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J.R. Slosar's "The Culture of Excess"

J.R. Slosar's "The Culture of Excess"

The Culture of Excess

How America Lost Self-Control and Why We Need to Redefine Success

By J.R. Slosar
Praeger/ABC-CLIO
From the Introduction
The first chapter provides a background of definition and symptoms of narcissism and its application to our culture and society. The complexity of the concept is presented from history, research, and application. Chapter 2 separates out the factors in the economic marketplace that contribute to cultural narcissism. Chapter 3 focuses on coping with the impact of the factors of cultural narcissism, and explores reality and loss, rigidity and self-destruction, and perfectionism and deception. The fourth chapter looks at our avoidance and anxiety of numbers, math or quantitative analysis, a cultural weakness that opens the door to faulty comparisons and poor decisions. A different perspective is offered in Chapter 5, as our health care system is offered as a primary example of how our society sanctions cultural narcissism and self-defeating behavior. Chapter 6 focuses upon changes in reality and hero images as representative of today’s cultural narcissism. An analysis of sports as a dramatic seeking of reality is discussed. Chapter 7 discusses identity theory and development with the focus on today’s youth and how they see and present themselves. Finally, the last chapter summarizes, integrates, and offers structural recommendations to help change directions and return to a more balanced and realistic appraisal of our economic system and our day-to-day lives and decisions.
From Chapter 5 – Health Care: Waste, Excess and Brokers
The dramatic insistence on free market principles and competition determines the way  health care is delivered today. The entire process exemplifies the culture of excess and cultural narcissism. The excess comes from the tremendous waste of money and resources. This is coupled with the ability of brokers and corporate entities to overcharge and take out money at everyone else’s expense. These are the entitled “me” in the equation. The rest of us continue to pay more and more and even get less and less. Or, many just cannot afford health care at all. Facts and meaningful comparisons are dismissed and not considered by the fear of an alternative labeled as Socialism.
From Chapter 8 – Generation We
To address current trends, our culture must develop a new generation that will move toward a different concept and process of attaining success or “making it.” This new concept is based on connectedness with culture and has a broader perspective of inclusiveness. It also involves having less sense of entitlement, more realistic expectations, and more willingness to regulate one’s own behavior and the marketplace we live in. These are the components need to develop a Generation of We. To effect these changes will mean challenging basic economic assumptions and the elevated status of established economic theories and principles. In turn, we must challenge our current definition of success. The transition from a “me” society to a “we” society can be framed as the classic dichotomy of individualism versus collectivism. But it is a larger and more complex issue than that.
The literature in social psychology is extensive in arguing about the issue of what comes first in order to change. Is it necessary to change behavior first, for change to occur – or is it necessary to change attitude before behavior change can occur? The dichotomy of behavior versus attitude for individuals to change is also applicable to our culture. Changes in individual behavior will principally follow changes dictated by policy. Our mass consumption society will only redirect when forced to. Narcissistic entitlement is too high – self-control is pummeled and expectations of voluntary change are naive. The cycle and patterns  of the culture of excess are too ingrained. As a result, regulation in policy will be an important factor in the change process, and replace the conscious efforts of deregulation and no regulation. As discussed earlier, the cultural deregulation and no regulation movement has deregulated our inner mechanisms of individual self-control. Changes in attitude and thinking will also be related to policy; however, confrontation must occur between current attitudes and thinking that is “me based.” Challenging some existing and entrenched beliefs about economics and economic growth will be necessary for change to occur.
http://www.cultureofexcess.com/

When you look at different models of health care delivery and its financing, the logic of single payer prevails. President Obama has stated such, and even many conservatives agree, though ideologically opposed. So it has been difficult for those of us who support health care justice to understand why there has not been an adequate national grassroots uprising demanding the enactment of an improved Medicare for all. Dr. Slosar’s book provides some insight as to why.
In “The Culture of Excess,” Dr. Slosar gives us the perspective of the discipline of psychology, both as applied to individuals and as applied to our culture. He explains how cultural narcissism has permeated our society and has led to the culture of excess. As the “me” society has dominated over the “we” society, narcissism has suppressed the support for collective solutions to our social problems. Within that framing, it is easier to understand why a near-perfect “we” solution for health care reform – single payer Medicare for all – was rejected in favor of the highly-flawed “me” solution – the individual private insurance plans.
Although the process will not be easy, Dr. Slosar shows us why addressing our cultural narcissism must be an integral part of achieving health care justice for all. In a Generation We, everyone will have the health care that they need.

J.R. Slosar’s “The Culture of Excess”

The Culture of Excess

How America Lost Self-Control and Why We Need to Redefine Success

By J.R. Slosar
Praeger/ABC-CLIO

From the Introduction

The first chapter provides a background of definition and symptoms of narcissism and its application to our culture and society. The complexity of the concept is presented from history, research, and application. Chapter 2 separates out the factors in the economic marketplace that contribute to cultural narcissism. Chapter 3 focuses on coping with the impact of the factors of cultural narcissism, and explores reality and loss, rigidity and self-destruction, and perfectionism and deception. The fourth chapter looks at our avoidance and anxiety of numbers, math or quantitative analysis, a cultural weakness that opens the door to faulty comparisons and poor decisions. A different perspective is offered in Chapter 5, as our health care system is offered as a primary example of how our society sanctions cultural narcissism and self-defeating behavior. Chapter 6 focuses upon changes in reality and hero images as representative of today’s cultural narcissism. An analysis of sports as a dramatic seeking of reality is discussed. Chapter 7 discusses identity theory and development with the focus on today’s youth and how they see and present themselves. Finally, the last chapter summarizes, integrates, and offers structural recommendations to help change directions and return to a more balanced and realistic appraisal of our economic system and our day-to-day lives and decisions.

From Chapter 5 – Health Care: Waste, Excess and Brokers

The dramatic insistence on free market principles and competition determines the way  health care is delivered today. The entire process exemplifies the culture of excess and cultural narcissism. The excess comes from the tremendous waste of money and resources. This is coupled with the ability of brokers and corporate entities to overcharge and take out money at everyone else’s expense. These are the entitled “me” in the equation. The rest of us continue to pay more and more and even get less and less. Or, many just cannot afford health care at all. Facts and meaningful comparisons are dismissed and not considered by the fear of an alternative labeled as Socialism.

From Chapter 8 – Generation We

To address current trends, our culture must develop a new generation that will move toward a different concept and process of attaining success or “making it.” This new concept is based on connectedness with culture and has a broader perspective of inclusiveness. It also involves having less sense of entitlement, more realistic expectations, and more willingness to regulate one’s own behavior and the marketplace we live in. These are the components need to develop a Generation of We. To effect these changes will mean challenging basic economic assumptions and the elevated status of established economic theories and principles. In turn, we must challenge our current definition of success. The transition from a “me” society to a “we” society can be framed as the classic dichotomy of individualism versus collectivism. But it is a larger and more complex issue than that.

The literature in social psychology is extensive in arguing about the issue of what comes first in order to change. Is it necessary to change behavior first, for change to occur – or is it necessary to change attitude before behavior change can occur? The dichotomy of behavior versus attitude for individuals to change is also applicable to our culture. Changes in individual behavior will principally follow changes dictated by policy. Our mass consumption society will only redirect when forced to. Narcissistic entitlement is too high – self-control is pummeled and expectations of voluntary change are naive. The cycle and patterns  of the culture of excess are too ingrained. As a result, regulation in policy will be an important factor in the change process, and replace the conscious efforts of deregulation and no regulation. As discussed earlier, the cultural deregulation and no regulation movement has deregulated our inner mechanisms of individual self-control. Changes in attitude and thinking will also be related to policy; however, confrontation must occur between current attitudes and thinking that is “me based.” Challenging some existing and entrenched beliefs about economics and economic growth will be necessary for change to occur.

http://www.cultureofexcess.com/

When you look at different models of health care delivery and its financing, the logic of single payer prevails. President Obama has stated such, and even many conservatives agree, though ideologically opposed. So it has been difficult for those of us who support health care justice to understand why there has not been an adequate national grassroots uprising demanding the enactment of an improved Medicare for all. Dr. Slosar’s book provides some insight as to why.

In “The Culture of Excess,” Dr. Slosar gives us the perspective of the discipline of psychology, both as applied to individuals and as applied to our culture. He explains how cultural narcissism has permeated our society and has led to the culture of excess. As the “me” society has dominated over the “we” society, narcissism has suppressed the support for collective solutions to our social problems. Within that framing, it is easier to understand why a near-perfect “we” solution for health care reform – single payer Medicare for all – was rejected in favor of the highly-flawed “me” solution – the individual private insurance plans.

Although the process will not be easy, Dr. Slosar shows us why addressing our cultural narcissism must be an integral part of achieving health care justice for all. In a Generation We, everyone will have the health care that they need.

The price of private health insurance

By Samuel Metz
The Oregonian, May 17, 2010

How much would you pay to keep your private health insurance instead of a single-payer system? A thousand dollars? Ten thousand dollars?

How about $350 billion?

Americans still persist in financing health care with unregulated private insurance. Consequently, our public health is the worst among civilized nations while our costs are the highest, bar none, in the world.

Driving this high cost is overhead – plain old ponderous paperwork generated by our private insurance system – to the tune of $350 billion a year. Make no mistake: This money does not pay for health care. It pays for administrators, accountants, billing clerks and benefits managers to transfer our money to health care providers.

Not all of this goes to private insurance companies, just $126 billion. And not all of that goes to profit and lobbying either. So where does the rest go?

It goes toward coercing insurance companies to pay up.

It isn’t easy for a health care provider to collect from an insurance company. Hospitals need sprawling billing departments, often larger than their nursing staff, to act as collection agencies. Physicians struggle as well. The average doctor spends $68,000 annually cajoling private insurance companies to pay what is owed. A family practitioner in Chicago might find herself dealing with 17,000 different schedules. Suddenly you realize what all those clerks are doing behind the counter at your physician’s office, staring at computer screens and waiting on hold.

Your employer is not spared paperwork either. Your harried boss finds the fine print of health insurance policies as baffling as you do. Hence the need for an expert, maybe dozens, just to keep track of your health care benefits.

It all adds up – to $350 billion.

Clearly filtering our dollars through private insurance companies squanders a lot of money (one dollar out of every three to be exact) before it gets to real-world health care. These losses would evaporate if the U.S. adopted a single-payer system. Mind you, single-payer systems still have administrative costs, just $350 billion less than we have now.

Let’s see how $350 billion in paperwork compares to other costs.

It is more than we spend on immigrant health care ($40 billion), defensive medicine ($60 billion), and health insurance fraud ($72 billion) — combined. It is more than we spend on medications ($261 billion), obesity-related diseases ($144 billion), tobacco-related diseases ($168 billion) or alcohol-related diseases ($96 billion). It’s more than we spent on the Afghanistan war ($179 billion). It’s more than the annual interest on our national debt ($224 billion).

And it’s more than the extra funding needed for comprehensive health care for all Americans ($225 billion).

Curiously, one of America’s own single-payer systems, the Veterans Administration, takes care of the sickest patients with the best results at the lowest cost with the highest patient satisfaction in the nation. Can life without private health insurance paperwork be all that bad?

If we insist on protecting our private health insurance industry with an extra $350 billion each year, we deserve a fair return on our investment.

What return are you getting for your $350 billion?

Samuel Metz is a Portland physician and a member of Physicians for a National Health Program and a foundingmember of Mad As Hell Doctors.

http://www.oregonlive.com/opinion/index.ssf/2010/05/the_price_of_private_health_in.html

Gingrich predicts nationalized health care

Gingrich in Va.: A Republican Congress could defund health care law

By Rosalind Helderman
The Washington Post
May 14, 2010

(Former House Speaker Newt) Gingrich’s comments came at a health-care industry sponsored conference held by Center for Health Transformation, a project of his consulting firm.

Gingrich argued the federal law has been intentionally designed to encourage businesses to drop health care for their employees, incurring a new fine in the law for not offering insurance. Employees will then enter new individual health exchanges, Gingrich argued, but find them so expensive that they will clamor for a nationalized health care system.

http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html

Comment: 

By Don McCanne, MD

Although we don’t agree with Newt Gingrich’s solution for our health system’s problems (computerize and privatize the entire system), we do agree with him and the multitude of other conservatives who state that the intolerable costs of health care eventually will drive the nation to demand a nationalized health care system. It’s just too bad that so much more suffering will take place before we arrive there.

Gingrich predicts nationalized health care

Gingrich in Va.: A Republican Congress could defund health care law

By Rosalind Helderman
The Washington Post
May 14, 2010
(Former House Speaker Newt) Gingrich’s comments came at a health-care industry sponsored conference held by Center for Health Transformation, a project of his consulting firm.
Gingrich argued the federal law has been intentionally designed to encourage businesses to drop health care for their employees, incurring a new fine in the law for not offering insurance. Employees will then enter new individual health exchanges, Gingrich argued, but find them so expensive that they will clamor for a nationalized health care system.
http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html

Although we don’t agree with Newt Gingrich’s solution for our health system’s problems (computerize and privatize the entire system), we do agree with him and the multitude of other conservatives who state that the intolerable costs of health care eventually will drive the nation to demand a nationalized health care system. It’s just too bad that so much more suffering will take place before we arrive there.

British Medical Association opposes for-profit commercialization

Our Principles

British Medical Association (BMA)

The BMA is against the increasing commercialisation of patient care. We want to see the NHS restored as a public service working co-operatively for patients, not a market of commercial businesses competing with each other. That’s why we’re campaigning for an NHS which:

1. Provides high quality, comprehensive healthcare for all, free at the point of use

2. Is publicly funded through central taxes, publicly provided and publicly accountable

3. Significantly reduces commercial involvement

4. Uses public money for quality healthcare, not profits for shareholders

5. Cares for patients through co-operation, not competition

6. Is led by medical professionals working in partnership with patients and the public

7. Seeks value for money but puts the care of patients before financial targets

8. Is fully committed to training future generations of medical professionals

http://www.lookafterournhs.org.uk/for-doctors/our-principles/

Comment: 

By Don McCanne, MD

Who could understand better the British National Health Service than the physicians of the British Medical Association? Their experience has led them to take a strong stand against for-profit commercialization of health care. Are physicians in the United States fundamentally that much different from those in Great Britain? Don’t think so.

British Medical Association opposes for-profit commercialization

Our Principles

British Medical Association (BMA)
The BMA is against the increasing commercialisation of patient care. We want to see the NHS restored as a public service working co-operatively for patients, not a market of commercial businesses competing with each other. That’s why we’re campaigning for an NHS which:
1. Provides high quality, comprehensive healthcare for all, free at the point of use
2. Is publicly funded through central taxes, publicly provided and publicly accountable
3. Significantly reduces commercial involvement
4. Uses public money for quality healthcare, not profits for shareholders
5. Cares for patients through co-operation, not competition
6. Is led by medical professionals working in partnership with patients and the public
7. Seeks value for money but puts the care of patients before financial targets
8. Is fully committed to training future generations of medical professionals
http://www.lookafterournhs.org.uk/for-doctors/our-principles/

Who could understand better the British National Health Service than the physicians of the British Medical Association? Their experience has led them to take a strong stand against for-profit commercialization of health care. Are physicians in the United States fundamentally that much different from those in Great Britain? Don’t think so.

Canadian private, for-profit hospital files for bankruptcy

Bankrupt beacon of privatized health-care

By Gillian Steward
thestar.com
May 11, 2010

A Calgary for-profit hospital, once a beacon of hope for medical entrepreneurs across the country, declared bankruptcy last week. And who will have to pick up the pieces? None other than the public health-care system and ultimately Alberta taxpayers.

For years, critics predicted that this experiment in privatized health care would prove unreliable and expensive. But no one imagined a scenario in which publicly funded Alberta Health Services would go to court in a bid to keep the lights on over the operating tables in an investor-owned hospital. No one imagined that AHS would be paying receivership fees in order to keep the doors open. But this is, in fact, what has happened because Calgary’s public health-care system is so reliant on private partners.

The private hospital, Health Resource Centre, was once the focal point of premier Ralph Klein’s health-care strategies. It was for the benefit of HRC and its bevy of investors and orthopedic surgeons that in 2000 the Alberta government passed the Health Care Protection Act, which allowed private surgical clinics to keep patients overnight, thus allowing HRC to perform hip and knee replacements that had previously been permitted only in public hospitals.

The Klein government had already closed three public hospitals in Calgary as it pared its budget in order to eliminate the deficit. So there was indeed a shortage of operating theatres, a shortage HRC was quite prepared to fill. It had taken over space in one of the hospitals that had been closed and sold off. And it had been lobbying government ministers and local health authority administrators in an effort to secure contracts to provide surgeries for publicly insured patients who could not be accommodated in the public hospitals.

In 2004, HRC finally hit pay dirt. The regional health authority awarded it a two-year contract worth $20 million for the provision of 2,500 hip and knee surgeries. The health authority acknowledged that it was paying 10 per cent more than what it would cost if the surgeries were done in a public hospital but, given the shortage of operating theatres, it didn’t have much choice.

The contracts continued and HRC became so successful that it decided to expand and rent expensive space in a new development. That’s when HRC ran into trouble. Before it had even moved in, the developer claimed HRC had defaulted on payments. HRC claimed that Alberta Health Services had cut back on promised contracts, and declared bankruptcy.

AHS then went to court to try and save HRC, for without it there are not enough operating theatres to accommodate all the patients scheduled for surgery.

http://www.thestar.com/news/canada/article/807403–steward-bankrupt-beacon-of-privatized-health-care

And…

Clinic rescue costs $2.8M

By Colette Derworiz
Calgary Herald
May 12, 2010

Alberta Health Services will spend at least $2.8 million to keep a financially troubled private surgical centre operating for the next eight months, sparking outrage the Stelmach government is using taxpayer money to prop up a for-profit enterprise.

Health Resource Centre — a private facility owned by Networc Health Inc. — will stay open to perform publicly funded knee and hip replacement surgeries after the Edmonton-based medical superboard took the unusual step of filing legal action to fend off a possible bankruptcy.

But the intervention comes with a price tag for taxpayers after AHS ended up buying $1.3 million of the company’s outstanding bank loans (at full value) to bolster the superboard’s legal standing in the case as a secured creditor.

In addition, AHS agreed to pay $600,000 in interim receivership costs and the clinic’s monthly rent — which will work out to nearly $960,000 from now until January — to Northwest Healthcare Properties, the landlord

“You have to wonder how many times taxpayers have to pay for the same service,” said Liberal MLA Kevin Taft. “Taxpayers seem to be on several hooks at once for this debt. It’s expensive for the taxpayers, unnerving for the patients and it’s gotta be difficult for the staff. This is just lose, lose, lose.”

Proponents of public health care said it’s an expensive lesson.

“AHS paying $100,000 a month on a building they sold for a song just rubs salt in the wounds of the paying public,” said David Eggen of Friends of Medicare.

Dr. Tom Noseworthy, a health policy expert at the University of Calgary, said the region “needed some breathing room” to continue delivering the surgeries.

“For practical purposes, that private enterprise has become an extension of their business, or shall we say, our business,” he said. “Private health-care delivery is never cheaper, it’s never of better quality and you don’t get better outcomes. I don’t know how many times we have to say that.”

http://www.calgaryherald.com/health/Clinic+rescue+costs/3017404/story.html

And…

Calgary Herald

July and August 2005

Premier Ralph Klein:  “Let me be blunt. We have unacceptable waiting lists in our publicly funded, rationed health-care system, and all the money in the world is not going to eliminate them.”

Don McCanne:  “Ralph Klein states that ‘all the money in the world’ is not going to eliminate waiting lists, unless the source of the funds is private instead of public. What nonsense.”

https://pnhp.org/news/2005/august/albertas_premier_kl.php

Comment: 

By Don McCanne, MD

Right-wing ideologues, such as former premier Ralph Klein of Alberta, have continued to push for more privatization of Canada’s health care system. They claim that the private sector provides greater access and higher quality at a lower cost. As if they didn’t have enough contrary evidence from the United States, they have continued with their experiments in privatization.

The experience with Health Resource Centre – a private, for-profit hospital – reinforces the proponents of the public system who use health policy science to sound the alarms over the ill-advised march toward further privatization.

The current saga began with Premier Klein’s notion that public hospitals had to be shut down because the taxpayers couldn’t afford them, yet private hospitals should position themselves to address the problem of excess queues which were further exacerbated by the failure of the government to appropriately adjust capacity in the system. He seems to imply that private funds manifest some sort of magical quality that public funds lack.

The results of this experiment would suggest the opposite. The for-profit Health Resource Center not only provided the same orthopedic services at a 10 percent greater cost, the center is now going to cost the taxpayers much more money in an effort to bail it out. This could have been prevented if Klein and others of his ilk had provided appropriate stewardship of the public program. Tweaking a public system is far less expensive than establishing a parallel private system.

Dr. Tom Noseworthy, health policy expert at the University of Calgary, states it well when he says, “Private health-care delivery is never cheaper, it’s never of better quality and you don’t get better outcomes. I don’t know how many times we have to say that.”

Napalm, Big Health Insurance, and Divestment

By Rob Stone M.D.
The Huffington Post
May 12, 2010

The modern era of fire as a weapon of war came with jellied gasoline, or napalm, dropped from bombers in the late days of WWII. The bombing of Tokyo created a firestorm that incinerated more people than the nuclear bombing of Hiroshima.

The modern era of corporate shareholder activism was born during the Vietnam War when the Medical Committee for Human Rights and its leader Dr. Quentin Young were given shares in Dow Chemical Company, infamous for manufacturing the napalm used in Vietnam. In 1968 Dr. Young submitted a resolution to Dow “that napalm shall not be sold to any buyer unless that buyer gives reasonable assurances that the substance will not be used on or against human beings.”

Dow fought inclusion of the proposal in its proxy statement and the Securities and Exchange Commission (SEC) initially sided with the company. Dr. Young appealed and the DC District Court ruled that part of the original intent of Congress in creating the SEC was “to give true vitality to the concept of corporate democracy [emphasis added],” and the resolution made it onto the proxy.

Isn’t “Corporate Democracy” an oxymoron? What are the effects of corporations on our democracy?

The corrosive effect of corporate influence on democracy was recognized by Abraham Lincoln in a letter to Col. William Elkins, November 21, 1864:

“I see in the near future a crisis approaching that unnerves me and causes me to tremble for the safety of my country. . . . corporations have been enthroned and an era of corruption in high places will follow, and the money power of the country will endeavor to prolong its reign by working upon the prejudices of the people until all wealth is aggregated in a few hands and the Republic is destroyed.”

Nobel Economics Prizewinner and Conservative icon Milton Friedman (Capitalism and Freedom, 1962) framed the crisis very differently from Lincoln:

“Few trends could undermine the very foundations of our free society as the acceptance by corporate officials of a social responsibility other than to make as much money for their shareholders as possible.”

While Lincoln felt corporations could destroy the Republic, Friedman felt that free society itself was threatened by the idea of any corporate responsibility other than making a profit.

The health insurance industry has been profitable for its investors. The five largest health insurance companies sailed through the worst economic downturn since the great Depression to set new industry profit records in 2009. WellPoint, UnitedHealth, Aetna, Humana, and CIGNA enjoyed combined profits of $12.2 billion, up 56 percent from 2008. It was the best year ever for Big Insurance.

You can argue for a robust profit motive for flat screen TV’s, but health insurance companies don’t even make a product. The only thing they make is money.

In 2007 WellPoint convinced the Federal Deposit Insurance Corporation to allow the company to incorporate as a bank in Utah. WellPoint chose Utah, a state where they sell no health insurance, because Utah has such loose banking regulations. Even Utah’s regulators balked at first, arguing that WellPoint was an insurance company, not a bank. But WellPoint succeeded in being reclassified as a financial institution.

When John McCain was running for president he drew this parallel between banking and health insurance (Washington Post 9/21/08)

“Opening up the health insurance market … as we have done over the last decade in banking, would provide more choices of innovative products less burdened by regulation.”

We know where financial deregulation got us.

Support for healthcare reform ran strong through most of 2009 with polls showing backing for the public option consistently over 60 percent through September. Now the consensus post-passage seems to be that the reform bill is unpopular. An April public opinion poll sheds light on how confused and frustrated people are. Although 58 percent supported repealing the bill, 67 percent still felt it was important that Congress work on “establishment of a public option that would give individuals a choice between government-provided health insurance or private health insurance,” and they wanted it done in the current legislative session!

How do you reconcile 58 percent in favor of repealing the bill but 67 percent still favoring a public option? People aren’t as stupid as politicians make them out to be. They understand that this bill doesn’t go nearly far enough. They resent having no choice but to buy private insurance.

That’s why we say, Healthcare Reform, We’re STILL FOR It… and we’re not done yet.

Have no doubt – the lobbyists for Big Insurance aren’t done yet.

Why do we need health insurance companies? We know that they raise premiums with no justification and cancel policies with the flimsiest of excuses. They notified their investors that they will spend billions of their record profits this year, not on anything to improve our lives, but to buy back their stock to bolster the share price, which increases executive compensation.

We know Big Insurance spent millions to influence Congress, and it resulted in a bill with some tissue paper handcuffs of new regulation, but a program that has the potential to bring them huge profits. Insurance corporations will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power and their ability to block future reform.

Before he died, Ted Kennedy wrote President Obama about healthcare reform, which he called “the great unfinished business of our society.” He made it clear that “what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

This is about justice and the character of our country. To care about such things would not fulfill the fiduciary responsibility of Big Insurance’s executives and boards of directors. They are wedded to a business model that we can no longer afford, financially or morally. They profit by collecting premiums from healthy people and avoiding by any means possible paying for the care of the sick. I went to medical school so that I could take care of sick people.

Dr. Quentin Young is still going strong at 87. He is the National Coordinator of Physicians for a National Health Program and recently had this to say, “The grave crisis engulfing the American health system is fundamentally the work product of the for-profit health insurance industry, which is driving up medical costs relentlessly.“

When his resolution calling on Dow to stop selling napalm was finally voted on, it went down in flames. Dow won that battle, but has neve
r escaped the tarnish of napalm.

I am sponsoring a resolution on the WellPoint/Anthem proxy calling on the company to study the feasibility of returning to its Blue Cross, charitable, non-profit roots (HuffingtonPost 4/12/10). My prediction is that even if it passes, WellPoint is incapable of reforming itself.

We need to move beyond shareholder resolutions and begin building a divestment campaign like the one aimed at American corporations doing business with South Africa’s apartheid government. From 1985 to 1990, over 200 U.S. companies cut all ties with South Africa, resulting in a loss of $1 billion in direct American investment. (May 4 was the 16th anniversary of Nelson Mandela’s election as president of South Africa, after spending 27 years in prison.)

The health insurance industry is the poster child for the corrosive effect huge corporations have on our Democracy. Their growing, unchecked power threatens our economy and our very health. Divestment opens a new avenue to expose them for the parasitic middlemen they are.

Will this reform bill be a step in the right direction, or a bail out for the insurance industry? Can we break the death grip Big Insurance has on Congress? Will we ever achieve affordable, universal coverage, like a single-payer Medicare for All program?

Burning questions remain. We’re not done yet.

Join Quentin Young, Rob Stone, and Wendell Potter at our rally in Indianapolis on Monument Circle, across the street from WellPoint corporate headquarters, Tuesday May 18th at 11:00 AM EDT. The rally follows the annual shareholders meeting. A printable flyer for the rally is available here.

http://www.huffingtonpost.com/rob-stone-md/napalm-big-health-insuran_b_573220.html

Canadian private, for-profit hospital files for bankruptcy

Bankrupt beacon of privatized health-care

By Gillian Steward
thestar.com
May 11, 2010
A Calgary for-profit hospital, once a beacon of hope for medical entrepreneurs across the country, declared bankruptcy last week. And who will have to pick up the pieces? None other than the public health-care system and ultimately Alberta taxpayers.
For years, critics predicted that this experiment in privatized health care would prove unreliable and expensive. But no one imagined a scenario in which publicly funded Alberta Health Services would go to court in a bid to keep the lights on over the operating tables in an investor-owned hospital. No one imagined that AHS would be paying receivership fees in order to keep the doors open. But this is, in fact, what has happened because Calgary’s public health-care system is so reliant on private partners.
The private hospital, Health Resource Centre, was once the focal point of premier Ralph Klein’s health-care strategies. It was for the benefit of HRC and its bevy of investors and orthopedic surgeons that in 2000 the Alberta government passed the Health Care Protection Act, which allowed private surgical clinics to keep patients overnight, thus allowing HRC to perform hip and knee replacements that had previously been permitted only in public hospitals.
The Klein government had already closed three public hospitals in Calgary as it pared its budget in order to eliminate the deficit. So there was indeed a shortage of operating theatres, a shortage HRC was quite prepared to fill. It had taken over space in one of the hospitals that had been closed and sold off. And it had been lobbying government ministers and local health authority administrators in an effort to secure contracts to provide surgeries for publicly insured patients who could not be accommodated in the public hospitals.
In 2004, HRC finally hit pay dirt. The regional health authority awarded it a two-year contract worth $20 million for the provision of 2,500 hip and knee surgeries. The health authority acknowledged that it was paying 10 per cent more than what it would cost if the surgeries were done in a public hospital but, given the shortage of operating theatres, it didn’t have much choice.
The contracts continued and HRC became so successful that it decided to expand and rent expensive space in a new development. That’s when HRC ran into trouble. Before it had even moved in, the developer claimed HRC had defaulted on payments. HRC claimed that Alberta Health Services had cut back on promised contracts, and declared bankruptcy.
AHS then went to court to try and save HRC, for without it there are not enough operating theatres to accommodate all the patients scheduled for surgery.
http://www.thestar.com/news/canada/article/807403–steward-bankrupt-beacon-of-privatized-health-care

And…

Clinic rescue costs $2.8M

By Colette Derworiz
Calgary Herald
May 12, 2010
Alberta Health Services will spend at least $2.8 million to keep a financially troubled private surgical centre operating for the next eight months, sparking outrage the Stelmach government is using taxpayer money to prop up a for-profit enterprise.
Health Resource Centre — a private facility owned by Networc Health Inc. — will stay open to perform publicly funded knee and hip replacement surgeries after the Edmonton-based medical superboard took the unusual step of filing legal action to fend off a possible bankruptcy.
But the intervention comes with a price tag for taxpayers after AHS ended up buying $1.3 million of the company’s outstanding bank loans (at full value) to bolster the superboard’s legal standing in the case as a secured creditor.
In addition, AHS agreed to pay $600,000 in interim receivership costs and the clinic’s monthly rent — which will work out to nearly $960,000 from now until January — to Northwest Healthcare Properties, the landlord
“You have to wonder how many times taxpayers have to pay for the same service,” said Liberal MLA Kevin Taft. “Taxpayers seem to be on several hooks at once for this debt. It’s expensive for the taxpayers, unnerving for the patients and it’s gotta be difficult for the staff. This is just lose, lose, lose.”
Proponents of public health care said it’s an expensive lesson.
“AHS paying $100,000 a month on a building they sold for a song just rubs salt in the wounds of the paying public,” said David Eggen of Friends of Medicare.
Dr. Tom Noseworthy, a health policy expert at the University of Calgary, said the region “needed some breathing room” to continue delivering the surgeries.
“For practical purposes, that private enterprise has become an extension of their business, or shall we say, our business,” he said. “Private health-care delivery is never cheaper, it’s never of better quality and you don’t get better outcomes. I don’t know how many times we have to say that.”
http://www.calgaryherald.com/health/Clinic+rescue+costs/3017404/story.html

And…

Calgary Herald

July and August 2005
Premier Ralph Klein:  “Let me be blunt. We have unacceptable waiting lists in our publicly funded, rationed health-care system, and all the money in the world is not going to eliminate them.”
Don McCanne:  “Ralph Klein states that ‘all the money in the world’ is not going to eliminate waiting lists, unless the source of the funds is private instead of public. What nonsense.”
https://pnhp.org/news/2005/august/albertas_premier_kl.php

Right-wing ideologues, such as former premier Ralph Klein of Alberta, have continued to push for more privatization of Canada’s health care system. They claim that the private sector provides greater access and higher quality at a lower cost. As if they didn’t have enough contrary evidence from the United States, they have continued with their experiments in privatization.
The experience with Health Resource Centre – a private, for-profit hospital – reinforces the proponents of the public system who use health policy science to sound the alarms over the ill-advised march toward further privatization.
The current saga began with Premier Klein’s notion that public hospitals had to be shut down because the taxpayers couldn’t afford them, yet private hospitals should position themselves to address the problem of excess queues which were further exacerbated by the failure of the government to appropriately adjust capacity in the system. He seems to imply that private funds manifest some sort of magical quality that public funds lack.
The results of this experiment would suggest the opposite. The for-profit Health Resource Center not only provided the same orthopedic services at a 10 percent greater cost, the center is now going to cost the taxpayers much more money in an effort to bail it out. This could have been prevented if Klein and others of his ilk had provided appropriate stewardship of the public program. Tweaking a public system is far less expensive than establishing a parallel private system.
Dr. Tom Noseworthy, health policy expert at the University of Calgary, states it well when he says, “Private health-care delivery is never cheaper, it’s never of better quality and you don’t get better outcomes. I don’t know how many times we have to say that.”

BMA launches public campaign against NHS commercialisation

British Medical Association
Press Release
(issued Friday 12 Feb 2010)

The public is being urged to join the BMA’s ‘Look After our NHS’ campaign against the role of commercial companies providing NHS care in England.

Successive government policies have created a market in healthcare and allowed commercially run firms to compete against existing NHS trusts and GP practices to provide NHS care. The BMA is concerned that this is having an adverse impact on many parts of the NHS in England.

The BMA’s ‘Look After our NHS’ campaign website has been revamped from today (Friday 12 February, 2010), so that members of the public can show their support for an NHS which is publicly funded and publicly provided.

And next week (from Monday 15 February, 2010) the BMA is sending ‘Look After our NHS’ campaign packs to each of its members in England – over 100,000 doctors and medical students. The packs contain posters picturing businessmen taking money out of the NHS, and call on the public to “help us put patients before profits.”

Leaflets for patients, warning them that “your local GP practice, hospital or community health service could be run by a commercial, profit-driven company in the future”, will also be distributed via GP practices and BMA representatives in hospitals.

Dr Hamish Meldrum, Chairman of Council at the BMA, says:

“We want an NHS with patients, not profits, at its heart. The public values the NHS as a publicly provided, publicly funded service. Like doctors, they do not want vital funding to be diverted to shareholders.

“NHS staff see on a daily basis the waste of taxpayers’ money caused by this fixation with market ideology. Particularly as the public purse strings tighten, it is crucial that public money is no longer wasted on expensive commercial experiments.

“Doctors have already backed the campaign. Now members of the public can show politicians the extent of opposition to commercialisation of their NHS.”

The campaign packs for doctors contain a brochure warning of the impact market-based reforms are having on the NHS. It states that:

  • The creation of a market in the NHS has meant an increase in bureaucracy; the number of senior managers in the NHS rose by 91% between 1995 and 2008 – more than double the increase in numbers of doctors and nurses
  • Many private NHS providers have received millions in guaranteed payments for contracts, despite treating fewer patients than planned; on average, the first wave of Independent Sector Treatment Centres delivered just 85% of activity paid for – suggesting a shortfall of £220 million on the £1.47 billion contracts
  • New ‘GP-led health centres’ have been costly, enjoying on average three times the funding per patient of regular GP practices, despite in some cases very few patients registering with them
  • Every eight cases diverted to an Independent Sector treatment centre costs the taxpayer the equivalent of almost ten cases dealt with by the NHS
  • The Private Finance Initiative is now funding over 100 new hospital schemes, valued at £10.9 billion, but set to cost the taxpayer £62.6 billion by the time the final payments are made in 2048

Notes to editors

1) View campaign materials:

Website (re-vamped site live from Friday 12 Feb – jpg of new home page available on request): http://lookafterournhs.org.uk

Campaign poster (both sides):
http://lookafterournhs.org.uk/wp-content/uploads/final-text-cartoon-poster-2701103.pdf

Brochure being sent to doctors:
http://lookafterournhs.org.uk/wp-content/uploads/doctor-final-270110.pdf

Leaflet for public being distributed in surgeries and hospitals:
http://lookafterournhs.org.uk/wp-content/uploads/public-leaflet-final-260110.pdf

2) The Look After our NHS campaign was launched to a primarily medical audience in June 2009.

The MMI proves that PPACA is already a failure

2010 Milliman Medical Index

Milliman, Inc.
May 2010

The annual Milliman Medical Index (MMI) reports total annual medical spending for a typical American family of four covered by an employer-sponsored preferred provider organization (PPO) program. The MMI represents the total cost of payments to healthcare providers, and excludes the non-medical administrative component of health plan premiums.

The total 2010 medical cost for a typical American family of four is $18,074.

This is an increase of 7.8%. This is the third year in a row that the annual rate of increase has been below 8%; however, the dollar increase of $1,303 is still the highest we have seen in the last 10 years and since the inception of this index.

Cost Implications of Healthcare Reform on Family of Four

While employers are making the immediate changes required to their benefit plans and adapting their longer-term benefit strategy to the new regulatory environment, healthcare costs continue to increase at rates exceeding most other costs of doing business. Debate continues on the extent to which the changes from healthcare reform have potential to bend the long-term cost curve; however, for the near term, the underlying drivers of increasing healthcare costs are not expected to immediately change.

Efforts to enforce insurance rate controls may have indirect impact on the growth in healthcare costs but still do not address the underlying cost of care. For now, the onus of control remains with insurers, who will attempt to put pressure of providers to lower costs to a level that approved premium rates can support. There may be more extensive shift in market dynamics in 2014, when the government takes on an even larger proportion of payment responsibility due to expansion in Medicaid, the creation of exchanges, and the availability of subsidies for certain lower-income individuals.

While underlying cost drivers as yet remain relatively unchanged, there are some changes that will have a predictable effect on cost. The most immediate changes, such as increasing dependent coverage up to age 26 and elimination of lifetime and annual benefit maximums, will cause a direct shift in costs from employees to employers. Other options that will be implemented later, such as federally-mandated state health exchange plans, require much deeper analysis before an employer can make an informed decision. Because the practical implementation of this new legislation has not yet been defined, many employers are choosing to delay changes to their benefit plans for future annual benefit cycles, although it is very possible that those changes could be dramatic.

Looking into the future for the “typical family of four” represented by this analysis, the cost implications of reform are unclear. Much depends on the underlying medical cost that is dissected in this report. When it comes to cost control, the status quo is not encouraging. If reform or some other factors can motivate a reduction in the underlying cost of care, it will have important implications for the future cost of care for American families.

http://www.milliman.com/expertise/healthcare/publications/mmi/pdfs/milliman-medical-index-2010.pdf

Comment: 

By Don McCanne, MD

The Milliman Medical Index (MMI) is especially significant this year because it proves that the Patient Protection and Affordable Care Act (PPACA) is already a miserable failure even before the provisions of the act take place. The MMI for 2010 is $18,074. Let’s look at what that means under the PPACA.

It’s important to understand precisely what the MMI is. It is the average amount that is already being spent on actual health care for a typical family of four enrolled in an employer-sponsored Preferred Provider Organization (PPO) plan. It does not include any of the administrative expenses or profits of the private insurers.

Already there’s a problem. Since the MMI represents the amounts being paid by PPOs, the discounts for network physicians and hospitals and other products and services are already built in. The MMI represents a lower level of spending made possible by contracting payment rates with the physicians and hospitals that are included in the networks. That means that families for whom the spending is at MMI levels have lost their right of free choice of physicians and hospitals unless they are willing and able to pay significant financial penalties for obtaining care outside of the networks. The plans that will be available in the state insurance exchanges will be network-restricted managed care plans – mostly PPOs with some HMOs. Health care reform that takes away choice is not the reform that we wanted.

One of the most important measures in PPACA attempts to address the problem of high costs and the poor coverage of the plans currently available in the individual and small group markets. Individuals and small employers who are having problems finding adequate affordable plans will be able to buy plans in the insurance exchanges that theoretically have the same benefits and cost efficiencies of the large group market currently available to larger employers. If these exchanges actually work as intended, then the MMI will represent the average cost of health care for a family of four enrolled through the exchanges. This assumes that the insurers will cooperate and not continue to use deceptive innovations that have resulted in lower-value products in the individual insurance markets.

Assuming that the exchanges work as intended, keep in mind that the insurers offering individual and small group plans within the exchanges will be required to maintain a medical loss ratio of 80 percent. That is the amount that must be spent on actual health care – the amount that is represented by the MMI, minus the out-of-pocket expenses. They will keep 20 percent for their own administrative costs and profits (or even more if they are successful in their current efforts to shove some of their administrative costs into the medical loss ratio by reclassifying these administrative costs as “health care).

So let’s look at the numbers. The standard Silver plans offered by the exchanges will have an actuarial value of 70 percent. That means that the plans will pay an average of 70 percent of the costs and the other 30 percent will be paid out-of-pocket by individuals and families, partially offset by subsidies for those who qualify. Using the 2010 MMI, the plans will pay for a family of four an average of $12,652 (70 percent of $18,074). The twenty percent for administrative costs and profits will add another $3,163 ($12,652 is 80 percent of the premium) which means that the premium that the insurer will have to charge will be $15,815 ($12,652 plus $3,163). The out-of-pocket portion for the family will be $5,422 (30 percent of $18,074). The the total average cost for the family for both the premium and out-of-pocket expenses combined will be $21,237 ($15,815 plus $5,422).

These are averages. To determine what each family actually would pay is more difficult because of several variables, including sliding scale subsidies for the premiums, sliding scale subsidies for the out-of-pocket expenses, opt-out eligibility based on the level of household income, and out-of-pocket spending, especially for those whose incomes exceed the eligibility thresholds for the subsidies.

Nevertheless, let’s look at a family of four with an income at 400 percent of the federal poverty level – the threshold at which they qualify for neither the subsidies for premiums nor the subsidies for out-of-pocket costs. That income level is $88,200. That family would pay an average of $21,237, or 24 percent of their income, for health care, leaving them $66,963 for all of their other expenses. But since that
is average, those with greater health care needs would face even larger out-of-pocket costs, which could be staggering. Even if the plan is promoted as having a stop-loss, private insurers are infamous for leaving patients stuck with charges for non-covered services and out-of-network providers. The bottom line is that PPACA has not ensured that the hard-working American family is protected from financial hardship or even personal bankruptcy should significant medical needs arise.

There are those who say that health care reform is done; we now have PPACA. They say that although it will likely require some adjustments along the way, our task now is to make it work. To those individuals I can only say, step back and look at the confounded mess! It will never insure everyone. It will never make health care affordable for each and every individual and family. It will never control administrative waste as it continues to add on more and more administrative complexity.

We need to keep and build on some of the health system reforms in PPACA, such as the reinforcement of our primary care infrastructure. But we desperately need to dump the sick, fragmented financing system that wastes so much in resources and perpetuates the profound inequities and physical and financial suffering experienced in our system. We need to enact an improved Medicare for all, and do it ASAP!