer, Dr. Scheetz argues, is that patients will have complete choice since everyone is covered by the same plan. She would rather have patients who see her because they have similar values than patients who have been “coerced into coming to me through an HMO or PPO.”

According to Knoche, every healthcare professional, salaried or temporary, will benefit from the security that national insurance could bring to the system. “Patients will have continuity of care and care regardless of whether their life situation changes–if they get divorced, change jobs, have a mental health issue,” he explains. “For doctors and nurse practitioners, it’s the whole idea that nobody’s going to be involved in treatment other than patients and the healthcare professional they choose.”

THE OPPOSITION

While Dr. Scheetz, Knoche, and Kucinich stand behind a Medicare-for-all model as the answer to healthcare woes, critics believe it is too focused on costs and too simplistic a “solution” for the system’s complicated failings.

“We need a system that is more responsive to patient needs and what patients value, and this proposal does not take this into account,” says Robert Book, PhD, a senior research fellow in health economics at the Heritage Foundation. “It’s totally focused on spending and limiting the amount of healthcare available–limited access to care for everybody.”

Book argues that the top-down structure proposed by the bill is restrictive, rather than liberating, for patients and doctors alike. As state health-security programs create global budgets for individual facilities every year, Book says the lack of financial flexibility is dangerous.

If a certain neighborhood in Dallas sees a flu surge and the majority of patients are all going to the same hospital, which has a lower annual budget than the hospital 10 miles away, he says the proposed legislation provides no way to move resources from the second to the first, where they would be most needed. “Now, they can hire more nurses and technologists if there’s a greater need. Now, money follows the patient,” Book says. “With this system? Money follows the facility. And there will be less demand for temporary [healthcare] workers of all sorts. They won’t be able to hire more people unless they pay less.”

As far as the administrative relief logic goes, Book and Dr. Pho dismissed the real value of trading in paperwork from multiple sources for bureaucratic paperwork from the government. “There’s a myth that Medicare has fewer overhead costs and less administrative paperwork, but it’s just as onerous as with a private insurer,” Dr. Pho comments.

Another concern for Book and other single-payer detractors is a substantial change in earnings. “Doctors’ incomes are going to have to be cut, and the same goes for other allied health professionals” to allow hospitals and health organizations to handle millions of new patients across the country, Book notes.

Dr. Pho agrees that lower salaries will be a real issue if the single-payer legislation becomes law. He says that Medicare–the single largest insurer in the United States–only covers 60 to 70 percent of costs at the doctor’s office. “Doctors see Medicare patients, they lose money on that, and with any business like a doctor’s office, you can’t sustain your business that way,” he says.

And with a serious shortage of working healthcare professionals, a broad set of medical mandates from the government will not help matters much. “How would you feel if you were told your income could never go up, no matter how hard you work?” Book asks of the medical community. “And you’re going to be fighting for your slice of a fixed pie of your industry that won’t be allowed to grow. ”

Healthcare professionals will not only be limited in their financial resources, but in their decision-making power, as well. Book says a single-payer system could dramatically threaten the doctor-patient relationship because the American Health Security Standards Board, to be created under proposed legislation, would actually prohibit through its broad oversight healthcare workers from serving their patients’ needs on an individual, case-by-case basis. “[The board] decides what the best treatment is for everybody, for the average patient,” Book says. “What if you aren’t average?”

THE STAFFING

No matter what their views on national insurance, reform advocates all agree that the healthcare system faces a severe staffing shortage that needs to be addressed before millions of previously uninsured patients can receive quality care.

Dr. Pho and Knoche say the primary care field, which the newest single-payer bill confronts, needs a serious boost. Some proposals set a benchmark
for medical students by state, of which at least 50 percent would be primary care residents in five years or the government will reduce funding. “There’s a several hundred thousand dollar a year discrepancy between primary care and specialty doctors’ salaries,” Dr. Pho notes. “[Students] are not stupid; that’s where they’ll go unless the incentive changes.”

A stronger corps of primary care doctors could also reduce costs over time. “That’s where people can be most effective in catching things in the early stages, seeing that they’re treated before they become costly and complicated issues,” Knoche adds.

Dr. Scheetz says underemployment is worst in the emergency room, where employees work “under terrible stress” with a high volume of patients and must quickly decide how to treat them based on their insurance.

With regard to nursing, Pat McFarland, RN, executive director of the Association of California Nurse Leaders, says that there’s a “false sense of security” about the end of a nursing shortage. “Older nurses are continuing to work longer or they’re picking up more shifts,” she says. “We are going to see a huge number of nurses retiring in the next 10 years or so, [and] we have to make sure there’s an infrastructure to train and replace them.”

While McFarland says that temporary or traveling healthcare professionals could be more vulnerable under a single-payer system, if permanent employees put off retirement and hospitals begin operating with a fixed annual budget, their prospects aren’t too different from those of their salaried medical colleagues.

“At all levels, professionals would be challenged to be responsive and really focused on the patient,” says Kathy Flaster, RN, the CEO of California-based staffing company HRN Services. “Where do you begin to say this is a program that would service all interests, all levels of care?”

Flaster says the current demand for physicians, nurses, pharmacists, and allied health professionals through HRN Services reflects the magnitude of the system’s shortcomings. Education is a vital part of solving the reform riddle, and the earlier the better. “We need to do much more in the way of promoting and illuminating healthcare careers, and we need to start young,” she says. “You have to start academic preparation as well as stimulate interest and tickle the intellect of people as early as elementary school.”

Like McFarland, Flaster rejects a single-payer model as too simplistic. When it comes to healthcare, “There are so many issues sociologically, and you run into what is often in the literature [called] the ‘moral hazards’ of what is in front of us,” she explains. “Do we really have an obligation to provide healthcare to the homeless? To pay for the able-bodied who choose not to work and accept government programs as their standard of living? If you think about how huge these issues are to our quality of life, we are so far removed from making an intelligent choice about single payer.”

In the end, national health insurance is a “horizon question,” Flaster says, “and there is much more traffic that needs to be navigated” before such a major policy change takes effect in an already distressed healthcare system.

Questions for Dr. Marcia Angell

By Anne Underwood
Prescriptions Blog
New York Times
August 12, 2009

Jodi Hilton for The New York Times Dr. Marcia Angell, a senior lecturer at Harvard University and former editor of The New England Journal of Medicine, in her office in January.

Dr. Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor of The New England Journal of Medicine. A longtime critic of the pharmaceutical industry, she has called for an end to market-driven delivery of health care in the United States. She spoke with freelance writer Anne Underwood.

Q. President Obama hopes to increase the number of Americans with insurance and to rein in costs. Do you believe any of the plans under consideration by Congress will accomplish those goals?

A. They won’t, and that’s the essential problem. If you keep health care in the hands of for-profit companies, you can do one or the other — increase coverage by putting more money into the system, or control costs by decreasing coverage. But you cannot do both unless you change the basic structure of the system.

Q. Segments of the health care industry — pharmaceutical companies, for instance — are promising to cut costs.

A. It’s not going to happen. These are investor-owned companies. Their fiduciary responsibility is to maximize profits. If they behaved like charities, heads would roll in the executive suites.

Q. But what about market mechanisms for reducing costs? Wouldn’t the public option, for instance, provide competition for the insurance companies?

A. Theoretically it would, but I doubt the public plan will pass. Industry is lobbying against it, and the president has not said this is a “must.” Even if it does pass, I’m afraid the private insurance industry will use their clout in Congress — and they have enormous clout in Congress — to hobble the public option and use it as a dumping ground for the sickest while they cream off the young and healthy for themselves.

Q. How? Won’t insurance companies have to cover all applicants regardless of health status?

A. It’s hard to regulate an enormous industry without setting up a bureaucracy to oversee it. That’s very expensive and creates a whole new set of problems.

Q. How about the individual mandate? Wouldn’t it reduce costs per capita by bringing in young, healthy people who are currently uninsured?

A. No. In Massachusetts [which enacted an individual mandate in 2006], there is no real price regulation. Essentially what the mandate does is say to people, you will go into this treacherous market and buy insurance at whatever price the companies choose to charge. In effect, it’s delivering a captive market to these profit-oriented companies.

Q. Are people at least getting better health care in Massachusetts now?

A. Massachusetts already spends one-third more on health care than other states, and costs are rising at unsustainable rates. As a result, they’re chipping away at benefits, dropping beneficiaries and increasing premiums and co-payments.

Q. Then what’s the path to meaningful cost control?

A. The only way to both control costs and have universal comprehensive coverage is a single-payer system — a nonprofit, single-payer system. Nothing else will work. All other advanced countries have some form of a single-payer system, and they pay less than half as much per person as we do. We should be asking, why is that so? It’s not because we provide more basic services. We do provide more tests and procedures for those who can pay, but not more basic services — and we don’t cover everybody. So why is it so? We are the only advanced country that delivers health care in a system that’s set up to generate profits, not to provide care.

Q. If a single-payer system isn’t feasible politically, aren’t the current proposals at least better than doing nothing? Isn’t half an aspirin better than none?

A. I think not. As costs continue to soar, people will not say, “That didn’t work. Let’s try a single-payer system.” Instead, they’ll try to pay for the costs in piecemeal ways, by increasing co-pays and deductibles, by limiting services, by making the system less equitable and less comprehensive. I’m afraid the lesson they’ll draw is that universal care is impossible.

But I’m not convinced that getting a single-payer system now is politically infeasible. The public would be happy with Medicare for all. Polls have shown that the public loves Medicare. The problem isn’t the public. It’s Congress, which caves in to special interests.

Q. If Congress is reluctant to cut out the insurance companies, is that partly because they, like the major banks, are too big to fail?

A. A nonprofit, single-payer system would lead to job losses in this sector, which constitutes 17 percent of the economy. But what about the other 83 percent of the economy? They’re being bled to death. Businesses can’t compete globally because the cost of providing coverage to their workers is so exorbitant. Whatever loss of jobs you might see would be more than offset by benefits and job gains in the rest of the economy.

[As for the insurance companies,] you could introduce the program incrementally. You could do it state by state. Or probably better, you could do it decade by decade. Medicare kicks in at age 65. In the first stage, you could take it down to 55. Between 55 and 65, people are vulnerable. They’re losing jobs, losing health care. They’re starting to have more medical needs. After a few years, you could drop it to 45, then 35. It would give insurance companies time to adjust.

Q. But Medicare is already hugely expensive. How can we afford such a plan for everyone?

A. Medicare costs are rising at an unsustainable rate because care is provided in a profit-maximizing system. The prescription drug benefit was nothing but a bonanza for the pharmaceutical industry. I would change that. I would also adjust the fee schedule, which preferentially rewards highly paid specialists for very expensive tests and procedures. For the system to work, it would have to be a nonprofit delivery system.

Q. How much could we save in administrative costs?

A. On average, the private insurance industry takes 15 to 20 percent right off the top of the premium dollar for its administrative costs and profits. That’s a lot to siphon off by an industry that adds almost nothing of value. It’s just a middleman. Medicare has overhead costs of less than 3 percent.

With the money in the system right now, we could cover everyone for every medically necessary service. But the system has to be distributed according to medical need and not as it currently is — as a commodity. Today, those who can pay get lots of M.R.I.’s they don’t need, while those who are uninsured can go without ones they do need.

Q. Military historians say we’re always fighting the last war. Is Mr. Obama now fighting the last health care war, in which Congress rejected the Clinton plan partly because it was developed without consulting other interested parties?

A. Yes. Mr. Obama has decided that he will listen to everybody. But it’s not working for him, because the public can’t become enthusiastic about a plan that doesn’t exist. That’s what he’s asking. Now Congress has gone home, and for the next month the special interests will be out there scaring people with stories of rationing and socialized medicine.

Q. Is the president really bringing everyone to the table?

A. He’s bringing everyone to the table except the single-payer people. It’s very odd. When he was a state senator, he emphatically favored a single-payer system. And in his July 22 press conference on health care, he stated that the only way to provide universal health care is with a single-payer system. Then he moved right on, as if that was somehow self-evidently absurd.

Q. So are you opposing this reform?

A. I am, though not for the same reasons as the Republicans and Blue Dogs. I’m opposing it more in sorrow than in anger. I’m afraid the president squandered a good opportunity.

Inside Story on Town Hall Riots: Right-Wing Shock Troops Do Corporate America's Dirty Work

How the health-care industry, the GOP and one media mogul made common cause with the anti-government fringe.

By Adele M. Stan
Alternet
August 10, 2009

The recent spate of town hall dustups may look like an overnight sensation, but they’ve been years, even decades, in the making.

Since the days in the late 1970s, when the New Right began its takeover of the Republican Party, it has cultivated a militia of white people armed with a grudge against those who brought forth the social changes of the ’60s.

These malcontents have been promised their day of retribution, a day for which they are more than ready. Few seem to understand that they are merely dupes for a corporate agenda that will only worsen the conditions in which they live.

Why, you may ask, would men of power and fame shake the rough, unmanicured hands of gun enthusiasts, conspiracy theorists, gay-haters, misogynists and racists?

Because somebody’s got to do the dirty work. Magnates don’t like to soil their French cuffs, and it’s hard for a bunch of rich guys to garner sympathy for threats to their bottom lines. It’s the classic inside-outside game that the right wing of the GOP has played for the last two decades.

The Health-Care Industry Executive

Imagine you’re an executive at a pharmaceutical company. Your U.S. operations are your cash cow; they earn you wild net profits because, unlike in other industrialized nations, you do not experience the price controls of a government-administered program in which the government negotiates for the best price on prescription drugs and devices.

Along comes a government plan for health-insurance reform that includes a public, government-financed plan. The public option, they call it. As part of the plan, you will be required to negotiate with the government for the price of medications and devices to be distributed within the plan.

Now that could really screw up your massive profit margins. Private plans might then insist on prices more like those the government is getting.

Instead of increasing your profit by double digits in the worst year the economy has seen since the Great Depression, as did an outfit called The Medicines Co., your shareholders may have to settle for profits more in line with the overall growth of the economy. And wouldn’t that just stink?

Meanwhile, polls show a clear majority of Americans–you know, regular Americans, the kind who don’t want to own an AK-47, or who do accept the president’s citizenship status–favor the public option. In fact, in June, CBS News found that majority to be 72 percent.

So, whaddaya do? Well, if your lobbying firm counts former Rep. Dick Armey, R-Texas, as its senior policy adviser, you don’t have do much. Dick will take care of the rest through FreedomWorks, the ostensibly grassroots, nonprofit organization of anti-taxers, cold warriors and affirmative-action opponents, which he chairs.

Need to make it look like regular Americans oppose the health-insurance reform bills now being considered by Congress? Make sure a handful of those angry white people turn up at the town hall meetings now being conducted by members of Congress throughout the country. Make sure they disrupt the meeting and rattle the congressperson.

Capture it all on amateur video and put it up on a faux, amateur-looking Web site, and try to kid the media into thinking there’s a widespread rebellion happening. After all, the media are gonna want that dramatic footage.

The Republican Member of Congress

Now, suppose you’re a Republican member of Congress. Your party got totally throttled in the 2008 election, and if you don’t derail this health care thing, it’s going to be a big win for your Democratic opponents, as millions of underinsured and uninsured Americans finally have some health care coverage–one bright spot in a largely dismal economy.

Meanwhile, you get a lot of your campaign cash from health-care-related industries and from the Wall Street bankers and brokers who want to keep those profits soaring.

A public option is going to stink for you, too. So, while Armey’s army of taxphobes is useful to you, it would be great to get some really hard-core types to further stoke the fires–especially if marshaled by guys who know how to really tar Democrats with racist imagery and slurs of unpatriotic behavior.

That’s where Grassfire.org and its brother networking site, ResistNet, come in. Sen. Jim DeMint, R-S.C., who promised to make health-care reform President Obama’s “Waterloo,” is a big fan. Says so right there on the Grassfire Web site. ResistNet is yet another right-wing hub for organizing the disruption of health-care town hall meetings.

The Media Mogul

Okay, now put on the hat of a media mogul, one who rails against the minimal restrictions the U.S. has on multi-outlet ownership, and one for whom the bottom line is everything. In fact, you actually own the Wall Street Journal.

If you can nip this health care thing in the bud, you could stand in the way of a president who wants to rein in Wall Street’s worse excesses and who may depress the profit margins of health-care companies in which your readers invest with his dastardly public option. What’s a mogul to do?

Why not hire a guy known for riling the discontented to host a show on your cable news channel, and empower him as an organizer? Let him create a little project pegged to fear and nationalism — something, say, like 9/11–through which he mobilizes bands of those aggrieved by the fact of a black president to disrupt town hall meetings.

That’s exactly what Rupert Murdoch did when he hired Glenn Beck to host a Fox News Channel show and to put together a little organizing site called The 9-12 Project.

Although Beck’s stated goal is to bring America back to where it was on Sept. 12, 2001–a nation pulled together in the wake of the terrorist attacks the day before–he draws together only those who embrace the goals of the right.

But his project site is shaped like a social-networking tool, and activists in Florida credit the Tampa 9-12 chapter as turning them out to a town hall they helped turn into a ruckus.

Put these three scenarios together, and you have the phenomenon that has become the summer of the town-hall scuff, a heated season of right-wing disruptions of civic fora.

Add to that an oppressed-white-people narrative that has its roots in the origins of what used to be called the New Right, and you have a confluence of interests ready to elevate to prime-time status a disgruntled and paranoid minority with a penchant for misplaced blame.

FreedomWorks and the K Street Lobbyist

In Washington’s K Street corridor, Dick Armey is a very important man–so important, in fact, that he was scooped up, upon his retirement from Congress, by the lobbying firm DLA Piper.

It’s been widely reported that Piper lobbies on behalf of health-care industry interests, including Bristol-Myers Squibb, but its top health-care-industry client, according to OpenSecrets.org, is The Medicines Co., a small, below-the-radar firm that has paid Armey’s lobbying firm nearly $2.4 million since the beginning of 2008–nearly 15 percent of DLA Piper’s overall lobbying income for the period.

I called The Medicines Co., requesting an interview with someone on staff who could spell out the company’s position on the pending health care bills, and I got back a rather empty, generic statement via e-mail from the company’s public relations firm, FD:

The Medicines Co., a small biotech company, was founded on and continues to follow our mission of saving lives, improving patient outcomes and reducing health care costs. Any suggestion that the Medicines Co. has opposed or retained anyone to oppose the pending health care reform bills is entirely mistaken.

I sent an e-mail back, asking for the company’s position on the health-care bills what it spent $2.4 million to lobby for, and received no response by press time.

The Medicines Co. operates so below the radar that it is not even listed as a member on the Web site of the Pharmaceutical Research and Manufacturer’s Association (PhRMA), which opposes the House bill because it empowers a non-elected panel of experts to oversee cost-containment in public programs.

PhRMA also claims the House plan will raise premiums on senior citizens enrolled in the Medicare prescription drug plan, a plan, as currently construed, largely seen as a giveaway to the pharmaceutical companies.

Last year, The Medicines Co. saw net earnings on its major product, the anti-coagulant Angiomax, increase 17 percent over the course of a single year.

Because of The Medicines Co.’s tight lips, we may never know whether it feels it’s getting its $2.4 million worth out of Piper, or its senior policy analyst, Armey, in his effort to derail health care through the FreedomWorks astroturf site.

Go to the site, and you’ll find a Health Care Action Kit (PDF), complete with talking points and Armey’s “ObamaCare translator” of key terms in the health care discussion, laced with Armey’s own witticisms. There’s even a mock “ObamaCare insurance card” (PDF) you can print out and pass around at town halls. It promises, among other things on a bulletted list, “Rationed health care” and “Anxiety, pain, risk of death.”

At the risk of mixing messages (a big public-relations no-no), Armey also advises health-care protesters to raise their opposition to the energy-reform provision called “cap and trade” in the health-care town halls.

Coincidentally, DLA Piper’s lobbying portfolio includes a number of oil and energy companies.

Then, there are the actual members of FreedomWorks, who leave the most enlightening comments on the Web site:

This, from Constantine Ivanov:

June 27, 2009 — 3:40pm

The problem is that no matter how passionately we are here condemning the socialized (better to say “Socialistisized”) Medicine, “die eisernen Stiefel” (the iron jackboots) of Obamistas are methodically and systematicly destroying the very core of our country.

And I recall German troops who at a steady gait moved as close as 10 miles to Moscow in 1941.

Or, this, from Joe Massana:

June 27, 2009 — 4:00pm

[Obama] and his socilist party are ruining this country … I know that if I was a black man right now, I would be able to get help from the government with my construction business and household bills.

If an entity providing 15 percent of the lobbying income at Armey’s day job took objection to any of this, do you think Armey would be overseeing the FreedomWorks outfit?

DLA Piper also earned $300,000 since early last year lobbying on behalf of the American Council of Life Insurers, which opposes the long-term care provisions in the House bill, which it sees as competition.

Grassfire and ResistNet

The FreedomWorks commenters are tame by comparison with those found on ResistNet, a project of Grassfire.org. Using a social-networking platform, Grassfire claims some 400,000 members who are dedicated to “resisting” the “Democratic agenda,” which, by their lights, includes “open borders” and “taxpayer-funded abortions.”

A 501(c)(4) nonprofit, Grassfire has been named as a “stealth political action committee” by Public Citizen. Its founder and president, Steve Elliott, has held up MoveOn.org as a model for where he would like to take his organization.

ResistNet, has become a major hub for turning out hard-core right-wingers to health-care town hall meetings. The organization took in $1.5 million in 2007 (the most recent year for which information is publicly available).

It’s difficult to find out much of anything about Elliott; he manages to keep a very low profile. But SourceWatch and Public Citizen report that Grassfire is represented by the Washington public relations firm Shirley & Bannister, whose principal is Craig Shirley, the man who gave us the Willie Horton ad of the 1988 presidential election.

Shirley promoted the movie, Stolen Honor, a Swiftboat-style smear piece made about 2004 presidential candidate Sen. John Kerry, D-Mass. Today, Shirley’s clients, according to the Shirley & Bannister Web site, include the National Rifle Association, author Ann Coulter, religious right co-founder Richard Viguerie, and other religious right figures.

But Shirley & Bannister retains ties to GOP establishment figures; its Web site bears an endorsement from William Kristol, who served in the administration of the first George Bush, who happens to be the candidate whose campaign reaped some of its victory from Shirley’s Horton ad.

The firm also promotes the books of former Rep. Joe Scarborough, R-Fla., (now of MSNBC) and former George H.W. Bush speechwriter Peggy Noonan (who promised us a “kinder, gentler nation”) — books published by Rupert Murdoch’s HarperCollins.

The site also lists several other major publishers as clients for the promotion of books by right-wing authors.

I called Shirley & Bannister on Friday morning, asking if Grassfire/ResistNet was its client, since it is not listed on the Web site. I was told that Amy Haas, the person who could answer my question, was on the phone, and would get back to me. She did not.

On its introductory page, Grassfire.org complimentary words from Rep. Mike Pence, R-Ind., and Sen. DeMint.

“Grassfire has done a great job and has done a great service to the American people,” reads the DeMint quote.

Grassfire makes the point often that it will show the president respect and refrain from personal attacks, as ResistNet, which touts a “no tolerance policy” (they can’t say “zero tolerance,” since “Zero” is the nickname by which many of their members call Obama–a play on the first letter of his last name) for “personal attacks, lewd or profane language, or militancy against Barack Obama or others.”

Yet a boxed statement on the opening page of the ResistNet site offers this: Welcome to the online community for patriotic citizens who are opposing the Obama-led socialist agenda …”

ResistNet is full of comments and blog posts that violate its purported “no tolerance” policy, including those calling for social insurrection and even the death of Obama. It promises that such comments will be removed by a moderator, and yet they live on the site for months.

Here’s a comment that appears below a letter one ResistNet member named Joel wrote to his congresswoman:

Comment by RBJ 1 day ago

Joel, I hate to be the one to tell you this, you remember the old saying about “Sticks and stones may break my bones, but words will never hurt me.”

Well that is all that we are doing here, just throwing words at the crowd of Socialist in D.C., aka “D.C.Terrorist”…

As we all know, when words fail, reach over and get a 2 X 4 and get after it. Words don’t hurt, but a good solid A$$ Whooping will get there attention everytime!

Once you have their attention, then you can talk.

Or check out this one, posted by George and Pat Wilkins on Aug. 6, in which they close a long post warning that “the statists will pass socialized medicine in September” by wishing for the death of the president:

Waiting lines will be long, those waiting will find operable conditions be found to be inoperable, Hospice and palliation for comfort will be their fate. Others will die. Why is this being done? back door reparations. I pray that God will strike Obama dead, and all who stand with him they are evil.

And those just two recent examples. Posted on July 2, and still living on the ResistNet site as I write is a video by the Rev. James David Manning, who warns that “white folks are gonna riot in the streets, and I’m gonna join them.” Throughout the video, Manning, an African American, refers to Obama as a “half-breed Mack Daddy”–slang for a kind of megapimp.

Then there’s this charming bit of propaganda, Obama = Hitler (which you can view at the bottom of this story), which dubs video of Obama delivering a speech with the voice of Adolf Hitler, and interposes swastikas and Obama’s campaign logo; Obama is shown wearing a swastika armband; Hitler is shown with the Obama logo as a belt buckle.

Footage of Obama supporters, most of them African American, is run side-by-side with Hitler’s adoring crowds. As Obama waves and moves his mouth, the dub is Hitler yelling, “Sieg Heil!”

The ResistNet site is also peppered with posts touting the birther conspiracy, and other right-wing favorites. After Thursday’s scuffle at the Tampa, Fla., health care town hall, Eric Erikson (cross-posting from RedState) blamed the violence on “SEIU thugs,” an emerging right-wing theme reported earlier by Steve Benen.

I tried to contact Grassfire President Steve Elliott to ask him about the conflict between ResistNet’s “no tolerance” policy and the vitriol I found on his site. I also wanted to find out if there are health-care interests among his donors. Elliott, said Tina, the woman who answered the phone, was traveling, and his spokesman, Ron DeJong, was on vacation. She promised to text Elliott with my contact information, but I never heard back.

Glenn Beck and the 9-12 Project

Which brings us to Glenn Beck. There’s little I can add to what’s been reported (click here for AlterNet’s Tana Ganeva writing on Beck’s racism), except that when I went to the Web site of Beck’s 9-12 Project, another hub of organizing for disrupters of health-care town hall meetings, I found that the comments section had been shut down.

The message left by someone named “Editor” bore no time stamp, only a date: August 6, the date of the infamous Tampa brouhaha at which anti-health-care protesters, according to the St. Petersburg Times, said they had been inspired by Beck and his project.

Each of these organizations have this in common: They’re all promoting a march on Washington for Sept. 12. Others in the mix include TeaPartyExpress.org, and the Our Country Deserves Better PAC, which was founded by Howard Kaloogian in the heat of the presidential campaign.

Kaloogian was the chairman of the “Recall Gray Davis Committee,” which succeeded in unseating the Democratic governor of California. Our Country Deserves Better ran the “Stop Obama” bus tour during the 2008 presidential election, and was faulted by Fact Check.org for airing misleading anti-Obama advertising.

The Inside-Outside Game

The right wing of the GOP has long played this kind of inside-outside game, from the earliest days of the founding of the religious right by Richard Viguerie, Howard Phillips and the late Paul Weyrich. All were veterans of the 1964 Barry Goldwater campaign, and all had experience within the establishment Republican Party.

Viguerie, following a model pioneered by Morris Dees for the 1972 Democratic primary campaign of Sen. George McGovern, D-S.D., harnessed the power of direct-mail solicitations to land Ronald Reagan in the White House. Weyrich founded the Heritage Foundation, which became a fax-generating spin and policy factory for the Reagan administration.

Phillips took the game outside, organizing on-the-ground misanthropes, and eventually founding his own political party, the U.S. Taxpayer’s Party (now the Constitution Party) to exert pressure on the GOP from the outside.

The strategy firmly established the right’s foothold in the GOP, leading to the party’s takeover. Any remnant of the old establishment of the Republican Party was crushed in 1996, when defeated presidential candidate Patrick J. Buchanan, now a MSNBC commentator, threatened to walk the delegates he had won in his primary war against Sen. Bob Dole, R-Kansas, out of the Republican National Convention and into the arms of Phillips’ U.S. Taxpayer Party if the GOP platform did not firmly enough oppose abortion. He also insisted the platform incorporate a host of other right-wing demands, such as a condemnation of the United Nations.

The GOP forked over the writing of its platform to Phyllis Schlafly (another veteran of the Goldwater campaign) and Buchanan’s sister, Bay, and the takeover was complete. The right wing became the Republican establishment.

All of the narratives today embraced by the ResistNet, FreedomWorks and the Glenn Beck crowd find their legs in the one-man clearinghouse that is Howard Phillips.

Through his Conservative Caucus, Phillips disseminated the “birther” theory that Obama is not an American citizen, gave right-wing operative Cliff Kincaid an award for researching Obama’s alleged socialist roots, and for years has railed against “socialized medicine”–even arguing that Medicare is unconstitutional and warning darkly of a time when the government might determine who shall live and who shall die.

“[W]hen the supply of medical care is controlled by politicians and bureaucrats,” Phillips told a 1997 gathering of his Conservative Caucus Foundation, “and the demand for that care exceeds the supply, then individual human beings created in God’s image become price factors in the eyes of medical gatekeepers–they’re not even medical, they’re bureaucratic gatekeepers–who determine medical decisions not on the basis of medical needs, but on the basis of bureaucratic priorities.”

Phillips’ disdain for feminists is palpable, and his language about LGBT people, routinely labeled on his Web site as “perverts,” “homos” and “sodomites” is contemptible. He refers to Planned Parenthood as “Murder Incorporated.”

I called Phillips for comment on this article, but he was en route to Mexico where he has convened a press conference to protest the nonexistent North American Union, another right-wing conspiracy theory. (Rep. Ron Paul, R-Texas, is an invited speaker.)

Phillips advanced the career of Randall Terry, founder of the militant anti-aborton group Operation Rescue. At one point, it seemed that his U.S. Taxpayer’s Party was to Operation Rescue what Sinn Fein is to the Irish Republican Army–the political wing of a movement steeped in violence. (In Terry’s case, the violence was in rhetoric and obstruction designed to incite others to act.)

Conspiracy of Silence

On Aug. 4, Terry, who is seeking to make a comeback with his new organization, Operation Rescue Insurrecta Nex, sent out an e-mail blast urging followers to attend health care town halls convened by members of Congress.

Trotting out the trope the that health-care reform bills provide for taxpayer-funded abortions, he urges his followers:

Stir up some dust!

Be “unreasonable!”

In fact, you might want to be a little noisier and a little more intense than you might normally be.

I put it this way: If you were in danger of being murdered, and I could possibly save you at a town hall meeting, how would you want people to behave in a town hall meeting?

At a July press conference, Terry warned of “random acts of violence” that would occur if the health-care bill passed. There would be violent “reprisals against those deemed guilty,” he said.

Think Terry’s too out on the fringe to matter? Think again. When AlterNet reported that the Supreme Court nomination hearing of Judge Sonia Sotomayor was being disrupted by Terry’s followers, not one Republican senator condemned him by name.

When Terry staged a demonstration outside the White House featuring men in Obama masks “whipping” him, not a distancing word was placed between him and the GOP establishment.

And now he is promulgating the false Republican claim that health-care reform will mean socialized euthanasia for the aged.

Former Alaska Gov. Sarah Palin also has links to Phillips; for seven years, her husband, Todd, claimed membership in the Alaska affiliate of the Constitution Party–the secessionist Alaska Independence Party, whose convention Palin addressed last year via video.

Every other day, it seems, I receive an e-mail from one right-wing organization or another, warning of the grave consequences of health-insurance reform.

The subject line in an e-mail from Human Events magazine screams at me “Grandmas and babies exterminated by Obama ‘health’ plan,” even as another of its e-mails asks, “Obama birth certificate destroyed?” The anti-gay American Family Association warns: “Liberals seek to silence and demonize those who oppose their socialism.”

Tony Perkins of the Family Research Council sent a plea for money to finance a television ad that features an elderly couple complaining of the government’s denial of surgery for the man while financing abortion with taxpayer dollars.

Think these organizations are not the Republican establishment? Consider that the annual Values Voter Summit sponsored by the Family Research Council’s PAC will feature former “moderate” GOP presidential candidate Mitt Romney as a keynote speaker.

In the corridors of Washington’s K Street lobbying offices, in the district offices of Republican members of Congress, and in the executive suite of one singular mogul, the men of power must be well-pleased with themselves, watching YouTube videos of the mayhem they have unleashed on the rest of us. But they may just get their pound of flesh.