Archive for April 7th, 2012

How to Fix Health Care Without the Mandate: Put Single-Payer On the Table by Sarah van Gelder


What happens if the Supreme Court strikes down the “individual mandate” in the health care reform law?

Commentators ranging from former Labor Secretary Robert Reich to Forbes Magazine columnist Rick Ungar agree: Such a decision could open the door to single-payer health care—perhaps even make it inevitable.

We don’t need to assume that our health care policy must be designed to maintain the health-industrial complex.

This may be the best news about health care in years. Because ever since Republicans convinced the Obama administration to drop the “public option” in the Affordable Care Act, health reform has been in trouble. True, most Americans favor many of the provisions of Affordable Care Act. But the overall plan rests on forcing you and me to buy insurance from the same companies that have been driving up the costs of health care all along—the same companies that have been finding creative ways to avoid covering needed care, shifting costs on to patients, and endlessly increasing premiums and out-of-pocket expenses for all of us.

Forcing all Americans into a failed system is bad policy, and it’s not just President Obama’s opponents who say so.

What the Doctors Ordered

When the Supreme Court agreed to hear a challenge to the Affordable Care Act brought by 26 state attorneys general, one of the supporting briefs came from an unexpected source—a group of 50 doctors who believe that single-payer health care is the way to cover everyone and contain costs. As a model for a revamped health care system, they point to Medicare, which covers millions of seniors while devoting just 2 percent of expenditures to overhead (compared to as much as 16 percent for private insurers).

In spite of all the fear about government involvement in health care, Medicare is enormously popular; in a recent poll, two-thirds of Americans oppose changing Medicare to something more like private insurance. In the Medicare model, as in Canada’s single-payer system, health care providers are in private practice, but the government acts as insurer, covering everyone. The money for the program comes from payroll taxes.

This model is just one of a variety of ways that industrialized countries provide universal coverage; only the United States does not yet offer universal coverage at all, and the impact of our fragmented, privatized approach ripples throughout the economy and into the lives of families that face bankruptcy and exclusion from needed treatment.

While we in the United States spend far more on health care, per person, than any other nation, we’re way behind other wealthy countries when it comes to our actual health. The residents of 25 other countries—all of which spend less on health care than we do—can expect to live longer, on average, than U.S. residents. In a recent study of 19 industrialized countries, the United States came in last when it came to averting preventable death. Researchers say that amounts to more than a 100,000 avoidable deaths each year.

We devote 15 percent of our economy (by GDP) to paying for health care (or $6,402 per person each year), and still leave millions without coverage. In contrast, the French spend 11 percent of GDP on health care (or $3,374 per person) and cover everyone; the French live two years longer, on average, than Americans, and have better health by all key measures.

Follow the Money

If we’re spending so much for poor results, where is all the extra money going? Private, for-profit health insurance companies spend big on overhead: covering the paperwork and arguments about who will cover what, finding ways to avoid covering people who might require costly services, disputing charges from health care providers. They spend money on marketing and on lobbying Congress, federal regulators, and state lawmakers. They pay dividends to shareholders and they pay executives six- or seven-figure compensation packages. No wonder premiums keep rising.

None of these costs are incurred by Medicare or other national insurance programs.

Asking each of us to choose among competing plans is like playing against the house in a casino—it might seem as though you’re getting choices among slot machines, but really, the odds are stacked against you.

Some argue that patients are better off with competing insurance companies because that gives them a choice. Perhaps this is true of a patient who spends many hours required to read the small print in competing insurance plans, producing spreadsheets to track the multiple variables, guessing what sort of coverage they and their family will need in years to come, and hoping that they made the right choice when an unexpected accident or illness means their life depends on the bet they made. On the other side, insurance companies have battalions of lawyers and adjusters making bets about coverage, co-pays, and deductibles—coming up with ways to cover less.

Asking each of us to choose among competing plans is like playing against the house in a casino—it might seem as though you’re getting choices among slot machines, but really, the odds are stacked against you whatever choice you make.

Where choice really matters to most people is in choosing health care providers. In France, where public financing of health care is the rule, patients actually have more choices among doctors than do Americans, who must choose among health care providers preferred by their insurance company.

So the doctors who are calling on the Supreme Court to strike down the individual mandate are on to something. Instead of locking us in even more tightly to an inefficient private insurance system, which has built-in incentives to take more of our money and do less for us, they argue we should switch gears. We’re spending $200 billion more per year than we would need to under a single-payer system, they say. We pay more out-of-pocket than other countries, and the Obama Affordable Care Act wouldn’t fix that.

What do Americans Want?

In poll after poll, a majority of Americans have expressed support for single-payer health care or national health insurance. This is true in spite of the near media blackout on this topic, and the failure of most national politicians to even consider single-payer as an option (the Obama administration and Democratic leadership in Congress excluded single-payer advocates from the key summits and hearings leading up to the passage of the health care bill).

In Massachusetts, which has had time to try out policies very similar to those in the Affordable Care Act, over 5 percent of the population remains uninsured. And, according to the doctors’ brief, local initiatives calling for single-payer health care passed by wide majorities in all the Massachusetts districts where they were on the ballot.

Vermont has adopted a single-payer health care plan, and the California Assembly twice passed single-payer, only to have it vetoed by the governor.

Single-payer health care, in short, is far more popular than the political establishment likes to admit—while requiring individuals to purchase health coverage from private insurance companies is wildly unpopular across the political spectrum. According to a recent poll, only a third of Americans favor the individual mandate, but 70 percent favor expanding the existing Medicaid program to cover more low-income, uninsured adults.

Here’s something to ask yourself: If you’re on Medicare now, would you give it up to move to a private insurance plan? If you’re not now covered and you could sign up for Medicare today, would you?

Medicare for All

That contrast offers a good starting point. We don’t need to assume that our health care policy must be designed to maintain the health-industrial complex and their lobbyists in the manner to which they have become accustomed. Instead, we can expand Medicare to cover more and more age groups, until everyone is covered. We could all then have access to a program that keeps overhead low, is wildly popular among its clients, and is similar to programs in Europe, Canada, Japan, and elsewhere that have excellent records of cost containment, universal coverage, and great health outcomes.

So what happens if the Supreme Court overturns the individual mandate or—as now seems possible—rejects the entire package? Such a move could turn out to be a great boon to those who doubt the wisdom of relying on private, profit-focused insurance companies to cover us when we get sick. It could offer us the opportunity to get the sort of proven universal coverage we can count on.


Sarah van Gelder wrote this article for YES! Magazine, a national, nonproifit media organization that fuses powerful ideas with practical actions. Sarah is co-founder and executive editor of YES!.

Interested?

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Reader Comments

Universal Health Care

Posted by Dilys Collier at Apr 06, 2012 08:14 PM
We Canadians love it even if it isn’t perfect. USA Republicans seem to consider Canadians “socialists.” We aren’t; our country is still run on a capitalist economic system (unfortunately). Socialism is an entirely different economic system. That’s not us. Our geographical circumstances determine our culture. During our extreme Canadian temperatures, we literally can live or die depending on whether we co-operate with one another. We don’t believe in leaving an injured Samaritan on the side of the road and passing by on the other side. Instead, we believe in offering assistance to everyone (regardless of colour, gender, or religion) by ensuring basic available health care to all.

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How to Fix Health Care Without the Mandate: Put Single-Payer On the Table by Sarah van Gelder.

3 Corporate Myths that Threaten the Wealth of the Nation | | Digg Mynews


April 5, 2012  |

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Corporations are not working for the 99%. But this wasn’t always the case. In a special 5-part AlterNet series, William Lazonick, professor at UMass, president of the Academic-Industry Research Network, and one of the leading expert on the American corporation, along with journalist Ken Jacobson and AlterNet’s Lynn Parramore, will examine the foundations, history, and purpose of the corporation to answer this vital question: How can the public take control of the business corporation and make it work for the real economy?

The wealth of the American nation depends on the productive power of our major business corporations. In 2008 there were 981 companies in the United States with 10,000 or more employees. Although they were less than two percent of all U.S. firms, they employed 27 percent of the labor force and accounted for 31 percent of all payrolls. Literally millions of smaller businesses depend, directly or indirectly, on the productivity of these big businesses and the disposable incomes of their employees.

When the executives who control big-business investment decisions place a high priority on innovation and job creation, then we all have a chance for a prosperous tomorrow. Unfortunately, over the past few decades, the top executives of our major corporations have turned the productive power of the people into massive and concentrated financial wealth for themselves. Indeed the very emergence of “the 1%” is largely the result of this usurpation of corporate power. And executives’ use of this power to benefit themselves often undermines investment in innovation and job creation.

These corporations do not belong to them. They belong to us. We need to confront some powerful myths of corporate governance as part of a movement to make corporations work for the 99%. To start, we have to recognize these corporations for what they are not.

• They are not “private enterprise.”

• They should not be run to “maximize shareholder value.”

• The mega-millions in remuneration paid to top corporate executives are not determined by the “market forces” of supply and demand.

Let’s take a closer look at each of these myths.

1. Public corporations are not private enterprise.

Here’s something you’ll rarely hear stated by today’s politicians and pundits: Publicly listed and traded corporations are not private enterprise. As documented by the pre-eminent business historian Alfred D. Chandler, Jr., in a book aptly called The Visible Hand, about 100 years ago the managerial revolution in American business placed salaried managers in charge of running the nation’s largest and most productive business corporations.

This was a peaceful revolution in which a generation of owner-entrepreneurs who had founded these companies some decades earlier used initial public offerings on the New York Stock Exchange to sell their ownership stakes to the public, leaving decision-making power in the hands of salaried managers. In effect, these corporate employees, and the boards of directors whom they selected, became trustees of the immense productive power that these corporations had accumulated.

Even when founders of companies that evolve into major public corporations become their CEOs, they generally occupy the top positions as corporate employees, not owners. For example, when the late Steve Jobs returned to Apple Computer in 1997, 11 years after being denied the CEO position of the company he had founded, his ascent to the top position was as a manager, not on owner. When a company founder like Larry Page of Google gives up private ownership by publicly selling shares, he may become CEO of the new corporation, but he is occupying this position as a hired hand, not as a private entrepreneur.

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3 Corporate Myths that Threaten the Wealth of the Nation | | Digg Mynews.

Newsweek/Daily Beast Poll Finds Majorities of Americans Think Country Divided by Race – The Daily Beast


Majorities of both whites (72%) and blacks (89%) believe the country is divided by race, the poll finds. But twice as many blacks (40%) as whites (20%) say it is very divided. And just 19 percent of whites say that racism is a big problem in America, vs. 60 percent of blacks.

Meanwhile, the killing of 17-year old Trayvon Martin has further polarized America along racial lines, the Newsweek/Daily Beast Poll finds. In the survey, whites are divided over whether they think Martin’s death was racially motivated. Thirty-five percent of whites say Martin’s death was racially motivated, while 30 percent say Zimmerman acted in self-defense and 35 percent are not sure. African-Americans, however, are convinced it was racially motivated (80% vs. 2%).

Whites also are divided on the question of whether Martin was targeted because he was a young black man–41 percent say yes, while 34 percent say no and 21 percent are not sure. Blacks are convinced he was targeted because he was a young black man (85% vs. 4%).

There also is a significant split over President Obama’s handling of the Trayvon Martin controversy—with a majority (52%) of whites saying they disapprove of the way he has handled the shooting while only 38 percent approve.

Blacks say the opposite—with near unanimous (87% vs. 5%) approval for the president’s handling of the shooting.

Nearly four years after the election of the nation’s first African-American president, majorities of both whites and African Americans surveyed say that race relations in the country have either stayed the same or gotten worse. Sixty-three percent of whites and 58 percent of African-Americans say race relations have either stayed the same or worsened—while only 28 percent of whites and 38 percent of African-Americans say they have gotten better.

Similarly, on the question of how Obama has handled race relations since he became president, whites disapprove (47% vs. 41%) while blacks are overwhelmingly positive (84% vs. 8%).

And when asked whether or not Obama has been helpful or not in bridging the racial divide in the country, whites say not helpful (51%) while blacks say helpful (69%).

The Newsweek/Daily Beast Poll found that both whites and blacks agree that racial stereotyping still occurs in American society today and majorities of both whites (72%) and blacks (89%) say America is divided on the basis of race.

But blacks and whites have fundamentally different perspectives when it comes to frequency, severity, and longevity of racial discrimination blacks face.

Whites and blacks disagree–and disagree fundamentally when it comes to when—blacks will achieve racial equality with whites. While a clear majority of whites (65%) say that blacks have achieved or will soon achieve racial equality, blacks are much less optimistic about the state of black progress. Only 16 percent of blacks say they have already achieved racial equality and nearly half of blacks (47%) say that they will not achieve racial equality in their lifetime or will never achieve racial equality.

African Americans were particularly sensitive to the economic downturn and were much more likely than whites to say that the prolonged recession contributed significantly to more discrimination in employment and housing.  Sixty-five percent of African-Americans surveyed said that the current economic situation today has played a role in promotion racial discrimination, compared to just 42% of whites.

And while 70 percent of whites think that blacks in America have the same chance as whites to get housing they can afford, only 35 percent of blacks agree.

Similarly, 70 percent of whites think blacks in America today have as good a chance as whites to get a job for which they’re qualified—a view shared by only a quarter of blacks.

And while virtually all whites (92%) and blacks (95%) agree that racial profiling occurs at least some of the time, the two groups diverge over whether profiling happens all of the time—a solid 63 percent of blacks say yes while less than one-quarter of whites agree.

Both whites and blacks agree that it is the responsibility of the federal government to make sure that the courts and the police treat minorities and whites equally. But the two groups disagree fundamentally over whether it is ever justified for police to take factors such as race ethnicity and overall appearance into consideration when making an arrest. A majority (56%) of whites say that it is at least sometimes justified for police to use factors such as race, ethnicity, and overall appearance–a view shared by only 28% of blacks.

Nearly six times as many African-Americans as whites (29% vs. 5%) say they have been unfairly stopped by the police because of their race or ethnicity all or some of the time.

When asked whether the police and courts treat blacks the same as they treat whites in America today, 82 percent of whites say that police treat blacks the same as whites all or some of the time, and 86 percent say the same of the courts.  A majority of blacks however, say that blacks are rarely or never treated equally by the police (53%) or the courts (52%).

The Newsweek/Daily Beast Poll was conducted by telephone between March 30 and April 1 from a random sample of 600 registered voters and a separate oversample of 400 registered African-American voters. The margin of error for the first group is plus or minus 4 percent while the margin of error for the second group is plus or minus 4.9 percent.

 

 

 

 

 

Newsweek/Daily Beast Poll Finds Majorities of Americans Think Country Divided by Race – The Daily Beast.

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