Trumpcare is dead, at least for now: But the health care fight will never end

McConnell-Ryan health plan collapses as conservatives bolt — but progressives have no victory to celebrate

It appears that the Republican effort to repeal and replace the Affordable Care Act is dead, at least for now. Donald Trump’s unrealistic, grandiose promise will go unfulfilled.

That didn’t work out. After weeks of prevarication and misdirection on the part of people like Vice President Mike Pence and Health and Human Services Secretary Tom Price, who went on TV last weekend and blatantly lied about the effects of the Senate health care bill, on Monday night two GOP senators, Mike Lee of Utah and Jerry Moran of Kansas, pulled the plug by saying they could not vote for it. Added to the previously announced no votes of Sens. Susan Collins and Rand Paul, Majority Leader Mitch McConnell is now at least two short. He has admitted that this bill will not pass.

We’ve been here before, of course. The first House bill was pulled and they came back and passed an even worse version. This may not end the way everyone seems to assume it will either.

Both Trump and McConnell acknowledged that the Senate’s BCRA is dead and signaled their support for a “full repeal plus two-year delay until they figure out what the hell is going on” plan. It is not impossible that they could put something else together.

After all, the reasons three of the four senators gave for their unwillingness to pass the bill is that it just wasn’t harsh enough. Repeal and replace with nothing would undoubtedly make them quite happy. That would leave the handful of Republican moderates in the Senate having to do something only Collins has so far been willing to do: take a stand for decency. Sens. Dean Heller of Nevada, Shelley Moore Capito of West Virginia, Rob Portman of Ohio, John Hoeven of North Dakota and Lisa Murkowski of Alaska have all said that they won’t vote to deny people health insurance. But there’s always a chance they can be appeased with the two-year delay and a fatuous promise to fix everything before then. Nobody should relax until it’s clear that this is all well and truly dead.

This repeal-and-delay plan was originally proposed back at the beginning of the year but faced a huge uproar, mostly from the health care industry, which cannot run its businesses with this kind of uncertainty about the financing, rules and regulations under which they must operate. A handful of senators balked at the time, including Bob Corker of Tennessee and Tom Cotton of Arkansas, who said, “I don’t think we can repeal Obamacare and say we’re going to get the answer two years from now.” Both Paul and Collins were against it too, as were many of the Republican governors who also have to plan their budgets.

But what really scared them off that time was public opinion. Only 20 percent of Americans were in favor of repeal-and-delay five months ago. It’s hard to imagine that after they’ve seen what kind of horrendous plans the Republicans tried to ram through the Congress they’ll be more favorably disposed today. According to a recent Gallup poll, Americans prefer Democrats to handle health care by 55 to 36 percent.

The Republican leadership exemplified by House Speaker Paul Ryan thought they had come up with a clever way to have their cake and eat it too. If they could repeal the Affordable Care Act and then take their big victory lap, that might satisfy their base that they were getting things done — after which they could pretend they were creating some kind of “new” health care system that would kick in gradually. The simple fact was that they had no idea how to cover the people who are currently covered under the ACA and they knew it. Their best hope was to ease people back into their previous anxiety and despair and blame Obamacare for it.

Donald Trump has said many times that he believes the best political move would be to keep Obamacare in place and help it fail, so he and his party could blame the Democrats. If Republicans can drag this out a couple of years and guilt Democratic lawmakers into signing on to some inadequate Band-aids in order to spare a few lives, that would really be sweet.

It will also be sweet for the Democrats when they run ads against every House Republican who voted for that AHCA atrocity under the assurance that they would “fix it in the Senate.” If the Democrats do manage to eke out a new House majority it will be the health care albatross that brings down the GOP. They can name him Donald.

But whether Republicans manage to push through repeal-and-delay or just drop it altogether, liberals and progressives need to reckon with the fact that this is not the end. There will never be an end.

Republicans have been trying to destroy the American safety net for decades. They’ve been hostile to Medicare and Medicaid since the day they were passed. They’ve been running against Social Security for 82 years. (They just tried to privatize it in 2005!) They will never stop attacking the ACA either.

This isn’t just about profits or ” free markets.” Consider that this Senate bill was opposed by all the so-called stakeholders: the insurance companies, the hospitals, doctors and even big business. It still has 48 out of 52 votes in the Senate. Conservatives simply do not believe that people have a right to health care. They see it as a commodity like any other, something which you should not have if you cannot pay for it.

By way of crude illustration, recall when libertarian godhead Rep. Ron Paul ran for president in 2008. CNN’s Wolf Blitzer asked him during a debate what an uninsured man who  became catastrophically ill and needed intensive care for six months should do. Paul replied, “What he should do is whatever he wants to do and assume responsibility for himself. That’s what freedom is all about, taking your own risk. This whole idea that you have to take care of everybody …” The audience then erupted into cheers, cutting off Paul’s sentence. Blitzer followed up by asking “Congressman, are you saying that society should just let him die?” Members of the audience clapped and shouted “Yeah!”

Or there was this remarkable moment from an Obamacare town hall in 2009:

The sainted Ronald Reagan made his name speaking out against “socialized medicine” for years, memorably warning that if the government passed Medicare, we were all “going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

Nobody who believes that human beings have a right to a government guarantee of health care, security in their old age and society’s support should they be unable to work should ever rest on their laurels. Those who don’t agree will never stop trying to take those things away.

Heather Digby Parton, also known as “Digby,” is a contributing writer to Salon. She was the winner of the 2014 Hillman Prize for Opinion and Analysis Journalism.

The opioid epidemic in the US: A national health emergency

18 July 2017

The Washington Post recently published an extraordinary article on policies to address the spiraling drug epidemic in the United States. The article—“As opioid overdoses exact a higher price, communities ponder who should be saved”—did not feature calls for emergency health care or rehabilitation programs, but rather suggestions by some local officials that the state should just let drug addicts die.

The Post highlighted, among others, the proposal of Middletown, Ohio Council Member Daniel Picard that emergency responders should not use the drug naloxone to save overdose victims more than two times. The newspaper noted that the drug is often “the only thing separating whether an overdose victim goes to the hospital instead of the morgue,” and draws the conclusion that it is perfectly reasonable to adopt policies to ensure that many more go to the latter rather than the former.

That such fascistic measures—what might be called the “Duterte solution” to the drug epidemic in the US—are being treated as a rational and legitimate part of the political debate is an expression of the debased political psychology that dominates in the American ruling class. As far as the corporate and financial elite is concerned, if tens of thousands more people die from drug overdoses, this is not only acceptable, it is a positive good.

Such measures are being advanced amidst a national public health emergency on a scale not seen since the AIDS epidemic of the 1980s and ‘90s. In 2015, a shocking 52,000 people in the United States died from drug overdoses, including more than 30,000 from opioids alone. This compares to just under 42,000 deaths from AIDS at its peak in 1995. The figures for 2016, when finally totaled, are expected to show an increase of nearly 20 percent, rising to nearly 170 people every day of the year.

In the hardest hit regions, stories of morgues and funeral homes running at maximum capacity are commonplace. Twice already this year in Montgomery County, Ohio, the coroner’s office has been so overwhelmed with bodies that it was forced to rent extra refrigeration units.

Opioid-related deaths have jumped in states throughout the country, devastating rural areas and big cities, and affecting all races and ethnicities. In Maryland, the number of opioid-related deaths has nearly quadrupled since 2010. In Ohio, opioid related deaths jumped from 296 in 2003 to 2,590 in 2015, a 775 percent increase. In Florida in 2015, three opioids—heroin, fentanyl and oxycodone—were directly responsible for the deaths of 3,896 people.

The number of people directly impacted by the crisis—including family members, friends and colleagues, medical responders, social workers and many others—is in the millions. Many addicts have children who are forced into a resource-starved foster care system, or are left in the hands of family members who cannot provide for them. A recent study from University of Michigan estimates that one baby is born addicted to some sort of opiate every hour.

Thousands of workers who have dedicated their lives to jobs that treat drug addiction experience second-hand trauma from the hardships that come with combating the epidemic, with little to no resources. Hospital workers are forced to turn away withdrawing addicts from the emergency room without care; social workers have the task of telling children they cannot be reunited with their parents, or worse, that one or both of their parents have died; rehabilitation clinicians are expected to “cure” addicts with nothing more than additional drugs and a 12-twelve step program.

The drug epidemic is a public health crisis of incredible magnitude, and yet nowhere in the political establishment is there serious discussion on the measures needed to combat it—or who is responsible.

The underlying assumption in articles like the one in the Post is that drug abuse is a moral failing, and that those addicted deserve to face the consequence of their actions. This is a convenient explanation for those who wish to wash their hands of a problem that threatens their pocketbooks.

The drug epidemic, however, is not an individual failing but a symptom of a diseased social system. It is the product of definite actions taken by the ruling class and its political representatives, Democratic and Republican.

There are of course the pharmaceutical companies, which have for years have been given a free hand to aggressively market some of the most addictive opioids, making huge profits in the process. These drugs were recklessly misbranded as “abuse resistant” throughout the 1990s and early 2000s, despite overwhelming evidence to the contrary. Prescriptions for opioids such as Percocet, Oxycontin and Vicodin skyrocketed from 76 million in 1991 to nearly 259 million in 2012, enough to supply each American adult with a bottle of pills, and some with two.

The same pharmaceutical companies continue to profit from the crisis that they helped foster. One of the reasons that cities face growing costs for using naloxone is that some companies marketing varieties of the drug have hiked up the price by as much as 500 percent.

More fundamentally, the drug epidemic is a symptom of the devastation produced by nearly forty years of social counterrevolution. Whatever the specific circumstances behind each individual tragedy, the crisis is the product of the unrelenting attack on social programs, wages, education and health care, combined with deindustrialization that has wiped out hundreds of thousands of jobs and produced levels of social inequality not seen since the 1920s.

Obama concluded his two terms in office declaring that “things have never been better” in the United States—a proclamation that applied to the ruling elite he served, but not to the great mass of the population. Now, under the Trump administration, the political establishment is engaged in a great “debate” over the future of health care, currently centered on just how much and in what way to destroy Medicaid, which funds at least eighty percent of drug abuse services.

The outcome of the new health care bill, whatever its form, will be nothing short of social murder. In this sense, Picard, the local Ohio official, is merely channeling the general outlook of the ruling class, for which the reduction in life expectancy is a basic strategic aim.

A health emergency on the scale of the drug epidemic requires an emergency response. The Socialist Equality Party insists that billions of dollars must be allocated to fund rehabilitation centers, using the most advanced scientific methods and procedures. The health care system must be equipped with detox centers and connected to institutions to help with long-term recovery. All social workers in the field must receive a decent wage and the counseling and support needed. Children must be given the highest level of care while their parents recover.

Such elementary measures and more must be connected to the reconstruction of society to ensure that everyone has the right to a high-paying job, health care, education and quality housing. Only in this way can the underlying causes of drug addiction be addressed.

None of these measures is possible without a frontal attack on wealth of the corporate and financial elite and its stranglehold on the entire economic and political system. As tens of thousands die, the ruling class conspires to spend trillions on war and conjure up new ways to amass ever greater fortunes.

The disease of which the drug epidemic is a symptom is the capitalist system. It can be cured only through the mobilization of the entire working class in the fight for socialism.

Genevieve Leigh

http://www.wsws.org/en/articles/2017/07/18/pers-j18.html

The End of the American Experiment

It’s Over. So What Can the World Learn?

It’s safe to say, I think, that the American experiment is at an end. No, America might not be finished as in civil war and secession. But it is clearly at an end in three ways.

First, to the world, as a serious democracy. Second, to itself, as a nation with dignity and self-respect. Third, its potential lies in ruins. Even if authoritarianism is toppled tomorrow, the problems of falling life expectancy, an imploding middle class, skyrocketing inequality, and so on, won’t be.

Now, like many fallen nations, maybe America won’t learn much from the failure of its own experiment — but history and the world surely can. So what has the experiment disproven? What was the null hypothesis?

We don’t have to look very far. What does America not have that the rest of the rich world does? Public healthcare, transport, education, and so on. Every single rich nation in the world has sophisticated, broad, and expansive public goods, that improve by the year. Today, even many medium income and even poor nations are building public healthcare, transport, etc. America is the only one that never developed any. Public goods protect societies in deep, profound, invisible ways (we’ll get to that).

First, here is the really curious thing. American leaders are pretending like the relationship above is a great, confounding mystery. Like dumbfounded dinosaurs watching the mushroom cloud engulf the land, never — not once — in American media will you read a column, hear a voice, or see a face discussing the above. It has never happened a single time in my adult lifetime as far as I can remember. Yet the relationship couldn’t be any more obvious, clear, or striking: no public goods are what uniquely separates America, the uniquely failed state, from the rest of the world.

Why is that? It would be easy for me to say that public goods represent some kind of a hard-fought compromise between left and right. But I think there is a social truth greater that is far more substantial than the surface political reality.

Working societies — if they are to endure, grow, and cohere, if they are to prosper, hang together, and really mature — need moral universals. Moral universals are simply things that people believe everyone should have. In the UK, those things — those moral universals — are healthcare and media and welfare. In Germany, they are healthcare and media and welfare and higher education. And so on.

Moral universals anchor a society in a genuinely shared prosperity. Not just because they “spread the wealth”, though they do: because, more deeply, moral universals civilize people. They are what let people grow to become sane, humane, intelligent human beings. A person that is desperate for a meal will resort to whatever they must to feed their kids. A person constantly fed a stream of nonsense by Fox News will end up believing the earth is flat. Moral universals let people act morally, and acting morally is what the process of civilization is.

Democracy therefore depends on moral universals. It is probably fairly hard, in the scope of human history, to establish a democracy. But it is harder still to keep it going. A democracy requires, before it demands votes, sane, humane, civilized people to vote. A society that cannot create sane, humane, civilized people can therefore no more reasonably stay a democracy than a global economy can be powered by fossil fuels forever. At some point, without moral universals to create citizens worthy of the word, democracy runs out of gas.

So: what really went wrong in America? Moral universals civilize people, but there aren’t any moral universals. The public goods universals result in educate, inform, train, school people, let them live long and peaceful lives. But Americans — whether it is today’s extremists or yesterday’s slave-auctioneers and owners — believe that moral universals are just a “cost”, a “tax”, and so forth. They have never seen — and still don’t see — the benefits: the civilizing process that democracy depends vitally on.

Thus, in America today, there are no broad, genuine, or accessible civilizing mechanisms left. As a simple example, America’s best universities churn out…hedge-fund traders. It’s economy is largely composed of…paper gains to the .01%. It’s media debates…climate change. And so on. The natural consequence of failing to civilize is breaking down as a democracy — democracy no longer exists in the sense of “people cooperating by voting to give each other greater prosperity”. They have merely learned to take prosperity away from one another. Whether by denying one another doctors, schools, trains, and so on. That is what a lack of civilization really results in, or to put more prosaically, there is no sanity or humanity, much less reason, wisdom, or virtue in such decisions — only nihilism, fatalism, and despair.

And that is what the end of the American experiment proves. Without moral universals, there is no process of civilization, and democracy itself can no longer continue to grow and develop. The painful irony is that American intellectuals are concerned about Western civilization. LOL. The West, such as it is, will be just fine: it is America where civilization, as a verb, a process, a way of moral being in the world, has broken down.

Even prisons have moral universals. There is only one other place in the world I can think of with none. A jungle.

Umair
July 2017

View story at Medium.com

Earth’s Sixth Mass Extinction Event Already Under Way, Scientists Warn

ENVIRONMENT
Researchers talk of “biological annihilation” as study reveals billions of populations of animals have been lost in recent decades.

Photo Credit: Maggy Meyer/Shutterstock

A “biological annihilation” of wildlife in recent decades means a sixth mass extinction in Earth’s history is under way and is more severe than previously feared, according to research.

Scientists analyzed both common and rare species and found billions of regional or local populations have been lost. They blame human overpopulation and overconsumption for the crisis and warn that it threatens the survival of human civilization, with just a short window of time in which to act.

The study, published in the peer-reviewed journal Proceedings of the National Academy of Sciences, eschews the normally sober tone of scientific papers and calls the massive loss of wildlife a “biological annihilation” that represents a “frightening assault on the foundations of human civilization”.

Prof Gerardo Ceballos, at the Universidad Nacional Autónoma de México, who led the work, said: “The situation has become so bad it would not be ethical not to use strong language.”

Previous studies have shown species are becoming extinct at a significantly faster rate than for millions of years before, but even so extinctions remain relatively rare giving the impression of a gradual loss of biodiversity. The new work instead takes a broader view, assessing many common species which are losing populations all over the world as their ranges shrink, but remain present elsewhere.

The scientists found that a third of the thousands of species losing populations are not currently considered endangered and that up to 50 percent of all individual animals have been lost in recent decades. Detailed data is available for land mammals, and almost half of these have lost 80 percent of their range in the last century. The scientists found billions of populations of mammals, birds, reptiles and amphibians have been lost all over the planet, leading them to say a sixth mass extinction has already progressed further than was thought.

Nearly half of the 177 mammal species surveyed lost more than 80% of their distribution between 1900 and 2015

Percent of species which have lost more than 80 percent of their range

Billions of animals have been lost as their habitats have become smaller with each passing year. (Guardian graphic | source: PNAS)

The scientists conclude: “The resulting biological annihilation obviously will have serious ecological, economic and social consequences. Humanity will eventually pay a very high price for the decimation of the only assemblage of life that we know of in the universe.”

They say, while action to halt the decline remains possible, the prospects do not look good: “All signs point to ever more powerful assaults on biodiversity in the next two decades, painting a dismal picture of the future of life, including human life.”

Wildlife is dying out due to habitat destruction, overhunting, toxic pollution, invasion by alien species and climate change. But the ultimate cause of all of these factors is “human overpopulation and continued population growth, and overconsumption, especially by the rich”, say the scientists, who include Prof Paul Ehrlich, at Stanford University in the U.S., whose 1968 book The Population Bomb is a seminal, if controversial, work.

“The serious warning in our paper needs to be heeded because civilization depends utterly on the plants, animals, and microorganisms of Earth that supply it with essential ecosystem services ranging from crop pollination and protection to supplying food from the sea and maintaining a livable climate,” Ehrlich told the Guardian. Other ecosystem services include clean air and water.

“The time to act is very short,” he said. “It will, sadly, take a long time to humanely begin the population shrinkage required if civilization is to long survive, but much could be done on the consumption front and with ‘band aids’—wildlife reserves, diversity protection laws—in the meantime.” Ceballos said an international institution was needed to fund global wildlife conservation.

The research analyzed data on 27,500 species of land vertebrates from the IUCN and found the ranges of a third have shrunk in recent decades. Many of these are common species and Ceballos gave an example from close to home: “We used to have swallows nesting every year in my home near Mexico city—but for the last 10 years there are none.”

The researchers also point to the “emblematic” case of the lion: “The lion was historically distributed over most of Africa, southern Europe, and the Middle East, all the way to northwestern India. [Now] the vast majority of lion populations are gone.”

Current and historic distribution of lions

Historically lions lived across Africa, southern Europe, the Middle East, all the way up to Northwestern India. Today their habitat has been reduced to a few tiny pockets of the original area. (Guardian graphic | source: PNAS)

Prof. Stuart Pimm, at Duke University in the US and not involved in the new work, said the overall conclusion is correct, but he disagrees that a sixth mass extinction is already under way: “It is something that hasn’t happened yet—we are on the edge of it.”

Pimm also said there were important caveats that result from the broad-brush approach used. “Should we be concerned about the loss of species across large areas—absolutely—but this is a fairly crude way of showing that,” he said. “There are parts of the world where there are massive losses, but equally there are parts of the world where there is remarkable progress. It is pretty harsh on countries like South Africa which is doing a good job of protecting lions.”

Robin Freeman, at the Zoological Society of London, U.K., said: “While looking at things on aggregate is interesting, the real interesting nitty gritty comes in the details. What are the drivers that cause the declines in particular areas?”

Freeman was part of the team that produced a 2014 analysis of 3000 species that indicated that 50 percent of individual animals have been lost since 1970, which tallies with the new work but was based on different IUCN data. He agreed strong language is needed: “We need people to be aware of the catastrophic declines we are seeing. I do think there is a place for that within the [new] paper, although it’s a fine line to draw.”

Citing human overpopulation as the root cause of environmental problems has long been controversial, and Ehrlich’s 1968 statement that hundreds of millions of people would die of starvation in the 1970s did not come to pass, partly due to new high-yielding crops that Ehrlich himself had noted as possible.

Ehrlich has acknowledged “flaws” in The Population Bomb but said it had been successful in its central aim—alerting people to global environmental issues and the the role of human population in them. His message remains blunt today: “Show me a scientist who claims there is no population problem and I’ll show you an idiot.”

Earth’s five previous mass extinctions

End-Ordovician, 443 million years ago

A severe ice age led to sea level falling by 100m, wiping out 60-70 percent of all species which were prominently ocean dwellers at the time. Then soon after the ice melted leaving the oceans starved of oxygen.

Late Devonian, c 360 million years ago

A messy prolonged climate change event, again hitting life in shallow seas very hard, killing 70 percent of species including almost all corals.

Permian-Triassic, c 250 million years ago

The big one—more than 95 percent of species perished, including trilobites and giant insects—strongly linked to massive volcanic eruptions in Siberia that caused a savage episode of global warming.

Triassic-Jurassic, c 200 million years ago

Three-quarters of species were lost, again most likely due to another huge outburst of volcanism. It left the Earth clear for dinosaurs to flourish.

Cretaceous-Tertiary, 65 million years ago

An giant asteroid impact on Mexico, just after large volcanic eruptions in what is now India, saw the end of the dinosaurs and ammonites. Mammals, and eventually humans, took advantage.

Study shows US has poorest health, widest health care gap between rich and poor

As Senate health plan calls for gutting Medicaid

By Kate Randall
15 July 2017

A new study reveals findings that will come as no surprise to most American workers and youth: In the United States, your level of income defines your access to health care, the quality of care you receive, and whether you will meet with an early death because of it. The US also has the poorest health overall among high-income countries.

Using survey data to measure and compare patient and physician experiences across 11 countries, the Commonwealth Fund’s “Mirror, Mirror 2017: International Comparisons Reflect Flaws and Opportunities for Better US Health Care” finds that the US ranks last overall on providing equally accessible and high-quality health care, regardless of income.

The report compares health care system performance in the US with that of 10 other high-income countries, ranking them in five areas: care process, access, administrative efficiency, equity and health care outcomes. The US ranks last overall, and last in all but one area studied, care process, in which it came in fifth.

If the United States were a politically healthy society, the release of this report would sound alarm bells in the White House and on Capitol Hill. Why, in “the greatest country on earth,” is the health of its citizens in such a deplorable state? What can be done to remedy what can only be described as a health care emergency of crisis proportions?

Instead, the study’s release follows the unveiling Thursday of the Senate Republicans’ latest version of their Better Care Reconciliation Act (BCRA), which proposes to slash $772 billion from the Medicaid program for the poor, and the Affordable Care Act’s expansion of Medicaid. The Congressional Budget Office estimated that an earlier version of the bill would leave 22 million more uninsured by 2026 than under current law.

The Commonwealth study points to factors contributing to this appalling US health report card, which will only be worsened under whatever health care “reform” is hatched in Washington. Life expectancy, after improving in recent years, has been aggravated by the opioid crisis. As the baby boom population ages, more people in the US are living with age-related disease, placing increased pressure on the health care system.

These are problems that could be confronted with timely and accessible health care, but these services are woefully inadequate. In particular, poor access to primary care has contributed to inadequate prevention and management of diseases. And in the US, far more than any other country studied, lower-income people are far more likely to lack access to affordable care, and to suffer and die because of it.

Forty-four percent of lower income people reported financial barriers to care, compared to 26 percent of those with higher incomes. By comparison, in the UK only 7 percent of people with lower incomes and 4 percent with higher incomes reported that costs prevented them from getting care.

According to the study, in the US population as whole in the past year:

• 33 percent had cost-related access problems to medical care.

• 32 percent skipped dental care or check-ups due to cost.

• 27 percent were denied insurance payment for care or did not receive as much as expected.

• 20 percent had serious problems paying or were unable to pay medical bills.

• 60 percent of doctors reported patients often had difficulty paying for medications or out-of-pocket costs.

• 54 percent of doctors reported time spent on insurance claims is a major problem.

• 54 percent of doctors reported a major problem getting patients needed medications or treatment because of insurance coverage restrictions.

These problems are worse in the low-income segment of the US population. For example, 44 percent of this group had a cost-related access problem to medical care, and 45 percent skipped dental care or a check-up due to cost. There is also a 24 percent gap between those in the above average and below average income groups who skipped dental care due to cost.

The study uses “average” income, which was about $75,000 in 2016, as the dividing line between upper and lower income. However, multimillionaires and billionaires skew this average upwards, and due to the growing income inequality in the US, the health care problems of those living in poverty in the “below average” group are most likely underrepresented.

Some of the most shocking statistics presented are on population mortality, in which the US ranked last in every category studied compared to the other 10 countries.

• Infant mortality: 6 deaths per 1,000 live births, compared to Sweden, with 2.2 (the lowest)

• Life expectancy at age 60: 23.5 years in the US, compared to 25.7 in France (the highest)

The study also examined “mortality amenable to health care,” or deaths considered preventable by timely and effective medical care. The US had 112 deaths per 100,000 people that could have been prevented with timely and effective care. This is more than twice the rate in Switzerland, at 55 per 100,000.

The US also had a much lower decline in these preventable deaths over 10 years, falling by only 16 percent compared to 34 percent in the Netherlands.

The US spent $9,364 per person on health care in 2016, compared to $4,094 in the UK, which ranked first overall in health care. In other words, while spending far more per person, the US population has poorer health than the other 10 countries studied.

Such figures evoke howls from both big business parties for spending to be slashed. Typical were the recent comments of Trump’s Health and Human Services Secretary Tom Price who said, while claiming to be committed to fighting the opioid epidemic that killed 60,000 people in the US last year, “We don’t need to be throwing money” at the crisis.

What goes unmentioned in such statements is the root cause of the health care crisis in America: a health care system based on capitalist profit. The for-profit insurance companies, pharmaceuticals and giant health care chains are not in business to promote the health of the American people, but to boost their bottom lines.

Whatever health care legislation is passed in Congress—either by the Republicans, or in a bipartisan “compromise” with the Democrats—will be based on this capitalist model. The Republicans’ House and Senate health bills are, in fact, based on Obamacare, incorporating the structures set up under the Democratic legislation.

The central purpose of Obamacare was to shift costs from the government and corporations to the working class, with health care increasingly rationed on a class basis. The Commonwealth Fund’s findings on the state of US health care, particularly those on mortality, are an indication of the preliminary results of this bipartisan strategy.

Behind the BCRA’s proposals to gut Medicaid, and to give the private insurers even more latitude to boost profits through offering shabby, high-cost coverage, lies a calculated effort to reduce life expectancy for working people, and to send many of the old, sick or disabled to an early grave.

http://www.wsws.org/en/articles/2017/07/15/care-j01.html

How Did Democrats Become the Party of Elites?

In order to win back statehouses and Congress, Democrats must rewrite the political narrative that now has them on the side of the establishment and Republicans on the side of sticking it to the man.

“For four decades now, Republicans have succeeded in framing Democrats as the party that uses government to bigfoot rather than aid the American people,” writes Leonard Steinhorn. (Photo by Georgia Democrats/ flickr CC 2.0)

How did it come to pass that of the two political parties, the Democrats — who have long fought for the underdog, civil rights, consumer protections, universal health care, the minimum wage and for unions against powerful interests that try to crush them — have now been branded in large swaths of the country as the party of the establishment and the elites?

And how did it come to pass that Republicans — whose policies, regardless of stated intent, benefit polluters, entrenched interests and the upper brackets of American wealth — are now seen by many as the anti-establishment populist party which delights in flipping off elites on behalf of the Everyman?

For the moment, keep Donald Trump out of this conversation — after all, Democrats have been hemorrhaging seats in statehouses and Congress for decades. Also set aside any talking points about which party’s policies truly benefit forgotten Americans or which short-term trends show up in the polls.

More important for Democrats is whether they can rewrite the political narrative that now has them on the side of the establishment and Republicans on the side of sticking it to the man.

If Democrats want to regain their electoral stride and recapture defiant voters who once saw the party as their advocate and voice — the same voters they need to establish a sustained governing majority throughout the land — they must think less about policies per se than about how those policies translate to messaging and brand.

Just as consumers purchase products not merely for what they do but for what they say about the people who buy them, voters are drawn to narratives, brands and identities as much as the policies that affect their lives. These narratives give voters meaning, define who they are, and become an essential part of their identity and self-image.

What’s most toxic in American politics today — as it has been throughout our history — is to become the party associated with domineering overlords and supercilious elites who seem to enjoy wielding power over the rest of us.

To some extent, the Democrats have only themselves to blame for their elite, establishment image.

Few question the party’s need to build its campaign coffers in what is now an arms race for political dollars. But by cozying up to Wall Street and the privileged — and appearing more at ease hobnobbing among them than among those who work in factories, small businesses and call centers — Democrats have sent a subtle message about the people they prefer to associate with and seek out for advice. To many Americans, it reeks of hypocrisy at best.

Republicans, who unapologetically celebrate wealth as a symbol of American dynamism, face no such messaging dissonance.

But perhaps more important is the jujitsu maneuver that Republicans have used to turn one of the Democratic Party’s strengths — its good faith use of government to level the playing field and help the little people — into a weakness.

From the New Deal through the ’60s, the Democrats were able to show that government was an essential tool to correct market inequities, protect the little people from unchecked power and special interests and ensure that the American birthright included safeguards against crippling poverty and misfortune.

Government, most Americans believed, was their defender and their voice. In 1964, according the the American National Election Studies, more than three-fourths of Americans said they trusted government most of the time or just about always. It was the Democrats that stood for grass-roots change and the Republicans who represented the powerful and resistant establishment.

Democrats then expanded their vision of a righteous government by exercising its power to fight segregation, discrimination, environmental blight, corporate malfeasance and consumer hazards — and to advance health care as a right and not a privilege. All of that seemed to follow the New Deal script of government as a force for good.

But with Richard Nixon channeling George Wallace’s racialized anger at the federal government and Ronald Reagan saying that the only way to christen our shining city on a hill is to free up aggrieved entrepreneurs and ordinary citizens stifled by burdensome red tape and regulations, the Democratic association with government began to turn noxious.

As Reagan put it in his 1981 inaugural address, we should not allow “government by an elite group” to “ride on our back.”

For four decades now, Republicans have succeeded in framing Democrats as the party that uses government to bigfoot rather than aid the American people. Democrats may celebrate public servants for keeping our food safe and our lakes healthy, but Republicans have successfully portrayed them as a humorless bureaucrats who salivate at the urge to exert power and control over taxpaying Americans.

And Republicans have very artfully created a counternarrative, turning the market into a synonym for liberty and defining it as an authentic expression of American grass-roots energy in which small businesses and entrepreneurs simply need freedom from government to shower benefits on us all.

Of course the market’s magic may be more mythical than real — given that powerful corporations and interests dominate and exploit it often at the expense of workers — but that inconvenient fact is immaterial to the brilliant messaging advantages Republicans have derived from it.

Indeed, in the Republican playbook it’s the teachers, unions, environmental groups, professors and civil rights organizations that constitute the establishment whereas Koch and other industry-funded astroturf groups are the real gladiators fighting the status quo.

But it’s not just the Democratic association with government that Republicans have used to brand it as the party of the establishment and elites. Republicans have also turned the table on the liberal values that Democrats embrace.

Beginning in the 1960s, liberals have sought to flush prejudice, bigotry and discriminatory attitudes from society by turning diversity into a moral value and creating a public culture intolerant of misogyny and intolerance. On the surface, that should be a sign of national progress.

But conservatives — with help from an unwitting or overly zealous slice of the left that too often overreaches — took these healthy normative changes and cleverly depicted them as an attempt by condescending and high-handed elites to police our language and impose a politically correct finger-pointing culture.

In effect, conservatives have rather successfully portrayed liberals and Democrats as willing to use cultural and political power against ordinary Americans. They want to take my guns, regulate my business, dictate who I can hire, and tell me what I can buy, which doctors I see, how I live, when I pray and even what I say — so goes the conservative narrative.

That their definition of “ordinary Americans” is quite narrow — meaning whites and particularly men — is beside the point because it’s the political branding that matters, not the fact that liberal economic policies and efforts against bigotry and discrimination have helped millions of ordinary Americans.

Our nation was founded on resistance to power, and it’s part of our political and cultural DNA to resent anyone who exercises or lords that power over others.

Taken together, Republicans have successfully defined Democrats as a party of bureaucrats, power brokers, media elites, special interests and snobs who have created a client state for those they favor, aim to control what everyone else does and look down their noses at the people who pay the taxes to fund the same government that Democrats use to control their lives.

And why is this so damning for Democrats? Because our nation was founded on resistance to power, and it’s part of our political and cultural DNA to resent anyone who exercises or lords that power over others.

Read past the first paragraphs of our Declaration of Independence and it’s all about King George III and his abuses of power. Our Constitution encodes checks and balances and a separation of powers. Our economic system rests on antitrust law, which is designed to keep monopolies from crushing smaller competitors and accumulating too much power.

So if large numbers of Americans see Democrats as the party of entrenched elites who exert power over the little people, then Democrats have lost the messaging battle that ultimately determines who prevails and who doesn’t in our elections.

And let’s be clear: Donald Trump didn’t originate this message in his 2016 campaign; he simply exploited, amplified and exemplified it better than almost any Republican since Ronald Reagan.

The Bernie Sanders answer, of course, is to train the party’s fire at banks, corporations and moneyed interests. After all, they are the ones exerting unchecked power, soaking up the nation’s wealth and distributing it to the investor class and not the rest of us.

And to some extent that has potential and appeal.

But remember, most Americans depend on corporations for their jobs, livelihoods, health care, mortgages and economic security. So it’s much more difficult today to frame big business as the elite and powerful establishment than it was when when workers manned the union ramparts against monopoly power. Working Americans today have a far more ambivalent relationship with corporate America than they did in the New Deal days.

Somehow Democrats have to come up with their own jujitsu maneuver to once again show that theirs is the party that fights entrenched power on behalf of the little people. Liberals have to figure out how to merge their diversity voice with the larger imperative of representing all of America’s underdogs. These are not mutually exclusive messages.

Democrats can preach all they want on health care and Trump and the environment. But if they don’t correct the larger narrative about who holds power in America — and who’s fighting to equalize that power on behalf of us all — then whatever small and intermittent victories they earn may still leave them short in the larger battle for the hearts and souls of American voters.

Leonard Steinhorn is a professor of communication and affiliate professor of history at American University, a CBS News political analyst, author of The Greater Generation: In Defense of the Baby Boom Legacy (2007) and co-author of By the Color of Our Skin: The Illusion of Integration and the Reality of Race (2000).

http://billmoyers.com/story/how-did-democrats-become-the-party-of-elites/

Health Care in America: Where is the Socialist Solution?

Photo by Molly Adams | CC BY 2.0

The introduction of the Republican legislation to “repeal and replace” Obamacare is no more than latest scrimmage in the ongoing one-sided war against the poor and working class. The “Affordable Care Act” (ACA, better known as Obamacare) proved to be both unaffordable and unable to provide comprehensive care for millions. Nevertheless, with the ACA being one of the only tangible “victories” Democrats could claim for an administration with a dismal record of noteworthy accomplishments, neoliberal Democrats and the party’s liberal base led by Bernie Sanders are now coalesced around the ACA and have vowed to defend it to the bitter end.

Yet, camouflaged by the hot rhetoric of confrontation and the diversionary struggle of the duopoly, the common agenda and objective interests being protected in this healthcare battle are quite clear. No matter what version of the healthcare bill passes or if the ACA remains in place, it will be a win for the market-based, for-profit beneficiaries of the U.S. system. As long as healthcare remains privatized, the real winners of healthcare reform will continue to be the insurance companies, hospital corporations and pharmaceutical and medical device companies.

That commitment to the interests of the insurance/medical complex ensures that the interests of healthcare consumers, the uninsured, the elderly and the sick will continue to be sacrificed to maintain a healthcare delivery system in which thousands suffer premature deaths from inadequate preventative treatment, millions are unable to afford coverage and millions who have private insurance fear using it because of prohibitive co-pays and deductibles.

That is why during the current debate the insurance companies have been largely silent. There is no need to engage in public debate because having largely written the ACA they are again deeply involved in the construction of the current legislation. Their interests will be protected even if it means forcing Republicans to embrace policies that are at odds with their professed philosophies – like including government subsidies for low-income people to purchase insurance. In fact, the only comments from insurance companies in this debate were related to their supposed concern that the Senate bill might not provide enough assistance to those who need help to pay for healthcare. They want what is being called a “stabilization fund” to reduce the numbers of people who might opt out of coverage because they can’t afford it.

The Senate bill provides those funds, but they are temporary and are scheduled to end after 2019. Which means that people will be forced to make an unpalatable decision after that – purchasing insurance with higher out-of-pocket costs like $10,000 deductibles or electing to go without insurance altogether. If history is a guide, many will opt out. In fact, the Congressional Budget Office predicts that the current bill will push 22 million people back into the ranks of the uninsured with the potential loss of millions of customers and potential profits for healthcare corporations.

But the companies have a plan should those funds prove inadequate to hold substantial numbers in the system: Increase individual premiums by at least 20 percent more than the double-digit increases already under consideration.

Coming to the aid of the Insurance/Medical complex: Ted Cruz and the Consumer Freedom Amendment

Insurers need large numbers of healthy people on the rolls, as their premiums help defray the cost of care for those who are sick. Because insurance companies are for-profit operations they set rates based on the risk pool in a market. With the potential loss of customers if the government does not provide adequate long-term subsidies, middle-class consumers who earn too much to qualify for temporary premium assistance will bear the brunt of any premium increases.

The Cruz amendment to the legislation has a solution to the possible increase in premiums and healthcare costs in general. The so-called “Consumer Freedom Amendment” represents the typical extreme individualism and anti-social sentiments of the right wing. It essentially advocates for reducing the burden on healthy consumers paying into system to help cover higher-risk fellow citizens.

The Washington Post’s analysis of the Cruz amendment suggests:

“Under Senator Cruz’s plan, insurers could sell cheaper, stripped-down plans free of Obamacare coverage requirements like essential health benefits or even a guarantee of coverage. These sparser plans would appeal to the healthiest Americans, who would gladly exchange fewer benefits for lower monthly premiums.

But insurers would also have to sell one ACA-compliant plan. The sickest patients would flock to these more expansive and expensive plans because they need more care and medications covered on a day-to-day basis. As a result, premiums for people with expensive and serious medical conditions like diabetes or cancer would skyrocket because all those with such serious conditions would be pooled together.”

And how would the elderly and people with pre-existing conditions pay for the increased premiums that they would face under the current Senate bill and Cruz’s amendment? “The $100 billion stabilization fund for states could help cover costs for the resulting pricier coverage for those with preexisting conditions under this amendment.”

In an ironic twist that both exposes the class interests of this initiative and its hypocritical approach to the question of the role of the government, Cruz’s amendment affirms that role in the form of subsidies for the sickest citizens and calls for an expansion of government resources to cover them.

The Cruz plan would segment the insurance market into healthier and higher-risk segments. High risk individuals along with the already-sick and the elderly would be pushed out of the market because those premiums would soar even with state subsidies, since insurance companies would still set premium rates to maximize profits.

Given the lose-lose options for consumers now being debated in Congress, the only rational objective for the majority of the people in the U.S. is to move toward the complete elimination of the for-profit healthcare system.

Socialization of Healthcare: The Only Solution

The ideological and political opposition to state-provided healthcare is reflected in the ACA and the various repeal-and-replace scenarios. Through mandates, coercion and the transfer of public funds to the insurance industry, the ACA delivered millions of customers to the private sector in what was probably the biggest insurance shams in the history of private capital. And that gift to the insurance companies is only one part of the story. The public monies transferred to the private sector amounted to subsidies for healthcare providers, hospital chains, group physician practices, drug companies and medical device companies and labs as well.

The Republican alternatives to the ACA variably supplement the corporate handouts with more taxpayer-funded giveaways. And once the private sector gains access to billions of dollars provided by the state, they and their elected water-carriers fiercely resist any efforts to roll those subsidies back.

The subsidies coupled with the mergers and acquisitions of hospital corporations and insurance providers over last few years and a general trend toward consolidation of healthcare services in fewer and fewer hands underscored the iron logic of centralization and concentration of capital represented by the ACA and was a welcome development for the biggest players in the healthcare sector. The movement toward a monopolization of the American health-care market means that rather than the reduction in healthcare costs that is supposed to be the result of repeal and replace, the public can instead expect those costs to escalate.

Many on the left have called for a single-payer system similar to those that work well (if not perfectly) in Britain, the Netherlands, Finland and elsewhere in Europe. But even with an “improved Medicare for all” single-payer system, costs will continue to increase in the U.S. because they cannot be completely controlled when all of the linkages in the healthcare system are still firmly in the hands of private capital.

The only way to control the cost of healthcare and provide universal coverage is to eliminate for-profit, market-based healthcare. Take insurance companies completely out of the mix and bring medical device companies, the pharmaceuticals companies and hospitals chains under public control.

The ideological implications of the Cruz amendment are that it reflects a growing public perception both domestically and internationally that healthcare should be viewed as a human right.

Putting people at the center instead of profit results in healthcare systems that can realize healthcare as a human right. This is the lesson of Cuba where the United Nations World Health Organizationdeclared that Cuba’s health care system was an example for all countries of the world.

That is the socialist option, the only option that makes sense and the one that eventually will prevail when the people are ready to fight for it.

Ajamu Baraka is the national organizer of the Black Alliance for Peace and was the 2016 candidate for vice president on the Green Party ticket. He is an editor and contributing columnist for the Black Agenda Report and contributing columnist for Counterpunch magazine.