The legacy of Obamacare: A five percent increase in heart patient deaths

15 November 2017

When one individual inflicts bodily injury upon another such that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet  murder it remains. (Friedrich Engels, The Condition of the Working Class in England, 1845)

* * *

A US government program supposedly devised both to improve medical care and cut costs has, predictably, succeeded in the latter while undermining the former. Research published Sunday in JAMA Cardiology (Journal of the American Medical Association) shows that an initiative introduced five years ago under the Affordable Care Act (ACA) to induce hospitals to reduce Medicare readmissions for heart patients has resulted in an increase in mortality rates among those studied.

Under the ACA’s Hospital Readmissions Reduction Program (HRRP), hospitals were penalized financially when heart failure patients were readmitted within a month. While the program has succeeded in reducing the number of 30-day readmissions, the number of patients who died within a year rose by 5 percentage points. According to one of the study’s senior authors, these findings could account for an additional 5,000 to 10,000 deaths annually across the US due directly to the program.

For the American ruling elite, HRRP and other schemes devised by bureaucrats at the Centers for Medicare and Medicaid Services (CMS) are part of an agenda that is as deliberate as it is ruthless: Men and women in the US are living too long into old age and measures must be taken to cut costs associated with their medical care and shorten their life expectancy. This is the deadly price that must be paid to prop up a society that is one of the most socially unequal both in terms of income and the delivery of health care.

The statistics do not lie. Study researchers analyzed 115,245 patients at 416 hospitals in the American Heart Association’s Get With the Guidelines-Heart Failure registry from January 2006 to December 2014. They examined readmission and death rates before and after the program began in 2012.

* Readmission rates within one month fell from 20 percent before HRRP penalties to 18.4 percent after HRRP (down 1.6 percent). Mortality rates, however, rose by almost the same rate, from 7.2 percent before HRRP to 8.6 percent after (up 1.4 percent).

* Statistics for readmission and mortality within one year were even more damning. Readmission within one year fell by only about 1 percent, from 57.2 percent before HRRP to 56.3 percent after. But the mortality rate within one year rose from 31.3 percent before HRRP to 36.3 percent after—a shocking 5 percent increase. These figures show that there is a direct correlation between implementation of the Obamacare policy and preventable deaths.

HRRP penalizes hospitals up to 3 percent of every Medicare dollar for “excessive” repeat hospital stays. That is 15 times more than the 0.2 percent penalty levied against hospitals with high mortality rates. In other words, while hospitals with higher rates of mortality face a minimal fine, hospitals are being substantially penalized for failure to comply with a program that is resulting in increased deaths.

Compounding the misery, financial penalties from HRRP have been shown to fall disproportionately on academic medical centers and “safety-net” hospitals where “higher readmission rates are associated with the higher case-mix complexity and lower socioeconomic status,” according to the study, i.e., those treating poorer and sicker patients. In such settings, hospitals are incentivized to “game” the system by delaying admissions, increasing observation stays or shifting inpatient-type care to emergency departments, to the detriment of patient welfare.

The US mortality rate rose in 2015 in the first year-over-year increase since 2005, with life expectancy falling between 2014 and 2015 from 85.8 years to 85.6 years for men, and from 87.8 years to 87.6 years for women. According to the Centers for Disease Control and Prevention, this decline was due to an increase in eight of the 10 leading causes of death in the US, including heart disease, stroke, Alzheimer’s disease and suicide.

With heart disease rising, there is no other way to interpret the penalties imposed by the ACA for early readmission of heart patients than a deliberate effort to see more men and women die. US corporations are already reaping a grim dividend from this downward trend, with at least 12 major corporations reporting this summer that they have reduced their estimates for how much they could owe in pension and other retirement obligations by a combined $9.7 billion due to shorter life spans.

It is fitting that the health care overhaul known as Obamacare was the instigator of HRRP, an irrefutable demonstration that the ACA was the first major volley in the bipartisan drive to restrict access to affordable health care and sharply reduce the length of workers’ lives.

As the World Socialist Web Site explained as early at 2009, the Obama administration’s health care “reform” established a framework for the insurers, the corporations and the government to drastically reduce the health benefits available to low- and middle-income individuals and families. The aim is to limit the amount that the government must pay out for health care and Social Security payments, as well as what corporations must pay in pensions and other retirement benefits.

Health care in the Obamacare era has nothing in common with quality, near-universal health care, as Obama initially pledged. It is based entirely on the for-profit health care system in America, including the insurance companies, giant hospitals, health care chains and pharmaceutical companies. Any repeal of the ACA—and its replacement with “Trumpcare” or any other legislation—will maintain the class-based delivery of health care and undoubtedly worsen it for the majority of Americans.

The empirical proof provided by research published in JAMA Cardiology that an ACA program has predictably caused increased deaths should serve as a stark warning to the working class. This Obamacare program is of a piece with the bipartisan attack on jobs and living standards, the attack on immigrants and democratic rights, and the drive to war.

This assault will inevitably provoke enormous social opposition among workers and young people. This opposition must be channeled into the fight for a progressive overhaul of the health care system that takes as its starting point an end to privately owned health care corporations and medicine-for-profit and the establishment of socialized medicine, democratically administered by a workers’ government, providing free, high-quality health care for all.

Kate Randall

http://www.wsws.org/en/articles/2017/11/15/pers-n15.html

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Will Trump’s sabotage wreck your health care?

Christopher Baum explains what Trump’s executive orders on health care will mean–and why no one should settle for the Democrats’ bipartisan “compromise.”

Donald Trump signs an executive order on health care (Andrea Hanks | WhiteHouse.gov)

Donald Trump signs an executive order on health care (Andrea Hanks | WhiteHouse.gov)

“OBAMACARE IS finished,” Donald Trump told reporters on October 16. “It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.”

Just saying the same thing over and over doesn’t make it true. But Trump has certainly been busy trying to turn these words into reality.

This summer, Senate Republicans failed three times to “repeal and replace” the Obama administration’s Affordable Care Act (ACA), thus denying Trump the victory he’s been promising to his right-wing base since last year’s election campaign.

But Trump has the power to do a lot of harm on his own, without any help from Congress. In October, he kicked his sabotage efforts into high gear–first by dismantling the ACA’s contraceptive mandate and then with a pair of orders that threaten to undermine the insurance markets established under the ACA.

A bipartisan pair of senators, Lamar Alexander of Tennessee and Patty Murray of Washington, are proposing a bill that they say will stop the Obamacare system from crashing because of Trump’s unaccountable orders.

But predictably, the bill is tailored to the concerns of the insurance companies threatened with a loss of federal government money to cover premium subsidies for poor and working-class Americans, rather than the problems so many millions of people face because of the ACA–and there’s no guarantee that Trump will support the bipartisan deal, or that the GOP-controlled House will pass it, anyway.

So Trump’s executive actions do represent a further threat to access to health care for millions of people. But even if Trump accepts the bipartisan “compromise” to temporarily prop up one aspect of Obamacare, the ACA status quo is breaking down as a result of a wider crisis, which includes sabotage on the part of the insurance industry itself.

We need to oppose the right-wing assault on our health care in any form–whether the outright “repeal and replace” proposals that would demolish the government’s Medicaid health care system for the poor or Trump’s whittling away at the ACA provisions that help ordinary people.

But the grassroots uprising that helped defeat Trumpcare this summer can’t be diverted by Democrats claiming their bipartisan compromises are enough to solve the worst of the problems.

The health care status quo built on Obamacare won’t do. We need a whole new system: a single-payer system that guarantees free comprehensive health care for all.

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TRUMP’S LATEST wave of attacks came in a one-two punch on October 12.

First, Trump issued an executive order directing his administration to “consider proposing regulations or revising guidance” in some key areas regarding the ACA.

These include association health plans (AHPs), which essentially allow small businesses to band together and thereby obtain more favorable pricing from insurers; and short-term limited duration insurance (STLDI), which provides limited coverage for a defined period for people who are in between jobs or otherwise need “gap” coverage while looking for a more permanent solution.

In both these areas, Trump called for expanded access and availability–which in effect means deregulation.

AHPs, for instance, offer tantalizing prospects to those who find Obamacare’s regulations on what health insurance policies must cover excessive.

The ACA essentially recognizes three types of insurance plans: individual plans, small group plans (covering two to 50 employees), and large group plans (covering 51 or more employees).

Some of the most important protections under Obamacare–such as the requirement that all plans cover a defined list of essential health benefits–apply only to individual and small group plans.

Large group plans can, for example, “avoid covering essential services like mental health care and substance use disorder treatment and, although they technically are not supposed to exclude pre-existing conditions or charge higher rates to people with them, they are in fact less constrained in doing so,” Timothy Jost wrote at the HealthAffairsBlog.com.

Trump’s idea, then, is to find ways to allow small groups–and perhaps even individuals–to band together into AHPs and get the same exemptions as large groups. As Jost goes on to write:

If association health plans could market health coverage claiming to be self-insured large group plans…they could be free from state regulation and could market plans with skimpy benefits and find it easier to cherry pick healthy enrollees and avoid unhealthy ones.

As for the short-term policies known as STLDI, Trump’s order instructs federal agencies to consider lengthening the coverage period and making the policies renewable–meaning that people could choose STLDI, as a more or less permanent option for health care coverage.

This appeals to the Trump administration because, as the executive order notes, STLDI is “exempt from the onerous and expensive insurance mandates and regulations” of Obamacare. Freed from the requirement that such policies be temporary, STLDI could be offered cheaply to young, healthy people who don’t anticipate having significant health care expenses.

Thus, Trump’s objective is clearly to expand the availability of insurance plans that aren’t subject to the full scope of the ACA’s patient protection requirements. As Jonathan Cohn wrote at Huffington Post, the order could allow “a proliferation of cheaper, less comprehensive plans that would undermine rules about who and what insurers must cover.”

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TRUMP’S SECOND order would end reimbursements to insurance companies for the cost-saving reductions (CSRs) they are required by law to make for low-income policyholders. These payments are estimated to total $7 billion in 2017.

Trump and Republicans have deceptively characterized these payments as “handouts” to the insurance industry. But CSR payments are the means that the Obama administration came up with to provide help for low-income consumers who have to purchase health insurance under the ACA rules.

Under the ACA, individuals and families with incomes up to 250 percent of the federal poverty line who buy insurance through state or federal markets are eligible for a reduction in premium payments and out-of-pocket costs. The ACA also requires that the federal government pay insurers to offset this reduction.

But because the law doesn’t explicitly require the government to appropriate funds to cover the CSR payments–and Congress didn’t pass a separate measure to fund them–the Republicans claimed that the CSR violated the constitution because the administration was making the payments without the sanction of Congress.

In 2016, a federal judge ruled in favor of the GOP in a lawsuit against the Obama administration, but immediately stayed her order blocking the payments in order to let the appeals process play out.

Ever since Trump took office, his administration has been threatening to use the court decision as a pretext for cutting off CSR payments.

The requirement that insurance companies continue to offer rate reductions to lower-income people remains in effect, whether or not they get CSR payments from the Feds. So the question is how the insurers will respond.

One danger is that more insurance companies will abandon the state and federal marketplaces for selling policies under the ACA–a trend that has been accelerating already over the last several years. Others might use the cutoff as an excuse to stop offering reduced rates as required, and wait to see how the Trump administration responds.

For insurers that remain in the ACA marketplace, another approach would be to raise premiums to offset the lost reimbursement from the federal government.

In August, the Congressional Budget Office (CBO) studied this possible outcome and concluded that most of the negative effects arising from higher premiums would be offset by corresponding increases in the premium tax credit (PTC), another Obamacare subsidy. In other words, the tax credit would increase for people paying higher premiums.

But this conclusion relies on the rather massive assumption that the PTC itself will remain intact.

The CBO estimates that with CSR payments to insurers eliminated, the cost of increased PTCs over the next 10 years in reduced tax revenue to the federal government would be a net of $247 billion.

Republicans in Congress have already demonstrated with every health care proposal they’ve tried to pass this year that they believe too much is being spent on subsidizing health care for the needy. What are they odds they’ll stand for such an increase?

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TO THE extent that a rise in premiums isn’t offset by tax credits or other means, the result will be higher costs, fewer plan options and reduced access to health care. And if enough insurers decide to exit the market, many people may find themselves with no health insurance options whatsoever.

But this–or at least the threat of this–is precisely what Trump wants.

“Now, we’re going to get the health care done,” Trump told reporters on October 16. “In my opinion, what’s happening is, as we meet–Republicans are meeting with Democrats because of what I did with the CSR, because I cut off the gravy train. If I didn’t cut the CSRs, they wouldn’t be meeting.”

As we have seen, the CSR is no “gravy train.” And however much Trump may flatter himself that his destructive behavior is just a clever maneuver, the only thing he’s truly demonstrated is his willingness to destroy anything or anybody to get what he wants.

Whether he is threatening health care subsidies desperately needed by millions of low-income people, or using the possibility of deportation for nearly a million DACA participants as a bargaining chip to get his beloved border wall, Trump’s message is the same: I’m going to get my way, or I’ll blow the whole thing up.

So it’s anybody’s guess whether Trump will support the deal worked out by Sens. Lamar Alexander and Patty Murray, which would fund CSR payments to insurers through 2019.

Although the response from congressional Republicans was lukewarm at best, Democrats were, of course, enthusiastic. Speaking to the press last week, Senate Minority Leader Chuck Schumer spoke of the “growing consensus that in the short term we need stability in the markets,” and praised the Alexander-Murray proposal for providing that–along with “some very significant anti-sabotage provisions,” although he didn’t elaborate on what these might be.

This was in keeping with the Democratic talking points that legislation is needed to “stabilize markets and lower premiums,” as Schumer said last month–and then Obamacare will be just fine.

But insurance markets won’t be “stable” unless they are profitable for insurance companies. If the insurers aren’t happy, they can simply leave.

This is why, for all their talk of serving the health care needs of ordinary people, the Democrats are only willing to pursue this goal to the extent that it is compatible with keeping the insurers happy.

Trump didn’t create this problem. Major insurers were leaving the ACA marketplaces, or threatening to do so, long before he took office. UnitedHealth, for instance, made the decision to exit in mid-2016–not because the insurance giant was losing money, but because profit margins weren’t high enough for its liking.

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THE REAL problem with Obamacare is that it depends on the voluntary participation of for-profit insurance companies–and as a result, it’s at the mercy of those companies.

No “anti-sabotage measures” are going to change this. If insurers decide they aren’t making enough money or if they’re unhappy for any other reason, they can simply take their ball and go home.

This must be kept in mind when considering the other major element that Democratic leaders claim they want to address. It’s fine to talk about lowering premiums, but again, the market must remain profitable for insurers. The usual tradeoff is between premiums and deductibles: the lower the one, the higher the other.

If you truly want to talk about “affordable health care,” both numbers need to be brought down. Otherwise, consumers may have a lower monthly payment–but if they actually need care, they will find themselves paying a ruinously high portion of the bill out of their own pocket before any insurance kicks in.

But the truth is that “affordable health care” is simply the wrong goal. As long as the objective is “affordability,” access to health care will remain a matter not of what people need, but of what they can afford.

The consequences of this are all around us: people who are sick and can’t pay for medication; people who are bankrupted by their medical bills, even though they have insurance; people who don’t get care because the cheap policy they bought doesn’t cover the treatment they need; and on and on.

There is only one way out of this–by providing comprehensive health care to all people, free of charge, without the for-profit insurance companies involved.

What we need, in other words, is a universal single-payer health care system.

As with all the Republicans’ earlier attacks on the ACA, this latest assault must be opposed–but we can’t stop there. No one should be lulled into thinking that all we need to do is tweak Obamacare here and there. Obamacare isn’t just broken; in its reliance on for-profit insurance companies, it is fatally flawed. It can never be the health care solution that every person living in this country needs and deserves.

We must demand single-payer, and fight for it with everything we have. The stakes are too high to settle for anything less.

https://socialistworker.org/2017/10/23/will-trumps-sabotage-wreck-your-health-care

Behind the opioid crisis: Republicans and Obama cleared the way for corporate murder

By Patrick Martin
16 October 2017

Leading Republican and Democratic members of Congress and top Obama administration officials collaborated to shut down efforts by the Drug Enforcement Administration (DEA) to stem the flow of prescription opioids that have killed 200,000 Americans over the past two decades, according to a devastating exposure published Sunday by the Washington Post and broadcast Sunday night on the CBS news magazine “60 Minutes.”

The joint investigation by the Post and “60 Minutes” made use of extensive whistleblower revelations by former officials of the DEA, which has the main responsibility for halting the flow of illegal narcotics, including prescription drugs like oxycodone and hydrocodone diverted into the black market.

Three major companies, all in the top 20 of the Fortune 500 and hugely profitable, dominate the distribution of these opioids: McKesson, Cardinal Health, and AmerisourceBergen, with combined revenues of more than $450 billion. McKesson chairman and CEO John Hammergren has the largest pension fund of any US corporate boss, a $160 million personal nest egg.

These gigantic revenues and huge personal fortunes were accumulated by means of what can only be termed a massive social crime: the flooding of impoverished working-class neighborhoods with high volumes of opioids, narcotics that were being prescribed in vast quantities by doctors and pharmacists and illegal “pain centers” and “pill mills” that were a constant presence in the affected areas.

The consequences have been felt in a historic reversal in the long-term rise of life expectancy in the United States. For middle-aged whites, particularly those living in rural areas, life expectancy is declining and death rates soaring, in large part because of the impact of opioid abuse and addiction.

Appalachia is a center of the opioid crisis. The figures presented in the Post/”60 Minutes” report are staggering—and damning. To Mingo County, West Virginia, an impoverished former mining area on the state border with Kentucky, population 25,000, the mid-sized Ohio-based drug distributor Miami-Luken shipped 11 million doses of oxycodone and hydrocodone in a five-year period: enough to give two pills a week to every man, woman and child in the county.

In the county seat, Williamson, population 2,938, Miami-Luken shipped 258,000 hydrocodone pills in one month to a single pharmacy. The city of Williamson has filed suit against the company and other drug distributors, charging them with deliberately flooding the city with pain pills to supply the black market. A document filed in the suit charges, “Like sharks circling their prey, multi-billion dollar companies descended upon Appalachia for the sole purpose of profiting off of the prescription drug-fueled feeding frenzy.”

Post reporters Scott Higham and Lenny Bernstein and “Sixty Minutes” reporter Bill Whitaker conducted dozens of interviews for their exposé, but the principal whistleblower is Joseph T. Rannazzisi, who headed the DEA’s Office of Diversion Control for a decade until he was forced out in 2015.

The Office of Diversion Control oversees the flow of prescription drugs produced by the major US pharmaceutical companies and shipped to hospitals and pharmacies and other prescribers by distributors, including the big three. By targeting unusually large and unexplained sales—for example, several Walgreen’s pharmacies in Florida sold more than one million opioid pills in a year, compared to a nationwide average of 74,000—the DEA unit could force companies to pay substantial fines.

These big three and smaller distributors paid more than $400 million in fines over the last decade as the result of the DEA, but this is a pittance compared to their gross revenues during that same period, well over $5 trillion. One former DEA official told the Post this sum simply represented “a cost of doing business.”

A more serious problem for the industry was the issuance of “freeze” orders, in which the DEA could use its authority to order a distributor to halt a shipment if there is “imminent danger” to the community. According to Rannazzisi, there was increasing resistance from top-level DEA officials, from 2011 on, to approving such “freeze” orders against opioid distributors. During this period, the drug distributors hired 46 DEA officials either directly or through law firms or lobbying groups representing them.

In 2014, industry lobbyists produced a bill, written by a former DEA lawyer, and introduced by Republican Representative Tom Marino, that substantially raised the threshold of proof for a DEA order to halt a shipment. Instead of “imminent danger,” such an order required proof of “a substantial likelihood of an immediate threat,” a standard so strict that, once adopted, there were no further DEA orders to halt drug distribution.

Marino’s bill was initially blocked by DEA opposition, but it was reintroduced with Democratic cosponsors and passed the House of Representatives by a voice vote, without opposition, in April 2015. In October 2015, Rannazzisi was pushed into retirement at the DEA, after previously being removed as head of the Office of Diversion Control by means of heavy pressure from congressional Republicans on the Obama Justice Department. In March 2016, the Senate passed a modified version of the Marino bill, and the House accepted the changes the following month. The DEA was now handcuffed, and the drug distributors could proceed without any concern about federal oversight.

As Rannazzisi told “60 Minutes”: “The drug industry—the manufacturers, wholesalers, distributors and chain drugstores—have an influence over Congress that has never been seen before. And these people came in with their influence and their money and got a whole statute changed because they didn’t like it.”

The protection of the giant drug distribution companies—amid a nationwide epidemic of drug overdose deaths caused by the products they were distributing—was a bipartisan affair. Congressional Democrats cosponsored the legislation, and a former top Clinton administration official, Jamie Gorelick, was a lead attorney and lobbyist for the distributors. Attorney General Loretta Lynch approved the legislation, and President Obama signed it into law, with the White House issuing a one-page press release to mark the occasion.

None of those involved, including Lynch and Obama, would comment to the Post or “60 Minutes.” According to the Post, “The DEA and Justice Department have denied or delayed more than a dozen requests filed by The Post and ‘60 Minutes’ under the Freedom of Information Act for public records that might shed additional light on the matter,” indicating that the Trump administration is continuing the stonewalling tactics begun under Obama.

When a “60 Minutes” camera crew came to Marino’s office, his aides called Capitol Hill police to have them removed.

Trump has rewarded the darling of the drug distributors, Representative Marino, by nominating him last month to become the next White House “drug czar,” in charge of coordinating federal efforts against the opioid crisis. Representative Marsha Blackburn of Tennessee, the main cosponsor of the bill, is now favored to be the Republican nominee for US Senate in Tennessee in 2018. Both representatives come from districts ravaged by the opioid crisis. According to the Post account, 106 people have died in Lycoming County, Pennsylvania, the largest in Marino’s district, since he first introduced his anti-enforcement legislation.

The following exchange from the “60 Minutes” program sums up the reality of corporate domination of American life, and the catastrophic impact on working people:

BILL WHITAKER: You know the implication of what you’re saying, that these big companies knew that they were pumping drugs into American communities that were killing people.

JOE RANNAZZISI: That’s not an implication, that’s a fact. That’s exactly what they did.

… These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.

http://www.wsws.org/en/articles/2017/10/16/drug-o16.html

Following Trump executive orders, Democrats offer Obamacare “fix”

A new stage in the bipartisan health care counterrevolution

14 October 2017

The last 10 days have marked an escalation of the bipartisan conspiracy against the health care rights of working class Americans. After Congressional Republicans’ numerous failed attempts in recent months to “repeal and replace” the Affordable Care Act (ACA), the Trump administration has issued a series of executive orders aimed at undercutting the legislation popularly known as Obamacare.

The president’s first order expanded exemptions for employers who claim moral or religious objections from requirements under the ACA to provide their workers with no-cost birth control.

Next, Trump finalized an executive order to allow “association health plans” an exemption from the ACA’s requirements to provide 10 essential services in their insurance coverage.

Finally, the administration announced that, beginning next Wednesday, it would be scrapping cost-sharing reduction payments (CSRs) to private insurers that help low-income Americans purchase health coverage.

Trump made clear that he is seeking to reach out to congressional Democrats to make a deal on health care “reform,” that is, changes to Obamacare to further reduce health care coverage. In a post on Twitter Friday morning, he said, “The Democrats[’] ObamaCare is imploding. Massive subsidy payments to their pet insurance companies has stopped. Dems should call me to fix!” He went on to call the law “a broken mess.”

All of Trump’s orders will have the effect of raising insurance premiums, particularly for older, poorer and unhealthy people, and denying access to basic medical services for millions. But this is not what concerns the Democrats in Congress.

House Minority Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer issued a demagogic statement Friday night scolding Trump for stopping the CSRs, stating in part: “[I]t seems President Trump will single-handedly hike Americans’ health premiums. It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America.”

But the Democratic leaders concluded with their real point, which was to chastise the president if his actions meant he “is walking away from the good faith, bipartisan Alexander-Murray negotiations and risking the health care of millions of Americans.”

Earlier this month, following the Republicans’ failed repeal and replace attempts, Trump tweeted, “I called Chuck Schumer yesterday to see if the Dems want to do a great HealthCare Bill.” Schumer responded: “If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions. A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs.”

Schumer is referring to the health care talks being led by Senators Lamar Alexander (Republican of Tennessee) and Patty Murray (Democrat of Washington). These bipartisan negotiations have nothing to do with expanding medical coverage to the 28 million Americans who remain uninsured, improving the already hopelessly inadequate benefits of many, or in any way reining in the profiteering and power of the insurance and pharmaceutical monopolies.

Instead, their “fixing” of Obamacare involves shoring up the insurance industry by means of various payouts. The Democrats have also agreed to a “compromise” allowing insurers to skirt the Obamacare regulations requiring insurance companies to offer a set of essential benefits by offering “skinny” plans, as well as to dodge ACA protections for individuals with preexisting conditions.

Any “compromise” between the Democrats and Republicans on health care reform is by its very nature a conspiracy against the working class. It is entirely premised on the subordination of the need for health care to the profits of the corporations and the functioning of the capitalist market.

Ohio Governor John Kasich was more transparent on what a bipartisan deal on health care would look like, stating this summer, “After two failed [Republican] attempts at reform, the next step is clear: Congress should first focus on fixing the Obamacare exchanges before it takes on Medicaid. … Once we see these repairs taking hold, Congress should then take up needed improvements to Medicaid as part of comprehensive entitlement reform.”

All of the failed Republican versions of Obamacare repeal and replace cut hundreds of billions of dollars from Medicaid, the government health insurance program for the poor, elderly, the disabled and pregnant women. They posed the virtual end of the program as a guaranteed entitlement program, by imposing block-granting and per-capita caps to the states, which would force states to deny benefits to people who qualify.

Through these measures, Medicaid would be starved of funds on the road to privatizing and ultimately dismantling the program. There have been no clear statements from leading Democrats opposing in principle the termination of Medicaid, which everyone in the political and media establishment knows is the first step to dismantling and privatizing Medicare, the government insurance program for the elderly, and Social Security, the government pension system.

The bipartisan plans to “fix” Obamacare in the interests of the insurance companies—further slashing benefits and raising premiums for working families, while cutting costs for the government and corporations—are not at odds with the spirit of Obamacare. In fact, they reflect its essence and objective: that workers are living too long into retirement, receiving costly and “unnecessary treatments,” and that something must be done to curb costs in the interest of corporate profit.

As early as 2009, the year before the ACA was signed into law, the World Socialist Web Site wrote:

“[Barack Obama’s] drive for an overhaul of the health care system, far from representing a reform designed to provide universal coverage and increased access to quality care, marks an unprecedented attack on health care for the working population. …

“Obama’s health care counterrevolution is of a piece with his entire domestic agenda. It parallels the multi-trillion-dollar bailout of the banks, the imposition of mass layoffs and wage and benefits cuts in the auto industry, and a stepped-up attack on public education and on teachers.”

The Democrats’ policies on health care reform are no alternative to Trump’s. Both will lead to untold suffering, misery and preventable deaths. The defense of basic social needs such as health care requires a fight against capitalism, which in its advanced stage of crisis is incompatible with basic democratic and social rights.

A fight in defense of health care requires a fight for socialism. The health care industry must be removed from private hands and placed under public ownership and the democratic control of the working class. This is not an unrealistic pipe dream but the only rational solution to a health care system dominated by profit and defended by an outmoded ruling elite.

Kate Randall

http://www.wsws.org/en/articles/2017/10/14/pers-o14.html

Trump administration limits access to birth control under ACA

By Trévon Austin
7 October 2017

The Trump administration has announced plans to revoke the federal requirement for employers to include birth control coverage in health insurance plans. The new policy would expand exemptions under the Affordable Care Act (ACA) for employers who claim moral or religious objections to contraception.

Under the previous mandate, more than 55 million women employees had access to no-cost birth control. According to the Kaiser Family Foundation, the percentage of women employees that pay with their own money for birth control fell from 21 percent to 3 percent after contraception became a covered preventive benefit.

The new exemptions will be available to for-profit companies, nonprofit organizations and colleges and universities that provide health care to students and employees.

Hundreds of thousands of women could potentially lose access to benefits they receive at no cost. The Trump administration itself estimated that some 200 employers who have already voiced opposition to the Obama-era mandate would qualify for exemption, and that 120,000 women would be affected.

In expanding the exemption for employers, the Trump administration claims there are “dozens of programs that subsidize contraception for the low-income women” and various alternative sources for birth control exist.

The administration also cites health risks that it says are correlated with the use of certain types of contraceptives, and claims the previous mandate that required employers to cover birth control could promote “risky sexual behavior” among teenagers and young adults.

In contrast, many obstetricians and gynecologists say contraceptives have been and are generally beneficial for women’s health.

Dr. Haywood L. Brown, the president of the American College of Obstetricians and Gynecologists, expressed concern for consequences on women’s health. “Affordable contraception for women saves lives,” he said. “It prevents pregnancies. It improves maternal mortality. It prevents adolescent pregnancies.”

The Trump administration cites the Religious Freedom Restoration Act, a 1993 law protecting religious liberty, as legal reasoning for the new mandate. The administration admits that moral objections are not protected by the law, but states: “Congress has a consistent history of supporting conscience protections for moral convictions alongside protections for religious beliefs.”

Attorney General Jeff Sessions announced the Department of Justice would take steps to protect the new policy and stated, “President Trump promised that this administration would ‘lead by example on religious liberty,’ and he is delivering on that promise.”

The new policy is expected to face a large number of lawsuits. The National Women’s Law Center, a nonprofit advocacy group, has been preparing a lawsuit since last spring. Brigitte Amiri, a senior attorney for the ACLU, said, “We are preparing to see the government in court.”

In addition, Massachusetts Attorney General Maura Healey and California Attorney General Xavier Becerra announced plans to file a suit against the new mandate.

Trump’s new policy is an obvious attempt to win support from religious groups and conservatives, such as Speaker of the House Paul Ryan, who claimed today is “a landmark day for religious liberty.”

A group supportive of the administration’s action is the Little Sisters of the Poor, an order of Roman Catholic nuns who said that being required to cover contraception would make them “morally complicit in grave sin.” The organization sued the government, despite an already existing exemption for churches and other religious employers to opt out by notifying the government.

During his 2016 presidential bid, Trump promised that he would “make absolutely certain religious orders like the Little Sisters of the Poor are not bullied by the federal government because of their religious beliefs.” At a Rose Garden ceremony in May, he told the religious order, “Your long ordeal will soon be over.”

The Trump administration’s mandate sets a dangerous precedent for working women’s health. In 2014, in the case Burwell v. Hobby Lobby, the Supreme Court ruled that the ACA violated the religious liberty of Hobby Lobby, and stated that corporations could object to the birth control coverage mandate on religious grounds. Under Trump’s mandate, corporations could deny women employees access to no-cost birth control simply based on “moral objections.”

The new policy sets a precedent for corporations to deny other health coverage to employees under conditions in which the state of women’s health in the United States is already dire. The US holds the highest maternal mortality rate among industrialized nations, and a lack of access to birth control will potentially exacerbate the problem.

The new policy goes into effect immediately.

http://www.wsws.org/en/articles/2017/10/07/birt-o07.html

America’s Overlooked Addiction Crisis

Alcohol abuse is a fast-growing problem. Higher taxes on beer, wine and spirits could help.
Cheap hit.

 Photographer: Denver Post via Getty Images

As alarms over the opioid crisis sound ever louder, a larger and more expensive substance problem in the U.S. is quietly growing much worse. One in eight Americans abuses alcohol, a new study finds, a 50 percent increase since the start of the century.

Alcohol abuse is as old as civilization itself, of course, but quantifying its costs is a more recent endeavor. Alcohol is responsible for one in 10 deaths among working-age Americans — from accidents as well as illnesses. There are almost 90,000 alcohol-related deaths in America every year. Excessive drinking, mainly binge drinking, costs some $250 billion a year in lost productivity, health care and other expenses. The toll in personal suffering and ruined lives is incalculable.

Yet there has been a strange reluctance to fight back with the weapons known to work: restrictions on alcohol sales and advertising and, even more effective, higher taxes on alcohol. The federal tax on spirits (about 21 cents per ounce of alcohol; taxes on beer and wine are less than half that) has not changed since 1991, and over the past few decades the inflation-adjusted cost of drinking has fallen considerably. Many states have likewise neglected to index their alcohol taxes to inflation.

That’s too bad, because making drinking more expensive is the single strongest way to reduce harm from alcohol. Yes, higher prices burden the poor more than the well-off, but they can significantly reduce excessive drinking and its harmful effects: crime, violence, car crashes, suicides and sexually transmitted diseases.

If that’s not enough reason for Congress and state legislatures to raise alcohol taxes, consider that the government’s share of alcohol’s economic cost is about $100 billion a year, while state and federal alcohol taxes bring in about $15 billion. The difference amounts to quite a subsidy for excessive drinkers paid by many taxpayers who drink moderately or not at all.

There are other ways besides simply raising taxes — setting a minimum price for every unit of alcohol a drink contains, for example. Unlike taxes, which can be selectively absorbed by wholesalers or retailers, minimum prices must be borne by the drinkers. Five years ago, Scotland passed a law meant to set a 50-pence (65-cent) minimum price for every unit a drink contains, though the Scotch Whisky Association has so far kept it tied up in court.

Lawmakers need to be clear about the problem, however, and ways to control it. Attorney General Jeff Sessions has declared drug overdose deaths, which reached nearly 60,000 in 2016, to be America’s “top lethal issue.” He’s not the only one who needs to be reminded that alcohol abuse is significantly more deadly, and just as deserving of attention.

To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net .

https://www.bloomberg.com/view/articles/2017-09-01/america-s-overlooked-addiction-crisis

How Renaissance Painting Smoldered with a Little Known Hallucinogen

Forrest Muelrath

Looking at depictions of St. Anthony in the paintings of Renaissance masters, the influence of the disease of ergotism on the history of art starts to become clear.

Follower of Pieter Bruegel the Elder, “The Temptation of Saint Anthony” (c. 1550/1575), oil on panel, Samuel H. Kress collection

A fungal infection known as ergotism influenced Northern Renaissance painting to an extent that a majority of art institutions have yet to grapple with. During the Renaissance ergotism was colloquially known as St. Anthony’s Fire, named for the third-century desert Father who had hallucinatory bouts with the devil.

In 1938 the Swiss chemist Albert Hoffman accidentally synthesized the psychedelic drug LSD-25 for the first time from ergot fungi — the same fungus that causes the disease ergotism — while researching pharmaceuticals for postpartum bleeding. Some of the symptoms of ergotism closely resemble the effects of LSD, which makes sense given that the same or similar alkaloids are present in both the fungus that causes illness and the drug. Looking at depictions of St. Anthony in the paintings of Renaissance masters, the influence of the disease on the history of art starts to become clear.

During the time of the Renaissance, ergotism was a phantasmagoric event with an onset that was difficult to distinguish from the bubonic plague: it came on first as nausea and insomnia, then developed into sensations of being engulfed in flames while hallucinating over several days, and often ended with the amputation of one or more limbs due to gangrene, or ended in death. In some locations, the symptoms associated with ergotism were considered to be the first step towards hell.

Ergot growing on rye (image courtesy Wikimedia commons)

The illness is contracted by ingesting ergot fungus, which appears on cereal grains when the growing conditions are right — most commonly on rye. The last known severe outbreak occurred in the French village of Pont-Saint-Espirit in 1951. The outbreak was documented in the British Medical Journal, which describes symptoms such as nausea, depression, agitation, insomnia, a delirium that includes feelings of self-accusation or mysticism, and hallucinations that commonly include animals and fire. A non-fiction book about the 1951 outbreak, written by American author John G. Fuller, titled, The Day of Saint Anthony’s Fire, describes specific ergot-related psychotic episodes. For example, there is the afflicted man who thought he was an airplane and jumped out the asylum’s second floor window with outstretched arms expecting to fly, telescoped both his legs upon landing, and then ran 50 meters at full speed on shattered bones before being wrestled to the ground by eight other men.  All in all, the accounts of symptoms from the 1951 outbreak resemble both acid causality tales hyperbolized as anti-drug propaganda, and descriptions from the LSD how-to manual coauthored by Timothy LearyRalph Metzner, and Richard Alpert, titled The Psychedelic Experience.

Some art historians, such as Bosch scholar Laurinda S. Dixon, have proffered for decades that the symptoms of ergotism influenced painters like Jheronimus (aka Hieronymus) Bosch and Matthias Grünewald. In looking further at depictions of Saint Anthony — from medieval folk art, a plethora of Renaissance work, to a series of paintings by surrealist artists, such as Max Ernst’s 1945, “The Temptation of Saint Anthony” — a pattern begins to develop in which a mimesis of visual hallucinations associated with ergotism is clearly presentFor instance, Gustave Flaubert’s novel The Temptation of Saint Anthony, contains not only hallucinatory imagery congruent with the effects of ergot alkaloids, but also contains in the opening passage of the novel a clear symbol of a known cause of ergot poisoning: a description of a loaf of black bread inside the hermit saint’s cabin.

The Isenheim altarpiece closed (image courtesy Wikimedia commons)

So why is St. Anthony associated with ergot? The devout will often look towards the legend of Anthony’s temptations when faced with mental or emotional anguish. This is because the devil is said to have tempted Anthony with mirages of jewels, and dressed up as seductive women to deter the hermit from his asceticism. As the devil was tormenting Anthony, the saint was said to be wandering through the Egyptian wilderness. The events of Anthony’s story as recounted by his original hagiographer, St. Athanasius of Alexandria, also read as hallucinatory, with a blend of imagery, ecstasy and madness. From Life of Saint Anthony by St. Athanasius:

For when they cannot deceive the heart openly with foul pleasures they approach in different guise, and thenceforth shaping displays they attempt to strike fear, changing their shapes, taking the forms of women, wild beasts, creeping things, gigantic bodies, and troops of soldiers. But not even then need ye fear their deceitful displays. For they are nothing and quickly disappear, especially if a man fortify himself beforehand.

The notion that the harmful hallucinations will cease if the subject is fortified beforehand, is a reoccurring theme not only in Life of Saint Anthony, but also in the instructions for tripping on LSD given in The Psychedelic Experience: 

At this time you may see visions of mating couples. You are convinced that an orgy is about to take place. Desire and anticipation seize you, You wonder what sexual performance is expected of you. When these visions occur, Remember to withhold yourself from action or attachment. Humbly exercise your faith. Float with the stream. Trust the process with great fervency. Meditation and trust in the unity of life are the keys.

This simple comparison between the texts of a third-century hermit and the megalomaniacal ‘60s drop-out prototype, Timothy Leary, is not enough to clearly demonstrate a correlation between Anthony and psychedelia. What this investigation does make clear is why the hagiography became important to those in the 17th century suffering from symptoms similar to LSD effects in the time before modern medicine first discovered the cause of ergotism.

Aside from the instructions for how to cope with hallucinations, Athanasius’s text also uses imagery that appeared in Renaissance painting, and finds a kinship with symptoms of ergot as described in the British Medical Journal and The Day of St. Anthony’s Fire. According to John G. Fuller, Zoopsie — from the French word meaning hallucinatory visions of animals — was rampant among the afflicted in Pont-Saint-Espirit, who experienced tormenting visions of serpents, tigers, giant spiders, etc. Anthony was tormented by similar visions over and over again, according to St. Athanasius:

the demons as if breaking the four walls of the dwelling seemed to enter through them, coming in the likeness of beasts and creeping things. And the place was on a sudden filled with the forms of lions, bears, leopards, bulls, serpents, asps, scorpions, and wolves…”

The Isenheim altarpiece outer wings opened (image courtesy Wikimedia commons)

Bosch provides the most fertile ground for art lovers wanting to believe that hallucinogenic fungi may have a significant place in art history. This is partially because the painter has a special connection to Anthony, depicting the saint over twenty times throughout his life — one of his most famous paintings being the Anthony triptych. In the town where Bosch grew up, there was a church dedicated to the saint, which the artist almost certainly attended with his family when he was young. The painter lived at a time when knowledge of ergotism would have been near its peak before the cause of the disease was discovered. By the early 16th century (he died in 1516), there would have been at least forty major outbreaks of St. Anthony’s Fire across Northern Europe since the 9th century, with one 1418 outbreak in Paris killing as many as 50,000 by some estimates.

Laurinda S. Dixon presents some of the most convincing evidence to date that Bosch’s imagery was directly influenced by Saint Anthony’s Fire. In a (1984) essay titled “Bosch’s St. Anthony Triptych — An Apothecary’s Apotheosis,” the author finds a common ingredient in medieval medicine used to treat ergot — mandrake root — and the distillation furnaces used to make that medicine. Examining the Bosch painting with the use of high resolution photos available on boschproject.org, Dixon argues that the bulbous buildings, often depicted with a stream of smoke coming out of the top, are nearly identical to the shapes found in contemporaneous schematics of apothecary furnaces.

Other notable imagery in the Anthony Triptych includes the fire raging in the background — fire is found in many Bosch paintings, and is common in other painters’ depictions of Saint Anthony as well. A pair of magi in the center panel are serving musicians a concoction made from berries and herbs — one of the magi with wide-eyes and perhaps intentionally dilated pupils. Anthony is depicted in all three panels, recognized in Bosch paintings by his blue robe and a tau cross either painted on the robe or dangling as jewelry. It’s amusing that in the center panel, Anthony has the look of a strung-out Dead Head at the end of two-day acid trip, with his raised index and middle finger looking simultaneously like a Christian hand gesture and a hippie peace sign. Just below the Grateful Dead Anthony in the center panel, there is another symbol of ergotism — an amputated foot clearly laid on a rag.

Moving on from Bosch, there are scores of paintings that contain depictions of Anthony with many of the same symbols that imply ergotism. A painting attributed to a follower of Pieter Bruegel the Elder shows Anthony in his hermit cabin, as well as flying through the sky on winged beasts. There is a common rumor that ergot alkaloids cause those under their influence to believe they can fly, both in accounts of the disease and in anti-drug propaganda. Again, as in Bosch’s triptych, we see the apothecary furnace on the left side of the painting, this time with a scared looking face peaking out the top — and of course the two fires raging in the distance.

Flemish Painter Jan Mandijn’s vision of Anthony contains a similar set of ergot indicia:  apothecary tools, fire, the saint flying through the air, gangrene. Add to this an odd grass bursting through the roof of the hermit’s cabin, with dark tips that look similar to images of the fungus growing on rye.

Jan Mandijn, “The Temptation of Saint Anthony” (circa 1550) oil on panel, height: 61.5 cm (24.2 in). Width: 83.5 cm (32.9 in). (image courtesy Wikimedia commons)

Moving from the Flemish region to what was then Western Germany, sculpture and woodworker Nikolaus Hagenauer (aka Nikolaus von Hagenau) is surrounded by perhaps the most solid historical evidence that Anthony was a symbol of ergot poisoning for Northern Renaissance artists. Hagenauer’s sculpture of Anthony, carved with virtuosic dexterity in the round from a walnut log, displays subject matter that is congruent with the earliest legends of Anthony — the saint struggling with a single demon underfoot. However, when the artist’s masterwork is taken into consideration — the Isenheim altarpiece which Hagenauer was commissioned to create with painter Mathias Grünewald — the ergot narrative takes flight.

Around the year 1070 C.E., Saint Anthony’s purported remains were moved to La-Motte-Saint-Didier, a commune in southeastern France. The relics of the saint were said to have healing properties that could cure Saint Anthony’s Fire, and in 1095 the Hospital of the Brothers of Anthony was founded with the primary objective of treating those afflicted with ergot poisoning. Four centuries later, Grünewald and Hagenauer were commissioned to paint an altarpiece in nearby Isenheim for a monastery run by the Brothers of Anthony.

The Isenheim altarpiece is in an unusual position for a work of art, in that it was made with the direct intention of soothing physical ailments, as well as symptoms of psychosis. Each of the altarpiece’s nine paintings and its woodcarvings relate to an element of recovery from the symptoms of ergotism. Art historian Horst Ziermann wrote that “it is conceivable that miraculous cures or the relief of symptoms did, in fact, occur at the alter.” Critic David Levi Strauss labeled the work “therapeutic realism.” According to Ziermann, the afflicted would recite prayers in front of the altarpiece that would have been similar to the following: “Anthony, venerable Shepherd, who renders holy those who undergo horrible torments, who suffer the greatest maladies, who burn with hellfire: oh merciful Father, pray to God for us.”

The Isenheim altarpiece inner wings opened (image courtesy Wikimedia commons)

In its original setting the altarpiece would have been illuminated by candles or sunlight through stained glass windows. Unfolding theatrically in three distinct sets of paintings, the wooden frame connected with hinges, each of the three views like an act in a play — or like the three bardos of Timothy Leary’s manual. The monastery where the altarpiece was kept was a place of concentrated prayer for the suffering. The monks would have had little means to treat patients, aside maybe from offering a place to lie that was more comfortable than the street, some warm food, and ointments to sooth the burning of open wounds. The primary tool for healing from ergot related ailments would have been prayer, and relief from the worries of facing hell in the afterlife was redemption through Christ — all which are reflected in the altarpiece.

The alternating horror and mystical ecstasy found between the second and third views of the altarpiece align with accounts of ergot-related mania and psychic anguish, as they do with descriptions found in The Psychedelic

Nikolaus von Hagenau, “Untitled” (ca. 1500) made in Strasbourg, Alsace, present-day France; walnut; 44 1/4 × 17 1/4 × 10 3/4 in., 66 lb. (112.4 × 43.8 × 27.3 cm) (courtesy the Metropolitan Museum of Art)

Experience. The vivacious colors in the second panel recall descriptions of the most ecstatic of those poisoned in Pont-Saint-Espirit, while also sharing elements of the brighter elements of Bosch. The third view returns to Anthony, who is as tormented as ever in the right wing. Most telling is the gangrenous person looking up at the besieged saint from below — his green skin covered in boils that ooze puss and blood, and his belly bloated due to starvation.

The counterculture use of ergot alkaloids proved to be a threat to the dominant mainstream US culture of the 1950s, causing their prohibition. Could the same have happened during the first half of the second millennium, in respect to Christian culture and ergot? Albert Hofmann contributed to an essay titled “The Road to Eleusis: Unveiling the Secret of the Mysteries,” which proposes that ergot alkaloids may have been present during the ancient Greek religious festival known as the Eleusinian mysteries.

Whether appearing as a drug or disease, the visual language of the Northern Renaissance was clearly influenced by the ergot fungus. Further research into this historical intersection will offer a better understanding of the way artists have responded to forces of temptation and torment with visual representation and might do so in the present day.