Monday, July 27, 2009

Health Bills Debate

In a scathing critique of health care coverage by America’s news media, the current issue of the Columbia Journalism Review contends that “this year’s health-care debate sounds like the one in 1993.” That debate produced the Clinton administration’s proposed reforms that were politically dead on arrival.

“With few exceptions … the press has done little to challenge this reality or help to broaden the health-care debate,” wrote Trudy Lieberman, a Columbia Journalism Review contributing editor who monitors this issue. “Rather, it has mostly passed along the pronouncements of politicians and the major stakeholders who have the most to lose from wholesale reform. By not challenging the status quo, the press has so far foreclosed a vibrant discussion of the full range of options, and also has not dug deeply into the few that are being discussed, thereby leaving citizens largely uninformed about an issue that will affect us all.”

As Congress winds down its latest try at reforming America’s hodge-podge health system, eying the exits for a long vacation, there’s been no real debate, for instance, over a bill in the hopper that would create a single-payer plan.

A Democratic Congressman from New York, Anthony Weiner, raised this issue last week to deafening silence in the national news media, which was all agog over the latest distractions to comprehensive reporting of what‘s happening on the medical-bills battlefront. Weiner is a cosponsor of the U.S. National Health Care Act (H.R. 676), sponsored by Rep. John Conyers (D-Mich.). This bill has 85 co-sponsors and is backed by a coalition of doctors, unions, civic groups and local governments in support of a single-payer system.

“Without acknowledging it, both sides seem to agree with the argument for a single-payer system. But instead of having a debate about its value, both sides have turned the idea into an odd punching bag,” Weiner said. “The right uses the term ‘single-payer’ to condemn the White House approach, while the White House — and my colleagues in the House and Senate — quickly decry the scurrilous charge and concoct legislative language to make their public option look less, well, public. By conceding that the public option would have less overhead, be more efficient and have the freedom to focus on health care rather than profits, opponents of the public option are in fact arguing for it. Isn’t complaining about the marketplace ‘advantage’ of the public plan just another way of saying that people are going to want it?”

Dr. Quentin Young, national coordinator of Physicians for a National Health Program, lauded Weiner’s stance and lambasted the reform plan cobbled together by House leaders as a “proven failure.” Young argued, in a news release on behalf of his group of 16,000 doctors, that “state-based reforms of this type — Massachusetts being the latest example — have repeatedly foundered.”

“Although many supporters of the House tri-committee bill are well-intentioned, it’s an inconvenient truth that only by replacing the private health insurance industry with a single-payer, Medicare-for-All program can we save $400 billion annually on overhead and bureaucracy — enough to provide comprehensive, first-dollar coverage to all,“ Young added. “Surveys show that two-thirds of the public favor national health insurance, as do most physicians. Over 550 labor organizations support H.R. 676, as do scores of civic and religious groups and city governments.”

The $400 billion savings that Young referred to would come from eliminating the administrative overhead in private insurance plans, which eat up 30 per cent of their billings, in contrast to Medicare’s administrative costs of 3 to 4 percent, freelance journalist Dave Lindorff recently noted on his website,

“So, want to have some fun? Tell your congressional delegation to demand that the Congressional Budget Office, which just came up with an estimate that the Senate’s health ‘reform’bill would add $1.6 trillion in costs over 10 years, do a study of what expanding Medicare to all would cost, after netting out the savings to individuals and employers of having their insurance payments and out-of-pocket health expenses eliminated,” Lindorff wrote in an op-ed piece that’s been popping up in various corners of the blogosphere. “And then tell them to support Michigan Congressman Rep. John Conyers' single-payer bill, HR 676, which would extend Medicare to one and all.”

That bill is not even on the radar screen in the Senate, where leaders of the finance committee are crafting a minimalist reform measure that excludes any hint of extending Medicare to more citizens. “After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits a requirement for businesses to offer coverage to their workers and lacks a government insurance option that President Barack Obama favors, according to numerous officials,” The Associated Press reported today. “They said any legislation that emerges from the talks is expected to provide for a non-profit cooperative to sell insurance in competition with private industry, rather than giving the federal government a role in the marketplace. The White House and numerous Democrats in Congress have called for a government option to provide competition to private companies and hold down costs.”

While Congress takes off on vacation in August, maybe its members will start paying attention to what local folks have to say about the health-billing mess. Consider what this emergency room doctor in Michigan argued today in the Detroit Free Press website:

“In order to maintain their profit margins, insurance companies are raising premiums while pushing more of the costs of care onto individual policyholders. Premiums are increasing annually at a rate that is three times the rate of inflation. Fewer employers, especially small firms, continue to offer comprehensive coverage, and for workers with employer-based insurance, out-of-pocket expenses increased 34% between 2004 and 2007. Those who have been laid off are finding that extension coverage under COBRA is overpriced and unaffordable,” noted Dr. James Mitchiner of Ann Arbor.

“But there is a viable alternative,” Mitchiner added. “Single-payer health insurance is simply a way to finance universal health care. By replacing the 1,200 private insurance companies – each having its own set of regulations, provider networks, prescription drug formulary, pre-authorization forms, 1-800 number and Web site – into a single insurance entity, such a single-payer system would reap the benefits of economies of scale, reduce administrative waste, mitigate bureaucratic duplication, sever the link between health insurance and employment, reduce health care disparities, and at last provide creditable coverage for the millions who lack it now.”

For more information:

Thursday, July 16, 2009

Socialized Medicine

The federal government is once again considering instituting a national health care plan, something first proposed by President Teddy Roosevelt more than a century ago. The problem is that many Americans are scared of getting dreaded “socialized medicine.” You know, like they have in Canada, where people have to wait for weeks to see a doctor, unless it’s an emergency. I can relate to that, having recently waited for four weeks to see a specialist for a knee injury and another two weeks for the MRI results. And that was under the current American health system!

So what’s going on here? When I was born in 1943, millions of Americans were in the armed services, subject to military health care. I don’t recall any complaints about how during World War II our soldiers and sailors, marines and air crews had to endure government-run “socialized medicine.” When I served in the Army in the early 1960s in Vietnam and stateside, I don’t recall any horror stories of soldiers being subjected to “socialized medicine.” For all the complaints about sometimes horrific problems at Veterans Administration hospitals, veterans’ groups have continually demanded that the government-run system be improved, not abolished.

I don’t recall anyone moaning that they dread Medicare, the government health care program that every American qualifies for when they retire and go on Social Security. Meanwhile, horror stories about families bankrupted by medical bills under the privately run HMO system have appeared in newspapers and magazines and TV reports for years.

No doubt Medicare, and any expanded national health care plan, will have glitches. But I’m dubious that it can top many of my nightmarish experiences with the non-governmental health care system. Besides recently waiting more than a month for treatment of a painful knee injury, I’ve previously waited in emergency rooms in utter agony—after dropping a filing cabinet on my foot, from kidney stones (twice)—so long to see a doctor that I wished I could have run to Canada for relief.

During a previous round in the long-running debate over health care, Bill Bradley, a senator from New Jersey at the time, suggested a simple, yet profound reform—give every American access to the same health care plan that members of Congress enjoy. Bet the naysayers in Congress don’t call what they’ve got “socialized medicine.”

Wednesday, July 8, 2009

Remembering Robert McNamara

“McNamara’s War” is what a senator called America’s disastrous military invasion of Vietnam. Reading news items about Robert McNamara’s death this week at age 93, I remembered how wide the gulf was between a soldier and the Secretary of Defense, whose exalted place in the chain of command we had to know by heart, when I served in Vietnam in the early 1960s. In 1967, after resigning from the US Military Academy and a military career, I sent McNamara a letter at the Pentagon enclosing my war medals and a protest of the conduct of the war. I never got a reply, although he subsequently had me investigated by the FBI for signing an antiwar statement in The New York Times. For a man who was often in the news with his views on Vietnam and war, it seems McNamara had lots to say to everybody except to the troops who disagreed with what he was overseeing.

A fellow antiwar veteran, Ben Chitty, illuminated this dark side of McNamara in an Internet posting. “Back when McNamara's memoir ‘In Retrospect’ came out, I wrote him a letter. Never did get a reply,” noted Chitty, a college librarian in New York City. Here’s what Chitty wrote to his former boss at the Pentagon:

Sunday, April 30th, 1995

Robert S. McNamara
c/o Times Books, Random House
New York, New York

Secretary McNamara,

I'm writing because of your book, In Retrospect.

I enlisted in the United States Navy in 1965, and deployed twice to Vietnam, in 1966-7 and again in 1968. I was medically discharged in 1969. Right away I joined an organization called Vietnam Veterans Against the War (VVAW) -- perhaps you've heard of us. I spent the next three years doing what I could to stop the war, especially working to keep 18-year-olds from being drafted into it. I had some success in the latter and smaller task, but we had none at all in the larger. Disillusioned, depressed and exasperated at our failure to stop the war, I left the country in 1972, returning only when Nixon had resigned.

So I read your book with some interest. Of course it told me nothing new about the war's cost and futility. Nor did it change my conviction that the war we waged in Indochina was a crime. Not a mistake, however deadly and tragic, but a crime. I believe we disagree in that assessment.

Howver, you say you wrote the book because you believe that we -- the people of the United States -- need to come to terms with the Vietnam experience and its legacy. I certainly do not disagree there.

We may not agree exactly what that legacy is. You rehearse a long series of errors in geopolitical understanding and mistakes in the procedures by which decisions were made, and describe a certain amount of wishful thinking. You offer to contribute to our understanding of the Vietnam experience by confessing your mistakes -- "our" mistakes, since you served and remained loyal to your presidents and their successors, our representatives in power.

A beginning, perhaps. Of course the veterans and victims of your war may be bitter about your late confession. Certainly the illusion that we could have won the war has been important to them all these years. Certainly that delusion needs to be deflated, since it deflects us from the process of understanding, healing and reconciliation. But the delusion that we could have won the war is not the main or central legacy of the Vietnam experience. That legacy is easy to delineate.

Our government undertook a war in which there were no military means of accomplishing "our" political objectives. A very large number of citizens realized this, and tried every means possible -- mostly constitutional -- to persuade "our" government to stop the war. Although "our" government -- at least many people in it, including yourself -- knew that the anti-war movement was right in its assessment of the war, "our" government fought this opposition bitterly, and finally unconstitutionally. The anti-war movement failed to stop the war. The direct legacy of Vietnam was Watergate. The political tragedy of Vietnam for our country -- then and now -- is that the anti-war movement failed.

This is the legacy you do not address. Our own government was beyond our control. Two issues can illustrate the problem.

You write of concern about widespread cynicism and distrust of government. Yet you do not reflect on the consequences of government deceit, or acknowledge the extent to which government deception remains common practice. During the years you remained silent, Geronimo Pratt, a decorated Vietnam combat veteran, was imprisoned in California, convicted of a murder the FBI knows he did not commit. He's still there. Just as your book was going to press, our government assured Jennifer Harbury it knew nothing about her husband's capture, torture and execution -- but the CIA did know; in fact, their informant did it. These cases are part of the legacy of the Vietnam experience too. There are very many others.

You write of the role played by the politicians critical of your war effort, the people we called "hawks." You and your Presidents feared their political influence, and concocted your war policies to deflect their criticism. You might say that tens of thousands of Americans -- mostly soldiers "serving their country" -- and hundreds of thousands of Indochinese -- mostly non-combatants -- died so that Lyndon Johnson (and Richard Nixon) could be President. Ronald Reagan and George Bush used these deaths again to help themselves get elected, and these deaths may yet help elect Bill Clinton's successor in 1996. Some of the hawks are still in Congress. Their political heirs just swept the last Congressional elections. You have little to say about them, except that some are your friends. But they feed (and feed on) the very delusion of a winnable war from which the rage against you rises, and which in fact you permitted to fester all these years.

This is not an issue of Republican and Democrat. There are plenty of hawks and their heirs on both sides of the aisle, and I myself am a veteran of Lyndon Johnson's war, your war, though I protested against Richard Nixon's war, and Henry Kissinger's. It is an issue of democracy and citizenship. I saw American "democracy" in action in Vietnam. I came back to the world and saw American "democracy" at home.

The American Legion has demanded that you forego your "profits" from this book. This is a little ironic, since the Legion always supported the war.

I myself don't much like capitalism, but I think that the Legion's criticism of your "profits" is trivial, though understandable. As you have suggested, it would be a good idea to support an inquiry into the mechanics of the mutual failures of the Vietnamese and American governments to end the war.

I'd like to make a different suggestion. The Americans who learned the best and the most from their experience in Vietnam are surely the veterans who have tried to help repair the damage you sent them to do, to compensate for the crime you commissioned. And unlike the programs for Vietnam veterans, where the need is so great that all your profits would hardly be noticed, for activities like the Veterans Viet Nam Reconstruction Project, Project Hearts and Minds, the Veterans Initiative or the U.S. Indochina Reconciliation Project, a little conscience money would make a lot of difference, both to the Vietnamese and to the veterans themselves.

Ben Chitty