Wednesday, August 26, 2009

The "Super Rich" and Our Healthcare

The New York Times, August 21, 2009, has a front-page article by David Leonhart and Geraldine Fabrikant titled “After 30-year run, rise of the super-rich hits a sobering wall” ( My heart bleeds. Not. Not at all. Couldn’t happen to more deserving people.

I do not mean to say that all super-rich folks are bad people. Some worked hard, got lucky, had a product or an idea that no one else had, and were able to turn it into great wealth. Others inherited it – ok, they did nothing to earn the wealth, but maybe they are spending it in very socially-conscious ways, supporting the movement for the environment and limiting climate change, working for peace, helping feed the hungry and house the homeless in this country and abroad.

But the “30-year run” is largely a story of greed gone wild. It is a story of the society that was among the most middle-class in world history, with poor people and rich people and some very rich people, to a society with lots of poor people, a declining role for the middle and upper middle class, and a relatively large (though still tiny) group of super-rich. It is a story of policies begun in the Reagan administration and carried through the subsequent administrations, both Republican and Democratic, of limiting restrictions and regulations that helped to keep business relatively honest. It encouraged lying, cheating and racketeering by making so much of it legal that some folks weren’t even sure where the line was. (Of course, some purposely stepped over the line.) It is a story that came to a head this last year with the near-collapse of the economy of the US and the world. It is good to hear that many of these people are losing their money, it is sad to hear that so many are not; they are getting money from the government (you and me) and spending it on bonuses for themselves. They have no humility.

I am looking forward to the creation of a memorial for these 30 years. Perhaps it can be prominently displayed in the broom closet of one of the surplus FEMA trailers that I have been advocating selling to these people after all their money is forfeit.

So what does this have to do with medicine? It has to do with social justice and with health reform. The current backtracking by the administration on the “public option” is shameful and inappropriate. The concept that co-ops could somehow cover everyone is flawed. Perhaps if they were true consumer-owned cooperatives, like most of the original groups (later called HMOs), such as Group Health of Seattle (one of the few remaining), Ross-Loos of Los Angeles, HIP of NY. But most of the consumer-cooperative HMOs, created by believers in cooperatives who felt that by cutting out the middleman – the insurance company – they could get more care for the same money or the same care for less money – were taken over, beginning in the 80’s, by – Insurance Companies! One of the threats that they faced, which made them susceptible to takeover, was increased costs without a willingness (or ability) to have increased premiums as their membership aged. It is strangely parallel to the history of the Israeli kibbutz – young idealists could do a lot when they were young and healthy, but as they aged, without replacement young workers, they found it difficult to survive. So a “co-op” owned by the insurance company would be the HMO that we have grown to know and hate over the last 20+ years, the one that makes money by denying us coverage. A true co-op movement would be neat for those who are in it, but would do nothing to help cover the uninsured. Whoops, let that cat out of the bag!

The whole concept misses the key, #1, worthless-if-it-isn’t-included, issue of health reform: It must cover everyone. Not like the economic “growth” we had when all those super-rich were created which left so many people out, and left out even more when we look at health coverage. Every year corporations, including the many controlled by these super-rich, cut benefits, cut coverage, increased co-pays, and even dropped health insurance altogether for dependents and sometimes for the workers themselves. The unions, whose job it should have been to protect the interests of their members, the workers, were greatly weakened by the same government policies that protected the super-rich and encouraged the financial-speculators-who-produce-nothing-but-steal-from-us-all crowd. And those unions who still had good health insurance had no interest in fighting for the rest of workers; they were too busy trying to hold on to their own. Like, for example, the UAW. Whoops, there went GM and “Cadillac” health benefits!

No, the only thing that will allow everyone to be covered is a public plan. As I have said often, the best public plan is one that covers everyone in one plan. But no “reform” absent a public plan will cover everyone. The objections to the “government” takeover of health care are, with the exceptions of those voiced by right-wing ideologues who are in the pay of the big “super-rich” corporations, misguided. Let’s look at some public plans. Medicare. No one who has it wants to lose it. At a recent town hall meeting, US Senator Claire McCaskill (D-MO) asked the audience how many had Medicare. About a third of those in attendance raised their hands. Then she asked (and I paraphrase) “how many of you want to give up your government-controlled public health insurance?” All hands went down.

Arguably, the only program as popular as Medicare is Social Security itself. A government plan. Like Medicare, it is government run, but the expenditure of funds is up to the individual. Remember the Republican plan, the Bush plan, to “privatize” Social Security? To invest the funds “in the market”? To take advantage of the huge growth of the stock market? I bet a bunch of current and soon-to-be seniors are breathing a big sigh of relief that that didn’t happen, but Republicans and other conservatives (what are they conserving? Not your retirement!) are still touting the same ideas! And the objections that they have brought up to health reform, such as the “death panels”, are completely spurious. But they are tenacious ideas, because of the big lie (as I addressed on August 11, “Should it be a crime to be poor – or instead to criminalize poverty”) and because of the psychology of stories and narrative, as addressed by George Lakoff in the Huffington Post (

In the Kansas City Star on August 20, 2009, Providence Journal columnist Froma Harrop wrote that “Health insurers have their own death panels” ( In it she describes the pain that she and her husband went through with their insurance company, United Health Care (the one that gave CEO William McGuire a more than $1 Billion bonus in 2006; yes, that United Health Care) trying to get treatment for his liver cancer. I do not have access to his medical records and cannot comment on the appropriateness of the care or not, but she makes it absolutely clear that there ARE “death panels” now, and they are operated by private insurance companies.

The basis of the opposition to a public option, to single-payer, is opposition to what will be good for Americans in pursuit of corporate profit and political gain. In his op-ed in the Times August 24, 2009, “All the President’s Zombies”, (, Paul Krugman makes this point very clearly; in echoes of Reaganism opponents of health reform keep trumpeting “government” when it is entirely clear, if you think about it, that it is only government programs that are likely to work, to cover everyone. He notes that DEMOCRATIC Sen. Ben Nelson of Colorado has “…warned ominously that if the option were available, Americans would choose it over private insurance — which he treats as a self-evidently bad thing, rather than as what should happen if the government plan was, in fact, better than what private insurers offer.” What is this, the Twilight Zone?

Commenting on the Democrats’ need to have A BILL, Cokie Roberts, on NPR Morning Edition August 24, 2009, that the Republicans will not vote for any health bill because they don’t want the Democrats to be able to take credit for it, as they have for years for Social Security and Medicare. She is probably correct. She also said that they have to have a bill that will not pass narrowly. I disagree. If a good bill, that will cover everyone with access to quality health, leave free choice of providers, eliminating prejudice against pre-existing conditions, and limits profit passes, the results will be wonderful and folks will love it more than they love Social Security and Medicare. Remember in TR Reid’s “Sick Around the World” (, the Swiss plan barely passed with just over 50% of people supporting it in the early ‘90s, but now no one would give it up.

This is what the opponents of health reform fear; real change. We need to keep up the pressure to get it.

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