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Relative Healthcare Costs as a % of GDP

I am sure you have all read/heard or speculated about the many different scenarios that could unfold should the Supreme Court nullify all or part of the Patient Protection and Affordable Care Act, passed as the signature legislative achievement during the first term of President Barack Obama. Whether Obama has a second term might well depend on the outcome of the Supreme Court decision and, if negative, his reaction to it.  Many have argued that if the “individual mandate” of the law is declared unconstitutional, many other valuable features of the bill will still remain intact. The “individual mandate,” which forces individuals to purchase insurance if they don’t have it through their place of employment, will be part of a $477 billion government subsidy to the insurance companies and without that critical source of funds, the entire healthcare plan could easily unravel. While this healthcare bill is projected to provide health insurance for 30 million Americans who lack this fundamental component of a civilized society, it will still leave about 20 million Americans without health insurance; it is thus an incomplete solution to our problem. Yet, isn’t it odd how things have been twisted, as the Democrats are now hoping that the Supreme Court will not rule against a bill that just a few years ago was a Republican plan for national healthcare, not a Democratic solution.

I can personally see the rationale for declaring the bill unconstitutional because the individual mandate forces people to buy insurance from a private company, thereby subsidizing their profits and insuring corporate survival by a mechanism different from the “free market.” We have a 5/4 “free market” Supreme Court, but in this case it’s hard to know how the court will react because government support of corporations is a big, non-verbal part of our “free market economy” (consider for example the government-subsidized military industrial complex or our government subsidies to oil companies that make obscene profits). In contrast to the new healthcare legislation, our other social programs, such as Medicare and Social Security, are government-run organizations, paid for through payroll deductions, not through subsidizing private companies. The Patient Protection and Affordable Care Act was conceived by the Heritage Foundation and its 2000 pages were written by corporate lobbyists representing them–it was designed to meet the needs of the for-profit health insurance industry. When the law was first passed, the stock value of the for-profit healthcare organizations went up–it was perceived as a victory for them by their investors.

There is another downside and inefficiency to the new healthcare law: it doesn’t separate us from our employment. The new law will still connect our healthcare to our jobs and if you lose your job, you lose your healthcare and have to replace it with something else, hopefully something less expensive than the nightmare, very costly alternatives we have now: we still don’t know how well that component will work, as it is not yet part of the system in motion. As we expand government subsidies to the private healthcare industry, we will make them more profitable and more effective in lobbying Congress to chip away at the healthcare laws and rules to make these healthcare giants ever more profitable. We have a history that includes the inability to resist that kind lobbying, particularly in the current iteration of our government: indeed that’s how our system works.  Money means influence and more money means more influence.  Just as we don’t want financial institutions that are too big to fail (even though we have them), we don’t want private healthcare providers to become so rich that they have ample profits to spend money on lobbying against our own healthcare laws. Remember, these companies describe themselves as healthcare organizations and no matter what their ads say, they are determined to get more profit and to do so by minimizing the care they deliver–it’s in their DNA.  Buried in those 2000 pages of the new healthcare bill are exceptions and exemptions that companies can use to deny care in the interests of profits. It is simply not possible to have a national healthcare system where one of the main components is trying to maximize its profits and compete against the interests of a population trying to get decent healthcare.  It’s not that these companies should be regulated more effectively–they should be eliminated as obstructionists to a decent healthcare system. The mere existence of these for-profit health insurance companies will pose a constant threat to our healthcare system, no matter where the Supreme Court decision on this bill should fall.

Chris Hedges, writing in Truthout, visited the demonstrations held outside the Supreme Court building when the debate was going on. There were those supporting what has become known as Obamacare while the right-wing was entrenched against it and refers to it as socialism (despite its Heritage Foundation origins).  But there were also a small number of thoughtful people, with whom Chris identified, including Dr. Margaret Flowers, who is a well known healthcare activist,  lobbying for the destruction of Obama’s individual mandate and replacing the entire Obamacare with a single payer system that would gut the for-profit healthcare industry and replace it with “Medicare for all.” They have a single payer website which you can visit, join and help advance the cause for a more rational healthcare system. Margaret Flowers’ point is this (quoted from the Hedges article): “If you are trying to meet the goal of universal health coverage and the only way to meet that goal is to force people to purchase private insurance, then you might consider that it is constitutional,” Flowers said. “Our argument is that the individual mandate does not meet the goal of universality. When you attempt to use the individual mandate and expansion of Medicaid for coverage, only about half of the uninsured gain coverage. This is what we have seen in Massachusetts.” Thus the healthcare system in Massachusetts, which has implemented basically the same healthcare system we plan to put in place under the new law, by experiential history , does not lead to universal coverage, something that should be the goal of any national healthcare system. Many people who support this bill believe it’s a start, that an early beginning can lead to later expansion of the system to cover all Americans. I don’t believe that will happen–I think it’s more likely that we will have a two tier system that won’t change for many years, simply because we are too divided as a country to agree on something as profound as universal healthcare–that has to happen through a surging political mandate. The cost factor of our present system is also problematic and seemingly doesn’t get fixed with the new healthcare law and we already top the charts compared to other countries (see chart): currently, our healthcare system costs twice as much as that of most other countries (as a percentage of our GDP) and one reason is the administrative costs incurred by the for-profit system as well as the many unnecessary medical procedures created from the profit motive. If you paid doctors a salary, like the Mayo Clinic and Cleveland Clinic do, you could reduce the motivation behind unnecessary medical procedures. When you consider that we already have the most expensive medical care system in the world, but still leave 20 million uninsured, you have the ingredients of a very sick system, even if the new law gets full backing from the Supreme Court.

But, suppose the Supreme Court rules against the healthcare system? Then imagine that Obama, faced with the reality of a Supreme Court, whose ideological composition may be in place for many years and motivated by public outrage at the Court’s decision, decides to campaign for a single payer system embodied in “Medicare for All.” Although polls show that the majority of Americans are opposed to the Patient Protection and Affordable Care Act, many of them are opposed to it because it doesn’t go far enough in support of a single payer option. Many of us were very unhappy when Obama didn’t give the single payer option more of an opportunity to resonate with the American people before it got pushed aside as an option that couldn’t be passed. Obama’s failure to give the public option more support served as one of the first disappointments in what turned out to be a long string of triangulating and seemingly cowardly attempts to placate the right at a time when everyone but the White House knew that they would not compromise. Not a single Republican voted for the Patient Protection and Affordable Care Act.  Obama has faced this problem for his entire Presidency.  But, the polls show that when the polling questions are formulated properly, the majority of Americans favor a single payer system. The bill that was proposed in favor of such a system was written on a single page, containing a few sentences describing who would be included in Medicare–all those between birth and death. What could be simpler; Medicare already works and has been serving people for more than fifty years. There is enough money to support this system, but part of it must be removed from the expensive, absurd costs of supporting for-profit healthcare and the excessive costs of drugs for seniors passed by a Republican congress and signed into law by GW Bush.  And we should not forget, that by making the for-profit healthcare companies even wealthier, we will be setting the stage for the lobbyist erosion of the best parts of the Affordable Care Act, because those parts will mean less profit to the healthcare corporations and serve as the first targets of their lobbying efforts. These efforts are already underway–these companies will forever be sending lobbyists to Washington to chip away at our healthcare system in order to enhance their profitability. When Bush announced his perception of candidates for the “axis of evil,” he forgot to include medicine for profit in the mix. I for one would be energized if the Supreme Court declared “Obamacare” unconstitutional.What about you?

RFM

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Afghanistan riots over Koran Burning

Just when the war in Afghanistan threatened to become America’s silent war, one destined for the back pages or in the business section of our newspapers, violence erupted spilling the war out onto the front pages again, stimulated by new events; the news of Americans burning the Koran spread like a virulent contagion throughout the country and, at least for now, seems to pose a threat to American safety as well as the future of our war effort. It should bother everyone to see how our relationship with the Afghans can turn on a dime because there is no underlying set of mutual goals–only mutual distrust. Suddenly the horrific accounts of bombings, daring raids, roadside explosions and  effective, deadly attacks by the Taliban, have given way to massive civil demonstrations and violence from Afghans, the very people we thought were on our side. The violent eruptions over the Koran burning demonstrates that our problems in Afghanistan are not just with the Taliban. In reality, they never were just about the Taliban or, for that matter, neither were they at one time just about Al Qaeda.  Raw nerves exist throughout the country and increasingly, we hear about killings of American and NATO soldiers by Afghan soldiers and employees working inside the government. Just yesterday we learned that two American officers were killed in Kabul inside the Interior Ministry building, protected by heavy security. Many feel that it is no longer safe for Americans to be working alongside Afghans because of this danger. The recent officer killings were apparently committed by a worker employed within the Ministry (though he was not captured at the time of this writing) and reflects the growing tension between those we are attempting to bring into the government and military in hopes of entrusting them to sustain a functional civil society, even though it’s an American version of what we think they should have, as we pointedly emphasize why Afghans should raise the rent on properties owned by Al Qaeda and the Taliban. But, no matter how hard we try, how much money we put into the country, we cannot achieve a sufficient level of security such that the country can put itself back together again. In that sense it’s an eery duplication of what we achieved in Iraq. Just call Afghanistan Iraq II. The major difference between the two is the difference between oil in the ground and a pipeline above ground.

The tension between American/NATO forces and Afghans has sharply escalated as a result of the Koran burnings, and the recent image of American soldiers urinating on the dead body of a resistance fighter has added to the outrage demonstrated in the streets.  To Muslims, these acts fit the image they have of Americans and their presence in Afghanistan. Most Americans do not understand how much we are hated in that part of the world and when Bush/Cheney/Rumsfeld formulated the word “islamofacism” to describe radicals in the region, it was very clear to Afghans that they were referring to all Muslims, not just a few radicals. We ignore the polls that tell us that we are viewed more as a threat to Afghan society, rather than an ally. Even President Karzi, the leader we installed,  can’t make up his mind about us and we are desperately seeking a solution to this war that involves a negotiated settlement with the Taliban.

In Eric Margolis’ book “American Raj: Liberation or Domination?: Resolving the Conflict Between the West and the Muslim World,” published in 2008,  he attempts to provide the American public with a view of what people in the Middle East think of Americans and why we find conflicts in that region so difficult to resolve. We don’t have a problem starting a war in this region, usually associated with quick military victories and what seems like a triumphant victory. But then the problems begin. Margolis’ message is especially relevant as he has traveled all over the region, reporting and following in the footsteps of his mother who also was a journalist in the Middle East. Afghans understand that they will be there long after we leave and they also clearly understand that our motives are never pure, but always involve a financial benefit that serves our own interests. Our intrusion into Afghanistan and the problems that we are having in that region reflect the poorest public relations effort ever perpetrated from one country onto another. Before Muslims understood what we were really like, at the close of WWII, we were viewed as honest, hard-working Americans who lived up to the demands of their noble constitution. At one time, Muslims viewed us as a model for their own future. It did not take long however for them to understand that what we offered was merely a different form of hegemonic control. Afghans believe for example that the American motivation for invading their country was so that we could be dealing with a more compliant partner than the Taliban to allow the construction of a major pipeline through the region to distribute natural gas from the Caspian Sea and avoid the distribution system of the Russians. This deal was set to go through, but, in 1998 American embassies in Nairobi and Dar es Salaam were bombed by Al Qaeda, operating within Afghanistan, as Osama bin Laden had moved there from Sudan in 1996. The course of history changed that day.

Three years later, when 9/11 hit us, Al Qaeda probably had about 300 members and Afghans did not believe that the United States would declare war on so few people–but there were many Afghans who understood that the U.S. declared war on Afghanistan (an unofficial war of the type we have conducted ever since the close of WW II) to control the country and its future destiny with a pipeline.  If this is a war that’s winding down, it’s winding down for us, not for the Taliban. They’re not going anyplace. If the “Long war” characterizes any side, it is that of the Taliban, not the Americans. We are war-wary and exhausted and no longer certain of our objectives in Afghanistan. Nation building? Counterinsurgency? Pacification? At one time or another these names have all appeared within our lexicon for the Afghan war, but like any buzz word they have all run their course, including the generalmania period of Patraeus and McChrystal. We no longer have a moniker for the war in Afghanistan, but it doesn’t mean our efforts are any less deadly to Afghanistans. The Taliban just have to wait until we leave, after which they know that the puppet government we have established will not offer significant resistance in our absence and Karzi himself would like to conclude a peace treaty with the Taliban before we leave. In the meantime, it’s the Taliban consider it their responsibility to extract as much pain and suffering from the U.S. Army troops as they have suffered underneath the boot of those same soldiers. As for accurate reporting about the war, you cannot trust the mild or even rosy reports of embedded journalists, which includes just about everyone,  because their vision of the situation is that which the military insists they see. As an embedded journalist you see what the military wants you to see, their eyes are your eyes and, at least in Iraq, there were far too many examples of Congressman giving a televised tour of their visit to illustrate how safe it was, dressed in a full body armor suit, surrounded by sharp shooters lined up along the roofs of the aligning buildings. John McCain went to Iraq under such circumstances to announce that it looked like we were finally winning the war because of the “surge.” The far more dangerous non-embedded journalists are the ones we should seek out and, as I have noted previously, reports that come back from journalists like Jeremy Scahill (see below) do not suggest we are making significant progress in the war–quite the opposite. In the meantime we put lots of our efforts into destabilizing Pakistan, a much larger country than Afghanistan and one that comes with its own supply of nukes. In two more years, Obama has promised to end the war in Afghanistan. When General Patraeus was in charge, he promised, like GW Bush, to give us a new version of the “Long War.” Under his leadership, we went from the “shock and awe” policies of the Bush administration, courtesy of Donald Rumsfeld, with a heavy emphasis on technology, to the counter insurgency strategy and the “surge injections” of more troops. It is doubtful that this worked in Iraq when Patraeus tried it in 2006, but there is little question that the Afghanistan surge did not work and Patraeus is no longer running that war, but instead came home to run the CIA. No one is defending the surge in Afghanistan and our own estimate of the war is that it’s a “stalemate.”

In case you haven’t heard, the “Long War” is over–it died of natural causes and shear exhaustion. The Afghan war we are fighting now uses Special Forces and missile firing drones to take out suspected terrorists in an ever-increasing arch of countries in Africa. The new model for conducting the war in Afghanistan is based on the way in which we killed bin Laden last year. Should the Republicans mention the Middle East in this year’s Presidential election, they will mention Iran and avoid talking about Afghanistan, because Obama already killed bin Laden. The Republicans will be far more comfortable blaming the rising cost of gasoline on Obama (despite the fact that during Obama’s three years America’s production of oil has increased, not decreased), numb to the fact that their own rhetoric against Iran may have already contributed to the rising cost of oil.

If you want to read reports on the Afghan war from a non-embedded reporter, you need to seek out journalists such as Jeremy Scahill and Rick Rowley. These two reporters went to Afghanistan last year, arranged their own schedule and visits without military escort or a travel guide. Very few reporters take such risks.  They reported last year that our military actions in Afghanistan were destroying our objective because we were killing too many Afghans and the opposition to our presence was building. We don’t hear about these events because they are carried out by Special Forces that conduct night-time raids and often kill whole families indiscriminately in retaliation for a nearby roadside bomb that went off in the neighborhood.  In the Vietnam war we were outraged by the disaster of My Lai, but the way operations are carried out by Special Forces in Afghanistan, we just don’t hear about them, primarily because they are not written up. You cannot claim access through the Freedom of Information Act if nothing about the raid was written down. And, we don’t hear too much about drone strikes which are also becoming a new component of the way we conduct our wars. Despite our poor history in fighting and winning wars in the Middle East in the last decade, we will hear this year about how the Obama administration should be bombing Iran to prevent them from getting a nuclear capability, despite the fact that there’s no evidence they have one.  This year the Republicans running for the Presidency have added incompetency to the list of their afflictions including the absence of any world view of politics or diplomacy.

It appears that Americans want to forget our war in Afghanistan and we are still in search of what or how a victory in that region of the world will be defined, no matter how it ends for the United States. At the moment, the war in Afghanistan seems like it will end like the war in Iraq: we will find some delusional way to declare a victory and leave the  country in shambles, but perhaps we will have added a pipeline to the landscape of Afghanistan and recruited enough people to guard it. And of course we never mention how we have devastated the culture of Iraq and put some of its archeological sites under asphalt to make room for our war machine. Andrew Bacevich, writing in TomDispatch has recently characterized the history of our wars in Afghanistan and Iraq, as we prepare to engage terrorists on an expanded map, with new bases for drones without every asking why or what it is we plan to get out of it and whether it can be done that way under our constitution. The new war plan under the Obama administration is one in which the war will become a silent war, made by executive decisions over life and death of not just terrorists, but anyone the President feels is a threat to the United States. If America should suddenly lose her status as a superpower, I am convinced that the American public will be the last to find out about it. Since GW Bush, we have heightened the authority of our President to make life and death decisions over people we refer to as terrorists, including U.S. Citizens. This is too much authority to put into the hands of a single President. Now more than ever, we need to have Congress take back their abandoned authority, the one spelled out in the constitution–that only congress has the right to declare war and congress should review the military budget periodically–we have far to many black budget items in the military budget and far too little authority over defense spending.
RFM

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Aftermath of Joplin MO Tornado 2011

It is innately human for us to recall and assess this past year’s major events and review the memories, as the end of the year winds down to the last few days. After that, the new year starts up and we supposedly have something to look forward to, as we turn our heads and point to the future, though not quite putting last year’s memories in a lock box. Whether this transition is cultural or more subtly linked to the events like the Winter Solstice, the transition we make on or about New Year’s day is a change from looking in the rear view mirror for a few moments, to catch a few fading memories and then switching to focus our eyes on the road ahead. Barack Obama will have to do that as he prepares for his re-election campaign. Right now, resting in Hawaii, he is probably soaking up the impact of his recent speech in Osawatomie, Kansas and trying to estimate how effectively it went down with the Millennial crowd, those for whom it was designed. I agree with other assessments that he will benefit more from the Millennial generation in the coming election compared to any other age group and that’s why his Osawatomie speech was so important. He currently holds a 25 point lead over Romney among Millennials–they alone will hold the key to his re-election and I think he finally knows this–they are strongly in support of the Occupy Wall Street Movement, but he will have to make a few more left turns in order to convince them and keep his big margin, enough so that the millennials will massively get out and vote in November 2012: they went missing in 2010.  This is an historic election coming up. Let’s hope that this election proves to be the year that we put the Republican Party, at least this iteration of it, in our rear view mirror on a more permanent basis.  On the other hand, for the older crowd, those that are in the pre-Baby Boomer generation, many of whom are members of the Tea party,  Obama trails Mitt Romney by a 54-41 margin, a very wide gap. Perhaps he can whittle away and gain a few points with this group, because as soon as Romney gets the nomination, he will shift his focus towards cutting benefits for Social Security and Medicare and eliminating the new healthcare bill he refers to as “Obamacare.” Those are issues that touch many of the Tea Party members–what they are actually mad about is not their benefits, but the idea that illegal immigrants and lazy young people will step in to get a share of the American pie while their own is increasingly at risk–that’s why they are conflicted with Romney’s candidacy. At the very moment Romney gets the nomination, many Tea Party members might be uttering “Hell hath no fury like a former private equity manager running for President.”

Not only do we as individuals assess the recent past, but it makes sense that our government agencies  try to do the same; one assessment among the U.S. government agencies stands out: the National Oceanic and Atmospheric Administration (NOAA) has tallied the cost of the many weather disasters we have been through in the past year. Justin Gillis reports on this in the New York Times: as he describes it, a typical year in this country for weather disasters usually has three or four incidents which reach the threshold of $1 billion or more each. But this year NOAA has done the math and, while the agency has not yet finished adding it all up, the final cost is likely to exceed $ 50 billion. It includes wildfires, floods, heat waves, dust storms and several deadly tornadoes, the likes of which have not been seen before.  According to  a weather expert who co-founded the website called “Weather Underground,” a search of the historical weather patterns going back to the late 1800s did not reveal anything comparable to 2011 for weather disasters. Though most climate scientists are certain that the heating of the earth from greenhouse gases accounts for many of these catastrophic events, right now it isn’t possible to say which events are global-climate-change-related and which are not. Climate scientists know that we are changing the scale of atmospheric events, because we are putting more energy into the atmosphere. This additional energy has to be dissipated in some way and more frequent and violent interactions with the Earth’s surface, whether over water or land, are about the only options. But things like tornadoes are hard to pinpoint in terms of their genesis because they are relatively small on a global scale and seem random. However, less random is the fact that funnels in some of the recent tornadoes, like that in Joplin Missouri, were a mile wide and touched down for much longer stretches than one’s experience would indicate. This was a violent tornado, destroying virtually everything in its path. Right now climate scientists are retooling climate models to deal with smaller regions and study more effectively the impact that global climate change has on these events. But there is some doubt about the accuracy with which these more refined models can be predictive and with public interest in global climate change at such a low ebb, and the economy in the tank, needed research resources to address these kinds of problems are not available.

In case you were thinking about serious mountain climbing this coming year, you might want to check out what has been happening to the large mountains on the planet, those with glaciers on top, most of which are in full retreat. One climber even reported seeing running water near the top of Mt. Everest, something never reported before. You might want to visit Mount Kilimanjaro in Africa before its glacier completely disappears, perhaps as early as 2015. Glaciers on major mountain tops have had serious erosion during the past few decades and because snow and ice have been the glue that keeps loose rocks and boulders bound together, hiking in many places has become more dangerous. While some climbing can be more accessible, it is often longer and more treacherous. To top it all off, a new report indicates that emissions of carbon dioxide into the atmosphere had the largest increase ever recorded, with an increase of 5.9 percent in 2010.  This contrasts with  the 1.4 percent drop in emissions in 2009, the year the recession generated a significant drop in the economy and greenhouse gas emissions. Most climate scientists agree that we have reached a tipping point in the sense that we will have to live through a significant period of  impact from global climate change and that our planet is likely to change in irreversible ways as this century progresses. Here’s hoping that our fondest memories each year are not related to the weather patterns we enjoyed, but may never see again.

RFM

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