Category Archives: corporations

As Numbers of Uninsured Soar, Health Insurance Companies Plan Rate Hikes

The latest report from the Census Bureau, which shows a significant rise in the number of Americans living in poverty in 2009, is making news today. Less widely reported are the figures for those living without health insurance, which indicate that in 2009 there were 50.7 million uninsured or 16 .7% of population, up from 46.3 million and 15.4% in 2008. Kaiser Health News has a roundup of stories on the sharp rise in the uninsured. The details from the Census Bureau report are as follows.

  • The number of people with health insurance decreased from 255.1 million in 2008 to 253.6 million in 2009. Since 1987, the first year that comparable health insurance data were collected, this is the first year that the number of people with health insurance has decreased.
  • Between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, while the number covered by government health insurance climbed from 87.4 million to 93.2 million. The number covered by employment-based health insurance declined from 176.3 million to 169.7 million. The number with Medicaid coverage increased from 42.6 million to 47.8 million.
  • Comparable health insurance data were first collected in 1987. The percentage of people covered by private insurance (63.9 percent) is the lowest since that year, as is the percentage of people covered by employment-based insurance (55.8 percent). In contrast, the percentage of people covered by government health insurance programs (30.6 percent) is the highest since 1987, as is the percentage covered by Medicaid (15.7 percent).
  • In 2009, 10.0 percent (7.5 million) of children under 18 were without health insurance. Neither estimate is significantly different from the corresponding 2008 estimate.
  • The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.
  • In 2009, the uninsured rates decreased as household income increased: from 26.6 percent for those in households with annual incomes less than $25,000 to 9.1 percent in households with incomes of $75,000 or more.
  • These figures are sure to reignite the health care squabbling in Congress, and add to the Tea Party shrieks that Obamacare won’t cure the health care mess, which is now more of a disaster than ever. While their analysis is flawed, the Tea Partisans’ conclusion is, sadly, pretty much on the mark. 

    In the wake of health care reform, insurance companies are raising their rates–apparently, in preparation for the tepid new rules that won’t go into effect for years, and thus give the industry plenty of time to jack up their prices and protect their profits.  The Wall Street Journal reports that premiums for individuals and small businesses will go up in 2011, in some cases by as much as 20 percent. 

    Once the reform measures do go into full effect, the government is supposed to turn the 50 million uninsured into new customers for the price-gouging private insurance companies, which will enjoy no competition from a public option. As I have been arguing since this so-called debate over the future of health care began, it all looks like a sham exercise by Congress that will only end up extending the grip of the insurance and pharmaceutical industries in the health care market. 

    Any serious economic recovery will be stopped in its tracks by these numbers. And with more price hikes in store, God only knows what the 2011 figures will look like.

    9/11: One Family’s Brave Effort to Expose Airline Culpability

    An article in Saturday’s  New York Times describes how all the families suffering losses on 9/11 have now taken settlements, receiving some $7 billion from the government and $500 million in private suits–all the families, that is, save one.

    The one holdout is the family of Mark Bavis, a passenger on United Airlines Flight 175, the second plane to strike the World Trade Center. Ever since the family filed suit in 2002, it has spurned efforts to negotiate, despite settlement attempts and a court mediation session.

    They recognize that they could have obtained a quicker resolution by settling; they say the case is not about money. They say they want to prove in a public courtroom what they and their lawyers believe was a case of gross negligence by United and other defendants that allowed the hijackers to board Flight 175 and the attacks to occur.

    The Bavis family is seeking damages directly from the airlines. Their suit represents the last real possibility for an independent inquiry into the culpability of these private carriers–not to mention the “regulators” at the Federal Aviation Administration, who appeared intent on serving the airlines rather than the public. It’s a long shot perhaps, but the Bavis suit might achieve some of what the expensive, timid, and inconclusive 9/11 Commission Report could not. 

    As the Times article points out, they have identified several areas in which the airlines’ negligence contributed to the events of 9/11 (emphasis added):

    Donald A. Migliori, a lawyer with Motley Rice, the firm that represents the Bavises and was involved in more than 50 other cases, said the firm’s investigation had focused on failures at airport security checkpoints, flawed cockpit doors, inadequate training and how the industry ignored confidential government warnings about terrorist threats.“The security breaches that day,” he said, “were absolutely known to these defendants before 9/11, and should have been addressed before this could happen.”

    My 2005 book, The 5 Unanswered Questions About 9/11, also explores these same areas, and sets out in detail the chain of evidence that demonstrates airline and government negligence leading up to the attacks. A few excerpts, citing factual records, follow. Readers can judge for themselves whether the airlines and government are culpable.

    Failures at Airport Security Checkpoints

    [In the 1990s], following the Pan Am 103 bombing, the FAA had been directed by Congress to create a “Red Team” to test airport security. A Red Team consists of a handful of people, often drawn from military special operations, to pose as terrorists and attempt to break through airport security–in effect, to stage unannounced mock terrorist attacks, and report on the airlines’ performance in thwarting these attacks…

    An October 1998 report by one airline, which was passed around the company offices in the United States, describes a meeting held the previous month with the FAA to discuss security at the San Francisco airport. Among other things, the report noted that the FAA’s Red Team “worked around different areas in SFO airport. They managed to break through different security screenings repeatedly in many different areas. Of 450 times when they were working their way past different security points to get to secure areas they were caught only 4 times.” SFO was one of the airports that had been targeted in the 1993 tests, and cited for a 60 percent failure rate. Five years later, the failure rate was 99.11 percent.

    The report stated that the Red Team “managed to get by passenger Xray screening repeatedly (7 times) having on them a gun sealed under their belt-buckle. Also, having an automatic Mac machine gun under their jacket on their back.” The team also easily entered the airlines’ private lounges and put bombs in the passengers’ carry-on luggage, which was not examined before they boarded the plane. Gaining entrance to the ramp area, they entered Skychef catering trucks, and with ease placed whatever they wanted to in the food trolleys. No one questioned them. “Most of the times the catering truck driver was either asleep or reading a book or just looking at the sky or waving a friendly hello,” according to the San Fransisco report. The intruders showed false IDs and then easily drove a van onto the ramp area, although the vehicle had no official plates or security seals. They boarded aircraft at will, and “could easily have placed a bomb on board.”

    All of this activity was videotaped by the Naval Surface Warfare Center at Port Hueneme, California, with the idea of using it as a training film for airport security personnel. But when the FAA saw how bad things were, they deep-sixed the video…

    According to Andrew Thomas [in his book Aviation Insecurity], “For years, Logan was known throughout the industry as one of the least secure airports in the nation.” In April 2001, Deborah Sherman of Boston’s Fox News station undertook her own investigation of air security at Logan airport, with the help of former Red Team member Steve Elson. Airing on May 6, 2001, her report showed serious security flaws, including knives smuggled through security and unguarded access to secure areas–making Logan clearly vulnerable to terrorist attack.

    The report had been instigated by Brian Sullivan, an FAA New England security agent who had retired earlier in the year and was seeking to blow the whistle on what he had observed on the job. On May 7, the day after the program aired, Sullivan sent a tape, along with a detailed and eloquent letter, to Senator John Kerry: “This report once again demonstrated what every FAA line agent already knows, the airport passenger screening system simply doesn’t work as intended. The FAA would like [rather] continue to promulgate a façade of security, than to honestly assess the system. Management knows how ineffective the current system is, but continues to tell Congress that our airport screening is an effective deterrent.”

    Flawed Cockpit Doors

    There was ample  evidence of how easily cockpits could be breached. As Andrew Thomas reports in Aviation Insecurity, in the two years prior to September 11, 2001, passengers managed to enter the cockpits of commercial airplanes thirty times. In one 2000 case, a passenger aboard a Southwest Airlines flight was suffocated to death—apparently by other passengers—after he made repeated attempts to take over the cockpit. In another case the same year, a deranged passenger entered the cockpit of a British Airways 747, bit the captain’s ear, grabbed the controls, shut off the autopilot, and sent the plane into a 10,000-foot dive before the co-pilot managed to regain control. Lack of cockpit security would, of course, become key to the terrorists’ success in the 9/11 attacks.

    Inadequate Training

    In 1996, President Clinton appointed a White House Commission on Aviation Safety and Security, headed by Vice President Al Gore, to examine security within the industry–and especially security against possible terrorist attacks…A preliminary report, released in September 1996, elicited a flurry of unhappy responses from airline lobbyists. Gore quickly capitulated to the airline industry, writing a sheepish letter to Carol Hallet, president of the Air Transport Association, the industry trade group: “I want to make it very clear that it is not the intent of this administration or of the Commission to create a hardship for the air transportation industry,” and suggesting that government and industry could work “in full partnership.” According to a study conducted by the Center for Responsive Politics, during the final weeks of the 1996 election campaign, with Clinton pitted against Bob Dole, the airlines poured $585,000 into the Democratic party coffers.

    The Gore Commission did make some 50 recommendations, but many of the most vital proposals were gutted or simply ignored. The Commission recommended criminal background checks for airport security personnel, along with a changed work system that would reward performance, rather than just low costs, for both individual security staff and the security companies used by the airlines. The airlines scoffed that these measures would be too expensive, and the FAA (then under the leadership of Linda Daschle [who later became an airline industry lobbyist]) never pursued them.

    One Commission member, Victoria Cummock, widow of a Pan Am 103 victim, wrote to Gore, “I register my dissent with the final report. . . . Sadly, the overall emphasis of the recommendations reflects a clear commitment to the enhancement of aviation at the expense of the Commission’s mandate of enhancing aviation safety and security. I can not sign a report that blatantly allows the American flying public to be regularly placed at unnecessary risk.” Cummock was quoted by CNN as saying, “I don’t know how we could really get a fair commission based on the degree of collusion that I see between the [airline] industry, the FAA, the DOT (Department of Transportation), and Al Gore.”

    Industry Ignored Government Warnings About Terrorist Threats

    In the six months prior to 9/11, FAA senior officials received 52 intelligence briefings regarding threats from Al Qaeda. “Among the 105 summaries issued between April 1, 2001 and September 10, 2001, almost half mentioned Bin Ladin, Al Qaeda, or both, mostly in regard to overseas threats,” the report said. In addition, the National Security Council’s Counterterrorism Security Group invited the FAA to a “meeting in early July 2001 at the White House to discuss with domestic agency officials heightened security concerns.”

    The FAA also sent out informational circulars to warn airports and air carriers about security issues. Seven circulars were sent before 9/11–one on the threat posed by surface to air missiles, five on threats overseas, and one on July 31 mentioning hijacking. Yet while Jane Garvey said “she was aware of the heightened threat during the summer of 2001,” several other top agency officials, as well as senior airline official and veteran pilots, said they were not aware.

    The End of Retirement

    American workers have little to celebrate on this Labor Day. That’s especially true for older workers, who face the end of any possibility of a secure retirement, so hard-won during the 20th century. In my recent Mother Jones piece on the subject, I wrote:

    I contemplate my future at a time of deep recession with no pension and a depleted 401(k). And it occurs to me that the very notion of a comfortable, paid retirement may turn out to have been a temporary phenomenon, with a life span almost precisely the same as my own…And I have to wonder if someday the tale of a foolish generation of Americans, who imagined that a lifetime of work would be rewarded with a comfortable and secure old age, will become just another footnote in the annals of the market.

    One commentary on the subject came earlier this year from AFL-CIO President Richard Trumka, speaking at the National Institute on Retirement Security. His conclusions regarding the possibility of change may be overly optimistic, but his analysis is sound. Here’s an excerpt:

    Today’s retirement security crisis is just one of the many painful consequences of the failed economic policies of the past 30 years—policies of radical deregulation and corporate empowerment.  

    They’ve culminated in the worst economic decade in living memory—job loss, wage loss, collapse of the housing and financial markets, enormous growth in inequality and the massive destruction of wealth.  

    These policies allowed — and even encouraged — employers to walk away from what had been a system of shared responsibility.  The result?  Today, fewer than 20 percent of private-sector workers have real, defined-benefit pensions. 

    As a country, our challenge now is to build a new economy on a solid foundation of good jobs, opportunity, a return to shared responsibility and a level playing field that allows both workers and business to thrive.

    Keeping the promise of retirement security must be part of this great transformation in American life…part of the legacy we seek to build and the future we envision. 

    Today only 13 percent of workers say they are very confident about having enough money for a comfortable retirement—that’s the lowest level in 16 years.  And this lack of confidence is justified.  The majority of America’s workers will face retirement with far less security than their parents.

    That’s especially painful to me—because it was our union movement that created retirement in the United States.  Before the rise of the labor movement in the 1930s and 40s, elderly Americans were the most impoverished age group in our society, and only a privileged few received government or employer pensions.

    With the enactment of Social Security and the growth of union-negotiated pensions, elderly Americans became the least impoverished age group.

    After the New Deal, it was collective bargaining that set the pattern for labor markets—and not just for workers covered by union contracts.

    These were the years that produced the three-tiered American retirement system:  Government provided a foundation with Social Security, employers provided defined-benefit pensions and individuals saved for their retirement. 

    With this system, our parents could retire after a career of hard work, confident of a stable income they would not outlive.  They could sleep at night knowing that, should they die, their spouse would continue to have a dependable income. 

    For millions of Americans—teachers and bus drivers, factory workers and flight attendants, construction workers and nurses—reliable, employer-funded pensions made their lives immeasurably better.

    That was a legacy.  That was the world I grew up in back in Nemacolin, Pennsylvania.  A world where working people had real pensions they had won at the bargaining table and on the picket line…

    …A world where retirement, which had been a dream realized only by bosses, had become a reality for tens of millions thanks to Social Security and collective bargaining. 

    Today, all three tiers of that retirement system we built are in danger.  Employers are increasingly abandoning their pension plans.  Workers with lost jobs and stagnant incomes are unable to save.

    In this bleak landscape, Social Security stands out as the one feature of what passes for our retirement system that works for all Americans.  But too many in Washington seem bent on perpetuating the Bush administration’s attacks on Social Security. 

    The labor movement took on those people and beat them in the Bush era — and we will do the same in the Obama era.

    When people lump together Social Security attacks with deficit reduction efforts, we have to remind the public of this basic fact: Social Security is NOT contributing to our budget deficit—in fact, the buildup of the Social Security Trust Fund is financing our budget deficit. 

    And while the program faces a funding shortfall over the next 75 years, in pension plan terms, Social Security is 88 percent funded over that 75 year period of time and by any measure would be considered a healthy pension plan.  Relatively modest adjustments—WITHOUT benefit cuts—can address even this long-term issue. 

    Social Security is the most important family income protection program and the most effective anti-poverty program ever enacted in the United States.  One-third of Social Security beneficiaries receive more than 90 percent of their income from Social Security.  Two out of three depend on it for more than half of their income. 

    Social Security is the sole source of income for nearly one in five seniors.  The average Social Security benefit is just little more than a minimum wage income—meaning a typical retiree needs almost twice the average monthly Social Security benefit for a reasonable standard of living.

    And if that’s not bad enough, growing Medicare cost-sharing means our seniors will need higher benefits just to maintain the replacement rate of the past 25 years.

    Social Security benefits must remain at least as robust as they are today…quite frankly, INCREASING Social Security benefits would be a massive boost for our economy right now and for our long-term ability to provide all Americans financial security in retirement.

    Social Security is the ONLY reliable and guaranteed benefit for the growing number of people without pensions.  But Social Security by itself cannot provide retirement security for most Americans.

    And despite all the flashy new investment products the financial services industry markets, traditional defined-benefit pension plans remain the soundest vehicles for building and safeguarding retirement income security. 

    If you are lucky enough to have a union, there is still a good chance that you have a pension plan.  Sixty-six percent of union workers have pensions, compared with only 15 percent of nonunion workers.  But unions are under increasing pressure at the bargaining table to allow employers to cut or eliminate real pensions. 

    In the private sector, the funding rules for single employer pension plans in the Pension Protection Act of 2006, coupled with new accounting standards, have contributed to an environment in which even healthy companies are freezing their pension plans entirely or closing them to new hires.

    Our current economic downturn has made this much worse.  In many parts of this country, public-sector workers have the right to form unions.  Not surprisingly, state and local government workers are four times more likely than private-sector workers to have defined-benefit plan coverage.  But public-sector plans are under attack through legislation and ballot initiatives.

    In the private sector, over the past decade, many employers have abandoned their real pensions for 401(k) plans—plans with little or no employer money … plans with no protection for workers against market risk or outliving your money … and plans with high investment management fees.

    We hear different reasons for this, but here’s the bottom-line problem:  Our current system lets employers off the hook.  They can refuse to provide any benefits at all.   If there ever was an implicit social contract, it has eroded.  My friends, that is NOT the vision I have for America. 

    Unfortunately, the vision put forth by policy makers in both political parties and the White House is for tepid reforms that address only the shortcomings of the 401(k) system.  I think we were all glad that the president included retirement security as a national issue in his State of the Union address last week. But his remedies fall short.

    Tinkering with 401(k)s by adding automatic enrollments as a plan feature will not bring about the change we need.  And what good is individual annuitization if you don’t have any money in your account and you are at the mercy of the insurance industry on pricing?

    At best, I’m afraid, these proposals will marginally increase retirement savings for those who already can afford to contribute, and will do nothing to make employers take some responsibility in this crisis.

    In this crisis economy workers can barely meet day-to-day expenses.  How much then can they save on their own for retirement?  Plainly put: There is no way that 401(k) plans can adequately substitute for the loss of a guaranteed lifetime benefit.

    Look at the data: The median account balance in 401(k) type plans for 62-year-old workers is worth an annuity payout of about $400 a month.  $400 a month.  That just doesn’t cut it.  And most workers will outlive their savings.

    A Time magazine cover story last fall on the failure of 401(k) plans about summed it up:  “This isn’t how retirement was supposed to be.”   After a lifetime of hard work, workers deserve to retire with dignity—with the economic security they have earned. 

    It is imperative to strengthen and preserve what remains of the current private-sector pension system by working on two tracks—through collective bargaining and through legislation…

    How We Pay Wall Street to Screw Us

    Our taxes, paid into the public treasury, have gone to bail out Wall Street. And what do bankers  do with the taxpayers’s money? They turn around and lobby for more. It’s called the “never give a sucker an even break” strategy. These statistics, prepared by Public Citizen, speak for themselves:

    • Amount financial industry has spent on lobbying this year: $251 million
    • Amount Citigroup spent on lobbying during the first half of 2010: $3 million
    • Amount Goldman Sachs spent on lobbying in the first half of 2010: $2.7 million
    • Amount Bank of America spent on lobbying in the first half of 2010: $2.1 million

     

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    The Puppy Protection Act Offers (Slim) Hope to (Some) Abused Pups

    Congress.org reports today on bills recently introduced in both houses of Congress. The Puppy Uniform Protection and Safety (PUPS) Act (S 3424 and HR 5434) would “amend the Animal Welfare Act to provide further protection for puppies.”

    The bills, from Sen. Dick Durbin (D-Ill.) and Rep. Sam Farr (D-Calif.), were introduced at the end of May and tail a Department of Agriculture inspector general report regarding federal investigations of breeders.

    The IG report, released May 25, says large breeders who sell animals covered under the Animal Welfare Act (AWA, PL 89-544) online are exempt from inspection and licensing requirements “due to a loophole in AWA.” The IG says there are “an increasing number” of these unlicensed, unmonitored breeders.

    The bills would require licensing and inspection of dog breeders that sell more than 50 dogs per year to the public (including online) and would also outline additional exercise requirements for dogs at facilities – such as having sufficient, clean space and proper flooring.

    According to a press release, Durbin said he would work administratively with the USDA to fix problems at its Animal and Plant Health Inspection Services, and then introduce addition legislation if needed.

    Supporting humane treatment of puppies would seem like a political no-brainer, right? As Liliana Segura pointed out on Twitter earlier today, what could be better in the upcoming midterm elections than “to be able to say ‘our opponents HATE puppies'”? Mainstream groups like the Humane Society have been pushing for legislation action on puppy mills for years, to little avail. (Click here to see video of a Humane Society raid on a massive puppy mill in Tennessee, and here to read some gruesome details from the USDA’s report on puppy mills.) Yet the bills are not exactly barreling their way through Congress; both are waiting for attention from agricultural subcommittees, and after two months, the Senate bill has only seven co-sponsors.

    In addition, when it comes to animals routinely used in cosmetic testing, and animals (including puppies and dogs) treated cruelly in drug testing and medical research, the federal government has pretty much sat on its hands–or worse. To take one particularly galling example, the Physicians Committee for Responsible Medicine last year exposed an effort on the part of the National Institutes of Health to sell young constituents on the idea of animal experimentation. As Stephanie Ernst wrote on Change.org:

    [T]he NIH promotes, on its Web site, a children’s coloring book that gives a skewed view of animal experiments. The coloring book implies that researchers are trying to cure animals that are already sick—rather than purposely infecting them with diseases—and ignores the fact that animals suffer and die in the process. The coloring book, entitled The Lucky Puppy, was produced by an industry trade group, the North Carolina Association for Biomedical Research, whose members have a financial interest in the continuation of animal research…

    The book erroneously portrays the lives of animals in laboratories as pleasant and carefree. Published scientific research and numerous undercover investigations clearly demonstrate that animals in laboratories suffer pain and distress from experimental procedures and routine laboratory practices. The coloring book also makes misleading claims about the benefits of animal experiments, implying that research findings from experiments on animals are directly applicable to both the animals used in research and to humans.

    The federal government is also actively engaged in protecting animal testing and experimentation against animal rights activists. Anyone who chooses to take action against an animal testing facility is not, as one would expect, subject to charges of breaking-and-entering or vandalism. Instead, they are branded terrorists under the notorious Animal Enterprise Terrorism Act; for actions in which no human being were harmed, they can end up serving long sentences in a federal supermax Communications Management Unit.  (See the blog Green Is the New Red for the best information on AETA.)

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    Meet the Real Death Panels: The Truth About Age-Based Health Care Rationing

    The latest issue of Mother Jones includes an article by me about the controversy over age-based health care rationing, which got transformed by the right into government “death panels.” Unfortunately, liberals have fallen into a different trap, because they refuse to take on the real enemies of affordable health care for all: the insurance companies, drug manufacturers, and other profiteers of our private health care system.

    As a result, old people are being asked if we would be willing to give up some expensive, life-sustaining treatment so that our grandchildren can have health care. This is a bogus question, and a bogus “choice.” The real question, as I say in the article, is whether we should give up the treatment “so some WellPoint executive can take another expensive vacation, so Pfizer can book $3 billion in annual profits instead of $2 billion, or so private hospitals can make another campaign contribution to some gutless politician.”

    It’s a long article, and I’m including just the opening here, with a link at the end to continue reading at the Mother Jones web site. Or you can read the whole thing at MotherJones.com by clicking here. And if you’re one of those geezers who still likes reading print and turning pages, the July/August issue is on newsstands now.

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    From Mother Jones, July/August 2010

    There’s a certain age at which you cease to regard your own death as a distant hypothetical and start to view it as a coming event. For me, it was 67—the age at which my father died. For many Americans, I suspect it’s 70—the age that puts you within striking distance of our average national life expectancy of 78.1 years. Even if you still feel pretty spry, you suddenly find that your roster of doctor’s appointments has expanded, along with your collection of daily medications. You grow accustomed to hearing that yet another person you once knew has dropped off the twig. And you feel more and more like a walking ghost yourself, invisible to the younger people who push past you on the subway escalator. Like it or not, death becomes something you think about, often on a daily basis.

    Actually, you don’t think about death, per se, as much as you do about dying—about when and where and especially how you’re going to die. Will you have to deal with a long illness? With pain, immobility, or dementia? Will you be able to get the care you need, and will you have enough money to pay for it? Most of all, will you lose control over what life you have left, as well as over the circumstances of your death?

    These are precisely the preoccupations that the right so cynically exploited in the debate over health care reform, with that ominous talk of Washington bean counters deciding who lives and dies. It was all nonsense, of course—the worst kind of political scare tactic. But at the same time, supporters of health care reform seemed to me too quick to dismiss old people’s fears as just so much paranoid foolishness. There are reasons why the death-panel myth found fertile ground—and those reasons go beyond the gullibility of half-senile old farts.

    While politicians of all stripes shun the idea of health care rationing as the political third rail that it is, most of them accept a premise that leads, one way or another, to that end. Here’s what I mean: Nearly every other industrialized country recognizes health care as a human right, whose costs and benefits are shared among all citizens. But in the United States, the leaders of both political parties along with most of the “experts” persist in treating health care as a commodity that is purchased, in one way or another, by those who can afford it. Conservatives embrace this notion as the perfect expression of the all-powerful market; though they make a great show of recoiling from the term, in practice they are endorsing rationing on the basis of wealth. Liberals, including supporters of President Obama’s health care reform, advocate subsidies, regulation, and other modest measures to give the less fortunate a little more buying power. But as long as health care is viewed as a product to be bought and sold, even the most well-intentioned reformers will someday soon have to come to grips with health care rationing, if not by wealth then by some other criteria.

    In a country that already spends more than 16 percent of each GDP dollar on health care (PDF), it’s easy to see why so many people believe there’s simply not enough of it to go around. But keep in mind that the rest of the industrialized world manages to spend between 20 and 90 percent less per capita and still rank higher than the US in overall health care performance. In 2004, a team of researchers including Princeton’s Uwe Reinhardt, one of the nation’s best known experts on health economics, found that while the US spends 134 percent more than the median of the world’s most developed nations, we get less for our money—fewer physician visits and hospital days per capita, for example—than our counterparts in countries like Germany, Canada, and Australia. (We do, however, have more MRI machines and more cesarean sections.)

    Where does the money go instead? By some estimates, administration and insurance profits alone eat up at least 30 percent of our total health care bill (and most of that is in the private sector—Medicare’s overhead is around 2 percent). In other words, we don’t have too little to go around—we overpay for what we get, and we don’t allocate our spending where it does us the most good. “In most [medical] resources we have a surplus,” says Dr. David Himmelstein, cofounder of Physicians for a National Health Program. “People get large amounts of care that don’t do them any good and might cause them harm [while] others don’t get the necessary amount.”

    Looking at the numbers, it’s pretty safe to say that with an efficient health care system, we could spend a little less than we do now and provide all Americans with the most spectacular care the world has ever known. But in the absence of any serious challenge to the health-care-as-commodity system, we are doomed to a battlefield scenario where Americans must fight to secure their share of a “scarce” resource in a life-and-death struggle that pits the rich against the poor, the insured against the uninsured—and increasingly, the old against the young.

    For years, any push to improve the nation’s finances—balance the budget, pay for the bailout, or help stimulate the economy—has been accompanied by rumblings about the greedy geezers who resist entitlement “reforms” (read: cuts) with their unconscionable demands for basic health care and a hedge against destitution. So, too, today: Already, President Obama’s newly convened deficit commission looks to be blaming the nation’s fiscal woes not on tax cuts, wars, or bank bailouts, but on the burden of Social Security and Medicare. (The commission’s co-chair, former Republican senator Alan Simpson, has declared, “This country is gonna go to the bow-wows unless we deal with entitlements.”)

    Old people’s anxiety in the face of such hostile attitudes has provided fertile ground for Republican disinformation and fearmongering. But so has the vacuum left by Democratic reformers. Too often, in their zeal to prove themselves tough on “waste,” they’ve allowed connections to be drawn between two things that, to my mind, should never be spoken of in the same breath: death and cost.

    Click here to the rest at MotherJones.com.

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    Newest Medical Combine: Delis and Hungry Docs

    Over the last year or so, there has been a campaign to break the hold of the pharmaceutical companies on doctors. The aim is to get more transparency so as to show the true relations between the drug industry and doctors, which involves taking gift , getting exotic all-expense- paid vacations, signing their names to articles they didn’t write, and on and on. The ultimate goal is to expose and eventually stop these practices.

    Among the most fervent of these efforts has been carried out by groups of medical students and doctors who try to stop drug companies from handing out free lunches to busy medical professionals, who are often in hospitals on their short breaks.

    Now, the pharma-free lunch movement faces the wrath of the restauarant lobby, which in Massachusetts is said to face a serious loss of business due to the reduction in the numbers of lunches bought by Big Pharma for the docs. Restaurants in Massachusetts want the gift ban ended, according to BNET:

    Statehouse Democrats say the ban, which prevents drug sales reps from delivering free sandwiches to doctors, has “severely impacted the profitability” of local businesses. Rep. Brian Dempsey told the Boston Business Journal:… “We’ve been hearing from device and biotech companies, the convention center and the restaurant industry, that this is causing additional problems during the worst recession in memory.

    As BNET reports, a pumped up Jeff Norris from Twins Restaurant & Catering in Erie, Pennsylvania, tells EZ Restaurant Marketing, an outfit that counsels restauranteurs how to break into feeding docs:  

    “I used to do 2 maybe 3 luncheons per week, and soon I was doing 2 or 3 luncheons PER DAY…Thru June 30th , 2004 I have done 4 TIMES the amount of business with drug reps than I did in ALL of 2003. My marketing is on cruise control. I have some offices REQUIRING drug reps to call me for their luncheons!”

    In Los Angeles, for example, Dr. Lunch, an outfit that caters to docs,provides this testimonial from a Dr. Martin Levine: “My staff and I request their lunches repeatedly. We have always enjoyed the food and service provided by DR.LUNCH. The food is not only delicious, but always fresh. I highly recommend them for any event, whether it be your office or home. 

     BNET further reports:

    Some doctors get so used to free lunches that they issue instruction sheets to sales reps, such as this delightfully specific one from a Baltimore doctor obtained by [the blog]Pharmalot: “(Please do not order wraps, several members of the office have not tolerated them well).”

    And we’re not just talking sandwiches and chips. Free lunches can be elaborate. Angelo’s of Flemington, NJ, offers Tiger Shrimp sautéed in a pink cream vodka sauce with penne pasta.

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