For the Record

U.S. run by corporations, hysterical lunatics; administered by craven capitulators

The latest bit of evidence here.

More evidence here.

I think I'll just keep the list going for a while.  What fun!

Bank-friendly Dems threaten to block Financial Regulatory reform bill.

Death of public option causes health insurance stocks to climb 20-30% to a 52-year peak.

Obama sells out, and then sells out some more.

Follow the money.

Wheee!

This about sums it up

Richard Gwyn, in today's Toronto Star, has an excellent "opinion" piece on the prospects for regulation and reform in the U.S.  The short cut:

[T]o really understand what's going on, follow the money. The American political system has become its hostage.

Reality check

A couple of months ago I wondered why many policy issues continue to be treated as ideological or political (supposedly reflecting differences of opinon or taste) as opposed to broadly scientific.  We've got tons of evidence, for example, about which approaches to health care provide the most health for your buck, and interestingly, in this case, all the main desiderata---for an economical, humane, effective system---point toward single-payer or at least the general availability of universal, not-for-profit care.  The measly public option that is presently under discussion in the U.S. would appear to be the bare minimum one might do by way of respecting the clear facts... so (to raise just two questions) why aren't (supposedly reality-based) progressive politicians and mainstream media hammering home facts clearly supporting a public option, and why are so many right-wingers frothing at the mouth about it?

I don't think the answer to the first question can ultimately advert to politicians or media being in the pocket of the health insurance industry.  For example, politicians aren't really getting that much in campaign contributions---a few mill, tops (which makes me wonder why someone doesn't do whatever it would take to guarantee that these guys would, if they did the right thing, get compensating grass-roots monies).  Moreover, it's clear that in many cases no amount of lobbying would provide reasonable grounds for a politician to support an empirically discredited cause (e.g., Christian Science).

So I guess I still don't understand why politicians, pundits and the media don't just keep throwing up slides showing, in particular, cost and health- and life-expectancy figures as between the U.S. and all the developed and semideveloped countries with government-based universal coverage.

I was thinking that the presupposition of the first question (namely, that the facts aren't getting out) suggested an answer to the second question.  The reason so many U.S.-ers don't "get it" is that so many U.S.-ers are, for whatever reason, generally unaware of the empirical facts, about health care and other pressing issues of the day.  Relatedly, as a friend pointed out, many are unaware of relevant causal mechanisms between things that they protest against (e.g., "socialist" health care and education) and things they desire (e.g., stable, safe and fulfilled people and communities.)

This is certainly part of the answer, and would explain why people better at accessing information tend to support heath care reform:

A guy at AEI has a piece about how younger voters feel about health care. He begins with a relatively accurate description of how he thinks younger people today function, calling them “generation choice”. Then he posits three reasons why younger voters might be better disposed towards health care reform than older voters: (1) they haven’t analyzed the bill, (2) they care more about the fairness of expanded coverage, and (3) they don’t care much about health care because they’re young and healthy. There’s an obvious fourth reason: they know that our system costs nearly twice as much as anyone else’s and is consistently ranked at the bottom in quality among western countries. Hence, they would choose a different system if possible.

It’s always important to remember that many, if not most, beliefs and customs in our society exist because of the widespread propagation of falsehoods. It’s why some people believe we have a great health care system. It’s also why some American League managers continue to use the sacrifice bunt.

For whatever reason, the internet has curbed the spread of these falsehoods among (the mostly younger) people who are able to navigate the internet without using AOL key words (though it may well have hastened the spread among people who are not). And that may well mark a sea change in American politics.

But it turns out that even when people are presented with the facts, there's no guarantee these will penetrate.  As Sharon Begley explains:

Some people form and cling to false beliefs about health-care reform (or Obama's citizenship) despite overwhelming evidence thanks to a mental phenomenon called motivated reasoning, says sociologist Steven Hoffman, visiting assistant professor at the University at Buffalo. "Rather than search rationally for information that either confirms or disconfirms a particular belief," he says, "people actually seek out information that confirms what they already believe." [...] "For the most part," says Hoffman, "people completely ignore contrary information" and are able to "develop elaborate rationalizations based on faulty information."

Of course, we all experience (dis)confirmation bias to some degree, but what is surprising is the extent to which retrospective rationalization ("inferred justification") can occur:

For their study, the scientists whittled down surveys filled out by 246 voters, of whom 73 percent believed in a Saddam-9/11 link, to 49 believers who were willing to be interviewed at length in October 2004. Even after the 49 were shown newspaper articles reporting that the 9/11 Commission had not found any evidence linking Saddam and 9/11, and quoting President Bush himself denying it, 48 stuck to their guns: yup, Saddam Hussein, directly or indirectly, brought down the Twin Towers.

When the scientists asked the participants why they believed in the link, they offered many justifications. Five argued that Saddam supported terrorism generally, or that evidence of a link to 9/11 might yet emerge. These counterarguments are not entirely illogical. But almost everyone else offered some version of "I don't know; I don't know anything"—that is, outright confusion over the conflict between what they believed and what the facts showed—or switched subjects to the invasion of Iraq. As one put it, when asked about his Saddam-9/11 belief, "There is no doubt in my mind that if we did not deal with Saddam Hussein when we did, it was just a matter of time when we would have to deal with him." In other words, holding fast to the Saddam-9/11 belief helped people make sense of the decision to go to war against Iraq.

"We refer to this as 'inferred justification,'" says Hoffman. Inferred justification is a sort of backward chain of reasoning. You start with something you believe strongly (the invasion of Iraq was the right move) and work backward to find support for it (Saddam was behind 9/11). "For these voters," says Hoffman, "the sheer fact that we were engaged in war led to a post-hoc search for a justification for that war."

Begley suggests, plausibly, that anti-reform nuts are typically people who didn't vote for Obama (or more generally, think progressives are spawn of satan) and are accordingly mainly engaging in inferred justification for their anti-Obama/progressive stance.

UPDATE: On second thought, I'm not sure that the phenomenon of inferred justification ultimately undermines the basic (and more hopeful) thesis that those clinging to discredited beliefs are suffering mainly from ignorance.  Wrt the study case, for example: what the clingers seem to be doing is trying to make some rational sense of why we went to war... they cling to the Saddam connection (perhaps) because they are unaware of alternative explainations, primarily related to oil- and related military-industrial-corporation complex considerations.

"fingernails on the cliff"

Great lecture here by Harvard's Elizabeth Warren. It's an hour long so I'll summarize. She's compared household expenses today and in momndad-time, finds all sorts of creepy stuff. Eg, spending is down on all fun stuff, way up on unfun stuff; the latter eats up all the $ from working women and much from dad. Unfun stuff hasta be paid so need two jobs to avoid fail. Add decreased safety net and increased ed costs and you get rise in bankruptcy, esp for fam with kids. Scary portent: the lucky pull away from the unlucky, eventually Brazil.

The new Agent Orange

As many as 20% of troops may have suffered brain damage after exposure to high-velocity explosions.

Dem candidates on revamping U.S. health care

A nutshell take on the candidates' positions so far:

When Clinton offers her proposal next week to cover the 47 million                 Americans who lack insurance, she will probably stake out the                 middle ground, appearing bolder than Senator Obama of Illinois                 and more pragmatic than former Senator Edwards of North Carolina.              

Obama, 46, has proposed mandating health-care coverage only for                 children. Clinton, 59, will likely make coverage mandatory for                 everyone, said a campaign aide who declined to offer details because                 he didn't want to pre-empt her speech, scheduled for Sept. 17                 at a medical center in Des Moines, Iowa.

Edwards, 54, would go further and create a government-run system                 to compete with private insurance. Every American would have the                 option of signing up for a program similar to Medicare, the U.S.                 program for the elderly and disabled.

Edwards... the voice of reason, as usual.

The true measure of power

The true measure of power is how much you can get away with, which makes the gangsters running the U.S. effectively all-powerful.

Socialized health-care: what U.S.-ers are missing

We've spoken here before about our positive experiences with Canada's single-payer regional healthcare system.  The only complaint about the system that has been confirmed is that certain elective surgical procedures (e.g., ACL repair) require waiting times that all agree are too long; but even here concrete efforts are underway (see, e.g., here) to rectify the situation. 

Meanwhile, wait times for elective surgeries are the least of the concerns of several of my friends and family back in the States.  Some have gone for years with no insurance (a few of the 47 million), unable to afford either premiums or needed treatment for ailments considerably worse than an ACL tear, but making too much to qualify for Medicaid; some have stayed in jobs they hated primarily in order to retain insurance covering a preexisting condition; one spent months on endless paperwork fighting against company goons whose primary job was evidently to find ways of denying rightful claims.  Relatedly, health insurance is no defense against debilitating medical debt:

A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses (14). Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.

In retrospect it was crazy to think that a for-profit system would result in efficient, humane, high-quality care.  But who knew that it would be as bad as it is?  And who knew that socialized single-payer systems would be as good as they are?  In any case, the evidence has long been in, and continues to be confirmed by countless stories (see, for example, this story and comment thread).  So why does the U.S. continue along the clearly worse path?  In this fascinating article Jill Quadagno discusses the history (1945-1996) of efforts to implement national health care in the U.S., and argues that U.S.ers have powerful stakeholder groups---notably, the AMA and private insurance organizations---to thank:

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal life course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist. Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare.

Of course, it's not exactly news that powerful lobbies have been at work here.  But the details are new (to me) and very illuminating: how physicians desiring professional autonomy teamed up with hospitals and insurance companies just long enough to shoot themselves in the foot; how post-war anti-Communist/Socialist propaganda led unions---the natural pro-single-payer lobby---to give up the fight for national health care and instead focus on fringe benefits; how the focus on benefits in turn led to the AFL/CIO's successfully lobbying for Medicare (basically, so they wouldn't have to worry about negotiating benefits for retirees); and much more.

A friend was asking the other day why someone should favor Edwards over Clinton or Obama for the Democratic nomination.  That powerful medical stakeholder groups are the primary barrier to socialized national health care in the U.S. provides one very good reason; for Edwards is a former trial lawyer who was brilliantly capable in putting these very sorts of groups in their place (see here for some illustrations).  That said, while Edwards advocates universal health care his proposal is a hodge-podge of measures still taken within the for-profit framework... a far cry from the single-payer proposal Ted Kennedy introduced in 1971.  Too bad!

The wholly privatized family

Unicef has just released a report assessing the well-being of children in the top 21 wealthiest countries (for which there is appropriate data; see below).

The [report] looks at six dimensions of child well-being: material well-being, health and safety, educational well-being, family and peer relationships, behaviors and risks, and young people's own perceptions of their well-being.

Both the U.S. and Britain were in the bottom two-thirds of five of the six categories, and came in dead last overall, by a considerable margin.  The overall results:

(Note: Australia, Iceland, Japan, Luxembourg, Mexico, New Zealand, the Slovak Republic, South Korea, and Turkey were excluded due to lack of data). The U.S. came in last on health and safety:

While none of the countries studied can claim "mission accomplished" in securing child well-being in every measurement, the United States fared particularly poorly. It ranked last in health and safety, primarily because of high rates of infant mortality, low birth weight, and deaths from accidents and injuries.

No great surprise, given the persistent legacies of Reagan and Thatcher:

One of the study's researchers, Jonathan Bradshaw, said children fared worse in the US and Britain -- despite high overall levels of national wealth -- because of greater economic inequality and poor levels of public support for families.

“What they have in common are very high levels of inequality, very high levels of child poverty, which is also associated with inequality, and in rather different ways poorly developed services to families with children,” said Bradshaw, a professor of social policy at the University of York in Britain.

“They don’t invest as much in children as continental European countries do,” he said, citing the lack of day care services in both countries and poorer health coverage and preventative care for children in the U.S.

More discussion of causal factors here.

Why is there a U.S. health care crisis?

Contrasting our positive experiences with the Canadian health care system with what she is experiencing in the U.S., my mother writes:

This is such a basic, serious issue that each and every American should be agreeing on.  Who and what is it that stands in the way of universal, caring health care for all Americans?  [...]

Is it the health insurance companies who now virtually do NOT insure anyone who has ever had a health problem in their background?  (My husband and I have both had cancer and have been cancer-free for 5 years, but are both uninsurable at any price in the US--one of our [relatives],  age 26, had a "iffy" Pap smear (not cancer but might turn into it sometime in the future) and was denied insurance.   

And what is the benefit to Americans that health insurance companies have the luxury of not insuring anyone who is in any way a "risk"?  Is not life itself a risk, and are we not all going to die, sooner or later, of something??  If health insurance is not a "viable business" given that we are all going to die, isn't that the best reason in the world to make health care the responsibility of the government, and not a profit-making corporation?

And then there is the prescription problem.  The restrictions and regulations in the new "Medicare D" are so ridiculous that it's almost impossible to describe it without thinking the world has gone crazy.  But it's all understandable if you understand that it's all about helping the pharmaceutical companies keep on making money. [...]

But to get back to my original point, who in the vast American population benefits when health insurance companies and pharmaceutical companies are virtually dictating who gets cared for and how much they pay for their drugs??

I realize that there are quite a few Republican congressmen and lobbyists and others who rake in a lot of dough as all this goes on.  But what are their ranks compared to the enormous number of people who just need decent, affordable health care---namely, almost all Americans.  Surely the millions who deserve fair, affordable health care far outnumber the handful of crooks who are cashing in on denying these millions the care they need.

Can it possibly be true that a few corporations and congresspeople are denying an entire nation of people this basic human right?   And why is it that each and every American who is at risk (and that is most of us) isn't screaming bloody murder about this one issue alone??   I really don't get it.

This excerpt from David Sirota's new book (Hostile Takeover: How Big Money and Corruption Conquered our Government -- and How We Take it Back) provides some answers to my mother's good question of why the interests of such a small segment of the U.S. population have been allowed to "deny an entire nation of people of this basic human right" (perhaps a right contingent on sufficient resources---but clearly this condition is met). 

Sirota makes the question more pointed, by noting that those who endorse (and in any case stand to benefit from) national health care include not just those needing care but increasingly, doctors and members of the business community:

According to a nationwide ABC/Washington Post poll in 2003, "Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current [private] employer-based system."

Doctors, too, are chiming in with support for universal health insurance. In 2003, the prestigious--and conservative--Journal of the American Medical Association published a proposal for government-sponsored universal health care that was endorsed by more than 8,000 physicians (including two former surgeon generals).

Even parts of the business community support government intervention. For instance, Ford, GM and Chrysler all endorsed Canada's system, where the government funds health care for all citizens. Similarly, a poll of Michigan small businesses found that 63 percent supported creating a universal health care system, even if it required tax increases. The health insurance industry, you see, is not only gouging patients--it is gouging employers who provide health care benefits to workers.

Horrifically, lack of universal health care is killing 18,000 U.S.-ers a year:

The Institute of Medicine was created by Congress in 1970 to be the chief, nonpartisan adviser to the federal government on all matters related to health care. That's why the announcement it made in 2004 was so stunning. "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States," the Institute said. Therefore, "By 2010, everyone in the United States should have health insurance ... [The Institute] urges the president and Congress to act immediately by establishing a firm and explicit plan to reach this goal."

The health care system, which is supposed to preserve and protect human life, is allowing thousands of Americans to die every year, and America's top experts were sounding the alarm.

Sirota goes on to address my mother's question:

So how is it that government and media have settled into complacency when the system is so bad for so many? The status quo pays big dividends.

In 2003, HMOs nearly doubled their profits from just a year before, adding $10 billion to their bottom line. That year, top executives at the 11 largest health insurers made a combined $85 million in one year. In the first three quarters of 2004, HMO profits increased by another 33 percent. The sheer numbers behind these profits are staggering: In 2004 alone, the four biggest health insurance companies reported $100 billion in revenues. That's $273 million a day, every day, 365 days of the year.

That's the kind of cash that allowed the health industry to spend more than $300 million on lobbying in 2003, and another $300 million on campaign contributions to politicians since 2000. Their agenda is pretty simple: stop any proposals to curb health care profiteering by private insurance companies. To make its arguments, the industry buys off high-profile ex-politicians and makes them its spokespeople.

Really, who needs lobbyists when corrupt politicians who will do the job?  People like Rep. Mike Rogers (R-Mich.) can be counted on to bring up the specter of health care "rationing" whenever the topic of universal health care comes up, as when Ron Pollock of Families USA testified before a house committee on the issue:

Like a drooling pit bull snarling at a passerby, Rogers barked, "You support rationing health care for American citizens and limiting the ability for them to have access to pharmaceutical treatment in order to keep costs down."

Rogers might well have screamed "Communist!" had his time not run out. Why was he so aggressively hurling out deceptive accusations? He was just doing the job he'd been paid to do: Over the previous four years, Rogers found himself in possession of more than a quarter million dollars of campaign contributions from the health care industry. Rogers is just a cog in the industry's spin machine--a $275,000 cog, but a cog nonetheless. That machine has been effective over the years in one of its most important goals: tarring any government health care initiative as the precursor to "rationing." So when advocates of government involvement make an appearance anywhere in Washington, the industry's hired goons can be counted on to shout them down before any ugly truth gets out there.

We are led to believe that because we have a private, for-profit health care system, we don't have health care rationing in America. But the whole point of most health insurance companies is to ration care, limiting the amount of coverage their patients get in order to save cash. Even the Supreme Court admits that. [...] The ultraconservative Washington Times admitted that the court made very clear that "it is the point of any HMO to ration care and within its prerogative to delay tests, avert expensive consultations or refuse experimental care."

Sirota goes on to make some obvious suggestions about how the health care crisis could be resolved: either go for a single-payer system ("Medicare for everyone") or else regulate the industry.  Easier said than done,  though.  The deeper answer to my mother's question remains unanswered: how on earth can U.S.-ers get corporations back into the bottle?