Aldous Huxley, Dying of Cancer, Left This World Tripping on LSD (1963)

Aldous Huxley put himself forever on the intellectual map when he wrote the dystopian sci-fi novel Brave New World in 1931. (Listen to Huxley narrating a dramatized version here.) The British-born writer was living in Italy at the time, a continental intellectual par excellence.

Then, six years later, Huxley turned all of this upside down. He headed West, to Hollywood, the newest of the New World, where he took a stab at writing screenplays (with not much luck) and started experimenting with mysticism and psychedelics — first mescaline in 1953, then LSD in 1955. This put Huxley at the forefront of the counterculture’s experimentation with psychedelic drugs, something he documented in his 1954 book, The Doors of Perception.

Huxley’s experimentation continued right through his death in November 1963. When cancer brought him to his death bed, he asked his wife to inject him with “LSD, 100 µg, intramuscular.” He died later that day, just hours after Kennedy’s assassination. Three years later, LSD was officially banned in California.

By way of footnote, it’s worth mentioning that the American medical establishment is now giving hallucinogens a second look, conducting controlled studies of how psilocybin and other psychedelics can help treat patients dealing with cancer, obsessive-compulsive disorder, post-traumatic stress disorder, drug/alcohol addiction and end-of-life anxiety. The New York Times has more on this story.

For a look at the history of LSD, we recommend the 2002 film Hofmann’s Potion(2002) by Canadian filmmaker Connie Littlefield. You can watch it here, or find it listed in our collection of Free Movies Online.

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Republican Congress, Trump plan assault on Medicare

committee-hearing

By Kate Randall
26 November 2016

During his election campaign, Donald Trump declared that he had no plans to make “substantial” changes to Medicare, the government-run health insurance plan for the elderly and disabled that covers 55 million Americans. The president-elect’s web site now says his administration will work to “modernize Medicare” and allow more “flexibility” for Medicaid, the health care program for the poor jointly administered by the federal government and the states.

These are code words signaling the readiness of the incoming administration to work with the Republican-controlled Congress to shift Medicare from a guaranteed government program to a plan with fixed government contributions—or vouchers—and to pave the way for the program’s privatization and dismantlement. Medicaid is to suffer a similar fate.

House Speaker Paul Ryan (Republican of Wisconsin) has been explicit about plans to gut Medicare. Under his plan, the government would give those in traditional Medicare a fixed amount to buy insurance. This amount would be tracked to the country’s overall growth rate or another index, plus a percentage increase, but it would not keep pace with rising health care costs. Seniors would eventually pay a larger share of costs, while government costs would shrink.

In an earlier version proposed by Ryan, cost-sharing—where the government currently pays roughly 70 percent of Medicare costs and beneficiaries pay 30 percent—would flip, leaving seniors responsible for 70 percent of costs and the government only 30 percent.

Skimpy vouchers would replace the current government guarantee, leaving traditional Medicare with a sicker, more costly insurance pool, with higher premiums. The New York Times quotes John K. Gorman, a former Medicare official who is now an insurance consultant, who said, “Regular Medicare would become the province of affluent beneficiaries who can buy their way out of” private plans.

The vast majority of working-class and middle-income seniors would be squeezed out of Medicare and left with narrow network Medicare Advantage plans, which are run by private corporations. Such a shift would have catastrophic consequences for the millions of seniors who rely on Medicare. They would see their access to specialist doctors and hospitals, life-saving treatments and procedures sharply curtailed, resulting in unnecessary suffering and death.

The attack on Medicare is part of a frontal assault to be carried out by the Trump administration against all that remains of the social reforms wrested by the working class from the ruling elite over the last century. None of the social programs enacted in the 1930s and 1960s, including Social Security, the government retirement program, will be outside the scope of the social counterrevolution that is being prepared.

Trump is not the initiator of this class war against working people. It has been underway for decades, beginning in earnest with the election of Ronald Reagan in 1980 and continuing under every succeeding administration, including the eight-year tenures of Democrats Bill Clinton and Barack Obama. The colossal redistribution of wealth and income from the bottom to the top of American society reached record proportions under Obama, whose legacy of falling living standards and worsening economic crisis for tens of millions of workers was a decisive factor in the victory of the fascistic demagogue and con artist Trump.

Trump’s victory, however, with its shift to “fortress America” nationalism, signals a sharp escalation of this class war policy.

No one should take for good coin claims by House Minority Leader Nancy Pelosi and other congressional Democrats that they will wage a serious fight against measures to undermine Medicare. In the short period since the General Election, President Obama and the Democrats have fallen all over themselves to pledge support for the incoming administration, maintaining a cowardly silence over the fact that Trump lost the popular vote by millions of ballots. The trade union bureaucracy has likewise signaled its eagerness to work with Trump in pitting American workers against their class brothers and sisters in China, Mexico and the rest of the world.

Trump’s plans for “flexibility” in Medicaid include transforming funding for the program into block grants for the states, in which a fixed and likely reduced grant would be provided to states to administer the health program for the poor. In those states that have expanded Medicaid under the Obama administration’s Affordable Care Act (ACA), including those run by Republican governors, block grants would mean deep cuts to already meager benefits.

While Trump and the Republicans rail against the ACA, commonly known as Obamacare, and vow to repeal many of its features if not the entire program, the Ryan plan for Medicare draws on some of the ACA’s most regressive features. Since Obama’s signature domestic program became law in 2010, the Department of Health and Human Services (HHS) has worked at breakneck speed to transform Medicare’s fee-for-service payments into a system that rewards doctors and hospitals for cutting costs.

HHS projects that nearly every fee-for-service payment to Medicare will be tied in some way to “value” by 2018. A recent estimate by the Congressional Budget Office anticipates a reduction in Medicare spending under Obamacare of $716 billion from 2013 to 2022.

The ferocity of the coming attacks on the basic social needs of the working class—health care, education, decent-paying jobs, pensions—is prefigured in the gang of billionaire parasites being assembled by Trump to staff his cabinet, virtually all of whom have made their fortunes by savaging workers’ living standards and attacking social programs.

Billionaire Betsy DeVos, Trump’s pick for secretary of education, is a leading proponent of charter schools and vouchers and vehement enemy of teachers and public education. Investor and former banker Wilbur Ross, Trump’s likely pick for secretary of commerce, made his fortune through leveraged buyouts of distressed steel and coal companies. He made billions by downsizing firms, slashing wages and pensions, and selling off what remained for a hefty profit.

The incoming administration has singled out the 2.7 million US federal employees for attacks on jobs, employment security and pensions.

Millions of workers are in for a huge shock when they see the reality behind Trump’s promise to “Make America Great Again.” The realization that they have once again been deceived by a capitalist con man will fuel the growth of social opposition.

Democratic Party politicians, on the other hand, who insisted during the election that Trump was “unfit” for the presidency, are now working to accommodate themselves to his agenda. It is not the wealthy upper-middle class that forms the Democrats’ main base of support, beyond Wall Street and the military/intelligence establishment, that will be hammered. Indeed, as the stock market surge since Trump’s election indicates, they stand to make themselves even richer off of the misery of working people and youth.

This party of big business, from Barack Obama and Hillary Clinton to Bernie Sanders and Elizabeth Warren, is a thousand times more fearful of a mass movement of the working class against capitalism than it is of Trump’s ultra-right agenda.

That can be halted only by a political movement of the working class consciously directed against the entire political order and the capitalist system it defends.

http://www.wsws.org/en/articles/2016/11/26/medi-n26.html

“The Last Waltz” at 40

The Band and their classic movie speak beyond boomer nostalgia

Scorsese’s 1978 movie with Van Morrison, Joni Mitchell and Muddy Waters appeals powerfully to younger musicians too

"The Last Waltz" at 40: The Band and their classic movie speak beyond boomer nostalgia
(Credit: United Artists)

The consummate musical cliché of the baby boomer era is the big, guitar-wielding encore where a bunch of white men in long hair and casual clothes take turns singing one verse after another of a really long, usually blues-based, song. Sometimes it is followed by a boomer-iffic group hug among presumably straight men.

In its crudest form, this describes the enormous, multi-band, marathon concert that came to be known as “The Last Waltz”: a rock-till-dawn gathering assembled by The Band, a quintet of roots musicians who had once backed up Bob Dylan, to play a farewell show alongside their old boss. Old friends and inspirations like Neil Young, Van Morrison, Joni Mitchell, Dr. John and Muddy Waters joined in as well (and, for some reason, Neil Diamond showed up).

As humble as The Band’s identity was — this was a group without a lead singer, after all, and which saw itself as channeling the spirit of the American past even though most of them came from Canada — the concert itself was like the final stand of rock’s royalty. It was a celebration of a legendary group, of the fellowship of the road, of the passing of an era.

But what’s funny about “The Last Waltz,” which was filmed on Thanksgiving 1976 in San Francisco’s Winterland Ballroom and released as a Martin Scorsese film two years later, is that it didn’t just engage nostalgic boomers. It spoke to music and film fans — some of whom would go on to become important players in a country-derived tradition The Band had helped inaugurate. Forty years later, it’s still a milestone. 

“Oh, man, it really blew my mind!” said the normally dry Gillian Welch, the pioneering new-acoustic musician, born in 1967, who didn’t hear the original three-LP album or see the film until she was in college. “So much of the music I loved — all in one show. I was unprepared for what it looked like when you played music that sounded like that. They were moving more than I thought. Oh man! They just looked like gods to me. I think it honestly went into me at a cellular level.”

The musician James Felice says he and his fellow Felice Brothers — an upstate New York roots band mostly in their early 30s — saw the film only about a decade ago. “I just remember feeling a palpable sense of awe at The Band’s musicianship,” he said by email. “Each guy was so damn good, and had such unique style and personality, but they made it work perfectly together. They were basically rock and roll superheroes, like ‘The Avengers’ or something.”

What’s surprising about this boomer milestone, made and released before most Xers were out of elementary school — some, because the birth range typically goes from 1964 to 1981, were not born yet — is how the movie connects across generations.

Part of it is just that this concert saw a collection of some of the greatest and deepest musicians of any generation. Some of it is Mojo-magazine-style nostalgia for a more authentic age. “We all romanticize that period so much,” says Taylor Goldsmith, the 31-year-old lead singer of the band Dawes, whose first few albums grew right out of the ground The Band plowed. Some members of Wilco, including bassist John Stirratt, are also major fans of the film and the group.

But part of it may be that “The Last Waltz” and the story of The Band — especially for those who know the whole tale — signified both boomer utopia and Gen X disillusionment at the same time. Nobody was killed, and no one OD’ed on the brown acid. But with one movie, Scorsese and The Band produced Woodstock and Altamont simultaneously. On its 40th anniversary, which sees Rhino reissuing the recording and film in various versions, it’s as ambiguous as ever.

* * *

Around the time of The Band’s Thanksgiving concert (which involved a turkey dinner served to thousands of audience members), the course of rock history was changing in a profound way. The group was retiring partly because its members were worn out from the road, but they also recognized that they were the final gasp of something — of a rock ’n’ roll tradition that was grounded in the Chicago blues, gospel and the rockabilly of the South. (The movie’s inclusion of Muddy Waters, the Staples Singers and their old boss Ronnie Hawkins was in some ways a nod to this.)

So it was not just vainglory to dub the concert “The Last Waltz”: This really was the end of something. Some of these musicians would have late-career renaissances years later — Neil Young and Dylan most notably — but most of them had already peaked artistically by 1976, and even their best work would seem out of place in the new world.

Glam musicians like David Bowie and Roxy Music had electrified young music fans, and made the denim-and-fringed-vest crowd look like backwoods day laborers. The year before the concert, a New York City poet named Patti Smith had released a volcanic debut album called “Horses” that went so deep into feminism and contemporary politics that even Joni Mitchell seemed positively medieval.

By Thanksgiving, history was bending. CBGBs was now more important than the Fillmore West: Its denizens, the band Television, had recorded punk rock’s most poetic LP — “Marquee Moon” — a few months before, and the gawky geniuses of Talking Heads had just signed to Sire. Britain was burning: The Clash and The Sex Pistols had just played a show together in Sheffield. If this new generation had its way, this would be a last waltz indeed. By the time the concert film was released, two years later, punk bands were moving into mid-career (the Clash was dreaming up “London Calling”), and “New Wave” showed a second, more pop-savvy vanguard led by a lanky, bespectacled Liverpudlian who had cheekily named himself for the king of rock ’n’ roll. The Sugarhill Gang would score hip-hop’s first hit with “Rapper’s Delight” just a year later.

This kind of irreverence, aggression and sonic experimentation was most decidedly not what The Band or “Last Waltz” fellow travelers like Eric Clapton or Emmylou Harris or Ringo Starr were about.

Gen Xers and their younger compatriots, though, grew up in a world shaped by punk and hip-hop, and the moussed-out glitz of MTV. And somehow, this earnest, often blues née country née folk-based music, so different from what this younger crowd heard on the radio and saw on television, would make profound sense to some of them. 

* * *

As celebratory as the concert was, as sincere its treatment of the music’s old guard, there was a darkness to “The Last Waltz” that was different from what the group may have intended. Some of the band members were wasted from drugs. The Band’s guitarist and songwriter Robbie Robertson told a backstage anecdote — the film was full of moments where the musicians spun stories from the road — that involved playing with legendary bluesman Sonny Boy Williamson, who would alternate playing harmonica with spitting blood into a can.

Most seriously, perhaps, the members of The Band — after 16 years on the road — hated each other. At least some of the time. Robertson was the only one dedicated to a retirement from touring; the others weren’t as sure. And it didn’t get better when the movie came out. Levon Helm, the band’s drummer and sometime singer, was particularly upset. “For two hours we watched as the camera focused almost exclusively on Robbie Robertson, long and loving close-ups of his heavily made-up face and expensive haircut,” he wrote in his memoir, “This Wheel’s on Fire.” “The film was edited so it looked like Robbie was conducting the band with expansive waves of his guitar neck.”

Robertson was most outgoing member of the group, and an engaging and charismatic storyteller, but at times it seemed like pianist Richard Manuel and organist Garth Hudson, who both sang as well, were barely part of the group. (Helm and bassist Rick Danko fared a bit better.)

The reality cut against the image of the band, memorialized in part by a bravura chapter in Greil Marcus’ “Mystery Train: Images of America in Rock ‘N’ Roll Music,” as a group of ego-less, passionate friends, singing vocal harmonies that could help the nation heal after the divisions of the Vietnam war.

When Goldsmith saw the movie in 2008, around the time Dawes was recording its debut album, “North Hills,” he saw, mostly, the dream. “You heard that there’s a whole philosophy to the group’s name: The guy who wrote the songs didn’t sing them, and there was no lead singer. It was so democratic. That’s what created the romance. You think of partnerships like Keith and Mick, or Lennon and McCartney. This was like a five-way relationship — that rock ’n’ roll band romance — epitomized in American rock.”

Perhaps appropriately for younger generations that inherited a less innocent nation after the reveries of the boomers, some Gen X and millennial fans responded to the film not in spite of, but because of the pain and tension.

“It made you want to see more of it, because it sounded like so much had been left out,” says Michael Trent of the Americana duo Shovels & Rope. “As much as I hated to take sides,” says his wife and bandmate Cary Ann Hearst, who was won over by Helm’s description of being an Arkansas country boy visiting New York City, “it’s hard not to. But it didn’t change my mind about the movie, or its sweetness.” Shovels & Rope sing a song about Hudson, “The Last Hawk,” on their new album.

As a first viewing of the movie became an obsession for young musicians, their point of view grew more complex. Some learned, for instance, that they were not really hearing what was played that night: Much of the parts were later overdubbed in the studio because the playing was so sloppy. “The more you get to know about ‘The Last Waltz,’ or get to know about Richard Manuel — in the film he’s pretty tweaked out… It was a pretty tragic story,” says Goldsmith. “They seem upset with each other. But it doesn’t make you love them any less.”

The hard tales from the road, the stories of personal tension, and the rigors of the touring life only excited Gillian Welch and her partner David Rawlings even more. “It means there was all this life behind this one concert,” she said. “You’d drive around for 20 years — yeah, that’s what you’d do. I honestly think it’s altered decisions Dave and I have made. We drive around in a Cadillac, and have been doing that for 20 years. You don’t take a shuttle to the airport.”

The Band — most of whom played with Dylan on his tumultuous 1966 world tour (as “The Hawks), on his epochal “Blonde on Blonde” album, and on the rough home recordings later released as “The Basement Tapes” — certainly had some great years before things all went bad.

But the albums after their first two — “Music from Big Pink” and “The Band” — only occasionally approached the old magic. And post-“Last Waltz,” their solo careers mostly faltered.

Things went from bad to worse. In 1986, Manuel hanged himself after ingesting liquor and cocaine. A heart attack after decades of drink and drugs killed Danko in 1999. Helm ran a series of “midnight rambles” at his farmhouse in Woodstock and made several celebrated albums in his 60s. But cancer took him in 2012. Hudson and Robertson are still alive.

But that’s not entirely all.

My interest in this group, album and film are not entirely archival. As a kid, I was dragged, partly against my will, to see the movie at the Brattle Theatre in Cambridge. It was a double feature with “Singin’ in the Rain,” which I knew and loved, but I was, at 10, not the least bit interested in waltzing. At the time I was a pure British Invasion-and-Dylan zealot — the idea that country rock even existed or could be any good had never crossed my mind. My father insisted.

But from the first scenes of backstage pool-playing and the one-two-three punch of Band songs “Up on Cripple Creek,” “The Shape I’m In,” and “It Makes No Difference,” my life changed. It took me years to get deeply into alt-country and the blues and Van Morrison, but I was launched on a journey. My dad wasn’t always right, but he often was. I dedicate this story to his memory.

 

Scott Timberg is a staff writer for Salon, focusing on culture. A longtime arts reporter in Los Angeles who has contributed to the New York Times, he runs the blog Culture Crash. He’s the author of the new book, “Culture Crash: The Killing of the Creative Class.”

Government announces huge Obamacare premium rises for 2017

obamacare

By Kate Randall
26 October 2016

Open enrollment for the Affordable Care Act (ACA), commonly known as Obamacare, begins November 1, just a week before Election Day. US officials announced Monday that in 2017 insurers will hike the premiums for many health plans sold on ACA exchanges by an average of 25 percent.

The projected premium increases are of concern not only to those shopping for insurance coverage under Obamacare. They are part of a sea change in the US health care system, in which corporations and the government are increasingly burdening working families with rising health care costs while simultaneously working to ration care for the vast majority of Americans.

In a call with reporters on Monday, the Department of Health and Human Services (HHS) confirmed the 25 percent average price hike for the second cheapest (“silver”) plans, which are used as the benchmark to determine government subsidies. The dramatic increase compares to an average 7.5 percent premium hike in 2016 and a 2 percent rise in 2015. Average monthly increases are estimated at anywhere from $50 to $300.

In addition to the ACA premium hikes, HHS announced that more than one in five consumers using the HealthCare.gov site would have only one insurer to choose from in 2017. This is mainly the result of the pullout of insurance giants UnitedHealthcare, Humana and Aetna from the ACA marketplace over the past year. The average number of insurance carriers available per US county in 2017 is projected at 2.9, down from 5.7 in 2016.

The premium hikes and dwindling plan choices are a direct function of Obamacare’s subordination to the multibillion-dollar private insurance industry. Under the ACA’s so-called individual mandate, individuals and families without insurance through their employer or a government-run program such as Medicare or Medicaid must purchase insurance or pay a tax penalty. Those who go without insurance next year could face tax penalties of $700 a person or more.

Rising premiums and huge deductibles are only part of the Obamacare story. Earlier this month, the New York Times ran a front-page lead article with the headline, “Next President Likely to Shape Health Law Fate: Changes Seen as Needed.” The article was a semi-official announcement that major changes would be imposed after the November 8 election, regardless of the outcome of the presidential race, to bolster the profits of insurance companies participating in the program.

Among the changes under consideration, according to the Times, are increasing taxpayer subsidies to insurance firms for “high-cost enrollees,” increasing tax penalties on individuals and families for not buying insurance, and curbing “abuse” of special enrollment periods by people who sign up for coverage after becoming sick.

The failure of Obamacare to attract a sufficient number of younger, healthier customers has resulted in a pool of less healthy enrollees who are more costly to insure. The private insurers, unwilling to accept any encroachment on their profits, have responded by requesting and receiving premium increases of 25 to 50 percent or more from state insurance commissions, or by pulling out of the ACA marketplace altogether.

HHS officials argue that consumers shopping on HealthCare.gov for 2017 should be able to find plans comparable in price to last year. But in general these are the least expensive “bronze” plans that come with deductibles in excess of $5,000 for an individual and other high out-of-pocket costs. In a further effort to cut costs, insurers are also offering an increasing number of plans with narrow networks of doctors and hospitals, as well as limited prescription drug coverage.

The Obama administration says that about 8 in 10 of the expected 11.4 million Obamacare enrollees in 2017 will qualify for government subsidies. The ACA exchanges have enrolled more than 80 percent of those with incomes below 150 percent of the (absurdly low) federal poverty level who are potentially eligible for subsidies. But another 5 to 7 million people who buy insurance on their own do not receive federal subsidies.

According to Avalere, a health policy consulting company, only about 17 percent of potential ACA customers with incomes from three to four times the poverty level ($35,640 to $47,520 for an individual) have enrolled. For many people in this income bracket and above—who are between jobs, self-employed, or retired but not yet eligible for Medicare—ACA insurance is unaffordable, with or without subsidies.

Using the estimator on HealthCare.gov for 2017 plans in Maricopa County, Arizona, a couple in their early 40s with two children under age 19 and a household income of $60,000 would receive a $1,451 monthly subsidy for the least expensive silver plan, bringing their estimated premium down to $313 a month. However, with a $10,500 annual family deductible and other out-of-pocket costs, estimated yearly costs would be $14,305, or nearly one-quarter of their household income.

Obamacare—with its soaring premiums, high out-of-pocket costs and dwindling networks and services—is serving as the model for employers across the country as they seek to shift more health care costs onto their workers.

Attacks on health care benefits have featured prominently in a series of recent contract disputes, including strikes by 4,800 nurses at Allina Health in Minnesota, a strike by 5,500 faculty and coaches at Pennsylvania’s 14 state-run universities, a strike at Harvard University by 700 dining service workers, and a walkout of Libbey Glass workers in Toledo, Ohio. In each case, employers have sought to drastically reduce health benefits and shift workers to inferior plans with burdensome out-of-pocket costs.

Obamacare is also the spearhead of a gathering attack on Medicare, the government health insurance program for 53 million American seniors and disabled people. Last year, President Obama signed into law a bipartisan bill revising the payment system for Medicare providers to reward doctors for cutting costs and penalize them if the volume and frequency of the health services they provide are deemed too high. Doctors will have a financial incentive to withhold more extensive tests and services from Medicare recipients.

President Obama spoke Thursday at Miami Dade College in Florida to tout the achievements of the ACA. While conceding the “growing pains” facing his signature domestic policy, he pointed to the ACA’s extension of health insurance to 20 million people, its prohibition on insurers denying coverage to people with preexisting conditions, and its guarantee of coverage for certain “essential” medical services.

He did not acknowledge that the ACA imposes no serious restraints on the insurance companies, pharmaceutical firms or hospital chains, and uses financial coercion to drive people to buy bare-bones plans with high out-of-pocket costs. Nor did he take note of the intensified assault on health benefits by employers, both private and public, across the US.

Obama boasted, “All told, about another 10 percent of the country now have coverage.” He was silent on the national scandal of 29 million Americans remaining uninsured.

With Election Day less than two weeks away, news of the premium hikes has forced a response from the presidential campaigns of both big-business parties. Republican Donald Trump proclaimed at a rally Monday night in Tampa, Florida, “It’s over for Obamacare.” He has called for the law’s repeal, not to replace it with a more progressive alternative, but to leave even more people without insurance. His stated health care agenda includes turning Medicaid, the government health insurance program for the poor, into a voucher program.

While acknowledging that “premiums have gotten too high,” Democrat Hillary Clinton, a staunch defender of Obamacare, has called for providing a new tax credit of up to $5,000 to help people pay for premiums and out-of-pocket costs. Such a measure, as she well knows, stands virtually no chance of passage by Congress.

Neither the Democrats nor the Republicans have any intention of challenging the for-profit health care industry. The deepening attack on health care, exemplified by the projected 25 percent hike in Obamacare premiums, serves as a warning of the austerity agenda of the next administration, whichever party occupies the White House in January.

WSWS

Rapid Burnout, Dissatisfaction of U.S. Doctors Threatens Public Health Crisis

Posted on Sep 29, 2016

Tim Waclawski / CC BY-ND 2.0

Half of U.S. physicians are “disengaged, burned out, and demoralized and plan to either retire, cut back on work hours, or seek non-clinical roles,” reports MedPage Today, citing a new nationwide survey commissioned by The Physicians Foundation.

“Many physicians are dissatisfied with the current state of the medical practice environment and they are opting out of traditional patient care roles,” said Walker Ray, MD, president of The Physicians Foundation, in remarks that appeared with the survey.

“The implications of evolving physician practice patterns for both patient access and the implementation of healthcare reform are profound.”

MedPage Today reports:

The majority of the 17,236 physicians surveyed (54%) describe their morale as somewhat or very negative, 63% are pessimistic about the future of the medical profession, 49% always or often experience feelings of burn-out, and 49% would not recommend medicine as a career to their children, according to the survey.

Physicians identified regulatory/paperwork burdens and loss of clinical autonomy as their primary sources of dissatisfaction. They spend 21% of their time on non-clinical paper work duties, according to the survey, while only 14% said they have the time they need to provide the highest standards of care. About two-thirds (72%) said third-party intrusions detract from the quality of care. …

The survey indicates that only 33% of physicians now identify as private practice owners, down from 49% in 2012, while 58% identify as employees, up from 44% in 2012.

Physicians also indicated that “they’re disengaged from key initiatives of healthcare reform,” MedPage Today reports.

Only 43% said their compensation is tied to value. Of these, the majority (77%) have 20% or less of their compensation tied to value. Only 20% are familiar with the Medicare Access and CHIP Reauthorization Act (MACRA) which will greatly accelerate value-based payments to physicians.

While 36% of physicians participate in accountable care organizations (ACOs), only 11% believe ACOs are likely to enhance quality while decreasing costs. Physicians also are dubious about hospital employment of doctors, another mechanism for achieving healthcare reform.

Two-thirds (66%) do not believe hospital employment will enhance quality of care or decrease costs. Even 50% of physicians who are themselves employed by hospitals, do not see hospital employment as a positive trend.

The survey additionally found:

* 80% of physicians are overextended or are at capacity, with no time to see additional patients
* 48% of physicians said their time with patients is always or often limited
* Employed physicians see 19% fewer patients than practice owners
* 46.8% of physicians plan to accelerate their retirement plans
* 20% of physicians practice in groups of 101 doctors or more, up from 12% in 2012
* Only 17% of physicians are in solo practice, down from 25% in 2012
* 27% of physicians do not see Medicare patients, or limit the number they see
* 36% of physicians do not see Medicaid patients, or limit the number they see

One Truthdig reader said of the findings:

One should compare what’s happened in the medical profession with what’s happened in the nation’s universities—greed and ideologically driven (rather than empirically based) business modeling turned control of persons educated to perform the profession’s real work over to hordes of bean counting ‘administrators’ whose policies and actions deprive doctors and professors of autonomy, reduce both time to perform and fair reward for their work, and slash due respect for their hard acquired skills and the developed judgment needed to effectively use them with patients and students.

These results follow from privatization, which is a form of theft consisting of the capitalist practice of plundering employees and reducing services to the public in order to leach wealth for owners, managers or both—workers, humanity and Earth’s future be damned.

Update: Via email, Truthdig reader Lawrence Raines, recently retired from a career in healthcare, adds to the findings and the preceding comment:

I was an independent General Surgeon who retired (after 31 years in same location) in August 2013 because of the relentless, oppressive intrusion of Corporatised Medicine which is nicely described by the above quote from one of your readers. There are myriad reasons that led to my retirement but using my long acquired and honed skills to care for my patients was not one of them. I loved being a doctor but my professional life was literally sucked out of me and according to the article and conversations with former colleagues it has continued to get worse, “much worse.” I don’t think this is unique to healthcare and I have grave concerns about what type of society will exist for my grandchildren. Greed and Power and the associated Immorality are corrupting the world.

—Posted by Alexander Reed Kelly

http://www.truthdig.com/eartotheground/item/rapid_burnout_of_us_doctors_threatens_public_health_crisis_20160929

The lie of white “economic insecurity”: Race, class and the rise of Donald Trump

The media loves to promote the lie that the white working class supports Trump and the GOP for economic reasons

The lie of white "economic insecurity": Race, class and the rise of Donald Trump
(Credit: Reuters/Mike Segar)

Questions of race and class have cast a heavy shadow over a presidential campaign in which “economic insecurity” has been repeatedly identified (quite incorrectly) by the mainstream news media as the driving force behind the rise of Donald Trump. In response, there has been a flurry of recent articles and essays exploring how matters of race and class are influencing the decision by “white working class” voters to support Donald Trump’s fascist, racist and nativist campaign for the White House.

Writing at The Guardian, sociologist Arlie Hochschild offers a devastating critique of how race and class intersect for white working-class American voters. In “How the Great Paradox of American Politics Holds the Secret to Trump’s Success,” Hochschild explores how white voters in the South and elsewhere rationalize their support for a Republican Party and a “small government” ethos that has devastated their lives and communities. She tells this story by focusing on one person, Lee Sherman, and his journey from pipefitter at a petrochemical plant to environmental activist and whistleblower to eventual Tea Party activist. Hochschild writes:

Yet over the course of his lifetime, Sherman had moved from the left to the right. When he lived as a young man in Washington State, he said proudly, “I ran the campaign of the first woman to run for Congress in the state.” But when he moved from Seattle to Dallas for work in the 1950s, he shifted from conservative Democrat to Republican, and after 2009, to the Tea Party. So while his central life experience had been betrayal at the hands of industry, he now felt – as his politics reflected – most betrayed by the federal government. He believed that PPG and many other local petrochemical companies at the time had done wrong, and that cleaning the mess up was right. He thought industry would not “do the right thing” by itself. But still he rejected the federal government. Indeed, Sherman embraced candidates who wanted to remove nearly all the guardrails on industry and cut the EPA. The Occupational Safety and Health Administration had vastly improved life for workmen such as Sherman – and he appreciated those reforms – but he felt the job was largely done.

Lee Sherman’s story is all too common. Because of political socialization by the right-wing media, the Christian evangelical movement, and closed personal and social networks, many white conservative voters are unable to practice the systems level thinking necessary to connect their day-to-day struggles with the policies put in place by the Republican Party.

While this way of seeing and understanding the social and political world (what Walt Whitman influentially described as “the pictures inside of people’s heads”) may be at odds with the type of critical thinking and evidence-based reasoning that liberals and progressives take for granted, it still exerts a powerful hold over many millions of conservatives. This alternate reality is, not surprisingly, anchored in place by the right-wing disinformation machine and Fox News.

Hochschild’s essay is further evidence of what I suggested in an earlier piece here at Salon: Republicans and the broader right-wing movement profit from a Machiavellian relationship where the more economic pain and suffering they inflict on red-state America, the more popular and powerful they become with those voters. This is political sadism as a campaign strategy.

Politico’s “What’s Going on With America’s White People?” features commentary by leading scholars and journalists such as Anne Case, Angus Denton, Nancy Isenberg, Carol Anderson and J.D. Vance, whose collective work examines the relationships between race, class and white America. The piece highlights how death anxieties greatly influence the political calculations and decision-making of white conservatives in red-state America. These people use their own broken communities — places that are awash in prescription drug addictions, have high rates of out-of-wedlock births and divorce, and see deaths of despair (suicide by guns and alcohol; chronic untreated illnesses) reign — to draw incorrect conclusions about America as a whole. These anxieties have combined with increasing levels of authoritarianism, racial resentment and old-fashioned racism among white conservatives and right-leaning independents to fuel extreme political polarization and make the emergence of a demagogue such as Donald Trump a near inevitability.

If the fever swamps that birthed Donald Trump are to be drained, there needs to be a renewed focus on the dynamics of race and class for white (conservative) voters during this 2016 presidential election. But these analyses should also be accompanied by several qualifiers.

First, liberals and progressives are often easily seduced by a narrative, popularized by Thomas Frank and others, in which white working-class and poor Americans are depicted as having been hoodwinked into voting for the Republican Party. In this argument, white poor and working-class red-state voters chose “culture war” issues over economic policies. However, as compellingly demonstrated by political scientist Larry Bartels (and complemented by fellow political scientist Andrew Gelman), poor and other lower-income voters tend to vote for the Democratic Party while middle- and upper-income voters tend to vote for the Republican Party. Poor and lower-income (white) voters participate in formal politics less frequently than middle- and upper-income voters. Moreover, “culture war” issues did not drive a mass defection of white working-class voters from the Democratic Party to the GOP.  In total, it is white economic and political elites and not the white poor and working classes who are largely responsible for the political and social dysfunction that plagues American politics today.

Second, since its very founding America has been struggling with two powerful impulses. On one hand, there is a truly progressive and left-wing type of pluralism that seeks to work across lines of race and class in order to create an inclusive democracy where upward mobility and the fruits of full citizenship are equally attainable for all people. This type of pluralism is embodied by Bernie Sanders — and to a lesser degree Hillary Clinton and the broader Democratic Party. Juxtaposed against this is a right-wing and reactionary type of pluralism that is exclusive and not inclusive, stokes the fires of racial and ethnic division, and offers a vision of America where white people stand on the necks of non-whites in order to elevate themselves. This is embodied by Donald Trump and a Republican Party that functions as the United States’ largest de facto white identity organization.

Most importantly, the white “working-class” and poor voters featured in the recent pieces by Politico and The Guardian possess agency. It has long been fashionable for liberals and progressives to suggest that the white poor and working classes are confused by “false consciousness” as demonstrated by their allegiance to America’s racial hierarchy and an economic system that often disadvantages people like them. In reality, the white poor and working class are keenly aware of the psychological and material advantages that come with whiteness and white privilege.

Whiteness is a type of property in the United States. For centuries, white people, across lines of class and gender, have coveted and fiercely protected it. The white working class and poor are not victims in this system; they have benefited greatly from it at the expense of non-whites. Ultimately, as Americans try to puzzle through their current political morass, a renewed emphasis on race and class is invaluable because it serves as a reminder of how simple binaries (one must choose between discussing either “race” or “class”) and crude essentialism (“a focus on class inequality will do more good than confronting racism!”) often disguises and confuses more than it reveals.

Chauncey DeVega is a politics staff writer for Salon. His essays can also be found at Chaunceydevega.com. He also hosts a weekly podcast, The Chauncey DeVega Show. Chauncey can be followed on Twitter and Facebook.

Proven Wrong About Many of Its Assertions, Is Psychiatry Bullsh*t?

Some psychiatrists view the chemical-imbalance theory as a well-meaning lie.

Photo Credit: Olena Yakobchuk / Shutterstock

In the current issue of the journal Ethical Human Psychology and Psychiatry, Australian dissident psychiatrist Niall McLaren titles his article, “Psychiatry as Bullshit” and makes a case for just that.

The great controversies in psychiatry are no longer about its chemical-imbalance theory of mental illness or its DSM diagnostic system, both of which have now been declared invalid even by the pillars of the psychiatry establishment.

In 2011, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times, stated, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” And in 2013, Thomas Insel, then director of the National Institute of Mental Health, offered a harsh rebuke of the DSM, announcing that because the DSM diagnostic system lacks validity, the “NIMH will be re-orienting its research away from DSM categories.”

So, the great controversy today has now become just how psychiatry can be most fairly characterized given its record of being proven wrong about virtually all of its assertions, most notably its classifications of behaviors, theories of “mental illness” and treatment effectiveness/adverse effects.

Among critics, one of the gentlest characterizations of psychiatry is a “false narrative,” the phrase used by investigative reporter Robert Whitaker (who won the 2010 Investigative Reporters and Editors Book Award for Anatomy of an Epidemic) to describe the story told by the psychiatrists’ guild American Psychiatric Association.

In “Psychiatry as Bullshit,” McLaren begins by considering several different categories of “nonscience with scientific pretensions,” such as “pseudoscience” and “scientific fraud.”

“Pseudoscience” is commonly defined as a collection of beliefs and practices promulgated as scientific but in reality mistakenly regarded as being based on scientific method. The NIMH director ultimately rejected the DSM because of its lack of validity, which is crucial to the scientific method. In the DSM, psychiatric illnesses are created by an APA committee, 69 percent of whom have financial ties to Big Pharma. The criteria for DSM illness are not objective biological ones but non-scientific subjective ones (which is why homosexuality was a DSM mental illness until the early 1970s). Besides lack of scientific validity, the DSMlacks scientific reliability, as clinicians routinely disagree on diagnoses because patients act differently in different circumstances and because of the subjective nature of the criteria.

“Fraud” is a misrepresentation, a deception intended for personal gain, and implies an intention to deceive others of the truth—or “lying.” Drug companies, including those that manufacture psychiatric drugs, have been convicted of fraud, as have high-profile psychiatrists (as well as other doctors). Human rights activist and attorney Jim Gottstein offers an argument as to why the APA is a “fraudulent enterprise”; however, the APA has not been legally convicted of fraud.

To best characterize psychiatry, McLaren considers the category of “bullshit,” invoking philosopher Harry Frankfurt’s 1986 journal article “On Bullshit” (which became a New York Times bestselling book in 2005).

Defining Bullshit

What is the essence of bullshit? For Frankfurt, “This lack of connection to a concern with truth—this indifference to how things really are—that I regard as of the essence of bullshit.”

Frankfurt devotes a good deal of On Bullshit to differentiating between a liar and a bullshitter. Both the liar and the bullshitter misrepresent themselves, representing themselves as attempting to be honest and truthful. But there is a difference between the liar and the bullshitter.

The liar knows the truth, and the liar’s goal is to conceal it.

The goal of bullshitters is not necessarily to lie about the truth but to persuade their audience of a specific impression so as to advance their agenda. So, bullshitters are committed to neither truths nor untruths, uncommitted to neither facts nor fiction. It’s actually not in bullshitters’ interest to know what is true and what is false, as that knowledge can hinder their capacity to bullshit.

Frankfurt tells us that liar the hides that he or she is “attempting to lead us away from a correct apprehension of reality.” In contrast, the bullshitter hides that “the truth-values of his statements are of no central interest to him.”

Are Psychiatrists Bullshitters?

Recall establishment psychiatrist Pies’ assertion: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” What Pies omits is the reality that the vast majority of psychiatrists have been promulgating this theory. Were they liars or simply not well-informed? And if not well-informed, were they purposely not well-informed?

If one wants to bullshit oneself and the general public that psychiatry is a genuinely scientific medical specialty, there’s a great incentive to be unconcerned with the truth or falseness of the chemical imbalance theory of depression. Bullshitters immediately recognize how powerful this chemical imbalance notion is in gaining prestige for their profession and themselves as well as making their job both more lucrative and easier, increasing patient volume by turning virtually all patient visits into quick prescribing ones.

Prior to the chemical imbalance bullshit campaign, most Americans were reluctant to take antidepressants—or to give them to their children. But the idea that depression is caused by a chemical imbalance that can be corrected with Prozac, Paxil, Zoloft and selective serotonin reuptake inhibitor antidepressants sounded like taking insulin for diabetes. Correcting a chemical imbalance seemed like a reasonable thing to do, and so the use of SSRI antidepressants skyrocketed.

In 2012, National Public Radio correspondent Alix Spiegel began her piece about the disproven chemical imbalance theory with the following personal story about being prescribed Prozac when she was a depressed teenager:

My parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story: “The problem with you,” she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then she handed my mother a prescription for Prozac.

When Spiegel discovered that the chemical imbalance theory was untrue, she sought to discover why this truth had been covered up, and so she interviewed researchers who knew the truth. Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, told Spiegel that by framing depression as a deficiency—something that needed to be returned to normal—patients felt more comfortable taking antidepressants. Frazer stated, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.” For Frazer, the story that depressed people have a chemical imbalance enabled many people to come out of the closet about being depressed.

Frazer’s rationale reminds us of Edward Herman and Noam Chomsky’s book Manufacturing Consent, the title deriving from presidential adviser and journalist Walter Lippmann’s phrase “the manufacture of consent”—a necessity for Lippmann, who believed that the general public is incompetent in discerning what’s truly best for them, and so their opinion must be molded by a benevolent elite who does know what’s best for them.

There are some psychiatrists who view the chemical imbalance theory as a well-meaning lie by a benevolent elite to ensure resistant patients do what is best for them, but my experience is that there are actually extremely few such “well-meaning liars.” Most simply don’t know the truth because they have put little effort in discerning it.

I believe McLaren is correct in concluding that the vast majority of psychiatrists are bullshitters, uncommitted to either facts or fiction. Most psychiatrists would certainly have been happy if the chemical-imbalance theory was true but obviously have not needed it to be true in order to promulgate it. For truth seekers, the falseness of the chemical imbalance theory has been easily available, but most psychiatrists have not been truth seekers. It is not in the bullshitters’ interest to know what is true and what is false, as that knowledge of what is a fact and what is fiction hinders the capacity to use any and all powerful persuasion. Simply put, a commitment to the truth hinders the capacity to bullshit.