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Thursday
May262011

Health care's incentives: running the right way?

 

Article first published as Debate over Health Care: Rationing of Intelligence Again on Blogcritics.

Health  care as a public policy issue again resurfaces as Republicans and Democrats spar over what measures to take to ease the federal budget deficit away from financial abyss. As elected Republicans and their party operatives tell it, the fix for our national debt is entitlement reform. Congressman Paul Ryan’s proposed 2012 federal budget, called “Path to Prosperity” (for whom? one may ask), includes an extreme  makeover of Medicare, scaffolded by such slogans as “freedom to choose,” “options,” and “market competition;” what any half-awake observer would call non-sequiturs when considering the factors that actually drive up the cost of medicine.

What is at stake in this debate is a prevailing assumption about the business side of meeting the basic need for physical wellness; one that few have dared to question. Addressing this assumption openly and honestly would force a confrontation with our values as individuals and as a nation.  Very much unlike the approach to health care favored by Dick Armey and Matt Kibbe; writing in a draft-Paul-Ryan-for-president mode, they urged readers of The Wall Street Journal  last week that, because of entitlements, America’s fiscal future hangs in the balance, and that “without substantial Medicare savings the budget cannot be balanced. Period.” Well, that settles it. 

Rather, it’s classic scaremongering misdirection from a couple of fellas who must have nodded off to sleep over the last ten years; while a Republican-dominated Senate, House and White House pushed through a series of unpaid-for tax cuts and borrowing for two wars, vaporizing what was once a federal budget surplus at the beginning of 2001. The non-partisan Center on Budget and Policy Priorities recently confirmed what actual numbers comprise the bulk of the staggering federal deficit. As of 2009, two thirds of the $1.4 trillion well of red ink came from the Bush tax cuts, war borrowing, TARP and the American Recovery and Reinvestment Act.

Not a whisper of reconsideration otherwise will you hear from Republicans bent on dismantling entitlements. And, oddly enough, not a word about the health care crisis afflicting the middle- and working classes; that is until Democrats in Congress finally plastered together enough votes last year to pass the ultra-mediocre Patient Protection and Affordable Care Act . Like a smothered echo of Obamacare, Paul Ryan’s budget scheme pantomimes concern about health care access and affordability, yet leaves the well-oiled health insurance industry untouched and intact.

Rep. Ryan’s remedy for the ills of our health care system is more of the same snake oil the Bush administration attempted to sell this country in 2005, then packaged as privatizing Social Security. The unqualified faith and devotion free marketeers like Ryan express for any accountability-free industry, such zealotry explains simpleton solutions featured in his Path to Prosperity plan:  “Give patients more control over the money this nation spends on health care, and so let competition in the marketplace control costs, improve quality, and expand access.” Indeed, more money in a patient’s hands means one less degree removed from the grip of the policy underwriter’s.

As the recently sustained spike in gas prices demonstrates, the marketplace has little interest in controlling costs. The only control happening is of a captive consumer class dependent on necessities like automobile fuel and health care insurance forced to shell out more of their stagnant salaries. Price structures that exploit such dependency should be labeled for what they are: gouging.

Speaking of gouging, how does raising health insurance premiums from year to year at least 100 percent sound? Personally I know of a private equity firm in Beverly Hills, a small-business client of Anthem Blue Cross, that endured this type of free market favor. The individual clients of the health insurer haven’t fared much better in recent years, seeing their rates rise almost 40 percent each year.

While the health care industry provides treatment and services that meet critical needs common to all citizens, where quality of life and life or death are at stake, it’s not too late to question how said treatment and services are delivered, and for how much.

As this debate illustrates a difficult turning point for this country, I am reminded of another turning point that took place over 40 years ago; a debate not unlike today's. Democrats and Republicans debated which path our nation’s health care system would take: a nationalized program providing care for all citizens or a system that would primarily benefit the medical industry and patient care underwriters. One pivotal moment was a conversation in the Nixon White House between the president and one of his policy advisers, John Ehrlichman. Mentioning a visit he had received  from Edgar Kaiser, CEO of the Kaiser Permanente HMO, Ehrlichman offered a key factor to the president’s “National Health Strategy,” announced on February 18, 1971, the  following day.  Describing Kaiser’s business model, the president’s adviser stated that the CEO was “running his Permanente deal for profit….  All the incentives are toward less medical care because the less care they give them, the more money they make.”

What irony President Nixon summoned the next day by criticizing traditional medical care delivery systems for having “no economic incentive for them to concentrate on keeping people healthy.”  An HMO would offer the alternative of “[a] fixed-price contract for comprehensive care [which] reverses this illogical incentive.” Yet, just the day before, Ehrlichman had sold the president on the idea of Kaiser’s incentives running “the right way,” meaning more revenue for less care.

And here is what has escaped the focus of our national consensus about the cost of medical care: the assumption that its value should be tethered to the impulse of profit making, as well as subservient to the demands of ultra wealthy shareholders and institutional investors. If nationalizing health care is not the means by which we manage to restrain the runaway costs of medicine, there must be other methods, through the tax code or industry regulation, to blunt their fierce momentum.

 

 

 

 
Tuesday
Apr052011

The sorcerer's willing apprentices

News from Japan's throttled nuclear reactor in Fukushima: the plant has had to unload 11,500 tons of radioactive water into the Pacific with assurances as to the liquid's "low" toxicity.

A necessary step, the site operator TEPCO asserts, to make room for the massive runoff of subsequently pumped waters used to combat reactor meltdown; toxic pools considered far more radioactive than the waters being released over the last couple of days.

This adds to a chain of calamitous events that followed the March 11 earth quake and tsunami hitting Japan, sending three of the plant's six nuclear reactors into partial meltdown; spewing radiation into the air, which prompted the government to evacuate citizens from a 12-mile radius of the plant. Just this past weekend a crack at the site had been discovered hemorrhaging radioactive water onto the shore, but appears for now to have been sealed.

As nuclear power industry defenders circle 'round the wagons to defend what they call a "safe" and "clean" source of energy, it's as good a time as any to think about the radioactive life span of nuclear waste and how there's no community insane enough to welcome its disposal. Radioactive wastes left over from the fissioning of atomic fuel (uranium 235) remain active--as in perilous to human health and life--for at least a thousand years.

Given our civilization's limited real-time experience tinkering with atomic energy and the length of generations-- in the tens of thousands--some of its by-products remain hazardous, how can you not see a race utterly unready to be responsible for the full magnitude of its power?

Thursday
Mar312011

Homeland Security, FOIA and the governing cult of secrecy

 

Of course no one would have dreamed of such a hearing the last time Republicans controlled the House of Representatives: 'Why Isn't The Department Of Homeland Security Meeting The President's Standard On FOIA? No matter the political leveraging behind the committee session On Oversight & Government Reform, President Obama's administration has proven itself not much more FOIA-friendly than George W. Bush's.

At said hearing happening today, the committee will listen to testimony by former Chief Privacy Officer Mary Ellen Callahan (an appointee of Homeland Security Secretary Janet Napolitano). As the official in charge of transmitting sensitive government files to political advisors for vetting before such documents can be released to the public, she confided to her then-deputy, Catherine Papoi, what a zealous ideological scouring they endured. "This level of attention is CRAZY," she wrote in a 2009 email, and expressed the hope that "someone [would] FOIA this whole damn process."

Perhaps such frank talk by a federal paper pusher may sound unbecoming, however, it may be an emblem of the extraordinary level of screening applied to the release of government records. Ms. Callahan would not be the first guest of the Oversight & Governement Reform Committee to suggest this.

William Leonard, current COO of the National Endowment for Democracy,  testified to the same congressional committee on March 14, 2006--when he was classification czar for the National Archives-- asserting the extreme lengths taken for secrecy's sake.  Yes, insufficient classification of military or government documents poses a potential threat to national security and can undermine diplomatic efforts.  "Conversely, too much classification, the failure to declassify information as soon as it no longer satisfies the standards for continued classification, or inappropriate reclassification, unnecessarily obstructs effective information sharing and impedes an informed citizenry, the hallmark of our democratic form of government."

More recently, as a panelist at the Criminal Law, National Security, and the First Amendment symposium held in Washington, DC in October 2010, Leonard said there was no defense for Wikileaks' unlawful disclosure of the Iraq and Afghan military diaries. Rightfully, governing officials have condemned such actions, he goes on, “…but I have yet to see any of our government leaders accept responsibility for what is directly under their control, and that is the reckless manner in which the critical national-security tool is applied.” Or one could argue, the reckless manner in which it isn’t applied.

As an example he pointed out that no classification distinction exists between a document reporting an auto accident and a document that records the identity of an Afghan national serving as an informant. Additionally, the former secrecy czar argues with blinding logic that in the case of a situation like Abu Ghraib, the abuse endured by captured enemy combatants or high-value targets, at the hands of U.S. ordered interrogations, isn't subject to classification because the experience itself isn't a secret to the victim of torture; nor are they required to sign a non-disclosure agreement should they be fortunate enough to be released.

From today's House hearing on Homeland Security's FOIA obligations, don't expect too much in the way of questioning that interrogates our government's prevailing paradigm of secrecy. To enable such a line of inquiry would require an open national debate about exactly what national security factors that merit privilege over civil and human rights.

Sunday
Mar272011

This imploding, mortal coil

This planet speaks from the deep does it not? Earthquake, tsunami and pestilent radiation--altogether a braided emblem of unrest the world over. The Middle East has awakened from the stupor of populations divided and thusconquered.

The West, even while performing democracy's chorus, stage manages fortriumph of the box-seated season ticket holders, no matter the outcome ofthe drama. We, the remainder of the audience, sit flattened by the torrent of words, images and sound--a phenomenon we confuse as deus-ex-machina; that technology's widening scope and velocity will in the end deliver us all.

Tuesday
Feb012011

Fnding out the hard way: democracy is not a wind up toy

©Jennifer Cannard

Only a few evenings ago, California's City of Bell voters cleared the slate of their municipality's corrupt council, who are alledged, along with City Manager Robert Rizzo, to have padded their salaries and siphoned city funds in excess of five million dollars.

And just yesterday, Wisconsin's legislature succeeded in passing a bill to strip the state's employee unions of most of their bargaining rights--defying the will of fourteen Democratic state senators who refused the upper chamber the quorum necessary to pass the original union-busting budget; as well as ignighting the opposition of tens of thousands of union members and supporters who massed in Madison over the last three weeks in protest.

State Sen. Bob Jauch, one of the fourteen senators who temporarily frustrated Gov. Scott Walker's anti-union scheme, stated aptly, "I think we have to realize that there's only so much we can do as a group to make a stand.... It's really up to the public to be engaged in carrying the torch on this issue."

So true; the turmoil of Middle Eastern countries like Egypt, Tunisia, Yemen, Libya, et. al. remind us of democracy's cost--whether citizens take to the streets or take arms to stand against abuse of power and to oppose the burdensome privilege of the elite few at the expense of the many.

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