Guest Editorial by Ernest A. Canning
"Americans think that it’s healthcare that produces health, when there really is very little evidence for that. What turns out to be really important is the nature of caring and sharing in society….Where societies are more equal --- and economic equality is the thing that is most important in this --- people look after each other…and pretty well everyone does better. There’s almost nothing that is better in a society that tolerates the extreme levels of inequality in the United States. And so, we end up dying younger than people in all the other rich countries, despite spending half the world’s healthcare bill." - Dr. Stephen Bezruchka, March 30, 2009
"Who are we? Is this what we have become --- a nation that dumps people off like garbage who can't pay their hospital bills?" - Michael Moore, following a segment in which a confused elderly woman in a flimsy hospital gown is dumped curbside near a Skid Row rescue mission, in his documentary Sicko!*
In Failed States (2006), Prof. Noam Chomsky, a preeminent linguist and one of this nation’s most prolific political writers, concludes that the U.S. suffers from a “democracy deficit” --- the significant gap between the policy positions of the electorate and their elected representatives --- which he attributes to the manner in which “elections are skillfully managed to avoid issues and marginalize the underlying population…freeing the elected leadership to serve the substantial people.”
The deficit is especially acute in what Chomsky describes as “the most dysfunctional healthcare system in the industrial world.” Chomsky notes that a single-payer system --- that is a system in which all medical providers would be paid by a government entity as now occurs with Medicare --- has long been overwhelmingly favored by “a considerable majority” of the American people, but routinely dismissed by both the corporate media and the leaders of both political parties as “lacking political support” and not being “politically possible.”
The issue touches on the core contradictions which arise because we have allowed private authoritarian entities, corporations, to subvert democracy by controlling our economy, our mass media and the manner in which we conduct elections.
This piece will focus on the irrationality of a privatized health care system which values the wealth of a handful of CEOs of the parasitic and entirely unnecessary middle-men --- for-profit carriers and HMOs --- over the health and very lives of our people. It will explain what corporate America and their bought-and-paid-for politicians do not want you to hear...
Still 'Sicko' in the U.S.A.
The importance of Michael Moore's Sicko lies in its ability to transcend the abstraction of statistics. Moore recites the all too familiar numbers --- 47 million Americans have no health insurance; 18,000 die each year (according to the National Academy of Science's Institute of Medicine) simply because they cannot afford to pay for health care insurance.
Sicko begins with an uninsured man who is sewing up a gash in his leg; another who was forced to choose which of two lopped off fingers to save. Moore then tells us that Sicko is not about them. It's about the 250 million who are insured, like Larry Smith, a former machinist, and his wife Donna, a former newspaper editor --- Americans who'd worked hard all their lives only to be forced to move into their daughter's tiny storage room after the co-pays for Larry's multiple heart attacks and Donna's cancer ate up their life savings and cost them their home. It's about the 9/11 rescue workers who travel to Cuba, receiving, free-of-charge, medical care their own ungrateful nation failed to provide at a price they could afford.
Physicians for a National Health Program (PNHP) reports "medical bills contribute to half of all personal bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick or injured."
Sicko exposes the fundamental conflict that arises when for-profit carriers and HMOs resort to utilization review (UR) (a system in which insurance industry physicians who never see the patients are paid to second-guess the judgment of the physicians who directly provide health care) and a myriad of other devices to avoid authorizing or paying for necessary procedures --- a point underscored by the tearful Congressional testimony of former UR physician, Linda Pino, M.D., who noted that the UR physicians with the highest number of denials receive the largest bonuses and that she was promoted because she denied "an essential procedure" which "cost a man his life."
Sicko reveals that a woman, rendered unconscious in an auto accident, was billed by her carrier for an ambulance ride to the hospital because it was not "pre-approved." "When was I supposed to get approval," she asked, "after I gained consciousness; while I was in the hospital?" The film portrayed the grief of a young widow whose husband died of cancer after their HMO repeatedly denied procedures as "unnecessary" or "experimental," including a bone marrow transplant from his younger brother. In Sicko, we see a distraught young mother whose toddler died because her HMO refused to permit a local hospital to provide vital emergency care.
How can we mourn the loss of 3,000 on 9/11, yet tolerate a dysfunctional health care system that kills 18,000 uninsured each year plus countless others who were denied needed care simply to protect the obscene wealth of a few CEOs?
As the above-cited PNHP article reveals, the irrationality and waste of the deadly US health care system is underscored by the statistics. In the US 31% of all health care costs goes to the parasitic middle men --- for profit carriers and HMOs. Canada, a single-payer country, devotes just 1.3% to administrative costs. Daniel Wirt, MD reports that the 31% translates to "more than $350 billion per year, provides no health care: it is consumed by enormous administrative costs, profits for investors and shareholders, and large salaries for managers of these for-profit insurance companies."
Americans pay nearly double what people pay for health care in single-payer countries, yet the World Health Organization ranks the US as 37th in the delivery of health care services.
Where opponents of single-payer rail against paying taxes toward a single-payer system, the PNHP reports that our taxes already pay for 60% of health care costs in the US. "Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it."
People in single-payer countries are healthier and live longer than we do. As revealed by Sicko, especially in the segment in which Moore interviews American exiles in Paris, with the stress and weight of America's health care burden removed, they also appear a whole lot happier --- a point which underscores the title of an article written by autoworker Phillip Bannowsky, “Capitalism produces rich bankers, but Socialism produces happiness."
The 'Universal Coverage' Scam
Regardless of variances in their application, "universal coverage" schemes share two essential features: (1) they do not address the core problem which is not a lack of coverage but the presence of parasites --- for-profit carriers and HMOs --- which are sucking up billions of health care dollars; (2) they provide the illusion of reform while reinforcing the corruption of the current dysfunctional system by providing subsidies that will find their way into the coffers of the unnecessary parasites.
The basic area of difference entails whether to adopt a hybrid system advocated by Sen. Edward Kennedy (D-MA) that would permit individuals to choose between private and public insurance and subsidy plans offered by Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, that would minimize the public option out of fear that the corrupt private health insurance carriers could not compete with an efficient public system. The Baucus plan would further burden those who have employer-funded health care insurance by taxing the insurance payments provided by their employers.
Kennedy and Baucus issued a joint statement on May 30, 2009 that they intended to offer “similar and complementary legislation that can be quickly merged into one bill for consideration on the Senate floor before the August recess.”
Dr. David Himmelstein of PNHP explained the deficiency of the "public option plan":
...Absent massive savings on administration, the expansion of coverage would be very costly, and costs would continue to rise in future years since the proposed plan has no means to achieve real health planning or use global budgets to set enforceable limits on cost growth. [The public option] plan would also do little or nothing for the tens of millions who are currently under-insured – they have coverage but still can’t afford care.
Dr. Quinton Young, Dr. Martin Luther King, Jr.'s personal physician and a long-time confidante of Barack Obama states:
Dr. Wirt supported this assessment, noting that whereas the number of uninsured adults in Massachusetts fell from 13% in 2006 to 7.1% in 2007, public spending skyrocketed from "$629.8 million in fiscal year 2007" to "$1089.2 million in fiscal year 2008 and $1317.7 million in fiscal year 2009...Most of the" reduction in the number of uninsured was realized by "expanding Medicaid and subsidizing the purchase of private insurance."
'Barack has been dishonest'
In 2003, as an Illinois State Senator, Barack Obama supported a single-payer system. But when he set his sights on the Presidency, US Senator Barack Obama changed his tune. Single-payer would be ideal if we were "designing a system from scratch." But "people have become accustomed to getting their health insurance through their employer...a lot of people work for insurance companies...[and] for HMOs." We need to "build off the system that we’ve got."
When asked by Amy Goodman what he thought of that remark, Dr. Young said [emphasis added]:
Under the weight of this private insurance system, doctors have finished training with huge debts, $150,000 on average, and the specialties, as it’s worked out under a private system, are paying on average two to three times what primary care doctors get. Primary care is very simple. It’s family practitioners, pediatricians and general internists. You need about 60 percent of your doctors in that category to have a balanced system. Well, that’s been slipping away, and now we’re well under 50 percent of primary care doctors. And that has to be reversed, or no system will work. And increasingly, there’s large areas in this country where people cannot find a primary care doctor. And in almost every, certainly metropolitan area, there’s an excess of specialists.
Unacceptable to Corporate America, Corporate Media
Both Democratic front-runners, Obama and Hillary Clinton, supported variations of the "universal coverage" scam. The only Democratic candidate who openly supported a single-payer system was Rep. Dennis Kucinich (D-OH), a co-sponsor with Rep. John Conyers (D-MI) of HR 676 ("Medicare for All").
If you looked only at the election results, you might assume that the vast majority of Democrats favored the Obama and Clinton policy positions; that the Kucinich policy positions had only nominal support. And you would be wrong.
In August 2007, some 67,000 voters took part in an internet "blind poll" survey which set forth the policy positions of Democratic candidates for President but did not include their names. Obama, the charismatic “change” candidate whose soaring rhetoric is second to none, received a meager 3%; Clinton, 3.6%. Kucinich was the choice of “a phenomenal 53%.”
The explanation for this gap goes beyond Chomsky's accurate analysis of the deception employed by the PR industry. The problem also entails a corporate-owned media which has a vested financial interest in evading substantive issues, thereby forcing candidates to purchase expensive 30-second deceitful ads --- a major source of media revenue. Where European democracies conduct elections over a span of weeks, the US has devolved into the permanent electoral cycle as newly elected “leaders” must begin trolling for financial support for the next election even before they take office.
While Obama knew full well that one cannot build on a health care system whose foundations are mired in corruption, he also knew that he would never have a realistic shot at the Presidency if he adopted the only logical solution (single-payer) because that solution was unacceptable to corporate America. Candidates who stray beyond the corporate range of discourse are shunned.
Case in point: America's "paper of record," The New York Times, which mentioned Kucinich only four times between an April 26, 2007 MSNBC debate --- in which Kucinich and former Senator Mike Gravel were relegated to the far ends of the debate stage and mostly ignored --- and prior to January 25, 2008 when the paper announced that Kucinich had withdrawn from the race. During that same period, the name Hillary Clinton appeared in more than 1,300 articles, columns, op-ed pieces and letters to the editor in The New York Times.
While much was made of the large number of small donations Obama's Internet campaign garnered, as revealed by Amy Goodman during an Oct. 23, 2008 segment of Democracy Now "only a quarter of this vast number of donors fall into the 'small' category (under $200)..." The cost of Presidential campaigns soared from $171 million in 1976 to more than $2 billion in 2008. "The $2-billion presidential race...guarantees vast profits for the broadcasters, the national networks and the local television stations. Hundreds of television stations are using the public airwaves, imposing themselves between the candidates and the public," Goodman noted.
Of course, the $2 billion for the Presidential race does not include the vast sums spent on Congressional and state races, including ballot propositions in states like California. (It is meaningless to talk about campaign finance reform without recognizing the need to divest corporate control over 95% of what we see, hear and read.)
Earlier, on July 22, 2008, Goodman reported that less than two weeks after Congress, with the aid of then Senator Obama's reversal, granted retroactive immunity to telecoms involved in the Bush spy program, "it’s been learned AT&T will be emblazoned on every delegate’s bag at the Democratic National Convention. Like Comcast, Motorola, Coca-Cola, Google and a host of other corporate sponsors, the telecom giant has donated over a million dollars to the DNC in return for prominent display space and access to elected officials."
On Jan. 20, 2009, Goodman reported that despite Obama's ban on corporate and lobbyist funding, 80% of the $27.6 million raised to fund the inauguration came "from 211 wealthy individuals who have bundled anywhere up to $300,000 each."
As investigative reporter Greg Palast observed in the title of his book, it's The Best Democracy Money Can Buy.
Shut Out of the Debate
A March 6, 2009 Fairness & Accuracy in Reporting (FAIR) study showed that, despite a January 2009 New York Times/CBS poll reflecting that nearly 2/3 of all Americans favored single-payer, during the week leading to Obama's March 5, 2009 health care summit, single-payer was greeted in the corporate media with deafening silence; mostly mentioned only in articles that attacked it. Per the FAIR study, single-payer "advocates...were almost entirely shut out" of the President's summit. FAIR reported:
The pattern continues. On June 3, 2009 The New York Times managed to cover the health care issue without so much as mentioning single-payer, let alone the fact that its own polling demonstrated that single-payer is favored by a 2 to 1 margin by the American people. It failed to mention HR 676 or the similar single-payer bill [PDF], S 703, introduced by Senator Bernie Sanders (I-VT).
But it isn't just the corporate media. A 2009 AFL/CIO Health Care for America Survey, for example, set forth eight different options, none of which included single-payer. The so-called Divided We Fail coalition whose four major members include AARP, Business Roundtable, SEIU, and the National Federation of Independent Business sent out an email to members stating “we need to have everyone at the table if we’re going to pass meaningful reform,” yet the statement it submitted into the record at the Senate Finance Committee hearings made no mention of single-payer.
A curious exception is MSNBC, which mentions single-payer multiple times on its web site in linking to May and June 2009 pieces, but the linked articles fail to discuss single-payer, except one which merely mentions that “liberals” shouted “single-payer” in protest. The effort to paint single-payer as a “liberal” position ignores the fact that it is supported by 2/3 of the American people --- a fact that either suggests a much broader range of support across the political spectrum or suggests that the American people are far more “liberal” than either their elected leaders or the corporate media.
Senator Baucus, a major recipient of health care insurer monies, insists that this is not the time to consider single-payer. He has not only excluded single-payer advocates from panels appearing before his Committee, but had the single-payer advocates who verbally protested arrested. One of those arrested, Russell Mokhiber of Single Payer Action, greeted Amy Goodman "from corporate-occupied territory, Washington, DC, where the drug companies and the health insurance companies control every nook and cranny."
Mokhiber's greeting pretty much sums up single-payer and the "democracy deficit." While Baucus agreed to meet privately with single-payer advocates on June 3, 2009, he continues to refuse them a seat at the table during public hearings.
The Kennedy/Baucus joint statement that they hope to pass their respective bills before the August recess, moreover, suggests that Baucus agreed to a private meeting with single-payer advocates only after the fix was in. Indeed, if activist David Swanson's description is anywhere near accurate, Baucus' willingness to privately meet with single-payer advocates was itself a scam. Baucus said it was a "mistake" not to include single-payer but that the legislative process was now too far along to correct the omission.
But this was no sin of omission. Baucus' earlier remarks make it clear that he intended to keep single-payer off-the-table all along. Indeed, the very title of the Baucus hearings, [emphasis added] the Senate Finance Committee Roundtable on Expanding Coverage on Health Care Reform, by definition excludes a single-payer solution.
The refusal by a bought-and-paid-for politician to permit 2/3 of the American people so much as a voice at public hearings is nothing short of scandalous, yet the scandal goes unreported in the all-too-complicit corporate media.
Towards the end of Sicko Michael Moore asked former British MP Tony Benn how the UK developed its national health care system in 1947.
Benn's short answer was "democracy."
Later, Benn added:
If the poor in the US and Britain turned out to vote for people who represent their interests it would be a real democratic revolution…
The "democracy deficit" is not an impenetrable gap. James Madison taught us that "knowledge will forever govern ignorance" and that "a people who mean to be their own Governors must arm themselves with the power knowledge can bring." Single-payer health care and the bridging of the democracy deficit can occur if we take the time to smash through the corporate media cone of silence, something which this article, in some small measure, aspires to achieve.
Those who wish to send their Senators an email demanding that single-payer advocates have a seat at the table during public hearings can do so right here.
UPDATE 6/6/09: Describing its author, Senator Edward M. Kennedy (D-MA) as the "longtime champion of health care for all," Robert Pear of The New York Times tauted Kennedy's hybrid "universal coverage" bill as a "sweeping health plan." While the bill includes the so-called public option, its principle features include subsidized "premiums for people with incomes up to 500 percent of the poverty level ($110,000 for a family of four)" and financial penalties on those who do not obtain "coverage," subject to an exemption for "exceptional financial hardship." "The bill," Pear conceded, "gives no indication of how Mr. Kennedy would pay for his proposals, other than by requiring contributions from individuals and employers," and will likely be merged with the bill being written by Sen. Baucus.
This is "reform" in reverse. Bad enough the parasites --- for profit carriers and HMOs --- are sucking up 31% of health care dollars under the current system. Kennedy would now place the burden upon the 47 million uninsured to prove "exceptional financial hardship" or face penalties, wasting tax dollars to further subsidize the parasites.
UPDATE 6/7/09: During the first quarter of 2009, five health insurance carriers, United Health Group, WellPoint, Aetna, Cigna & Humana, together with the trade group American Insurance Plans, spent $6.4 million lobbying on health care legislation. Additionally, "MetLife Inc. spent nearly $1.2 million lobbying in the first quarter on legislation related to health insurance, overhauling the health care system, home mortgages, financial regulations and other issues..."
In its Sunday, June 07, 2009 paper, The New York Times gave front page coverage to President Obama’s desire to have a direct impact on the health care debate. That and a separate article entitled “State Coverage Model No Help for Uneasy Insurance Industry” took up an entire page of the printed edition. "Single-payer" was never mentioned.
UPDATE 6/10/09: Kevin Zeese reported on OpEdNews that single-payer advocates will now be permitted to appear as witnesses before both Senate and House committees conducting hearings that will address health care reform.
Ernest A. Canning has been an active member of the California State Bar since 1977 and has practiced in the fields of civil litigation and workers' compensation at both the trial and appellate levels. He graduated cum laude from Southwestern University School of Law where he served as a student director of the clinical studies department and authored the Law Review Article, Executive Privilege: Myths & Realities. He received an MA in political science at Cal State University Northridge and a BA in political science from UCLA. He is also a Vietnam vet (4th Infantry, Central Highlands 1968).