Almost every other industrialized nation has it. 43 million uninsured Americans wish they had it. Our businesses are less competative because we don't have it.
The time has come for Congress and the President to initiate legislation making Medicare available to all citizens, young and old. Known as "single-payer health insurance," Medicare For All would instantly solve one of the worst problems our country faces: an almost unworkable health care system with spiralling costs that now sees over 43 million Americans with no health insurance at all.
This will be a two-part article. Part one rebuts the arguments made by pharmaceutical companies, health insurance companies and libertarians against Medicare For All. Part two rebuts anecdotal attacks against single-payer health plans in other nations.
Since Lyndon Johnson signed it into law in 1965, our nation's senior citizens have been covered by a phenomenally successful single-payer health plan called Medicare. Before then, only about 50% of citizens over age 65 were covered by health insurance; today about 97% of our older citizens have insurance. Almost from its inception Medicare has been efficient and reliable. Medicare represents the best our government can do, and the program is almost universally respected among the populace.
If Medicare works so well and almost everyone enrolled is happy with it, doesn't it make sense to make the program available to all citizens? After all, everyone agrees that having almost one-sixth of the citizenry uncovered by any health plan at all is a travesty.
Well, the health insurance industry and Big Pharma don't quite see it that way. The current system serves them just fine, thank you; health care is big business in this country, and business is good. Top health care executives garner multi-million dollar salaries and millions more in stock options. They fly in private jets and own multiple vacation homes. To say they have a vested interest in the status quo is a vast understatement.
Their arguments against Medicare For All almost always boil down to three issues: first, they claim Medicare isn't really more efficient than the current system. Second, that Medicare For All would result in fewer choices and a substandard health care system. Finally, they argue Medicare For All would be too expensive.
In 2006 the Council For Affordable Health Insurance (CAHI), an advocacy group comprised of most of the nation's health insurance providers, published a white paper by Dr. Merrill Mathews entitled Medicare's Hidden Administrative Costs (pdf. file here). This paper is based in part on a study published by Mark Litow of Milliman, Incorporated, a consulting firm that delivers health insurance plans, investing plans and employee benefits plans for businesses.
Leaving aside the fact that, given their financial interests, neither CAHI nor Milliman, Inc. can be expected to be impartial in their analysis, let's look at the claims in Dr. Mathews' white paper. One of the arguments often put forth by advocates of Medicare For All is the program's legendary efficiency; most claim that just two or three percent of all Medicare outlays are administrative, whereas for-profit insurance firms typically spend 20 to 30 percent for administration. Mr. Litow says that, contrary to popular belief, Medicare's legendary efficiency is overstated (he says it's 5.2%), and for-profit inefficiency is overstated (he says it's 16.7%). We'll come back to those numbers in a moment.
Dr. Mathews further claims that Medicare should appear more efficient because the average yearly claim amount for a Medicare recipient is $6,600, while a private insurance recipient receives just $2,700 per year. Thus the administrative costs per dollar paid should be lower for Medicare.
Dr. Mathews then goes on to make the bizarre claim that private insurance administrative costs actually add value for the consumer, because much of those costs involve a closer scrutinizing of claims and a subsequent denial of coverage (about how this helps health care consumers I haven't the foggiest notion).
Therein lies the rub: much of the higher administrative costs associated with for-profit health insurance involve the one thing most people hate about private health insurance: in their drive for profits, insurance companies consistently deny coverage to people that their own doctors think they need.
In addition, private insurance companies further enhance their profits by excluding patients with pre-existing conditions, shunting them to far more expensive plans, or off the rolls altogether. No wonder their administrative costs are higher: they reduce claims by only taking healthy people, and when those healthy people do happen to get sick, they deny them coverage.
O.K., let's get back to the numbers. The insurance industry's advocacy group claims the current system works just fine, even though, by their own numbers, administration of Medicare is 11.5% more efficient. In other words, if we had Medicare For All, we'd immediately save 11.5%. Maybe I'm crazy, that sounds like a compelling argument to throw out the entire for-profit system and make Medicare available to everyone.
The second argument, that consumers won't have any choice under Medicare For All, is patently ridiculous on its face.
Private schools didn't disappear with the advent of public education. People who can afford it and choose to do so still send their children to private school. But they also understand why it's important to contribute tax dollars towards public education: an educated and productive citizenry is advantageous for society as a whole.
Likewise, Medicare For All would neither destroy the private health insurance industry nor lead to fewer choices for consumers. People who can afford it and choose to do so could buy private plans. But people would come to realize funding Medicare For All benefits society for the same reason they support public education: a healthy and productive citizenry is also advantageous for society as a whole.
Finally, the cost issue. Most estimates are that it would cost about $1.86 trillion dollars per year, at least initially, to begin offering Medicare For All. Of this, the federal government already spends about %852 billion on Medicaid, Medicare and a host of other health care programs, so we need to find about a trillion dollars per year to institute Medicare For All. Eventually those costs would come down somewhat, provided the Federal Government was given the power to negotiate drug prices with the big pharmaceutical companies.
Also, the 43 million uninsured cost us proportionally more than they should because they often don't seek preventative treatment and, when they are treated, it's usually in an emergency room, which costs more. Still, most experts say premiums will be in the $90 to $120 per month range -- far less than most people currently pay for their private plans.
The group Physicians For a National Health Plan (PNHP) have come up with this plan to raise the money for Medicare For All. It involves employee contributions and employer contributions (albeit at a far lesser level than most employees and employers currently contribute under our for-profit system), and a variety of taxes, mostly on the top 5% of wage earners.
Having said this, I think I've come up with an alternative funding plan -- not just for Medicare For All but for a host of other programs I think we need to Fix America. I will detail that funding plan in Step 10 of my 10 Steps, but I'll give a hint: in also involves asking the rich to accept a much more progressive tax program than is currently in place. After all, the rich got rich primarily because of the vast infrastructure that is the American economy; it seems only fair they contribute proportionally greater sums back to that infrastructure.
Medicare For All is, above all, a moral imperative. Basic health care services should be a universal human right. The time has come for the most powerful economy on the face of the earth to cover the health care of its citizens.
Next: Exploding the anecdotal myths about single-payer in other industrialized nations.
Monday, July 9, 2007
Sunday, July 8, 2007
California's Burning
The fire season has just started here in California, and it seems as if half the state is already burning.
Most distressing to me is a series of fires in the Eastern Sierra known as the Inyo Complex fires. These fires are burning up my favorite stomping grounds, the places I go to hunt quail, hike into the High Sierra backcountry and just generally hang out in relative peace.
One, the Sage Fire, us burning up Big Pine Canyon, which just happens to be one of the most stunningly beautiful canyons in the Sierra. Another, known as the Seven Oaks fire, is burning on both sides of historic Highway 395 north and west of the quaint little town of Independence, consuming acres and acres of prime quail and tule elk habitat.
Altogether there are five major fire complexes burning in the state, with over 61,000 acres burned (although the Goldledge Fire north of Kernville is 96% contained). And that's not including the disastrous Angora Fire in South Lake Tahoe that burned over 3,100 acres and destroyed over 200 homes. Among the fires still out of control is the Zaca Fire in the Los Padres National Forest, which has consumed 7,800 acres in the Figueroa Mountain area, lands known for having some of the best spring wildflower viewing in the entire state.
California suffered through its driest rainy season in history last year, so things will probably only get worse. I fear that as I take to the field this summer and fall many of my favorite places will no longer be recognizable.
Most distressing to me is a series of fires in the Eastern Sierra known as the Inyo Complex fires. These fires are burning up my favorite stomping grounds, the places I go to hunt quail, hike into the High Sierra backcountry and just generally hang out in relative peace.
One, the Sage Fire, us burning up Big Pine Canyon, which just happens to be one of the most stunningly beautiful canyons in the Sierra. Another, known as the Seven Oaks fire, is burning on both sides of historic Highway 395 north and west of the quaint little town of Independence, consuming acres and acres of prime quail and tule elk habitat.
Altogether there are five major fire complexes burning in the state, with over 61,000 acres burned (although the Goldledge Fire north of Kernville is 96% contained). And that's not including the disastrous Angora Fire in South Lake Tahoe that burned over 3,100 acres and destroyed over 200 homes. Among the fires still out of control is the Zaca Fire in the Los Padres National Forest, which has consumed 7,800 acres in the Figueroa Mountain area, lands known for having some of the best spring wildflower viewing in the entire state.
California suffered through its driest rainy season in history last year, so things will probably only get worse. I fear that as I take to the field this summer and fall many of my favorite places will no longer be recognizable.
Saturday, July 7, 2007
"That's some catch, that Catch-22"
-- Joseph Heller, Catch-22
With a bit of circular logic that would have even Joseph Heller cringing, the U.S. 6th Circuit Court of Appeals said yesterday, in a two to one decision, that plaintiffs who had challenged the Bush administration's domestic spying program did not have legal standing to do so because they could not prove the program had harmed them.
In other words, the group couldn't prove a secret program had affected them because, well, it's secret. As long as the Bush cabal maintains in secret any program it wants to operate, there's nothing anybody can do about it.
Needless to say, the two judges who ruled in favor of the administration, Alice M. Batcheider and Julia Smith Gibbons, were appointed by Republicans. Several days ago I called for the impeachment of Supreme Court justices Roberts and Alito. Perhaps I should amend my opinion to include the impeachment of any Republican-appointed federal judge since the Nixon administration.
Indeed, Richard Nixon, in whatever hell he inhabits, must today be slapping himself upside the head and exclaiming "why didn't I think of that?"
-- Joseph Heller, Catch-22
With a bit of circular logic that would have even Joseph Heller cringing, the U.S. 6th Circuit Court of Appeals said yesterday, in a two to one decision, that plaintiffs who had challenged the Bush administration's domestic spying program did not have legal standing to do so because they could not prove the program had harmed them.
In other words, the group couldn't prove a secret program had affected them because, well, it's secret. As long as the Bush cabal maintains in secret any program it wants to operate, there's nothing anybody can do about it.
Needless to say, the two judges who ruled in favor of the administration, Alice M. Batcheider and Julia Smith Gibbons, were appointed by Republicans. Several days ago I called for the impeachment of Supreme Court justices Roberts and Alito. Perhaps I should amend my opinion to include the impeachment of any Republican-appointed federal judge since the Nixon administration.
Indeed, Richard Nixon, in whatever hell he inhabits, must today be slapping himself upside the head and exclaiming "why didn't I think of that?"
Thursday, July 5, 2007
More Random Thoughts On the Day's News
Spent the night of July 4th at the in laws. This morning, when I woke up, they informed me another celebrity had been busted for speeding and drugs, this time in Southern Orange County. My first impulse was to think: Paris Hilton, Lindsay Lohan or Nicolle Richey, but then that unholy triumvirate usually does its damage in L.A. County.
When told it was Al Gore's son, clocked at 100 miles per hour in his Toyota Prius, with marijuana and illegal prescription drugs in the car, my first response was: damn! I didn't know a Prius would go that fast! Seriously, anyone driving that fast at that time in the morning with illegal drugs in his car can't be too bright. Let's just say Al Gore's apple tree appears to be planted on a very, very steep incline.
The latest CBS poll puts George Bush's approval rating at 27%. At this point, Mr. Bush is plumbing truly Nixonian levels. Moreover, and pollsters differ on this, but most say that between 10% and 20% of poll respondents will always say "yes" to the approval question because, well, he is the president and we should always support him (think Britney Spears). This means that, at best, only 17% of the people in this country who possess a brain still support this guy.
My informal research indicates the 17% is comprised entirely of: A) managers and executives of the fifty largest multi-national corporations in the country, including Big Oil, Big Pharma, Big Banking and Walmart; and B) extremely rich people who own significant shares in the fifty largest multi-national corporations in the country, including Big Oil, Big Pharma, Big Banking and Walmart. For everyone else Bush has pretty much been a disaster.
Lost in the celebration of removing the bald eagle from the endangered species list is this: according to the L.A. Times, the Bush administration has added just 58 species to the endangered species list, and 54 of them were in response to litigation by various environmental groups. By contrast, Bush's father, in just four years, added 231 species to the list. And there is no truth to the rumor the Bush administration favors adding "fiscal conservatives" to the endangered species list because, in the words of a Bush spokesman, "it's too late, they're already extinct."
When told it was Al Gore's son, clocked at 100 miles per hour in his Toyota Prius, with marijuana and illegal prescription drugs in the car, my first response was: damn! I didn't know a Prius would go that fast! Seriously, anyone driving that fast at that time in the morning with illegal drugs in his car can't be too bright. Let's just say Al Gore's apple tree appears to be planted on a very, very steep incline.
The latest CBS poll puts George Bush's approval rating at 27%. At this point, Mr. Bush is plumbing truly Nixonian levels. Moreover, and pollsters differ on this, but most say that between 10% and 20% of poll respondents will always say "yes" to the approval question because, well, he is the president and we should always support him (think Britney Spears). This means that, at best, only 17% of the people in this country who possess a brain still support this guy.
My informal research indicates the 17% is comprised entirely of: A) managers and executives of the fifty largest multi-national corporations in the country, including Big Oil, Big Pharma, Big Banking and Walmart; and B) extremely rich people who own significant shares in the fifty largest multi-national corporations in the country, including Big Oil, Big Pharma, Big Banking and Walmart. For everyone else Bush has pretty much been a disaster.
Lost in the celebration of removing the bald eagle from the endangered species list is this: according to the L.A. Times, the Bush administration has added just 58 species to the endangered species list, and 54 of them were in response to litigation by various environmental groups. By contrast, Bush's father, in just four years, added 231 species to the list. And there is no truth to the rumor the Bush administration favors adding "fiscal conservatives" to the endangered species list because, in the words of a Bush spokesman, "it's too late, they're already extinct."
Tuesday, July 3, 2007
Praying For Al Gore, or Where Do We Go From Here?
With the commutation of Scooter Libby's sentence, there is much angst on the liberal blogosphere and liberal message boards about why the Democrats need to impeach President Bush. I want to go on record as suggesting that yes, I believe Bush has committed high crimes and misdemeanors. Still, I would suggest that to impeach would be both futile and a waste of time. There is simply no way we can get the 66 votes in the Senate to convict and remove. Independent voters would see it as political grandstanding with no hope of succeeding, hurting Democratic candidates in 2008. So what should be do? O.K., here's my suggestion on how we should proceed from here.
First, we need to understand that sometime next spring Bush will declare victory and bring our boys and girls home, hoping to take away our strongest issue. There is no way the Republicans will allow Iraq to dominate the 2008 elections. Democrats need to start focusing now on other issues, particularly the issues that most citizens really care about.
So we need to pass bill after bill on real issues: health care, energy independence, repeal NAFTA, repeal tax breaks for big oil, repeal Bush's tax breaks for the rich, repeal the bankruptcy bill, repeal the Medicaid scam, make illegal the use of electronic voting machines. Sure, he'll veto every one, and we don't yet have the votes to override, but it will put both the Democrats and the Republicans on record. It will give our candidates in 2008 something to run for -- we can't just be against Republicans, we need to be for a better America.
We also need to investigate, investigate, investigate. Continue to investigate the prosecutor firings. Continue to investigate the Plame scandal. Continue to investigate war profiteering and privatization. Continue to investigate the administration's handling of Katrina. Continue to hammer on the Libby commutation. Continue to investigate illegal wiretapping. Expose the Bush cabal for what it really is: an affront not only to average Americans but to the Constitution as well. Then, in 2008, any Republican who continued to support this bunch can be roasted over the fire-pit of public revulsion.
We have to win the presidency in 2008, people. If we don't we may be doomed as a free nation. I can't stress enough how important this next election will be. If we lose, the Supreme Court will be lost for at least a generation. An election process already rigged to elect Republicans will be so ingrained in the system we won't be able to dig out. Corporations will be further enriched at the expense of an ever shrinking middle class. We have to focus on this election, because it may be our last chance to save the nation. Concentrating on a futile effort to impeach only takes our eyes off the ball.
The reason Republicans have been so successful the past two decades is because all they care about is winning. We have to have a strategy to win first -- then we can go about the business of actually governing the country out of this mess the Republicans have made.
And that is why I am beseeching Al Gore to throw his hat in the ring. As sad as it is to write today, in the year 2007, both racism and sexism are alive and well in America. Quite simply, I don't believe either Barack Obama or Hillary Clinton are electable. Sure, the polls and focus groups suggest we, as a nation, are ready for a black man or a woman to be president. And I would like to believe the people responding to these polls are not lying; I just think, in their heart of hearts, many of these people, in the privacy of the voting booth, won't be able to pull the lever for a black man or a white woman.
That is why I think Al Gore must be our nominee. Failing that, we must support John Edwards, who I believe is the only other candidate running on the Democratic side who is electable. Because winning is of such paramount importance this time around, in 2008 ideology must wait.
First, we need to understand that sometime next spring Bush will declare victory and bring our boys and girls home, hoping to take away our strongest issue. There is no way the Republicans will allow Iraq to dominate the 2008 elections. Democrats need to start focusing now on other issues, particularly the issues that most citizens really care about.
So we need to pass bill after bill on real issues: health care, energy independence, repeal NAFTA, repeal tax breaks for big oil, repeal Bush's tax breaks for the rich, repeal the bankruptcy bill, repeal the Medicaid scam, make illegal the use of electronic voting machines. Sure, he'll veto every one, and we don't yet have the votes to override, but it will put both the Democrats and the Republicans on record. It will give our candidates in 2008 something to run for -- we can't just be against Republicans, we need to be for a better America.
We also need to investigate, investigate, investigate. Continue to investigate the prosecutor firings. Continue to investigate the Plame scandal. Continue to investigate war profiteering and privatization. Continue to investigate the administration's handling of Katrina. Continue to hammer on the Libby commutation. Continue to investigate illegal wiretapping. Expose the Bush cabal for what it really is: an affront not only to average Americans but to the Constitution as well. Then, in 2008, any Republican who continued to support this bunch can be roasted over the fire-pit of public revulsion.
We have to win the presidency in 2008, people. If we don't we may be doomed as a free nation. I can't stress enough how important this next election will be. If we lose, the Supreme Court will be lost for at least a generation. An election process already rigged to elect Republicans will be so ingrained in the system we won't be able to dig out. Corporations will be further enriched at the expense of an ever shrinking middle class. We have to focus on this election, because it may be our last chance to save the nation. Concentrating on a futile effort to impeach only takes our eyes off the ball.
The reason Republicans have been so successful the past two decades is because all they care about is winning. We have to have a strategy to win first -- then we can go about the business of actually governing the country out of this mess the Republicans have made.
And that is why I am beseeching Al Gore to throw his hat in the ring. As sad as it is to write today, in the year 2007, both racism and sexism are alive and well in America. Quite simply, I don't believe either Barack Obama or Hillary Clinton are electable. Sure, the polls and focus groups suggest we, as a nation, are ready for a black man or a woman to be president. And I would like to believe the people responding to these polls are not lying; I just think, in their heart of hearts, many of these people, in the privacy of the voting booth, won't be able to pull the lever for a black man or a white woman.
That is why I think Al Gore must be our nominee. Failing that, we must support John Edwards, who I believe is the only other candidate running on the Democratic side who is electable. Because winning is of such paramount importance this time around, in 2008 ideology must wait.
Monday, July 2, 2007
Corrupt To the Core
I just had the pleasure of hearing an interview with Ambassador Joe Wilson on the local radio station, KTLK AM1150, on this day President Bush commuted the sentence of one Lewis "Scooter" Libby. Wilson said, more than once, that he believes the Bush administration is "corrupt to the core." Today's decision is indeed more proof of that, if we needed it.
The president and his minions obviously are not interested in the American people finding out the ultimate truth in this matter, because the only leverage to force Libby to talk was jail time. Even more obvious is the president pointedly didn't want Libby singing, fearful of what might come to light. Now Libby can remain quiet, like the good mobster he is, and make millions on the speaking and book circuits.
The president also plainly doesn't care if the American people approve of this commutation; he's a lame duck and he knows it, and doesn't care if his approval ratings plummet into the teens. He knows there aren't the votes to convict in the Senate, regardless of what comes to light in the coming months, and that he's destined to serve out his term.
Anybody who's paying attention knows this bunch is the most corrupt and vile in our nation's history. I suspect even most Republicans know it, but are still more interested in pure power than in what would be best for the country. These are sad times indeed.
The president and his minions obviously are not interested in the American people finding out the ultimate truth in this matter, because the only leverage to force Libby to talk was jail time. Even more obvious is the president pointedly didn't want Libby singing, fearful of what might come to light. Now Libby can remain quiet, like the good mobster he is, and make millions on the speaking and book circuits.
The president also plainly doesn't care if the American people approve of this commutation; he's a lame duck and he knows it, and doesn't care if his approval ratings plummet into the teens. He knows there aren't the votes to convict in the Senate, regardless of what comes to light in the coming months, and that he's destined to serve out his term.
Anybody who's paying attention knows this bunch is the most corrupt and vile in our nation's history. I suspect even most Republicans know it, but are still more interested in pure power than in what would be best for the country. These are sad times indeed.
More Random Thoughts On the Day's News
The London "bomb scare" is looking more and more like amateur hour. These were not car bombs, but more like giant Molotov cocktails. This isn't Hollywood people; cars do not explode, even if filled with barrels of gasoline with nails in them.
Yet the blowhards on the right are on the T.V., breathlessly telling us there could have been "significant loss of life, blah blah blah." At this point I think most Americans realize they're just trying to scare us.
Giuliani was on the T.V. last week telling us 9/11 was Clinton's fault (isn't everything?) and that liberals are weak on terrorism because they want to treat it like a police action instead of a "war." Note to Republicans: this doesn't work anymore. Find something new to lie about.
Now that Lewis "Scooter" Libby has exhausted his appeals, expect the Republican noise machine to go into overdrive as Limbaugh et al decry that Libby is going to prison for "a minor offense for which no underlying crime was found." Funny, they didn't think Bill Clinton's perjury and obstruction were so minor.
Of course, look at the "underlying crime" in each case. Clinton was lying to cover up the fact he was getting a hummer from someone not his wife. Libby was lying to cover up the outing of a CIA operative who worked on nuclear nonproliferation. Yeah, now I think I see the difference.
Mark my words: by next spring Bush will declare victory and bring our boys and girls home, depriving the Democratic nominee of his or her best issue. The Dems better get busy talking about energy independence, health care and the environment or they'll be seen as out of touch.
Is it just me, or is Paris Hilton on the cover of every magazine in existence? If she shows up on the cover of The Nation I'm going to run screaming into the night -- right after I cancel my subscription.
Yet the blowhards on the right are on the T.V., breathlessly telling us there could have been "significant loss of life, blah blah blah." At this point I think most Americans realize they're just trying to scare us.
Giuliani was on the T.V. last week telling us 9/11 was Clinton's fault (isn't everything?) and that liberals are weak on terrorism because they want to treat it like a police action instead of a "war." Note to Republicans: this doesn't work anymore. Find something new to lie about.
Now that Lewis "Scooter" Libby has exhausted his appeals, expect the Republican noise machine to go into overdrive as Limbaugh et al decry that Libby is going to prison for "a minor offense for which no underlying crime was found." Funny, they didn't think Bill Clinton's perjury and obstruction were so minor.
Of course, look at the "underlying crime" in each case. Clinton was lying to cover up the fact he was getting a hummer from someone not his wife. Libby was lying to cover up the outing of a CIA operative who worked on nuclear nonproliferation. Yeah, now I think I see the difference.
Mark my words: by next spring Bush will declare victory and bring our boys and girls home, depriving the Democratic nominee of his or her best issue. The Dems better get busy talking about energy independence, health care and the environment or they'll be seen as out of touch.
Is it just me, or is Paris Hilton on the cover of every magazine in existence? If she shows up on the cover of The Nation I'm going to run screaming into the night -- right after I cancel my subscription.
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