TheMillerCircle.org

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

• Comments Off

Mountaintop removal eliminates the mountain and fills the valley below

I have been waiting for the documentary “The Last Mountain” to be released to my  Netflix streaming queue for sometime and then it suddenly showed up, so I watched it a few nights ago. Directed by Bill Haney, it tells the gripping story of the fight to keep Coal River Mountain West Virginia from being destroyed by the Massey Energy  Company.  The residents of Coal River Valley have been threatened for years by mountain top removal in a region of the state that has breath-taking, tree-covered hills and valleys; this region however has been progressively destroyed by coal mining through the technique of  mountaintop removal, based on massive, mechanized  machinery and explosives. Although Robert Kennedy played a major role as an activist and adviser in the documentary, and clearly adds a sense of national urgency to the issues addressed, the story is also about how local residents of Coal River Valley got together and formed an activist resistance to the Massey Coal Company’s plan to remove Coal River Mountain, a mountain that serves as a watershed for residents of the valleys below.  Many other mountains in the region have already been destroyed by coal mining, such that Coal River Mountain was and is the “last mountain standing”  of significance for the region. The removal of this mountain will destroy the water system of people living downstream and increase the severity of flooding, two well-known, obligatory features of mountaintop removal.  Many residents believe that Massey Coal wants to depopulate the Coal River Valley and eliminate downstream community occupancy, to give them more space for strip-mining. It is a very ugly process.

While the Obama administration has been more sensitive to the destruction of the water supply by mountaintop coal mining and violations of environmental laws, the original permits to remove Coal River Mountain were given during the Bush administration and Massey Coal has proceeded to execute its march towards mountain destruction. However, in a somewhat duplicitous manner, the Obama administration continues to issue permits for more mountaintop removal in the region. An interesting feature of this controversy was revealed in the documentary based on studies  that raise the feasibility of putting windmill generators across the top of Coal River Mountain. Those who have studied this suggest that wind power generation would produce more jobs and give the neighboring communities more long-term income through power generation and improvements in the tax base, when compared to the resources generated by the Massey mountaintop removal project,  which  of course will end at some time in the future. The demonstrations, sit-ins and tree sitting by environmentalists and residents are greeted with hostility by the miners who still have jobs working for Massey Coal. Oddly enough, I didn’t see many of the mountain top removal defenders (50 percent of our electricity comes from coal) argue that the future of the industry depends on the development of new clean coal technologies, none of which were on display or even discussed. Many coal-based power plants claim that they are ready for “carbon-capture” technology when it becomes available. But that possibility is very remote because once in service, the public will not tolerate retrofitting for carbon-capture, even if the technique becomes feasible, as it would add enormous costs to existing energy production. If carbon-capture or some similar clean coal technology ever comes along, it is likely to increase the cost of coal-based power plants to a prohibitively high level. Coal is currently the worst source of air pollution and the long list of its pollution offenses  goes beyond carbon dioxide and includes such things as mercury contamination, which accounts for warnings we get about eating fish too often because of their high mercury content. Mercury is toxic to the brain and impacts on brain development. It might be that Republicans have been eating too much fish.

Robert Kennedy is articulate in pointing out that the impact of Massey Coal has been to increase the poverty of the region, first by destroying the unions in the 1980s (companies close mines, send unionized workers home and then reopened the mines with non-union miners, complete with reduced salary and benefits) and second, by reducing the labor force through automation and modernization of equipment and techniques: strip mining is replacing deep hole mining, with a reduction in the labor force needed.  But if the true cost of coal mining was reflected in the price of coal, including the serious health care costs and safety issues, the cost of this form of energy would be prohibitively expensive. We are not just trapped by the history of the region as a long-standing coal-mining center, but also by the powerful lobbying interests of coal mining and transportation (trains) that thrive on their operations in West Virginia and other coal-intensive states.  One can add that Wall Street has billions invested in these companies because they are profitable and seem to be free from serious regulatory control. Add to that formula the corrupt organization of the state’s environmental protection agency, which allows coal companies to violate water and air quality standards without fines, and you have an updated version of “Love Canal.”

The environmental damage does not stop with a disappearing mountain top. The heavy coal mining leads to toxic waste sites in the mountain regions above the valleys, created from the water used to wash the coal before it is shipped and these sites leak and pollute the water supply downstream, carrying highly toxic material.  Several websites have been put up to monitor the mining operation, but the state and Federal Government seem to collude as obstacles for better environmental regulation. The trouble is that while wind energy might be successful for the future of local inhabitants, how will the energy needs of others be met who receive the coal over long distance railroad shipments? You have to decommission these coal plants one at a time, when you have a suitable alternative and until that can be achieved, the forces promoting mountaintop removal will keep going with few obstacles in sight that can stop them. If you had only two solutions to our energy needs, nuclear power and coal mining, the preferred choice would be obvious.  The solution at hand is to build a new, modern transcontinental power grid that collects electricity from all forms of power generated in different ways and distribute that power efficiently to homes and businesses. This is an infrastructure issue. Yes, it would be better to replace coal-fired power plants with natural gas in the short-run, and it seems obvious that the wind turbine option for the people of Coal River Valley makes far more economic and environmental sense, but how to resolve the challenges of implementing this new technology in place of coal is something we can only achieve through the force of a national government, not a state government, which, in the case of West Virginia seems hopelessly corrupt and entirely devoted to the private, rather than the public interest.

RFM

• Comments Off

Fig. 1 Planet Earth (NASA)

Every educated person on the planet has heard about the threats to human existence imposed by Global Warming. Yet, few of us are knowledgeable enough to explain the basic mechanisms that determine our climate, especially when talking to those among whom are doubting members of the choir. Understanding the essential elements of Global Warming requires effort and an intellectual expenditure, but you can converse intelligently on the subject, while stopping short of explaining the situation on the basis of a thermodynamic theory of equilibrium. Besides, the earth’s climate has never truly been in any form of equilibrium–some positive or negative driving force or energy imbalance has always been trying to change our climate, though, until now, such changes have taken place over millenia, not over the two hundred plus years of the industrial revolution.  Our climate has always been changing, even though the time constants for change are way beyond a human lifetime, and lie properly scaled and recorded within the geological and paleoclimatological record, which gives up its secrets slowly. But once properly deciphered that record reveals a surprisingly coherent history for those willing to put the effort into interpreting the scrolls, or to be more accurate, deciphering the core drillings of oceans and glaciers. Of course, we don’t yet have a complete story. There are large gaps in our knowledge, but we know enough already to be mesmerized by our planetary history and the forces that have shaped our climate. And we should know enough to be alarmed and very wary about our future.

It is now clear that never before in our climate history have we witnessed the kind of experiment now underway–the forcing of our planet to go through something it has never experienced before–a sharp, man-made increase in atmospheric carbon dioxide that is now taking place and pushing us towards a climatological precipice that we might not be able to escape. But if we act quickly, this experiment is still under our control, depending on whether we can muster the political will to curb our use of fossil fuels and restore energy balance to keep the planet as it was, with atmospheric carbon dioxide at 350 parts per million (ppm) or less ; it is now at 387 ppm and rising at a rate of about 2 ppm per year. The alternative is that we run the risk of higher levels of carbon dioxide that will trigger the melting of Greenland and the polar ice caps and eventually raise our sea level by 270 feet! We are probably not at risk for a sea level increase of that magnitude during this century, but we do run the risk of having this kind of sea level rise take place, and once it starts, there will be nothing we can do to stop it. Not only will this massive ice melting proceed out of our control, it will cool the local regions where the melting takes place, impact our weather systems and change the driving forces for oceanic currents. The emergency we must address now has been created by the fact that the carbon dioxide we have put into the atmosphere has a very long half-life and its actions on our planet will be with us for a  very long time. Couple this reality to the fact that we are already seeing weather patterns that reflect Global Warming and you inescapably conclude that our short-term climate does not look good–it will inescapably be more violent. But, we can still do something for the long-term, by acting soon and now is not too early. There is little doubt that if we continue to burn fossil fuels through a business-as-usual mode, our planet will be markedly different and our planetary future will be seriously in doubt. In many ways, that’s the shock–not only that the climate is never in equilibrium, but that it is also super-sensitive to the very fuels we have chosen as our cheapest form of energy. For too long we have assumed constancy in our climate lives: that luxury has now gone, at least the assumption part of it.

• Continue reading or Leave a comment... Comments Off