Health Care Reform

And Carburetor Tweaking

What we call a “health care system” in America is by my standard a strange and almost incomprehensibly corrupt and twisted thing. The continued existence of such a cruel and dysfunctional system requires that a great deal of mind-fogging fairy dust be continually thrown in our faces by the health care industry and the politicians they own. At all costs, they must inoculate us against the possibility that a spontaneous outbreak of common sense might infect the populace. Rest assured that the strategists for the drug and insurance companies understand what they are up against.

They understand that to keep in place a fundamentally irrational system, they have to maintain an eternal vigilance to prevent dangerous principles like logic, reason and fairness from entering into the healthcare equation. The ‘industry’ must make for-profit medicine seem normal, acceptable, and our only reasonable option. They must also make the kinds of publicly funded healthcare systems operated by most every other nation on the planet seem weird, subversive and dangerous.

Much of the vacuous banter about “healthcare reform” that appears in the press and in speeches by our politicians seems designed to be both boring and to make healthcare issues appear very complex. Health insurance, in concept, is really not a devastatingly difficult thing to understand.

Here’s how it works: The insured pool their resources so that when any of them get sick the pool pays for their care. The pool must also pay the system’s administrative costs. This is the comprehensive list of essential elements.

It only seems so simple because it is.

Most of the complications involved in “reforming” our present system can be traced back to its fundamental design defect. We place a huge burden on our health care system by demanding that “profit” be extracted from its operation. It is this design characteristic that twists, perverts and distorts the very notion of health care in America.

It seems obvious that the first goal of a “health care provider” should be to give the best possible care to those that are “provided” for. Just as obviously, we can see that in our for-profit health care system, delivery of actual care is a side effect.

Is there really any question that a “healthcare” system that allows insurance companies to deny coverage to people on the grounds that they may actually need medical care is one that has been hideously deformed, diverted and subverted? It might be more accurately described as a “profit delivery” system.

But to the dismay of those that are committed to spreading fairy dust, every healthcare system creates a product that can be examined. According to the World Health Organization, our nation ranks 37th in the world in quality of care, placing just below Costa Rica and Dominica. Our system now leaves about 50 million people without access to even basic medical care.

But we are number one, and by a large margin, in cost of medical services, executive compensation, and percentage of healthcare dollars spent on administrative overhead. Without a generous quantity of fairy dust, a phony debate in the corporate media, the complicity of a bought-off Congress, and a new President whose words support reform but whose timid, incremental approach will likely only diminish the possibility of systemic change, the inexcusably lame performance of our health care system would be recognized for what it is: intolerable.

Imagine your car came in 37th in the race, after you dropped more money than anyone thought possible on the most expensive model that was available. If you really wanted to win, wouldn’t it be best to pay attention to the fact that all 36 of the much faster cars that beat you in the race use an engine design that is completely different from yours? What if you discovered that the other cars, in addition to being faster, used only about half the fuel your car burned?

Would you then go home and tinker with your carburetor in the hopes that a little tweaking would somehow overcome the poor performance that results from the basic design of your machine? Or would you consider it obvious that your only chance to compete successfully would be to replace your obsolete and incredibly expensive racecar with one that has been designed to deliver a higher level of performance?

When it comes to healthcare, President Obama seems to support the carburetor-tweaking approach. According to an article by Bill Moyers, Obama was asked at a town hall meeting a couple of weeks ago about the possibility of switching to a single-payer national health care system. He said that single-payer might “make sense” but only if we were “starting from scratch” to build a new health care system. Obama says our current for-profit healthcare system is “too large a percentage of our economy” to consider changing.

To the fifty million Americans without any health insurance at all, and to the millions more that are struggling under the crushing financial burden of our current system, I am sure it appears that health care is too large a percentage of our economy to consider not changing. It is only so very large because it has gorged itself on our misery until it has become insupportable.

If you discovered that leeches were attached to your flesh, would you decline to remove them on the grounds that they had already consumed such a large a percentage of your blood that it would not be wise to disturb them now?

Granted, if I were designing a brand new health care system “from the ground up,” I would not create one in which the primary mandate was to establish and maintain a parasitic executive class whose main function was to generously award itself the largest share possible from funds that would otherwise be available to care for sick people.

But regardless of whether we are in the process of creating, operating, maintaining, or “reforming” our health care system, what does not make sense is to retain the one design element that contains within it a terminal conflict of interest that no tinkering can ever resolve. A for-profit system assumes that we can somehow make people rich as a result of caring for the sick, but what we really do is make people sick by caring for the rich.

One thing is clear: despite spending tens of millions of dollars worth of their ill-gotten profits to buy off our politicians and deform public opinion on the issues, Americans are not buying the traditional array of industry excuses any more. Even absent any substantial support for the idea in Washington or in the corporate mass media, about two- thirds of our citizens want to switch to a single-payer system now.

What is there really to argue or debate? Healthcare industry executives, some of the best paid people on the planet, seem less than eager to appear before the public in front of a banner that reads, “We’re number thirty seven — and that’s good enough!” So they and their politicians and media outlets spread fairy dust.

Virtually all of the current “reform” plans being tossed about by our politicians, including the much-touted “public option,” leave in place a network of for-profit private insurance companies to administer the system.

This arrangement fails completely to address our systemic defect. For-profit healthcare is the problem. It cannot possibly be the solution.

This is why I will not be joining with the liberal groups that are frantically calling for us to support “Obama’s public option” against the forces of darkness. I don’t believe that this is where the battle should be fought. In my cosmology, it seems clear that the forces of darkness have already wormed their way into Obama’s plans and processes, rendering any and all detailed discussion of them a waste of time.

Democrats control the White House and both branches of Congress, and could count on the overwhelming support of a large majority of citizens on the single-payer issue. Yet they refuse to even put real reform “on the table.” Instead, they choose to put all of their effort into a battle over incredibly complex sets of half-measures that are designed to placate the insurance and drug industries by leaving them in firm control of our system. Even then, they seem to be preparing us for the idea that they may somehow actually lose this little skirmish to the big bad evil Republican obstructionists.

This approach is absurd and should be considered unacceptable. It will leave us with no option other than to continue tiptoeing around the elephant that has taken up permanent residence in our living room.

The solution to our perpetual health care dilemma is actually far simpler than all of that. What we need and should demand is fundamental systemic reform. In this situation, the only reform worthy of its name will be of the kind that unequivocally removes the profit motive from our health care system, and covers everyone under a federally administered single-payer plan.

Paul Dean is a composer and bassist with the band Blusion, whose music is described as "a remarkably unmarketable blend of jazz, funk, hip-hop, blues, salsa, rock, vocal and instrumental music." Blusion exists "to serve as a warning to all those who would perhaps otherwise be tempted to attempt something new and different. We starve so that others may live." Paul can be reached at: Read other articles by Paul, or visit Paul's website.

24 comments on this article so far ...

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  1. bozh said on June 20th, 2009 at 10:47am #

    as i see it, US governance {system of rule} allows or even demands privatization of some aspects {or potentially all aspects} of governance.
    deprivatization of healthcare wld ‘violate’ US governance.
    deprivatization of the armed services aspect of governance shld also be a good thing, etc.
    so the first step one has to take is to rewrite the constitution of US which demands a governance for profit.
    the new constitution shld explicitly state that healthcare, armed services, spy agencies must not be run for profit or be controled by a private person or persons.
    a humanitarian and just constitution shld say: Every person residing in US and every american citizen must have healthcare!
    what obama said two weeks ago is really in line with the constitution of US.
    but even the governmental services, such WH and congress, shld be deprivatized.
    to conclude, let individual privatize the moon if it’ll make them feel better and leave the earth to us earthlings. tnx bozhidar balkas vancouver

  2. Mulga Mumblebrain said on June 20th, 2009 at 5:56pm #

    The reality is that, under late market capitalism, the character of not only the economy, but also the robopaths who control and profit from its exquisite cruelties and headlong rush to planetary biosphere destruction, have been so transfigured that there is literally no possibility of ‘reform’. While any half, nay quarter, brained eejit can see that Obama is the biggest sell-out in US history, the mainstream media still continues business as usual. Obama’s myriad betrayals simply do not exist as far as these creatures are concerned. Whether this is cynical hypocrisy and mendacity in the tradition of the Rightwing media apparatus, or evidence of auto-brainwashing to a startling degree, or both, who cares? On the other hand, it is instructive how closely Murdochism in the media resembles Stalinism in bureaucracy of another type. One or two summary executions ‘encourage the others’, the non-conformists are weeded out early and vigorously, and ‘going-along’, learning the rules of the ‘pre-emptive buckle’ along the Master’s well known ideological lines, and being well rewarded for selling one’s soul to Mephistofeles, all ensure ideological correctness that would have had the editors of Pravda gob-smacked with admiration. I must say, if you want a belly-laugh of the gallows type, just peruse Murdoch’s Australian flagship, ‘The Australian’ (aka ‘The Fundament’) where the acceptable opinion spans the spectrum from A to A flat, on the far, far, Right,as one would expect in the ‘Free World’.
    So, while the US Empire grinds on, reducing Iraq, Afghanistan, Pakistan and Somalia to rubble, while the Israeli cappo proposes a Palestinian ‘state’ akin to an electronic zoo, overseen by the ‘Chosen’ keepers, and no concrete action, whatsoever, to avert cataclysmic anthropogenic climate change is even in distant sight, I’m afraid the perverse cruelties, inefficiencies and insatiable rapacity of the US ‘Health’ system is simply a sadistic sideshow.
    Somehow I neglected to include resource depletion, species extinction and economic collapse triggered by insatiable elite avarice. We can safely contemplate the constellation of fulminating and synergistic systemic crises and know, with near certainty, that this is, indeed, the last human century, if there is not a revolution. A revolution in power, of course, as a system so innately anti-human must be destroyed, by any means necessary, but we also desperately require a spiritual and moral revolution.
    For too long the reins of power have been in the hands of the worst in human society. The greedy, the cruel, the egotist, the liar, the lacker of human empathy and he that feels no pity, only indifference to the fate of others. That is the type produced by market capitalism, where everything in existence, in all its awesome diversity, is reduced to a series of entries in money accounts. The type for whom a million a year in pillaged gelt in insufficient, and for whom the rest of humanity are the enemy in the war of all against all.
    The prospects for such an overturning of millenia of human moral and spiritual decline seem, to me, to be vanishingly tiny, particularly at five minutes to (or is it already past?) midnight.

  3. polack in idaho said on June 21st, 2009 at 8:58am #

    A concept of for-profit medicine contains a fatal design flaw, as the author rightly points out. A useful analogy would be, perhaps, to try nailing a board using a glass hammer… If one does not strike with a sufficient force, a nail will not penetrate; if too much force is used, the hammer will break. The most likely result of this operation is a lot of noise, a loose board, and broken glass. Every decision in a for-profit healthcare system is unavoidably subjected to a conflict of contradictory aims, which makes it impossible for the system to perform efficiently. Even if the people managing it had the best and purest intentions, it could not work, because of this inherent conflict.

  4. Don Hawkins said on June 21st, 2009 at 9:30am #

    Idaho good one well written so why do it. Special interests it’s the best they can do. What might they be doing right now these special interests wait don’t tell me. Sending there clothes to the dry cleaners on the course at the club talking on TV. Feeling sorry for the little people I mean we the people. Getting a check up from a well known doctor. “Well Doc how do I look”, “You seem ok but I can’t find a heartbeat”. “Oh and why is it that you can only see me after dark”? “Is it true you sleep in your basement”. Calm at peace. Use the knowledge.

  5. Paul dean said on June 21st, 2009 at 8:58pm #

    I agree with most of the sentiments expressed here. Yes, the profit motive is probably a systemic defect whose detrimental effects can be seen at work in many places, and in the overall political social and environmental situation.

    But I think isolating health-care as an issue here, and focusing on the absurdity of a for-profit structure, (and where is this more easily demonstrated than in a health-care system?) provides us with an opportunity, right now.

    The glass hammer analogy is a great tool for describing the futility of our current system.

    I think we need to take the position that we are tired of their carefully orchestrated campaigns to obscure the obvious truth: for-profit health-care is the reason we need reform, and the reform we need is to eliminate the profit motive entirely.

    I like the style he exhibits when people ask Noam Chomsky to interpret some absurd statement. Rather than waste his time responding to some logically or factually twisted nonsense, he says something like “So and so simply cannot be taken seriously when they say that.”

    We have reached the point where this is the response we have to give, I think, to the endless and uniformly absurd complex proposals for reform that clearly are not, and will never reform anything. It is now obvious that neither the Democrats or the Republicans intend any real reform. Their proposals are worse than weak, they are corrupt and anti-democratic.

    They simply cannot be taken seriously unless they address the real problem. As you can probably tell from the tone of this and my piece, I am so deeply sorry for those execs that stand to get kicked off the gravy train, but there is no other way.

    I say, tell em. We are not listening to your excuses, to your pretense, to your ridiculous statements, to your elaborate, complcated, difficult to follow, incomparably dull, morally and financially bankrupt proposals that all seek to keep in place what can no longer be excused or accepted.

    Tell them-Single Payer Now, and get out of my face with your weak excuses!!!!

    Thanks to the folks that took the time to comment here…..

  6. Max Shields said on June 22nd, 2009 at 6:20am #

    The problem, I’m afraid, is not simply a particular “system” like the for-profit health care. It is the fact that our politics and property owerns; aka corporate wealth hoarders, have a symbiotic relationship that supercedes the common good.

    The whole system, not simply the health care system (which can’t be peeled off from the rest) is in dire need of fundamental transformation.

    The reason why we confront this problem over and over is because the underlying causes are 1) not addressed 2) there is no movement to rectify them.

    The machine, corporate capitalism is a machine built, much like a shark, to do exactly what it does so well, increase profits for shareholders. It does that with total abandonment. It is a pathology, not just because it is irrational to treat healthcare as some kind of commodity to be privatized and profiteered; but because the whole notion of common wealth is dismissed outright.

    The very technology that makes modern medicene (for example) possible is not owned by one company; but was made possible through a collection of culture, nature and communities. This can be multipled over and over and over on every front. What is Google? It is using our common wealth – the internet – to post billions on the stock market for their shareholders. Not one of these behmouths could do a thing without extracting from nature and the common wealth which, if quantified is worth many times more than the total pool of privatized assets.

    The system, such as it is, does not recognize this at any level for any goods or services provided as output from these corporate machines that run our politics. The pathology is that the system of government is open to the highest bidder; and with that our domestic problems begin. As much as I see the validity of single-payer, it is just about unfathomable to imagine such an anomoly in the midst of a system which will reject it with all of the power that comes from having all of the political/financial power at its disposal.

    The answer: the commons must be recognized through a complete overhaul of our economics. That is the commons must become a protected sector whereby we all get a return on its use and protect it for now and into the future.

    Without recognizing the fundamental obsticle we keep playing this over and over. I don’t recall France having this 60 year debate, or Britain, or Germany or Canada. A wave of demonstrations and protests will not bring about this change. Perhaps some kind of buycott might, but doubt that not using healthcare could possibly be the answer.

  7. Melissa said on June 22nd, 2009 at 7:17am #

    This is why I lurk on DV. Lovely stuff here in the article and comments . . .

    What a strange thing for all of these politicians to openly recognize the mandate being given them by the People, then just say, in effect, that we can’t possibly appreciate the REALITY of the situation !?! -That what the People pay for with our labor, and what our future generations will be paying for, is none of our business; what we get, we get, and no complaining. What a crock.

    For me, the for-profit model failure of the current crap really highlights the stupidity of corporations having personhood . . . get them out of our political process, stop making it so damn easy for a few non-productive people to siphon off the many. Does an exec or financial “industry” really PRODUCE anything? No, they are parasites.

    I know the original form of government that was set up in the USA is not well thought of here at DV, but I have to say . . . this situation is NOT supported by what is supposed to be the Law. First, corporations with “personhood” should not exist in the same place where democracy is supposed to reign. Second, We the People are supposed to be the government, the politicians our servants. The power of goverment is meant to be indigenous power instead of the surrogate power that we are seeing. So, the idea that every person (with a little bit of brain as well as those with a lotta brain) is demanding single-payer and the parasites in corporations and inside the beltway keep saying no, it’s just, well, crazy and not all in keeping with the oaths they took. I couldn’t be more torqued.

    “A revolution in power, of course, as a system so innately anti-human must be destroyed, by any means necessary, but we also desperately require a spiritual and moral revolution.” -Mulga Mumblebrain

    Mm huh. Stop co operating with the wrong systems, and start co operating with people around you . . . the systems only exist as long as we submit to them. But, what if the Obama engine pushes an expensive, inefficient “new” system upon the nation’s people, requires that we buy into it, and there is no escape? Will they begin to mandate everything about my health care? Will alternatives be ground out? How does health care “reform” allow for choice? Is it right that the gov will take my labor at the point of a gun to pay for something I don’t want, something that I can’t use? Is it fair that I pay for chemotherapy when I know that it is poison, that it is not medicine? But the safe, not profitable alternatives are illegal? This is my hang-up on trusting these whackjobs with socialized services . . . they can create monopolies that mandate quack medicine, and they can squash alternatives and choice.

    We can’t let the corruption in government continue as we choose more and more socialized services. We will never get what we want or need, the gaps will grow, and feudalism will have a permanent foothold. We really should get this power thing back into our hands before we hand over more centralization, or we will be screwed. Those old documents written by old white guys can help here . . . if we stand up and own it. What would our world look like if common sense of the people ruled the day? I am thinking it would look very nice. I don’t think we’d be expending so much money and energy just to beg for some decency.

    When I move about in my community, I meet (mostly) very decent people. I live in an urban area, in a neighborhood with more subsidized housing than not, and dammit, people are mostly good. I really don’t appreciate this attitude that “the common people” don’t know what they want, that we are rabble that need to be controlled, that decisions about every individual’s personal life can’t be theirs . . . I think We the People are much more human, pragmatic and altruistic than any politician claiming to be a public servant.

    Will you please run for office?

  8. Paul Dean said on June 22nd, 2009 at 7:56am #

    Yes, it is a systemic problem, not limited to health care. There is no such thing as a self-made man or woman. Max’s Google illustration is apt.

    When I hear a story about a wealthy capitalist that “deserves” their extravagant pay because they work so hard, because they are so creative, they take the initiative, etc I have to laugh.

    A self made man would be one that is pushed out of the train in Siberia, left in the snow with only his bare hands to work with, and fashions an empire from his own labor. By the time he builds tools to harvest and prepare trees out of what he finds, builds a mansion, plants a garden, etc, it is not likely he will have a lot of energy left or the ability to conquer his neighbors and appropriate their wealth.

    From an activist perspective it might be difficult logistically to attack and defeat “capitalism” greed arrogance, selfishness and small-mindedness all in one pass. Not the the idea isn’t good, it just seems unlikely. So I think we need a handle to grab onto, or a lever etc.

    Health care is one possible lever. Anyone that wants to effect change must take criticisms from the abstract, general and theoretical, and move into territory where the lever might find a purchase and be able to displace some mass. I say health care is a good place to start, and the time is now. Even “Reagan Democrats” and folks without much depth of political understanding or involvement, can relate to the health care thing as a huge problem when they cannot afford medical help. This is what is up today. When even the corporate newspapers admit that single payer has 66% support, this is an issue we should hammer on and not give up until we win, or give it all trying. If we lose, we are no worse off than before.

  9. Max Shields said on June 22nd, 2009 at 8:27am #

    Melissa, yes, “we” put them in, these no-nothings, and they become the smart-asses that tell “us” that we just don’t understand.

    But it is a systemic problem to be sure. It doesn’t seem we can correct this in bits and pieces.

    Government and private property/corporations will not simply be separated. They depend on each other. Almost any law that is past (and there are very few that don’t favor the wealthy lobby-paying corporations) that would protect the common good, is chipped away by these profiteers. Lawmakers are beholden and there is just no one who protects, not only the vast majority of living people, but future generations and the living planet that is critical for life itself. No one speaks for the relative powerless; and therefore, politicians flip and equivocate until issues like health care become unrecognizable to any public good. The economics, the health and well being of people, and the morality of the issue are all set aside for the lobbiest who through their clients run the joint.

    Paul, I agree there is a need to address this issue. That it can be a “lever” is questionable – though I’m in favor of pulling whatever levers we think there are.

    The shark knows but one thing, hunt, kill, eat. It will never sleep until its mission is accomplished and that mission never ends. That’s what you’re up against. Without an ounce of cynicism, we must face the fact that the Congress is a tool of that mission. The organizing principles of this country from it’s very founding until this moment is predicated on property owners and capital at the head of queue.

    That’s not going to change by taking on one issue – and a mighty big one at that. What’s needed is a major structural change that balances this out so at least equal weight is in the hands of the common good. In other words, the real lever will only come from structural change; not by pulling the same one over and over.

  10. bozh said on June 22nd, 2009 at 11:09am #

    several questions arise about how to better/best treat medically sick/injured/dying people.
    the first question wld be, Is being treated medically an inheritance or not?
    second question is, Shld it be run by us or by them?
    well, i am not an expert on how to run medical care; so i alight from this topic.
    and i am not an expert on any isssue save on basic human rights. I am and expert, even tho i finished last in my class in each of the three yrs of schooling, because it takes a child’s brain {unless previously made null and void} to understand the basic human rights.

    there is but one genetic pool which even plutocrats don’t own as yet; thus by the necessary[apodictic] truth there has to be also one healthcare system and not several-tiered as it had been for the last four century.
    but even jurisprudence, education, access to adequate info, are multitiered.

    and if amers get their rightful inheritance, such as healthcare, right to be informed, the whole hell might break loose. Once people taste these goodies, appetite for more of their inheriatnce might change american governance to that degree that even might lead to a rewrite of plutocratic and strongly unamerican constitution.

    all this is academic once plutocrats learn how to control/influence what genetic pool creates.
    It cld create only smart and healthy people; so, haelthcare, constitution, basic human rights, etc., wld be mere curiosos. tnx bozhidar balkas vancouver

  11. dan e said on June 22nd, 2009 at 1:54pm #

    Scattergun: popular movements DO arise in the USA from time to time, when enough people are outraged enough about some particular evil. But as soon as they mobilize to demand redress, their energy is diverted and co-0pted round the mulberry bush or mulberry obama.

    It is well understood that the GOP represents privilege, which is its appeal to its market niche. There is a deeply-rooted myth that the Dems represent the less privileged parts of the population. Most DV readers know this just isn’t so, but they don’t completely understand how this myth is sustained. Most seem not to have gotten close enough to the process to see what goes on behind the scenes.

    The fact is that the Democrat Pty, once based on slaveholders, later on the Jim Crow-ocracy, has now come under the complete and total control of the Zionist Power Configuration, that is, the Israeli Fifth Column in the US. You can’t run for dogcatcher, your local school board, or for a seat on an unpaid powerless local commission, without being first cleared by your local Jewish Community Relations Council/JCRC thought police.
    All Media personnel retain their employment at the pleasure of the JCRCs, right down to your local non-network station’s Traffic Segment cutie-pie.
    Israel’s behavior has become so obviously criminal that it can’t be concealed, so now we have various persons speaking out against some of its worst abuses without being openly attacked by the JCRC/ADL/Fed et al. But what you can’t do is speak of generalized Jewish affluence and political influence in a public forum. This will bring them down on you quick. Of course there are certain Jewish sociologists who study and monitor closely how well “the Jews” are doing Only In America, but results of such studies aren’t made generally available, except to those who know where to look.

    Switch gears: Class struggle is a fact, not a choice. In his book “The origin of the family, private property, and the state”, Frederich Engels described in painstaking detail how human society evolved from the early gatherer/hunter egalitarian matriarchal groups into class-divided patriarchal urbanizations run by a partnership between priests and elite warriors ruling over much more numerous classes of producers.
    Adam Smith, the Physiocrats, the Mercantilists, all the great pre-Marx political economists recognized the reality of class-struggle in a capitalist social setting. Marx was v. careful not to claim credit for discovering the class struggle, always paying homage to preceding investigators even though he disagreed violently with their conclusions. BTW I’ve never seen it suggested that Engels background included any Jewish element.
    Engels was actually the first to propound the ideas on which modern bourgeois/p.b. Feminism is based, but first his insights had to be sanitized by excising the parts about Private Property and The State.
    Marxism: it is a fact that Marxism is an enormous ideological force in the world today, often in a perverted form but not necessarily, cf. what Chavez is talking about. Such ideas are widely known and discussed in Latin American and throughout the colonized world. Even those who fundamentally disagree with Marx & Engels first principles find it important to study their body of work, as well as that of the different schools of “Marxists” including Lenin, whose “Imperialism The Highest Stage of Capitalism” remains the seminal work on that topic, whether or not you agree with his ideas on how to organize “the revolution” or post-revolutionary society.
    So when I hear people pontificate about “by focussing on Zionism you are diverting attn from US Imperialism”, and in the same breath poohpooh Marx, I know they don’ t have the foggiest idea what they’re talking about.
    Actually by posing as “anti-Imperialist” such people, who include major segments of the Demo Pty like the Progressive Dems of America, Dem. Socialist of Amer. , CPUSA, CCDS and others, divert attn from the urgent task of making a close concrete investigation of the actual dimensions of the ZPC and its economic basis.

    And here I am again, spending my time casting pearls before Libertarians instead of attending to my household chores. Sorry but that’s all the time we have, be sure & tune in next time:)

  12. bozh said on June 22nd, 2009 at 3:08pm #

    dan e,
    in a one party system, politics are just a curioso. That’s because all powers- and not just narrow political one- come from barrel of the gun.
    when an amer pol speaks on any issue he is backed by cia, fbi, police, prvate spy agencies/armies, armed services, wmd, and most importantly by an interpretative constitution interpreted by the leaders of above-mentioned missionaries.
    that is the reason why a pol after makes a truthful remark, can easily wiggle out of it by easy expedients: tiredness, misspeaking, misquoting and every pol will understand and stand behind the mistaken person.
    viva la viagra; both sexual and governmental!
    tnx bozhidar balkas vancouver

  13. dan e said on June 22nd, 2009 at 4:42pm #

    Bozh — pretty good jonny but that ain’t the way I heerd it:) IMO you are guilty of oversimplifying a complex subject.

    Power comes out barrel of gun at certain pts, but who points the gun & why? Who made/supplied the gun to the gunneer?

    Power is exercised in Capitalist societies on behalf of the ruling class by the Capitalist State, which has three main branches: political, including coercive; ideological, everything from sunday school to TV to graduate school; and economic, primarily the State Financial Sector. Most of the “private sector” is in fact part of the State Apparatus. cf. Louis Althusser “For Marx” & “Reading Capital” which was elaborated re the US by some PhD’s at U of Ariz Tucson some yrs ago. Any intelligent discussion of Power in a capitalist dominated society must take Althusser & partner Etienne Balibar into account.

    Sorry to disagree, I appreciate many of your comments but wish you would be more specific, speak in more concrete terms?
    I do apologize for any inconsistencies in my comments made in haste.

    Thanks for your interest!

  14. TDC said on June 24th, 2009 at 4:18pm #

    When a cheaper alternative with lower quality is made available, employers will opt to purchase those less costly insurance plans, forcing employees to accept this cheaper alternative which may or may not allow them to keep their current doctors. Employees may also be invited to purchase their own healthcare if they have their heart set on keeping their own physician after years of establishing a trusting doctor-patient relationship. This is the part you’re not told, that ultimately, it will be a luxury to keep your existing physician and your existing health plan.

  15. bozh said on June 25th, 2009 at 6:45am #

    dan e,
    in many of my posts i have stated that the basic structure of governance in US does not differ from almost any other land’s or empire’s structure of governance.
    broadly speaking there is a ruling class and non-ruling class in almost all lands.
    rulers do as they see fit. E.G., US rather wages wars or manufactures weapons while refusing to give back to people their inheritance.
    such a governance is backed [elsewhere also] by power or as i often say: by econo-military-educational power.
    i hyphenize the three aspects of one reality because on a living level, these aspects are inseparable.

    natch, if people in US [some 99%] evaluate that US is an exception and exceptional in all aspects of one reality, that, too, is power; tho not as influential as tanks, cia, etc.
    hope this throws more light on how people are ruled now and have been ruled everywhere else for millennia.
    US does not differ in kind; let’s say, from assyria, rome, persia, UK, russia- only in degree.
    it seems more brutal only because of its military power and the ease of its use.
    and expect even greater brutality as US manufactures even ‘better’ and easier weapons to use to defend its ‘interests’ tnx bozhidar balkas

  16. Melissa said on June 25th, 2009 at 7:22am #

    TDC: Isn’t that the point though? That we all reduce our standards in order to get basic coverage to those who’ve been locked out? If we are true to the sentiments of this collective good, isn’t it worth it?

    Besides, people who are “flush” can always pay more to stay in their preferred situation.


  17. Paul Dean said on June 25th, 2009 at 8:36am #

    TDC- That’s some really silly stuff you wrote here, in that it is completely irrelevant to the article, discussion, etc. I am not arguing for a “cheaper alternative” to our hyper-inflated and lame health care system. I am advocating for completely reforming the system and removing your “free market” nonsense from the picture entirely.

    You argue as if the article was in support of Obama’s half measures, and use the standard industry scare tactics to attempt to tamp down the remote possibility that he will set up a system that “competes” with the bloated and inefficient system we have now.

    But I am not arguing for a rival “competitive “ system in which there will be restrictions on medical coverage and doctors etc. In a single payer-not for profit system, any doctor that wants to be paid will participate in the system, period. It will be the only game in town.

    Competition between a government run system and a private system is a silly idea, because there is zero chance (as some prominent republicans have openly admitted recently) that a for-profit system that burns up about 30% of its income in profits and overhead, can compete with a not-for profit system like Canada’s where overhead runs 3-4%. Private insurance could only compete with that if they could improve their efficiency by a factor of ten. How would this be accomplished?

    If Obama manages to get some form of his lame plan passed it will likely only be a disaster and a waste of time. Since a private insurance industry cannot possibly compete, they will turn their attention to their next best hope: destroying the new system by design sabotage.

    The private insurance industry is a parasitic drain on our society. I do not advocate setting up a new system in which parasites pretend to “compete” with each other. I say we cut out the parasites and be done with them, so we can build a real health care system that actually tries to take care of our health.

    If you want to argue something, next time I recommend you take the time to see what it is you are arguing about, and what the position is you are arguing against. But I understand that the troll thing is about spamming the world with think-tank manufactured fairy dust, and not about making a real point that directly relates to the world and the people in it.

  18. Melissa said on June 25th, 2009 at 9:45am #

    I heard on right wing radio yesterday (yeah, I expose myself to the full spectrum) the frantic argument that Obama’s plan will destroy private insurance companies. They said it like it was a bad thing.

  19. Dan Clayton said on June 29th, 2009 at 10:35am #


    I agree on one thing as an auditor in healthcare. It is a tangled mess. However, the solution is far from a single payor. In fact a single payor will only make the problem worse.

    The reality of healthcare’s challenge is one of cost “control.” A natural market is controlled by the decisions that users make, judging value and cost. However, healthcares challenge is that doctors and patients have largely been separated from information about, or vested interest in, COST. I believe few realize that Stark and Ant kickback legislation forbids a doctor from most types of ownership in healthcare entities. Years ago, concerns over inappropriate behavior by some doctors who referred to their owned entities sparked this legislation. However, it has become an economic death-nail for the healthcare market. It is a sludge hammer rather than a scalpel. As an internal auditor I have witnessed doctors make different cost decisions when they have a vested interest in net profit of an entity. They are human too. Where they have no interest, they choose, almost without exception the latest and usually most expensive item in case they are ever sued. This well intended legislation has broken natural cost control by the key decision maker in care delivery. To make matters worse we continue to distance patients for consideration of costs as well. Our new patient rights forgo cost awareness by the patient or even information to better assess the value of the care received. We should not be surprised that the result is a tangled and expensive care delivery system that is not meeting everyone’s needs.In this tangled mess medical device and drug manufacturers do not have to prove the added value of the products they bring to market. They need only convince the physician that it may have some marginal benefit. Cost is irrelevant to the doctor. We should not be surprised that costs of drugs and equipment are unsustainable going forward. If this were any other industry some simple legislation to restore and reward those who consider cost would be passed with immediate and dramatic reduction in costs. However we have chosen to run healthcare with an emotional perspective that drug and medical device profiteers feed off of with large lobbying dollars. They would prefer the topic to remain on evil insurance, while all along they are primary drivers of unsustainable costs.

    This conversation will never change until we reward those decision makers for considering and controlling costs, or at least making them prove the value of their care choices…

  20. Paul Dean said on June 30th, 2009 at 10:57am #

    So, in your mind Dan, the whole issue comes down to controlling costs. Your solution seems to be to make doctors stakeholders in making the healthcare “industry” profitable. If doctors could help insurance companies limit care, then what? More of the money could be available for executive salaries, auditors, and claims processors?

    You said:
    “The reality of healthcare’s challenge is one of cost “control.” A natural market is controlled by the decisions that users make, judging value and cost. However, healthcares challenge is that doctors and patients have largely been separated from information about, or vested interest in, COST.”

    You waste our time with this weak stuff. What you mean is the “industry” needs to frame the issue as one of “cost control.” And then ignore the most important factors that affect cost. “Healthcare’s challenge” is not “cost control.” The challenge we face as a society is how to design and operate a system that takes care of people.

    You want to cut costs? Me too. How about reducing costs from 25-30% of every dollar spent on healthcare all the way down to 3-4% like in the Canadian system. Does that qualify?

    I have been reading about executive compensation. In 1996, the highest paid HMO exec, Stephen Wiggins, CEO of Oxford Health Plans, received $21,061,599 in salary. In 2000, the top earner walked away with more than 50 million, without considering his stock options. How many “unnecessary” tests and procedures could that money have paid for?

    Last year, it seems that the executives of the top seven publicly traded health care companies made significantly more in compensation than the salaries of all the top earners in government combined-the prez, the congress, the judicial. How about we cut costs by eliminating all of that waste?

    There is no “natural market” for health care, and there never will be. It is understandable that the insurance industry would like to enlist the help of doctors in reducing those pesky medical costs that impede the delivery of profits to the execs and shareholders. But don’t pretend that this move would improve health care for actual patients. It is another band- aid fantasy, and constitutes misdirection. Your ‘solution,’like all the others that are desperate to try to somehow justify the unjustifiable (a.k.a. a for-profit system) will do nothing except keep the loot flowing to insurance companies at the expense of the rest of us.

    Single Payer Not for Profit Health Care, Now!

  21. Dan Clayton said on August 14th, 2009 at 1:07pm #


    Your comments are narrow-minded. Cost is the only issue today. It will literally be impossible to sustain it going forward. What you were unable to understand in my comments is that when you allow doctors to be rewarded to providing low cost, quality healthcare they will be motivated to move in the direction of quality and will make reasonable decisions about cost.

    Even if they don’t consultants will help them align care systems in a more effecient way, because it will be profitable to both of them to do so. Profit is not evil it is the basis of capitalism. The only laws that should be in place should be the ones required to protect vulnerabile people and limit greed. However today we have assumed all are vulnerable and greed is rampant. I agree some CEO’s are way overpaid. However, if this was a market you wouldn’t have to woryy about that because you would have alternatives.

  22. Paul Dean said on August 15th, 2009 at 3:33pm #

    Hey Dan,

    Interesting perspective, yours. Cost is the only issue? For the sake of argument, lets accept the premise.

    Did you fail to understand that single payer not for profit health insurance would immediately cut costs by far more than your proposal could ever possibly? 20-30% overhead becomes 3-5% overhead. How’s that for controlling costs?

    As an insider, surely you must understand that most of what insurance companies do, most of that overhead, is eaten up in multiply redundant private bureaucracies whose primary mission is to deny care to patients. That is what the whole game hinges on. That allows a class of billionaire and millionaire CEOs to extract obscene, (and amply documented) levels of profits from the system.

    Arcane rules and hyper complex policies with widely varying degrees of coverage, co-pays, pre-existing conditions, the need to distinguish between arbitrarily labeled things like “proceedures,” “office visits”, “in-patient” vs. “outpatient” etc.: all of this clearly functions as it was intended, to limit and deny care.

    I understand the idea that offering incentives to doctors to limit costs would be desirable from an industry perspective. I do not think doctors should have any financial incentives one way or another regarding the care they provide. Yes, they should understand how much tests cost, so they can avoid ordering routine but very expensive tests in situations where they are really unnecessary. This would be true in any system.

    But you need to understand that, sincere or no, the argument which you have presented as the main thrust of your rebuttal, is the tail wagging the dog or a wart on a hippopotamus. Your original post made no mention of the billions that are extracted from the system in executive compensation, wasted in completely redundant bureaucracy, or paid out to shareholders.

    Systemic change can be painful. Your original post said you were a claims adjustor, (investigator?) or something like that. I have a close friend that sells health insurance policies. I am sensitive to the fact that in a new system many people will be personally affected.

    Your job, and my friend’s job may be at stake, but the other side of the equation is fifty million citizens that have no health coverage at all. The best evidence indicates that on average, 60 people a day die from treatable, preventable illnesses which go undiagnosed because health care is too expensive. Single payer will fix much of this. Your proposal (make doctors and insurance companies partners in limiting care) will have no effect on any of this. It would likely only increase profits to CEOs.

    I have proposed a sweeping reform. You have not addressed my argument at all. You have responded as if the blame for our dysfunctional and failed system hinges almost entirely on doctors ordering too many expensive tests. Then you spouted some ideological boilerplate about profit not being evil. Could it be that your idea of what capitalism should or should not be, has blinded you to the reality of what is taking place here?

    What is your idea of evil? On the one hand, we have multi million dollar salaries for execs. On the other hand, we have older workers who have paid into a system of “insurance” all of their lives, and now they lose their jobs and their coverage, just when (and precisely because) they will actually need medical care. There is much suffering in America, homelessness and misery, as a direct result of the system which you seem to assume is incapable of evil.
    On the one hand we have the American for-profit health care system, which is broken, dysfunctional and cruel. On the other hand, we have the example of the rest of the world. Are you a narrow minded capitalist ideologue?

    Do you think Britain, France, Germany, Italy, Spain, Costa Rica, Switzerland, etc. are socialist or non-capitalist nations? Does the nature of our health care system define our entire economic system? If so we are the only true capitalist nation on earth, an island of capitalism in a socialist sea. Is that your assertion?

    I have pointed out that if we change the system that we have in place, we can actually take much better care of our people. I don’t give a rats ass what anyone calls the system. If public healthcare is socialism, so is the public library, public schools, and the US military. Do you view these institutions as subversive?

    The American system of privatized health care cannot possibly compete with a single payer system, and the industry knows it. I am sorry to put it so bluntly, but a little research makes this obvious. This is why persons who wish to maintain the systemic dysfunction we presently suffer from, begin by changing the subject away from the most significant flaws of the system, avoid all discussion of the superior single payer system, and instead raise peripheral issues like doctors ordering expensive tests.

    I really do appreciate your response to the article, and contribution to this discussion. It ‘s just that I completely disagree with you. Thanks for taking the time to write.

    Paul Dean

  23. Dan Clayton said on September 24th, 2009 at 2:31pm #

    Hey Paul,

    I stumbled on this today and no longer see my response to your prior comment…hmmm In short. Yes insurance can be corrupt, but if there were truely multiple lines of bureaucracy that could be eliminated, whouldn’t someone have figured that out and been able to offer cheeper insurance. Collusion “where multiple parties get together to screw the market” is extreamly hard to maintain. Even OPEC has a hard time convincing its partners to trim supply and control costs. I guarentee you that insurance companies run lean. Much leaner than the government could. Compare the department of motor vehicles to a business with simliar objectives and you will see a vast difference. What does happen in some insurance companies is that Executives get a little too powerful and compensate themselves at the cost of the company (steeling the profits) while the Board is asleep at the wheel. But that is the exception and generally a very public one. There is no government function that works better than the market. It is like saying the Referees could play a better game than any NBA team because they can set the rules… It just won’t happen.

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