PNHP

Media's "false equivalency" and single payer

Media's "false equivalency" and single payer

False-Equivalence Watch: The Platonic-Ideal Form

By James Fallows
The Atlantic, April 4, 2012

Yesterday Barack Obama went to the annual Associated Press luncheon and exhorted journalists to avoid the “false equivalence” syndrome in coverage of controversial events. If you’ve missed the previous 10 million items on this theme, you can read his speech or my precis of it. In short, the false equivalence problem is that although it’s convenient and “objective”-seeming for reporters simply to quote “both sides” of a public issue, the results can be misleading when one of the sides is simply making things up.

Today the same Associated Press published an article on his speech that perfectly exemplified the problem Obama was complaining about, and was all the more piquant for being presented as a “fact check.” The subject was the now-infamous “individual mandate” provision of the administration’s health-care plan.

As Obama pointed out in his speech, the individual mandate originated as a conservative/Republican idea. Conservatives preferred it precisely because it was an alternative to government-run “single-payer” coverage, like Medicare or the VA. This was part of the reason Mitt Romney embraced the mandate in his health-care plan in Massachusetts. Yesterday Obama said:

“So as all of you are doing your reporting, I think it’s important to remember that the positions I’m taking now, … if we had been having this discussion 20 years ago, or even 15 years ago, would have been considered squarely centrist positions.  What’s changed is the center of the Republican Party.”
 
Today the AP was back with its “fact check”:

“[I]f Republicans have moved to the right on health care, it’s also true that Obama has moved to the left. He strenuously opposed a mandate forcing people to obtain health insurance until he won office and changed his mind.”

This is false equivalence in its Platonic-ideal form. It’s presented as being “objective” — These politicians! They all just flip and flop! — but in fact is deeply misleading about the realities. As Brian Beutler pointed out today on TPM, making things seem symmetrically unprincipled in this case requires either lack of awareness of, or knowing manipulation of, the basic facts.

Yes, Obama’s position on health care has changed. But his embrace of the “individual mandate” represents a move TO THE RIGHT, not leftward as the story claims. Before that, he had been in favor of (a) single-payer coverage, in his days as an Illinois politician, and (b) the “public option” during his 2008 primary campaign against Hillary Clinton. His decision to build “ObamaCare” around the individual mandate — rather than on the public option or a single-payer concept — reflected pressure on the administration to make the plan more “centrist,” not more leftist or radical. When the switch to individual mandate was announced, by far the most heated criticism came from the left, on grounds that Obama had sold out supporters of the public option. Meanwhile, the likes of the impeccably conservative Senator Charles Grassley of Iowa were saying that there was a “bipartisan consensus” in favor of the individual mandate compromise. So: the current Republican hostility to the individual mandate represents a rightward shift, and so too does Obama’s embrace of the plan.

Beutler sums up the achievement of this latest “fact check”:

“His hosts [at AP] weren’t listening — and as a result they’ve made Obama’s points about Republicans and the media for him….

“It’s true that Obama campaigned against an individual mandate in 2008, only to embrace it — however reluctantly — after he became president. But to say that constitutes a move to the left betrays a lack of understanding about the origins and purpose of the individual mandate, and of Obama’s broader evolution on health care reform.”

http://www.theatlantic.com/politics/archive/2012/04/false-equivalence-watch-the-platonic-ideal-form/255468/

Comment:

By Don McCanne, MD

Within the mainstream media there is hardly an article on politics that doesn’t make some effort to present “both sides” of the issue, often settling on reporting suggesting that “centrist” views best represent an application of the facts. Where does single payer fit in this?

For the past few years, single payer was largely considered irrelevant and not included in most discussions. Earlier, the “public option” – a public insurance program to be offered as an option in the insurance exchanges – was considered to represent the position of the left.

Some of us dedicated single payer supporters were loudly protesting that the public option was merely a decoy to create the impression that the legislation was centrist, rather than actually being merely a perpetuation of the highly dysfunctional financing system that we have. The mainstream media again dismissed us as irrelevant and covered “both sides” as if this dispute were over support for the public option representing the views of the left, and opposition to the option representing the views of the right.

In truth, most in the progressive community had latched onto the public option, and so the media was not totally off track. A very large sector the progressive community had moved far to the right by supporting the public option, thereby implicitly supporting the model being created in Congress – the Heritage/Republican mandate proposal requiring individuals to purchase private insurance plans.

And where are we now? Most progressives have set aside their demands for the public option and are asking the Supreme Court to support the right-wing individual mandate! Thus the media is presenting “both sides” as the left supporting the mandate and the right opposed – a dispute taking place in far-right territory.

Not all progressives have followed the lemmings. A group of fifty noble physicians and a couple of single payer organizations have submitted an amicus in opposition to the individual mandate. The rationale is that we should get rid of this horrendous legislation and clear the way for the only other alternative – a single payer national health program. The amicus was a tactical decision on which passionate single payer supporters could differ.

The leadership of Physicians for a National Health Program – a single payer advocacy organization strongly opposed to the financing model of the Affordable Care Act – elected not to take a position either for or against the Supreme Court challenge since it was a distracting diversion from PNHP’s mission. Instead, we made the tactical decision that we would be more effective continuing with our unrelenting advocacy for single payer while condemning the cruel and inhumane financing system perpetuated in the Affordable Care Act.

In the heat of the Supreme Court debate we are seeing the issue of single payer creeping back into the national dialogue. In an effort to present both sides, many reporters, in covering the debate over the mandate, have included the view of those who believe that rejecting the mandate will result in turning to the only other option – single payer.

And, by the way, “both sides” does not mean the right and the left. There are many on the right who support the single payer concept, and some on the left oppose it.

Let’s do all we can to dump the false-equivalence debate over the public option and the individual mandate and move on to covering what are truly “both sides” – an efficient, equitable and affordable single payer system versus the wasteful, costly, inequitable, and fragmented financing system of the Affordable Care Act which would leave far too many of us sick and broke.

Media’s “false equivalency” and single payer

False-Equivalence Watch: The Platonic-Ideal Form

By James Fallows
The Atlantic, April 4, 2012

Yesterday Barack Obama went to the annual Associated Press luncheon and exhorted journalists to avoid the “false equivalence” syndrome in coverage of controversial events. If you’ve missed the previous 10 million items on this theme, you can read his speech or my precis of it. In short, the false equivalence problem is that although it’s convenient and “objective”-seeming for reporters simply to quote “both sides” of a public issue, the results can be misleading when one of the sides is simply making things up.

Today the same Associated Press published an article on his speech that perfectly exemplified the problem Obama was complaining about, and was all the more piquant for being presented as a “fact check.” The subject was the now-infamous “individual mandate” provision of the administration’s health-care plan.

As Obama pointed out in his speech, the individual mandate originated as a conservative/Republican idea. Conservatives preferred it precisely because it was an alternative to government-run “single-payer” coverage, like Medicare or the VA. This was part of the reason Mitt Romney embraced the mandate in his health-care plan in Massachusetts. Yesterday Obama said:

“So as all of you are doing your reporting, I think it’s important to remember that the positions I’m taking now, … if we had been having this discussion 20 years ago, or even 15 years ago, would have been considered squarely centrist positions.  What’s changed is the center of the Republican Party.”
 
Today the AP was back with its “fact check”:

“[I]f Republicans have moved to the right on health care, it’s also true that Obama has moved to the left. He strenuously opposed a mandate forcing people to obtain health insurance until he won office and changed his mind.”

This is false equivalence in its Platonic-ideal form. It’s presented as being “objective” — These politicians! They all just flip and flop! — but in fact is deeply misleading about the realities. As Brian Beutler pointed out today on TPM, making things seem symmetrically unprincipled in this case requires either lack of awareness of, or knowing manipulation of, the basic facts.

Yes, Obama’s position on health care has changed. But his embrace of the “individual mandate” represents a move TO THE RIGHT, not leftward as the story claims. Before that, he had been in favor of (a) single-payer coverage, in his days as an Illinois politician, and (b) the “public option” during his 2008 primary campaign against Hillary Clinton. His decision to build “ObamaCare” around the individual mandate — rather than on the public option or a single-payer concept — reflected pressure on the administration to make the plan more “centrist,” not more leftist or radical. When the switch to individual mandate was announced, by far the most heated criticism came from the left, on grounds that Obama had sold out supporters of the public option. Meanwhile, the likes of the impeccably conservative Senator Charles Grassley of Iowa were saying that there was a “bipartisan consensus” in favor of the individual mandate compromise. So: the current Republican hostility to the individual mandate represents a rightward shift, and so too does Obama’s embrace of the plan.

Beutler sums up the achievement of this latest “fact check”:

“His hosts [at AP] weren’t listening — and as a result they’ve made Obama’s points about Republicans and the media for him….

“It’s true that Obama campaigned against an individual mandate in 2008, only to embrace it — however reluctantly — after he became president. But to say that constitutes a move to the left betrays a lack of understanding about the origins and purpose of the individual mandate, and of Obama’s broader evolution on health care reform.”

http://www.theatlantic.com/politics/archive/2012/04/false-equivalence-watch-the-platonic-ideal-form/255468/

Comment:

By Don McCanne, MD

Within the mainstream media there is hardly an article on politics that doesn’t make some effort to present “both sides” of the issue, often settling on reporting suggesting that “centrist” views best represent an application of the facts. Where does single payer fit in this?

For the past few years, single payer was largely considered irrelevant and not included in most discussions. Earlier, the “public option” – a public insurance program to be offered as an option in the insurance exchanges – was considered to represent the position of the left.

Some of us dedicated single payer supporters were loudly protesting that the public option was merely a decoy to create the impression that the legislation was centrist, rather than actually being merely a perpetuation of the highly dysfunctional financing system that we have. The mainstream media again dismissed us as irrelevant and covered “both sides” as if this dispute were over support for the public option representing the views of the left, and opposition to the option representing the views of the right.

In truth, most in the progressive community had latched onto the public option, and so the media was not totally off track. A very large sector the progressive community had moved far to the right by supporting the public option, thereby implicitly supporting the model being created in Congress – the Heritage/Republican mandate proposal requiring individuals to purchase private insurance plans.

And where are we now? Most progressives have set aside their demands for the public option and are asking the Supreme Court to support the right-wing individual mandate! Thus the media is presenting “both sides” as the left supporting the mandate and the right opposed – a dispute taking place in far-right territory.

Not all progressives have followed the lemmings. A group of fifty noble physicians and a couple of single payer organizations have submitted an amicus in opposition to the individual mandate. The rationale is that we should get rid of this horrendous legislation and clear the way for the only other alternative – a single payer national health program. The amicus was a tactical decision on which passionate single payer supporters could differ.

The leadership of Physicians for a National Health Program – a single payer advocacy organization strongly opposed to the financing model of the Affordable Care Act – elected not to take a position either for or against the Supreme Court challenge since it was a distracting diversion from PNHP’s mission. Instead, we made the tactical decision that we would be more effective continuing with our unrelenting advocacy for single payer while condemning the cruel and inhumane financing system perpetuated in the Affordable Care Act.

In the heat of the Supreme Court debate we are seeing the issue of single payer creeping back into the national dialogue. In an effort to present both sides, many reporters, in covering the debate over the mandate, have included the view of those who believe that rejecting the mandate will result in turning to the only other option – single payer.

And, by the way, “both sides” does not mean the right and the left. There are many on the right who support the single payer concept, and some on the left oppose it.

Let’s do all we can to dump the false-equivalence debate over the public option and the individual mandate and move on to covering what are truly “both sides” – an efficient, equitable and affordable single payer system versus the wasteful, costly, inequitable, and fragmented financing system of the Affordable Care Act which would leave far too many of us sick and broke.

Media's "false equivalency" and single payer

False-Equivalence Watch: The Platonic-Ideal Form

By James Fallows
The Atlantic, April 4, 2012
Yesterday Barack Obama went to the annual Associated Press luncheon and exhorted journalists to avoid the “false equivalence” syndrome in coverage of controversial events. If you’ve missed the previous 10 million items on this theme, you can read his speech or my precis of it. In short, the false equivalence problem is that although it’s convenient and “objective”-seeming for reporters simply to quote “both sides” of a public issue, the results can be misleading when one of the sides is simply making things up.
Today the same Associated Press published an article on his speech that perfectly exemplified the problem Obama was complaining about, and was all the more piquant for being presented as a “fact check.” The subject was the now-infamous “individual mandate” provision of the administration’s health-care plan.
As Obama pointed out in his speech, the individual mandate originated as a conservative/Republican idea. Conservatives preferred it precisely because it was an alternative to government-run “single-payer” coverage, like Medicare or the VA. This was part of the reason Mitt Romney embraced the mandate in his health-care plan in Massachusetts. Yesterday Obama said:
“So as all of you are doing your reporting, I think it’s important to remember that the positions I’m taking now, … if we had been having this discussion 20 years ago, or even 15 years ago, would have been considered squarely centrist positions.  What’s changed is the center of the Republican Party.”
Today the AP was back with its “fact check”:
“[I]f Republicans have moved to the right on health care, it’s also true that Obama has moved to the left. He strenuously opposed a mandate forcing people to obtain health insurance until he won office and changed his mind.”
This is false equivalence in its Platonic-ideal form. It’s presented as being “objective” — These politicians! They all just flip and flop! — but in fact is deeply misleading about the realities. As Brian Beutler pointed out today on TPM, making things seem symmetrically unprincipled in this case requires either lack of awareness of, or knowing manipulation of, the basic facts.
Yes, Obama’s position on health care has changed. But his embrace of the “individual mandate” represents a move TO THE RIGHT, not leftward as the story claims. Before that, he had been in favor of (a) single-payer coverage, in his days as an Illinois politician, and (b) the “public option” during his 2008 primary campaign against Hillary Clinton. His decision to build “ObamaCare” around the individual mandate — rather than on the public option or a single-payer concept — reflected pressure on the administration to make the plan more “centrist,” not more leftist or radical. When the switch to individual mandate was announced, by far the most heated criticism came from the left, on grounds that Obama had sold out supporters of the public option. Meanwhile, the likes of the impeccably conservative Senator Charles Grassley of Iowa were saying that there was a “bipartisan consensus” in favor of the individual mandate compromise. So: the current Republican hostility to the individual mandate represents a rightward shift, and so too does Obama’s embrace of the plan.
Beutler sums up the achievement of this latest “fact check”:
“His hosts [at AP] weren’t listening — and as a result they’ve made Obama’s points about Republicans and the media for him….
“It’s true that Obama campaigned against an individual mandate in 2008, only to embrace it — however reluctantly — after he became president. But to say that constitutes a move to the left betrays a lack of understanding about the origins and purpose of the individual mandate, and of Obama’s broader evolution on health care reform.”
http://www.theatlantic.com/politics/archive/2012/04/false-equivalence-wa…

Within the mainstream media there is hardly an article on politics that doesn’t make some effort to present “both sides” of the issue, often settling on reporting suggesting that “centrist” views best represent an application of the facts. Where does single payer fit in this?
For the past few years, single payer was largely considered irrelevant and not included in most discussions. Earlier, the “public option” – a public insurance program to be offered as an option in the insurance exchanges – was considered to represent the position of the left.
Some of us dedicated single payer supporters were loudly protesting that the public option was merely a decoy to create the impression that the legislation was centrist, rather than actually being merely a perpetuation of the highly dysfunctional financing system that we have. The mainstream media again dismissed us as irrelevant and covered “both sides” as if this dispute were over support for the public option representing the views of the left, and opposition to the option representing the views of the right.
In truth, most in the progressive community had latched onto the public option, and so the media was not totally off track. A very large sector the progressive community had moved far to the right by supporting the public option, thereby implicitly supporting the model being created in Congress – the Heritage/Republican mandate proposal requiring individuals to purchase private insurance plans.
And where are we now? Most progressives have set aside their demands for the public option and are asking the Supreme Court to support the right-wing individual mandate! Thus the media is presenting “both sides” as the left supporting the mandate and the right opposed – a dispute taking place in far-right territory.
Not all progressives have followed the lemmings. A group of fifty noble physicians and a couple of single payer organizations have submitted an amicus in opposition to the individual mandate. The rationale is that we should get rid of this horrendous legislation and clear the way for the only other alternative – a single payer national health program. The amicus was a tactical decision on which passionate single payer supporters could differ.
The leadership of Physicians for a National Health Program – a single payer advocacy organization strongly opposed to the financing model of the Affordable Care Act – elected not to take a position either for or against the Supreme Court challenge since it was a distracting diversion from PNHP’s mission. Instead, we made the tactical decision that we would be more effective continuing with our unrelenting advocacy for single payer while condemning the cruel and inhumane financing system perpetuated in the Affordable Care Act.
In the heat of the Supreme Court debate we are seeing the issue of single payer creeping back into the national dialogue. In an effort to present both sides, many reporters, in covering the debate over the mandate, have included the view of those who believe that rejecting the mandate will result in turning to the only other option – single payer.
And, by the way, “both sides” does not mean the right and the left. There are many on the right who support the single payer concept, and some on the left oppose it.
Let’s do all we can to dump the false-equivalence debate over the public option and the individual mandate and move on to covering what are truly “both sides” – an efficient, equitable and affordable single payer system versus the wasteful, costly, inequitable, and fragmented financing system of the Affordable Care Act which would leave far too many of us sick and broke.

Obama can't get single payer out of his head

Video: Obama Blasts GOP Medicare, Medicaid Plans

Kaiser Health News, April 3, 2012

Speaking in Washington to an association of newspaper editors, Obama not only attacked Republican budget proposals, but in response to a question, he also laid out a defense of the 2010 health law and why he thinks the Supreme Court will uphold the law as constitutional.

Excerpts

Question:  … If the court were to overturn individual mandate, what would you do or propose to do for the 30 million people who wouldn’t have health care after that ruling?

President Obama:  … And the point I think that was made very ably before the Supreme Court, but I think most health care economists who have looked at this have acknowledged, is there are basically two ways to cover people with pre-existing conditions or assure that people can always get coverage even when they have bad illnesses.

One way is a single-payer plan. Everybody is a under a single system, like Medicare. The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room. That doesn’t work, and so as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.

So I don’t anticipate the court striking this down. I think they take their responsibilities very seriously.

But I think what’s more important is for all of us, Democrats and Republicans, to recognize that in a country like ours, the wealthiest, most powerful country on earth, we shouldn’t have a system in which millions of people are at risk of bankruptcy because they get sick or end up waiting until they do get sick and then go to the emergency room, which involves all of us paying for it.

Video and transcript:
http://www.kaiserhealthnews.org/Multimedia/2012/April/obama-gop-budget-medicare.aspx

And…

White House pushes back on single-payer claims

By Byron Tau
Politico, April 3, 2012

President Obama’s advisers are pushing back against claims that the president floated single-payer, government-run health care as a possible solution to the individual mandate.

Obama said during remarks Tuesday that either a mandate or a single-payer government health plan were the only way to ensure coverage of everyone with pre-existing conditions.

“The President was simply explaining the individual responsibility provision in the context of the decades-long debate about fixing America’s healthcare system. He was not talking about any hypothetical situation where ACA is overturned, nor has the White House commented on such hypotheticals, because we firmly believe the law is Constitutional and will be upheld,” a White House official said.

http://www.politico.com/politico44/2012/04/white-house-pushes-back-on-single-payer-claims-119540.html

Comment:

By Don McCanne, MD

The Barack Obama whom we had hoped was elected as president, on the topic of health care coverage, once again has stated clearly, “One way is a single-payer plan. Everybody is a under a single system, like Medicare,” whereas “The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room. That doesn’t work, and so as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.”

The ease with which single payer flows from his consciousness while the awkwardness of his expression of the individual mandate concept seem to be telling. He understands. Yet he is the central cog in a complex White House machine driven by politics rather than policy. That is why the White House felt compelled to release a statement dismissing single payer without even mentioning it by name.

Let’s hope that, if he is reelected, he replaces the political machinery within the White House with machinery that is driven by sound, compassionate policy.

Obama can’t get single payer out of his head

Video: Obama Blasts GOP Medicare, Medicaid Plans

Kaiser Health News, April 3, 2012

Speaking in Washington to an association of newspaper editors, Obama not only attacked Republican budget proposals, but in response to a question, he also laid out a defense of the 2010 health law and why he thinks the Supreme Court will uphold the law as constitutional.

Excerpts

Question:  … If the court were to overturn individual mandate, what would you do or propose to do for the 30 million people who wouldn’t have health care after that ruling?

President Obama:  … And the point I think that was made very ably before the Supreme Court, but I think most health care economists who have looked at this have acknowledged, is there are basically two ways to cover people with pre-existing conditions or assure that people can always get coverage even when they have bad illnesses.

One way is a single-payer plan. Everybody is a under a single system, like Medicare. The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room. That doesn’t work, and so as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.

So I don’t anticipate the court striking this down. I think they take their responsibilities very seriously.

But I think what’s more important is for all of us, Democrats and Republicans, to recognize that in a country like ours, the wealthiest, most powerful country on earth, we shouldn’t have a system in which millions of people are at risk of bankruptcy because they get sick or end up waiting until they do get sick and then go to the emergency room, which involves all of us paying for it.

Video and transcript:
http://www.kaiserhealthnews.org/Multimedia/2012/April/obama-gop-budget-medicare.aspx

And…

White House pushes back on single-payer claims

By Byron Tau
Politico, April 3, 2012

President Obama’s advisers are pushing back against claims that the president floated single-payer, government-run health care as a possible solution to the individual mandate.

Obama said during remarks Tuesday that either a mandate or a single-payer government health plan were the only way to ensure coverage of everyone with pre-existing conditions.

“The President was simply explaining the individual responsibility provision in the context of the decades-long debate about fixing America’s healthcare system. He was not talking about any hypothetical situation where ACA is overturned, nor has the White House commented on such hypotheticals, because we firmly believe the law is Constitutional and will be upheld,” a White House official said.

http://www.politico.com/politico44/2012/04/white-house-pushes-back-on-single-payer-claims-119540.html

Comment:

By Don McCanne, MD

The Barack Obama whom we had hoped was elected as president, on the topic of health care coverage, once again has stated clearly, “One way is a single-payer plan. Everybody is a under a single system, like Medicare,” whereas “The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room. That doesn’t work, and so as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.”

The ease with which single payer flows from his consciousness while the awkwardness of his expression of the individual mandate concept seem to be telling. He understands. Yet he is the central cog in a complex White House machine driven by politics rather than policy. That is why the White House felt compelled to release a statement dismissing single payer without even mentioning it by name.

Let’s hope that, if he is reelected, he replaces the political machinery within the White House with machinery that is driven by sound, compassionate policy.

Union advocacy is this doctor’s prescription for health care access and reform

AFT Public Employee Advocate, April 2, 2012

Dr. Andrew Coates has not been on the job that long, but he has quickly learned that the patients he sees need an advocate in the legislative and executive branches of government where decisions are made about the state’s delivery and availability of psychiatric care.

Since taking a job with the New York Office of Mental Health five years ago as a Medical Specialist II at the Capital District Psychiatric Center in Albany, Coates says he has “learned a lot of public policy and tax policy” that he would not have learned otherwise.

The reason: The state Office of Mental Health has been downsizing, consolidating and privatizing state psychiatric care; thanks to the state budget enacted in 2011, OMH is allowed to close facilities within 60 days notice.

“I think it is dreadful public policy,” says Coates, whose concerns range from the “cruelty” of not having community-based care available for the people who need it, to general public safety when such care is not available, to the state shifting the burden of care onto counties and cities.

“The union is the only voice that will now speak up for these patients,” says Coates, a member of the New York State Public Employees Federation. He noted that the accelerated facility-closure process have prevented patients’ families from mobilizing against closures that move their loved ones hours away.

“There is a measure of moral distress in working for a system that is collapsing so quickly,” says Coates. “We find it harder and harder to get what our patients need.”

The budget situation that has contributed to OMH’s revamp is not deterring Coates’ advocacy for his patients — and all consumers of health care.

Coates, who also is medical director at Albany County Nursing Home, is president-elect of Physicians for a National Health Program, which advocates for a universal, comprehensive single-payer national health program.

When Coates takes the helm of PNHP in January 2013, he says, “My goal is to reinforce that when it comes to health care reform, we absolutely need a mass movement. We need the weight of the trade unions, the only institutions in our society that are independent of corporate power.”

Between studies that show publicly financed health care delivers superior quality of care at a lower cost, and the federal Medicare and Veterans Affairs systems, Coates says, “there is really no excuse for continuing an employer-based private system that is designed to extract resources that should go to patient care.”

[PNHP note: This article, which in the original includes a photo of Dr. Coates, appeared in the April/May issue, Vol. 31, No. 4, page 8.]

http://www.aft.org/emags/pe_advocate/pea_aprmay2012/index.html#/8/

Dr. Margaret Flowers on the Supreme Court and American Health Care

By Joan Brunwasser
OpEd News, April 2, 2012

My guest today is Dr. Margaret Flowers, former congressional fellow for PNHP, Physicians for a National Health Program. Welcome back to OpEdNews, Margaret. You and your colleagues have been working toward a single payer insurance system for quite some time. What’s new with that?

Dr. Flowers: Thank you for asking, Joan. My colleagues at PNHP have been focused on a number of fronts. While we all believe that the simplest and most just way to reach single payer is to create a national single-payer health program, there are efforts in many places to pass single payer at the state level. Vermont is leading the way with its “Health care is a human right” campaign and its new health legislation. Other states, such as Maryland and Oregon, are following Vermont’s lead and creating similar rights-based campaigns. There is also a strong campaign led by Dr. Rob Stone of Indiana to encourage socially responsible investing which includes divestment of stock in private for-profit health insurance corporations such as WellPoint.
 
At present, some of our members are also focused on the Supreme Court case regarding the constitutionality of the individual mandate in the Affordable Care Act (ACA). Single Payer Action, ItsOurEconomy.us and 50 physicians filed an amicus brief with the Supreme Court arguing that the individual mandate is not necessary because it will not achieve the goal of universal, affordable and guaranteed health care and in fact, a single-payer health program is the best and simplest way to achieve this goal. [PNHP note: PNHP as an organization is not part of the amicus brief seeking to strike down the individual mandate provision in the ACA.]

Brunwasser: Opposing the individual mandate in the Affordable Care Act is viewed by many as a controversial and perhaps counter-intuitive move. Are you and your colleagues being unrealistic and hard-nosed? Isn’t what ACA has accomplished, while perhaps not great, better than nothing?

Dr. Flowers: What we are seeing on the right and the left is a lot of confusion about the ACA and partisanship rather than a focus on the actual policy. The individual mandate provision is an idea that came from the Heritage Foundation and was used to counter health reform during the Clinton years. Then, Governor Mitt Romney used the individual mandate as an anchor in the Massachusetts state health bill implemented in 2006. President Obama opposed the individual mandate initially during his campaign but ultimately came to embrace it. Now we find Democrats aggressively defending the individual mandate and Republicans opposing it. One can imagine in this environment that if McCain was president, the Democrats would be opposing the mandate and Republicans would be defending it.

So let’s put partisanship aside and look at the individual mandate. It forces people who do not qualify for public health programs like Medicaid and Medicare to purchase private insurance under penalty if they fail to do so. This further entrenches the insurance industry as part of the health care system and further empowers private insurers with hundreds of millions in public dollar subsidies. If you believe that the solution to our health crisis is to have more people with private insurance, then one would support the individual mandate.

However, it is actually the private insurance part of our health care system that is the source of many of our problems. It is the part of our health care sector that is least efficient and that places obstacles to care because the private insurers’ bottom line is profit, not health. The individual mandate puts us further down the road to a market-based health system and this is the opposite direction that we need to go. The argument that the ACA is an initial step and can be improved upon is a false argument and does not hold water from a health policy standpoint. The ACA is a step in the wrong direction.

What would be a first step towards a universal, guaranteed and affordable health care system would be to initially expand Medicare to cover everyone. This would move us away from a market-based system to a nonprofit, publicly financed system. We would then need to tweak Medicare in many ways to improve it and would have to concurrently build a national health program that used health planning to utilize our health resources in the way that meets the needs of our population.

Are there beneficial parts of the ACA? Of course there are. Every health bill has beneficial aspects and they are used to divide people. If the bill is better for women and children, then groups that advocate on behalf of women and children fight to preserve it and ignore the fact that others are left out. Attempts have been made to patch together our current system at the state and federal level for decades. None of these attempts have addressed the fundamental problems and none have moved us forward — our health care costs continue to skyrocket, we continue to have tens of millions who are uninsured and our health outcomes are still poor compared to what they should be for the money we are spending on health care.

If we truly want to create a health care system that works for everyone, then we will have to be persistent and clear in our demand for a system that works for everyone, and that’s single payer. If we believe that health care is a human right, then we must believe that everybody should have health care. And if we continue to accept the crumbs that are handed out and not have the courage to insist on real reform, then we will not get real health reform. So, in my view, it is those who ally themselves with political agendas rather than focusing on the issue that hold our progress back.

Brunwasser: What happens to our health care if the individual mandate is struck down by the Supreme Court? Are we back to square one? Many are concerned that we’ll be even worse off than we are at the present. Congress is so beholden to the health care lobby that single payer seems more and more of a pipe dream.

Dr. Flowers: If the individual mandate is struck down and the rest of the ACA is kept intact, we will see the true nature of the private health insurance industry — an industry that sells insurance to make a profit and that profits by denying and restricting care. We will see premiums skyrocket and more care denied.

If the individual mandate is struck down and the ACA is considered to be “unseverable,” meaning that the whole legislation is struck down, then we will be at square one. This provides a real opportunity. The majority of the U.S. favors single payer. All of the evidence points to single payer. The Occupy Movement is a manifestation of social unrest. All signs point to the fact that Congress and the White House are beginning to fear the people.

This is our opportunity to push for single payer. After the passage of the health bill, Ezra Klein and others started to admit that if the ACA fails, the U.S. will have to seriously consider Medicare for All.

And the truth is that the ACA is going to fail. It will follow the same path of similar legislation that has been passed in the U.S. previously. Either the cost of health care will become even more unbearable, or as has happened in Massachusetts, people or health benefits will be cut. Even those on the Deficit Commission who don’t support single payer admitted that lack of control of our health care costs is the greatest problem for the U.S. economy.

The longer we wait to pass the inevitable, the more people in the US suffer, die or go bankrupt. This is our opportunity to push for the inevitable.

Brunwasser: In May 2009, you and a number of other health care providers were arrested at the Senate hearings on health care. You’ve been at this for a long time. Can you tell our readers a
little about your background, Margaret? What makes you care so much about this issue?

Dr. Flowers: I am a pediatrician. I went into pediatrics because I believe in the importance of providing children with a healthy start in life as one of the best ways to lead to a healthier population. My vision as a physician has always been that every person should have the same high standard of health care and that every person should have the opportunity to reach their full potential.

When I was in practice as a hospitalist at a rural hospital and then in private practice, I experienced the obstacles to delivering high quality care that are created by our current health system that relies on private insurers whose bottom line is profit, not health. I had to find ways to keep children in the hospital if they were not ready to go home but the insurer wanted them to be discharged. I was pushed to see more patients and spend less time with them. This was counter to the way I thought I could provide the best care for my patients.

I then became involved in health reform and the more I learned, the more my eyes were opened and I could not close them. The United States is the only industrialized nation that uses this market model for health care and it is failing us. Our health care costs are rising out of control and our health outcomes are relatively poor. I could go on and on, but the bottom line is that we have the resources in this country to provide high quality lifelong comprehensive health care to every person and the reason that we don’t is because the corporations that profit off of the current system are writing the laws in their favor. This is unacceptable to me. I believe it is my professional responsibility as a physician to speak out about this and to do all that I can to change this situation.

[PNHP note: The article above has been slightly edited. The full text of the interview and related materials are available here.]

Obama can't get single payer out of his head

Video: Obama Blasts GOP Medicare, Medicaid Plans

Kaiser Health News, April 3, 2012
Speaking in Washington to an association of newspaper editors, Obama not only attacked Republican budget proposals, but in response to a question, he also laid out a defense of the 2010 health law and why he thinks the Supreme Court will uphold the law as constitutional.
Excerpts
Question:  … If the court were to overturn individual mandate, what would you do or propose to do for the 30 million people who wouldn’t have health care after that ruling?
President Obama:  … And the point I think that was made very ably before the Supreme Court, but I think most health care economists who have looked at this have acknowledged, is there are basically two ways to cover people with pre-existing conditions or assure that people can always get coverage even when they have bad illnesses.
One way is a single-payer plan. Everybody is a under a single system, like Medicare. The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room. That doesn’t work, and so as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.
So I don’t anticipate the court striking this down. I think they take their responsibilities very seriously.
But I think what’s more important is for all of us, Democrats and Republicans, to recognize that in a country like ours, the wealthiest, most powerful country on earth, we shouldn’t have a system in which millions of people are at risk of bankruptcy because they get sick or end up waiting until they do get sick and then go to the emergency room, which involves all of us paying for it.
Video and transcript:
http://www.kaiserhealthnews.org/Multimedia/2012/April/obama-gop-budget-medicare.aspx
And…

White House pushes back on single-payer claims

By Byron Tau
Politico, April 3, 2012
President Obama’s advisers are pushing back against claims that the president floated single-payer, government-run health care as a possible solution to the individual mandate.
Obama said during remarks Tuesday that either a mandate or a single-payer government health plan were the only way to ensure coverage of everyone with pre-existing conditions.
“The President was simply explaining the individual responsibility provision in the context of the decades-long debate about fixing America’s healthcare system. He was not talking about any hypothetical situation where ACA is overturned, nor has the White House commented on such hypotheticals, because we firmly believe the law is Constitutional and will be upheld,” a White House official said.
http://www.politico.com/politico44/2012/04/white-house-pushes-back-on-single-payer-claims-119540.html

The Barack Obama whom we had hoped was elected as president, on the topic of health care coverage, once again has stated clearly, “One way is a single-payer plan. Everybody is a under a single system, like Medicare,” whereas “The other way is to set up a system in which you don’t have people who are healthy but don’t bother to get health insurance, and then we all have to pay for them in the emergency room. That doesn’t work, and so as a consequence, we’ve got to make sure that those folks are taking their responsibility seriously, which is what the individual mandate does.”
The ease with which single payer flows from his consciousness while the awkwardness of his expression of the individual mandate concept seem to be telling. He understands. Yet he is the central cog in a complex White House machine driven by politics rather than policy. That is why the White House felt compelled to release a statement dismissing single payer without even mentioning it by name.
Let’s hope that, if he is reelected, he replaces the political machinery within the White House with machinery that is driven by sound, compassionate policy.

Using insurance products to penalize unhealthy patients

Employers Tie Financial Rewards, Penalties To Health Tests, Lifestyle Choices

By Julie Appleby
Kaiser Health News, April 2, 2012

Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease management programs and quit smoking to qualify for hundreds, even thousands of dollars’ worth of premium or deductible discounts.

Proponents say such plans offer people a financial incentive to make healthier choices and manage chronic conditions such as obesity, high blood pressure and diabetes, which are driving up healthcare costs in the USA. Even so, studies of the effect of such policies on lifestyle changes are inconclusive. And advocates for people with chronic health conditions, such as heart disease and diabetes, fear that tying premium costs directly to test results could lead to discrimination.

Nonetheless, such plans could be the wave of the future. Faced with crippling healthcare costs, the number of employers embracing such programs shot up from 49 percent in 2010 to 54 percent last year — and more say they expect to do so soon, according to a survey by consultants Aon Hewitt. Big-name participants include insurer UnitedHealthcare, car rental firm Hertz, postage meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY.

And more employers are expected to adopt them starting in 2014, when the health law allows them to offer larger incentives or penalties than they can now.

Starting in 2014, federal law allows employers to raise the value of the perk or penalty from 20 percent of the cost of a worker’s health insurance plan, to 30 percent. Based on the average cost of employer-offered insurance today, that means firms will be able to offer annual discounts or penalties of more than $4,500 a family, or $1,600 for individuals.

Given the available data, it’s hard to parse how much of the reported savings from such programs come from improved health, and how much from the frequent pairing of such programs with high deductible policies, which shift more costs onto workers.

http://www.kaiserhealthnews.org/Stories/2012/April/02/employers-financial-rewards-penalties-health-tests.aspx

Comment:

By Don McCanne, MD

Because we continue to insist that private insurance remains a mainstay of financing health care, we perpetuate the confusion between the health insurance product itself and the actual health care that people need. A well functioning health care financing system should remove financial barriers to health care that people need.

Single payer supporters understand that a universal pool should be financed equitably through progressive taxes, and that full payment for necessary health care should come from this pool – pretty much as they do in Canada. When people need health care, they get it, and the bill goes to the public agency.

In the United States we have inserted these very expensive and wasteful insurer intermediaries that continue to manipulate the patients and the health care providers primarily to meet the requirements of their own insurer business model. To cater to these intermediaries, we are paying them far too much for their administrative excesses while we fail to improve the payment system with the goal of obtaining optimal value in our health care purchasing.

Today’s message demonstrates more of the innovative approaches designed to keep the insurers in business while pretending that these financing innovations improve health, when there is a paucity of evidence for that. Smoking cessation programs are an exception, but they should be separate programs unrelated to health insurance.

Blaming the patient for hypertension, hyperlipidemia, obesity, and diabetes is misdirected since most of these patients have little control over being inflicted with their chronic disorders. Yes, interventions should be instituted where effective, but that does not mean that these people should be financially penalized. Supposed rewards for not having these disorders are really penalties for those that do since the pooled funds are directed away from the patients in need and to the healthy.

This is just another example of attacking the social contract under which we should all receive the care that we need, and transferring the responsibility to individuals who have greater needs. These programs use not only cash penalties and penalties disguised as pseudo-rewards, but also they usually are combined with greater cost sharing, especially higher deductibles. That transfers more of the responsibility to the “consumers” who then have greater control over their own health care – or so the phony argument goes. In reality, these individuals have less control because of the financial barriers being erected between them and their health care – the exact opposite of policies which we should be adopting.

Today Kaiser Health News published a haiku which I wrote in response to Julie Appleby’s article above about penalties being assessed for failing certain health tests. In the haiku, my hyperbole is within the bounds of poetic license since it represents the continuing trends under private insurers:

PAY TO THE TEST

Bad health? Pay up here.
Social contract? That’s passe.
You are on your own.

-Don McCanne, MD

Minnesota: The case for universal care at the state level

By Amy Lange
Star Tribune (Minneapolis), April 2, 2012

Nothing is quite as awe-inspiring as welcoming a newborn into the world. As a nurse and midwife, I’ve been privileged to comfort thousands of laboring women and welcome more than 550 Minnesota babies into my waiting hands. Whether arriving with a robust cry or stunned silence, each is imbued with human dignity and promise. I worked knowing that each mother and baby deserved my full attention and expertise, and I believe that each child, woman and man deserves quality care and secure health coverage. Most Minnesotans, I’m convinced, share this emotional instinct.

Yet in our state and country, the health care we receive is rationed by our ability to afford it rather than provided based on our medical need. Meanwhile, the financial burden for basic care is increasing with the rapid rise of high-deductible plans. And the dominance of employer-based insurance means that a change in jobs yields gaps in coverage, interruptions in care and disruption of the provider-patient relationship.

This sorry state of our health care system is again front-page news, as the Supreme Court weighs arguments it heard last week on the constitutionality of the Affordable Care Act (ACA). Many citizens are wondering what happens next as those necessary reforms hang in the balance.

Against this backdrop, I’m pleased to have collaborated recently with Growth & Justice, a Minnesota public-policy research organization, to produce a report that analyzes the economics of a redesigned health care system for Minnesota (www.growthandjustice.org/beyondaca). Together with the expertise of the Lewin Group, a highly regarded national consulting firm, we analyzed the benefits and costs of a unified and universal health care system for Minnesota, often known as “single-payer.”

Here’s what we found: If Minnesota adopted a unified system with a statewide risk pool, continuous coverage, a common benefit set, and uniform payment rates and reimbursement rules, the annual administrative savings would approach $5 billion. The negotiating clout of a single buyer could save Minnesotans nearly $1 billion on prescription drugs and medical equipment. And with a single claims administrator and the subpoena powers of a state program, we could reduce fraud and realize another $200 million in savings. Paying for the system with a progressive tax structure, rather than increasingly expensive premiums, would reduce average health care costs for all households, except for those in the very highest income brackets.

These combined savings are more than enough to offset both the increased utilization that would result from covering every Minnesotan, and the elimination of deductibles, coinsurance and most copays. In fact, even with a benefit package covering medical, dental, mental health, hospitalization, rehab, vision, hearing and prescription medications, a unified system would save us $4 billion overall in 2014, a 9 percent decrease in health spending. These savings would be achieved despite covering the additional 262,000 Minnesotans who are expected be left uncovered by the ACA.

How much is that in real money, for businesses and families?

The study estimates that, under one financing scenario, employers who currently offer insurance to their employees would save an average of about $1,200 per employee per year. Under the same scenario, an average family would save $1,240 on annual health spending. Those savings would compound over time, because a unified system can establish predictable financing and a global health care budget. With a unified system we could finally bend that cost curve that has been vexing businesses, consumers and governments for decades. The Lewin Group’s projections estimate that the unified system would slow health spending growth, resulting in annual savings of 12 percent or more by 2023.

There are myriad ways to design a health care system, establish benefits and share costs, and there are countless financing alternatives. In fact, we see those variations among all the other wealthy democracies, but the basics are the same in any unified system: birth-to-death coverage, with the democratic government assuring affordability, transparency, equity and access.

Minnesota would not be alone among the states if it forged ahead to provide a universal and unified health system. Governors, legislatures and citizens groups are pushing similar reforms in Vermont, Montana, Oregon and Hawaii. And Minnesota Gov. Mark Dayton favored a universal system for Minnesota in his 2010 campaign.

To be sure, there would be implementation hurdles and political, legal and logistical challenges. Paying for health care with taxes instead of premiums, even if cheaper and fairer overall, will be resisted by antigovernment and antitax ideologues. And yes, sweeping change would create disruption, including the loss of some 42,000 jobs in the current health care bureaucracy. But studies have shown that those losses eventually would be made up by economic growth in other sectors that benefit from greatly reduced health care costs.

Surely few of us are satisfied with the way things are, or are convinced that the Affordable Care Act is the final reform, even if the U.S. Supreme Court upholds it. So let’s hold onto the “unified and universal” option for Minnesota, with the knowledge that we can afford a system in which all newborns can be assured the essential human dignity of access to life-giving care, from the moment they enter the world until they draw their last breath.

Amy Lange, a registered nurse and certified nurse-midwife, is a policy fellow on health care for Growth & Justice, a research organization focused on expanding prosperity.

http://www.startribune.com/opinion/commentaries/145845025.html

Using insurance products to penalize unhealthy patients

Employers Tie Financial Rewards, Penalties To Health Tests, Lifestyle Choices

By Julie Appleby
Kaiser Health News, April 2, 2012
Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease management programs and quit smoking to qualify for hundreds, even thousands of dollars’ worth of premium or deductible discounts.
Proponents say such plans offer people a financial incentive to make healthier choices and manage chronic conditions such as obesity, high blood pressure and diabetes, which are driving up healthcare costs in the USA. Even so, studies of the effect of such policies on lifestyle changes are inconclusive. And advocates for people with chronic health conditions, such as heart disease and diabetes, fear that tying premium costs directly to test results could lead to discrimination.
Nonetheless, such plans could be the wave of the future. Faced with crippling healthcare costs, the number of employers embracing such programs shot up from 49 percent in 2010 to 54 percent last year — and more say they expect to do so soon, according to a survey by consultants Aon Hewitt. Big-name participants include insurer UnitedHealthcare, car rental firm Hertz, postage meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY.
And more employers are expected to adopt them starting in 2014, when the health law allows them to offer larger incentives or penalties than they can now.
Starting in 2014, federal law allows employers to raise the value of the perk or penalty from 20 percent of the cost of a worker’s health insurance plan, to 30 percent. Based on the average cost of employer-offered insurance today, that means firms will be able to offer annual discounts or penalties of more than $4,500 a family, or $1,600 for individuals.
Given the available data, it’s hard to parse how much of the reported savings from such programs come from improved health, and how much from the frequent pairing of such programs with high deductible policies, which shift more costs onto workers.
http://www.kaiserhealthnews.org/Stories/2012/April/02/employers-financial-rewards-penalties-health-tests.aspx

Because we continue to insist that private insurance remains a mainstay of financing health care, we perpetuate the confusion between the health insurance product itself and the actual health care that people need. A well functioning health care financing system should remove financial barriers to health care that people need.
Single payer supporters understand that a universal pool should be financed equitably through progressive taxes, and that full payment for necessary health care should come from this pool – pretty much as they do in Canada. When people need health care, they get it, and the bill goes to the public agency.
In the United States we have inserted these very expensive and wasteful insurer intermediaries that continue to manipulate the patients and the health care providers primarily to meet the requirements of their own insurer business model. To cater to these intermediaries, we are paying them far too much for their administrative excesses while we fail to improve the payment system with the goal of obtaining optimal value in our health care purchasing.
Today’s message demonstrates more of the innovative approaches designed to keep the insurers in business while pretending that these financing innovations improve health, when there is a paucity of evidence for that. Smoking cessation programs are an exception, but they should be separate programs unrelated to health insurance.
Blaming the patient for hypertension, hyperlipidemia, obesity, and diabetes is misdirected since most of these patients have little control over being inflicted with their chronic disorders. Yes, interventions should be instituted where effective, but that does not mean that these people should be financially penalized. Supposed rewards for not having these disorders are really penalties for those that do since the pooled funds are directed away from the patients in need and to the healthy.
This is just another example of attacking the social contract under which we should all receive the care that we need, and transferring the responsibility to individuals who have greater needs. These programs use not only cash penalties and penalties disguised as pseudo-rewards, but also they usually are combined with greater cost sharing, especially higher deductibles. That transfers more of the responsibility to the “consumers” who then have greater control over their own health care – or so the phony argument goes. In reality, these individuals have less control because of the financial barriers being erected between them and their health care – the exact opposite of policies which we should be adopting.
Today Kaiser Health News published a haiku which I wrote in response to Julie Appleby’s article above about penalties being assessed for failing certain health tests. In the haiku, my hyperbole is within the bounds of poetic license since it represents the continuing trends under private insurers:
PAY TO THE TEST
Bad health? Pay up here.
Social contract? That’s passe.
You are on your own.
-Don McCanne, MD

GOP attorney general suing over ACA supports single payer

GOP Attorney General Suing Over Obamacare Supports Single-Payer: ‘I Trust The Government More’

By Scott Keyes
Think Progress, March 30, 2012

According to one Republican attorney general in the lawsuit against the health care individual mandate, the problem with Obamacare is that it’s not a government takeover of health care.

ThinkProgress spoke with Louisiana Attorney General Buddy Caldwell outside the Supreme Court on Wednesday. Caldwell opposes Obamacare and the individual mandate, but for a different reason than most of his fellow litigants: it props up the private health insurance industry. “Insurance companies are the absolute worst people to handle this kind of business,” he declared. “I trust the government more than insurance companies.” Caldwell went on to endorse the idea of a single-payer health care system, saying it’d “be a whole lot better” than Obamacare:

KEYES: You don’t think the subsidies for low-income people are going to be helpful?

CALDWELL: No, no. The worst thing you can do is give it to an insurance company. I want to make my point. All insurance companies are controlled in their particular state. If you have a hurricane come up the east coast, the first one that’s going to leave you when they gotta pay too many claims is an insurance company. Insurance companies are the absolute worst people to handle this kind of business. I trust the government more than insurance companies. If the government wants to put forth a policy where they will pay for everything and you won’t have to go through an insurance policy, that’d be a whole lot better.

http://thinkprogress.org/health/2012/03/30/454261/buddy-caldwell-private-insurance/

Comment:

By Don McCanne, MD

Louisiana Attorney General Buddy Caldwell, a Republican, who has joined the lawsuit against the Affordable Care Act, certainly understands the greatest flaw in the legislation. “The worst thing you can do is give it to an insurance company.” Leading to his conclusion, “If the government wants to put forth a policy where they will pay for everything and you won’t have to go through an insurance policy, that’d be a whole lot better.”